BR112014024177B1 - STAPLER SET FOR USE WITH A STAPLER - Google Patents

Abstract

tissue thickness compensator comprising a plurality of medicaments. in various embodiments, a buffer 22820 may comprise a buffer body comprising a plurality of first packets 22824a and a plurality of second packets 22824b, wherein in at least one embodiment, each second packet is positioned between two or more first packets. the buffer may further comprise a first medicament positioned in each first pack and a second medicament positioned in each second pack, the first medicament being different from the second medicament.

Description

background

[001] The present invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling instruments and staple cartridges thereof that are designed to cut and staple tissue.

summary

[002] The following is a non-exhaustive list of embodiments of the present invention that are or can be claimed.1. A compensator attachable to an anvil of a fixture, the anvil including a forming surface, and the compensator comprising:

[003] a compressible compensator body, comprising:

[004] a plurality of first packets; and

[005] a plurality of second packets, wherein each second packet is positioned between two or more first packets;

[006] a first drug positioned within each first pack;

[007] a second drug positioned within each second package, wherein the first drug is different from the second drug; and

[008] a fixing portion configured to be fixed to the anvil.2. Compensator, according to modality 1, characterized in that the first medicine comprises a first powder and the second medicine comprises a second powder.3. Compensator according to modality 1 or modality 2, characterized in that the first medicament comprises alginate and the second medicament comprises calcium. 4. Compensator, according to any of the foregoing embodiments, characterized in that the compensator body comprises a longitudinal axis, and the first and second packages being arranged in an alternating arrangement along the longitudinal axis.5. Compensator, according to any of the previous modalities, characterized by the fact that the first packets and the second packets are arranged in an alternating arrangement.6. Compensator, according to any of the previous modalities, characterized in that the first drug comprises non-woven oxidized regenerated cellulose.7. Stapling set for use with a stapler, the stapling set comprising:

[009] an anvil comprising:

[0010] a plurality of forming surfaces; and

[0011] a slot configured to receive a cutting member therein;

[0012] a compensator attached to the anvil, wherein the compensator comprises a plurality of first packs aligned with the slot and a plurality of second packs aligned with the slot, and wherein the first packs and second packs are configured to be cut by the member cutting;

[0013] a first drug positioned within each first packet; and

[0014] a second drug positioned within each second package, where the first drug is different from the second drug.8. Staple set, according to modality 7, characterized by the fact that the slit defines a trajectory for the cutting member, and the first packages and the second packages extend in a direction that is transversal to the trajectory.9. Stapling assembly, according to embodiment 7 or embodiment 8, characterized in that the compensator comprises a clamping portion configured to fit into the slot, and wherein the clamping portion is configured to be cut by the cutting member. 10. Stapling kit, according to any one of embodiments 7 to 9, characterized in that the first medicament comprises a first powder and the second medicament comprises a second powder.11. The stapling kit according to any one of embodiments 7-10, wherein the first medicament comprises alginate and the second medicament comprises calcium.12. Stapling assembly, according to any one of the modalities from 7 to 11, characterized in that the first packages and the second packages are arranged in an alternating arrangement along the slit.13. Stapling set for use with a stapler, the stapling set comprising:

[0015] an anvil comprising:

[0016] a plurality of forming surfaces; and

[0017] a longitudinal slit;

[0018] a cutting member configured to be moved within the slit;

[0019] a compensator attached to the anvil, wherein the compensator comprises a plurality of first lateral cavities that extend laterally with respect to the slit and a plurality of second lateral cavities that extend laterally with respect to the slit, and wherein the cutting member is configured to cut first side cavities and second side cavities;

[0020] a first medicament positioned within each first lateral cavity; and

[0021] a second drug positioned within each second lateral cavity, wherein the first drug is different from the second drug.14. Stapling assembly, according to embodiment 13, characterized in that the compensator comprises a fixing portion configured to fit into the longitudinal slot, and wherein the cutting member is configured to cut the fixing portion.15. Staple assembly, according to modality 13 or modality 14, characterized in that the first medicament comprises a first powder and the second medicament comprises a second powder.16. The stapling kit according to any one of embodiments 13-15, wherein the first medicament comprises alginate and the second medicament comprises calcium.17. Stapling assembly according to any one of embodiments 13 to 16, characterized in that the first side cavities and the second side cavities are arranged in an alternating arrangement along the longitudinal slit. 18. Stapling assembly, according to any one of embodiments 13 to 17, characterized in that the longitudinal slot defines a longitudinal axis, and the first side cavities and the second side cavities each define an axis side perpendicular to the longitudinal axis. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] The features and advantages of this invention, and the manner of achieving them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention, obtained in conjunction with the attached drawings, being that:

[0023] Figure 1 is a cross-sectional view of a surgical instrument modality;

[0024] Figure 1A is a perspective view of an embodiment of an implantable staple cartridge;

[0025] Figures 1B to 1E illustrate portions of an end actuator that grips and staples tissue with an implantable staple cartridge;

[0026] Figure 2 is a partial cross-sectional side view of another end actuator coupled to a portion of a surgical instrument with the end actuator supporting a surgical staple cartridge and with its anvil in an open position;

[0027] Figure 3 is another side view in partial cross-section of the end actuator of Figure 2 in a closed position;

[0028] Figure 4 is another partial cross-sectional side view of the end actuator of Figures 2 and 3 as the knife bar begins to advance through the end actuator;

[0029] Figure 5 is another side view in partial cross-section of the end actuator of Figures 2 to 4 with the knife bar partially advanced through it;

[0030] Figures 6A to 6D show a diagram of the deformation of a surgical staple positioned in the body of a retractable staple cartridge according to at least one embodiment;

[0031] Figure 7A is a diagram illustrating a staple positioned in the body of a collapsible staple cartridge;

[0032] Figure 7B is a diagram illustrating the deformable staple cartridge body 7A of Figure being deformed by an anvil;

[0033] Figure 7C is a diagram illustrating the deformable staple cartridge body 7A of Figure being further deformed by the anvil;

[0034] Figure 7D is a diagram illustrating the staple of Figure 7A in a fully formed configuration and the collapsible staple cartridge of Figure 7A in a fully deformed condition;

[0035] Figure 8 is a top view of a staple cartridge according to at least one embodiment comprising staples inserted into the body of the retractable staple cartridge;

[0036] Figure 9 is an elevation view of the staple cartridge of Figure 8;

[0037] Figure 10 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge comprising staples therein and a system for driving the staples against an anvil;

[0038] Figure 10A is a partial cutaway view of an alternative embodiment of the staple cartridge of Figure 10;

[0039] Figure 11 is a cross-sectional view of the staple cartridge of Figure 10.

[0040] Figure 12 is an elevation view of a slider configured to traverse the staple cartridge of Figure 10 and move the staples toward the anvil;

[0041] Figure 13 is a diagram of a clamp driver that can be lifted towards the anvil by the slider of Figure 12;

[0042] Figure 14 is a perspective view of a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator for use with a surgical stapling instrument in accordance with at least one embodiment of the invention;

[0043] Figure 15 is a partially exploded view of the staple cartridge of Figure 14;

[0044] Figure 16 is a fully exploded view of the staple cartridge of Figure 14;

[0045] Figure 17 is another exploded view of the staple cartridge of Figure 14 without a warp covering the fabric thickness compensator;

[0046] Figure 18 is a perspective view of a cartridge body, or support portion, of the staple cartridge of Figure 14;

[0047] Figure 19 is a top perspective view of a movable slider within the staple cartridge of Figure 14 for positioning staple cartridge staples;

[0048] Figure 20 is a bottom perspective view of the slider of Figure 19;

[0049] Figure 21 is an elevation view of the slider of Figure 19;

[0050] Figure 22 is a top perspective view of a driver configured to support one or more staples and to be lifted upwards by the slider of Figure 19 to eject the staples from the staple cartridge;

[0051] Figure 23 is a bottom perspective view of the actuator of Figure 22;

[0052] Figure 24 is a housing configured to at least partially surround a compressible tissue thickness compensator of a staple cartridge;

[0053] Figure 25 is a partial cutaway view of a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrated with staples being moved from a non-fired position to a fired position during a first sequence;

[0054] Figure 26 is an elevation view of the staple cartridge of Figure 25;

[0055] Figure 27 is a detailed elevational view of the staple cartridge of Figure 25;

[0056] Figure 28 is an end view in cross section of the staple cartridge of Figure 25;

[0057] Figure 29 is a bottom view of the staple cartridge of Figure 25;

[0058] Figure 30 is a detailed bottom view of the staple cartridge of Figure 25;

[0059] Figure 31 is a longitudinal cross-sectional view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrated with staples being moved from a non-fired position to a position triggered during a first sequence;

[0060] Figure 32 is another cross-sectional view of the anvil and staple cartridge of Figure 31 illustrating the anvil in an open position after the firing sequence has been completed;

[0061] Figure 33 is a partial detail view of the staple cartridge of Figure 31 illustrating the staples in an unfired position;

[0062] Figure 34 is an elevational cross-sectional view of a staple cartridge comprising a rigid support portion and a compressible fabric thickness compensator illustrating the staples in an unfired position;

[0063] Figure 35 is a detail view of the staple cartridge of Figure 34;

[0064] Figure 36 is an elevational view of an anvil in an open position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position;

[0065] Figure 37 is an elevational view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position and tissue captured between the anvil. and the fabric thickness compensator;

[0066] Figure 38 is a detail view of the anvil and staple cartridge of Figure 37;

[0067] Figure 39 is an elevational view of an anvil in a closed position and a staple cartridge comprising a rigid support portion and a compressible tissue thickness compensator illustrating the staples in an unfired position illustrating thicker tissue positioned between the anvil and the staple cartridge;

[0068] Figure 40 is a detail view of the anvil and staple cartridge of Figure 39;

[0069] Figure 41 is an elevational view of the anvil and staple cartridge of Figure 39 illustrating tissue having different thicknesses positioned between the anvil and staple cartridge;

[0070] Figure 42 is a detail view of the anvil and staple cartridge of Figure 39, as illustrated in Figure 41;

[0071] Figure 43 is a diagram illustrating a fabric thickness compensator that is compensating for different fabric thicknesses captured within different staples;

[0072] Figure 44 is a diagram illustrating a tissue thickness compensator applying compressive pressure to one or more vessels that have been transected by a row of staples;

[0073] Figure 45 is a diagram illustrating a circumstance in which one or more clamps were improperly formed

[0074] Figure 46 is a diagram illustrating a fabric thickness compensator that could compensate for improperly formed staples;

[0075] Figure 47 is a diagram illustrating a fabric thickness compensator positioned in a region of fabric cut by multiple rows of staples;

[0076] Figure 48 is a diagram illustrating tissue captured within a staple;

[0077] Figure 49 is a diagram illustrating fabric and a fabric thickness compensator captured within a staple;

[0078] Figure 50 is a diagram illustrating tissue captured within a staple;

[0079] Figure 51 is a diagram illustrating thick tissue and a tissue thickness compensator captured within a staple;

[0080] Figure 52 is a diagram illustrating thin tissue and a tissue thickness compensator captured within a staple;

[0081] Figure 53 is a diagram illustrating fabric having an intermediate thickness and a fabric thickness compensator captured within a staple;

[0082] Figure 54 is a diagram illustrating fabric having another intermediate thickness and a fabric thickness compensator captured within a staple;

[0083] Figure 55 is a diagram illustrating thick tissue and a tissue thickness compensator captured within a staple;

[0084] Figure 56 is a partial cross-sectional view of an end actuator of a surgical stapling instrument illustrating a firing bar and a staple firing slider in a retracted and unfired position;

[0085] Figure 57 is another partial cross-sectional view of the end actuator of Figure 56 illustrating the trigger bar and staple trigger slider in a partially advanced position;

[0086] Figure 58 is a cross-sectional view of the end actuator of Figure 56 illustrating the firing bar in a fully advanced or fired position;

[0087] Figure 59 is a cross-sectional view of the end actuator of Figure 56 illustrating the firing bar in a retracted position after being fired and the staple firing slider left in its fully fired position;

[0088] Figure 60 is a detail view of the firing bar in the retracted position of Figure 59;

[0089] Figure 61 is an exploded view of a retainer assembly including a retainer and two fabric thickness compensators in accordance with at least one embodiment;

[0090] Figure 62 is a perspective view of the retainer assembly shown in Figure 61;

[0091] Figure 63 is a perspective view of an anvil with which the retainer assembly of Figure 61 can be used;

[0092] Figure 64 is an illustration representing the retainer assembly shown in Figure 61 being inserted into an end actuator of a surgical stapler that includes an anvil and a staple cartridge;

[0093] Figure 65 is a side view of the retainer assembly shown in Figure 61 engaged with the staple cartridge of Figure 64;

[0094] Figure 66 is a side view of the retainer assembly shown in Figure 61 engaged with the staple cartridge and anvil of Figure 64 illustrating the anvil in a closed position;

[0095] Figure 67 is a side view of the retainer assembly of Figure 61 being removed from the end actuator of Figure 64;

[0096] Figure 68 is a perspective view of a retainer;

[0097] Figure 69 is a side view of the retainer of Figure 68 with tissue thickness compensators attached to the base and top surfaces thereof which illustrates one of the tissue thickness compensators engaged with a staple cartridge on a surgical stapler that comprises an anvil;

[0098] Figure 70 is a side view illustrating the anvil of Figure 69 in a closed position;

[0099] Figure 71 is an exploded perspective view of a retainer and a fabric thickness compensator according to at least one embodiment;

[00100] Figure 72 is an exploded perspective view of the tissue thickness compensator of Figure 71 and an anvil of a surgical stapler;

[00101] Figure 73 is an exploded top perspective view of a retainer and fabric thickness compensator according to at least one embodiment;

[00102] Figure 74 is an exploded bottom perspective view of the retainer and fabric thickness compensator of Figure 73;

[00103] Figure 75 is a top perspective view of the retainer and tissue thickness compensator of Figure 73 engaged with a surgical stapler;

[00104] Figure 76 is a bottom perspective view of the retainer and tissue thickness compensator of Figure 73 engaged with the surgical stapler of Figure 75;

[00105] Figure 77 is a side view of the retainer and tissue thickness compensator of Figure 73 engaged with the surgical stapler of Figure 75;

[00106] Figure 78 is a bottom perspective view of the retainer and tissue thickness compensator of Figure 73 illustrating the tissue thickness compensator attached to the anvil of the surgical stapler of Figure 75;

[00107] Figure 79 is a top perspective view of the retainer and tissue thickness compensator of Figure 73 illustrating the tissue thickness compensator attached to the anvil of Figure 78;

[00108] Figure 80 is a side view of the tissue thickness compensator of Figure 73 attached to the anvil of Figure 78;

[00109] Figure 81 is a cross-sectional view of the retainer and tissue thickness compensator of Figures 73 and 74 attached to a staple cartridge and the channel of a surgical stapler;

[00110] Figure 82 is a cross-sectional view of the retainer and tissue thickness compensator of Figures 73 and 74 attached to the staple cartridge and surgical stapler channel of Figure 81 illustrating a surgical stapler anvil engaged with the compensator fabric thickness;

[00111] Figure 83 is a cross-sectional view of the tissue thickness compensator of Figure 73 attached to the anvil of the surgical stapler and being moved away from the retainer;

[00112] Figure 84 is a side cross-sectional view of a retainer assembly comprising a retainer, fabric thickness compensators mounted on the first and second surfaces of the retainer, and connectors through holes in the retainer in accordance with at least a modality;

[00113] Figure 85 is a perspective view of the retainer assembly of Figure 84 illustrated with a portion of a fabric thickness compensator removed for purposes of illustration;

[00114] Figure 86 is a side view of the retainer assembly of Figure 84 engaged with a surgical stapler comprising an anvil illustrated in an open position;

[00115] Figure 87 is a side view of the retainer assembly of Figure 84 and the anvil of Figure 86 illustrated in a closed position;

[00116] Figure 88 is a side view of the retainer assembly of Figure 84 illustrating the retainer being removed from the retainer assembly fabric thickness compensators;

[00117] Figure 89 is a side view of the retainer removed from the fabric thickness compensators of Figure 84;

[00118] Figure 90 is a perspective view of a retainer configured to engage an anvil of a surgical stapler according to at least one embodiment;

[00119] Figure 91 is a top view of the retainer of Figure 90;

[00120] Figure 92 is a side view of the retainer of Figure 90;

[00121] Figure 93 is a bottom view of the retainer of Figure 90;

[00122] Figure 94 illustrates a retainer assembly comprising the retainer of Figure 90 and a tissue thickness compensator being attached to a staple cartridge for a surgical stapler;

[00123] Figure 95 illustrates the retainer assembly and staple cartridge of Figure 94 that engages an anvil of an end actuator of a surgical stapler;

[00124] Figure 96 illustrates the retainer assembly and staple cartridge of Figure 94 that engages the anvil of the end actuator of the surgical stapler of Figure 95;

[00125] Figure 97 illustrates the retainer assembly and staple cartridge of Figure 94 engaged with the anvil of the surgical stapler of Figure 95;

[00126] Figure 98 illustrates the retainer assembly and staple cartridge of Figure 94 engaged with the anvil of the surgical stapler of Figure 95 and the anvil being moved into a closed position;

[00127] Figure 99 illustrates the anvil of the surgical stapler of Figure 95 in an open position with the tissue thickness compensator attached thereto and the retainer engaged with the staple cartridge channel of the surgical stapler;

[00128] Figure 100 illustrates the retainer of Figure 94 engaged with the staple cartridge channel of the surgical stapler of Figure 95 and the anvil in an open position;

[00129] Figure 101 is a cross-sectional view of a retainer including a tissue thickness compensator comprising protuberances or wings configured to engage an anvil of a surgical stapler;

[00130] Figure 102 is a cross-sectional view of a retainer including a tissue thickness compensator comprising a socket configured to engage an anvil of a surgical stapler;

[00131] Figure 103 is a perspective view of a retainer that includes two plates connected by a hinge according to at least one embodiment;

[00132] Figure 104 is a side view of the retainer of Figure 103;

[00133] Figure 105 is a rear perspective view of an embodiment of an insertion tool configured for use with the retainer of Figure 103;

[00134] Figure 106 is a top perspective view of the insertion tool of Figure 105;

[00135] Figure 107 is a rear perspective view of the insertion tool of Figure 105 with a portion of the insertion tool removed for illustrative purposes;

[00136] Figure 108 is a side view of the insertion tool of Figure 105 with a portion of the insertion tool removed for illustrative purposes;

[00137] Figure 109 is a top view of the insertion tool of Figure 105;

[00138] Figure 110 is a perspective view of a retainer assembly comprising the retainer of Figure 103, a tissue thickness compensator positioned on the retainer, a staple cartridge positioned on the retainer, and the insertion tool of Figure 105 engaged the retainer, wherein a portion of the insertion tool is removed for illustrative purposes;

[00139] Figure 111 is a side view of a retainer assembly comprising the retainer of Figure 103, a tissue thickness compensator positioned on the retainer, and the insertion tool of Figure 105 engaged with the retainer, wherein a portion of the tool insert is removed for illustrative purposes;

[00140] Figure 112 illustrates the retainer assembly of Figure 110 being inserted into a surgical instrument comprising an anvil and a staple cartridge channel, wherein a portion of the insertion tool is removed for purposes of illustration;

[00141] Figure 113 illustrates the retainer assembly of Figure 110 being inserted into a surgical instrument comprising an anvil and a staple cartridge channel, wherein a portion of the insertion tool is removed for purposes of illustration;

[00142] Figure 114 illustrates the insertion tool of Figure 105 being moved relative to the retainer to engage the staple cartridge to the staple cartridge channel and to engage the tissue thickness compensator to the anvil, wherein a portion of the tool insert is removed for illustration purposes;

[00143] Figure 115 illustrates the insertion tool of Figure 105 being moved relative to the retainer to disengage the retainer from the tissue thickness compensator and staple cartridge, wherein a portion of the insertion tool is removed for illustrative purposes ;

[00144] Figure 116 is a cross-sectional view of a tissue thickness compensator attached to an anvil of a surgical stapling instrument according to at least one embodiment;

[00145] Figure 117 is a diagram illustrating deformed staples that at least partially capture the fabric thickness compensator of Figure 116 therein;

[00146] Figure 118 is a cross-sectional view of an end actuator of a surgical stapling instrument including a staple cartridge comprising a first tissue thickness compensator and an anvil comprising a second tissue thickness compensator. fabric according to at least one embodiment;

[00147] Figure 119 is a cross-sectional view of the end actuator of Figure 118 illustrating staple cartridge staples moved from a non-fired position to a fired position;

[00148] Figure 120 is a perspective view of a tissue thickness compensator attached to an anvil of an end actuator, wherein the tissue thickness compensator comprises a plurality of capsules according to at least one embodiment;

[00149] Figure 120A is a partial perspective view of the fabric thickness compensator of Figure 120;

[00150] Figure 121 is a cross-sectional view of staples being moved from a non-fired position to a fired position to pierce the caps of the tissue thickness compensator of Figure 120;

[00151] Figure 122 is an exploded view of an anvil and a tissue thickness compensator according to at least one embodiment;

[00152] Figure 123 is a cross-sectional view of an anvil comprising a plurality of staple forming pockets and a fabric thickness compensator comprising a plurality of capsules aligned with forming pockets in accordance with at least a modality;

[00153] Figure 124 is a detailed view of the fabric thickness compensator caps of Figure 123;

[00154] Figure 125 is a diagram illustrating the anvil and tissue thickness compensator of Figure 123 positioned with respect to tissue that is to be stapled by staples of a staple cartridge positioned on the opposite side of the tissue;

[00155] Figure 126 is a diagram illustrating the anvil of Figure 123 moved towards the staple cartridge of Figure 125 and staples partially fired from the staple cartridge;

[00156] Figure 127 is a diagram illustrating the staples of Figure 126 in a fully fired configuration and the tissue thickness compensator caps of Figure 123 in a ruptured state;

[00157] Figure 128 is a diagram illustrating a clamp of Figure 126 in an erroneously triggered condition;

[00158] Figure 129 is a diagram illustrating the staples of Figure 126 in a fully fired configuration and the fabric thickness compensator of Figure 123 in an at least partially transected condition;

[00159] Figure 130 is a cross-sectional perspective view of an alternative embodiment of a fabric thickness compensator according to at least one embodiment;

[00160] Figure 131 is a perspective view of an alternative embodiment of a tissue thickness compensator comprising a plurality of capsules aligned with a cutting member of a surgical stapling instrument;

[00161] Figure 132 is a detailed view of the capsules of Figure 131;

[00162] Figure 133 is a cross-sectional view of the tissue thickness compensator of Figure 131 comprising a plurality of capsules aligned with a knife slit of an anvil of a surgical stapling instrument;

[00163] Figures 134 and 135 illustrate an alternative embodiment of a tissue thickness compensator being attached to an anvil;

[00164] Figure 136 is an exploded cross-sectional view of an anvil and a compensator according to at least one embodiment;

[00165] Figure 137 illustrates the compensator of Figure 136 attached to the anvil;

[00166] Figure 138 is a partial perspective view of a fabric thickness compensator and a cutting member that incises the fabric thickness compensator in accordance with at least one embodiment;

[00167] Figure 139 is a partial cross-sectional view of an alternative embodiment of a fabric thickness compensator according to at least one embodiment;

[00168] Figure 140 is a partial cross-sectional view of another alternative embodiment of a fabric thickness compensator according to at least one embodiment;

[00169] Figure 141 is an illustration depicting a fabric thickness compensator comprising a plurality of irregular and/or asymmetrical cavities in accordance with various embodiments;

[00170] Figure 142 is a partial cutaway view of a tissue thickness compensator attached to an anvil of a surgical stapling instrument according to at least one embodiment;

[00171] Figure 143 is a perspective view of a jointless extruded housing, or outer tube, of a fabric thickness compensator according to at least one embodiment;

[00172] Figure 144 is a perspective view of another jointless extruded housing, or outer tube, of a fabric thickness compensator according to at least one embodiment;

[00173] Figure 145 is a perspective view of oxidized regenerated cellulose fibers;

[00174] Figure 146 is a perspective view of oxidized regenerated cellulose fibers that are shorter than the fibers of Figure 145;

[00175] Figure 147 is a diagram illustrating the fibers of Figure 145 being woven into a strand using the fibers of Figure 146;

[00176] Figure 148 represents the cord of Figure 147 being softened and at least partially cut;

[00177] Figure 149 depicts a gripper inserted through a compartment, or outer tube, of a fabric thickness compensator and positioned to grip the cord of Figure 147;

[00178] Figure 150 illustrates the claw of Figure 149 being removed from the compartment and the cord of Figure 147 being crossed by the compartment;

[00179] Figure 151 illustrates the compartment and cord of Figure 150 being segmented;

[00180] Figure 152 illustrates the ends of the housing being welded and/or heat sealed;

[00181] Figure 153 illustrates a process for creating a fabric thickness compensator without side seams;

[00182] Figure 154 illustrates an anvil of a surgical stapling instrument and a plurality of compensators selectively attachable to the anvil, wherein each of the compensators comprises an array of capillary channels;

[00183] Figure 155 is a plan view of a compensator configured to be attached to an anvil;

[00184] Figure 156 is a detailed view of a portion of the compensator of Figure 155;

[00185] Figure 157 is a perspective view of an end actuator of a surgical stapling instrument;

[00186] Figure 158 is another perspective view of the end actuator of Figure 157 illustrating a fluid being placed in a fabric thickness compensator of the end actuator;

[00187] Figure 159 is another perspective view of the end actuator of Figure 159 illustrating a compensator attached to an end actuator anvil;

[00188] Figure 160 is a detailed view of an arrangement of capillary channels in the compensator of Figure 159;

[00189] Figure 161 is an exploded view of a compensator comprising a plurality of layers according to at least one embodiment;

[00190] Figure 162 is an exploded view of a compensator and anvil of a surgical stapling instrument according to at least one embodiment;

[00191] Figure 163 is a partial cross-sectional view of the compensator and anvil of Figure 162;

[00192] Figure 164 is an exploded view of a compensator comprising a cellular invagination matrix according to at least one embodiment;

[00193] Figure 165 is a perspective view of the compensator of Figure 164;

[00194] Figure 166 is a perspective view of a fibrous layer of material for a compensator;

[00195] Figure 167 is a perspective view of a plurality of fibrous layers stacked on top of one another according to at least one embodiment;

[00196] Figure 168 is a perspective view of another plurality of fibrous layers stacked on top of one another according to at least one embodiment;

[00197] Figure 169 is a perspective view of a fibrous layer of material for a compensator;

[00198] Figure 170 is a perspective view of a plurality of fibrous layers stacked one on top of the other, wherein the fibers are arranged in different directions according to at least one embodiment;

[00199] Figure 171 is a perspective view of another plurality of fibrous layers stacked on top of one another according to at least one embodiment;

[00200] Figure 172 is a perspective view of an end actuator insert and an end actuator of a surgical instrument according to at least one embodiment;

[00201] Figure 173 is an elevation view of a tissue thickness compensator positioned on an end actuator of a surgical instrument according to at least one embodiment;

[00202] Figure 174 is an elevation view of a tissue thickness compensator positioned on the end actuator of the surgical instrument according to at least one embodiment;

[00203] Figure 175 is a perspective view of a sleeve positioned on an anvil for the end actuator of the surgical instrument according to at least one embodiment;

[00204] Figure 176 is a plan view of the pinned portion of the sleeve of Figure 175;

[00205] Figure 177 is an elevation view of the pinned portion of the sleeve of Figure 175;

[00206] Figure 178 is an end view of the pinned portion of the sleeve of Figure 175;

[00207] Figure 179 is a perspective view of the pinned portion of the sleeve of Figure 175;

[00208] Figure 180 is a plan view of a fabric compensator of a sleeve according to at least one embodiment;

[00209] Figure 181 is a perspective view of the fabric compensator of Figure 180;

[00210] Figure 182 is an elevation view of the fabric compensator of Figure 180;

[00211] Figure 183 is a plan view of a fabric compensator of a sleeve according to at least one embodiment;

[00212] Figure 184 is a perspective view of the fabric compensator of Figure 183;

[00213] Figure 185 is an elevation view of the fabric compensator of Figure 183;

[00214] Figure 186 is a perspective view of a tip of the sleeve of Figure 175;

[00215] Figure 187 is another perspective view of the tip of Figure 186;

[00216] Figure 188 is a top plan view of the tip of Figure 186 depicting the internal geometry in ghost lines;

[00217] Figure 189 is an elevation view of the tip of Figure 186 representing the internal geometry in ghost lines;

[00218] Figure 190 is another perspective view of the sleeve of Figure 175 positioned on the anvil;

[00219] Figure 191 is a plan view of the sleeve of Figure 175 positioned on the anvil;

[00220] Figure 192 is an elevation view of the sleeve of Figure 175 positioned on the anvil;

[00221] Figure 193 is a plan view of the sleeve of Figure 175 positioned on the anvil representing a translational trigger bar shown in ghost lines;

[00222] Figure 194 is an elevation view of the sleeve of Figure 175 positioned on the anvil representing a translational firing bar shown in phantom lines;

[00223] Figure 195 is a plan view of the sleeve of Figure 175 positioned on the anvil representing the release of the sleeve tip;

[00224] Figure 196 is an elevation view of the sleeve of Figure 175 positioned on the anvil representing the release of the sleeve tip;

[00225] Figure 197 is a plan view of the sleeve of Figure 175 positioned on the anvil representing the firing bar in phantom lines and the release of the sleeve tip;

[00226] Figure 198 is an elevational view of the sleeve of Figure 175 positioned on the anvil depicting the firing bar in phantom lines and the release of the sleeve tip;

[00227] Figure 199 is a partial perspective view of the sleeve, anvil and firing bar of Figure 197;

[00228] Figure 200 is another partial perspective view of the sleeve, anvil and firing bar of Figure 197;

[00229] Figure 201 is an elevational cross-sectional view of the sleeve and anvil of Figure 175;

[00230] Figure 202 is an elevational cross-sectional view of the anvil of Figure 175 representing the release of the fabric compensator from the sleeve;

[00231] Figure 203 is a plan view of an end actuator insert according to at least one embodiment;

[00232] Figure 204 is an elevation view of the end actuator insert of Figure 203;

[00233] Figure 205 is a perspective view of the end actuator insert of Figure 205;

[00234] Figure 206 is a partial perspective view of the end actuator insert of Figure 203 depicting the engagement of the end actuator insert with the end actuator anvil of a surgical instrument;

[00235] Figure 207 is a partial perspective view of the end actuator insert of Figure 203 depicting the engagement of the end actuator insert with the end actuator staple cartridge of a surgical instrument;

[00236] Figure 208 is an elevation view of the end actuator insert of Figure 203 depicting the engagement of the end actuator insert with the end actuator of a surgical instrument;

[00237] Figure 209 is an elevation view of the end actuator insert of Figure 203 positioned in the end actuator of a surgical instrument;

[00238] Figure 210 is a perspective view of a tissue thickness compensator positioned on the end actuator of a surgical instrument in accordance with at least one illustrated embodiment with a portion of the tissue thickness compensator cut away;

[00239] Figure 211 is a perspective view of the fabric thickness compensator of Figure 210 attached to the end actuator anvil by means of static loading;

[00240] Figure 212 is a perspective view of the fabric thickness compensator of Figure 210 attached to the end actuator anvil by means of suction elements;

[00241] Figure 213 is a perspective view of the fabric thickness compensator of Figure 210 attached to the end actuator anvil by hook and loop fasteners;

[00242] Figure 214 is a partial perspective view of the fabric thickness compensator of Figure 210 attached to the end actuator anvil by means of a strap;

[00243] Figure 215 is a partial perspective view of the tissue thickness compensator of Figure 210 secured to the end actuator anvil by means of a snap to the distal end of the tissue thickness compensator;

[00244] Figure 216 is a perspective partial cross-sectional view of a tissue thickness compensator attached to the anvil of the end actuator of a surgical instrument according to at least one embodiment;

[00245] Figure 217 is an elevational cross-sectional view of the fabric thickness compensator of Figure 216;

[00246] Figure 218 is another elevational cross-sectional view of the fabric thickness compensator of Figure 216;

[00247] Figure 219 is an elevational cross-sectional view of a tissue thickness compensator attached to the end actuator anvil of a surgical instrument representing a closure in a closed position according to at least one embodiment;

[00248] Figure 220 is an elevational cross-sectional view of the fabric thickness compensator of Figure 219 depicting the closure in the open position;

[00249] Figure 221 is an elevational cross-sectional view of a tissue thickness compensator attached to the end actuator anvil of a surgical instrument according to at least one embodiment;

[00250] Figure 222 is an elevational cross-sectional view of a tissue thickness compensator attached to the end actuator anvil of a surgical instrument according to at least one embodiment;

[00251] Figure 223 is an elevational cross-sectional view of a tissue thickness compensator attached to the end actuator anvil of a surgical instrument according to at least one embodiment;

[00252] Figure 224 is an elevational cross-sectional view of a tissue thickness compensator attached to the anvil of the end actuator of the surgical instrument according to at least one embodiment;

[00253] Figure 225 is an exploded view in perspective cross-section of a tissue thickness compensator attached to an anvil of a surgical instrument end actuator according to at least one embodiment;

[00254] Figure 226 is a perspective view of the tissue thickness compensator of Figure 225 depicting movement of the tissue thickness compensator toward the anvil;

[00255] Figure 227 is an elevational cross-sectional view of the fabric thickness compensator of Figure 225 engaged with the anvil;

[00256] Figure 228 is a perspective cross-sectional view of a tissue thickness compensator attached to the end actuator anvil of a surgical instrument according to at least one embodiment;

[00257] Figure 229 is an exploded perspective cross-section view of the tissue thickness compensator and anvil of Figure 228;

[00258] Figure 230 is an elevational view of a fabric thickness compensator according to at least one embodiment;

[00259] Figure 231 is a perspective view of the fabric thickness compensator of Figure 230;

[00260] Figure 232 is another perspective view of the fabric thickness compensator of Figure 230;

[00261] Figure 233 is a perspective view of the tissue thickness compensator of Figure 230 depicting the movement of the tissue thickness compensator towards the anvil of the end actuator of a surgical instrument;

[00262] Figure 234 is a cross-sectional plan view of the fabric thickness compensator of Figure 230 positioned on the anvil;

[00263] Figure 235 is a perspective view of the tissue thickness compensator of Figure 230 positioned on the anvil;

[00264] Figure 236 is a perspective view of the fabric thickness compensator of Figure 230 positioned on the anvil illustrating a cutting element separating the fabric thickness compensator;

[00265] Figure 237 is a cross-sectional elevation view of an end actuator of a surgical stapling instrument comprising an anvil and a loadable layer according to at least one embodiment;

[00266] Figure 238 is a bottom view of the anvil and loadable layer of Figure 237;

[00267] Figure 239 is an exploded view of the anvil and loadable layer of Figure 237 and a fabric thickness compensator releasably attachable to the loadable layer;

[00268] Figure 240 is a perspective view of a fabric thickness compensator according to at least one embodiment;

[00269] Figure 241 is a plan view of the fabric thickness compensator of Figure 240;

[00270] Figure 240A is a perspective view of a fabric thickness compensator according to at least one alternative embodiment;

[00271] Figure 241A is a plan view of the fabric thickness compensator 240A of the Figure;

[00272] Figure 242 is a perspective view of a fabric thickness compensator according to at least one alternative embodiment;

[00273] Figure 243 is a plan view of the fabric thickness compensator of Figure 242;

[00274] Figure 244 is a perspective view of a fabric thickness compensator according to at least one embodiment;

[00275] Figure 245 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one embodiment;

[00276] Figure 246 is a cross-sectional view of the anvil and tissue thickness compensator of Figure 245;

[00277] Figure 247 is a cross-sectional view of the fabric thickness compensator of Figure 245;

[00278] Figure 248 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one alternative embodiment;

[00279] Figure 249 is a cross-sectional view of the anvil and tissue thickness compensator of Figure 248;

[00280] Figure 250 is a cross-sectional view of the fabric thickness compensator of Figure 248 in an open configuration;

[00281] Figure 251 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one alternative embodiment;

[00282] Figure 252 is a cross-sectional view of the anvil and tissue thickness compensator of Figure 251;

[00283] Figure 253 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one alternative embodiment;

[00284] Figure 254 is a cross-sectional view of the anvil and tissue thickness compensator of Figure 253;

[00285] Figure 255 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one alternative embodiment;

[00286] Figure 256 is a cross-sectional view of the anvil and tissue thickness compensator of Figure 255;

[00287] Figure 257 is a perspective view of a tissue thickness compensator attached to an anvil according to at least one alternative embodiment; and

[00288] Figure 258 is a cross-sectional view of the anvil and tissue thickness compensator. Figure 257

[00289] Matching reference characters indicate matching parts in all multiple views. The exemplifications described herein illustrate certain embodiments of the invention, in one form, and such exemplifications are not to be considered as limiting the scope of the invention in any way.

DETAILED DESCRIPTION

[00290] The applicant of the present application also retains the rights of the US patent applications identified below which are each incorporated herein by reference in their respective entireties:

[00291] US Patent Application Serial No. 12/894,311 entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS (Attorney's Document No. END6734USNP/100058);

[00292] US Patent Application Serial No. 12/894,340 entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS (Attorney's Document No. END6735USNP/100059);

[00293] US Patent Application Serial No. 12/894,327 entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS (Attorney's Document No. END6736USNP/100060);

[00294] US Patent Application Serial No. 12/894,351 entitled SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS (Attorney's Document No. END6839USNP/100524);

[00295] US Patent Application Serial No. 12/894,338 entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT (Attorney's Document No. END6840USNP/100525);

[00296] US Patent Application Serial No. 12/894,369 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER (Attorney's Document No. END6841USNP/100526);

[00297] US Patent Application Serial No. 12/894,312 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS (Attorney's Document No. END6842USNP/100527);

[00298] US Patent Application Serial No. 12/894,377 entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE (Attorney's Document No. END6843USNP/100528);

[00299] US Patent Application Serial No. 12/894,339 entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT (Attorney's Document No. END6847USNP/100532);

[00300] US Patent Application Serial No. 12/894,360 entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM (Attorney's Document No. END6848USNP/100533);

[00301] US Patent Application Serial No. 12/894,322 entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS (Attorney's Document No. END6849USNP/100534);

[00302] US Patent Application Serial No. 12/894,350, entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT (attorney's document number END6855USNP/100540) ;

[00303] US Patent Application Serial No. 12/894,383 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS (Attorney's Document No. END6856USNP/100541);

[00304] US Patent Application Serial No. 12/894,389 entitled COMPRESSIBLE FASTENER CARTRIDGE (Attorney's Document No. END6857USNP/100542);

[00305] US Patent Application Serial No. 12/894,345 entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT (Attorney's Document No. END6858USNP/100543);

[00306] US Patent Application Serial No. 12/894,306 entitled COLLAPSIBLE FASTENER CARTRIDGE (Attorney's Document No. END6859USNP/100544);

[00307] US Patent Application Serial No. 12/894,318 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS (Attorney's Document No. END6860USNP/100546);

[00308] US Patent Application Serial No. 12/894,330 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX (Attorney's Document No. END6861USNP/100547);

[00309] US Patent Application Serial No. 12/894,361 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX (Attorney's Document No. END6862USNP/100548);

[00310] US Patent Application Serial No. 12/894,367 entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX (Attorney's Document No. END6863USNP/100549);

[00311] US Patent Application Serial No. 12/894,388 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER (Attorney's Document No. END6864USNP/100550);

[00312] US Patent Application Serial No. 12/894,376 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES (Attorney Document No. END6865USNP/100551);

[00313] US Patent Application Serial No. 13/097,865 entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FOR MING POCKETS (Attorney Document No. END6735USCIP1/100059CIP1);

[00314] US Patent Application Serial No. 13/097,936 entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER (Attorney's Document No. END6736USCIP1/100060CIP1);

[00315] US Patent Application Serial No. 13/097,954 entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION (Attorney's Document No. END6840USCIP1/100525CIP1);

[00316] US Patent Application Serial No. 13/097,856 entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF (Attorney's Document No. END6841USCIP1/100526CIP1);

[00317] US Patent Application Serial No. 13/097,928 entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS (Attorney's Document No. END6842USCIP1/100527CIP1);

[00318] US Patent Application Serial No. 13/097,891 entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL (Attorney's Document No. END6843USCIP1/100528CIP1);

[00319] US Patent Application Serial No. 13/097,948 entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION (Attorney's Document No. END6847USCIP1/100532CIP1);

[00320] US Patent Application Serial No. 13/097,907 entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY (Attorney's Document No. END6848USCIP1/100533CIP1);

[00321] US Patent Application Serial No. 13/097,861 entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES (Attorney Document No. END6849USCIP1/100534CIP1);

[00322] US Patent Application Serial No. 13/097,869 entitled STAPLE CARTRIDGE LOADING ASSEMBLY (Attorney's Document No. END6855USCIP1/100540CIP1);

[00323] US Patent Application Serial No. 13/097,917 entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS (Attorney's Document No. END6856USCIP1/100541CIP1);

[00324] US Patent Application Serial No. 13/097,873 entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION (Attorney's Document No. END6857USCIP1/100542CIP1);

[00325] US Patent Application Serial No. 13/097,938 entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS (Attorney's Document No. END6858USCIP1/100543CIP1);

[00326] US Patent Application Serial No. 13/097,924 entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR (Attorney's Document No. END6859USCIP1/100544CIP1);

[00327] US Patent Application Serial No. 13/242,029 entitled SURGICAL STAPLER WITH FLOATING ANVIL (Attorney's Document No. END6841USCIP2/100526CIP2);

[00328] US Patent Application Serial No. 13/242,066 entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT (Attorney's Document No. END6841USCIP3/100526CIP3);

[00329] US Patent Application Serial No. 13/242,086 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK (Attorney's Document No. END7020USNP/110374);

[00330] US Patent Application Serial No. 13/241,912 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT (Attorney's Document No. END7019USNP/110375);

[00331] US Patent Application Serial No. 13/241,922 entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS (Attorney's Document No. END7013USNP/110377);

[00332] US Patent Application Serial No. 13/241,637 entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS (Attorney Document No. END6888USNP3/110378); and

[00333] US Patent Application Serial No. 13/241,629 entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR (Attorney Document No. END6888USNP2/110379).

[00334] The Applicant of the present application also owns the US patent applications identified below which were filed on the same date as the present application and which are each incorporated herein by reference in their entirety, respectively:

[00335] US application serial number, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES, (attorney's document number END6864USCIP1/100550CIP1);

[00336] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS, (attorney's document no. END6864USCIP2/100550CIP2);

[00337] US application serial number, entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR, (attorney's document number END6843USCIP2/100528CIP2).

[00338] US Application Serial No., entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR (Attorney Document No. END6843USCIP3/100528CIP3);

[00339] US application serial number, entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR, (attorney's document number END6843USCIP4/100528CIP4);

[00340] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT, (attorney's document no. END6843USCIP5/100528CIP5);

[00341] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION, (attorney's document no. END6843USCIP6/100528CIP6);

[00342] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD, (attorney's document no. END6843USCIP7/100528CIP7);

[00343] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD, (attorney's document no. END6843USCIP8/100528CIP8);

[00344] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS, (attorney's document no. END6843USCIP9/100528CIP9);

[00345] US Application Serial No., entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR AR-RANGEMENTS FOR SURGICAL STAPLERS, (Attorney Document No. END6843USCIP10/100528CP10);

[00346] US Application Serial No., entitled TIS-SUE THICKNESS COMPENSATORS, (Attorney Document No. END6843USCIP11/100528CP11);

[00347] US Application Serial No., entitled LAYERED TISSUE THICKNESS COMPENSATOR, (Attorney Document No. END6843USCIP12/100528CP12);

[00348] US Application Serial No., entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS, (Attorney's Document No. END6843USCIP13/100528CP13);

[00349] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT, (attorney's document no. END7100USNP/110601);

[00350] US application serial number, entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS, (attorney's document number END7101USNP/110602);

[00351] US application serial number, entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR, (attorney's document number END7107USNP/110603);

[00352] US application serial number, entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME, (attorney's document number END7103USNP/110605);

[00353] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS, (attorney's document no. END7104USNP/110606);

[00354] US application serial no., entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES, (attorney's document no. END7105USNP/110607); and

[00355] US application serial number, entitled DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COM-PENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS, (attorney's document number END7106USNP/110608).

[00356] Certain exemplary embodiments will now be described to provide a general understanding of the principles of structure, function, fabrication and use of the devices and methods of the present invention presented. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary, non-limiting embodiments. Features illustrated or described in conjunction with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are included within the scope of the present invention.

[00357] Any of the methods disclosed or claimed herein for manufacturing, forming or otherwise producing an article or product, may be used to manufacture, form or otherwise produce all or part of the article or product in question, and provided that such method is used to manufacture, form or otherwise produce part of the article or product in question, the remainder of the article or product may be produced in any way, including by means of the use of any of the other methods disclosed and claimed herein for manufacturing, forming or otherwise producing the article or product, and the various parts so produced may be combined in any way. Similarly, any article or product disclosed or claimed herein may exist alone or in combination with, or as an integral part of, any other article or product disclosed in that form with which it is compatible. In this way, the particular features, structures or characteristics illustrated or described in conjunction with an article, product or method may be combined, in whole or in part, with the features, structures or characteristics of one or more other compatible articles, products or methods. , without limitation. Such modifications and variations are included within the scope of the present invention.

[00358] Where it is disclosed herein, with reference to a particular figure or otherwise, that a certain embodiment of the invention or a certain article, product or method may comprise certain structures, features or features, it will be understood by the reader that this means that those structures, characteristics or features may be incorporated into the article, product or method in question in any compatible combination. In particular, such disclosure of numerous ideal structures, features or features shall be understood to also reveal all such structures, features or features in combination, except in the case of structures, features or features which are revealed as alternatives to one another. Where such structures, features or resources are revealed as alternatives to one another, it must be understood that this reveals these alternatives as being replacements for another.

[00359] The terms "proximal" and "distal" are used in the present invention with reference to a clinician's manipulation of the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion located furthest from the clinician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "upwards" and "downwards" may be used in the present invention in connection with the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

[00360] Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily understand that the various methods and devices disclosed in the present invention can be used in numerous surgical procedures and applications, including in connection with open surgical procedures. As the present detailed description proceeds, the reader will further appreciate that the various instruments disclosed in the present invention can be inserted into a body in any manner, such as through a natural orifice, through an incision or perforation hole formed in tissue. , etc. The working portions or end actuator portions of instruments may be inserted directly into the patient's body or may be inserted through an access device which has a working channel through which the end actuator and elongated stem of an instrument surgery can be advanced.

[00361] Turning to drawings where numbers indicate similar components across the various views, Figure 1 shows a surgical instrument 10 that is capable of performing several unique benefits. Surgical stapling instrument 10 is designed to handle and/or actuate end actuators 12 of various shapes and sizes that are operatively attached to the instrument. In Figures 1 to 1E, for example, the end actuator 12 includes an elongate channel 14 that forms a lower jaw 13 of the end actuator 12. The elongate channel 14 is configured to support an "implantable" clamp cartridge 30 and also support movably an anvil 20 which acts as an upper grip 15 of the end actuator 12.

[00362] The elongated channel 14 may be manufactured from, for example, stainless steel, titanium, etc. series 300 & 400, 17-4 & 17-7 and be formed with spaced side walls 16. The anvil 20 can be manufactured, for example, from stainless steel series 300 & 400, 17-4 & 17-7, titanium , etc., and having a lower staple-forming surface generally identified as 22 which has a plurality of staple-forming pockets 23 formed therein. See Figures 1B to 1E. In addition, the anvil 20 has a bifurcated ramp assembly 24 that protrudes proximally from the anvil. An anvil pin 26 projects from each side of the ramp assembly 24 to be received in a corresponding slot or opening 18 in the side walls 16 of the elongate channel 14 to facilitate its movable or pivoting attachment thereto.

[00363] Various forms of implantable staple cartridges may be employed with the surgical instruments disclosed herein. Specific staple cartridge configurations and constructions will be discussed in more detail below. However, in Figure 1A, an implantable staple cartridge 30 is shown. The staple cartridge 30 has a body portion 31 consisting of a compressible hemostatic material, for example oxidized regenerated cellulose ("ORC") or an oxidized regenerated cellulose ("ORC"). bioabsorbable foam on which rows of unformed metal staples are supported 32. To prevent the staple from being affected and the hemostatic material being activated during the insertion and placement process, the entire cartridge can be coated or wrapped in a biodegradable film 38, as a polydioxanone film sold under the trademark PDS®, or with a film of polyglycerol sebacate (PGS) or other biodegradable films formed from PGA (polyglycolic acid, marketed under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecapron 25, sold under the tradename Monocryl) or a compound of PGA, PCL, PLA, PDS that will be used waterproof until broken. The body 31 of the staple cartridge 30 is sized to be removably supported in the elongated groove 14 as shown, so that each staple 32 therein aligns with the corresponding staple forming pockets 23 on the anvil when the anvil 20 is actuated to form contact with the staple cartridge 30.

[00364] In use, after the end actuator 12 is positioned adjacent to the target tissue, the end actuator 12 is manipulated to capture or clamp the target tissue between a top face 36 of the staple cartridge 30 and the surface of Staple forming 22 of anvil 20. Staples 32 are formed by moving anvil 20 in a path that is substantially parallel to elongated groove 14 to bring out staple forming surface 22 and, more particularly, staple forming pockets 23 in substantially simultaneous contact with the top face 36 of the staple cartridge 30. As the anvil 20 continues to move in the staple cartridge 30, the legs 34 of the staples 32 contact a corresponding staple forming the pocket 23 in the anvil 20 which serves to fold the legs of the clamps 34 over each other to form the clamp 32 into a "B-shape". Further movement of anvil 20 towards elongated groove 14 will further compress and form clamps 32 to a desired final formed height "FF".

[00365] The above described staple formation process is generally represented in Figures 1B to 1E. For example, Figure 1B illustrates the end actuator 12 with the target tissue "T" between the anvil 20 and the top face 36 of the implantable staple cartridge 30. Figure 1C illustrates the initial clamping position of the anvil 20 in which the anvil 20 was closed over the target tissue "T" to secure the target tissue "T" between the anvil 20 and the top face 36 of the staple cartridge 30. Figure 1D illustrates the initial formation of the staple in which the anvil 20 has begun to compress the staple cartridge 30 so that the legs 34 of the staples 32 are beginning to be formed by the staple forming pockets 23 in the anvil 20. Figure 1E illustrates the staple 32 in its final state formed through the fabric. "T" target with anvil 20 removed for clarity. After the clips 32 are formed and secured to the target tissue "T", the surgeon moves the anvil 20 to the open position to allow the cartridge body 31 and clips 32 to remain attached to the target tissue while the end actuator 12 is taken from the patient. The end actuator 12 forms all the clamps simultaneously as the two jaws 13, 15 are pressed. The other materials of the "crumpled" body 31 act as a hemostatic material (the ORC) and a staple line reinforcement (PGA, PDS or any of the other film compositions mentioned above 38). Furthermore, as the staples 32 never need to leave the cartridge body 31 during formation, the probability of defective formation of the staples 32 during this process is minimized. For use in the present invention, the term "implantable" means that, in addition to the clips, the cartridge body materials that support the clips will also remain in the patient and may eventually be absorbed into the patient's body. Such implantable staple cartridges are distinguishable from previous cartridge arrangements which remain positioned within the end actuator in its entirety after they have been fired.

[00366] In various implementations, the end actuator 12 is configured to be coupled to an elongate stem assembly 40 that projects from a cable assembly 100. The end actuator 12 (when closed) and the elongate stem assembly 40 may have similar cross-sectional shapes and be sized to pass operatively through a trocar tube or working channel in another form of access instrument. For use in the present invention, the term "operationally pass" means that the end actuator and at least a portion of the elongate rod assembly can be introduced through or passed through the opening of the channel or tube and can be manipulated therein as required. necessary to complete the surgical stapling procedure. When in a closed position, jaws 13 and 15 of end actuator 12 can provide the end actuator with a superficially circular cross-sectional shape that facilitates its passage through a circular passage/opening. However, the end actuators of the present invention, as well as the elongated stem assemblies, could conceivably be provided with other shapes in cross section that could otherwise pass through passages and access openings which are non-circular shapes in cross section. In this way, an overall size of a closed-end actuator cross-section will be related to the size of the passage or opening through which it is intended to pass. Thus, an end actuator for example can be called a "5mm end actuator", meaning it can operatively pass through an opening that is at least approximately 5 mm in diameter.

[00367] The elongated stem assembly 40 may have an outside diameter that is substantially equal to the outside diameter of the end actuator 12 when in a closed position. For example, a 5mm end actuator can be coupled to an elongated rod assembly 40 whose cross-sectional diameter is 5mm. However, as the present detailed description progresses, it will become apparent that the present invention can be effectively used in connection with different sizes of end actuators. For example, a 10mm end actuator can be attached to an elongated rod that has a cross diameter of 5mm. In contrast, for applications where a 10mm or greater opening or access passage is provided, the elongate rod assembly 40 may have a 10mm (or greater) transverse diameter, but may also be capable of actuating a 5mm or 10mm end. Accordingly, the outer stem 40 may have an outer diameter that is the same as or different from the outer diameter of a closed-end actuator 12 attached thereto.

[00368] As shown, the elongate rod assembly 40 extends distally from the handle assembly 100 in a generally straight line to define a longitudinal axis A-A. For example, the elongate rod assembly 40 may have a length of approximately 229 to 406 mm (9 to 16 inches). However, the elongate stem assembly 40 may be supplied in other lengths or may contain unions or be otherwise configured to facilitate articulation of the end actuator 12 with respect to other portions of the stem or cable assembly as will be discussed in more detail. below. The elongate stem assembly 40 includes a back element 50 that extends from the handle assembly 100 to the end actuator 12. The proximal end of the elongate channel 14 of the end actuator 12 has a pair of retaining pivot pins 17. protruding therefrom, which are sized to be received within corresponding swivel pin openings or cradles 52 which are provided at a distal end of the back element 50 to allow the end actuator 12 to be removably coupled to the assembly of elongated shank 40. Back element 50 may be manufactured from, for example, 6061 or 7075 aluminum, stainless steel, titanium, and the like.

[00369] The cable assembly 100 comprises a pistol grip housing which may be manufactured in two or more pieces for assembly purposes. For example, the cable assembly 100, as shown, comprises a right-hand housing element 102 and a left-hand housing element (not shown) that are molded or otherwise manufactured from a polymer or plastic material and are designed to fit together. to fit in. These housing elements may be secured together by snaps, dowels and sockets molded or otherwise formed into the elements and/or by means of adhesive, screws, etc. Back element 50 has a proximal end 54 which has a flange 56 formed thereon. The flange 56 is configured to be pivotally supported in a groove 106 formed by paired ribs 108 that project inwardly from each of the housing elements 102, 104. Such an arrangement facilitates the attachment of the back element 50 to the assembly. cable assembly 100 and further allows the back element 50 to be rotated relative to the cable assembly 100 about the longitudinal axis AA in a 360° trajectory.

[00370] As can be seen in Figure 1, the back element 50 passes through and is supported by a mounting pad 60 which is pivotally secured to the cable assembly 100. The mounting pad 60 has a proximal flange 62 and a distal flange 64 defining a rotational groove 65 which is configured to rotatably receive a nose portion 101 of the cable assembly 100. Such an arrangement allows the mounting pad 60 to pivot about the longitudinal axis AA with respect to the cable assembly 100. handle 100. The back element 50 is non-rotatably pinned to the mounting pad 60 by a back pin 66. In addition, a rotary knob 70 is secured to the mounting pad 60. For example, the rotary knob 70 has a hollow mounting flange portion 72 which is sized to receive a mounting pad portion 60 therein. The knob 70 can be made of, for example, glass or carbon filled nylon, polycarbonate, Ultem®, etc., and is secured to the mounting pad 60 by the back stud 66 as well. In addition, an inwardly projecting retaining flange 74 is formed over the mounting flange portion 72 and is configured to extend into a radial groove 68 formed in the mounting pad 60. In this way, the surgeon can rotating the back element 50 (and the end actuator 12 attached thereto) about the longitudinal axis AA in a 360° trajectory by holding the knob 70 and rotating it with respect to the cable assembly 100.

[00371] The anvil 20 is held in an open position by an anvil spring 21 and/or other limiting arrangement. The anvil 20 is selectively movable from the open position to various closed or clamping and firing positions by a firing system, generally designated as 109. The firing system 109 includes a "firing element" 110 comprising a hollow tube of trigger 110. The hollow trigger tube 110 is axially movable over the back element 50 and thereby forms the outer portion of the elongate rod assembly 40. The trigger tube 110 may be manufactured from a polymer or other suitable material and have a proximal end which is attached to a firing yoke 114 of the firing system 109. For example, the firing yoke 114 may be overmolded to the proximal end of the firing tube 110. However, other fastener arrangements may be employed. .

[00372] As can be seen in Figure 1, the firing fork 114 can be pivotally supported on a support collar 120 which is configured to move axially on the cable assembly 100. The support collar 120 has a pair of laterally extending fins which are sized to be slidably received in fin slots formed in the right and left housing elements. In that way, the support collar 120 can slide axially in the cable compartment 100 and still allow the firing fork 114 and the firing tube 110 to rotate with respect thereto about the longitudinal axis A-A. In accordance with the invention, a longitudinal slot is provided through the firing tube 110 to allow the dorsum pin 66 to extend therethrough into the dorsum element 50 while facilitating axial displacement of the firing tube 110 over the back element 50.

[00373] The firing system 109 further comprises a firing actuator 130 which serves to control the axial displacement of the firing tube 110 over the back element 50. See Figure 1. Such axial movement in the distal direction of the firing tube 110 in firing interaction with anvil 20 is referred to in this document as "firing motion". As can be seen in Figure 1, the trigger 130 is movably or pivotally coupled to the cable assembly 100 via a pivot pin 132. A torsion spring 135 is employed to move the trigger 130 away from the trigger portion. grip the pistol 107 of the handle assembly 100 to a non-actuated or initial "open" position. As can be seen in Figure 1, the trigger driver 130 has an upper portion 134 which is movably (pinned) attached to trigger links 136 which are movably attached (pinned) to the support collar 120. Accordingly, movement of the trigger 130 from the initial position (Figure 1) towards an end position adjacent to the pistol grip portion 107 of the handle assembly 100 will cause the trigger fork 114 and the trigger tube 110 to collapse. move in the distal "DD" direction. Movement of the trigger 130 in the opposite direction to the pistol grip portion 107 of the handle assembly 100 (under the action of the torsion spring 135) will cause the trigger hook 114 and the trigger tube 110 to move in the same direction. proximal direction "PD" over the back element 50.

[00374] The present invention can be employed with different sizes and configurations of implantable staple cartridges. For example, the surgical instrument 10, when used in conjunction with a first trigger adapter 140, can be used with a 5 mm end actuator 12 that has a length of approximately 20 mm (or other lengths) that supports an implantable staple cartridge 30. This end actuator size may be particularly well suited, for example, to complete dissection and relatively fine vascular transactions. However, as will be discussed in more detail below, the surgical instrument 10 can also be employed, for example, in conjunction with other sizes of end actuators and staple cartridges by replacing the first firing adapter 140 with a second firing adapter. . As a further alternative, the elongate stem assembly 40 may be configured to be attached to only one end actuator shape or size.

[00375] A method of detachably coupling the end actuator 12 to the back element 50 will be explained below. The coupling process is initiated by inserting the swivel retaining pins 17 in the elongated channel 14 into the swivel pin cradles 52 in the back element 50. Thereafter, the surgeon advances the triggering trigger 130 towards the handle of the gun 107 of housing assembly 100 to distally advance firing tube 110 and first firing adapter 140 over a proximal end portion 47 of elongate channel 14 to thereby retain trunnions 17 in their respective cradles 52. first firing adapter 140 over swivel pins 17 is referred to in this document as the "coupled position". The present invention may also have an end actuator lock assembly to lock the trigger actuator 130 in position after an end actuator 12 has been attached to the back element 50.

[00376] More specifically, one embodiment of the end actuator locking assembly 160 includes a retaining pin 162 that is movably supported on the upper portion 134 of the trigger actuator 130. As discussed earlier, the trigger tube trigger 110 should initially be advanced distally to the engaged position where the first trigger adapter 140 retains the retaining rotating pins 17 of the end actuator 12 in the rotating pin cradles 52 on the dorsum element 50. The surgeon advances the adapter trigger 140 distally to the engaged position by pulling trigger trigger 130 from the home position to the pistol grip direction 107. As trigger trigger 130 is initially actuated, retaining pin 162 is moved distally until the trigger 130 is initially actuated. the firing tube 110 has advanced the first firing adapter 140 to the engaged position, at which point the retaining pin 162 is forced into a latch cavity 164 formed in the el carcass item. Optionally, when detent pin 162 enters latch cavity 164, pin 162 may produce a latching or other sound, as well as providing a tactile indication to the surgeon that end actuator 12 has "locked" into the element. 50. In addition, the surgeon cannot inadvertently continue to actuate the trigger 130 to begin forming the clamps 32 on the end actuator 12 without intentionally forcing the retaining pin 162 out of the latch cavity 164. Similarly, if the surgeon releases the trigger 130 when it is in the engaged position, it will be held in that position by the retaining pin 162 to prevent the trigger trigger 130 from returning to the home position and thereby releasing the end actuator. 12 of the back element 50.

[00377] The present invention may also include a trigger lock button 137 that is pivotally secured to the cable assembly 100. In one form, the trigger lock button 137 has a lock 138 formed over a distal end thereof which is oriented to engage the firing yoke 114 when the firing release button is in a first latched position. As can be seen in Figure 1, the lock spring 139 serves to force the firing system lock button 137 into the first locked position. In various circumstances, the latch 138 serves to engage the firing fork 114 at a point where the position of the firing fork 114 on the back element 50 corresponds to a point at which the first firing adapter 140 is about to advance distally towards up on the nip ramp 28 over the anvil 20. One skilled in the art will understand that as the first trigger adapter 140 advances axially up the nip ramp 28, the anvil 20 will move in a path such that its portion of staple forming surface 22 will be substantially parallel to the top face 36 of staple cartridge 30.

[00378] After the end actuator 12 is coupled to the back element 50, the staple forming process is initiated by first pressing the firing system lock button 137 to allow the firing fork 114 to be moved additionally in a distal position on the back element 50 and, finally, compressing the anvil 20 into the staple cartridge 30. After pressing the trigger lock button 137, the surgeon continues to actuate the trigger 130 in the pistol grip 107, thereby driving the first staple collar 140 upwards on the corresponding staple-forming chute 29 to force the anvil 20 into forming contact with the staples 32 in the staple cartridge 30. trigger system lock 137 prevents accidental formation of staples 32 until the surgeon is ready to begin this process. In this embodiment, the surgeon must press the trigger lock button 137 before the trigger trigger 130 can be further actuated to begin the staple formation process.

[00379] The surgical instrument 10 may be used exclusively as a tissue stapling device if desired. However, the present invention may also include a fabric cutting system, generically designated 170. In at least one form, the fabric cutting system 170 comprises a knife element 172 that can be selectively advanced from an adjacent non-actuated position. to the proximal end of the end actuator 12 to a position actuated by actuation of a knife advance driver 200. The knife element 172 is movably supported on the back element 50 and is secured or otherwise projects from there. knife shank 180. Knife member 172 may be manufactured from, for example, 420 or 440 stainless steel with a hardness greater than 38HRC (Rockwell Hardness C scale) and have a fabric cutting edge 176 formed on the distal end 174 thereof and configured to extend slidably through a slot in the anvil 20 and a centrally arranged slot 33 in the staple cartridge 30 for cutting through tissue that is clamped in the end actuator 12. The knife rod 180 extends through the back element 50 and has a proximal end portion that actionably interfaces with a knife transmission that is operatively attached to the knife advance driver 200. The Knife feed driver 200 is attached to pivot pin 132 so that it can be pivoted or otherwise actuated without actuating trigger driver 130. In accordance with the invention, a first knife gear 192 is also attached to pivot pin 130. pivot 132 so that the actuation of the knife advance driver 200 also pivots the first knife gear 192. A trigger return spring 202 is secured between the first knife gear 192 and the cable housing 100 to force the trigger knife feed 200 to an initial or non-actuated position.

[00380] The knife drive also includes a second knife gear 194 that is pivotally supported on a second gear spindle and in mesh with the first knife gear 192. The second knife gear 194 is in engagement meshed with a third knife gear 196 which is supported on a third gear spindle. Also supported on the third gear spindle 195 is a fourth knife gear 198. The fourth knife gear 198 is adapted to drively engage a series of annular gear teeth or rings on a proximal end of the knife shank 180. Des In this form, such an arrangement allows the fourth knife gear 198 to axially drive the knife shank 180 in the distal "DD" or proximal "PD" direction and further allows the firing shaft 180 to rotate about the longitudinal axis. AA relative to the fourth knife gear 198. Accordingly, the surgeon can axially advance the firing rod 180 and ultimately the knife element 172 in a distal position by pulling the knife advance driver 200 in the gripping direction of the knife. pistol 107 of cable assembly 100.

[00381] The present invention further includes a knife lock system 210 that prevents advancement of knife element 172 unless firing trigger 130 has been pulled to the fully fired position. This feature will therefore prevent activation of the knife advance system 170 unless they were first fired or formed in the fabric. As can be seen in Figure 1, various implementations of the knife blocking system 210 comprise a knife blocking bar 211 that is pivotally supported on the pistol grip portion 107 of the handle assembly 100. The knife blocking bar 211 has a trigger end 212 which is adapted to be engaged by trigger trigger 130 when trigger trigger 130 is in the full trigger position. In addition, the knife lock bar 211 has a retaining hook 214 at its other end which is adapted to fixedly engage a lock rod 216 over the first cutting gear 192. A knife lock spring 218 is employed to force the knife lock bar 211 to a "locked" position in which the retaining hook 214 is retained in engagement with the locking rod 216 to thereby prevent actuation of the knife advance driver 200 unless the trigger 130 is in the full trigger position.

[00382] After the staples are "fired" (formed) into the target tissue, the surgeon can press the fire trigger release button 167 so that the trigger trigger 130 returns to the initial position under spring pull 135 which in turn causes the anvil 20 to be forced into an open position under the action of the spring 21. When in the open position, the surgeon can withdraw the end actuator 12 leaving the implantable staple cartridge 30 and staples 32 on site. In applications where the end actuator is inserted through a passage, working channel, etc., the surgeon returns the anvil 20 to the closed position activating the trigger trigger 130 to allow the end actuator 12 to be removed through the passage or working channel. If, however, the surgeon wishes to cut the target tissue after firing the staples, the surgeon must activate the knife advance driver 200 in the manner described above to drive the knife bar 172 through the target tissue to the end of the actuator. end. Thereafter, the surgeon may release the knife advance driver 200 to allow the trigger return spring 202 to cause the trigger drive to return the knife bar 172 to the home (non-actuated) position. After the knife bar 172 is returned to the starting position, the surgeon may open the jaws of the end actuator 13, 15 to release the implantable cartridge 30 in the patient and then withdraw the end actuator 12 from the patient. In this way, surgical instruments facilitate the use of small cartridges of implantable staples that can be inserted through relatively small working channels and passageways, while at the same time providing the surgeon with the option of firing the staples without cutting the tissue or, if desired, also cut the fabric after firing the staples.

[00383] Several unique and innovative embodiments of the present invention employ a compressible staple cartridge that supports staples in a substantially stationary position for anvil contact formation. The anvil is directed into the unformed staples where, for example, the degree of formation of the staple depends on how far the anvil is directed into the staples. Such an arrangement provides the surgeon with the ability to adjust the amount of forming or triggering pressure applied to the staples and thereby altering the final formed height of the staples. In the present invention, surgical stapling arrangements may employ staple drive elements that can lift the staples toward the anvil. This is described in more detail below.

[00384] Optionally, with respect to the above, the amount of trigger movement that is applied to the movable anvil depends on the degree of triggering of the trigger. For example, if the surgeon wishes to obtain only partially formed staples, then the firing trigger is only partially pressed inwards in the pistol grip direction 107. To obtain more staple formation, the surgeon simply presses the firing trigger further, the which results in the anvil being driven further into forming contact with the clamps. As used herein, the term "contact forming" means that the staple forming surface or staple forming pockets contact the ends of the legs of the staples and begin to form or flex the legs into a formed position. The degree of cleat formation refers to the amount of bending suffered by the legs of the cleats and finally refers to the cleat formation height as mentioned above. Those of ordinary skill in the art will further understand that because the anvil 20 moves in a substantially parallel relationship with the staple cartridge as firing motions are applied thereto, the staples are formed substantially simultaneously. with substantially equal formed heights.

[00385] Figures 2 and 3 illustrate a 12" reciprocating end actuator that is similar to the 12' end actuator described above, with the exception of the following differences which are configured to accommodate a 172' knife bar. Knife bar 172' is coupled to or projects from a knife shank 180 and is otherwise operated in the manner described above with respect to knife bar 172. However, in that embodiment, knife bar 172' is long enough to span the entire length of the 12” end actuator and therefore a separate distal knife element is not employed on the 12” end actuator. Knife bar 172' has an upper cross member 173' and a lower cross member 175' formed thereon. Upper cross member 173' is oriented to slide through a corresponding elongated slot 250 in anvil 20" and lower cross member 175' is oriented to cross elongate slot 252 in elongate channel 14" of end actuator 12". A release slot (not shown) is also provided in the anvil 20" so that when the knife bar 172' is driven into an end position with the thin end actuator 12", the upper cross member 173' drops out. through the corresponding slot to allow the anvil 20” to move into the open position to disengage from the clamp and cut the tissue. Anvil 20" may otherwise be identical to anvil 20 described above and elongate groove 14" may otherwise be identical to elongate groove 14 described above.

[00386] In these embodiments, the anvil 20” is forced into a fully open position (figure 2) by a spring or other opening arrangement (not shown). The anvil 20" is moved between the open and fully tightened positions by axial displacement of the firing adapter 150 in the manner described above. When the trigger adapter 150 is advanced to the fully tightened position (Figure 3), the surgeon can then advance the knife bar 172" distally, in the manner described above. If the surgeon wishes to use the end actuator as a gripping device to manipulate tissue, the trigger adapter can be moved proximally to allow the anvil 20” to move away from the elongated channel 14”, as shown in Figure 4 in dashed lines. In this embodiment, when knife bar 172" moves distally, upper cross member 173' and lower cross member 175' pull the anvil 20" and elongated groove 14" together to obtain the desired staple formation when the 172” knife bar is advanced distally through the 12” end actuator. See Figure 5. Thus, in this embodiment, staple formation occurs simultaneously with tissue cutting, but staples can be formed sequentially as knife bar 172” is driven distally.

[00387] The unique and innovative features of the various surgical staple cartridges and surgical instruments of the present invention allow the staples in these cartridges to be arranged in one or more rows of linear or non-linear staples. A plurality of such rows of staples may be provided on each side of an elongate slot which is centrally arranged in the staple cartridge to receive the tissue cutting member therethrough. In one arrangement, for example, staples in one row may be substantially parallel to staples in adjacent rows of staples, but offset therefrom. As a further alternative, one or more rows of staples may be non-linear in nature. That is, the base of at least one staple in a row of staples may extend along an axis that is substantially transverse to the bases of other staples in the same row of staples. For example, the rows of staples on either side of the elongated slit may have a zigzag appearance.

[00388] In accordance with the invention, a staple cartridge may comprise a cartridge body and a plurality of staples stored in the cartridge body. In use, the staple cartridge can be introduced into a surgical site and positioned on one side of the tissue being treated. In addition, the staple forming anvil can be positioned on the opposite side of the fabric. The anvil may be carried by a first jaw and the staple cartridge may be carried by a second jaw, whereby the first jaw and/or the second jaw may be moved towards each other. After the staple cartridge and anvil are positioned relative to the tissue, the staples can be ejected from the staple cartridge body so that the staples can pierce the tissue and contact the staple forming anvil. After the staples are applied from the staple cartridge body, the staple cartridge body can then be removed from the surgical site. The staple cartridge, or at least a portion of a staple cartridge, can be deployed with the staples. For example, as described in more detail below, a staple cartridge may comprise a cartridge body that can be compressed, crushed and/or flattened by the anvil when the anvil is moved from an open position to a closed position. When the cartridge body is compressed, crushed and/or flattened, the clamps positioned in the cartridge body can be deformed by the anvil. Alternatively, the jaw supporting the staple cartridge can be moved towards the anvil to a closed position. In either case, the clips can be deformed while still at least partially positioned in the cartridge body. In some cases, staples may not be ejected from the staple cartridge while, in other cases, staples may be ejected from the staple cartridge along with a portion of the cartridge body.

[00389] Now referring to Figures 6A to 6D, a compressible staple cartridge, such as staple cartridge 1000, for example, may comprise an implantable compressible cartridge body 1010 and, in addition, a plurality of positioned staples 1020 in the body of the compressible cartridge 1010, although only one clip 1020 is shown in Figures 6A to 6D. Figure 6A illustrates the staple cartridge 1000 supported by a staple cartridge holder, or staple cartridge groove, 1030, with the staple cartridge 1000 being illustrated in an uncompressed condition. In such an uncompressed condition, the anvil 1040 may or may not be in contact with the tissue T. In use, the anvil 1040 can be moved from an open position in contact with the tissue T, as illustrated in Figure 6B, and position the tissue T against the cartridge body 1010. Although the anvil 1040 can position the tissue T against a tissue-contacting surface 1019 of the staple cartridge body 1010, again with reference to Figure 6B, the staple cartridge body 1010 can be subjected to little or no compressive force or pressure at such a point and the clamps 1020 may remain in an unformed or unfired condition. As illustrated in Figures 6A and 6B, the staple cartridge body 1010 may comprise one or more layers and the staple legs 1021 of the staples 1020 may extend upwardly through these layers. The cartridge body 1010 may comprise a first layer 1011, a second layer 1012, a third layer 1013, with the second layer 1012 being disposed in an intermediate position between the first layer 1011 and the third layer 1013, and a fourth layer 1014, wherein the third layer 1013 may be disposed in an intermediate position between the second layer 1012 and the fourth layer 1014. The bases 1022 of the clips 1020 may be positioned in recesses 1015 in the fourth layer 1014 and the legs of the clips 1021 may be extending upwards from bases 1022 and through fourth layer 1014, third layer 1013 and second layer 1012, for example. Optionally, each deformable leg 1021 may comprise a point, such as the sharp point 1023, for example, which can be positioned on the second layer 1012, for example, when the staple cartridge 1000 is in an uncompressed condition. For example, prongs 1023 may not extend into and/or through first layer 1011, prongs 1023 may not protrude through tissue-contacting surface 1019 when staple cartridge 1000 is in a poor condition. not compressed. The sharp points 1023 may be positioned on the third layer 1013, and/or any other suitable layer, when the staple cartridge is in an uncompressed condition. Alternatively, the body of a staple cartridge can have any suitable number of layers such as less than four layers or more than four layers, for example.

[00390] Optionally, as described in more detail below, the first layer 1011 may consist of a reinforcing material and/or plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example, and the second layer 1012 may consist of a bioabsorbable foam material and/or a compressible hemostatic material, such as oxidized regenerated cellulose (ORC), for example. Optionally, one or more of the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 may hold the staples 1020 in the staple cartridge body 1010 and further maintain the staples 1020 in alignment with each other. the others. The third layer 1013 may be comprised of a reinforcing material, or a reasonably incompressible or inelastic material, which may be configured to hold the clamp legs 1021 of the clamps 1020 in a position relative to one another. In addition, second layer 1012 and fourth layer 1014, which are positioned on opposite sides of third layer 1013, may stabilize, or reduce the movement of staples 1020 although second layer 1012 and fourth layer 1014 may be comprised of a material of compressible or elastic foam. The ends 1023 of the legs of the staples 1021 may be, at least partially, incorporated into the first layer 1011. For example, the first layer 1011 and the third layer 1013 may be configured to cooperatively and firmly hold the legs of the staples 1021 in position. First layer 1011 and third layer 1013 may each comprise a sheet of bioabsorbable plastic, such as polyglycolic acid (PGA), available under the tradename Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly - hydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the trade name Monocryl, polycaprolactone (PCL), and/or a compound of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example, and the second layer 1012 and fourth layer 1014 may each be comprised of at least one hemostatic material or agent.

[00391] While the first layer 1011 may be compressible, the second layer 1012 may be substantially more compressible than the first layer 1011. For example, the second layer 1012 may be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and/or about ten times as compressible, for example, as the first layer 1011. Said another way, the second layer 1012 can compress about twice , about three times, about four times, about five times, and/or about ten times more than the first layer 1011, for a given applied force. The second layer 1012 may be about twice as compressible and about ten times as compressible, for example, as the first layer 1011. The second layer 1012 may comprise a plurality of air voids defined therein, the The amount and/or size of the air voids in the second layer 1012 can be controlled to provide a desired compressibility of the second layer 1012. Similar to the above embodiment, while the third layer 1013 may be compressible, the fourth layer 1014 may be substantially more compressible than third layer 1013. For example, fourth layer 1014 can be about twice as compressible, about three times as compressible, about four times as compressible, about five times as compressible, and/or about ten times as compressible, for example, as the third layer 1013. Put another way, the fourth layer 1014 can compress about twice, about three times s, about four times, about five times, and/or about ten times more than the third layer 1013, for a given applied force. The fourth layer 1014 can be about twice as compressible and about ten times as compressible, for example, as the third layer 1013. The fourth layer 1014 can comprise a plurality of air voids defined therein, the The amount and/or size of the air voids in the fourth layer 1014 can be controlled to provide a desired compressibility of the fourth layer 1014. In various circumstances, the compressibility of a cartridge body, or cartridge body layer, can be expressed in terms of a compression ratio, that is, a distance over which a layer is compressed for a given amount of force. For example, a layer that has a high compression ratio will compress a greater distance for a given amount of compression force applied to the layer compared to a layer that has a lower compression ratio. That said, the second layer 1012 may have a higher compression ratio than the first layer 1011, and similarly, the fourth layer 1014 may have a higher compression ratio than the third layer 1013. The second layer 1012 and the fourth layer 1014 may be comprised of the same material and may comprise the same compression ratio. The second layer 1012 and the fourth layer 1014 may be comprised of materials that have different compression ratios. Similarly, the first layer 1011 and the third layer 1013 may be comprised of the same material and may comprise the same compression ratio. First layer 1011 and third layer 1013 may be comprised of materials having different compression ratios.

[00392] As the anvil 1040 is moved toward its closed position, the anvil 1040 can contact the tissue T and apply a compressive force to the tissue T and staple cartridge 1000, as illustrated in Figure 6C . In such circumstances, the anvil 1040 may force the top surface, or the tissue-contacting surface 1019, of the cartridge body 1010 down towards the staple cartridge holder 1030. The staple cartridge holder 1030 may comprise a cartridge supporting surface 1031 which can be configured to support the staple cartridge 1000 as the staple cartridge 1000 is compressed between the cartridge supporting surface 1031 and the tissue contacting surface 1041 of the anvil 1040. to the pressure applied by the anvil 1040, the cartridge body 1010 can be compressed and the anvil 1040 can contact the clamps 1020. More particularly, the compression of the cartridge body 1010 and the downward movement of the tissue contact surface 1019 can cause the tips 1023 of the legs of the staples 1021 to pierce the first layer 1011 of the cartridge body 1010, pierce the fabric T, and enter the forming pockets 1042 in the bigo 1040. As the cartridge body 1010 is further compressed by the anvil 1040, the prongs 1023 may contact the walls defining the forming pockets 1042 and, as a result, the legs 1021 may be deformed or bent inwardly, for example, as illustrated in Figure 6C. As the legs of the staples 1021 are deformed, as also illustrated in Figure 6C, the bases 1022 of the staples 1020 may contact or be supported by the staple cartridge holder 1030. Optionally, as described in more detail below, the staple cartridge holder 1030 may comprise a plurality of support features, such as grooves, slots or staple holder recesses 1032, for example, which may be configured to support the staples 1020, or at least the bases 1022 of the staples 1020 , as the clamps 1020 are deformed. As also illustrated in Figure 6C, the cavities 1015 in the fourth layer 1014 may flatten as a result of the compressive force applied to the staple cartridge body 1010. In addition to the cavities 1015, the staple cartridge body 1010 may additionally comprise one or more voids, such as voids 1016, for example, which may or may not comprise a portion of a clip positioned therein, which may be configured to allow the cartridge body 1010 to be flattened. Cavities 1015 and/or voids 1016 may be configured to flatten so that the walls defining the cavities and/or walls are deflected downwardly and contact the platform surface of the cartridge 1031 and/or contact a layer of the cartridge body 1010 positioned under the cavities and/or voids.

[00393] Comparing Figure 6B and Figure 6C, it is evident that the second layer 1012 and the fourth layer 1014 were substantially compressed by the compressive pressure applied by the anvil 1040. It can also be seen that the first layer 1011 and the third layer 1013 were also compressed. As the anvil 1040 is moved to its closed position, the anvil 1040 may continue to further compress the cartridge body 1010 by forcing the tissue-contacting surface 1019 down toward the staple cartridge holder 1030. cartridge body 1010 is further compressed, anvil 1040 can deform clamps 1020 into their fully formed shape, as illustrated in Figure 6D. Referring to Figure 6D, the legs 1021 of each staple 1020 may be deformed downwardly toward the base 1022 of each staple 1020 to capture at least a portion of the T fabric, of the first layer 1011, of the second layer 1012, of the third layer. 1013, and fourth layer 1014 between deformable legs 1021 and base 1022. Comparing Figures 6C and 6D, it is further evident that second layer 1012 and fourth layer 1014 were substantially further compressed by the compressive pressure applied by the anvil 1040. It can also be seen after comparing Figures 6C and 6D that the first layer 1011 and the third layer 1013 were also further compressed. After the staples 1020 are completely, or at least sufficiently, formed, the anvil 1040 can be lifted away from the tissue T and the staple cartridge holder 1030 can be removed from, and/or detached from, the staple cartridge 1000. shown in Figure 6D, and as a result of the foregoing, cartridge body 1010 can be implanted with staples 1020. In various circumstances, implanted cartridge body 1010 can support tissue along the row of staples. In some circumstances, a hemostatic agent and/or any other suitable therapeutic drug contained in the implanted cartridge body 1010 can treat tissue over time. A hemostatic agent, as mentioned above, can reduce the bleeding of stapled and/or cut tissue while a binding agent or tissue adhesive can provide strength to the tissue over time. The 1010 implanted cartridge body can consist of materials such as ORC (oxidized regenerated cellulose), extracellular proteins such as collagen, polyglycolic acid (PGA), available under the tradename Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly - hydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the tradename Monocryl, polycaprolactone (PCL), and/or a compound of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. In certain circumstances, the cartridge body 1010 may comprise an antibiotic and/or antimicrobial material, such as colloidal silver and/or triclosan, for example, which may reduce the possibility of infection at the surgical site.

[00394] The 1010 cartridge body layers can be connected to each other. Second layer 1012 can be adhered to first layer 1011, third layer 1013 can be adhered to second layer 1012 and fourth layer 1014 can be adhered to third layer 1013 using at least one adhesive such as fibrin and/or hydrogel of protein, for example. Although this is not illustrated, the layers of the cartridge body 1010 can be connected together by means of a mechanical interlock. For example, the first layer 1011 and the second layer 1012 may each comprise corresponding interlocking features, such as a tongue and groove arrangement and/or a mortise joint arrangement, for example. Similarly, second layer 1012 and third layer 1013 may each comprise corresponding interlocking features, while third layer 1013 and fourth layer 1014 may each comprise corresponding interlocking features. Although not illustrated, staple cartridge 1000 may comprise one or more rivets, for example, which may extend through one or more layers of cartridge body 1010. For example, each rivet may comprise a first end, or head. , positioned adjacent the first layer 1011 and a second head positioned adjacent the fourth layer 1014 which may be mounted on or formed by a second end of the rivet. Due to the compressible nature of the cartridge body 1010, the rivets may compress the cartridge body 1010 so that the rivet heads can be recessed relative to the fabric contacting surface 1019 and/or the bottom surface 1018 of the cartridge body. 1010 cartridge, for example. For example, rivets may consist of a bioabsorbable material such as polyglycolic acid (PGA), available under the tradename Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the tradename Monocryl, polycaprolactone (PCL), and/or a compound of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. The layers of the cartridge body 1010 may not be connected to each other, apart from clips 1020 contained therein. For example, frictional engagement between the legs of the clamps 1021 and the cartridge body 1010, for example, can hold the layers of the cartridge body 1010 together, and after the clamps are formed, the layers can be captured in the clamps 1020. At least a portion of the legs of the clamps 1021 may comprise a roughened surface or a rough coating which can increase the frictional forces between the clamps 1020 and the cartridge body 1010.

[00395] As described above, a surgical instrument may comprise a first jaw that includes the staple cartridge holder 1030 and a second jaw that includes the anvil 1040. Optionally, as described in more detail below, the staple cartridge 1000 may comprising one or more retaining features that can be configured to engage the staple cartridge holder 1030 and, as a result, releasably retain the staple cartridge 1000 in the staple cartridge holder 1030. The staple cartridge 1000 is clampable to the staple cartridge holder 1030 by at least one adhesive, such as fibrin and/or protein hydrogel, for example. In use, in at least one circumstance, specifically in laparoscopic and/or endoscopic surgery, the second jaw can be moved to a closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through a trocar in a surgical site. For example, the trocar may define an opening, or cannula, of approximately 5 mm, through which the first and second jaws can be inserted. The second jaw can be moved into a partially closed position intermediate between the open position and the closed position which can allow the first and second jaws to be inserted through the trocar without deforming the staples 1020 contained in the staple cartridge body 1010. For example, the anvil 1040 may not apply a compressive force to the staple cartridge body 1010 when the second jaw is in its partially closed intermediate position while the anvil 1040 may compress the staple cartridge body 1010 when the second jaw is in its partially closed intermediate position. Although the anvil 1040 may compress the staple cartridge body 1010 when in such an intermediate position, the anvil 1040 may not sufficiently compress the staple cartridge body 1010 such that the anvil 1040 contacts the staples 1020 and/or or so that staples 1020 are deformed by anvil 1040. After the first and second jaws are inserted through the trocar into the surgical site, the second jaw can be opened again and the anvil 1040 and staple cartridge 1000 can be be positioned relative to the target tissue as described above.

[00396] Now referring to Figures 7A to 7D, an end actuator of a surgical stapler may comprise an implantable staple cartridge 1100 placed in an intermediate position between an anvil 1140 and a staple cartridge holder 1130. similar to the above embodiment, the anvil 1140 may comprise a tissue-contacting surface 1141, the staple cartridge 1100 may comprise a tissue-contacting surface 1119, and the staple cartridge holder 1130 may comprise a platform surface 1131 which can be configured to support the staple cartridge 1100. Referring to Figure 7A, the anvil 1140 can be used to position the fabric T against the tissue contacting surface 1119 of the staple cartridge 1100 without deforming the staple cartridge 1100 and , when the anvil 1140 is in such a position, the tissue contacting surface 1141 may be positioned a distance 1101a from the cartridge supporting surface d and staples 1131 and the tissue contacting surface 1119 can be positioned a distance 1102a from the staple cartridge support surface 1131. Thereafter, as the anvil 1140 is moved towards the staple cartridge support 1130, now with reference to Figure 7B, the anvil 1140 can force the top surface, or the tissue-contacting surface 1119, of the staple cartridge 1100 downwards and compress the first layer 1111 and the second layer 1112 of the cartridge body 1110. As layers 1111 and 1112 are compressed, again with reference to Figure 7B, second layer 1112 can be crushed and legs 1121 of staples 1120 can pierce first layer 1111 and enter fabric T. clips 1120 may be at least partially positioned in clip cavities, or voids, 1115 in second layer 1112, and when second layer 1112 is compressed, clip cavities 1115 may flatten and, as a result, become flat. allow the second layer 1112 to be flattened around the staples 1120. The second layer 1112 may comprise covering portions 1116 which can extend over the staple cavities 1115 and enclose, or at least partially enclose, the staple cavities 1115. Figure 7B illustrates cover portions 1116 being crushed down into staple cavities 1115. Second layer 1112 may comprise one or more weakened portions which may facilitate flattening of second layer 1112. Optionally, such weakened portions may comprise markings, perforations and/or thin cross-sections, for example, which may facilitate a controlled flattening of the cartridge body 1110. The first layer 1111 may comprise one or more weakened portions which may facilitate penetration of the legs of the staples 1121 through the first layer 1111. Optionally, these weakened portions may comprise markings, perforations and/or cross sections. thin salts, for example, which may be aligned, or at least substantially aligned, with the legs of the clamps 1121.

[00397] When the anvil 1140 is in a partially closed unfired position, again with reference to Figure 7A, the anvil 1140 may be positioned a distance 1101a from the support surface of the cartridge 1131 so that a gap is defined in that region. This gap can be filled by the staple cartridge 1100, which has a height of the staple cartridge 1102a, and the fabric T. As the anvil 1140 is moved downward to compress the staple cartridge 1100, again with reference to Figure 7B , the distance between the fabric contact surface 1141 and the cartridge support surface 1131 can be defined by a distance 1101b which is shorter than the distance 1101a. In various circumstances, the gap between the tissue-contacting surface 1141 of the anvil 1140 and the platform surface of the cartridge 1131, defined by the distance 1101b, may be greater than the original, undeformed height of the staple cartridge 1102a. As the anvil 1140 is moved closer to the cartridge support surface 1131, now referring to Figure 7C, the second layer 1112 can continue to be flattened and the distance between the legs of the clamps 1121 and the forming pockets 1142 can decrease. Similarly, the distance between the tissue-contacting surface 1141 and the platform surface of the cartridge 1131 may decrease to a distance 1101c which may be greater than, equal to, or less than the original, undeformed height of the cartridge 1102a. . Referring now to Figure 7D, the anvil 1140 can be moved to a final firing position in which the clamps 1120 have been fully formed, or at least formed to a desired height. In this position, the tissue-contacting surface 1141 of the anvil 1140 may be a distance 1101d from the platform surface of the cartridge 1131, with the distance 1101d being shorter than the original, undeformed height of the cartridge 1102a. As also illustrated in Figure 7D, clamp cavities 1115 may be completely, or at least substantially, flattened, and clamps 1120 may be completely, or at least substantially, surrounded by second flattened layer 1112. In various circumstances, anvil 1140 may be completely, or at least substantially, surrounded by flattened second layer 1112. thereafter be moved away from the staple cartridge 1100. After the anvil 1140 is disengaged from the staple cartridge 1100, the cartridge body 1110 can at least partially re-expand at various locations, i.e., intermediate locations of adjacent staples 1120 , for example. The crushed cartridge body 1110 may not resiliently re-expand. The formed clips 1120 and, in addition, the cartridge body clips 1110 placed in an adjacent intermediate position 1120 may apply pressure, or compressive forces, to the tissue T, which may provide various therapeutic benefits.

[00398] As discussed earlier, again with reference to Figure 7A, each clip 1120 may comprise clip legs 1121 extending therefrom. While staples 1120 are shown as comprising two staple legs 1121, multiple staples may be used which may comprise one staple leg or, alternatively, more than two staple legs, such as three staple legs or four staple legs, for example . As illustrated in Figure 7A, each clamp leg 1121 can be incorporated into the second layer 1112 of the cartridge body 1110 so that the clamps 1120 are secured to the second layer 1112. The clamps 1120 can be inserted into the clamp cavities 1115 in the cartridge body. cartridge 1110 so that the prongs 1123 of the legs of the clamps 1121 enter the cavities 1115 before the bases 1122. After the prongs 1123 are inserted into the cavities 1115, the prongs 1123 can be pressed against the cover portions 1116 and cut the second layer 1112. Clips 1120 may be seated deep enough in second layer 1112 so that clips 1120 do not move, or at least substantially move, relative to second layer 1112. Clips 1120 may be seated deep enough in the second layer 1112 so that the bases 1122 are positioned or incorporated into the staple cavities 1115. Alternatively, the bases 1122 may not be positioned. or incorporated into the second layer 1112. Again referring to Figure 7A, the bases 1122 may extend below the bottom surface 1118 of the cartridge body 1110. The bases 1122 may rest on, or may be positioned directly against, the surface of cartridge platform 1130. Cartridge platform surface 1130 may comprise support features extending therefrom and/or defined therein whereby, for example, bases 1122 of clamps 1120 may be positioned on and supported by one or more support grooves, slots or recesses 1132, for example in the staple cartridge holder 1130, as described in more detail below.

[00399] Now referring to Figures 8 and 9, a staple cartridge, such as staple cartridge 1200, for example, may comprise a compressible implantable cartridge body 1210 comprising an outer layer 1211 and an inner layer 1212. similar to the above embodiment, staple cartridge 1200 may comprise a plurality of staples 1220 positioned in cartridge body 1210. Optionally, each staple 1220 may comprise a base 1222 and one or more staple legs 1221 extending therefrom. For example, the legs of the staples 1221 may be inserted into the inner layer 1212 and seated at a depth at which the bases 1222 of the staples 1220 are bordering and/or disposed adjacent to the bottom surface 1218 of the inner layer 1212. , for example. In Figures 8 and 9, inner layer 1212 does not comprise staple cavities configured to receive a portion of staples 1220 while, alternatively, inner layer 1212 may comprise such staple cavities. In addition to the above, the inner layer 1212 may consist of a compressible material, such as bioabsorbable foam and/or oxidized regenerated cellulose (ORC), for example, which may be configured to allow the cartridge body 1210 to be flattened when a compressive load is applied to it. The inner layer 1212 may consist of a lyophilized foam comprising polylactic acid (PLA) and/or polyglycolic acid (PGA), for example. The ORC may be commercially available under the tradename Surgicel and may comprise a loose woven cloth (such as a surgical sponge), loose fibers (such as a cotton ball), and/or a foam. The inner layer 1212 may consist of a material that includes drugs, such as freeze-dried thrombin and/or fibrin, for example, contained therein and/or coated over the layer, which may be activated by water and/or activated by fluids in the body. patient, for example. For example, freeze-dried thrombin and/or fibrin can be maintained in a Vicryl matrix (PGA), for example. In certain circumstances, however, activatable drugs may be unintentionally activated when the staple cartridge 1200 is inserted into a surgical site on the patient, for example. Referring again to Figures 8 and 9, the outer layer 1211 may consist of a material impermeable, or at least substantially impermeable, to water and water, so that liquids do not come into contact with, or at least substantially contact with, the surface. inner layer 1212 until the cartridge body 1210 has been compressed and the legs of the staples have penetrated the outer layer 1211 and/or until the outer layer 1211 has been cut in some way. The outer layer 1211 may consist of a reinforcing material and/or plastic material, such as polydioxanone (PDS) and/or polyglycolic acid (PGA), for example. Outer layer 1211 may comprise a wrapper that surrounds inner layer 1212 and clips 1220. More particularly, clips 1220 may be inserted into inner layer 1212 and outer layer 1211 may be wrapped around the subassembly comprising inner layer 1212 and clamps 1220 and then sealed.

[00400] As described herein, the staples of a staple cartridge may be formed entirely by an anvil when the anvil is moved to a closed position. Alternatively, now referring to Figures 10 to 13, the staples of a staple cartridge, such as the staple cartridge 4100, for example, can be deformed by an anvil when the anvil is moved to a closed position and, additionally, by a clamp drive system that moves the clamps towards the closed anvil. The staple cartridge 4100 may comprise a compressible body 4110 which may consist of a foam material, for example, and a plurality of staples 4120 positioned, at least partially, on the compressible body 4110. The staple drive system may comprise a actuators 4160, a plurality of staple drivers 4162 positioned on driver holders 4160, and a staple cartridge housing 4180 that can be configured to retain staple drivers 4162 in driver holder 4160. For example, drivers of staples 4162 may be positioned in one or more slots 4163 in the driver support 4160, so that the side walls of the slots 4163 can help guide the staple drivers 4162 upward toward the anvil. Clamps 4120 can be held in slots 4163 by clamp drivers 4162, with clamps 4120 being fully positioned in slots 4163 when clamps 4120 and clamp drivers 4162 are in the unfired position. Alternatively, at least a portion of the clamps 4120 may extend upwardly through the open ends 4161 of the slots 4163 when the clamps 4120 and the clamp drivers 4162 are in the unfired position. For example, now referring primarily to Figure 11, the bases of the clamps 4120 may be positioned on the actuator support 4160 and the tips of the clamps 4120 may be immersed in the compressible body 4110. Approximately one third of the height of the clamps 4120 may be positioned in the driver holder 4160 and approximately two-thirds of the height of staples 4120 may be positioned on cartridge body 4110. Referring to Figure 10A, staple cartridge 4100 may additionally comprise a wrapper or a water impermeable membrane 4111 surrounding the body cartridge 4110 and driver support 4160, for example.

[00401] In use, the staple cartridge 4100 can be placed in a staple cartridge groove, for example, and the anvil can be moved towards the staple cartridge 4100 to a closed position. The anvil may contact and compress the compressible body 4110 when the anvil is moved to its closed position. The anvil may not contact the 4120 clamps when it is in the closed position. The anvil may contact the legs of the clamps 4120 and at least partially deform the clamps 4120 when the anvil is moved to the closed position. In any of these cases, the staple cartridge 4100 may additionally comprise one or more sliders 4170 that can be advanced longitudinally on the staple cartridge 4100 so that the sliders 4170 can sequentially engage the staple drivers 4162 and move the staple drivers 4162. clamps 4162 and clamps 4120 towards the anvil. Sliders 4170 can slide between staple cartridge compartment 4180 and staple drivers 4162. When closing the anvil has initiated the process of forming staples 4120, the upward movement of staples 4120 toward the anvil can complete the forming process and deforming the clamps 4120 to their fully formed, or at least desired, height. When closing the anvil has not deformed the clamps 4120, upward movement of the clamps 4120 towards the anvil can initiate and complete the forming process and deform the clamps 4120 to their fully formed, or at least desired, height. Sliders 4170 can be advanced from a proximal end of the staple cartridge 4100 to a distal end of the staple cartridge 4100 so that the staples 4120 positioned at the proximal end of the staple cartridge 4100 are formed completely before the staples 4120 positioned at the distal end of the staple cartridge 4100 are fully formed. Referring to Figure 12, the sliders 4170 may each comprise at least one angled or sloped surface 4711 that can be configured to slide under the staple drivers 4162 and lift the staple drivers 4162 as illustrated in Figure 13 .

[00402] In addition to the above description, the staples 4120 may be formed to capture at least a portion of the T-tissue and at least a portion of the compressible body 4110 of the staple cartridge 4100. After the staples 4120 are formed, the anvil and staple cartridge channel 4130 of the surgical stapler may be spaced away from the implanted staple cartridge 4100. In various circumstances, the cartridge housing 4180 may be fixedly engaged with the staple cartridge channel 4130 so that, as a result, the cartridge housing 4180 can be separated from compressible body 4110 as staple cartridge groove 4130 is spaced away from implanted cartridge body 4110. Referring again to Figure 10, cartridge housing 4180 may comprise opposing side walls 4181 between which cartridge body 4110 may be removably positioned. For example, the compressible cartridge body 4110 can be compressed between the side walls 4181 so that the cartridge body 4110 can be removably retained in that region during use and releasably disengaged from the cartridge housing 4180 as the 4180 cartridge compartment is removed. For example, the Trigger Holder 4160 can be attached to the Cartridge Slot 4180 so that the Trigger Holder 4160, Triggers 4162, and/or Sliders 4170 can remain in Cartridge Slot 4180 when Cartridge Slot 4180 is closed. removed from the surgical site. The 4162 Triggers can be ejected from the 4160 Trigger Holder and left in the surgical site. For example, 4162 triggers can be comprised of a bioabsorbable material such as polyglycolic acid (PGA), available under the tradename Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the tradename Monocryl, polycaprolactone (PCL), and/or a compound of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. Drivers 4162 may be attached to clamps 4120 such that drivers 4162 are deployed with clamps 4120. For example, each driver 4162 may comprise a recess configured to receive the bases of clamps 4120, for example, the recesses being can be configured to hold clamp bases by snap and/or snap-in.

[00403] In addition to the above, driver holder 4160 and/or sliders 4170 can be ejected from cartridge compartment 4180. For example, sliders 4170 can slide between cartridge housing 4180 and driver holder. sliders 4160 so that as sliders 4170 are advanced to drive staple drivers 4162 and staple drivers 4120 upward, sliders 4170 can also move driver support 4160 up and out of cartridge compartment 4180. For example, the 4160 Driver Holder and/or the 4170 Slider may consist of a bioabsorbable material such as polyglycolic acid (PGA), available under the tradename Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), available under the tradename Monocryl, polycaprolactone (PCL), and/or a compound of PGA, PLA, PDS, PHA, PGCL and/or PCL, for example. Sliders 4170 may be integrally formed and/or attached to a drive bar, or cutting member, which pushes slides 4170 through staple cartridge 4100. In such cases, slides 4170 may not be ejected from cartridge housing 4180. and may remain with the surgical stapler whereas, in other cases where the slides 4170 are not attached to the drive bar, the slides 4170 may be left in the surgical site. In any case, in addition to the above, the compressibility of the cartridge body 4110 may allow the use of thicker staple cartridges in the end actuator of a surgical stapler, since the cartridge body 4110 may compress, or retract. , when the stapler anvil is closed. As a result of at least partial deformation of the staples upon closing the anvil, taller staples could be used, such as staples that have a height of approximately 4.6 mm (0.18 inches), for example, with a height of approximately 3.0 mm (0.12 inches) from the height of the clip may be positioned on the compressible layer 4110 and wherein the compressible layer 4110 may have an uncompressed height of approximately 3.6 mm (0.14 inches). inch), for example.

[00404] As described herein, a staple cartridge may comprise a plurality of staples therein. Optionally, such staples may consist of a metal wire deformed into a substantially U-shaped configuration having two staple legs. Alternatives are envisaged in which the clips may comprise different configurations such as two or more strands which have been joined together and having three or more clip legs. The yarn or yarns used to form the staples may comprise a round, or at least substantially round, cross-section. The staple wires may comprise any other suitable cross-section, such as square and/or rectangular cross-sections, for example. Staples may consist of plastic threads. Staples may consist of plastic coated metal wires. In accordance with the invention, a cartridge may comprise any suitable type of fastener in addition to or in place of staples. For example, such a fastener may comprise pivoting arms which are bent when engaged by an anvil. Two-piece fasteners could be used. For example, a staple cartridge may comprise a plurality of first fastener portions and an anvil may comprise a plurality of second fastener portions which are connected to the first fastener portions when the anvil is pressed against the staple cartridge. As described above, a slider or driver can be advanced into a staple cartridge to complete the staple forming process. A slider or driver may be advanced within an anvil to move downwardly one or more forming elements in engagement with the staple cartridge and the opposing staples, or fasteners, positioned therein.

[00405] A staple cartridge may comprise four rows of staples stored therein. The four rows of staples can be arranged into two rows of inner staples and two rows of outer staples. For example, an inner row of staples and an outer row of staples can be positioned on a first side of a cutting member, or knife, slot in the staple cartridge, and similarly, an inner row of staples and a row of Outer clips can be positioned on a second side of the slit, cutting limb, or knife. A staple cartridge may not comprise a cutting member slot; however, such a staple cartridge may comprise a designated portion configured to be cut by a cutting member instead of a staple cartridge slot. The rows of inner staples may be arranged on the staple cartridge so that they are equally, or at least substantially equally, spaced from the cutting member slot. Similarly, rows of outer staples may be arranged on the staple cartridge so that they are equally, or at least substantially equally, spaced from the cutting member slot. In accordance with the invention, a staple cartridge may comprise more or less than four rows of staples. A staple cartridge may comprise six rows of staples. For example, the staple cartridge may comprise three rows of staples on a first side of a cutting member slot and three rows of staples on a second side of the cutting member slot. A staple cartridge may comprise an odd number of rows of staples. For example, a staple cartridge may comprise two rows of staples on a first side of a cutting member slot and three rows of staples on a second side of the cutting member slot. The rows of staples may comprise staples that have the same, or at least substantially the same, unformed staple height. Alternatively, one or more of the rows of staples may comprise staples that have an unformed staple height different from the height of other staples. For example, clips on a first side of a cutting member slot may have a first unformed height and clips on a second side of a cutting member slot may have a second unformed height which is different from the first height, for example example.

[00406] Optionally, as described above, a staple cartridge may comprise a cartridge body that includes a plurality of staple cavities defined therein. The cartridge body may comprise a support and an upper support surface, where each staple cavity may define an opening in the support surface. As also described above, a staple can be positioned within each staple cavity so that the staples are stored within the cartridge body until they are ejected. Prior to being ejected from the cartridge body, the staples may be contained with the cartridge body so that the staples do not protrude above the platform surface. When the staples are positioned below the platform surface, in such cases the possibility of the staples becoming damaged and/or prematurely contacting the target tissue can be reduced. In various circumstances, clips can be moved between an unfired position in which they do not protrude from the cartridge body and a fired position in which they emerge from the cartridge body and can contact an anvil positioned opposite the cartridge. of staples. The anvil and/or forming pockets defined within the anvil may be positioned a predetermined distance above the platform surface so that when the staples are being dispensed from the cartridge body they are deformed to a predetermined formed height. In some cases, the thickness of tissue captured between the anvil and staple cartridge may vary and as a result, thicker tissue may be captured within certain staples while thinner tissue may be captured within certain other staples. . In any case, the pinching pressure, or force, applied to the tissue by the staples may vary from staple to staple or can vary between a staple at one end of a row of staples and a staple at the other end of the row of staples, for example. . Under certain circumstances, the gap between the anvil and the staple cartridge holder can be controlled so that the staples apply a certain minimum pinch pressure within each staple. In some such circumstances, however, there may still be significant variation in pinch pressure within different clamps. Similar surgical stapling instruments are disclosed in US Patent No. 7,380,696, which was issued June 3, 2008, the disclosure of which is incorporated herein by reference. An illustrative multi-course handle for the surgical stapling and cutting instrument is described in greater detail in the co-pending US patent application by the same holder entitled SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM, Serial No. 10/374,026), the contents of which are incorporated herein by reference in their entirety. Other applications compatible with the present invention may incorporate a single firing stroke, as described in the co-pending and co-pending US patent application SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, Serial No. 10/441,632), the contents of which are is incorporated herein by reference in its entirety.

[00407] As described herein, a staple cartridge may comprise means for compensating for the thickness of tissue captured within staples dispensed from the staple cartridge. Referring to Figure 14, a staple cartridge, such as the staple cartridge 10000, for example, may include a rigid first portion, such as the support portion 10010, for example, and a second compressible portion, such as the 10020 fabric, for example. Referring primarily to Figure 16, the support portion 10010 may comprise a cartridge body, an upper platform surface 10011, and a plurality of staple cavities 10012 wherein, similarly to the above, each staple cavity 10012 may define an opening in platform surface 10011. A clip 10030, for example, may be removably positioned in each clip cavity 10012. For example, each clip 10030 may comprise a base 10031 and one or more legs 10032 extending therefrom. starting from base 10031. Before staples 10030 are dispensed, as also described in more detail below, bases 10031 of staples 10030 may be supported by staple drivers positioned within support portion 10010 and, simultaneously, legs 10032 of the clips 10030 may be at least partially contained within the clip cavities 10012. The clips 10030 may be dispensed between a non-dispensing position. separated and a fired position such that legs 10032 move through fabric thickness compensator 10020, penetrate through a top surface of fabric thickness compensator 10020, penetrate fabric T, and contact an anvil positioned opposite the staple cartridge 10000. When the legs 10032 are deformed against the anvil, the legs 10032 of each staple 10030 can capture a portion of the fabric thickness compensator 10020 and a portion of the fabric T within each staple. 10030 and apply a compressive force to the fabric. In addition to the above, the legs 10032 of each staple 10030 can be deformed downwardly towards the base 10031 of the staple to form a staple gripping area 10039 in which the fabric T and the fabric thickness compensator 10020 can be captured. In various circumstances, the clamp gripping area 10039 can be defined between the inner surfaces of the deformed legs 10032 and the inner surface of the base 10031. The size of the gripping area for a staple can depend on various factors, such as the length of the legs. , the diameter of the legs, the width of the base, and/or the extent to which the legs are deformed, for example.

[00408] In the past, it was often necessary for the surgeon to select the proper staples with the proper staple height for the tissue being stapled. For example, a surgeon might select tall staples for use with thick tissue and short staples for use with thin tissue. In some circumstances, however, the fabric being stapled did not have a consistent thickness, and therefore some staples were unable to achieve the desired fired configuration. For example, Figure 48 illustrates a high staple used in thin fabric. Referring now to Figure 49, when a fabric thickness compensator, such as the fabric thickness compensator 10020, for example, is used with thin fabric, for example, the larger staple can be formed to a desired fired configuration.

[00409] Due to the compressibility of the fabric thickness compensator, the fabric thickness compensator can compensate for the thickness of the fabric captured within each staple. More particularly, now referring to Figures 43 and 44, a fabric thickness compensator, such as the fabric thickness compensator 10020, for example, may consume larger and/or smaller portions of the staple gripping area 10039 of each staple 10030 depending on the thickness and/or type of fabric contained within the staple gripping area 10039. For example, if thinner tissue T is captured within a staple 10030, the fabric thickness compensator 10020 may consume a larger portion of the area 10039 staple trapping compared to cases where thicker tissue T is captured inside the 10030 staple. Correspondingly, if thicker tissue T is captured inside a 10030 staple, the tissue thickness compensator 10020 may consume a smaller portion of the staple entrapment area 10039 compared to cases where thinner tissue T is captured within the staple 10030. In this way, the thickness compensator of t Fabric can compensate for thinner fabric and/or thicker fabric and ensure that compressive pressure is applied to the fabric independently, or at least substantially independent, of the thickness of the fabric captured within the staples. In addition to the above, the fabric thickness compensator 10020 can compensate for different types, or compressibilities of fabrics captured within different staples 10030. Now, referring to Figure 44, the fabric thickness compensator 10020 can apply a compressive force to vascular tissue T which may include vessels V and, as a result, restrict blood flow through less compressible vessels V, while also applying a desired compressive pressure to surrounding tissue T. In various circumstances , in addition to the above, the fabric thickness compensator 10020 can also compensate for malformed staples. Referring to Figure 45, malformation of multiple staples 10030 can result in larger staple entrapment areas 10039 being defined within such staples. Due to the resilience of the fabric thickness compensator 10020, now referring to Figure 46, the fabric thickness compensator 10020 positioned within malformed staples 10030 can still apply sufficient compressive pressure to the fabric T even though the staple entrapment areas 10039 defined within such malformed clamps 10030 can be enlarged. In various circumstances, the fabric thickness compensator 10020 located between adjacent staples 10030 may be pulled against the fabric T by appropriately formed staples 10030 surrounding a malformed staple 10030 and, as a result, apply compressive pressure to the surrounding tissue and/or or captured within the malformed clamp 10030, for example. In various circumstances, a tissue thickness compensator can compensate for different tissue densities that may arise due to calcifications, fibrous areas, and/or tissue that has been previously stapled or treated, for example.

[00410] In accordance with the invention, a fixed, or immutable, tissue gap can be defined between the support portion and the anvil and, as a result, the staples can be deformed to a predetermined height regardless of the thickness of the tissue captured within. of the staples. When a tissue thickness compensator is used in such cases, the tissue thickness compensator can adapt to the tissue captured between the anvil and staple cartridge of the support portion and, due to the resilience of the tissue thickness compensator, the Fabric thickness compensator can apply additional compressive pressure to the fabric. Now referring to Figures 50 to 55, a staple 10030 has been formed to a predefined height H. Referring to Figure 50, a fabric thickness compensator has not been used and the fabric T consumes the entire staple gripping area 10039 Referring to Figure 57, a portion of a fabric thickness compensator 10020 was captured within a staple 10030, compressed the fabric T, and consumed at least a portion of the staple gripping area 10039. Now referring to Figure 52, thin tissue T has been captured within the clamp 10030. In this embodiment, the compressed tissue T has a height of approximately 2/9H and the compressed tissue thickness compensator 10020 has a height of approximately 7/9H, for example. Referring now to Figure 53, fabric T with an intermediate thickness has been captured within the clamp 10030. In this embodiment, the compressed fabric T has a height of approximately 4/9H and the compressed fabric thickness compensator 10020 has a height of approximately 5/9H, for example. Referring now to Figure 54, fabric T with an intermediate thickness has been captured within the clamp 10030. In this embodiment, the compressed fabric T has a height of approximately 2/3H and the compressed fabric thickness compensator 10020 has a height of approximately 1/3H, for example. Referring now to Figure 53, thick tissue T has been captured within the staple 10030. In this embodiment, the compressed tissue T has a height of approximately 8/9H and the compressed tissue thickness compensator 10020 has a height of approximately 1/9H, for example. In various circumstances, the fabric thickness compensator may comprise a compressed height comprising approximately 10% of the staple gripping height, approximately 20% of the staple gripping height, approximately 30% of the staple gripping height, approximately 40% of the staple gripping height, approximately 50% of the staple gripping height, approximately 60% of the staple gripping height, approximately 70% of the staple gripping height, approximately 80% of the staple gripping height, and /or approximately 90% of the clamp grip height, for example.

[00411] Clamps 10030 may comprise any suitable unformed height. Clips 10030 may comprise an unformed height of between approximately 2 mm and approximately 4.8 mm, for example. Clips 10030 may comprise an unformed height of approximately 2.0 mm, approximately 2.5 mm, approximately 3.0 mm, approximately 3.4 mm, approximately 3.5 mm, approximately 3.8 mm, approximately 4.0 mm. mm, approximately 4.1 mm, and/or approximately 4.8 mm, for example. The height H at which the clamps can be deformed can be determined by the distance between the platform surface 10011 of the support portion 10010 and the opposing anvil. The distance between the platform surface 10011 and the tissue contacting surface of the anvil can be approximately 2.5 mm (0.097”), for example. Height H can also be determined by the depth of formation pockets defined inside the anvil. Formation pockets can have a depth measured from the fabric contact surface, for example. Optionally, as described in more detail below, the staple cartridge 10000 may further comprise staple drivers which can lift the staples 10030 toward the anvil and lift, or "excessively move", the staples above the platform surface 10011. In such cases , the height H at which clips 10030 are formed can also be determined by the distance at which clips 10030 are excessively directed. For example, clamps 10030 can be further moved by approximately 0.71 mm (0.028”), for example, and can result in clamps 10030 being formed to a height of approximately 4.80 mm (0.189”), for example. Clips 10030 can be formed to a height of approximately 0.8mm, approximately 1.0mm, approximately 1.5mm, approximately 1.8mm, approximately 2.0mm, and/or approximately 2.25mm , for example. Clips can be formed to a height between approximately 2.25 mm and approximately 3.0 mm, for example. In addition to the above, the height of the staple gripping area of a staple can be determined by the formed height of the staple and the width, or diameter, of the wire comprising the staple. The height of the staple gripping area 10039 of a staple 10030 may comprise the formed height H of the staple minus two wire diameter widths. The staple wire may comprise a diameter of approximately 0.2261 mm (0.0089"), for example. The staple wire may comprise a diameter between approximately 0.1753 mm (0.0069") and approximately 0.3023 mm (0.0119"), for example. For example, the shaped height H of a 10030 clamp can be approximately 4.80 mm (0.189”) and the wire diameter of the clamp can be approximately 0.23 mm (0.0089”) resulting in a clamping height clamp length of approximately 4.34 mm (0.171”), for example.

[00412] In addition to the above, the fabric thickness compensator may comprise an uncompressed, or pre-dispensed height, and may be configured to deform to one of a plurality of compressed heights. The fabric thickness compensator may comprise an uncompressed height of approximately 3.18 mm (0.125"), for example. The fabric thickness compensator may comprise an uncompressed height greater than or equal to approximately 2.032 mm (0.080"), for example. The fabric thickness compensator may comprise an uncompressed, or pre-released height, which is greater than the unfired height of the staples. The uncompressed, or pre-dispensed, height of the fabric thickness compensator can be approximately 10% higher, approximately 20% higher, approximately 40% higher, approximately 60% higher, approximately 80% higher, approximately 30% higher, approximately 50% higher, approximately 70% higher, approximately 90% higher, and/or approximately 100% higher than the non-triggered height of the clamps, for example. The uncompressed, or pre-dispensed, height of the fabric thickness compensator can be up to approximately 100% higher than the unfired height of the staples, for example. The uncompressed, or pre-released height of the fabric thickness compensator can be more than 100% higher than the unfired height of the staples, for example. The fabric thickness compensator may comprise an uncompressed height which is equal to the unfired height of the staples. The fabric thickness compensator may comprise an uncompressed height that is less than the unfired height of the staples. The uncompressed, or pre-released, thickness compensator height can be approximately 10% shorter, approximately 20% shorter, approximately 30% shorter, approximately 40% shorter, approximately 50% shorter, approximately 60% shorter , approximately 70% shorter, approximately 80% shorter, and/or approximately 90% shorter than the unfired height of the staples, for example. The second compressible portion may comprise an uncompressed height which is higher than an uncompressed height of the fabric T being stapled. The fabric thickness compensator may comprise an uncompressed height which is equal to an uncompressed height of the fabric T being stapled. The fabric thickness compensator may comprise an uncompressed height that is shorter than an uncompressed height of the fabric T being stapled.

[00413] As described above, a fabric thickness compensator can be compressed within a plurality of formed staples, regardless of whether thick tissue or thin tissue is captured within the staples. For example, staples within a row, or row, of staples can be deformed so that the staple gripping area of each staple comprises a height of approximately 2.0 mm, for example, where the T fabric and the Fabric thickness compensator can be compressed within this height. Under certain circumstances, the fabric T may comprise a pinch height of approximately 1.75mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 0.25mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 1.50 mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 0.50 mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 1.25mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 0.75mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 1.0 mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 1.0 mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 0.75mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 1.25mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 1.50 mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 0.50 mm within the staple gripping area , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example. Under certain circumstances, the fabric T may comprise a pinch height of approximately 0.25 mm within the staple gripping area while the fabric thickness compensator may comprise a pinch height of approximately 1.75 mm within the staple gripping area. , thus totaling the height of the clamp gripping area of approximately 2.0 mm, for example.

[00414] In addition to the above, the fabric thickness compensator may comprise an uncompressed height which is less than the height fired from the staples. The fabric thickness compensator may comprise an uncompressed height which is equal to the fired height of the staples. The fabric thickness compensator may comprise an uncompressed height that is greater than the height fired from the staples. For example, the uncompressed height of a fabric thickness compensator may comprise a thickness that is approximately 110% of the height of the formed staple, approximately 120% of the formed staple height, approximately 130% of the formed staple height, approximately 140% of the formed clamp height, approximately 150% of the formed clamp height, approximately 160% of the formed clamp height, approximately 170% of the formed clamp height, approximately 180% of the formed clamp height, approximately 190% of the formed clamp height, and/or approximately 200% of the height of the formed clip, for example. The fabric thickness compensator may comprise an uncompressed height which is more than twice the height fired from the staples. The fabric thickness compensator may comprise a compressed height that is from approximately 85% to approximately 150% of the height of the formed staple, for example. Optionally, as described above, the fabric thickness compensator can be compressed between an uncompressed thickness and a compressed thickness. The compressed thickness of a fabric thickness compensator can be approximately 10% of its uncompressed thickness, approximately 20% of its uncompressed thickness, approximately 30% of its uncompressed thickness, approximately 50 % of its uncompressed thickness, approximately 60% of its uncompressed thickness, approximately 70% of its uncompressed thickness, approximately 80% of its uncompressed thickness, and/or approximately 90% of its uncompressed thickness, for example . The uncompressed thickness of the fabric thickness compensator can be approximately twice, approximately ten times, approximately fifty times, and/or approximately one hundred times thicker than its compressed thickness, for example. The compressed thickness of the fabric thickness compensator can be between approximately 60% and approximately 99% of its uncompressed thickness. The uncompressed thickness of the fabric thickness compensator can be at least 50% thicker than its compressed thickness. The uncompressed thickness of the fabric thickness compensator can be up to one hundred times thicker than its compressed thickness. The second compressible portion can be elastic, or at least partially elastic, and can pull the T-fabric against the deformed legs of the staples. For example, the second compressible portion can resiliently expand between the T fabric and the base of the staple so as to push the T fabric against the staple legs. As discussed in more detail below, the fabric thickness compensator can be positioned between the fabric T and the deformed clamp legs. In various circumstances, as a result of the above, the fabric thickness compensator may be configured to consume any gaps within the staple gripping area.

[00415] The tissue thickness compensator may comprise materials characterized by one or more of the following properties: biocompatible, bioabsorbable, bioresorbable, biodurable, biodegradable, compressible, fluid absorbable, dilatable, self-expanding, bioactive, medicament, pharmaceutically active, anti-adhesion, hemostatic , antibiotic, antimicrobial, antiviral, nutritional, adhesive, permeable, hydrophilic and/or hydrophobic, for example. In accordance with the invention, a surgical instrument comprising an anvil and a staple cartridge may comprise a tissue thickness compensator associated with the anvil and/or the staple cartridge comprising at least one of a hemostatic agent, such as fibrin and thrombin. , an antibiotic such as doxicpl, and a drug such as matrix metalloproteinases (MMPs).

[00416] The fabric thickness compensator may comprise synthetic and/or non-synthetic materials. The fabric thickness compensator may comprise a polymeric composition comprising one or more synthetic polymers and/or one or more non-synthetic polymers. The synthetic polymer may comprise an absorbable synthetic polymer and/or a non-absorbable synthetic polymer. The polymeric composition may comprise a biocompatible foam, for example. The biocompatible foam may comprise a porous open cell foam and/or a porous closed cell foam, for example. The biocompatible foam may have a uniform pore morphology or it may have a gradient pore morphology (i.e., small pores that gradually increase in size to large pores across the thickness of the foam in one direction). The polymeric composition may comprise one or more of a porous scaffold, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a filamentous matrix, a tubular matrix, a composite matrix, a membrane matrix, a polymer. biostable, and a biodegradable polymer, and combinations thereof. For example, the fabric thickness compensator may comprise a foam reinforced by a filamentous matrix, or it may comprise a foam that has an additional hydrogel layer that expands in the presence of body fluids to provide further compression on the fabric. In accordance with the invention, a fabric thickness compensator could also be comprised of a coating over a material and/or a second or third layer that expands in the presence of body fluids to provide even more compression on the fabric. Such a layer could be a hydrogel which could be a synthetic and/or naturally derived material and could be biodurable and/or biodegradable, for example. The tissue thickness compensator may comprise a microgel or a nanogel. The hydrogel may comprise microgels and/or nanogels derived from carbohydrates. A fabric thickness compensator could be reinforced with fibrous non-woven materials or fibrous mesh-like elements, for example, which can provide additional flexibility, rigidity, and/or strength. According to the invention, a fabric thickness compensator having a porous morphology that exhibits a gradient structure, for example small pores on one surface and larger pores on the other surface. Such morphology could be better for tissue ingrowth or hemostatic behavior. Additionally, the gradient could also be compositional with a different bioabsorption profile. A short-term absorption profile may be preferred to handle hemostasis while a long-term absorption profile may better handle tissue healing without leakage.

[00417] Examples of non-synthetic materials include, but are not limited to, lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin, fibrinogen, elastin, proteoglycan, keratin, albumin, hydroxy ethyl cellulose, cellulose, oxidized cellulose , oxidized regenerated cellulose (ORC), hydroxy propyl cellulose, carboxy ethyl cellulose, carboxy methyl cellulose, chitan, chitosan, casein, alginate and combinations thereof.

[00418] Examples of synthetic absorbable materials include, but are not limited to, polylactic acid (PLA), poly(L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly(trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), a copolymer of glycolide and ε-caprolactone (PGCL), a copolymer of glycolide and trimethylene carbonate, poly(glycerol sebacate) (PGS) , poly(dioxanone) (PDS), polyesters, poly(orthoesters), polyoxaesters, polyethers, polycarbonates, polyamide esters, polyanhydrides, polysaccharides, poly(ester amides), tyrosine-based polyarylates, polyamines, polyiminocarbonates tyrosine-based, tyrosine-based polycarbonates, poly(D,L-lactide-urethane), poly(hydroxybutyrate), poly(B-hydroxybutyrate), poly(E-caprolactone), polyethylene glycol (PEG), poly[ bis(carboxylatephenoxy)phosphazene] poly(amino acids), pseudo-poly(amino acids), absorbable polyurethanes, poly(phosphazine), polyphosphine azenes, polyalkylene oxides, polyacrylamides, polyhydroxyethylmethylacrylate, polyvinylpyrrolidone, polyvinyl alcohols, poly(caprolactone), polyacrylic acid, polyacetate, polypropylene, aliphatic polyesters, glycerols, copoly(ether esters), polyalkylene oxalates, polyamides, poly(iminocarbonates), polyalkylene oxalates and combinations thereof. The polyester may be selected from the group consisting of polylactides, polyglycolides, trimethylene carbonates, polydioxanones, polycaprolactones, polybutesters and combinations thereof.

[00419] The synthetic absorbable polymer may comprise one or more of a 90/10 poly(glycolide-L-lactide) copolymer, commercially available from Ethicon, Inc. under the tradename VICRYL (polyglactic 910), polyglycolide, commercially available from American Cyanamid Co. under the tradename DEXON, polydioxanone, commercially available from Ethicon, Inc. under the tradename PDS, poly(glycolide-trimethylene carbonate) random block copolymer, commercially available from American Cyanamid Co. under the tradename MAXON, copolymer 75/25 poly(glycolide-ε-caprolactone-polyglecaprolactone 25), commercially available from Ethicon under the tradename MONOCRYL, for example.

[00420] Examples of non-absorbable synthetic materials include, but are not limited to, foamed polyurethane, polypropylene (PP), polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate ( PMMA), polystyrene (PS), polyester, polyether ether ketone (peek), polytetrafluoro ethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone, silicones and combinations thereof. Synthetic non-absorbable polymers can include, but are not limited to, foamed elastomers and porous elastomers, such as, for example, silicone, polyisoprene, and rubber. Synthetic polymers may comprise expanded polytetrafluoroethylene (ePTFE), commercially available from W. L. Gore & Associates, Inc. under the tradename GORE-TEX Soft Woven Patch and copolyetherester urethane foam commercially available from Polyganics under the tradename NASOPORE.

[00421] The polymeric composition may comprise from approximately 50% to approximately 90% by weight of the polymeric composition of PLLA and approximately 50% to approximately 10% by weight of the polymeric composition of PCL, for example. The polymeric composition may comprise approximately 70% by weight of PLLA and approximately 30% by weight of PCL, for example. The polymeric composition may comprise from approximately 55% to approximately 85% by weight of the PGA polymeric composition and 15% to 45% by weight of the PCL polymeric composition, for example. The polymeric composition may comprise approximately 65% by weight of PGA and approximately 35% by weight of PCL, for example. The polymeric composition may comprise from approximately 90% to approximately 95% by weight of the PGA polymeric composition and approximately 5% to approximately 10% by weight of the PLA polymeric composition, for example.

[00422] The synthetic absorbable polymer may comprise a bioabsorbable biocompatible elastomeric copolymer. Suitable bioabsorbable biocompatible elastomeric copolymers include, but are not limited to, copolymers of ε-caprolactone and glycolide (preferably having a molar ratio of ε-caprolactone to glycolide of about 30:70 to about 70:30, preferably 35:65 to about 65:35, and more preferably 45:55 to 35:65); elastomeric copolymers of ε-caprolactone and lactide, including L-lactide, D-lactide and mixtures thereof, or lactic acid copolymers (preferably having a molar ratio of ε-caprolactone to lactide of about 35:65 to about 65:35 and more preferably 45:55 to 30:70), elastomeric copolymers of p-dioxanone (1,4-dioxan-2-one) and lactide including L-lactide, D-lactide and lactic acid (preferably having a molar ratio of p-dioxanone to lactide of from about 40:60 to about 60:40); elastomeric copolymers of ε-caprolactone and p-dioxanone (preferably having a molar ratio of ε-caprolactone to p-dioxanone of from about 30:70 to about 70:30); elastomeric copolymers of p-dioxanone and trimethylene carbonate (preferably having a molar ratio of p-dioxanone to trimethylene carbonate of about 30:70 about 70:30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably having a molar ratio of trimethylene carbonate and glycolide of from about 30:70 to about 70:30); elastomeric copolymer of trimethylene carbonate and lactide including L-lactide, D-lactide, mixtures thereof or lactide copolymers (preferably having a molar ratio of trimethylene carbonate to lactide of from about 30:70 to about 70 :30) and mixtures thereof. The elastomeric copolymer may be a copolymer of glycolide and ε-caprolactone. Alternatively, the elastomeric copolymer is a copolymer of lactide and ε-caprolactone.

[00423] The disclosures of US Patent No. 5,468,253 entitled ELASTOMERIC MEDICAL DEVICE, which was issued November 21, 1995, and US Patent No. 6,325,810 entitled FOAM BUT-TRESS FOR STAPLING APPARATUS, which was granted December 4, 2001, are incorporated herein by reference in their entirety.

[00424] The fabric thickness compensator may comprise an emulsifier. Examples of emulsifiers may include, but are not limited to, water-soluble polymers such as polyvinyl alcohol (PVA), polyvinylpyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), PLURONICS, TWEENS, polysaccharides and combinations thereof.

[00425] The fabric thickness compensator may comprise a surfactant.

[00426] Examples of surfactants may include, but are not limited to, polyacrylic acid, metallose, methyl cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, octyl ether. polyoxyethylene, polyoxyethylene phenyl ether, polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, poly(ethylene-oxy)ethanol dialkylphenoxy and polyoxamers.

[00427] The polymeric composition may comprise a pharmaceutically active agent. The polymeric composition can release a therapeutically effective amount of the pharmaceutically active agent. The pharmaceutically active agent can be released when the polymeric composition is desorbed/absorbed. The pharmaceutically active agent may be released into the fluid, for example blood, which passes over or through the polymeric composition. Examples of pharmaceutically active agents may include, but are not limited to, hemostatic agents and drugs, such as, for example, fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs such as diclofenac, aspirin, naxoprene, subidac and hydrocortisone; antibiotic and antimicrobial drug or agents such as, for example, triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anti-cancer agents such as, for example, cisplatin, mitomycin, adriamycin.

[00428] The polymeric composition may comprise a hemostatic material. The tissue thickness compensator may comprise hemostatic materials comprising poly(lactic acid), poly(glycolic acid), poly(hydroxybutyrate), poly(caprolactone), poly(dioxanone), polyalkylene oxides, copoly(ether-esters). ), collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, cellulose carboxyethyl, carboxymethyl cellulose, chitan, chitosan, agarose, maltose, maltodextrin, alginate, clotting factors, methacrylate, polyurethanes, cyanoacrylates, platelet agonists, vasoconstrictors, alum, calcium, RGD peptides, proteins, protamine sulfate, ε-amino caproic acid, ferric sulfate, ferric subsulfates, ferric chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfates, aluminum acetates, permanganates, t anines, bone wax, polyethylene glycols, fucans and combinations thereof. The tissue thickness compensator can be characterized by hemostatic properties.

[00429] The polymeric composition of a fabric thickness compensator can be characterized by the percentage of porosity, pore size, and/or hardness, for example. The polymeric composition may have a porosity percentage of approximately 30% by volume to approximately 99% by volume, for example. The polymeric composition may have a porosity percentage of approximately 60% by volume to approximately 98% by volume, for example. The polymeric composition may have a porosity percentage of from approximately 85% by volume to approximately 97% by volume, for example. The polymeric composition may comprise approximately 70% by weight of PLLA and approximately 30% by weight of PCL, for example, and may comprise approximately 90% porosity by volume, for example. For example, as a result, the polymeric composition would comprise approximately 10% copolymer by volume. The polymer composition may comprise approximately 65% by weight of PGA and approximately 35% by weight of PCL, for example, and may have a porosity percentage of approximately 93% by volume to approximately 95%, in volume, for example. The polymeric composition may comprise porosity greater than 85% by volume. The polymeric composition may have a pore size from approximately 5 micrometers to approximately 2000 micrometers, for example. The polymeric composition may have a pore size between approximately 10 micrometers and approximately 100 micrometers, for example. For example, the polymeric composition may comprise a copolymer of PGA and PCL, for example. The polymeric composition may have a pore size between approximately 100 micrometers and approximately 1000 micrometers, for example. For example, the polymeric composition may comprise a copolymer of PLLA and PCL, for example.

[00430] According to certain aspects, the hardness of a polymeric composition can be expressed in terms of Shore hardness, which can be defined as the permanent indentation resistance of a material, as determined with a durometer, such as a Shore durometer. . In order to assess the durometer value for a given material, pressure is applied to the material with a durometer indenter foot according to ASTM procedure D2240-00 entitled, "Standard Test Method for Rubber Property-Durometer Hardness", which is fully incorporated herein by reference. The durometer indenter foot can be applied to the material for a sufficient period of time, such as 15 seconds for example, whereupon a reading is then taken at the proper scale. Depending on the type of scale used, a reading of 0 may be obtained when the indenter foot completely penetrates the material, and a reading of 100 may be obtained when no penetration occurs in the material. This reading is dimensionless. The durometer can be determined according to any suitable scale, such as type A and/or type OO scales, for example according to ASTM D2240-00. The polymer composition of a fabric thickness compensator may have a Shore A hardness value of approximately 4 A to approximately 16 A, for example, which is approximately 4500 to approximately 6500 in the Shore OO range. For example, the polymeric composition may comprise a PLLA/PCL copolymer or a PGA/PCL copolymer, for example. The polymer composition of a fabric thickness compensator may have a Shore A hardness value of less than 15 A. In various embodiments, the polymer composition of a fabric thickness compensator may have a Shore A hardness value of less than 10 A. The polymeric composition of a fabric thickness compensator may have a Shore A hardness value of less than 5 A. In certain embodiments, the polymeric material may have a Shore OO composition value of from approximately 3500 to approximately 7500, for example.

[00431] The polymeric composition may have at least two of the properties identified above. The polymeric composition can have at least three of the properties identified above. The polymer composition may have a porosity of 85% to 97% by volume, a pore size of 5 micrometers to 2000 micrometers, and a Shore A hardness value of 4 A to 16 A and a Shore OO hardness value of 45 OO to 65 OO, for example. The polymeric composition may comprise 70% by weight of the polymeric composition of PLLA and 30% by weight of the polymeric composition of PCL having a porosity of 90% by volume, a pore size of 100 micrometers to 1000 micrometers. , and a Shore A hardness value of 4 A to 16 A and a Shore OO hardness value of 45 OO to 65 OO, for example. The polymeric composition may comprise 65% by weight of the PGA polymeric composition and 35% by weight of the PCL polymeric composition having a porosity of 93% to 95% by volume, a pore size of 10 micrometers. to 100 micrometers, and a Shore A hardness value of 4 A to 16 A and a Shore OO hardness value of 45 OO to 65 OO, for example.

[00432] The fabric thickness compensator may comprise an expandable material. As discussed above, the fabric thickness compensator may comprise a compressed material that expands when decompressed or installed, for example. The fabric thickness compensator may comprise a self-expanding material formed in situ. The tissue thickness compensator may comprise at least one precursor selected to spontaneously cross-link when brought into contact with at least one of the other precursor(s), water and/or body fluids. In accordance with the invention, a first precursor may contact one or more other precursors to form an expandable and/or expandable tissue thickness compensator. The fabric thickness compensator may comprise a fluid swellable composition, such as a water swellable composition, for example. The fabric thickness compensator may comprise a gel comprising water.

[00433] The fabric thickness compensator may comprise a biodegradable foam which has an encapsulation comprising dry hydrogel particles or granules incorporated therein. Without being bound by any theory, encapsulations in foam can be formed by contacting an aqueous solution of a hydrogel precursor and an organic solution of biocompatible materials to form the foam. The aqueous solution and the organic solution can form micelles. The aqueous solution and the organic solution can be dried to encapsulate dry hydrogel particles or granules in the foam. For example, a hydrogel precursor, such as a hydrophilic polymer, can be dissolved in water to form a micelle dispersion. The aqueous solution may be contacted with an organic dioxane solution comprising poly(glycolic acid) and polycaprolactone. The aqueous and organic solutions can be lyophilized to form a biodegradable foam which has dry hydrogel particles or granules dispersed therein. Without being bound by any theory, it is believed that the micelles form the encapsulation which has the dry hydrogel particles or granules dispersed in the foam structure. The encapsulation can be broken and the dry hydrogel particles or granules can come into contact with a fluid such as a body fluid and expand.

[00434] Optionally, as described above, the fabric thickness compensator may comprise an initial thickness and an expanded thickness. The initial thickness of a fabric thickness compensator can be approximately 0.001% of its expanded thickness, approximately 0.01% of its expanded thickness, approximately 0.1% of its expanded thickness, approximately 1% of its expanded thickness, approximately 10% of its expanded thickness, approximately 20% of its expanded thickness, approximately 30% of its expanded thickness, approximately 40% of its expanded thickness, approximately 50% of its expanded thickness, approximately 60% of its expanded thickness, approximately 70% of its expanded thickness, approximately 80% of its expanded thickness and/or approximately 90% of its expanded thickness, for example. The expanded thickness of the fabric thickness compensator can be approximately twice, approximately five times, approximately ten times, approximately fifty times, approximately one hundred times, approximately two hundred times, approximately three hundred times, approximately four hundred times , approximately five hundred times, approximately six hundred times, approximately seven hundred times, approximately eight hundred times, approximately nine hundred times and/or approximately one thousand times thicker than its initial thickness, for example. The initial thickness of the fabric thickness compensator can be up to 1% of its expanded thickness, up to 5% of its expanded thickness, up to 10% of its expanded thickness, and up to 50% of its expanded thickness. The expanded thickness of the fabric thickness compensator can be at least 50% thicker than its initial thickness, at least 100% thicker than its initial thickness, at least 300% thicker than its initial thickness, and at least 500 % thicker than its initial thickness. As described above, in various circumstances, as a result of the above, the fabric thickness compensator may be configured to consume any gap within the staple gripping area.

[00435] As discussed above, the fabric thickness compensator may comprise a hydrogel. The hydrogel may comprise homopolymer hydrogels, copolymer hydrogels, multipolymer hydrogels, interpenetrating polymer hydrogels and combinations thereof. The hydrogel may comprise microgels, nanogels and combinations thereof. The hydrogel may generally comprise a hydrophilic polymer network that has the ability to absorb and/or retain fluids. The hydrogel may comprise a non-crosslinked hydrogel, a crosslinked hydrogel and combinations thereof. The hydrogel may comprise chemical crosslinks, physical crosslinks, hydrophobic segments and/or water-insoluble segments. The hydrogel can be chemically cross-linked via polymerization, small molecule cross-linking and/or polymer-polymer cross-linking. The hydrogel can be physically cross-linked through ionic interactions, hydrophobic interactions, hydrogen bonding interactions, stereo-complexation and/or supramolecular chemistry. The hydrogel may be substantially insoluble due to crosslinks, hydrophobic segments and/or water-insoluble segments, but may be expandable and/or swellable due to fluid absorption and/or retention. The precursor may cross-link with endogenous materials and/or tissues.

[00436] The hydrogel may comprise an environmentally sensitive hydrogel (ESH). The ESH may comprise materials that have fluid expansion properties related to environmental conditions. Environmental conditions may include, but are not limited to, the physical conditions, biological conditions, and/or chemical conditions at the surgical site. The hydrogel can swell or shrink in response to temperature, pH, electric fields, ionic resistance, enzymatic and/or chemical reactions, electrical and/or magnetic stimuli, and other physiological and environmental variables, for example. ESH can comprise multifunctional acrylates, hydroxyethylmethacrylate (HEMA), elastomeric acrylates and related monomers.

[00437] The fabric thickness compensator comprising a hydrogel may comprise at least one of the non-synthetic materials and synthetic materials described above. The hydrogel may comprise a synthetic hydrogel and/or a non-synthetic hydrogel. The fabric thickness compensator may comprise a plurality of layers. The plurality of layers may comprise porous layers and/or non-porous layers. For example, the fabric thickness compensator may comprise a non-porous layer and a porous layer. In another example, the fabric thickness compensator may comprise a porous layer intermediate a first non-porous layer and a second non-porous layer. In another example, the fabric thickness compensator may comprise a non-porous layer intermediate a first porous layer and a second porous layer. The non-porous layers and the porous layers may be positioned in any order with respect to the surfaces of the staple cartridge and/or anvil.

[00438] Examples of the non-synthetic material may include, but are not limited to, albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, dextran, elastin, fibrin, fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, whey and starch. The cellulose may comprise hydroxy ethyl cellulose, oxidized cellulose, oxidized regenerated cellulose (ORC), hydroxy propyl cellulose, carboxy ethyl cellulose, carboxy methyl cellulose and combinations thereof. The collagen may comprise bovine pericardium. The carbohydrate may comprise a polysaccharide, such as lyophilized polysaccharide. The protein may comprise glycoprotein, proteoglycan and combinations thereof.

[00439] Examples of the synthetic material may include, but are not limited to, polylactic acid, poly(glycolic acid), poly(hydroxybutyrate), poly(phosphazine), polyesters, polyethylene glycols, polyethylene oxide, polyethylene oxide, copolypropylene oxide , copolyethylene oxide, polyalkylene oxides, polyacrylamides, polyhydroxyethylmethylacrylate, poly(vinylpyrrolidone), polyvinyl alcohols, poly(caprolactone), poly(dioxanone), polyacrylic acid, polyacetate, polypropylene, aliphatic polyesters, glycerols, poly(amino acids), copoly(ether esters), polyalkylene oxalates, polyamides, poly(iminocarbonates), polyoxaesters, polyorthoesters, polyphosphazenes and combinations thereof. The above non-synthetic materials can be synthetically prepared, for example synthetic hyaluronic acid, using conventional methods.

[00440] The hydrogel can be produced from one or more hydrogel precursors. The precursor may comprise a monomer and/or a macromer. The hydrogel precursor may comprise an electrophilic functional group and/or a nucleophilic electrophilic functional group. In general, electrophiles can react with nucleophiles to form a bond. The term "functional group" as used herein refers to electrophilic or nucleophilic groups that have the ability to react with each other to form a bond. Examples of electrophilic functional groups may include, but are not limited to, N-hydroxysuccinimides ("NHS"), sulfosuccinimides, carbonyldiimidazole, sulfonyl chloride, aryl halides, sulfosuccinimidyl esters, N-hydroxysuccinimidyl esters, succinimidyl esters such as succinimidyl succinates and/or succinimidyl propionates, isocyanates, thiocyanates, carbodiimides, benzotriazole carbonates, epoxides, aldehydes, maleimides, imidoesters, combinations thereof and the like. The electrophilic functional group may comprise a succinimidyl ester. Examples of nucleophilic functional groups may include, but are not limited to, -NH2 , -SH, -OH, -PH2 and -CO-NH-NH2 .

[00441] The hydrogel can be formed from a single precursor or from multiple precursors. The hydrogel can be formed from a first precursor and a second precursor. The first hydrogel precursor and the second hydrogel precursor can form a hydrogel in situ and/or in vivo upon contact. Hydrogel precursor can generally refer to a polymer, a functional group, a macromolecule, a small molecule and/or a crosslinker that can be part of a reaction to form a hydrogel. The precursor may comprise a homogeneous, heterogeneous solution or a separate phase solution in a suitable solvent, such as water or a buffer, for example. The buffer may have a pH of from about 8 to about 12, such as about 8.2 to about 9, for example. Examples of buffers may include, but are not limited to, borate buffers. The precursor(s) may be in an emulsion. In accordance with the invention, a first precursor can be reacted with a second precursor to form a hydrogel. The first precursor can spontaneously cross-link when brought into contact with the second precursor. In accordance with the invention, a first set of electrophilic functional groups on a first precursor can react with a second set of nucleophilic functional groups on a second precursor. When precursors are mixed in an environment that allows for the reaction (eg, with respect to pH, temperature, and/or solvent), the functional groups can react with each other to form covalent bonds. Precursors can become cross-linked when at least some of the precursors react with more than one other precursor.

[00442] The tissue thickness compensator may comprise at least one monomer selected from the group consisting of 3-sulfopropyl potassium acrylate salt ("KSPA"), sodium acrylate ("NaA"), N-(tris( hydroxylmethyl)methyl)acrylamide ("tris acryl") and 2-acrylamido-2-methyl-1-propane sulfonic acid (AMPS). The fabric thickness compensator may comprise a copolymer comprising two or more monomers selected from the group consisting of KSPA, NaA, tris acryl, AMPS. The tissue thickness compensator may comprise homopolymers derived from KSPA, NaA, trisacryl and AMPS. The fabric thickness compensator may comprise hydrophilic capacity modifier monomers copolymerizable therewith. The hydrophilic capacity modifier monomers may comprise methylmethacrylate, butylacrylate, cyclohexylacrylate, styrene, styrene sulfonic acid.

[00443] The fabric thickness compensator may comprise a crosslinker. The crosslinker may comprise a low molecular weight di or polyvinyl crosslinking agent, such as ethylene glycol diacrylate or dimethacrylate, di-, tri- or tetra-ethylene glycol diacrylate or dimethacrylate, allyl (meth)acrylate, a C2-C8-alkylene diacrylate or dimethacrylate, divinyl ether, divinyl sulfone, di- and trivinylbenzene, trimethylolpropane triacrylate or trimethacrylate, pentaerythritol tetraacrylate or tetramethacrylate, bisphenol A diacrylate or dimethacrylate, methylene bisacrylamide or bismethacrylamide, ethylene bisacrylamide or ethylene bismethacrylamide, triallyl phthalate or diallyl phthalate. The crosslinker may comprise N,N'-methylenebisacrylamide ("MBAA").

[00444] The tissue thickness compensator may comprise at least one of acrylate and/or methacrylate functional hydrogels, biocompatible photoinitiator, alkyl cyanoacrylates, isocyanate functional macromers, which optionally comprise amine functional macromers, succinimidyl ester functional macromers , which optionally comprise amine- and/or sulfhydryl-functional macromers, epoxy-functional macromers, which optionally comprise amine-functional macromers, mixtures of proteins and/or polypeptides, and aldehyde crosslinkers, Genipin, and water-soluble carbodiimides, anionic polysaccharides and polyvalent cations.

[00445] The fabric thickness compensator may comprise unsaturated organic acid monomers, acrylic substituted alcohols and/or acrylamides. The fabric thickness compensator may comprise methacrylic acids, acrylic acids, glycerolacrylate, glycerolmethacrylate, 2-hydroxyethylmethacrylate, 2-hydroxyethylacrylate, 2-(dimethylaminoethyl)methacrylate, N-vinyl pyrrolidone, methacrylamide and/or N,N - poly(methacrylic acid) dimethylacrylamide.

[00446] The fabric thickness compensator may comprise a reinforcing material. The reinforcing material may comprise at least one of the non-synthetic materials and synthetic materials described above. The reinforcing material may comprise collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxy ethyl cellulose, carboxy methyl cellulose, chitan, chitosan, alginate, poly(lactic acid) , poly(glycolic acid), poly(hydroxybutyrate), poly(phosphazine), polyesters, polyethylene glycols, polyalkylene oxides, polyacrylamides, polyhydroxy ethyl methyl acrylate, polyvinylpyrrolidone, polyvinyl alcohols, poly(caprolactone), poly(dioxanone ), polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyesters, glycerols, poly(amino acids), copoly(ether esters), polyalkylene oxalates, polyamides, poly(iminocarbonates), polyalkylene oxalates, polyoxaesters , polyorthoesters, polyphosphazenes and combinations thereof.

[00447] The fabric thickness compensator may comprise a layer comprising the reinforcing material. A porous layer and/or a non-porous layer of a fabric thickness compensator may comprise the reinforcing material. For example, the porous layer may comprise the reinforcing material and the non-porous layer may not comprise the reinforcing material. The reinforcing layer may comprise an inner layer intermediate a first non-porous layer and a second non-porous layer. The reinforcement layer may comprise an outer layer of fabric thickness compensator. The reinforcement layer may comprise an outer surface of the fabric thickness compensator.

[00448] The reinforcing material may comprise meshes, monofilament braids, multifilament braids, fibers, batts, felts, particles and/or powders. The reinforcement material may be incorporated into a layer of the fabric thickness compensator. The reinforcing material may be incorporated into at least one of a non-porous layer and a porous layer. A mesh comprising the reinforcing material may be formed using conventional techniques such as, for example, knitting, weaving, crocheting and/or lace making.

[00449] According to the invention, a plurality of reinforcement materials can be oriented in a random direction and/or a common direction. The common direction can be one of parallel to the staple line and perpendicular to the staple line, for example. For example, monofilament and/or multifilament braids can be oriented in a random direction and/or in a common direction. Monofilament and multifilament braids can be associated with the non-porous layer and/or the porous layer. The fabric thickness compensator may comprise a plurality of reinforcing fibers oriented in a random direction within a non-porous layer. The fabric thickness compensator may comprise a plurality of reinforcing fibers oriented in a common direction within a non-porous layer.

[00450] The fibers can form a non-woven material such as, for example, a blanket and a felt. The fibers can be of any suitable length, for example from 0.1 mm to 100 mm and 0.4 mm to 50 mm. The reinforcing material can be ground to a powder. The powder can have a particle size of 10 micrometers to 1 cm, for example. Powder can be incorporated into the fabric thickness compensator.

[00451] The fabric thickness compensator can be formed in situ. The hydrogel can be formed in situ. The tissue thickness compensator can be formed in situ through covalent, ionic and/or hydrophobic bonds. Physical crosslinks (non-covalent) can result from complexation, hydrogen bonding, desolvation, Van der Waals interactions, ionic bonding and combinations thereof. Chemical (covalent) cross-linking can be accomplished through any number of mechanisms, including: free radical polymerization, condensation polymerization, anionic or cationic polymerization, stepwise growth polymerization, electrophile-nucleophile reactions, and combinations thereof.

[00452] Optionally, the in situ formation of the tissue thickness compensator may comprise the reaction of two or more precursors that are physically separated until in situ contact and/or the reaction to an ambient condition to react with each other to form the hydro- gel. In situ polymerizable polymers can be prepared from precursor(s) which can react to form a polymer at the surgical site. The tissue thickness compensator can be formed through crosslinking reactions of the precursor(s) in situ. The precursor may comprise an initiator which has the ability to inhibit a polymerization reaction for the formation of the tissue thickness compensator in situ. The tissue thickness compensator may comprise a precursor which can be activated at the time of application to create a cross-linked hydrogel. In situ formation of the tissue thickness compensator may comprise activating at least one precursor to form bonds to form the tissue thickness compensator. Optionally, activation can be achieved by changes in physical conditions, biological conditions and/or chemical conditions at the surgical site including, but not limited to, temperature, pH, electrical fields, ionic strength, enzymatic and/or chemical reactions, stimuli electrical and/or magnetic and other physiological and environmental variables. Precursors can be contacted outside the body and introduced into the surgical site.

[00453] The tissue thickness compensator may comprise one or more encapsulations, or cells, which may be configured to store at least one component therein. The encapsulation can be configured to store a hydrogel precursor therein. The encapsulation can be configured to store two components in it, for example. The encapsulation may be configured to store a first hydrogel precursor and a second hydrogel precursor therein. A first encapsulation can be configured to store a first hydrogel precursor therein and a second encapsulation can be configured to store a second hydrogel precursor therein. As described above, the encapsulations may be aligned, or at least substantially aligned, with the clamp legs to puncture and/or otherwise rupture the encapsulations when the clamp legs contact the encapsulation. Encapsulations can be compressed, crushed, flattened and/or otherwise ruptured when the staples are fired. After the encapsulations have been broken, the component(s) stored in them can flow out of the encapsulation. The component stored therein may contact other components, fabric thickness compensator layers and/or fabric. The other components may flow from the same or different encapsulations, provided in the tissue thickness compensator layers and/or provided at the surgical site by the physician. As a result of the foregoing, the component(s) stored in the encapsulations may provide expansion and/or dilation of the tissue thickness compensator.

[00454] The fabric thickness compensator may comprise a layer comprising encapsulations. The encapsulation may comprise a void, a pocket, a dome, a tube and combinations thereof associated with the layer. Encapsulations can comprise empty spaces in the layer. The layer may comprise two layers that can be secured together, where encapsulations can be defined between the two layers. Encapsulations may comprise bellows on the surface of the layer. For example, at least a portion of the encapsulations may be positioned within bellows extending above the layer. Encapsulations may comprise pockets formed within the layer. A first portion of the encapsulations may comprise a dome and a second portion of the encapsulations may comprise a pocket. Encapsulations may comprise a tube embedded in the layer. The tube may comprise the non-synthetic materials and/or the synthetic materials described herein, such as PLA. The fabric thickness compensator may comprise a bioabsorbable foam, such as ORC, which comprises PLA tubes embedded therein, and the tube may encapsulate a hydrogel, for example. Encapsulations may comprise separate cells that are not connected to each other. One or more of the encapsulations may be in fluid communication with each other through one or more passages, conduits and/or channels, for example, extending through the layer.

[00455] The release rate of a component from the encapsulation can be controlled by the thickness of the tissue thickness compensator, the composition of the tissue thickness compensator, the size of the component, the hydrophilic capacity of the component and/or the physical and /or chemicals between the component, the tissue thickness compensator composition and/or the surgical instrument, for example. The layer may comprise one or more thin sections or weakened portions, such as partial perforations, for example, which may facilitate puncture of the layer and rupture of encapsulations. Partial perforations may not extend completely through a layer while, in some cases, perforations may extend completely through the layer.

[00456] Optionally, an anvil may comprise a tissue thickness compensator comprising an encapsulated component comprising at least one microsphere particle. The fabric thickness compensator may comprise an encapsulation comprising an encapsulated first component and an encapsulated second component. The fabric thickness compensator may comprise an encapsulation comprising a first microsphere particle and a second microsphere particle.

[00457] The tissue thickness compensator may be suitable for use with a surgical instrument. As described above, the tissue thickness compensator can be associated with the staple cartridge and/or the anvil. The fabric thickness compensator can be configured to any shape, size and/or dimension suitable to fit the staple cartridge and/or anvil. As described herein, the tissue thickness compensator may be releasably attached to the staple cartridge and/or anvil. The tissue thickness compensator may be attached to the staple cartridge and/or anvil in any mechanical and/or chemical manner that has the ability to retain the tissue thickness compensator in contact with the staple cartridge and/or anvil before or during the stapling process. The tissue thickness compensator can be removed or released from the staple cartridge and/or anvil after the staple has penetrated the tissue thickness compensator. The tissue thickness compensator can be removed or released from the staple cartridge and/or anvil as the staple cartridge and/or anvil moves in the opposite direction of the tissue thickness compensator.

[00458] Now referring to Figure 14, a staple cartridge, such as the staple cartridge 10000, for example, may comprise a support portion 10010 and a compressible fabric thickness compensator 10020. Now referring to Figures 16 to 18 , the support portion 10010 may comprise a support surface 10011 and a plurality of clip recesses 10012 defined within the support portion 10010. Each clip recess 10012 may be sized and configured to releasably store a clip, such as a clamp 10030, for example. Staple cartridge 10000 may further comprise a plurality of staple drivers 10040 which can each be configured to support one or more staples 10030 within staple cavities 10012 when staples 10030 and staple drivers 10040 are in the their unfired positions. For example, with reference primarily to Figures 22 and 23, each clamp driver 10040 may comprise one or more cradles, or channels, 10041, for example, which may be configured to support the clamps and limit relative movement between the clamps 10030 and the staple drivers 10040. Again referring to Figure 16, the staple cartridge 10000 may further comprise a staple firing slider 10050 which is moveable from a proximal end 10001 to a distal end 10002 of the staple cartridge so as to lift sequentially the staple drivers 10040 and staples 10030 from their unfired positions to an anvil positioned opposite the staple cartridge 10000. Referring primarily to Figures 16 and 18, each staple 10030 may comprise a base 10031 and one or more legs 10032 extending from base 10031 wherein each clip may be at least one of substantially U-shaped and substantially nte in a V-shape, for example. Clamps 10030 may be configured so that the ends of clamp legs 10032 are recessed with respect to platform surface 10011 of support portion 10010 when clamps 10030 are in their unfired positions. Clamps 10030 may be configured so that the ends of clamp legs 10032 are flush with the platform surface 10011 of support portion 10010 when clamps 10030 are in their unfired positions. Clamps 10030 may be configured so that the ends of clamp legs 10032, or at least some portion of clamp legs 10032, extend above the platform surface 10011 of support portion 10010 when clamps 10030 are in their non-active positions. shot. In such cases, the clamp legs 10032 can extend inwardly and can be fitted within the fabric thickness compensator 10020 when the clamps 10030 are in their unfired positions. For example, clamp legs 10032 can extend above the platform surface 10011 by approximately 1.9 mm (0.075”), for example. The clamp legs 10032 can extend above the platform surface 10011 by a distance between approximately 0.64 mm (0.025”) and approximately 3.18 mm (0.125”), for example. In addition to those set out above, the fabric thickness compensator 10020 may comprise an uncompressed thickness between approximately 2.0 mm (0.08") and approximately 3.18 mm (0.125"), for example.

[00459] In use, in addition to the above and with reference primarily to Figure 31, an anvil such as the anvil 10060 for example can be moved to a closed position opposite the staple cartridge 10000. As described in more detail below , the anvil 10060 can position the fabric against the fabric thickness compensator 10020 and compress the fabric thickness compensator 10020 against the platform surface 10011 of the support portion 10010, for example. When the anvil 10060 has been properly positioned, the staples 10030 can be dispensed with, as also illustrated in Figure 31. Optionally, as mentioned above, the staple firing slider 10050 can be moved from the proximal end 10001 of the staple cartridge 10000 to the distal end 10002, as shown in Figure 32. When the sled 10050 is advanced, the sled 10050 can contact the 10040 staple drivers and lift the 10040 staple drivers into the 10012 staple cavities. The 10050 and the staple drivers 10040 may each comprise one or more slopes, or inclined surfaces, which may cooperate to move the staple drivers 10040 upward from their unfired positions. For example, with reference to Figures 19 to 23, each clamp driver 10040 may comprise at least one sloped surface 10042 and the slider 10050 may comprise one or more sloped surfaces 10052 which may be configured so that sloped surfaces 10052 can slide under the angled surface 10042 when the slider 10050 is advanced distally into the staple cartridge. When the staple drivers 10040 are lifted into their respective staple cavities 10012, the staple drivers 10040 can lift the staples 10030 so that the staples 10030 can emerge from their staple cavities 10012 through openings in the holder clip 10011. During an exemplary firing sequence, referring primarily to Figures 25 to 27, slider 10050 may first contact clip 10030a and begin lifting clip 10030a. When sled 10050 is advanced further distally, sled 10050 may begin lifting clamps 10030b, 10030c, 10030d, 10030e, and 10030f, and any subsequent clamps, in a sequential order. As illustrated in Figure 27, the slider 10050 can direct the clamps 10030 upwards so that the legs 10032 of the clamps contact the opposing anvil, are deformed into a desired shape, and ejected from the support portion 10010. In various circumstances , the sled 10030 can move multiple clamps up simultaneously as part of a firing sequence. With respect to the firing sequence illustrated in Figure 27, staples 10030a and 10030b have been moved to their fully fired positions and ejected from support portion 10010, staples 10030c and 10030d are in the process of being fired and are at least partially contained within the support portion 10010, and clamps 10030e and 10030f are still in their unfired positions.

[00460] As discussed above, and with reference to Figure 33, the clamp legs 10032 of the clamps 10030 may extend above the support surface 10011 of the support portion 10010 when the clamps 10030 are in their unfired positions. With further reference to this firing sequence illustrated in Figure 27, the staples 10030e and 10030f are illustrated in their unfired position and their staple legs 10032 extend above the support surface 10011 and into the fabric thickness compensator 10020. ends of staple legs 10032, or any other portion of staple legs 10032, may not protrude through a top fabric contacting surface 10021 of fabric thickness compensator 10020 when staples 10030 are in their unfired positions . When the staples 10030 are moved from their non-fired positions to their fired positions, as illustrated in Figure 27, the tips of the staple legs may protrude through the tissue-contacting surface 10032. The tips of the staple legs 10032 may comprise sharp points that can cut and penetrate the fabric thickness compensator 10020. The fabric thickness compensator 10020 may comprise a plurality of openings that may be configured to receive the staple legs 10032 and allow the staple legs 10032 to slide relative to the fabric thickness compensator 10020. Support portion 10010 may further comprise a plurality of guides 10013 extending from platform surface 10011. Guides 10013 may be positioned adjacent to staple cavity openings in the support surface 10011 so that the clamp legs 10032 can be at least partially supported by the guides 10013. A guide 10013 can be positioned at a proximal end and/or a distal end of a staple cavity opening. In accordance with the invention, a first guide 10013 can be positioned at a first end of each opening of the staple cavity and a second guide 10013 can be positioned at a second end of each opening of the staple cavity so that each first guide 10013 can support a first clamp leg 10032 of a clamp 10030 and each second guide 10013 can support a second clamp leg 10032 of the clamp. Referring to Figure 33, each guide 10013 may comprise a groove or slot, such as groove 10016, for example, within which a clamp leg 10032 may be slidably received. Optionally, each guide 10013 may comprise a handle, protuberance, and/or peg that may extend from the platform surface 10011 and may extend into the fabric thickness compensator 10020. As discussed in more detail below, the handles, protuberances , and/or pegs may reduce relative movement between the fabric thickness compensator 10020 and the support portion 10010. The ends of the staple legs 10032 may be positioned within the guides 10013 and may not extend above the top surfaces of the clips 10032. guides 10013 when clamps 10030 are in their unfired position. For example, guides 10013 may define a guide height and clamps 10030 may not extend above this guide height when they are in their unfired positions.

[00461] In accordance with the invention, a fabric thickness compensator, such as the fabric thickness compensator 10020, for example, can be comprised of a single sheet of material. A fabric thickness compensator may comprise a continuous sheet of material that may cover the entire upper platform surface 10011 of the support portion 10010 or, alternatively, cover less than the entire platform surface 10011. The sheet of material may covering the staple cavity openings in the support portion 10010 while, alternatively, the sheet of material may comprise openings that can be aligned, or at least partially aligned, with the staple cavity openings. In accordance with the invention, a fabric thickness compensator may be comprised of multiple layers of material. Referring now to Figure 15, a fabric thickness compensator may comprise a compressible core and a shell surrounding the compressible core. A housing 10022 may be configured to releasably secure the compressible core to the support portion 10010. For example, the support portion 10010 may comprise one or more projections, such as projections 10014 (Figure 18), for example, that extend therefrom and which can be received within one or more openings and/or slots, such as openings 10024, for example, defined in housing 10022. Projections 10014 and openings 10024 can be configured so that projections 10014 can secure the housing 10022 to the support portion 10010. The ends of the projections 10014 may be deformed, as by a hot-fitting process, for example, in order to widen the ends of the projections 10014 and, as a result, limit relative movement between the housing 10022 and the support portion 10010. The housing 10022 may comprise one or more perforations 10025 that can facilitate the release of the housing 10022 from the support portion 10010, as per il 15. Referring now to Figure 24, a fabric thickness compensator may comprise a housing 10222 that includes a plurality of apertures 10223, wherein apertures 10223 may be aligned, or at least partially aligned, with apertures in the cavity for staples in the support portion 10010. The fabric thickness compensator core may also comprise apertures that are aligned, or at least partially aligned, with the apertures 10223 in the housing 10222. Alternatively, the fabric thickness compensator core may comprises a continuous body and can extend below the openings 10223 so that the continuous body covers the openings of the staple cavity in the platform surface 10011.

[00462] Optionally, as described above, a fabric thickness compensator may comprise a housing for releasably securing a compressible core to the support portion 10010. For example, with reference to Figure 16, a staple cartridge may additionally comprise tabs retainers 10026 which may be configured to inhibit the shell, and compressible core, from prematurely detaching from the support portion 10010. Optionally, each retaining clip 10026 may comprise apertures 10028 which may be configured to receive projections 10014 extending therefrom. of the support portion 10010 so that the retainer tabs 10026 can be retained on the support portion 10010. The retainer tabs 10026 may each comprise at least one reservoir portion 10027 which can extend beneath the support portion 10010 and may support and retain the clamp drivers 10040 within the support portion 10010. As described above, a fabric thickness compensator may be removably attached to the support portion 10010 by the clips 10030. More particularly, as also described above, the legs of the staples 10030 may extend into the fabric thickness compensator 10020 when the staples 10030 are in the unfired position and, as a result, releasably secure the fabric thickness compensator 10020 to the support portion 10010. The legs of the staples 10030 may contact the side walls of their respective cavities to staples 10012 wherein, due to friction between staple legs 10032 and the side walls, staples 10030 and fabric thickness compensator 10020 may be retained in position until staples 10030 are dispensed from staple cartridge 10000. When staples 10030 are dispensed, the fabric thickness compensator 10020 can be captured inside the staples 10030 and held against the stapled fabric T. rna is later moved to an open position to release the fabric T, the support portion 10010 can be moved away from the fabric thickness compensator 10020 which has been secured to the fabric. An adhesive may be used to removably secure the fabric thickness compensator 10020 to the support portion 10010. A two-part adhesive may be used of which a first part may be placed on the platform surface 10011 and a second part of the adhesive can be placed over the fabric thickness compensator 10020 so that when the fabric thickness compensator 10020 is placed against the platform surface 10011, the first part can contact the second part to activate the adhesive and secure detachably the fabric thickness compensator 10020 to the support portion 10010. Optionally, any other suitable means could be used to detachably secure the fabric thickness compensator to the support portion of a staple cartridge.

[00463] In addition to the above, the slider 10050 may be advanced from the proximal end 10001 to the distal end 10002 to completely dispense all staples 10030 contained within the staple cartridge 10000. Now referring to Figures 56 to 60, the slider 10050 may be advanced distally into a longitudinal cavity 10016 within the support portion 10010 by a trigger element, or cutter bar, 10052 of a surgical stapler. In use, the 10000 staple cartridge can be inserted into a staple cartridge channel in a surgical stapler jaw, such as the 10070 staple cartridge channel, for example, and the 10052 trigger element can be advanced to contact with the 10050 slider as shown in Figure 56. When the sled 10050 is advanced distally by the trigger element 10052, the sled 10050 may contact the more proximal staple driver or drivers 10040 and fire or eject clips 10030 from the cartridge body 10010 as described above. As illustrated in Figure 56, the trigger element 10052 may further comprise a cutting edge 10053 which can be advanced distally through a knife slot in the support portion 10010 when the staples 10030 are being triggered. In accordance with the invention, a corresponding knife slot can extend through the anvil positioned opposite the staple cartridge 10000 so that the cutting edge 10053 can extend between the anvil and the support portion 10010 and cut the tissue and the fabric thickness compensator positioned between them. In various circumstances, the slider 10050 may be advanced distally by the trigger element 10052 until the slider 10050 reaches the distal end 10002 of the staple cartridge 10000, as shown in Figure 58. At this point, the trigger element 10052 may be retracted proximally. Slider 10050 can be retracted proximally with trigger 10052 but, now referring to Figure 59, slider 10050 may be left behind at distal end 10002 of staple cartridge 10000 when trigger 10052 is retracted. When the trigger element 10052 has been sufficiently retracted, the anvil can be reopened, the fabric thickness compensator 10020 can be detached from the support portion 10010, and the remaining non-implanted portion of the used staple cartridge 10000, inclusive. support portion 10010, can be removed from staple cartridge groove 10070.

[00464] After the used staple cartridge 10000 has been removed from the staple cartridge slot, in addition to the above, a new staple cartridge 10000, or any other suitable staple cartridge, can be inserted into the staple cartridge slot 10070 In addition to the above, the staple cartridge channel 10070, the trigger element 10052, and/or the staple cartridge 10000 may comprise cooperating elements that can prevent the trigger element 10052 from being advanced distally a second time, or a subsequent time, without a new, or unfired, staple cartridge 10000 positioned in the staple cartridge groove 10070. More particularly, again with reference to Figure 56, when firing element 10052 is advanced into contact with slider 10050 and, when the slider 10050 is in its proximal unfired position, a support tip 10055 of the trigger 10052 may be positioned on and/or along a support ledge. and 10056 on slider 10050 so that trigger element 10052 is held in a sufficient vertical position to prevent a lock, or beam, 10054 extending from trigger element 10052 from falling into a locking recess defined within the groove of staple cartridge. As the lock 10054 will not fall into the locking recess, in such circumstances, the lock 10054 may not be in a position bordering a distal side wall 10057 of the locking recess when the trigger 10052 is advanced. When the trigger element 10052 pushes the sled 10050 distally, the trigger element 10052 can be supported in its firing position upwards due to the support tip 10055 resting on the support projection 10056. When the trigger element 10052 is retracted with respect to the slider 10050, as discussed above and illustrated in Figure 59, the trigger element 10052 may detach downwardly from its upward position when the support tip 10055 is no longer resting on the support boss 10056 of the slider 10050 For example, the surgical clip may comprise a spring 10058, and/or any other suitable traction element, which may be configured to traction the trigger element 10052 to its downward position. When firing element 10052 has fully retracted, as shown in Figure 60, firing element 10052 cannot be advanced distally through spent staple cartridge 10000. More particularly, firing element 10052 cannot be held in its upper position by the sled 10050 when the sled 10050, at this point in the operating sequence, has been left behind at the distal end 10002 of the staple cartridge 10000. Thus, as mentioned above, in the case where the trigger element 10052 is advanced again without replacement of the staple cartridge, the locking beam 10054 will contact the side wall 10057 of the locking recess which will prevent the trigger element 10052 from being advanced distally into the staple cartridge 10000 again. In other words, once the used staple cartridge 10000 has been replaced with a new staple cartridge, the new staple cartridge will have a proximally positioned sled 10050 that can hold the firing element 10052 in its upper position and allow the element to trigger 10052 is re-advanced distally.

[00465] As described above, the sled 10050 can be configured to move the clamp drivers 10040 between a first unfired position and a second fired position in order to eject the clamps 10030 from the support portion 10010. The drivers of clips 10040 may be contained within clip cavities 10012 after clips 10030 have been ejected from support portion 10010. Support portion 10010 may comprise one or more retention elements which may be configured to prevent clip drivers 10040 from are ejected or fall out of staple cavities 10012. Alternatively, slider 10050 may be configured to eject staple drivers 10040 from support portion 10010 with staples 10030. For example, staple drivers 10040 may be comprised of a bioabsorbable and/or biocompatible material, such as Ultem, for example. Staple drivers can be attached to staples 10030. For example, a staple driver can be molded onto and/or around the base of each staple 10030 so that the driver is integrally formed with the staple. US Patent Application Serial No. 11/541,123 entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, filed September 29, 2006, is incorporated herein by reference at its entirety.

[00466] As described above, a surgical stapling instrument may comprise a staple cartridge groove configured to receive a staple cartridge, an anvil rotationally coupled to the staple cartridge groove, and a trigger element comprising a tip. blade that is movable with respect to the anvil and staple cartridge groove. In use, a staple cartridge can be positioned inside the staple cartridge groove and, after the staple cartridge has been at least partially used, the staple cartridge can be removed from the staple cartridge groove and replaced. for a new staple cartridge. For example, the staple cartridge groove, anvil, and/or trigger element of the surgical stapling instrument can be reused with the replacement staple cartridge. Alternatively, a staple cartridge may comprise a portion of a disposable loading unit assembly which may include a staple cartridge channel, an anvil, and/or a firing element, for example, which can be replaced along with the cartridge. of staples as part of the replacement disposable charging unit assembly. Certain disposable charging unit assemblies are disclosed in US Patent Application Serial No. 12/031,817 entitled END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, which was filed February 15, 2008, the disclosure of which is incorporated herein by way of reference.

[00467] The fabric thickness compensator may comprise an extrudable, fusible and/or moldable composition comprising at least one of the synthetic and/or non-synthetic materials described herein. The fabric thickness compensator may comprise a film or sheet comprising two or more layers. Fabric thickness compensator can be obtained using conventional methods such as mixing, blending, formulating, spraying, capillary absorption, solvent evaporation, immersion, brushing, steam deposition, extrusion, calendering, casting , molding and the like. In extrusion, an aperture may be in the form of a die comprising at least one aperture for shaping the emerging extrudate. In calendering, an opening may comprise a throttling between two rollers. Conventional molding methods may include, but are not limited to, blow molding, injection molding, foam injection, compression molding, thermoforming, extrusion, foam extrusion, blown film forming, calendering, spinning, solvent welding, coating methods such as dip coating and spin coating, solution casting and film molding, plastisol processing (including knife coating, roller coating and casting) and combinations thereof. In injection molding, an opening may comprise a nozzle and/or channels/gutters and/or mold features and cavities. In compression molding, the composition can be placed in a mold cavity, heated to a suitable temperature, and formed by exposure to compression under relatively high pressure. In casting, the composition may comprise an aqueous liquid or slurry that can be poured or otherwise supplied into, on and/or around a mold or object to replicate features of the mold or object. After casting, the composition can be dried, cooled and/or cured to form a solid.

[00468] According to the invention, a method of manufacturing a tissue thickness compensator comprising at least one drug stored and/or absorbed therein may generally comprise providing a tissue thickness compensator and placing in contact the tissue thickness compensator and the medicament to retain the medicament in the tissue thickness compensator. A method of manufacturing a fabric thickness compensator comprising an antibacterial material may comprise supplying a hydrogel, drying the hydrogel, swelling the hydrogel in an aqueous solution of silver nitrate, contacting the hydrogel and a chloride solution. of sodium to form the fabric thickness compensator that has antibacterial properties. The fabric thickness compensator may comprise silver dispersed therein.

[00469] Now referring to Figure 116, a tissue thickness compensator, such as the tissue thickness compensator 22020, for example, can be attached to an anvil of a surgical stapling instrument, such as the anvil 22060, for example. Fabric thickness compensator 22020 may include a cavity 22024 defined between a first film 22026 and a second film 22027, wherein at least portions of the first film 22026 are attached to the second film 22027. For example, the first film 22026 may be attached to the second film 22027 along side junctions 22028a and 22028b, for example. The first film 22026 may be attached to the second film 22027 along a sealed perimeter to sealably confine the cavity 22024. The first film 22026 and the second film 22027 may be heat-insulated together with the side seams 22028a, 22028b and/or or any other junction that connects movies 22026 and 22027, for example. Referring again to Figure 116, the anvil 22060 may comprise a plurality of staple forming pockets 22062 which may each be configured to receive and deform the staple leg, wherein the second film 22027 may comprise projections 22022 which may extend into forming pockets 22062. Projections 22022 may be sized and configured so that they fit tightly into forming pockets 22062 and can retain fabric thickness compensator 22020 to anvil 22060. As illustrated, anvil 22060 may comprise six rows of forming pockets 22062, wherein fabric thickness compensator 22020 may similarly comprise six rows of projections 22022 which are aligned with forming pockets 22062, for example. Other embodiments comprising more or less than six rows of forming pockets 22062 and/or projections 22022 could be used. One or more adhesives could be used to retain the fabric thickness compensator 22020 to the anvil 20060.

[00470] As discussed above, the fabric thickness compensator 22020 may comprise a cavity 22024 defined therein. Cavity 22024 may extend longitudinally along with anvil 22060. Again referring to Figure 116, tissue thickness compensator 22020 may comprise a compressible material positioned in cavity 22024. Now referring to Figure 117, staples such as staples 22030 , for example, can be ejected from a staple cartridge so that staples 22030 penetrate tissue T and then penetrate tissue thickness compensator 22020 before contacting anvil 22060. As per legs of staples 22030 are deformed by the anvil 22060, the legs can be turned down to re-enter the fabric thickness compensator 22020 once more. In either case, once the staples 22030 have penetrated the fabric thickness compensator 22020, one or more fluids contained in the cavity 22024, for example, may flow or drip out of the fabric thickness compensator 22020 and onto the fabric T. Cavity 22024 may comprise one or more powders contained therein which may escape cavity 22024 once fabric thickness compensator 22020 has been at least partially ruptured by staples 22030, for example. In accordance with the invention, a material 22025 positioned within the cavity 22024 may be compressed or compressed in the clamps 22030 when the clamps 22030 are deformed into their fired configurations so that a fluid stored in the material 22025 can be expressed from the material 22025, e.g. example. Referring again to Figure 117, staples 22030 may also be configured to capture a fabric thickness compensator, such as compensator 22029, for example, removably secured to the staple cartridge against the other side of the fabric T.

[00471] In addition to the above, material 22025 may comprise freeze-dried thrombin, freeze-dried fibrin and/or small fiber nonwoven oxidized regenerated cellulose, for example. Material 22025 may comprise a pellet of compacted powder. The sealed cavity 22024 may comprise an internal atmosphere that has a pressure below the atmosphere surrounding the fabric thickness compensator 22020. In such a case, the pressure difference between the atmosphere in the internal cavity 22024 and the atmosphere may cause the films to 22027 and 22028 are extracted inwards. When inner cavity 22024 is breached by clamps 22030 as described above, the vacuum in inner cavity 22024 can equalize to the surrounding atmosphere and material 22025 can escape inner cavity 22024, also as described above. Under such circumstances, the fabric thickness compensator 22020 may expand and apply a compressive force to the T fabric captured in the staples 20030. Where the material 22025 is vacuum packed in the fabric thickness compensator 22020, the material 22025 may expand after the inner cavity 22024 has been drilled. Films 22026, 22027 may be comprised of a bioabsorbable material and may be configured to dissolve once placed on the patient. For example, each film 22026, 22027 may be comprised of a layer, or laminate, that is between approximately 0.0064 mm (0.25 mils) and approximately 0.013 mm (0.50 mils) thick, for example. In any event, in addition to the above, fabric thickness compensator 22020, including material 22025, may be transected by a cutting element as staples 22030 are fired from its staple cartridge.

[00472] Again with reference to Figure 116, cavity 22024 and material 22025 of fabric thickness compensator 22020 may be positioned below the four inner rows of staple forming pockets 22062 while seams 22028a, 22028b may be positioned below the outer rows of forming pockets 22062. In such cases, staples in the outer rows of staples may not engage material 22025 and thus may not capture material 22025 therein. Instead, such clips can only capture films 22026 and 22027 along junctions 22028a, 22028b. Alternatively, now referring to Figures 118 and 119, a fabric thickness compensator 22120 may comprise, similar to the above, a first film 22126, a second film 22127 and a plurality of materials 22125a-d captured between the first film 22126 and the second film 22127. For example, referring first to Figure 118, the first material 22125a may be aligned with an outer row of staples 22030 in staple cartridge 22000 and an outer row of staple cavities 22062 on the anvil 22060, wherein the second material 22125b and the third material 22125c can each be aligned with the two inner rows of staples 22030 and the cavities of staples 22062, and the fourth material 22126d can be aligned with the other outer row of staples 22030 and clip cavities 22062. In such a case, now referring to Figure 119, all clips 22030 can be arranged so that they can capture at least one of the materials 2212 5a to 22125d therein. As illustrated in Figures 118 and 119, in addition to the above, staples 22030 can be lifted between a non-fired position and a fired position by means of staple drivers 22040 positioned on the staple cartridge 22000.

[00473] Again with reference to Figures 118 and 119, layers 22126 and 22127 may define one or more sealed cavities in which materials 22125a-d may be positioned. Layers 22126 and 22127 may be sealed together along a perimeter which may include side seams 22128a and 22128b, for example, using any suitable process, such as heat and/or laser welding, for example. Each of materials 22125a to 22125d may be sealed in separate cavities while alternatively two or more materials 22125a to 22125d may be sealed in the same cavity. Materials 22125a to 22125d may be comprised of the same material or materials while, alternatively, one or more materials 22125a to 22125d may be comprised of different materials. One or more materials 22125a to 22125d may be comprised of sodium stearate and/or LAE, for example. Materials 22125a to 22125d may comprise a lubricant. In such cases, the legs of the staples 22030 may be exposed to the lubricant when the staple legs penetrate the materials 22125a to 22125d of the fabric thickness compensator 22120. After the legs pass through the fabric thickness compensator 22120, the legs may come into contact. contact with the 22060 anvil, where the lubricant can reduce the friction coefficient and friction forces between the clamp legs and the 22060 anvil. Under such circumstances, the force required to fire the 22030 clamps can be reduced. Due to the position of the fabric thickness compensator 22120 against the anvil 22060, the clamp legs of the staples 22030 can contact the anvil 22060 directly after exiting the fabric thickness compensator 22120 thus reducing the possibility that the lubricant can be removed from the clamp legs prior to contacting the 22060 anvil. Similarly, the clamp legs of the 22030 clamps may contact the 22060 anvil directly after being exposed to one or more drugs in the 22060 Clamp Thickness Compensator. fabric 22120 thus reducing the possibility that drugs may be removed from the staple legs before re-entering the T fabric. Under some circumstances, the staple legs may re-enter the fabric thickness compensator 22120 as the staple legs are deformed down so the clamp legs can be re-exposed to drugs before re-entering the T fabric, for example. Optionally, similar to the above, the second film 22127 may comprise a plurality of projections 22122, for example, which may be firmly received in the clamp cavities 22062 in order to retain the fabric thickness compensator 22120 to the anvil 22060, for example. example.

[00474] Now referring to Figures 120 and 121, an end actuator of a surgical stapling instrument may comprise a tissue thickness compensator, such as the compensator 22220, for example, which may comprise a plurality of aligned cavities 22222 to the staple forming pockets 22062 of the anvil 22060. The compensator 22220 may be comprised of a first or base layer 22226 and a second or top layer 22227, wherein the first layer 22226 and/or the second layer 22227 may comprise a plurality of raised portions or partial bubbles that may define cavities 22222. As illustrated in Figure 120, compensator 22220 may be attached to anvil 22060 such that cavities 22222 align, or at least substantially align, with staple forming pockets 22062 of anvil 22060. Optionally, each cavity 22222 may include one or more medicaments contained therein, such as oxidized regenerated cellulose. a, calcium and/or alginate. In use, each cavity 22222 may be in a sealed, unpunctured state prior to being punctured by staples 22030 ejected from staple cartridge 22000, for example. After the legs of the staples 22030 have passed through the fabric T, now referring to Figure 121, each staple leg can pierce and penetrate the first layer 22226 and enter a cavity 22222 in which the staple leg can pass through one or more drugs contained therein. in it before piercing and penetrating the second layer 22227. Similar to the above, the legs of the clamps 22030 may then contact the anvil 22060.

[00475] Cavities 22222 can maintain the one or more drugs stored therein in a dry or at least substantially dry state before being ruptured. After a cavity 22222 has been ruptured, a fluid, such as blood, for example, can enter the cavity 22222 and mix with one or more drugs. Mixing the fluid with a drug may cause the drug to expand in cavity 22222, where, for example, the drug may comprise at least one hydrogel, for example. The medicament may comprise at least one hemostatic material, for example. First layer 22226 and/or second layer 22227 may be comprised of a flexible material that can stretch to accommodate expansion of the drug. Layers 22226, 22227 may be comprised of a CAP/GLY material, for example. In either case, the expansion of the drug may apply a compressive force to the T-tissue captured within and/or positioned around the staples 22030, for example. Under various circumstances, expansion of the drug can cause cavities 22222 to rupture. A first group of cavities 22222 can comprise a first medicament therein while a second group of cavities 22222 can comprise a second medicament therein, for example. For example, the first drug can be configured to expand at a first amount and/or at a first rate while the second drug can be configured to expand at a second amount and/or at a first rate. second rate, for example, where the first amount may be different from the second amount and/or the first rate may be different from the second rate. In addition to the above, one or more cavities 22222 may include two or more drugs stored in each cavity, wherein the drugs may comprise a first drug and a second drug, for example. A cavity 22222 can maintain the first drug and the second drug in a dry state, or at least substantially dry, before being ruptured. After cavity 22222 has been ruptured as described above, blood, for example, may enter cavity 22222 and mix with the first and second drugs, whereupon the first and second drugs may form an expanding gel.

[00476] Referring now to Figures 122 to 124, a fabric thickness compensator, such as compensator 22320, for example, may comprise a plurality of first cavities 22322a and a plurality of second cavities 22322b which may be aligned with the forming pockets of staples 22062a and 22062b, respectively. Referring first to Figure 123, the staple forming pockets 22062a and 22062b may be defined on separate staggered surfaces on the anvil 22060. More particularly, the forming pockets 22062a may be defined on the first surfaces 22069a of the anvil 22060 and forming pockets 22062b may be defined on second surfaces 22069b, wherein first surfaces 22069a may be positioned offset from, or higher than, second surfaces 22069b, for example. The first cavities 22322a of the fabric thickness compensator 22320 can be larger than the second cavities 22322b, wherein, for example, the first cavities 22322a can extend higher than the second cavities 22322b. As a result of the foregoing, the first cavities 22322a can extend upwardly into the first staple forming pockets 22062a while, at the same time, the second cavities 22322b can extend upwardly into the second staple forming pockets 22062a. 22062b clamps. Optionally, each of the first cavities 22322a can be configured to contain a greater amount of a drug than the second cavities 22322b, for example. Alternatively, first cavities 22322a and second cavities 22322b may obtain the same, or at least substantially the same, amount of medicament therein even if cavities 22322a and 22322b are of different sizes.

[00477] In addition to the above, the first cavities 22322a can be arranged in certain rows, while the second cavities 22322b can be arranged in different rows. A fabric thickness compensator may comprise cavities aligned with each forming pocket while, alternatively, with reference to Figure 130, a fabric thickness compensator such as the compensator 22420, for example, may comprise cavities aligned with only a few forming pockets. . Referring again to Figure 123, compensator 22320 can be attached to anvil 22060. Cavities 22322a and/or cavities 22322b can be configured to fit securely into staple forming pockets 22062a and/or 22062b, respectively. The compensator 22320 may be mounted on the anvil 22060 so that the second layer 22327 of the compensator 22320 is positioned against the second surfaces 22069b of the anvil 22060. Alternatively, now referring to Figures 125 and 126, the compensator 22320 may be positioned adjacent to the anvil 22060 so that the compensator 22320 can be adjacent to the anvil 22060 when the anvil 22060 is moved towards the staple cartridge 22000 to compact the fabric T together. Since staples 22030 have been fired from staple cartridge 22000 and deformed by anvil 22060, now referring to Figure 127, compensator 22320 can be captured against tissue T by staples 22030 and anvil 22060 can be moved in the opposite direction. compensator 22320. Under certain circumstances, now referring to Figure 128, one or more staples 22030 may not be properly deformed by the anvil 22030. Under such circumstances, now referring to Figure 129, the cavities in the fabric thickness compensator that overlap the misfired or malformed staples may not be pierced when the staples are fired. For example, the tissue thickness compensator may be comprised of a bioabsorbable material that can dissolve and subsequently release the drug contained in the unperforated cavities.

[00478] In addition to the above, the first cavities 22322a and/or the second cavities 22322b of the fabric thickness compensator 22320 may comprise a gas, such as air, carbon dioxide and/or nitrogen, for example, sealed therein. . Cavities 22322a and/or 22322b may comprise bubbles which may burst when clamps 22030 are fired through cavities 22322a and 22322b to release the gas contained therein. Such an explosion can provide audio feedback to the surgeon that cavities 22322a and 22322b are bursting. Under some circumstances, however, some of the clamps 22030 may be misfired, as described above, and the cavities 22322a and 22322b associated therewith may not explode. Under various circumstances, the surgeon may scan the stapled tissue for any unexploded blisters, or cavities 22322a and 22322b, and determine if any corrective action is needed.

[00479] As discussed above, now with reference to Figure 131, a surgical stapling instrument may comprise a triggering member, such as triggering member 22080, for example, which may include a cutting member, or cutting edge, 22081 that may advance through fabric T and one or more fabric thickness compensators as firing member 22080 advances through cartridge 22000 to position staples 22030 therefrom. Referring first to Figure 133, a compensator, such as compensator 22520, for example, may be attached to the anvil 22060 of the surgical stapling instrument, wherein the anvil 22060 may include a sized and configured knife slot 22061 to receive at least a portion of the cutting member 22081. Similarly, the staple cartridge 22000 may comprise a knife slot 22011 which is also sized and configured to receive at least a portion of the cutting member 22081. Again with reference to the Figure 131, compensator 22520 may comprise one or more cavities, such as cavities 22522, for example, positioned along a cut line 22521 of compensator 22520, wherein cavities 22522 may be aligned with knife slot 22061 defined in anvil 22060 As cutting member 22081 progresses distally through staple cartridge 22000 to position staples 22030, cutting member 22081 can incise tissue T and cavities 22522 of compensator 22520. Similar to the above, with reference first to Figure 132, each cavity 22522 may define a sealed cavity 22524 which may contain one or more drugs 22525 therein. One or more cavities 22522 may be configured to contain a fluid that can be released when cavities 22522 are at least partially incised by cutting member 22081. Under various circumstances, cutting member 22081 may sequentially incise cavities 22522 and, as a result, release the drugs contained in them sequentially.

[00480] Referring first to Figure 133, the compensator 22520 may comprise lateral projections, or wings, 22529 which may extend along the sides thereof. Projections 22529 may be attached to anvil surfaces 22069a and/or anvil surfaces 22069b using one or more adhesives, for example. Projections 22522 can be sized and configured to fit tightly into knife slot 22061 of anvil 22060 so that, for example, projections 22522 can retain compensator 22520 to anvil 22060. Side projections 22529 can be sized and configured accordingly. that they extend over, or overlap, the staple-forming pockets 22062b and/or the staple-forming pockets 22062a. Alternatively, now referring to Figures 134 and 135, a compensator 22620 may comprise lateral projections 22629 that do not extend over, or overlap, the staple-forming pockets 22062a and 22062b of the anvil 22060 and/or any other staple-forming pockets, for example. For example, the trimmer 22620 may not be captured in a staple 22030 ejected from the staple cartridge 22030. In either case, again with reference to Figure 131, the cutting member 22081 may transection of the trimmer 22520 as the trimmer 22520 is attached to the T fabric by staples 22030. In such cases, tab 22520 may detach from anvil 22060 and remain with fabric T. Again with reference to tab 22620 illustrated in Figures 134 and 135, staples 22030 may not hold tab 22620 to anvil 22060 and may remain attached to anvil 22060 after cutting member 22081 has transected compensator 22620.

[00481] Now referring to Figures 136 and 137, an end actuator of a surgical stapling instrument may comprise a tissue thickness compensator, such as the compensator 22720, for example, which may be secured, or may be - secured to be fixed to an anvil, such as anvil 22760, among others. Similar to the above, the anvil 22760 may comprise a plurality of staple forming pockets 22762 and a longitudinal knife slot 22761 configured to receive a cutting member therein as the cutting member advances through the end actuator. Compensator 22720 may comprise a first layer of film 22726 and a second layer of film 22727 which can be secured together to define a cavity 22724. For example, first layer of film 22726 may be secured to second layer of film 22727 along of a sealed outer perimeter 22728, wherein the sealed outer perimeter 22728 may contain at least one drug 22725 in cavity 22724, for example. As illustrated in Figure 137, cavity 22724 and medicament 22725 may extend under all clamp cavities 22762 and the sealed perimeter 22728 may be positioned laterally with respect to the outermost clamp cavities 22762. Compensator 22720 may additionally comprise a rib longitudinal 22721, for example, which may be configured to extend upwards into the knife slot 22761. For example, the rib 22721 may be sized and configured to fit tightly into the knife slot 22761 in order to hold the compensator 22720 to the anvil 22760. The rib 22721 may be configured to align or center the tab 22720 with respect to the anvil 22760. Similarly, with reference to Figure 138, a fabric thickness tab 22820 may comprise a retaining rib 22821 which may be positioned in knife slot 22761, for example, in order to secure compensator 22820 to anvil 22760. Again with reference to Figure 137, As a cutting member advances through knife slot 22761, under various circumstances, the cutting member may transection rib 22721 and release compensator 22720 from anvil 22760. Such cutting member is shown in Figure 138 as part of the firing member 22080, for example.

[00482] Referring again to Figure 138, the fabric thickness compensator 22820 may comprise a first layer 22826 and a second layer 22827 which may be configured and arranged to define a plurality of first packets 22824a and a plurality of second packets 22824b. Each of the first packets 22824a may be configured to contain a first drug and each of the second packets 22824b may be configured to contain a second drug, wherein the second drug may be different from the first drug. First packets 22824a and second packets 22824b may be arranged in an alternating arrangement. For example, first packs 22824a and second packs 22824b may extend laterally along fabric thickness compensator 22820 such that a second pack 22824b is positioned intermediate the first two packs 22824a and a first pack 22824a is positioned intermediate the two second 22824b packets, for example. As the cutting member 22080 progresses through the compensator 22820, as illustrated in Figure 138, the cutting member 22080 may transition a first packet 22824a, followed by a second packet 22824b, followed by a first packet 22824a, followed by a second package 22824b and so on. Correspondingly, in such cases, the cutting member 22080 may sequentially release the first drug contained in a first packet 22824a and the second drug contained in a second packet 22824b in an alternating arrangement, for example. Where first packets 22824a and second packets 22824b are positioned adjacent to each other, the first drug may be configured to mix with the second drug when they are released from their respective first packets 22824a and second packets 22824b. For example, advancing the permeable cutting member of the compensator 22820 may mix the first drug with the second drug.

[00483] In addition to the above, the first drug may comprise a first powder while the second drug may comprise a second powder. The first drug and/or the second drug may be comprised of a hemostatic material, oxidized regenerated cellulose, alginate and/or calcium, for example. The first drug and/or the second drug may comprise a fluid. One or more of the first packs 22824a and/or one or more of the second packs 22824b may comprise a lubricant that can reduce the force required to advance the trigger member 22080 through the compensator 22820 and/or the fabric T. The first layer of film 22826 and/or the second film layer 22827 may be comprised of a bioabsorbable material, such as PDS, for example. The first film layer 22826 and the second film layer 22827 may be secured together so that the first packets 22824a are sealed from the second packets 22824b before being incised by the trigger member 22080. The first packets 22824a and/or the second packages 22825b may comprise a certain breaking strength in order to withstand a certain burst pressure. More particularly, when an anvil, such as anvil 22760, for example, moves compensator 22820 toward a staple cartridge positioned opposite anvil 22760, packs 22824a, 22824b may be positioned against tissue positioned intermediate the packs 22824a, 22824b and the staple cartridge, wherein the anvil 22760 can then be pushed, or pinched, down toward the staple cartridge to compress the tissue positioned therebetween. Under such circumstances, packages 22824a, 22824b may be subjected to compressive pressures. Under some circumstances, it may be desirable for packs 22824a and/or packs 22824b to remain intact until they are incised by cutting member 22080 and/or pierced by staples fired from the staple cartridge. In certain other circumstances, it may be desirable for the packs 22824a and/or packs 22824b to rupture due to the compressive pinch load applied thereto.

[00484] As discussed above, first packets 22824a and second packets 22842b may extend laterally along compensator 22820. First packets 22824a may extend along transverse axes 22823a, while second packets 22824b may extend along of transverse axes 22823b, for example. The first axis 22823a and/or the second axis 22823b may be perpendicular, or at least substantially perpendicular, to a longitudinal axis 22083 of the compensator 22820. For example, the longitudinal axis 22083 may define the cutting path of the firing member 22080. The first axis 22823a and/or second axis 22823b may not be perpendicular to longitudinal axis 22083 and may be inclined with respect to longitudinal axis 22083. Optionally, as discussed above, first packs 22824a and second packs 22824b may be arranged in an alternate layout. Alternatively, any other suitable arrangement of first packets 22824a and second packets 22824b can be used. For example, a sequence of packs arranged on a fabric thickness compensator could include a first pack 22824a, a second pack 22824b, a second pack 22824b and a first pack 22824a. A fabric thickness compensator may further comprise a plurality of third packs that comprise a third drug that is different from the first drug and the second drug. For example, the first packets, the second packets and the third packets can be arranged in an alternating arrangement. For example, a sequence of packs arranged on a fabric thickness compensator could include a first pack, followed by a second pack, which is followed by a third pack, for example.

[00485] Again with reference to Fig. 138, the first packs 22824a and/or the second packs 22824b of the fabric thickness compensator 22820 may define U-shaped, or at least substantially U-shaped, cross-sections, for example. Referring now to Figure 139, packs 22924 of a fabric thickness compensator 22920 may define circular, or at least substantially circular, cross-sections, for example. Referring now to Figure 140, packs 23024 of a fabric thickness compensator 23020 may define oval and/or elliptical cross-sections, for example. Referring again to Figure 138, first cavities 22824a and second cavities 22824b may comprise symmetrical, or at least nearly symmetrical, configurations which are defined in parallel, or at least substantially parallel, rows. Alternatively, now referring to Figure 141, a fabric thickness compensator, such as the compensator 23120, for example, may comprise asymmetric cavities 23122 defined therein which may have an irregular and/or non-repeating pattern, for example . For example, each of the cavities 23122 may contain one or more different drugs therein.

[00486] Now referring to Figure 142, a fabric thickness compensator, such as the fabric thickness compensator 23220, for example, may comprise a housing 23226 defining a cavity 23224 therein and a material 23225 positioned in the cavity 23224. Compartment 23226 could be comprised of a resorbable polymer, PDS, PGA, PLLA, Cap Gly and/or PCL, for example, while material 23225 could be comprised of a hemostatic agent, oxidized regenerated cellulose, Hercules, fibrin and/or thrombin , for example, which can take any suitable form such as a powder, fiber and/or gel, for example. Housing 23226 can be manufactured using an extrusion process. In such cases, housing 23226 may comprise a constant, or at least substantially constant, cross-section along its length that can be created without having to weld a joint. For example, cavity 23224 may be defined by a side wall extending around the entire perimeter thereof with no openings defined therein. Housing 23226 may be comprised of a mesh and/or straw-like material having openings defined therein. Apertures may be cut in housing 23226 by means of a laser cutting process and/or a die cutting process, for example.

[00487] As part of the fabrication of material 23225, now referring to Figures 145 to 147, a strand of yarn can be created using fibers and/or a fibrous material, such as oxidized regenerated cellulose, for example. The longer fibers 23325, shown in Figure 145, and the shorter fibers 23425, shown in Figure 146, may be blended as illustrated in Figure 147 to form the strand of yarn of material 23225. The strand of yarn may be extracted and/or or placed under tension in order to stretch the fibers contained therein in a longitudinal direction. Referring now to Figure 148, the strand of yarn of material 23225 can be softened by grippers 23290 which can grip and twist the material 23225 in order to increase the volume of the strand of yarn. For example, grips 23290 can soften material 23225 as the strand of yarn moves relative to grips 23290, for example. Referring again to Figure 148, the cutting elements 23291 could be used to make small incisions and/or microcuts, for example, in the strand of yarn of material 23225. Similar to the above, the cutting elements 23291 can cut the material 23225 as the strand of yarn moves relative to the cutting elements 23291. The strand of yarn of material 23225 may be softened before the incisions described above are performed while, alternatively, the strand of yarn of material 23225 could be incised before to be softened.

[00488] Once the strand of yarn of material 23225 has been properly prepared, the material 23225 can be positioned in compartment 23226. Now referring to Figure 149, two or more compartments 23226 could be formed together as part of an extrusion process, discussed above, in which compartments 23226 can be connected together as part of a tube 23227. The strand of yarn of material 23225 can be positioned within, or drawn into, cavity 23224 defined in tube 23227. strand of wire of material 23225 may be positioned adjacent and/or within a first open end 23221 of cavity 23224, wherein a jaw 23292 may be inserted through a second open end 23222 of cavity 23224. The jaw 23292 may be be then pushed through cavity 23224 until jaws 23292a of gripper 23292 pass through, and/or are positioned with respect to, first open end 23222 so that gripper jaws 23292a can be manipulated to grip the strand of yarn of material 23225. A gripper may comprise a hook member, for example, which can be configured to grip the strand of yarn of material 23225. In either case, once the gripper 23292 has sufficiently gripped the strand of material yarn 23225, the gripper 23292 can be dragged back into the cavity 23224 in order to pull the strand of material yarn 23225 into the cavity 23224. The gripper 23292 can be configured to twist the strand of yarn of material 23225 before, during and/or after the strand of yarn is pulled into the tube 23227.

[00489] Once the strand of yarn of material 23225 has been properly positioned in the tube 23227, the gripper 23292 can then be operated to release the strand of yarn of material 23225. The strand of yarn can be released before that the strand of yarn is pulled through the second open end 23222 of the tube 23227 while, alternatively, the strand of yarn may be released after the strand of yarn has been passed through the second open end 23222, as illustrated in Figure 150. In certain circumstances, the strand of yarn may be passed through the second open end 23222 so that when the strand of yarn is released, the strand of yarn can shrink, or press back, in the tube 23227 through the second open end 23222 Under various circumstances, the strand of wire may be cut adjacent to the first open end 23221 so that, similar to the above, the strand of wire may shrink, or snap back, in the t 23227 through the first open end 23222. Under various circumstances, in addition to the above, the gripper 23292 may apply a tension force to the strand of wire of material 23225 so that when the gripper 23292 releases the strand of wire and /or when the strand of yarn is cut, the tension force in the strand of yarn can be recovered, thus allowing the strand of yarn to contract.

[00490] Once the strand of yarn of material 23225 has been sufficiently positioned in the tube 23227, now referring to Figure 151, the tube 23227 and the material 23225 can be cut to form a plurality of segments, where each segment can be be turned into a 23220 fabric thickness compensator, for example. The cavity 23224 extending through the cap 23226 of each segment may comprise an open end at opposite ends thereof. For example, one or both of the open ends may be closed and/or sealed by means of a hot fit, heat solder and/or laser solder process, for example. Referring to Figure 152, a segment comprising a cap 23226 and a portion of material 23225 therein may be positioned in a die configured to close and/or seal the open ends of the cap 23226. More particularly, the die may comprise a base 23294 and a movable portion 23296, for example, wherein the segment can be positioned in a cavity 23295 defined in the base 23294. Once positioned, the movable portion 23296 can be moved downwardly to apply a force to the segment. Optionally, heat may be applied to the segment via the base 23294 and/or the movable portion 23296, wherein the heat and/or force applied to the segment can distort the cap 23226. More specifically, the movable portion 23296 may define a pocket 23297 which can be circumvented to apply a pinching force to certain portions of the cover 23226, such as the open ends thereof, in order to close, flatten, and/or narrow such portions of the fabric thickness compensator 23220. For example, the pocket 23297 may be configured to form the closed ends 23228 of the fabric thickness compensator 23220 and flatten the portion of the fabric thickness compensator 23220 positioned intermediate the closed ends 23228. After the fabric thickness compensator 23220 has been properly formed, the movable portion 23296 can be moved to an open position and the fabric thickness compensator 23220 can be removed from the die. The fabric thickness compensator 23220 can then be positioned in a cooling vessel, where the compensator 23220 can be allowed to cool to room temperature and/or to any other suitable temperature.

[00491] Alternatively, in addition to the above, tube 23227 may be positioned in a hot forming die after material 23225 has been positioned therein. After the tube 23227 and the material 23225 positioned therein have been formed, the tube 23227 and the material 23225 can then be segmented into a plurality of fabric thickness compensators 23220, for example. Referring again to Figure 142, the fabric thickness compensator 23220 may comprise side wings, or tabs, 23229 which may be configured to be attached to the anvil 22060, for example. For example, side wings 23229 can be formed on cover 23226 when fabric thickness compensator 23220 is formed between die portions 23294 and 23296 as described above. Referring now to Figure 143, a fabric thickness compensator 23320 may comprise side wings 23329 extending from cover 23326. Now referring to Figure 144, a fabric thickness compensator 23420 may comprise a cover 23426 having a or more flexible side joints 23428, for example, which may allow the cap 23426 to flex and flatten when subjected to compressive pressure in the hot forming die described above. Optionally, as a result of the above, the fabric thickness compensator 23220 may not comprise side seams. In such cases, again referring to Figure 142, material 23225 may extend to the side edges of anvil 22060, for example.

[00492] As described above, a strand of yarn can be passed through a tube and then cut to length to form one or more fabric thickness compensators. In addition to the above, a strand of wire can be pulled or pushed through a tube using a rigid strand of material. A rigid bead of polymeric material, such as PCL, for example, can be heated above its glass transition temperature and extended into a deformed shape. For example, the rigid strand may comprise an undeformed coil shape which, when extended in its deformed shape, may comprise a straight, or at least substantially straight, shape, for example. Thereafter, the rigid bead can be cooled below the glass transition temperature of the material while the rigid bead is constricted so that the rigid bead can maintain its deformed shape. Once the rigid strand is in its deformed shape, fibers for example can be formed around the rigid strand. A strand of ORC yarn, for example, can be wrapped around, bunched and/or folded over the rigid strand. Alternatively, the rigid strand can be inserted into ORC fibers, for example. The rigid strand may comprise a tacky surface which can be wrapped and/or dipped in the ORC fibers. In either case, the rigid strand and ORC fibers can then be inserted into a tube, similar to the one set out above, and heated again above the glass transition temperature of the rigid strand. Under such circumstances, the rigid cord may be unconstrained, or at least substantially unconstrained, and may be allowed to return, or at least substantially return, to its original undeformed shape. For example, the rigid cord can contract when it returns to its original shape and retracts the ORC fibers in the tube. The center of the tube can be pinched to retain the rigid strand and ORC fibers in the center of the tube as the rigid tube contracts. Similar to the above, the ends of the tube may be sealed to confine the rigid strand and ORC fibers therein.

[00493] Now referring to Figure 244, a fabric thickness compensator 33320 may comprise a housing 33326, a compressible core positioned in the housing 33326 and closed ends 33328 which may be configured to contain the compressible core in the housing 33326. As set out above, housing 33326 may be produced from a continuous extrusion process and may comprise a continuous cross-sectional shape along the length thereof. Referring now to Figures 245 to 247, a fabric thickness compensator 33420 may comprise a housing 33426, a cavity 33424 defined in housing 33426, and a core 33425 positioned in cavity 33424. For example, housing 33426 may comprise a film body formed from a continuous extruded shape and the core 33425 may comprise a fibrous drug core, such as ORC, for example. Housing 33426 may comprise one or more flexible legs 33423 which may be configured to extend into a knife slot 22063 defined in anvil 22060 and releasably retain fabric thickness compensator 33420 to anvil 22060. Figures 248 to 250, a fabric thickness compensator 33520 may comprise a housing 33526, a cavity 33524 defined in housing 33526, and a core 33425 positioned in cavity 33524. For example, housing 33526 may comprise a film body. formed from a continuous extruded shape and the core 33425 may comprise a fibrous drug core, such as ORC, for example. Housing 33526 may comprise one or more retaining members 33528 which may be configured to extend around the outer surface of anvil 22060 and releasably retain tissue thickness compensator 33520 to anvil 22060. For example, referring to 250, the housing 33526 may comprise movable portions 33527 and a gap 33523 defined between the movable portions 33527, wherein, after the fabric thickness compensator 33520 has detached from the anvil 22060, the movable portions 33527 can spring open to expose the 33425 core contained therein. Referring now to Figures 251 and 252, a fabric thickness compensator 33620 may comprise a housing 33626, a cavity 33424 defined in housing 33626, and a core 33425 positioned in cavity 33424. For example, housing 33626 may comprise a film body formed from a continuous extruded shape and the core 33425 may comprise a fibrous drug core, such as ORC, for example. Housing 33626 may comprise a thin section 33623 that may be aligned with the knife slot 22063 defined in the anvil 22060 so that a cutting member passing through the fabric thickness compensator 33620 can pass through the thin section 33623 and reduce the force or energy required. to transect the fabric thickness compensator 33620. Now referring to Figures 253 to 254, a fabric thickness compensator 33720 may comprise a housing 33726, a cavity 33424 defined in the housing 33726 and a core 33425 positioned in the cavity 33424. For example, housing 33726 may comprise a film body formed from a continuous extruded shape and core 33425 may comprise a fibrous drug core such as ORC, for example. Housing 33726 may comprise one or more retaining members 33723 which may be configured to wrap around the outer surface of anvil 22060 and releasably retain fabric thickness compensator 33720 to anvil 22060. Now with reference to Figures 255 and 256, a fabric thickness compensator 33820 may comprise a housing 33826, a cavity 33424 defined in housing 33826, and a core 33425 positioned in cavity 33424. For example, housing 33826 may comprise a film body formed from an extruded shape. continuous and the core 33425 may comprise a fibrous drug core, such as ORC, for example. Housing 33826 may comprise a substantially rectangular cavity 33424 and a substantially flat fabric contact surface 33829 as opposed to the arcuate cavity 33424 and the fabric contact surface shown in Figure 254, for example. Referring now to Figures 257 to 258, a fabric thickness compensator 33920 may comprise a housing 33926, a plurality of cavities 33924 defined in housing 33926, and a core 33925 positioned in each of cavities 33924. For example, housing 33926 may comprise a film body formed from a continuous extruded shape and the cores 33925 may each comprise a fibrous drug core such as ORC, for example. The 33925 cores can be comprised of different materials. Housing 33926 may comprise one or more retaining members 33923 which may be configured to extend into knife slot 22063 of anvil 22060.

[00494] Now referring to Figure 153, a fabric thickness compensator can be formed using a bending process. In accordance with the invention, a 23525 material, such as oxidized regenerated cellulose, for example, can be placed on a lid sheet 23526 which can be folded and then sealed to encapsulate the 23525 material. cap 23526 can be comprised of cap gly, for example. A continuous process can be used in which lid sheet 23526 can be passed under a hopper 23592 which is configured to dispense material 23525 onto lid sheet 23526. For example, lid sheet 23526 can be flattened between a cylinder 23591 and an anvil 23590 before the material 23525 is placed on the cover sheet 23526. The material 23525 may be placed on one side, or over half, of the cover sheet 23526, wherein the other side, or half, of the cover sheet. cap 23526 may be folded, or inverted, over material 23525. Before, during, and/or after material 23525 has been placed over cap sheet 23526, cap sheet 23526 may be folded or at least partially folded. Anvil 23590, for example, may comprise a cam surface 23594 that may be configured to lift one edge or side of longitudinally moving lid sheet 23526 and then fold lid sheet 23526 in half, for example. Cam surface 23594 may comprise a three-dimensional cam or barrel cam, which progressively lifts and rotates a portion of lid sheet 23526 as lid sheet 23526 passes cam surface 23594.

[00495] After the cover sheet 23526 has been folded over the material 23525, the folded cover sheet 23526 and the material 23525 positioned thereon can pass through a die 23593 which can compress and/or compact the folded cover sheet 23526 and the material 23525 to form a tube 23527. The edges of the folded lid sheet 23526 may be sealed by using any suitable process such as heat welding and/or laser welding, for example. Tube 23527 may be further flattened by means of one or more cylinders 23595, for example, before the side wall of tube 23527 has been sealed. Tube 23527 may be further flattened by means of one or more cylinders after the side wall of tube 23527 has been sealed. In either case, the tube 23527 may be segmented into portions to create separate fabric thickness compensators. The ends of the fabric thickness compensators may be sealed using any suitable process such as heat welding and/or laser welding, for example, while alternatively one or both ends of the fabric thickness compensator may remain in a open configuration, for example.

[00496] Now referring to Fig. 154, a buffer may be attached to an anvil, such as anvil 22060, for example, wherein the buffer may be configured to store at least one drug therein. A compensator 23620 may comprise a central body portion 23626 and lateral attachment portions 23628 which may be configured to be attached to anvil 22060. Compensator 23620 may further comprise an array of capillary channels 23627 defined in a tissue contact surface 23625 of the compensator 23620, wherein the capillary channels 23627 may be configured to store one or more drugs therein. For example, the drug may comprise a fluid which, due to fluid tension forces, may be held between the side walls of the capillary channels 23627. Under various circumstances, the drug may be applied to the buffer 23620 before the buffer 23620 is attached. to the anvil 22060 while, under some circumstances, the drug may be applied to the compensator 23620 after it has been attached to the anvil 22060, for example. In either case, the compensator 23620 can be configured to contact tissue positioned between the anvil 22060 and a staple cartridge positioned opposite the anvil 22060, whereby the drug stored in the capillary channels 23627 can flow over the tissue. Under various circumstances, the drug can flow into the 23627 capillary channels.

[00497] Again with reference to the compensator 23620 illustrated in Figure 154, the capillary channel arrangement 23627 may be constructed and arranged in a cross hatch pattern, wherein a first quantity of channels 23627 may extend in a first direction and a second quantity of channels 23627 can extend in a second direction. The first number of channels 23627 may intersect and may be in fluid communication with the second number of channels 23627. Now referring to Figure 155, a compensator 23920 may comprise a body 23926 that includes an array of capillary channels 23927 defined in a tissue contact surface 23925. Channels 23927 can be defined along linear paths while channels 23927 can be defined along non-linear paths. A first number of channels 23927 may extend along axes 23923 while a second number of channels 23927 may extend along axes 23924, for example where axes 23923 may extend in directions other than axes 23924. The axes 23923 may be perpendicular, or at least substantially perpendicular, to axes 23924, where channels 23627 may define islands 23922 therebetween. For example, the top surfaces of the islands 23922 may define the fabric contact surface 23925 of the compensator 23920. The compensator 23920 may comprise a longitudinal axis 23921 and the channels 23627 may extend in directions that are transverse or inclined with respect to the axis. 23921. Again with reference to Figure 154, a compensator 23720 may comprise a frame 23726 and a plurality of capillary channels 23727 defined in the body 23726. The compensator 23720 may additionally comprise a longitudinal channel 23721 that may be in fluid communication with the capillary channels 23727. Optionally, one or more drugs may be stored in longitudinal channel 23721, wherein drugs may flow between channel 23721 and capillary channels 23727, for example. Channel 23721 may define a longitudinal protrusion that may extend upward into a longitudinal knife slot 22061 defined in anvil 22060.

[00498] As discussed above, again with reference to Figure 154, an array of capillary channels defined in a compensator may comprise a cross hatch pattern. Alternatively, however, an array of capillary channels may comprise any suitable shape or configuration. For example, with reference to the compensator 23820 illustrated in Figure 154, the channels 23827 defined in the body 23826 of the compensator 23820 may comprise parallel diagonal channels that converge in the direction and/or diverge in the opposite direction to a central channel 23821, for example. Referring now to Figure 158, an end actuator of a surgical stapling instrument may include a staple cartridge 24000 including a tissue thickness compensator 24010, wherein the tissue thickness compensator 24010 may include at least one drug, such as the medicament 24001, for example, in and/or on the same. Referring now to Figure 159, a compensator 24020 attached to an anvil 24060, for example, can be moved to a closed position in order to bring the compensator 24020 into contact with the tissue thickness compensator 24010. Under such circumstances, the drug 24001, for example, can be transferred from fabric thickness compensator 24010 to compensator 24020. Now referring to Figure 160, compensator 24020 may comprise a fabric contact surface 24025 that can be brought into contact with the thickness compensator of tissue 24010, wherein drug 24001 may flow into capillary channels 24027 defined in tissue contact surface 24025. Now referring to Figure 157, buffer 24020 may include at least one drug, such as drug 24002, for example , on the same and/or on the same that can be transferred from the compensator 24020 to the fabric thickness compensator 24010.

[00499] Referring now to Figures 240 and 241, a tissue thickness compensator 33020 may comprise a plurality of channels and/or wells defined in the surface thereof. Fabric thickness compensator 33020 may comprise a longitudinal channel 33026 extending along a longitudinal axis defined through fabric thickness compensator 33020. For example, the end of longitudinal channel 33026 may be in fluid communication with the perimeter of the fabric thickness compensator 33020. tissue thickness compensator 33020. The tissue thickness compensator 33020 may further comprise a plurality of wells 33022 and, in addition, a plurality of diagonal channels 33024 which are in fluid communication with the wells 33022 and with the longitudinal channel 33026. O fabric thickness compensator 33020 may further comprise a plurality of inlet and outlet channels 33027 which may be in fluid communication with the wells 33022 and with the perimeter of the fabric thickness compensator 33020. Optionally, as a result of the foregoing, fluids may flow into and/or out of the 33020 Fabric Thickness Compensator before, d during and/or after it has been implanted against the patient's tissue. The pattern of channels 33024, 33026 and 33027 and the wells 33022 defined in the fabric contact surface 33025 of the fabric thickness compensator 33020 can define grip edges that can be configured to contact the fabric and limit slip between the 33020 fabric thickness compensator and fabric. Referring now to Figures 240A and 241A, a fabric thickness compensator 33120 may comprise a plurality of circular channels defined in the surface thereof. Fabric thickness compensator 33120 may comprise concentric circular channels 33127 comprising openings defined in the perimeter of fabric thickness compensator 33120. Similar to the above, fluids may flow into and/or out of the fabric thickness compensator 33120. fabric 33120 through channels 33127. Fabric thickness compensator 33120 may comprise concentric circular channels 33122 which may not include openings defined in the perimeter of fabric thickness compensator 33120. Now referring to Figures 242 and 243, a fabric thickness compensator 33120 fabric 33220 may comprise a plurality of ridges 33227 extending therefrom which may be configured to catch fabric that is positioned against the fabric thickness compensator 33220. Crests 33227 may be straight or ridges 33227 may comprise a contour curved, for example. While the ridges and channels described above may be useful for tissue thickness compensators, such ridges and channels could be used with any suitable bioabsorbable and/or biocompatible layer.

[00500] According to the invention, a compensator can be comprised of a plurality of layers. The compensator may comprise a first layer and a second layer attached to the first layer, for example. The first layer may comprise a tissue-contacting surface and a plurality of capillary channels defined in the tissue-contacting surface. The first layer may also comprise capillary channels defined on a side that faces the second layer and faces away from the tissue contacting surface. The second layer may comprise capillary channels defined therein. Wells can be defined between the first layer and the second layer of the compensator. Capillary channels can be formed in the layers of the compensator using any suitable process, such as during a molding process in which the layers are formed and/or during a hot assembly process, for example. A hot assembly process can be used to fix the compensator layers together, for example. For example, the layers may be comprised of a material that can become deformable when heat is applied to them, such as CAP/GLY (36/64), for example. In either case, the capillary channels defined in the tissue contacting surface of the compensator can define gripping surfaces therebetween which can improve gripping, or control, which can be applied to tissue positioned between the anvil and staple cartridge of the compensator. surgical stapling instrument. Stated another way, the capillary channels defined in the tissue contacting surface of a compensator can decrease the area in which the compensator can contact tissue. Under such circumstances, the smaller contact area can result in higher contact pressures between the compensator and fabric for a given force. Under various circumstances, higher contact pressures can reduce slip between the compensator and fabric.

[00501] Optionally, one or more drugs can be positioned in the capillary channels and/or voids defined within and/or between the first layer and the second layer. The plurality of layers comprising a buffer may comprise a package of therapeutic layers or therapies. For example, a first layer may be comprised of a first drug and a second layer may be comprised of a second drug, where the first drug may be different from the second drug. For example, capillary channels defined in the first layer may store a third drug and capillary channels defined in the second layer may store a fourth drug, where the first, second, third and/or fourth drugs may be different, for example. The first, second, third and/or fourth drugs may be different, for example. Referring now to Fig. 161, a compensator 24120 may comprise a plurality of layers, such as layers 24121 to 24125, for example. First layer 24121 and/or fifth layer 24125 may comprise a flat sheet of material between which second layer 24122, third layer 24123 and/or fourth layer 24124 may be sandwiched. Optionally, one or more layers 24121 to 24125 may comprise one or more channels 24127 defined therein. Channels 24127 can extend from one end of the compensator 24120 to the other end and channels 24127 can extend from one side of the compensator 24120 to the other. Channels 24127 may extend in any suitable direction between any suitable side and/or end of compensator 24120. Now referring to Figures 164 and 165, a compensator 24820 may comprise two or more inner layers 24827 which may define side channels 24822, for example, which extend from one side of the 24820 compensator to the other. Referring again to Figure 161, channels 24127 defined in one of layers 24121 to 24125 can be aligned to channels defined in a layer positioned adjacent thereto. Channels 24127 defined in one of layers 24121 to 24125 may face, or open in direction, towards a flat surface in a layer positioned adjacent thereto. Again referring to Figure 161, one or more of layers 24121 to 24125 may comprise at least one well 24129 defined therein. Wells 24129 may be in fluid communication with one or more of the channels 24127 defined in the layer. Similar to the above, wells 24129 may comprise an aperture system that opens towards, or faces, an adjacent layer, whereby the adjacent layer may plug the aperture.

[00502] In addition to the above, channels 24127 and/or wells 24129 can be configured to contain one or more drugs therein. Channels 24127 may comprise one or more open ends that may allow a drug to flow out of channels 24127. Similarly, channels 24127 may include one or more openings that may be configured to allow a fluid, such as blood, to flow through. for example, flow into channels 24127. In such cases, fluid may flow into buffer 24120, absorb at least a portion of a drug and/or a layer 24121 to 24125, and then flow out of buffer 24120. Referring again to Figures 164 and 165, compensator 24820 may comprise apertures 24828 defined in outer layer 24826, for example. Referring again to Figure 161, layers 24121 to 24125 can be comprised of any suitable material, such as a bioabsorbable polymer, PLA and/or PGA, for example. All layers 24121 to 24125 may be comprised of the same material. Alternatively, one or more of layers 24121 to 24125 could be comprised of different materials. Optionally, one or more of layers 24121 to 24125 may include through holes 24128 extending therethrough which may be configured to allow fluids, such as blood, for example, to flow into channels 24127, wells 24126 and/or between two or more from layers 24121 to 21135, for example. One or more of layers 24121 to 24125 can be connected to each other using a hot welding process and/or laser welding, for example. In such cases, the fluid or fluids flowing into the compensator 24120 can dissolve the welded portions of layers 24121 to 24125 and allow layers 24121 to 24125 to separate and/or delaminate. One or more of layers 24121 to 24125 may be comprised of a material that dissolves at a faster rate and/or at a slower rate than the material or materials comprising outer layers 24121 to 24125. inner layers 24122 to 24124 of the buffer 24120 may be comprised of a material that dissolves at a faster rate than the material or materials comprising outer layers 24121 and 24125, for example. In such cases, the compensator 24120 can maintain a consistent overall shape, or at least substantially consistent, while the inner part of the compensator 24120 dissolves in the opposite direction. The outermost layers of a compensator may be comprised of a material that dissolves at a faster rate than the material, or materials, comprising the innermost layers of the compensator, for example. The layers may comprise sheets of material having a thickness between approximately 0.025 mm (1 mil) and approximately 0.10 mm (4 mils), for example.

[00503] Now referring to Figures 162 and 163, a compensator, such as the compensator 24220, for example, may comprise a support layer 24226 which may be configured to be attached to an anvil, such as the anvil 22060, for example, and /or a staple cartridge. Compensator 24220 may further comprise a frame 24222 attached to support layer 24226, wherein frame 24222 may comprise a plurality of layers of frame 24227. The frame may comprise a three-dimensional structural matrix, for example. Optionally, each of the frame layers 24227 may be comprised of a plurality of fibers. Referring now to Figure 166, each frame layer 24227 may be comprised of a fiber web including a first plurality of fibers 24228 extending in a first direction and a second plurality of fibers 24229 extending in a second direction, or different. Each fiber web may comprise a plurality of pockets, or cavities, 24223, wherein layers 24227, fibers 24228, 24229, and cavities 24223 may define a matrix favorable to tissue and cell invagination. Fibers 24228, 24229 and/or any other suitable fiber may be comprised of a bioabsorbable material. Fibers can be comprised of a hemostatic agent, active agents linked such as those that are biologically and/or pharmacologically active and/or support members, for example, which can be intercalated with each other. In either case, the material of the fibers can be selected to induce a desirable biological response such as cell migration into the 24222 scaffold, secretion of ECM and/or proliferation of structural support cells, for example.

[00504] In addition to the above, backing layer 24226 may be configured to structurally support frame 24222. Frame 24222 may be secured to backing layer 24226 using one or more bioabsorbable adhesives, for example. Similarly, backing layer 24226 can be attached to an anvil or staple cartridge using one or more biocompatible adhesives, for example. Layers 24227 of frame 24222 may be arranged, or stacked, in any suitable manner. Each layer 24227 can comprise a pattern of fibers, where the layers 24227 can be arranged on the frame 24222 so that the patterns of the layers 24227 are aligned with each other. Referring to Figure 167, layers 24227 can be stacked on top of one another so that fibers 24228 in a first layer 24227 are aligned with fibers 24228 in a second layer 24227. Similarly, layers 24227 can be stacked one on top of each other. the other so that fibers 24229 in first layer 24227 are aligned with fibers 24229 in second layer 24227. Now referring to Figure 168, a frame 24422 may comprise a plurality of layers of frame 24427, wherein fibers 24429 in each layer frame 24427 are oriented in the same direction, such as a longitudinal direction for example. Referring now to Figure 170, each frame layer 24227 may comprise a pattern of fibers, wherein the layers 24227 may be arranged in a frame 24322 so that the patterns of layers 24227 are not aligned with each other. Layers 24227 can be stacked on top of each other so that fibers 24228 in a first layer 24227 extend in a direction that is transverse or oblique to fibers 24228 in a second layer 24227. Similarly, layers 24227 can be stacked one on top of the other so that the fibers 24229 in the first layer 24227 extend in a direction that is transverse or oblique to the fibers 24229 in the second layer 24227. Now referring to Figure 171, a frame 24522 may comprise a plurality of frame layers 24427 that are oriented so that the fibers 24229 in each frame layer 24427 are oriented in different directions, for example.

[00505] In addition to the above, a first frame layer 24227 of a frame 24222, for example, may be comprised of a first material, while a second frame layer 24227 of a frame 24222 may be comprised of a - Second material, or different. The first material may comprise a first drug, while the second material may comprise a second or different drug, for example. In addition to the above, a first frame layer 24227 of a frame 24222, for example, may comprise a first drug absorbed into the fibers thereof, while a second frame layer 24227 of frame 24222 may comprise a second or different drug. , absorbed in the fibers thereof, for example. The first material may comprise a first drug, while the second material may comprise a second or different drug, for example. A frame may comprise any suitable number of layers having any suitable density of fibers which are comprised of any suitable number of materials.

[00506] Tissue Thickness Compensators can be fitted to a surgical device, such as a surgical cutting and stapling device, for example, using a retainer. The retainer may include a gripping surface and allows a surgeon, nurse, technician, or other individual to align one or more of the tissue thickness compensators to features of the surgical instrument, such as an anvil and/or staple cartridge, for example. The retainer may include features that align with one or more tissue thickness compensators by engaging a staple cartridge of the surgical instrument. The retainer may include features that align with one or more tissue thickness compensators by engaging an anvil of a surgical instrument. A surgical instrument staple cartridge may be included with the retainer, and the engagement of the surgical instrument retainer may install the staple cartridge in the surgical instrument and align with one or more of the tissue thickness compensators. After the tissue thickness compensators have been aligned and secured to the surgical instrument, the retainer can be detached from the tissue thickness compensators and then removed from the surgical instrument.

[00507] Figures 61-67 illustrate an embodiment of a retainer 19000 that can be used to attach a first fabric thickness compensator 19002 to an anvil 19040 and a second fabric thickness compensator 19004 to a staple cartridge 19050 of a surgical stapler, for example. A retainer assembly 19060 may be provided that includes retainer 19000, first tissue thickness compensator 19002, and second tissue thickness compensator 19004. In general use, retainer assembly 19060 may be inserted between the anvil 19040 and a channel configured to support the staple cartridge 19050. Thereafter, the anvil 19040 can be closed. When closing the anvil 19040, the anvil 19040 can be pressed against the first fabric thickness compensator 19002 so that the first fabric thickness compensator 19002 can be fixed to the anvil 19040. Closing the anvil 19040 compresses the retainer 19000 and seats the 19050 staple cartridge in the channel of the surgical instrument. When the anvil 19040 is opened again, the first tissue thickness compensator 19002 may detach from the retainer 19000 and when the retainer 19000 is subsequently removed from the surgical device, the retainer 19000 may detach from the second tissue thickness compensator 19004. The surgical device is then ready for use with the first tissue thickness compensator 19002 attached to the anvil 19040 and the second tissue thickness compensator 19004 attached to the staple cartridge 19050.

[00508] Referring to Figure 61, retainer 19000 may include a handle 19014 through which an individual, such as a surgeon, nurse, or technician who prepares surgical instruments, may grasp retainer 19000. Retainer 19000 may include a first surface 19001 upon which a first fabric thickness compensator 19002 may be positioned and an opposing second surface 19003 upon which a second fabric thickness compensator 19004 may be positioned. Optionally, one or more adhesives may be applied to the first surface 19001 and/or the second surface 19003 to secure the first and second fabric thickness compensators 19002 and 19004 thereto. The retainer 19000 can also include clips that can engage a staple cartridge 19050 of the surgical device, for example. Referring to Figure 64, retainer 19000 may include distal lugs 19108 configured to engage a recess 19056 on a distal end of staple cartridge 19050 and/or proximal lugs 19106 configured to engage a ridge or edge 19054 on the staple cartridge 19054. 19050 staples.

[00509] Referring to Figure 61, the first fabric thickness compensator 19002 may include a retainer facing surface 19006 and an anvil facing surface 19010. The retainer facing surface 19006 may be attached to the first surface. -surface 19001 of retainer 19000 through adhesives and/or hooking features, for example. The anvil facing surface 19010 can include at least one adhesive thereon that can secure the first tissue thickness compensator 19002 to the anvil 19040 of the surgical device. For example, the adhesive may comprise an activatable adhesive that can be adhered to a staple forming surface 19044 (Figure 63) of anvil 19040.

[00510] Referring to Figures 61 and 63 to 66, the anvil facing surface 19010 of the first fabric thickness compensator may include engagement features 19020 that engage similar engagement features 19042 on anvil 19040. In this way, a first retaining force may retain the first tissue thickness compensator 19002 to the retainer 19000 and a second retaining force may retain the first tissue thickness compensator 19002 to the anvil 19040. The second retaining force may be greater than the first force retainer so that the first fabric thickness compensator 19002 can remain attached to the anvil 19040 and detach from the retainer 19000 when the retainer 19000 is removed from the end actuator.

[00511] Referring again to Figure 61, the second fabric thickness compensator 19004 may include a surface facing the retainer 19008 and a surface facing the staple cartridge 19012. The surface facing the retainer 19006 may be attached to the first surface 19001 of retainer 19000 through one or more adhesives and/or engagement features. The surface facing the staple cartridge 19012 may include an adhesive thereon that can secure the second tissue thickness compensator 19004 to the staple cartridge 19050 of the surgical device. For example, with reference to Figure 64, the adhesive may adhere the second fabric thickness compensator 19004 to a staple platform 19052 of the staple cartridge 19050. The surface facing the staple cartridge 19012 may also include engagement features that engage engage cooperative engagement features on the staple cartridge 19050. In this way, a first holding force may retain the second fabric thickness compensator 19004 to the retainer 19000 and a second retaining force may retain the second fabric thickness compensator 19004 to the retainer 19000. staple cartridge 19050. The second holding force may be greater than the first holding force so that the second fabric thickness compensator 19004 can remain attached to the staple cartridge 19050 and detach from the retainer 19000 when the retainer 19000 is re-moved from end actuator.

[00512] As shown in Figure 64, the retainer assembly 19060 can be attached to a staple cartridge 19050 as indicated by arrow A. As described above, the distal clips 19018 on the retainer 19000 can engage a recess 19056 on the staple cartridge. staples and the proximal clips 19016 on the retainer may engage the edge or crest 19054 on the 19050 staple cartridge. At that point, the retainer 19000 is secured to the staple cartridge 19050, as shown in Figure 65, and the second thickness compensator of tissue 19004 may be attached to the staple cartridge 19050. As shown in Figure 66, the confinement of the anvil 19040 of the surgical device in the direction of arrow B may place an anvil surface 19044, such as a staple forming surface and/or a surface of fabric contact, for example in contact with the first fabric thickness compensator 19002. As described above, the anvil 19040 in contact with the first thickness compensator and fabric thickness 19002 can cause the first fabric thickness compensator 19002 to attach to the anvil 19040.

[00513] After the retainer assembly 19060 has been attached to the staple cartridge 19050 and the anvil 19040 has been closed, the first fabric thickness compensator 19002 may be attached to the anvil 19040 and the second fabric thickness compensator 19004 may be attached to staple cartridge 19050. As described above, the holding force holding the first fabric thickness compensator 19002 to the keeper 19000 may be less than the holding force holding the first fabric thickness compensator 19002 to the anvil 19040. That way, when the anvil 19040 is opened again, the first fabric thickness compensator 19002 can detach from the retainer 19000 and remain with the anvil 19040, as shown in Figure 67. Also as described above, the retaining force that retaining second fabric thickness compensator 19004 to retainer 19000 may be less than the retaining force retaining first fabric thickness compensator 19004 to ca staple cartridge 19050. In this way, when retainer 19000 is removed in the directions of arrows C and D in Figure 67, retainer 19000 can separate from second tissue thickness compensator 19004. The surgical stapler shown in Figure 67 includes the first fabric thickness compensator 19002 attached to anvil 19040 and the second fabric thickness compensator 19004 attached to staple cartridge 19050 and is ready for use.

[00514] Figures 390-396 show retainer 19000 being used with a first fabric thickness compensator 19002 and a second fabric thickness compensator 19004. The retainer 19000 may also be used with only one of the first fabric thickness compensator 19004. fabric 19002 and the second fabric thickness compensator 19004. For example, the first fabric thickness compensator 19002 may be omitted.

[00515] Figures 68-70 show an embodiment of a retainer 19100 that may include engagement features 19108 on a surface 19101. As shown in Figures 69 and 70, engagement features 19108 on retainer 19100 engage cooperative engagement features 19109 on a first 19102 fabric thickness compensator.

[00516] Figures 71 and 72 show an embodiment of a retainer 19200 that may include a surface 19202 configured to align and secure a fabric thickness compensator 19210 to an anvil 19230. The retainer 19200 may include alignment pins 19204 extending from the surface 19202. The retainer 19200 shown in Figures 71 and 72 includes four alignment dowels 19204, but a lesser or greater number of alignment dowels 19204 may be present. Referring to Figure 72, fabric thickness compensator 19210 may include a body 19212 that includes holes 19216 that may be located to correspond to the locations of alignment dowels 19204 extending from retainer 19200. Each hole 19216 in the Fabric Thickness Compensator 19210 fits onto an Alignment Dowel 19204 and, due to a tight fit between holes 19216 and Dowels 19204, the fabric thickness compensator 19210 can be aligned to retainer 19200. Optionally, each hole 19216 can be slightly smaller than its corresponding peg 19204 so that each hole 19216 stretches when placed on its peg 19204. Such stretching may retain the holes 19216 in the pegs 19204. Each hole 19216 may include an adhesive therein to create a removable bond between pegs 19204 and fabric thickness compensator 19210.

[00517] Fabric thickness compensator 19220 may include tabs 19220 extending from a body 19212 of fabric thickness compensator 19220 which may be configured to be received by slots 19234 in an anvil 19230. Slots 19234 in the anvil 19230 may be situated on a staple forming surface 19232, for example. After retainer 19200 has been attached to a staple cartridge, similar to the above, anvil 19230 can be closed against fabric thickness compensator 19210 in retainer 19200. As anvil 19230 is closed, referring to Figure 72 , tabs 19220 on fabric thickness compensator 19210 may engage slots 19234, thereby securing fabric thickness compensator 19210 to anvil 19230. Referring first to Figure 71, each tab 19220 may include a portion tapered portion 19222 which guides tab 19220 into slots 19234 of anvil 19230. Tapered portion 19222 may include sloping walls and may have increased cross-sectional area along the length thereof. A base portion 19226 of each tab 19220 may have a lesser cross-sectional area than the greater cross-sectional area of the tapered portion 19222. The tapered portion 19222 may comprise a latch surface 19224, wherein when a tab 19220 comes into a slot 19234, the locking surface 19224 can engage a lip 19235 in the slot 19234. As a result, the locking surface 19224 can retain the tab 19220 in the slot 19234 and thereby retain the fabric thickness compensator 19210 to the anvil 19230. Slots 19228 defined in fabric thickness compensator 19210 and extending between tabs 19220 may allow tabs 19220 to flex inwardly and engage slots 19234. Tabs 19220 that are held with slots 19234 can define a first retaining force which retains the fabric thickness compensator 19210 to the anvil 19230 and the holes 19216 in the fabric thickness compensator 19210 which are retained in the pegs 19204 may define a second a holding force. The first holding force may be greater than the second holding force so that the fabric thickness compensator 19210 can remain attached to the anvil 19230 and detach from the retainer 19200 when the retainer 19200 is removed from the end actuator.

[00518] Body 19212 of fabric thickness compensator 19210 in Figures 71 and 72 may also define slots 19214 therein. Slots 19214 may be aligned along a longitudinal axis of fabric thickness compensator 19210. For example, slots 19214 may be arranged on a longitudinal axis so that slots 19214 are aligned to a longitudinal path of a cutting blade of the surgical device when the tissue thickness compensator 19210 is attached to an anvil 19230. The slits 19214 can reduce the amount of energy required for the cutting blade to cut through the tissue thickness compensator 19210.

[00519] Figures 73-83 show an embodiment of a retainer 19300 that includes clips 19310 that are configured to retain a fabric thickness compensator 19340 on a first surface 19302 of retainer 19300. When an anvil 19360 is closed in retainer 19300, similar to the above, the anvil 19360 can push and displace the tabs 19310 outward and, as a result, disengage the retainer 19300 from the fabric thickness compensator 19340. The fabric thickness compensator 19340 can attach to the anvil 19360 when anvil 19360 is pressed against fabric thickness compensator 19340 and moved away from retainer 19300 when anvil 19360 is opened again.

[00520] The retainer 19300 may include staple cartridge mounting tabs 19312 and 19314 which may be similar to those described above with respect to Figures 61 to 70. In addition to the first surface 19302 described above, the retainer 19300 may also include a second surface 19304 that can be configured to carry a second fabric thickness compensator. The second surface 19304 may include an alignment feature such as a raised ridge 19308. The raised ridge 19308 may engage a slot in a second fabric thickness compensator and/or a slot in a staple cartridge 19370, for example.

[00521] Referring to Figures 75 to 77, in use, retainer 19300 can be attached to a staple cartridge 19370 by means of clips 19314 and 19312. The first fabric thickness compensator 19340 can be positioned on the first surface 19302 on retainer 19300 and may be held in place by loops 19310. First, with reference to Figures 81 to 83, each loop includes a plane 19313 that can clamp first fabric thickness compensator 19340 against first surface 19302 of the retainer 19300. Each clip 19310 may include an inwardly facing tapered or curved surface 19311. As the anvil 19360 moves in the direction of arrow E, with reference to Figure 82, the edges 19366 of the anvil 19360 may contact the curved surfaces facing inward 19311 of the 19310 clamps. As the 19360 anvil continues to move in the direction of arrow E, the interference between the edges 19366 of the 19360 anvil and the curved surfaces 19311 of the The loops 19310 can push the loops 19310 out in the direction of arrow F, as shown in Figure 82. As the loops 19310 move in the direction of arrow F, the first fabric thickness compensator 19340 is released from the planes 19313 of the loops 19310 .

[00522] As anvil 19360 continues to move in the direction of arrow E, it also contacts and attaches to tissue thickness compensator 19340. For example, as anvil 19360 moves in the direction of arrow E, a engagement feature, such as a raised ridge 19344, on the fabric thickness compensator 19340 engages a channel 19364 on the anvil 19360. The raised ridge 19344 may be configured to have an interference fit with channel 19364 so that the fabric thickness compensator 19340 attaches to the anvil 19360. The fabric thickness compensator 19340 may include an adhesive that adheres to the surfaces of the anvil 19360. The raised ridge 19344 may include an adhesive that adheres to the surfaces of the channel 19364. similarly, the body surfaces 19342 of the fabric thickness compensator 19340 may include an adhesive that adheres to a surface 19362 of the anvil 19360. After the fabric thickness compensator 19340 is attached to the anvil In the 19360, the Fabric Thickness Compensator 19340 can lift from the retainer 19300 and remain with the anvil 19360 as the anvil 19360 returns to its open position by moving in the direction of arrow G, as illustrated in Figure 83.

[00523] Figure 84 shows a cross-sectional side view of one embodiment of a retainer 19400. The first fabric thickness compensator 19410 is positioned on a first side 19402 of the retainer 19400 and a second fabric thickness compensator 19420 is positioned on a second opposite side 19404 of retainer 19400. Retainer 19400 defines one or more holes 19406 extending therethrough. The first fabric thickness compensator 19410 and the second fabric thickness compensator 19420 are connected through the holes by connectors 19430 that extend through the holes 19406. The first fabric thickness compensator 19410, the second fabric thickness compensator 19420 and the 19430 connectors may all be formed from a unitary material. For example, the first fabric thickness compensator 19410, the second fabric thickness compensator 19420, and connectors 19430 may be molded with an overlap over retainer 19400. Alternatively, connectors 19430 may be formed as part of one of the thickness compensators. such as the first fabric thickness compensator 19410. The connectors 19430 can be passed through the holes 19406 and then attached to the remaining fabric thickness compensator such as the second fabric thickness compensator 19420 The 19430 connectors can be attached to the second 19420 fabric thickness compensator, for example, through the use of an adhesive or through the use of an interference fit between one end of the connector and a receiving port (not shown) on the second. Fabric thickness compensator 19420. Connectors 19430 can be separate components that are placed in holes 19406 and to which the prim The first fabric thickness compensator 19410 and the second fabric thickness compensator 19410 may be secured, for example, through the use of adhesives or interference fittings between ends of the connectors 19430 and receiving ports on the first fabric thickness compensator 19410 and on the second fabric thickness compensator 19420.

[00524] After the retainer 19400 has been placed on a 19450 staple cartridge, for example, a surgical device anvil 19440 can be moved in the direction of arrow H to a closed position. An adhesive and/or engagement features on a surface 19414 of the first fabric thickness compensator 19410 may secure the first fabric thickness compensator 19410 to the anvil 19440 when the anvil 19440 closes. Similarly, an adhesive and/or engagement features on a surface 19424 of the second fabric thickness compensator 19420 may secure the second fabric thickness compensator 19420 to the staple cartridge 19450. After the anvil 19440 is closed and the first and second tissue thickness compensators 19410 and 19420 are attached to anvil 19440 and staple cartridge 19450, respectively, retainer 19400 can be pulled in the direction of arrow I (Figure 88) to remove retainer 19400 from the first tissue thickness compensator 19410 and the second fabric thickness compensator 19420 and to break the connectors 19430. As shown in Figure 89, after the connectors 19430 are broken and the retainer 19400 has been removed, the anvil 19440 can be opened again and the first thickness compensator of fabric 19410 will be attached to the anvil 19440 and the second fabric thickness compensator 19420 will be attached to the staple cartridge 19450.

[00525] In accordance with the invention, a proximal portion 19407 of each hole 19406 in retainer 19400 may include a cutting edge. When the retainer is pulled in the direction of arrow I (Figure 88), a pulling force is transmitted through the proximal portion 19407 of the holes 19406 to break the connectors. A cutting edge at the proximal portion 19407 of each hole 19406 will concentrate the transmitted force on a relatively small area of each connector. As a result, the connectors will break more easily and less pulling force may be required to remove the retainer 19400 between the first fabric thickness compensator 19410 and the second fabric thickness compensator 19420.

[00526] As described above, a retainer assembly may comprise a retainer positioned between a first fabric thickness compensator and a second fabric thickness compensator, wherein, after the two fabric thickness compensators have been inserted and secured to an end actuator of a surgical instrument, the retainer can be pulled between the tissue thickness compensators and removed from the end actuator. The retainer may provide a barrier between the first and second fabric thickness compensators. Once the retainer is removed between the first and second fabric thickness compensators, substances within and/or on the first fabric thickness compensator may react with substances within and/or on the second fabric thickness compensator. fabric thickness, for example. One or both of the fabric thickness compensators may include a film that can confine substances in the fabric thickness compensators. Films may be attached to the retainer, whereby when the retainer is pulled between the fabric thickness compensators as described above, the retainer may pull the films away from the fabric thickness compensators to expose the substances contained therein. the same. At such a point, the substances in each of the tissue thickness compensators can interact with each other.

[00527] Figures 90-100 illustrate an embodiment of a retainer that engages an anvil of a surgical device, such as a surgical stapler. The retainer may align a first tissue thickness compensator to the anvil and a second tissue thickness compensator to a staple cartridge. Closing the anvil causes the first tissue thickness compensator to attach to the anvil and the second tissue thickness compensator to attach to the staple cartridge. The retainer may also carry the staple cartridge with a fabric thickness compensator optionally disposed between the retainer and the staple cartridge. Closing the anvil causes the staple cartridge to attach to a channel of the surgical stapler and causes the first tissue thickness compensator to attach to the anvil.

[00528] Figures 90-93 show an embodiment of a retainer 19500. The retainer 19500 includes a handle 19502 through which a surgeon, nurse, technician or other individual can manipulate the retainer 19500. The handle 19502 may include a textured surface, such as protruding 19503 portions, for example, which can provide a better gripping surface. The retainer 19500 may include a surface 19504 upon which a fabric thickness compensator may be mounted. Surface 19504 may include one or more projections 19506, wherein projections 19506 may engage recesses in the fabric thickness compensator and align the fabric thickness compensator with respect to surface 19504 of retainer 19500. The recesses in the thickness compensator of fabric may be slightly smaller than the projections 19506 so that, when engaged in the recesses, the projections 19506 can retain the fabric thickness compensator to the surface 19504. The projections 19506 may pass through the holes in the fabric thickness compensator and engaging a slot such as a cutting blade slot 19558 on anvil 19550 shown in Figure 95, thereby aligning the fabric thickness compensator with retainer 19500 and also providing additional alignment of retainer 19500 to anvil 19550. O 19540 fabric thickness compensator may include an adhesive and/or latching features, described above, onto a 19542 surface for attachment of the fabric thickness compensator to a 19550 anvil.

[00529] As shown in Figure 94a, the staple cartridge 19530 can be attached to the retainer 19500. The staple cartridge 19530 can be attached to the retainer 19500 by the tabs 19510 and 19512 extending from the retainer 19500. The tabs 19512 on the retainer 19500 may engage a slot 19534 in staple cartridge 19530. Loops 19510 of retainer 19500 may encircle the bottom 19532 of staple cartridge 19532. In accordance with the invention, a second fabric thickness compensator may be attached to the cartridge of staples 19530. A second fabric thickness compensator may be attached to a staple platform 19536 of the staple cartridge 19530.

[00530] As shown in Figures 95 and 96, a retainer assembly 19590 comprising retainer 19500, tissue thickness compensator 19540 and staple cartridge 19530 can slide over the anvil 19550 of a surgical device such as a stapler in the direction of arrow L. Guide tabs 19508 on retainer 19500 can encircle the edges 19552 of anvil 19550 and position retainer assembly 19590 relative to anvil 19550. After retainer assembly 19590 is engaged with anvil 19550 as shown in Figures 97 and 98, the anvil can be closed in the direction of arrow M. Closing the anvil 19550 can position the staple cartridge 19530 in a channel 19560 of the surgical device. Closing the 19550 anvil may cause the 19510 clips extending from the 19500 retainer to engage a ridge 19562 of the 19560 channel in order to securely position the 19530 staple cartridge in the 19560 channel. When the 19550 anvil is opened again in the direction of arrow N, now with reference to Figures 99 and 100, the tissue thickness compensator 19540 can remain attached to the anvil 19550 and separates from the retainer 19500. The retainer 19500 can then be removed from the surgical instrument in the direction of the arrow O (Figures 99 and 100) leaving the staple cartridge 19530 in the channel 19560 of the surgical device and a tissue thickness compensator 19540 attached to the anvil 19550.

[00531] Figures 101 and 102 show examples of two alternative embodiments of fabric thickness compensators 19570 and 19580, respectively. Figure 101 is a cross-sectional view of a fabric thickness compensator 19570 secured to a retainer 19501, wherein the fabric thickness compensator 19570 may include protrusions 19574 that may contact the edges 19552 of the anvil 19550 and encircle partially an outer surface 19556 of the anvil 19550. The protuberances may catch the anvil 19550 and/or be secured to the anvil 19550 using one or more adhesives. In order to release the 19570 Tissue Thickness Compensator from the 19550 Anvil after the 19570 Compensator has been implanted against a patient's tissue, the 19574 Protrusions can flex outward from the 19550 Anvil thus allowing the 19570 Tissue Thickness Compensator is pushed away from the anvil 19550. Figure 102 is a cross-sectional view of a fabric thickness compensator 19580 attached to retainer 19501 shown in Figure 101. The fabric thickness compensator 19580 includes a fitting 19584 that can encircle the anvil 19550 to align the fabric thickness compensator 19580 to the anvil 19550 and/or to retain the fabric thickness compensator 19580 to the anvil 19550. The socket 19584 can retain the fabric thickness compensator 19580 to the anvil 19550. the socket 19584 of the anvil 19550, the fabric thickness compensator 19580 can be torn in the opposite direction to the socket 19584 in the perforations 19586, for example. In this way, the insert 19584 can remain on the anvil 19550 while the remainder of the tissue thickness compensator 19580 can remain stapled to the patient tissue.

[00532] A tissue thickness compensator, such as the 19570 tissue thickness compensator, for example, may include an inner portion comprising a biocompatible substance positioned therein. The biocompatible substance may include an anti-inflammatory, a coagulant and/or an antibiotic, for example. In accordance with the invention, a body, such as a insert, for example, can be inserted into the inner portion of the fabric thickness compensator. For example, the insert can be inserted through an open end of the fabric thickness compensator into a cavity defined therein. The insert can be retained within the cavity of the fabric thickness compensator by means of an interference fit. The steps for mounting the insert to the fabric thickness compensator may include a first step of heating the fabric thickness compensator so that the fabric thickness compensator expands. When the fabric thickness compensator expands, the cavity defined therein can also expand. When the fabric thickness compensator is in an expanded state, according to a second step, the insert can be inserted into the cavity. Then, as the fabric thickness compensator cools, according to a third step, the cavity can shrink into the insert and retain the insert in place in the cavity.

[00533] Figures 103-115 illustrate an embodiment of a retainer comprising a separate insertion tool. The insertion tool can be used to insert a set into a surgical instrument such as a surgical stapler for example. The insertion tool may also compress a staple cartridge and one or more tissue thickness compensators of the retainer assembly into position on the surgical instrument. Referring to Figures 103 and 104, a retainer 19600 may include a first plate 19620 and a second plate 19622. The first plate 19620 and the second plate 19622 may be connected by a hinge 19612. The hinge 19612 may position the first plate 19620 at an angle to the second plate 19622 and also allow the first plate 19620 to rotate relative to the second plate 19622 around the hinge 19612.

[00534] The first plate 19620 may include an outward facing surface 19604 and an inward facing surface 19606. Similarly, the second plate 19622 may include an outward facing surface 19610 and an inward facing surface 19608. Inward facing surface 19606 of first plate 19620 may include a cam protrusion 19614. Similarly, the inward facing surface 19608 of second plate 19622 may include a cam protrusion 19616. Referring to Figures 110 to 115, the inward facing surface outside 19604 of the first plate may include a fabric thickness compensator positioned thereon. The outward facing surface 19601 of the second plate 19622 may also include a fabric thickness compensator positioned thereon. Fabric Thickness Compensators can be attached to external surfaces 19604 and 19610 using adhesive snap-in features and/or other suitable attachment means, for example. The retainer 19600 can include tabs 19618 extending from the second plate 19622 that can be configured to engage a staple cartridge 19690, as shown in Figures 110 and 112 to 115.

[00535] Now referring to Figures 105 to 109, an insertion tool 19630 may include a first end 19632 and a second end 19634. The first end 19632 may be large enough to be grasped by a surgeon, nurse and/or technician , for example. Second end 19634 defines a cavity 19640, wherein the cavity may include a cam 19648 positioned therein. A first cam side 19648 may include a first shoulder 19642, a second shoulder 19644, and a first anti-rebound 19646 positioned therebetween. A second side of cam 19648 may include a third shoulder 19643, a fourth shoulder 19645 and a second anti-rebound 19647 positioned therebetween. For example, the bosses and anti-kicks can be arranged in a mirrored fashion. In other words, the first shoulder 19642 may be arranged on the first side of cam 19648 directly opposite the third shoulder 19643 on the second side of cam 19648. Similarly, the second shoulder 19644 may be arranged on the first side of cam 19648 directly in opposed to the fourth shoulder 19645 on the second side of cam 19648. Additionally, the first anti-kickback 19464 may be arranged on the first side of cam 19648 directly opposite the second anti-kidney 19647 on the second side of cam 19648.

[00536] In use, the second end 19634 of the insertion tool 19630 is placed between the first plate 19620 and the second plate 19622 of the retainer 19600 so that the cam protrusion 19614 on the first plate 19620 engages the anti-reimbeat 19646 and the protrusion cam 19616 on the second plate 19622 engages with anti-kickback 19647, for example. As shown in Figures 112 and 113, an insertion assembly 19700, which includes the retainer 19600, the insertion tool 19630, one or more tissue thickness compensators, and the staple cartridge 19690, can be inserted into a surgical instrument. The surgical instrument, such as a surgical stapler, may include a channel 19740, which is configured to receive the staple cartridge 19690, and an anvil 19720. Insert assembly 19700 may be inserted into the surgical instrument in the direction of arrow P (Figure 113). ) to lock the staple cartridge 19690 in channel 19740. In such a position, cams 19614 and 19616 can be aligned with anti-kickbacks 19646 and 19647, respectively.

[00537] After the staple cartridge 19690 is locked into channel 19740, as shown in Figure 114, the insertion tool 19600 can continue to be moved in the direction of arrow Q relative to the surgical instrument. Further movement of insertion tool 19600 in the direction of arrow Q may align first shoulder 19642 to first cam protrusion 19614 and third shoulder 19634 to second cam protrusion 19616. Such alignment may cause retainer plates 19620 and 19622 rotate away from each other around hinge 19612 in the direction of arrow R (Figure 114). Under such circumstances, retainer plate 19620 and fabric thickness compensator 19670 may move towards anvil 19720 and retainer plate 19622 may move towards and contact anvil 19720. Optionally, as a result of the above, the fabric thickness compensator 19670 can be seated on the anvil 19720. After the fabric thickness compensator 19670 is attached to the anvil 19720, the insertion tool 19630 can be retracted or moved in the direction of the arrow S (shown in Figure 115). Movement of insertion tool 19630 in the direction of arrow S can cause cam protrusions 19614 and 19616 to disengage from first cam 19642 and third cam 19643, respectively, and re-align with first anti-kilt 19646 and second anti-kidge 19647 , respectively. Second boss 19642 and fourth boss 19645 can be contiguous with cam bosses 19614 and 19616 respectively and can prevent insertion tool 19630 from separating completely from retainer 19600. With cam bosses 19614 and 19616 realigned to anti-bosses 19646 and 19647, the first plate 19620 can rotate at least partially towards the second plate 19622 around the hinge 19612 and away from the anvil 19720. The retainer 19600 can also be separated from the channel 19740 and then removed in the direction of the arrow S, leaving the fabric thickness compensator 19670 attached to the anvil 19720, for example.

[00538] As described here, a retainer assembly can be used to install one or more tissue thickness compensators on an end actuator of a surgical stapling instrument. A retainer set can install layers plus tissue thickness compensators on a surgical instrument. The layers may include an absorbable material and/or a biocompatible material, for example.

[00539] Referring to Figure 172, an end actuator 12 may be configured to receive an end actuator insert 25002. The end actuator 12 may comprise a lower jaw 25070 and an anvil 25060 which is configured to pivot in with respect to lower jaw 25070. End actuator insert 25002 may comprise a staple cartridge 25000 which is pivotally connected to an anvil insert 25004. End actuator 12 may be configured to receive the anvil insert 25004. end actuator insert 25002 so that the staple cartridge 25000 fits into a staple cartridge channel 25072 of the lower jaw 25070, for example, and the anvil insert 25004 contacts the anvil 25060, for example. Lower jaw 25070 may comprise a plurality of gripping members 25074 configured to secure staple cartridge 25000 to staple cartridge channel 25072. Anvil insert 25004 may comprise at least one retaining protrusion configured to engage at least one at least one retaining groove in the anvil 25060. The anvil insert 25004 can be configured to pivot correspondingly toward the staple cartridge 25000 when the anvil 25060 pivots toward the lower jaw 25070, as described in more detail in this document.

[00540] Still referring to Figure 172, the end actuator insert 25002 may additionally comprise a retainer 25010. The retainer 25010 may securely engage with at least one of the staple cartridge 25000 and the anvil insert 25004. The retainer 25010 may comprise at least one gripping clip 25012 that can engage, engage, engage, grip, and/or engage the staple cartridge 25000. As shown in Figure 172, retainer 25010 may comprise two gripper clips 25012 in each longitudinal side thereof, for example. For example, the gripper clips 25012 can be configured to clip over a portion of the staple cartridge 25000, for example. In accordance with the invention, a fabric thickness compensator may be retained in position with respect to the end actuator insert 25002 by retainer 25010. For example, a fabric thickness compensator may be positioned between retainer 25010 and the 25000 staple cartridge.

[00541] Optionally, when an operator inserts the end actuator insert 25002 into the end actuator 12, the retainer 25010 can provide a solid or substantially solid element for the operator to grip. Furthermore, retainer 25010 can prevent premature deformation of a fabric thickness compensator that is confined by retainer 25010, for example. Retainer 25010 can be removed from end actuator 12 prior to using end actuator 12 to cut and/or clamp fabric. Alternatively, retainer 25010 may remain positioned on end actuator 12. For example, retainer 25010 may be transected by cutting element 25052 (Figure 207) as staples are fired from the cavities of staples 25002 (Figure 207) in the cartridge. clips 25000. Retainer 25010 may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer, for example. Retainer 25010 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and/or oxidized regenerated cellulose (ORC), for example. Retainer 25010 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent.

[00542] Referring to Figure 173, an end actuator 26012 may comprise an anvil 26060 and a lower jaw 26070. In accordance with the invention, a fabric compensator 26020 may be releasably secured to anvil 26060, lower jaw 26070 and/or anvil 26060 and lower jaw 26070. For example, a first fabric compensator 26020 may be releasably attached to a staple cartridge 26000 in the lower jaw 26070 and a second fabric compensator 26022 may be releasably attached to anvil 26060. The first and second fabric compensators 26020, 26022 may be deformable and/or resilient, similar to at least one fabric thickness compensator described herein. For example, the first and second tissue compensators 26020, 26022 may comprise a polymeric composition such as a bioabsorbable, biocompatible elastomeric polymer, for example. The first and second tissue buffers 26020, 26022 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and/or oxidized regenerated cellulose (ORC), for example. The first and second tissue compensators 26020, 26022 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent.

[00543] The tissue compensator 26020, 26022 may comprise a firm or substantially firm point 26024, 26026. For example, a first point 26024 can be positioned at the distal end of the first tissue compensator 26020 and a second point 26026 can be positioned on the distal end of the second fabric tab 26022. Tips 26024, 26026 can prevent or limit premature deformation of fabric tabs 26020, 26022. For example, tips 26024, 26026 can protect fabric tabs 26020, 26022 when fabric tabs 26020, 26022 tissue 26020, 26022 are moved through a trocar and/or maneuvered around a patient's tissue, for example. Similarly, with reference to Figure 174, the end actuator 12 may comprise a first fabric compensator 25020 releasably attached to the staple cartridge 25000 in the lower jaw 25070 and a second fabric compensator 25022 releasably attached to the anvil 25060 In accordance with the invention, a tip 25026 may be positioned at the distal end of the second tissue compensator 25022. The tip 25026 may be positioned adjacent a deformable and/or resilient portion of the tissue compensator 25022. The tip 25026 may extend over and/or around a portion of the fabric compensator 25022 such that the tip 25026 protects the distal end and an intermediate portion of the fabric compensator 25022.

[00544] Referring to Figures 175 to 202, a sleeve 27010 can be configured to engage the anvil 25060 of the actuator end 12 of a surgical instrument, for example. Sleeve 27010 may comprise an extended portion 27040 (Figures 176179), a nose 27080 (Figures 186-189) and a compensator 27120 (Figures 180-182). The 27010 sleeve can be configured to release a 27020 compensator when a 25052 translation trigger bar (Figure 196) approaches the distal end of the end actuator 12. The 27020 compensator can be deformable and/or resilient, similar to at least one fabric thickness compensator described herein. For example, the buffer 27020 may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer, for example. The buffer 27020 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or oxidized regenerated cellulose (ORC), for example. The buffer 27020 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent. Referring first to Figure 175, the pin portion 27040 can be positioned on and/or around an outer surface 25061 of the anvil 25060. The tip 27080 of the sleeve 27010 can be positioned on and/or around from a distal portion of anvil 25060. Compensator 27020 may be positioned on and/or around an inner surface of anvil 25060.

[00545] Still referring to Figure 175, the pinned portion 27040 may comprise at least one pin 27042a. Optionally, as illustrated in Figures 505 to 508, the pinned portion 27040 may comprise a first pin 27042a and a second pin 27042b. Pins 27042a, 27042b may be symmetrical or substantially symmetrical, for example. The first pin 27042a may be asymmetrical with respect to the second pin 27042b. The first and/or second pins 27042a, 27042b may taper at the distal end thereof. For example, each pin 27042a, 27042b may comprise a tapered end 27048. Referring first to Figure 178, the pinned portion 27040 can be bypassed, for example. Referring again to Figure 175, the contour of the pin portion 27040 may correspond or substantially correspond to an contour of the outer surface 25061 of the anvil 25060, for example. First, with reference to Figures 178 and 179, the pin portion 27040 may also comprise at least one fastener 27044a extending from the first pin 27042a. A first fastener 27044a can be positioned on a first side of the pin portion 27040 and a second fastener 27044b can be positioned on a second side of the pin portion 27040. Fasteners 27044a, 27044b can be positioned at or near the proximal end of the pin portion 27044a. with pin 27040, for example. Fasteners 27044a, 27044b may be positioned at or near the distal end of the pin portion 27040, such as along the first and/or second pins 27042a, 27042b, for example. Fasteners 27044a, 27044b may extend along a substantial length of peg portion 27040 and/or along a shorter length of peg portion 27040. A plurality of fasteners 27044a, 27044b may be positioned along each side lengthwise of the pinned portion, for example. Referring first to Figure 179, the first fastener 27044a may comprise a first fastener extension 27046a and/or the second fastener 27044b may comprise a second fastener extension 27046b. The first fastener extension 27046a can protrude from at least a portion of the fastener 27044a and the second fastener extension 27046b can protrude from at least a portion of the fastener 27044b, for example. In addition, the first cleat extension 27046a and the second cleat extension 27046b can each be configured to engage a gap 27128 (Figure 181) on the tab 27020, as described in more detail herein.

[00546] Referring now to Figure 201, the tab 27020 for the sleeve 27010 may comprise a longitudinal protrusion 27024 and an edge 27026 on each longitudinal side of the tab 27020. The tab 27020 may be positioned adjacent an inner surface 25063 of the anvil 25060 Additionally, when sleeve 27010 is positioned on anvil 25060, longitudinal protrusion 27024 may be substantially aligned and/or positioned within a longitudinal slot 25062 on anvil 25060. Edges 27026 of compensator 27020 may wrap at least partially around the anvil 25060 towards the outer surface 25061 thereof. First, with reference to Figures 180 to 181, a compensator 27120 for a sleeve 27110 may comprise a body 27122 having a longitudinal bulge 27124 that extends along at least a portion of the body 27122. The longitudinal bulge 27124 may define a longitudinal path along the midline of body 27122, for example. Longitudinal protrusion 27124 may be received by longitudinal slot 25062 (Figure 201) on anvil 25060 when sleeve 27110 is positioned on anvil 25060. Referring first to Figure 182, longitudinal protuberance 27124 may comprise a rounded projection. For example, the cross section of the longitudinal protuberance 27124 may form an arc and/or a partial ring. Alternatively, the longitudinal bulge 27124 may comprise an angled and/or staggered projection. Trim 27120 may additionally comprise an edge 27126, which may be straight, angled, grooved, wavy, and/or zigzag patterned, for example. Edge 27126 may comprise slots 27128 which may be configured to receive cleat extensions 27046a, 27046b (Figure 179) when assembled sleeve 27110 is positioned on anvil 25060. Fastener extensions 27046a, 27046b may fit through slot 27128 to engaging with anvil 25060 such that fastener extensions 27046a, 27046b help secure sleeve 27110 to anvil 25060, for example.

[00547] First, with reference to Figures 183 to 185, a compensator 27220 for a sleeve 27210 may comprise a body 27222 comprising a longitudinal protuberance 27224 that extends along at least a portion of the body 27222. Optionally, from Similar to the above, longitudinal protrusion 27224 may be received by longitudinal slot 25062 (Figure 202) on anvil 25060 when sleeve 27210 is positioned on anvil 25060. Referring first to Figure 185, longitudinal protuberance 27224 may comprise an angled projection so that the cross section of the bulge 70224 forms a substantially rectangular shape. Trim 27220 may further comprise an edge 27226, which may be straight, angled, grooved, wavy and/or zigzag patterned, for example. Edge 27226 may comprise slots 27228 which may be configured to receive cleat extensions 27046a, 27046b (Figure 179) when assembled sleeve 27210 is positioned on anvil 25060. Fastener extensions 27046a, 27046b may fit through the slots. 27228 and engages anvil 25060 such that fastener extensions 27046a, 27046b help secure sleeve 27210 to anvil 25060, for example. Trim 27220 may additionally comprise a plurality of ribs 27229 which laterally traverse the body 27222 of trim tab 27220. The ribs 27229 may support body 27222 of trim tab 27220 when sleeve 27210 is positioned on anvil 25060 and/or when trim tab 27220 enters contact with the tissue.

[00548] Referring to Figures 386 to 390, the tip 27080 of the sleeve 27010 may comprise an alignment ridge 27082 which may be substantially aligned with the longitudinal slot 25062 (Figure 201) on the anvil 25060. When the alignment ridge 27082 is aligned to the longitudinal slot 25062 and when the sleeve 27010 is positioned on the anvil 25060, the tip 27082 may at least partially encircle a distal portion of the pinned portion 27040 of the sleeve 27010. For example, the tapered end 27048 of each pin 27042a, 27042b may be positioned on point 27080 when sleeve 27010 is positioned on anvil 25060. As described in more detail in this document, point 27080 can flex pins 27042a, 27042b closer together and/or downwards when pinned portion 27042 is engaged with point 27080 Furthermore, as illustrated in Figure 190, when the tapered ends 27048 of the pin portion 27040 are positioned at the point 27080, the fasteners es 27044a, 27044b on pin portion 27040 may engage edges 27026 of compensator 27020, for example. As a result of such engagement, the compensator 27010 can be attached to the anvil 25060.

[00549] Referring to Figures 191 to 195, when nose 27080 is engaged with pinned portion 27040 of sleeve 27010, compensator 27020 may be attached to anvil 25060. Nose 27080 may remain engaged with pinned portion 27040 in accordance with trigger bar 25050 translates along a portion of longitudinal slot 25062 on anvil 25060. Now with reference to Figures 195 to 200, when cutting element 25052 on trigger bar 25050 and/or any other suitable portion of trigger bar 25050, as the retaining flange 25054, for example, approaches the distal end of the anvil 25060, the trigger bar 25050 may disengage tip 27080 from the pin portion 27040. The trigger bar 25050 may, for example, contact the point 27080 and push the point 27080 off the anvil 25060 so that the point 27080 disconnects from the pinned portion 27040 of the sleeve 27010. Now referring to Figure 202, when the point 27080 disengages from the pinned portion 27040, the first and second pins 27042a, 27042b can be configured to flex away from the anvil 25060. For example, when the pinned portion 27070 is engaged with the spike 27080, the pins 27042a, 27042b can be flexed closer together and/or down towards anvil 25060 and held in such position by nose 27080. Pins 27042a, 27042b may be retained under a spring load by nose 27080 so that pins 27042a, 27042b seek to regain a neutral configuration once the nose 27080 is disengaged from pins 27042a, 27042b. Alternatively, pins 27042a, 27042b may be sufficiently deformable that pins 27042a, 27042b can be deformed or flared outward by firing bar 25050 once prong 27080 has disengaged therefrom. When pins 27042a, 27042b move away from anvil 25060, fasteners 27044a, 27044b along a longitudinal side of each pin 27042a, 27042b may disengage from tab 27020, which may allow tab 27020 to be released from anvil 25060.

[00550] Referring to Figures 203 to 209, the end actuator 12 of a surgical instrument, for example, may be configured to receive an end actuator insert 28010. The end actuator insert 28010 may comprising a compensator body 28012 and at least one tab 28014a, 28014b. End actuator insert 28010 may comprise a proximal loop 28014b at the proximal end of trim body 28012 and a distal loop 28014a at the distal end of trim body 28012, for example. Referring first to Figure 206 , the distal clip 28014a may be secured to the anvil 25060 of the end actuator 12 on or near the distal end of the anvil 25060. For example, the distal clip 28014a may be substantially aligned and/or or partially positioned within the longitudinal slot 25062 of the anvil 25060. Referring first to Figure 207, the proximal clip 28014b may be secured to a staple cartridge 25000 in the lower jaw 25070 of the end actuator 12 (Figure 208). ). The proximal clip 28014b may be secured to the staple cartridge 25000 on or near the proximal end of the staple cartridge 25000. For example, the proximal clip 28014b may be substantially aligned and/or positioned within a longitudinal slot 25004 in the staple cartridge. 25000

[00551] Now referring to Figures 208 and 209, the end actuator insert 28010 can be inserted into the end actuator 12 of a surgical instrument. Optionally, at least a portion of the end actuator insert 28010, such as the compensator body 28012, the distal lugs 28014a and/or the proximal lug 28014b, may be deformable and/or resilient, for example. When the end actuator insert 28010 is inserted into the end actuator 12, the distal and/or proximal lugs 28014a, 28014b may bend or flex. When the cleats 28014a, 28014b are flexed, for example, the cleats 28014a, 28014b may seek to return to their initial undeformed configuration and may generate a corresponding bending or restoring force, for example. Optionally, when the end actuator insert 28010 is positioned within the end actuator 12, the end actuator insert 28010 may apply a spring load to the end actuator 12. End 28010 may be solid or substantially solid so that an operator can grip insert 28010 when the operator is inserting end actuator insert 28010 and staple cartridge 25000 into end actuator 12.

[00552] End actuator insert 28010 may be removed from end actuator 12 prior to cutting and/or clamping operations on end actuator 12. Alternatively, end actuator insert 28010 may remain positioned in the end actuator 12 during cutting and/or firing operations. For example, end actuator insert 28010 may be transected by cutting element 25052 as staples are fired from their staple cavities 25002 (Figure 207) in staple cartridge 25000. End actuator insert 28010 may comprise a fabric thickness compensating material similar to at least one of the fabric thickness compensators described herein. For example, the end actuator insert 28010 may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer, for example. End actuator insert 28010 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or oxidized regenerated cellulose (ORC), for example. End actuator insert 28010 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent.

[00553] Referring to Figures 210 to 215, a tissue thickness compensator 29020 may be positioned on the end actuator 12 of a surgical instrument. Fabric thickness compensator 29020 may be substantially similar to at least one of the fabric thickness compensators described herein. For example, the fabric thickness compensator 29020 may be sufficiently deformable and resilient that the deformation of the fabric thickness compensator 29020 generates a bending or restoring force. Referring first to Figure 211, a static load can attract the fabric thickness compensator 29020 to the anvil 25060 of the end actuator 12 so that the static load holds the fabric thickness compensator 29020 to the anvil 25060 The static charge may be neutralized so that the anvil 25060 releases the fabric thickness compensator 29020. Additionally or alternatively, now referring to Figure 212, the fabric thickness compensator 29020 may be secured to the anvil 25060 by means of at least at least one suction element 29022. For example, a plurality of micro-suction elements 29022 on a surface of fabric thickness compensator 29020 may releasably secure fabric thickness compensator 29020 to anvil 25060. Additionally or alternatively , referring to Figure 213, hook and loop fasteners 29024 can secure fabric thickness compensator 29020 to anvil 25060. For example, a fabric thickness compensator surface 29020 may comprise a plurality of hook-shaped fasteners 29024a and an anvil surface 25060 may comprise a plurality of loop-shaped fasteners 29024b, for example. Hook-shaped fasteners 29024a may engage with loop-shaped fasteners 29024b so that fabric thickness compensator 29020 is releasably secured to anvil 25060.

[00554] Additionally or alternatively, now referring to Figure 214, the fabric thickness compensator 29020 may be attached to the anvil 25060 by means of a strap 29026. The strap 29026 may comprise an elastomeric polymer and/or may be tied or rolled around anvil 25060. When strip 29026 is removed from anvil 25060, fabric thickness compensator 29020 may be released from anvil 25060. To facilitate removal of strip 29026, strip 29026 may be extended and/or cut, for example . In accordance with the invention, a plurality of strips 29026 may attach fabric thickness compensator 29020 to anvil 25060. Alternatively or additionally, now referring to Figure 215, fabric thickness compensator 29020 may be attached to anvil 25060 by means of of a socket 29028 positioned at the distal end of the tissue thickness compensator 29020. The socket 29028 may be configured to receive the distal end of the anvil 25060 therein, for example. An alignment lug 29029 on fabric thickness compensator 29020 can be aligned and/or positioned within longitudinal slot 25062 on anvil 25060. For example, alignment lug 29029 can slide into longitudinal slot 25062 as per the thickness compensator of fabric 29020 is positioned over and/or is removed from the anvil 25060.

[00555] Referring to Figures 216 to 218, a tissue thickness compensator 30020 may be positioned on the anvil 25060 of the end actuator 12 of the surgical instrument. Fabric thickness compensator 30020 may comprise a body 30022 and a pocket 30024. A compensator material 30026 may be retained between the body 30022 and the pocket 30024, for example. The 30026 buffer material may comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or oxidized regenerated cellulose (ORC), for example. Additionally or alternatively, the buffer material 30026 may comprise at least one therapeutic agent such as a medicament or pharmaceutically active agent. Fabric thickness compensator 30020 may be deformable and/or resilient, similar to at least one fabric thickness compensator described herein. For example, the fabric thickness compensator 30020 may comprise a polymeric composition such as a bioabsorbable, biocompatible elastomeric polymer, for example. The tissue thickness compensator 30020 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or oxidized regenerated cellulose (ORC), for example.

[00556] Referring first to Figure 217, the body 30022 of the fabric thickness compensator 30020 may comprise an alignment element 30028 which can be received within the longitudinal slot 25062 of the anvil 25060 when the thickness compensator of fabric 30020 is attached to anvil 25060. Body 30022 may comprise a stepped thickness so that the geometry of body 30022 substantially matches the geometry of anvil 25060. Additionally, body 30022 may comprise longitudinal flanges 30029. For example, a lon flange -gitudinal 30029 may extend along each longitudinal side of body 30022 of fabric thickness compensator 30020, for example. Longitudinal flanges 30029 may wrap at least partially around anvil 25060 to secure fabric thickness compensator 30020 to anvil 25060. Additionally, longitudinal flanges 30029 may be resilient enough so that longitudinal flanges 30029 can flex to accommodate and/or engage anvil 25060, for example. The longitudinal flanges 30029 may exert a pinching force on the anvil 25060 when the flanges 30029 engage the anvil 25060. The pocket 30024 may comprise an indentation 30025. When the fabric thickness compensator 30020 is attached to the anvil 25060, the indentation 30025 may be substantially aligned with longitudinal slot 25062 in anvil 25060, for example. The fabric thickness compensator 30020 may be thinner at the indentation 30025 so that translation of the cutting element 25052 (Figure 207) separates the fabric thickness compensator 30020 where it is thinner.

[00557] Now referring to Figures 219 and 220, a fabric thickness compensator 30120 may comprise a body 30122 which is configured to retain a balance material 30026 therein. The fabric thickness compensator 30120 may comprise an alignment element 30128, an indentation 30125 and/or longitudinal flanges 30129. The fabric thickness compensator 30120 may also comprise a latch 30124 which is movable between an open position and a closed position. . When the latch 30124 is in the closed position, as shown in Figure 219, the trim material 30026 can be enclosed within the body 30122 of the fabric thickness compensator 30120 and when the latch 30124 is in the open position, as shown in Figure 220 , the compensating material 30026 may escape from the body 30122. Similar to at least one of the fabric thickness compensators described herein, the fabric thickness compensator 30120 may be deformable and/or resilient. For example, the fabric thickness compensator 30120 may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer, for example. The 30120 tissue thickness compensator may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or oxidized regenerated cellulose (ORC), for example. Due to the resilience of the fabric thickness compensator 30120, at least a portion of the body 30122 can be flexed to move the latch 30124 between the open position and the closed position. The body 30122 of the tissue thickness compensator 30120 may remain attached to the anvil when the anvil is removed from the surgical site. For example, body 30122 may be configured to tear away from any clip that may have captured body 30122 therein.

[00558] Referring to Figure 221, a fabric thickness compensator 30220 may comprise a body 30222 and a pocket 30224. The compensator material 30026 may be retained between the body 30222 and the pocket 30224, for example. Fabric thickness compensator 30220 may comprise an alignment element, an indentation and/or longitudinal flanges 30229. Additionally, at least one longitudinal flange 30229 may comprise a groove, or slot, 30228 which may be configured to receive a tab 30225 extending from the pocket 30224 of the fabric thickness compensator 30220. In such a case, the engagement of the groove 30228 and the tab 30225 can connect the body 30222 and the pocket 30224. Additionally, in such a case, the connection between the groove 30028 and tab 30025 may confine and/or retain the trim material 30026 within the fabric thickness compensator 30220. Now referring to Figure 222a, a pocket 30324 of a fabric thickness compensator 30320 may comprise an anchor 30325 extending up from the same. Additionally, fabric thickness compensator 30320 may comprise a body 30322 having an inlet 30328. Anchor 30325 can extend from pocket 30324 to engage inlet 30328 in body 30322. In such an arrangement, pocket 30324 and body 30222 can confine the 30026 offset material to each other. The fabric thickness compensator 30320 may additionally comprise one or more flanges 30229 which may be mounted on the anvil to retain the body 30322 to the anvil.

[00559] Now referring to Figure 223, a fabric thickness compensator 30420 may comprise a body 30422 and a pocket 30424. The compensation material 30026 may be retained between the body 30422 and the pocket 30424 of the fabric thickness compensator 30420 Body 30422 may comprise hole 30428 and pocket 30424 may comprise anchor 30425. Anchor 30425 may extend from pocket 30424 and through hole 30428 of body 30422, for example. Anchor 30425 may engage anvil 25060 when fabric thickness compensator 30420 is attached to anvil 25060, for example. Anchor 30525 may be sufficiently deformable and resilient so that anchor 30425 flexes when it engages anvil 25060. Additionally, flexed anchor 30425 may apply a pinching force to anvil 25060 to secure or assist in gripping the anvil 25060. fabric thickness 30420 to anvil 25060. Alternatively, an anchor may not extend completely through a hole in the compensator body. Referring to Figure 224, an anchor 30525 in a pocket 30524 of a fabric thickness compensator 30520 may engage a hole 30528 in a body 30522 of a fabric thickness compensator 30520. Anchor 30525 may engage the hole 30528 to secure pocket 30524 to body 30522. For example, hole 30528 may comprise a necked portion extending into a socket. Anchor 30525 may comprise a gripping edge, which may pass through the necked portion and engage the socket to secure anchor 20525 in hole 30528. Fabric thickness compensator 30520 may also comprise an alignment element, an indentation and/or an indentation. or 30529 longitudinal flanges, for example.

[00560] Referring to Figures 225 to 227, a tissue thickness compensator 31020 may be configured to engage an anvil 31060 of an end actuator 31012 of a surgical instrument. Fabric thickness compensator 31020 may comprise an outer film 31022, an inner film 31024 and a compensating material 31026 positioned therebetween. Fabric thickness compensator 31020 may be deformable and/or resilient, similar to at least one of the fabric thickness compensators described herein. For example, the 31026 offset material may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer, for example. The tissue thickness compensator 31020 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and/or oxidized regenerated cellulose (ORC), for example. Tissue thickness compensator 31020 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent. The compensating material 31206 of the tissue thickness compensator 31020 may comprise a therapeutic agent.

[00561] Inner film 31024 may be positioned adjacent to staple forming pockets 31066 on anvil 31060, for example. Referring first to Figure 225, the inner film 31024 may comprise a staggered geometry such that the geometry of the inner film 31024 substantially matches the geometry of the anvil 31060. The inner film 31024 may additionally comprise an alignment ridge 31028 , which may be substantially aligned and/or parallel to a longitudinal slot 31062 in anvil 31060, for example. As described in more detail in this document, the inner film 31024 may comprise an inner flange 31025 extending from each longitudinal side of the inner film 31024 and terminating in a latch 31027. The outer film 31022 may comprise a body 31021 and at least an outer flange 31023, for example. Optionally, an outer flange 31023 can extend from each longitudinal side of the body 31021, for example. The outer flange 31023 can be secured to the inner flange 31025 so that the offset material 31026 is retained between the outer film 31022 and the inner film 31024.

[00562] Referring first to Figure 227, the anvil 31060 may comprise an outer surface 31061 and at least one groove 31064 along at least a portion of the outer surface 31061. In accordance with the invention, a latch 31027 on inner flange 31025 of inner film 31024 may be positioned within a groove 31064. Referring to Figure 226, for example, fabric thickness compensator 31020 may slide around anvil 31060. Grooves 31064 on anvil 31060 may extend to the distal end of the anvil 31060. In such cases, the latches 31027 of the fabric thickness compensator 31020 may slide into the grooves 31064 and along a length of the fabric thickness compensator 31020.

[00563] Now referring to Figures 228 and 229, a fabric thickness compensator 31120 may comprise a compensation material 31026 and at least one connector 31124. Each connector 31124 may extend around the compensation material 31026 and may terminate in a 31127 latch on opposite ends thereof. Locks 31127 may be positioned in grooves 31064 of anvil 31060 to secure fabric thickness compensator 31120 to anvil 31060. grooves 31164 on anvil 31060 may extend to the distal end of anvil 31060. In such cases, locks 31127 of connectors 31124 may slide into grooves 31064. Alternatively, connectors 31224 may be resilient so that they can flex or snap-fit around the anvil 31060. In use, connectors 31224 may retain the offset material 31026 in the place until the compensation material 31026 separates from the anvil 31060. Under certain circumstances, connectors 31224 may remain attached to the anvil 31060 and may be removed from the surgical site with the anvil. In other circumstances, the 31224 connectors may separate from the 31060 anvil and may be deployed with the 31026 offset material.

[00564] Referring to Figures 230 to 236, a fabric thickness compensator 32020 may comprise a body portion 32022, at least one longitudinal flange 32024 and at least one pocket 32026. The fabric thickness compensator 31020 may be deformable and/or resilient, similar to at least one of the fabric thickness compensators described herein. For example, the 31026 offset material may comprise a polymeric composition such as a bioabsorbable, biocompatible elastomeric polymer, for example. The tissue thickness compensator 31020 may additionally comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen and/or oxidized regenerated cellulose (ORC), for example. Longitudinal flange 32024 may extend along each longitudinal side of body portion 32022. Referring first to Figure 233, longitudinal flanges 32024 of fabric thickness compensator 32020 may be configured to engage the anvil 25060. For example, fabric thickness compensator 32020 may slide over anvil 25060 and longitudinal flanges 32024 and may wrap at least partially around a portion of anvil 25060. In such cases, flanges 32024 may attach fabric thickness compensator 32020 to anvil 25060, for example. Optionally, when the fabric thickness compensator 32020 is attached to the anvil, the body portion 32022 of the fabric thickness compensator 32020 may overlap the staple forming pockets 25066 on the inner surface of the anvil 25060.

[00565] In addition to the above, a plurality of pockets 32026 may laterally traverse the body portion 32022. Referring first to Figure 234, the plurality of pockets 32026 may comprise at least one therapeutic agent such as a drug or pharmaceutically active agent. In accordance with the invention, a plurality of first pockets 32026a may comprise a first therapeutic agent or combination thereof and a plurality of second pockets 32026b may comprise a second therapeutic agent or combination thereof. First pockets 32026a and second pockets 32026b may be positioned alternately along body portion 32022, for example. Additionally, when the first therapeutic agent is released from the first pocket 32026a and the second therapeutic agent is released from the second pocket 32026b, the first and second therapeutic agents can be configured to react with each other. Referring to Figure 236, pockets 32026 can release the therapeutic agent(s) retained therein when the cutting element 25052 on firing bar 25050 translates along longitudinal slot 25062 on anvil 25060, for example.

[00566] Referring now to Figure 237, an end actuator of a surgical stapling instrument may comprise an anvil 32560 and a staple cartridge 32500 comprising a tissue thickness compensator 32520. Similar to the above, the cartridge of staples 32500 may comprise a plurality of staples 32530 contained at least partially therein that are ejectable therefrom to capture the fabric thickness compensator 32520 therein. Also similar to the above, staples 32530 may penetrate fabric thickness compensator 32520 and contact staple forming pockets 32562 defined in anvil 32560. Now referring to Figure 239, anvil 32560 may further comprise a layer 32570 attached thereto which may be configured to retain a fabric thickness compensator 32580 to the anvil 32560. For example, layer 32570 may comprise a loadable layer which may be configured to retain and/or generate an electrostatic charge and attract the 32580 fabric thickness compensator for the same. More specifically, active or passively actuated Van der Waals molecular forces, for example, can hold the 32580 tissue thickness compensator to the 32570 layer. The 32570 chargeable layer can be in electrical communication with a surgical stapling instrument cable that may comprise a control configured to selectively couple the 32570 chargeable layer to a power source and, as a result, allow an electrostatic charge to be selectively generated within the 32570 chargeable layer. For example, the 32570 chargeable layer may comprise conductive electrodes incorporated into a polymer, for example. In either case, the statically charged layer 32570 can attract oppositely charged particles in the fabric thickness compensator 32580 and retain the fabric thickness compensator 32580 to the anvil. Referring now to Figure 238, the chargeable layer 32570 may comprise a grid, or grid, of conductors 32571 that are in electrical communication with each other. For example, the conductors can be positioned and arranged so that they surround the staple forming pockets 32562 defined in the anvil 32560. In such cases, the staples 32530 can be ejected from the staple cartridge 32500 and then deformed by the anvil. 32560 without capturing the 32571 conductors in them. Under various circumstances, the 32570 chargeable layer may be disconnected from the power supply after the 32530 clamps have been engaged with the 32580 fabric thickness compensator so that the electrostatic charge on the 32570 layer can dissipate. Under other circumstances, the loadable layer 32570 may be decoupled from the power supply before the 32530 clamps are fired. In either case, as the electrostatic charge dissipates, the 32560 anvil can be opened again and the 32570 layer can be moved away from the 32580 fabric thickness compensator. The electrostatic charge may need to dissipate completely before the 32570 layer can be separated from the fabric thickness compensator 32580 while, alternatively, the layer 32570 may be separated from the fabric thickness compensator 32580 before the electrostatic charge on the layer 32570 has been completely dissipated. As a result of the above, fabric thickness compensator 32580 can be attached to anvil 32560 without the use of a chemical adhesive.

[00567] In addition to the above, layer 32570 can also provide feedback capability for the surgical stapling instrument handle. For example, layer 32570 may be pressure sensitive and may be configured to sense pinch pressure applied to it by anvil 32560, for example.

[00568] In addition to the above, a tissue thickness compensator may be comprised of a biocompatible material. The biocompatible material, such as a foam, may comprise tackifiers, surfactants, fillers, crosslinkers, pigments, dyes, antioxidants and other stabilizers and/or combinations thereof to provide the desired properties of the material. A biocompatible foam may comprise a surfactant. The surfactant can be applied to the surface of the material and/or dispersed in the material. Without being bound by any particular theory, the surfactant applied to the biocompatible material can reduce the surface tension of fluids in contact with the material. For example, the surfactant can reduce the surface tension of water in contact with the material in order to accelerate the penetration of water into the material. Water can act as a catalyst. The surfactant can increase the hydrophilic capacity of the material.

[00569] The surfactant may comprise an anionic surfactant, a cationic surfactant and/or a non-ionic surfactant. Examples of surfactants include, but are not limited to, polyacrylic acid, metallose, methyl cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, polyoxyethylene phenyl ether , polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, dialkylphenoxy poly(ethyleneoxy)ethanol and polyoxamers and combinations thereof. The surfactant may comprise a copolymer of polyethylene glycol and polypropylene glycol. The surfactant may comprise a phospholipid surfactant. The phospholipid surfactant may provide antibacterial stabilizing properties and/or disperse other materials in the biocompatible material.

[00570] The tissue thickness compensator may comprise at least one drug. The fabric thickness compensator may comprise one or more natural materials, non-synthetic materials and/or synthetic materials described herein. The tissue thickness compensator may comprise a biocompatible foam comprising gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polylactic acid, polydioxanone, polyhydroxyalkanoate, polyglecaprone and combinations thereof. The fabric thickness compensator may comprise a film comprising the at least one drug. The fabric thickness compensator may comprise a biodegradable film comprising the at least one drug. The medicament may comprise a liquid, a gel and/or a powder. Medicaments may comprise anti-cancer agents, for example cisplatin, mitomycin and/or adriamycin.

[00571] The tissue thickness compensator may comprise a biodegradable material to provide elution or controlled release of the at least one drug as the biodegradable material degrades. The biodegradable material can degrade, decompose or lose its structural integrity when it comes into contact with an activator, for example an activator fluid. The activating fluid may comprise saline or any other electrolyte solution, for example. The biodegradable material may come into contact with the activating fluid through conventional techniques, including, but not limited to, sprinkling, dipping and/or brushing. In use, for example, a surgeon may immerse an end actuator and/or staple cartridge comprising the tissue thickness compensator comprising the at least one drug in an activating fluid comprising a saline solution such as sodium chloride. , calcium chloride and/or potassium chloride. The tissue thickness compensator can release the drug as the tissue thickness compensator degrades. Elution or release of drug from the tissue thickness compensator can be characterized by a rapid initial elution or release rate and a slower elution or sustained release rate.

[00572] In accordance with the invention, a tissue thickness compensator, for example, may be comprised of a biocompatible material which may comprise an oxidizing agent. The oxidizing agent may be an organic peroxide and/or an inorganic peroxide. Examples of oxidizing agents may include, but are not limited to, hydrogen peroxide, urea peroxide, calcium peroxide and magnesium peroxide, and sodium percarbonate. The oxidizing agent may comprise peroxygen-based oxidizing agents and hypoalite-based oxidizing agents, for example hydrogen peroxide, hypochlorous acid, hypochlorites, hypocodes and percarbonates. The oxidizing agent may comprise alkali metal chlorites, hypochlorites and perborates, for example sodium chlorite, sodium hypochlorite and sodium perborate. The oxidizing agent may comprise vanadate. The oxidizing agent may comprise ascorbic acid. The oxidizing agent may comprise an active oxygen generator. In accordance with the invention, a fabric scaffold may comprise biocompatible material which comprises an oxidizing agent.

[00573] The biocompatible material may comprise a liquid, a gel and/or a powder. The oxidizing agent may comprise microparticles and/or nanoparticles, for example. For example, the oxidizing agent can be ground into microparticles and/or nanoparticles. The oxidizing agent can be incorporated into the biocompatible material by suspending the oxidizing agent in a polymer solution. The oxidizing agent can be incorporated into the biocompatible material during the lyophilization process. After lyophilization, the oxidizing agent can be attached to the cell walls of the biocompatible material to interact with the tissue upon contact with it. The oxidizing agent may not be chemically bonded to the biocompatible material. A dry percarbonate powder can be incorporated into a biocompatible foam to provide a prolonged biological effect through the slow release of oxygen. A dry powder of percarbonate can be incorporated into a polymer fiber in a non-woven structure to provide a prolonged biological effect through the slow release of oxygen. The biocompatible material may comprise an oxidizing agent and a medicament, for example doxycycline and ascorbic acid.

[00574] The biocompatible material may comprise a rapid release oxidizing agent and/or a slower sustained release oxidizing agent. The elution or release of the oxidizing agent from the biocompatible material can be characterized by a rapid initial elution or release rate and a slower elution or prolonged release rate. The oxidizing agent can generate oxygen when the oxidizing agent comes into contact with body fluid, for example water. Examples of bodily fluids may include, but are not limited to, blood, plasma, peritoneal fluid, cerebrospinal fluid, urine, lymphatic fluid, synovial fluid, vitreous fluid, saliva, gastrointestinal luminal contents, and/or bile. Without being bound by any particular theory, the oxidizing agent can reduce cell death, improve tissue viability and/or maintain the mechanical strength of tissue that can be damaged during cutting and/or stapling.

[00575] The biocompatible material may comprise at least one microparticle and/or a nanoparticle. The biocompatible material may comprise one or more of the natural materials, non-synthetic materials and synthetic materials described herein. The biocompatible material may comprise particles having an average diameter of about 10 nm to about 100 nm and/or about 10 mm to about 100 mm, for example 45 to 50 nm and/or 45 to 50 mm The biocompatible material may comprise biocompatible foam which comprises at least one microparticle and/or nanoparticle incorporated therein. The microparticle and/or nanoparticle may not be chemically bonded to the biocompatible material. The microparticle and/or nanoparticle can provide controlled drug delivery. the microparticle and/or the nanoparticle may comprise at least one drug. The microparticle and/or nanoparticle may comprise a hemostatic agent, an antimicrobial agent and/or an oxidizing agent, for example. The tissue thickness compensator may comprise a biocompatible foam which comprises a hemostatic agent which comprises oxidized regenerated cellulose, an antimicrobial agent which comprises doxycycline and/or gentamicin and/or an oxidizing agent which comprises a percarbant. The microparticle and/or nanoparticle can provide controlled drug release for up to three days, for example.

[00576] The microparticle and/or the nanoparticle can be incorporated into the biocompatible material during a manufacturing process. For example, a biocompatible polymer, for example a PGA/PCL, may be contacted with a solvent, for example dioxane to form a mixture. The biocompatible polymer can be ground to form particles. The dry particles, with or without ORC particles, can be contacted with the mixture to form a suspension. The suspension can be lyophilized to form a biocompatible foam comprising PGA/PCL which has dry particles and/or ORC particles incorporated therein.

[00577] The fabric thickness compensators or layers disclosed herein may be comprised of an absorbable polymer, for example. A fabric thickness compensator can be comprised of foam, film, fibrous fabric, fibrous non-woven PGA, PGA/PCL (poly(glycolic acid-co-caprolactone)), PLA/PCL (poly(lactic acid-co-polycaprolactone) ), PLLA/PCL, PGA/TMC (poly(glycolic acid-trimethylene co-carbonate)), PDS, PEPBO or other absorbable polyurethane, polyester, polycarbonate, polyorthoesters, polyanhydrides, polyesteramides and/or polyoxaesters, for example. According to the invention, a tissue thickness compensator can be comprised of PGA/PLA (poly(glycolic acid-co-lactic acid)) and/or PDS/PLA (poly(p-dioxanone-co-lactic acid)) , for example. According to the invention, a fabric thickness compensator may be comprised of an organic material, for example. A tissue thickness compensator can be comprised of carboxymethyl cellulose, sodium alginate, cross-linked hyaluronic acid and/or oxidized regenerated cellulose, for example. In accordance with the invention, a fabric thickness compensator may comprise a durometer in the ranges 3-7 Shore A (30-50 Shore OO) with a maximum hardness of 15 Shore A (65 Shore OO), for example. A fabric thickness compensator may be subjected to 40% compression under a load of 13 N (3 lbf), 60% compression under a load of 27 N (6 lbf), and/or 80% compression under a load of of 89 N (20 lbf), for example. One or more gases, such as air, nitrogen, carbon dioxide and/or oxygen, for example, may be bubbled through and/or contained within the fabric thickness compensator. A fabric thickness compensator may comprise microspheres therein that comprise between approximately 50% and approximately 75% of the hardness of material comprising the fabric thickness compensator.

[00578] According to the invention, a tissue thickness compensator may comprise hyaluronic acid, nutrients, fibrin, thrombin, platelet-rich plasma, sulfasalazine (Azulfidine® - 5ASA+Sulfapyridine diazo binding)) - prodrug - bacterial colonic acid (Azoreductase), mesalamine (5ASA with different prodrug configurations for delayed release), asacol® (5ASA + coated Eu- dragit-S - pH > 7 (coating dissolution)), Pentasa® (5ASA + ethylcellulose coated - pH/time dependent slow release), Mesasal® (5ASA + coated Eudragit-L - pH > 6), Olsalazine (5ASA + 5ASA - colonic bacterial (Azoreductase)), Balsalazide (5ASA + 4Aminobenzoyl-B-alanine ) - colonic bacterial (Azoreductase)), granulated mesalamine, Lialda (delay and SR formulation of mesalamine), HMPL-004 (herbal blend that can inhibit the activation of TNF-alpha, interleukin-1 beta and nuclear-kappa B), CCX282-B (oral chemokine receptor antagonist that interferes with the traffic of l T-infocytes in the intestinal mucosa), Rifaximin (non-absorbable broad-spectrum antibiotic), infliximab, murine chimeric (monoclonal antibody directed against TNF-alpha-approved for the reduction of signs/symptoms and maintenance of clinical remission in adult patients). - pediatric patients with fistula-producing Crohn's disease and moderate/severe luminal who had an inadequate response to conventional therapy), adalimumab, Total Human IgG1 (anti-TNF-alpha monoclonal antibody - approved for the reduction of signs/symptoms of Crohn's disease and for the induction and maintenance of clinical remission in adult patients with moderately/severely active Crohn's disease who have inadequately responded to conventional therapies or who have become infliximab intolerant), Certolizumab pegoll, humanized anti-TNF' FAB (fragment of monoclonal antibody linked to polyethylene glycol - approved for the reduction of signs/symptoms of Crohn's disease and for the induction and maintenance of a response in adult patients with moderate/severe disease with inadequate response to conventional therapies), Natalizumab, first non-TNF-alpha inhibitor (approved biological compound for Crohn's disease), humanized monoclonal IgG4 antibody (targeted against alpha-4 integrin - FDA approved for induction and maintenance of clinical response and remission in patients with moderate/severe disease with evidence of inflammation and who have had an inadequate response or are unable to tolerate conventional therapies against Crohn's disease and TNF-alpha inhibitors), concomitant immunomodulators given potentially with infliximab, azathioprine 6-Mercaptopurine (purine synthesis inhibitor - pro-drug), methotrexate (binds the enzyme dihydrofolate reductase (DHFR) which participates in the synthesis of tetrahydrofolate, inhibits all purine synthesis), antihypertensive therapy Allopurinol and thioprine, PPI, H2 for acid suppression to protect the healing line, C-Diff - Flagyl, Vancomycin (faecal translocation treatment; probiotics; repopulation of normal endoluminal flora), and/or Rifaximin (treatment of excessive bacterial proliferation (notably, hepatic encephalopathy); not absorbed in the GI tract with action on intraluminal bacteria), for example.

[00579] As described here, a tissue thickness compensator can compensate for variations in tissue thickness that are captured in staples ejected from a staple cartridge and/or contained in a row of staples, for example. In other words, certain staples in a staple line can capture thick pieces of fabric, while other staples in the staple line can capture thin pieces of fabric. Under such circumstances, the fabric thickness compensator can assume different heights or thicknesses on the staples and apply a compressive force to the tissue captured by the staples regardless of whether the captured tissue is thick or thin. In accordance with the invention, a fabric thickness compensator can compensate for variations in fabric hardness. For example, certain staples in a staple line can capture highly compressible portions of tissue, while other staples in the staple line can capture portions of tissue that are less compressible. Under such circumstances, the fabric thickness compensator may be configured to assume a lower height on staples that have captured tissue that has a lower compressibility or higher hardness, and correspondingly greater height on staples that have captured tissue. that has a higher compressibility or lower hardness, for example. In any event, a fabric thickness compensator, regardless of whether it compensates for variations in fabric thickness and/or variations in fabric hardness, for example, may be called a 'fabric compensator' and/or 'compensator', for example.

[00580] The devices described here may be designed to be discarded after a single use, or they may be designed to be used multiple times. In either case, however, the device may be refurbished for reuse after at least one use. Overhaul may include any combination of the steps of disassembling the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device may be dismantled, and any number of particular parts or parts of the device may be selectively exchanged or removed, in any combination. After cleaning and/or replacing particular parts, the device can be reassembled for subsequent use in a refurbishment facility or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that refurbishing a device can use a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of such techniques, and the resulting refurbished device, are all within the scope of this application.

[00581] Preferably, the invention described herein will be processed prior to surgery. First, a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument are then placed in the field of radiation that can penetrate the container, such as gamma radiation, X-rays, or high-energy electrons. Radiation kills bacteria on the instrument and container. The sterilized instrument can then be stored in a sterile container. The sterile container keeps the instrument sterile until it is opened in the medical facility.

[00582] Any patent, publication, or other descriptive material, in whole or in part, which is said to be incorporated by reference into the present invention is incorporated into the present invention only to the extent that the incorporated materials do not come into conflict with existing definitions, statements or other descriptive material presented in this description. Accordingly, and to the extent necessary, the description as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, which is incorporated by reference into the present invention, but which conflicts with existing definitions, statements, or other descriptive materials set forth herein, will be incorporated herein only to the extent that no conflict will appear between the embedded material and the existing description material.

[00583] While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the description. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Additionally, this application is intended to cover deviations from the present disclosure that may occur with known or customary practice in the art to which this invention relates.

Claims (9)

1. Stapling assembly for use with a stapler, the stapling assembly comprising: an anvil (22060) comprising: a plurality of forming surfaces; a slot (22063); and a cutting member (22080) configured to be received within the slot (22063), wherein the slot (22063) defines a path for the cutting member (22080); a tissue thickness compensator (22820) attached to the anvil (22060) , wherein the buffer (22820) comprises a plurality of first packets (22824a) aligned with the slot (22063) and a plurality of second packets (22824b) aligned with the slot (22063), and wherein the first packets (22824a) and second packs (22824b) extend laterally through the compensator in a direction that is transverse to the path, and are configured to remain intact until they are cut by the cutting member (22080); a first medicament positioned within each first pack (22824a); characterized in that the compensator (22820) comprises a second medication positioned within each second package (22824b), wherein the first medication is different from the second medication; wherein the cutting member (22080) advances along the path of the injection mixes the first drug with the second drug. 2. A stapling assembly according to claim 1, characterized in that the compensator (22820) comprises a clamping portion (22721) configured to fit the slot (22063), and wherein the clamping portion (22721) is configured to be cut by the cutting member. 3. Staple assembly according to claim 1 or 2, characterized in that the first packets (22824a) and the second packets (22824b) are arranged in an alternating arrangement. 4. Staple assembly according to claim 1, characterized in that: the first packs (22824a) are first lateral cavities extending laterally in relation to the slit (22063) and the second packs (22824b) are second cavities laterals extending laterally in relation to the slit (22063). 5. Staple assembly according to claim 4, characterized in that the compensator (22820) comprises a fixing portion (22721) configured to fit the longitudinal slot (22063), and wherein the cutting member is configured to cut the fixing portion (22721). 6. Staple kit according to any one of claims 1 to 5, characterized in that the first medicament comprises a first powder and the second medicament comprises a second powder. 7. Staple kit according to any one of claims 1 to 6, characterized in that the first medicament comprises an alginate and the second medicament comprises calcium. A stapling assembly according to any one of claims 4 to 7, characterized in that the first side cavities and the second side cavities are arranged in an alternating arrangement along the longitudinal slot (22063). A stapling assembly according to any one of claims 4 to 8, characterized in that the longitudinal slot (22063) defines a longitudinal axis, and wherein the first side cavities and the second side cavities each define a lateral axis perpendicular to the longitudinal axis.

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