BR112020016741A2 - THREE-DIMENSIONAL ACCESSORIES FOR SURGICAL STAPLERS - Google Patents

Abstract

the present invention relates to stapling sets for use with a surgical stapler and methods for making them. the present invention also relates to three-dimensional accessories for use with a surgical stapling set and methods for making them.

Description

Invention Patent Descriptive Report for "THREE-DIMENSIONAL ACCESSORIES FOR SURGICAL STAPLERS".

FIELD

[0001] The present invention relates to three-dimensional accessories and methods of manufacturing them.

BACKGROUND

[0002] Surgical staplers are used in surgical procedures to close openings in tissues, blood vessels, ducts, "shunts" (anastomoses) or other objects or parts of the body involved in the specific procedure. The openings can be naturally occurring, such as passages in blood vessels or an internal organ such as the stomach, or they can be formed by the surgeon during a surgical procedure, such as through a perforation in a tissue or blood vessels to form a deviation or an anastomosis, or by cutting a fabric during a stapling procedure.

[0003] For some surgical staplers, the surgeon needs to select the appropriate staples and the appropriate height for the tissue being stapled. For example, a surgeon could select tall staples for use with thick tissue and short staples for use with thin tissue. In some cases, however, the fabric that is stapled does not have a consistent thickness, so staples cannot reach the desired trigger setting at each stapling location. As a result, it is not possible to form a desirable seal at or near all stapling sites, thereby allowing blood, air, gastrointestinal fluids and other fluids to infiltrate the unsealed locations.

[0004] In addition, staples, as well as other objects and materials that can be implanted in conjunction with procedures such as stapling, are generally devoid of some characteristics of the tissue in which they are implanted. For example, staples and other objects and materials may not have the natural flexibility of the tissue in which they are implanted and, therefore, are not able to withstand the varying intricate pressures at the site of their implantation. This can lead to undesirable tears in the fabric and, consequently, leaks at or near the stapling site.

[0005] Therefore, there is a need for improved instruments and methods that solve current problems with surgical staplers.

SUMMARY

[0006] Three-dimensional bioabsorbable accessories for use with a stapling set are provided.

[0007] In an exemplary embodiment, a three-dimensional bioabsorbable accessory is provided that can include a plurality of resilient struts that are formed from a first matrix that includes at least one fused bioabsorbable polymer. The plurality of resilient struts can form geometric repeating units, and the struts of the plurality of resilient struts can be configured to deform when compressed. The accessory can be configured to be releasably retained on a staple body, and to allow staples from a plurality of staples disposed within the staple body to pass through it so that the accessory can be attached to the fabric by the plurality of staples. In one embodiment, the accessory may also include at least one locking element that can be configured to limit the amount of compression of the accessory.

[0008] In one aspect, empty spaces of varying sizes may be present in the accessory.

[0009] In certain respects, at least one fused bioabsorbable polymer from the first matrix can be selected from the group consisting of thermoplastic bioabsorbable polyurethane, ultraviolet light-curable bioabsorbable polyurethane, poly (lactic acid), polycaprolactone, polyglycolide, polydioxanone, poly ( lactic-co-glycolic acid), polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, copolymers thereof and combinations thereof.

[0010] In one aspect, the accessory can be configured to apply a tension of at least about 3 g / mm2 to the fabric stapled to the accessory for at least 3 days when the accessory is in a state implanted in the fabric.

[0011] The plurality of resilient struts can have a variety of configurations. For example, the struts of the plurality of struts are substantially spiral in shape. In some respects, struts from the plurality of resilient struts can be interconnected at nodes to form lattice-like structures that can be configured to flex when compressed. In one embodiment, the interconnectivity of the plurality of resilient struts and nodes can form a geometry that can be configured to allow the attachment to compress in a first predetermined direction and to limit movement in a second direction that is different from the first predetermined direction . In another embodiment, the nodes can be formed from a second matrix that includes at least one fused bioabsorbable polymer that is different from at least one fused bioabsorbable polymer from the first matrix.

[0012] In certain aspects, the plurality of struts can define a first portion, a second opposite portion of the accessory and a channel between said portions that can be configured to receive a cutting element. The first and second portions can be selectively connected by at least one connecting member that extends through the channel.

[0013] In other respects, the plurality of struts can allow a contact surface with the fabric and a contact surface with the body to compress towards each other.

[0014] In another exemplary embodiment, a three-dimensional bioabsorbable accessory can be provided that includes a plurality of resilient struts that are connected in joints to form a lattice structure. The lattice structure can be formed from at least one matrix that includes at least one fused bioabsorbable polymer. The interconnectivity of the plurality of struts and joints can be configured to allow the accessory to compress. The lattice structure can include a fabric contact surface and an assembly contact surface that is opposite the fabric contact surface. The lattice structure can be configured to allow clips from a plurality of clips arranged within the stapling assembly to pass through it so that the accessory can be attached to the fabric by the plurality of clips. In one embodiment, the accessory may also include at least one locking element that can be configured to limit the amount of compression of the accessory.

[0015] In some respects, the plurality of resilient struts may be formed from a first matrix that includes at least one fused bioabsorbable polymer and the joints may be formed from a second matrix that includes at least one fused bioabsorbable polymer that is different from the hair. least one fused bioabsorbable polymer from the first matrix.

[0016] In certain aspects, empty spaces are present in the lattice structure. The voids can form a substantially continuous network of openings throughout the accessory. In other respects, the lattice structure can have a first end, a second end and a longitudinal geometric axis that extends between them. The lattice structure can also include voids that extend at least partially through the lattice structure.

[0017] In one aspect, the plurality of struts can define the first side portion, a second opposite side portion of the lattice structure and a channel between said portions that can be configured to receive a cutting element. The first and second side portions can be selectively connected by a plurality of connecting members extending through the channel.

[0018] In another aspect, the accessory can be configured to apply a tension of at least about 3 g / mm2 to the fabric stapled to the accessory for at least 3 days when the accessory is in a state implanted in the fabric.

BRIEF DESCRIPTION OF THE DRAWINGS

[0019] This invention will be more fully understood from the detailed description below in conjunction with the accompanying drawings, in which:

[0020] Figure 1 is a perspective view of an exemplary modality of a conventional surgical cutting and stapling instrument;

[0021] Figure 2 is a perspective view of a wedge slide of a staple cartridge of the stapling and surgical cutting instrument of Figure 1;

[0022] Figure 3 is a perspective view of a knife and a firing bar ("rod with E profile") of the stapling and surgical cutting instrument of Figure 1;

[0023] Figure 4 is a longitudinal cross-sectional view of a surgical cartridge that can be disposed within the stapling and surgical cutting instrument of Figure 1;

[0024] Figure 5 is a top view of a clamp in a non-triggered (pre-positioned) configuration that can be disposed within the clamp cartridge of the surgical cartridge assembly of Figure 4;

[0025] Figure 6 is a longitudinal cross-sectional view of an exemplary embodiment of a surgical cartridge set that has an accessory attached to a cartridge platform;

[0026] Figure 7 is a schematic illustration of the accessory of Figure 6 in a state implanted in the tissue;

[0027] Figure 8A is a perspective view of an exemplary modality of an accessory that has a plurality of repetition units of interconnected struts;

[0028] Figure 8B is an enlarged view of an accessory repetition unit shown in Figure 8A taken at 8B;

[0029] Figure 9A is a schematic illustration of the repetition unit of Figure 8B in a pre-compressed state;

[0030] Figure 9B is a schematic illustration of the repetition unit of Figure 8B in a first compressed state;

[0031] Figure 9C is a schematic illustration of the repetition unit shown in Figure 8B in a second compressed state;

[0032] Figure 10 is a graphic illustration of the relationship between rigidity and compression of an accessory;

[0033] Figure 11A is a perspective view of an exemplary modality of an accessory that has a plurality of interconnected struts and internal connectivity features;

[0034] Figure 11B is a cross-sectional view of the accessory shown in Figure 11A taken at 11B;

[0035] Figure 12A is a perspective view of another exemplary embodiment of an accessory that has a plurality of interconnected struts and connecting members;

[0036] Figure 12B is an enlarged view of an accessory repetition unit shown in Figure 12A taken at 12B;

[0037] Figure 13A is a perspective view of another exemplary modality of an accessory that has a plurality of struts of a first material that are interconnected in joints or nodes of a second material;

[0038] Figure 13B is an enlarged view of an accessory repetition unit shown in Figure 13A taken at 13B;

[0039] Figure 14 is a perspective view of yet another exemplary embodiment of a repetition unit of struts interconnected with end shapes;

[0040] Figure 15 is a perspective view of an accessory according to another embodiment that has a plurality of struts and at least one locking element;

[0041] Figure 16 is a perspective view of an exemplary embodiment of an accessory that has a plurality of struts that have a substantially spiral shape;

[0042] Figure 17 is a perspective view of another exemplary modality of an accessory that includes a plurality of struts in the form of vertical columns with different lengths;

[0043] Figure 18A is a schematic illustration of the accessory shown in Figure 17 at a pre-compressed height;

[0044] Figure 18B is a schematic illustration of the accessory shown in Figure 17 in a first compressed height;

[0045] Figure 18C is a schematic illustration of the accessory shown in Figure 17 at a second compressed height;

[0046] Figure 19 is a side view of an exemplary embodiment of an accessory that includes a plurality of struts in the form of vertical columns and curved columns;

[0047] Figure 20 is a graphical representation of the mechanical behavior of the accessory shown in Figure 19 over a range of compressions;

[0048] Figure 21A is a perspective view of another exemplary embodiment of an accessory that has a channel configured to receive a cutting element and provided with tabs to fix the accessory to a staple cartridge;

[0049] Figure 21B is an exemplary embodiment of a staple cartridge assembly that has the accessory shown in Figure 21A attached to the cartridge body; and

[0050] Figure 22 is an example of an accessory that has connecting members.

DETAILED DESCRIPTION

[0051] Certain exemplifying modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the instruments and methods disclosed herein. One or more examples of these modalities are illustrated in the attached drawings. Those skilled in the art will understand that the instruments, systems and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting modalities and that the scope of the present invention is defined exclusively by the claims. The resources illustrated or described in relation to an exemplary modality can be combined with the resources of other modalities. Such modifications and variations are intended to be included in the scope of the present invention.

[0052] Additionally, in the present disclosure, components with the same names in the modalities have, in general, similar resources and, therefore, in a particular modality, not all the resources of each component with the same names are necessarily described in detail. In addition, to the extent that linear or circular dimensions are used in describing the instruments, systems and methods disclosed herein, these dimensions are not intended to limit the types of formats that can be used in combination with such instruments, systems and methods. One skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. The sizes and formats of the systems and instruments, as well as their components, may depend at least on the anatomy of the individual in which the systems and instruments will be used, the size and shape of the components with which the systems and instruments will be used, and the methods and procedures in which the devices will be used.

[0053] It will be recognized that the terms "proximal" and "distal" are used here with reference to a user, for example a doctor, who holds the handle of an instrument. Other spatial terms such as "front" and "rear" correspond similarly to distal and proximal, respectively. It will also be understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in connection with the drawings. However, surgical instruments are used in many orientations and positions, and such spatial terms are not intended to be limiting and absolute.

[0054] Values or ranges can be expressed here as "about" and / or from / about "about" a specific value up to another specific value. When such values or ranges are expressed, other modalities disclosed include the specific value mentioned and / or from / the specific value up to another specific value. Similarly, when the values are expressed as approximations, using the antecedent "about", it must be understood that here several values are presented and that the specific value constitutes another modality. It will be further understood that various values are presented within, and that each value is also disclosed in the present invention as "about" that specific value in addition to the value itself. In modalities, "about" can be used to mean, for example, within 10% of the mentioned value, within 5% of the mentioned value or within 2% of the mentioned value.

[0055] For the purposes of describing and defining the present teachings, it is noted that, unless otherwise indicated, the term "substantially" is used in the present invention to represent the inherent degree of uncertainty that can be attributed to any quantitative comparison , value, measure or other representation. The term "substantially" is also used in the present invention to represent the degree to which a quantitative representation can vary from an established reference without resulting in a change in the basic function of the matter in question.

[0056] Surgical stapling sets and fabrication methods and tissue stapling sets are provided. In general, the present invention provides a stapling assembly that has a body (for example, a staple cartridge or end actuator body) with a plurality of staples disposed within it. The stapling set also includes a compressible three-dimensional accessory that is formed from a matrix that includes at least one fused bioabsorbable polymer and is configured to be releasably retained on the body. The accessory can be releasably retained to the body so that when a clamp is released from the body and implanted in the fabric, at least a portion of the accessory can be attached to the fabric captured by the clamp. As discussed here, the accessory can be configured to compensate for variations in fabric properties, such as variations in fabric thickness, and / or to promote internal growth of the fabric when the accessory is stapled to the fabric. For example, the accessory can be configured to apply a tension of at least about 3 g / mm2 to the fabric for at least 3 days when in a state implanted in the fabric (for example, when the accessory is stapled to the fabric in vivo).

[0057] An exemplary stapling set can include a variety of features to facilitate the application of a surgical staple, as described here and illustrated in the drawings. However, one skilled in the art will recognize that the stapling set may include only some of these features and / or may include a variety of other features known in the art. The stapling sets described here are intended to represent only a few exemplary modalities. In addition, although accessories are described in connection with surgical staple cartridge sets, and do not need to be replaceable, the accessories can be used in connection with staple refills that are not based on cartridges or any type of surgical instrument.

[0058] Figure 1 illustrates an exemplary surgical stapling and cutting instrument 100 suitable for use with an implantable accessory. The illustrated surgical stapling and cutting instrument 100 includes a staple application set 106 or an end actuator that has an anvil 102 hingedly coupled to an elongated staple channel 104. The staple application set 106 can be attached to its end proximal to an elongated drive shaft 108 forming an implementation portion

110. When the clamp application set 106 is closed, or at least substantially closed, the implementation portion 110 may have a sufficiently small cross section suitable for inserting the clamp application set 106 through a trocar. Although instrument 100 is configured to staple and cut tissue, surgical instruments configured to staple but not cut tissue are also contemplated by the present invention.

[0059] In several cases, the clamp application set 106 can be manipulated by means of a handle 112 connected to the elongated drive shaft 108. The handle 112 can include user controls, such as a rotary knob 114 that rotates the shaft. elongated drive 108 and the clamp application set 106 around a longitudinal geometric axis of the elongated drive shaft 108, and a closing trigger 116 that can be pivoted in front of a gun handle 118 to close the gun application set clips 106. The closing release button 120 can face outwardly on the handle 112 when the closing trigger 116 is engaged, and thus the closing release button 120 can be pressed to release the closing trigger 116 and open the staple application set 106, for example.

[0060] A trigger trigger 122, which can be hinged in front of the closing trigger 116, can cause the clamp application set 106 to simultaneously cut and staple the tissue trapped within it. In many cases, multiple firing strokes can be employed using the trigger trigger 122 to reduce the amount of force required to be applied by the surgeon's hand to each stroke. In certain embodiments, the grip 112 may include one or more rotary indicator buttons, for example, the rotary indicator button 124 which can indicate the progress of a shot. A manual firing release lever 126 can allow the firing system to retract before the full firing path has been completed, if desired, and in addition, firing release lever 126 can allow a surgeon,

or another doctor, retract the firing system if the firing system locks and / or fails.

[0061] Additional details on surgical stapling and cutting instrument 100 and other surgical stapling and cutting instruments suitable for use with the present disclosure are provided, for example, in US patent No. 9,332,984 and in the patent application publication US No. 2009/0090763, the disclosures of which are incorporated herein, by reference, in their entirety. In addition, the surgical stapling and cutting instrument does not need to include a handle, but instead a cabinet, which is configured to attach to a surgical robot, for example, as described in US order No. 15 / 689,198, deposited on August 29, 2017 to Frederick E. Shelton et al., the disclosure of which is incorporated herein by reference in its entirety.

[0062] With reference to Figures 2 and 3, a firing set, such as firing set 228, can be used with a stapling and surgical cutting instrument, such as instrument 100 shown in Figure 1. The firing set firing 228 can be configured to advance a wedge slider 230 provided with a plurality of wedges 232 configured to implant staples from a staple application set, such as the staple application set 106 shown in Figure 1, into the fabric captured between an anvil, such as anvil 102 shown in Figure 1, and an elongated clamp channel, such as channel 104 shown in Figure 1. In addition, an E 233 profile rod in a distal portion of firing assembly 228 can fire the staples from the staple set, as well as position the anvil in relation to the elongated staple channel during firing. The illustrated E-profile rod 233 includes a pair of upper pins 234, a pair of intermediate pins 236 that can follow portion 238 of the wedge slide 230 and a lower or base pin 240. The E-profile rod 233 may include also a sharp cutting edge 242 configured to cut the captured tissue as the firing assembly 228 is advanced distally. In addition, an upper guide 244 and an intermediate guide 246, integrally formed and projecting proximally and supporting each vertical edge of the cutting edge 242, can additionally define a tissue preparation area 248 to help guide the fabric to the cutting edge sharp 242 before being cut. The intermediate guide 246 can also be used to engage and trigger the clamp application set by placing a central stepped member 250 of the wedge slide 230 contiguously which promotes the formation of clamps by the clamp application set.

[0063] Referring to Figure 4, a staple cartridge 400 may be used with a surgical stapling and cutting instrument, such as the surgical stapling and cutting instrument 100 shown in Figure 1, and may include a cartridge body 402 and a plurality of clip 404 cavities within the cartridge body

402. A staple 406 can be removably positioned in each staple cavity 404. Staple 406 in a non-triggered (pre-positioned, unformed) configuration is shown in more detail in Figure 5. Staple cartridge 400 can include also a longitudinal channel that can be configured to receive a firing and / or cutting member, for example, an E-profile rod, such as the E-profile rod 233 shown in Figure 3.

[0064] Each clamp 406 may include a crown (base) 406C and one or more legs 406L extending from crown 406C. Before staples 406 are implanted, the crowns 406 C of staples 406 can be supported by staple drivers 408 positioned inside the staple cartridge 400 and, simultaneously, the legs 406L of staples 406 can be at least partially contained within the cavities of staple 404. In addition, staple legs 406L of staples 406 may extend beyond the tissue contact surface 410 of staple cartridge 400 when staples 406 are in their non-triggered position. In certain cases, as shown in Figure 5, the tips of the 406L staple legs can be sharp to make an incision and penetrate tissue.

[0065] In some implementations, the clamps may include one or more external coatings, for example, a sodium stearate based lubricant and / or one or more antimicrobial agents. The one or more antimicrobial agents can be applied to the clamps as their own coating or can be incorporated into another coating in the form of a lubricant. Non-limiting examples of suitable antimicrobial agents include 5-chloro-2- (2,4-dichlorophenoxy) phenol, chlorhexidine, silver formulations (such as nanocrystalline silver), lauric arginate ethyl ester (LAE), octenidine, poly hexamethylene biguanide ( PHMB), taurolidine, lactic acid, citric acid, acetic acid, and their salts.

[0066] Staples 406 can be deformed when moving from an un-triggered position to a triggered position when legs 406L move through the staple cavities 404, penetrate the fabric positioned between an anvil, such as anvil 102 shown in Figure 1, and the staple cartridge 400, and come into contact with the anvil. As the legs 406L are deformed as a result of contact with the anvil, the legs 406L of each clamp 406 can capture a portion of fabric within each clamp 406 and apply a compressive force to the fabric. In addition, the legs 406L of each staple 406 can be deformed downwardly towards the crown 406C of staple 406 to form a staple trapping area within which the fabric can be captured. In several cases, the clamp trapping area can be defined between the internal surfaces of the deformed legs and the internal surface of the clamp crown. The size of a clip's trapping area can depend on several factors such as the length of the legs, the diameter of the legs, the width of the crown and / or the degree of deformation of the legs, for example.

[0067] In use, an anvil, such as anvil 102 shown in Figure 1, can be moved to a closed position by pressing a closing trigger, such as closing trigger 116 shown in Figure 1, to advance a profile rod in E, like the E 233 profile rod shown in Figure 3. The anvil can position the tissue against a contact surface with the tissue 410 of the staple cartridge 400. When the anvil is properly positioned, the staples 406 can be implanted .

[0068] To deploy staples 406, as discussed above, a staple trigger slide, such as slide 230 shown in Figure 2, can be moved from a proximal end 400p to a distal end 400d of staple cartridge 400. As a set trigger, as the trigger assembly 228 shown in Figure 3 is advanced, the slide can come in contact with the clamp drivers 408 and lift the clamp drivers 408 upward into the clamp cavities 404. In at least one example , the slide and clamp drivers 408 can each include one or more ramps, or inclined surfaces, which can operate together to move the clamp drivers 408 upwards from their non-triggered positions. As the staple drivers 408 are lifted upward within their respective staple cavities 404, staples 406 are advanced upward, emerging from their staple cavities 404 and penetrating the tissue. In many cases, the slider can move several clips upwards at the same time as part of a firing sequence.

[0069] One skilled in the art will recognize that, although accessories are shown and described as shown below, the accessories disclosed herein can be used with other surgical instruments and do not need to be attached to a staple cartridge as described. Additionally, one skilled in the art will also recognize that staple cartridges do not need to be replaceable.

[0070] As discussed above, with some types of surgical staplers, a surgeon must often select the appropriate staples with the appropriate staple height for the tissue to be stapled. For example, a surgeon could select tall staples for use with thick tissue and short staples for use with thin tissue. In some cases, however, the fabric that is stapled does not have a consistent thickness, so staples cannot reach the desired firing setting for each section of the stapled fabric (for example, sections of thick fabric and thin fabric) . The inconsistent thickness of the fabric can also cause unwanted leaks and / or tears of the fabric at the stapling site when staples of the same or substantially the same height are used, particularly when the stapling site is exposed to intractable pressures at the stapling site and / or along the staple line.

Consequently, several modalities of three-dimensionally printed accessories are presented here that can be configured to compensate for the variable thickness of the fabric that is captured within fired (implanted) staples to avoid the need to take into account the height of the staple for the stapling the tissue during surgery. That is, the accessories described here may allow the use of a set of staples of the same height or similar heights to staple a fabric of variable thickness (that is, from thin fabrics to thick fabrics), and at the same time, in combination with the accessory, to allow adequate tissue compression within and between fired clips. In this way, the accessories described here can maintain an adequate compression against a thin fabric or a thick fabric stapled to them, thus minimizing leaks and / or tears in the fabric at the stapling sites.

[0072] Alternatively or additionally, the three-dimensionally printed accessories can be configured to promote the internal growth of the fabric. In several cases, it is desirable to promote the internal growth of the tissue into the implantable attachment, to promote healing of the treated tissue (e.g., stapled and / or cut tissue) and / or to accelerate the patient's recovery. More specifically, the internal growth of the tissue into an implantable accessory can reduce the incidence, extent and / or duration of inflammation at the surgical site. The internal growth of tissue into and / or around the implantable accessory can control the spread of infections at the surgical site, for example. The internal growth of blood vessels, especially white blood cells, for example, into and / or around the implantable attachment can fight infections in and / or around the implantable attachment and surrounding tissue. The internal growth of the tissue can also stimulate the acceptance of foreign matter (for example, the implantable attachment and clips) by the patient's body and can reduce the likelihood that the patient's body will reject the foreign matter. Foreign material rejection can cause infection and / or inflammation at the surgical site.

[0073] Unlike conventional accessories (for example, accessories that are not three-dimensionally printed, such as woven accessories), the three-dimensionally printed accessories of the present invention can be formed with microstructures (units) that are consistent and reproducible. In other words, unlike other manufacturing methods, three-dimensional (3D) printing significantly improves control over microstructural resources, such as the arrangement and connection of elements. As a result, the variability in both microstructure (s) and associated properties of the accessory is reduced compared to that of conventional woven accessories. For example, these three-dimensionally printed accessories can be structured to compress a predetermined quantity substantially uniformly. The precise control over the microstructure can also allow the porosity of the accessory to be adapted to improve the internal growth of the tissue. In addition, the three-dimensionally printed accessories disclosed here can be adapted for use with a variety of staples and types of fabric.

[0074] In general, the accessories provided here are designed and positioned on a body, like the cartridge body 402 shown in Figure 4. When fired (implanted) from the body, the clamps penetrate through the accessory and into the interior of the fabric. As the staple legs are deformed against the anvil that is opposite the staple cartridge assembly, the deformed legs capture a portion of the attachment and a portion of the fabric within each staple. That is, when the clamps are fired into the fabric, at least a portion of the accessory is positioned between the fabric and the fired clamp. Although the accessories described here can be configured to be attached to a cartridge body of a staple cartridge set, the present disclosure also contemplates that the accessories can be configured to fit other components of the instrument, such as the clamp of a surgical stapler. . One skilled in the art will recognize that the accessories provided herein can be used with replaceable cartridges or refill staples that are not cartridge-based.

[0075] Figure 6 illustrates an exemplary embodiment of a staple cartridge assembly 600 that includes a staple cartridge 602 and an accessory 604. In addition to the differences detailed below, staple cartridge 602 may be similar to staple cartridge 400 ( Figure 4) and will therefore not be described in detail. As shown, accessory 604 is positioned against staple cartridge 602. The staple cartridge can include a cartridge body 606 and a plurality of staples 608 disposed within it, such as staples 406 shown in Figures 4 and 5. The staples 608 can have any suitable unformed height (pre-positioned). For example, clamps 608 can have an unformed height between about 2 mm and 4.8 mm. Before implantation, the crowns of the clamps 608 can be supported by clamp drivers 610.

[0076] In the illustrated embodiment, accessory 604 can be coupled to an external surface 612, for example, the contact surface with the fabric, of the cartridge body 606. In some embodiments, the external surface 612 of the cartridge body 606 can include one or more fastening features. The one or more clamping features can be configured to engage accessory 604 and thus prevent unwanted movements of accessory 604 in relation to the 606 cartridge body and / or premature release of accessory 604 from the 606 cartridge body. exemplifiers can be found in US patent publication No. 2016/0106427, which is incorporated herein in its entirety for reference.

[0077] Accessory 604 is compressible so that it can be compressed at various heights, thereby compensating for the variable thickness of the tissue captured within an implanted clamp. Accessory 604 has an uncompressed (not deformed), or pre-implanted height, and is configured to deform at one of a plurality of compressed (deformed), or implanted heights. For example, accessory 604 may have an uncompressed height that is greater than the fired height of clamps 608 (for example, the height (H) of fired clamp 608a shown in Figure 7). That is, accessory 604 can have an undeformed state in which a maximum height of accessory 604 is greater than the maximum height of a fired clamp 608a (i.e., a clamp that is in a formed configuration). In one embodiment, the uncompressed height of accessory 604 can be about 10% higher, about 20% higher, about 30% higher, about 40% higher, about 50% higher, about 60% taller, about 70% taller, about 80% taller, about 90% taller, or about 100% taller than the fired height of the 608 clamps. In certain embodiments, the uncompressed height of the accessory 604 can be more than 100% higher than the fired height of clamps 608, for example.

[0078] Accessory 604 can be releasably attached to the outer surface 612 of the cartridge body 606. As shown in Figure 7, when the clips are fired, the fabric (T) and a portion of the accessory 604 are captured by the fired clips (formed) 608a. The fired clips 608a each define the trapping area inside it, as discussed above, to accommodate the captured accessory 604 and the fabric (T). The trapping area defined by a fired clip 608a is limited, at least in part, by the height (H) of the fired clip 608a. For example, the height of a fired clip 608a can be about 0.160 inch or less. In some embodiments, the height of a first clamp 608a can be about 0.130 inch or less. In one embodiment, the height of a fired clip 608a can be about 0.020 inch to 0.130 inch. In another embodiment, the height of a fired clip 608a can be about 0.060 inch to 0.160 inch.

[0079] As described above, accessory 604 can be compressed into a plurality of fired clips, whether the thickness of the tissue captured within the clips is the same or different within each fired clip. In at least one exemplary embodiment, the staples in a row, or row, of staples can be deformed so that the fired height of the staples is about 2.75 mm, for example, where the fabric (T) and the accessory 604 can be compressed within that height. In certain cases, the fabric (T) can have a compressed height of about 1.00 mm and the accessory 604 can have a compressed height of about 1.75 mm. In certain cases, the fabric (T) can have a compressed height of about 1.50 mm and the accessory 604 can have a compressed height of about 1.25 mm. In certain cases, the fabric (T) can have a compressed height of about 1.75 mm and the accessory 604 can have a compressed height of about 1.00 mm. In certain cases, the fabric (T) can have a compressed height of about 2.00 mm and the accessory 604 can have a compressed height of about 0.75 mm. In certain cases, the fabric (T) can have a compressed height of about 2.25 mm and the accessory 604 can have a compressed height of about 0.50 mm. Consequently, the sum of the compressed heights of the captured tissue (T) and the accessory 604 can be equal, or at least substantially equal, to the height (H) of the triggered clip 608a.

[0080] As discussed in more detail below, the structure of the accessory can be configured so that when the accessory and the fabric are both captured within the triggered clip, the accessory can apply a tension that can withstand the pressure of the blood circulating through of the fabric. High blood pressure is typically considered to be 210 mmHg, and therefore it would be desirable for the accessory to apply a tension to the tissue that is equal to or greater than 210 mmHg (for example, 3 g / mm2) over a period predetermined time (for example, 3 days). Thus, in certain modalities, the accessory can be configured to apply a tension of at least about 3 g / mm2 to the captured tissue for at least 3 days. The attachment is in a state implanted in the tissue when the attachment is stapled to the tissue in vivo. In one embodiment, the applied voltage can be about 3 g / mm2. In another embodiment, the applied voltage can be greater than 3 g / mm2. In yet another embodiment, the tension can be at least about 3 g / mm2 and applied to the captured tissue for more than 3 days. For example, in one embodiment, the tension can be at least about 3 g / mm2 and applied to the captured tissue for about 3 to 5 days.

[0081] To design an accessory that is configured to apply a tension of at least about 3 g / mm2 to the captured tissue for a predetermined time, the principles of Hooke's law (F = kD) can be used. For example, when the force (tension) to be applied to the captured tissue is known, an accessory with a certain stiffness (k) can be designed. The stiffness can be defined by adjusting the geometry of the accessory (for example, the diameter and / or the interconnectivity of the struts, for example, the angles and the space between the struts). Additionally, the accessory can be designed so that it has a maximum amount of compression displacement for a minimum fabric thickness, for example, 1 mm, and therefore the length of the displacement D can be the combination of a minimum fabric thickness , for example, 1 mm, plus an accessory thickness when stapled to the fabric for a given maximum staple height, for example, 2.75 mm. As an example, in one embodiment, an accessory can be structured to have a height that is greater than a maximum height of 2.75 mm formed clamp and to compress to a height of 1.75 mm when stapled to a fabric with a minimum thickness of 1 mm. Thus, the accessory can vary in compressibility to maintain a constant length of displacement D, so that the stiffness (k) and the total thickness (D) of the captured fabric and the accessory can apply a tension of 3 g / mm2 to the fabric captured. It should be noted that an element skilled in the art will recognize that the aforementioned formula can be modified to take account of temperature variations, for example, when the accessory changes from room temperature to body temperature after implantation.

[0082] In addition, the accessory can be further developed to apply a substantially continuous tension to the captured tissue (for example, 3 g / mm2) for a predetermined time (for example, 3 days). For this, it would be necessary to take into account the rate of degradation of the accessory materials and the internal growth rate of the fabric inside the accessory during the accessory design. In this way, an accessory can be designed so that the rigidity of the accessory and / or the total thickness of the captured fabric and the accessory do not vary in a way that it is possible to apply a tension less than 3 g / mm2.

[0083] An accessory is stapled to the fabric under various stapling conditions (for example, thickness of the fabric, height of the staple formed, intratido pressure). Depending on the stapling condition, an effective amount of tension can be determined that the accessory needs to be able to apply to the fabric to prevent leaks and tears from the fabric. For example, in one embodiment, an effective amount of tension is at least about 3 g / mm2. In order for the accessory to provide an effective amount of tension to the fabric, the accessory can be designed to effectively compensate for various stapling conditions. In this way, the accessory's geometry can be adapted to assume different compressed heights when stapled to the fabric. As there is a finite range of intricate pressures, fabric thicknesses and staple heights formed, suitable geometric structures for the accessory can be determined which can be effective in applying a substantially continuous desired fabric tension (for example, 3 g / mm2 ) when stapled to it for a given period of time (for example, at least 3 days) over a range of stapling conditions. That is, as described in more detail below, the accessories of the present invention are formed from compressible materials and geometrically configured to allow the accessory to be compressed at various heights in predetermined planes when stapled to the fabric. In addition, this varied response provided by the accessory may also allow the accessory to maintain its application of a desired continuous tension to the fabric when exposed to fluctuations in the intricate pressure that can occur when the accessory is clamped to the fabric (for example, a peak pressure blood).

[0084] Accessories can be manufactured by additive manufacturing processes, also known as three-dimensional printing or 3D printing. 3D printing is a high-speed additive manufacturing technology that can deposit various types of materials in a manner similar to printing. In other words, 3D printing is carried out by depositing successive layers of material to create formats. To print, the printer reads the design of the model in a digital file and arranges successive layers of material to create a series of cross sections. These layers, as decided by the model, are automatically joined or merged to create the final shape. This technique makes it possible to create various shapes or geometric features with control and precision. Non-limiting examples of suitable 3D printing processes, also known as additive manufacturing, as classified by the ASTM Committee 42, include photopolymerization in a vat (eg stereolithography) in which a liquid photopolymer in a vat is selectively cured by light-activated polymerization; blasting of material in which droplets of construction material are selectively deposited; blasting of binder in which a liquid bonding agent is selectively deposited to join powder materials; powder bed melting (for example, selective laser sintering) in which thermal energy selectively fuses regions of a powder bed; deposition by targeted energy in which focused thermal energy is used to melt materials by melting them as they are deposited; deposition by targeted energy in which focused thermal energy is used to melt materials by melting them as they are deposited; extrusion of materials (for example, casting by casting material) in which the material is selectively dispensed through a nozzle or orifice; and lamination of sheets in which sheets of material are bonded to form an object.

[0085] For example, in some embodiments, the method may include scanning with a bundle to fuse a plurality of layers of powder to form a bioabsorbable compressible accessory with an elongated body with a tissue contact surface, a surface of contact with the cartridge that is opposite to the surface of contact with the fabric, and a plurality of struts that form geometric units of repetition that extend between the surfaces of contact with the fabric and of contact with the cartridge. In one embodiment, the method may also include coating the accessory with one or more antimicrobial agents.

[0086] The accessory can be formed from one or more matrices. In certain embodiments, the one or more matrices can be in the form of a particulate matrix. In such cases, each particulate matrix may be formed of fused particles (for example, fused bioabsorbable polymer particles).

[0087] In general, each matrix can be formed from at least one molten polymer. At least one molten polymer can be selected to give the accessory a desired compressibility. For example, in one embodiment, the matrix includes a molten polymer, whereas in other embodiments, the matrix can include two or more different molten polymers. Alternatively or additionally, in cases where the accessory includes two or more matrices, each matrix can be formed from the same fused polymer or from different fused polymers. For example, a first matrix can include a first molten polymer and a second matrix can include a second molten polymer that is more or less flexible than the first molten polymer. In this way, the fused polymers can give the accessory variable flexibility. In addition, fused polymers can have different degradation rates, so that the compressibility of the accessory can be adapted to vary over time as a function of the degradation rates.

[0088] Although several types of materials can be used, in some embodiments, the at least one molten polymer is a bioabsorbable polymer. Non-limiting examples of suitable bioabsorbable polymers include thermoplastic bioabsorbable polyurethane, ultraviolet light-curable bioabsorbable polyurethane, poly (lactic acid) (PLA), polycaprolactone (PCL), polyglycolide, polydioxanone (PDS), poly (lactic-co-glycolic acid) ( PLGA), poly (glycolic acid), trimethylene carbonate, glycolide, dioxanone, polyester, any copolymers thereof and combinations thereof.

Additional non-limiting examples of suitable bioabsorbable polymers include macromers with PCL or poly (DL-lactide) terminated by three-branch hydroxyl modified by terminal group of acrylate or methacrylate, PLA-PEG or poly (trimethylene carbonate), acrylate or dimethyl methacrylate or PEG trimethyl, polypropylene fumarate, L-lactide / caprolactone copolymers, PLGA polymers infiltrated with collagen, PCL tricalcium phosphate (TCP), PLGA-TCP copolymers coated with hyaluronic acid, PCL-PLGA-TCP, copolymers of PLGA-PCL, PDS polymers and copolymers, PCL polymer and hyaluronic acid, PCL and tricalcium beta-phosphate with collagen coating, polyvinyl alcohol, calcium phosphate / poly (hydroxybutyrate-co-valerate) and calcium / polyhydroxyapatite L-lactide.

[0089] For example, in some embodiments, the accessory may be formed of several components, each being formed from a matrix that includes at least one fused bioabsorbable polymer. In some embodiments, the accessory may have a first component formed from a first matrix of at least one fused bioabsorbable polymer (e.g., polyglactin or polydioxanone) and a second component formed from a second matrix that includes at least one polymer fused bioabsorbable (for example, a polycaprolactone copolymer). The at least one fused bioabsorbable polymer for each matrix can include at least two different bioabsorbable polymers. In one embodiment, the first component can have a first color and the second component can have a second color that is different from the first color.

[0090] In some modalities, the accessory can be a drug eluter. For example, one or more components of the accessory may include a composition that has a pharmaceutically active agent. The composition can release a therapeutically effective amount of the pharmaceutically active agent. In various embodiments, the pharmaceutically active agent can be released as the attachment is desorbed / absorbed. In various embodiments, the pharmaceutically active agent can be released into a fluid, such as blood, which circulates over or through the accessory. Non-limiting examples of pharmaceutically active agents include hemostatic agents and drugs, such as, for example, fibrin, thrombin and oxidized regenerated cellulose (ORC); anti-inflammatory drugs, for example diclofenac, aspirin, naproxen, sulindac and hydrocortisone; antibiotic and antimicrobial drugs or agents, such as, for example, triclosan, ionic silver, ampicillin, gentamicin, polymyxin B and chloramphenicol; and anti-cancer agents, such as, for example, cisplatin, mitomycin and adriamycin.

[0091] The accessory may also include an external coating. The coating can be part of the 3D printing process or applied secondarily to the accessory. For example, in some implementations, the accessory may be partially or completely coated with antimicrobial agents. Non-limiting examples of suitable antimicrobial agents include triclosan, chlorhexidine, silver formulations (such as nanocrystalline silver), lauric arginate ethyl ester (LAE), octenidine, poly-hexamethylene biguanide (PHMB), taurolidine; lactic acid, citric acid, acetic acid, and their salts.

[0092] The accessory, or any component thereof, may be at least partially coated with a bioabsorbable polymer that is different from at least one fused bioabsorbable polymer of the accessory. In this way, one or more properties of the accessory can be varied from the properties of its base material (s) (for example, fused bioabsorbable polymer (s)). For example, the accessory can be coated with one or more bioabsorbable polymers that improve structural stability.

Alternatively, or in addition, the accessory may be coated with a bioabsorbable polymer that has a slower rate of degradation compared to the degradation rate of at least one fused bioabsorbable polymer of the accessory. In this way, the accessory's longevity can be increased without sacrificing the desired compressibility of the accessory provided at least in part with at least one fused bioabsorbable polymer.

[0093] Accessories can have a variety of configurations. In general, accessories can include a fabric contact surface, an opposite body contact surface (for example, a cartridge contact layer) and an elongated body positioned between these surfaces (structural layer). The surfaces of contact with the fabric and of contact with the cartridge can, in certain modalities, have a structure that is different from the structural layer, to form layers of contact with the fabric and the cartridge. In some modalities, the elongated body is formed of multiple struts. The struts can have several configurations and, in certain exemplifying modalities, the struts can form interconnected geometric units of repetition.

[0094] In some embodiments, the contact layer with the fabric may include a plurality of surface features that are configured to engage the fabric located between the accessory and the anvil, thus substantially preventing the fabric from sliding in relation to the accessory during stapling. These surface features can also be configured to minimize the sliding movement of the accessory relative to the fabric when the accessory is stapled to the fabric. Such surface features can have a variety of configurations. For example, the surface features can extend from the fabric contact surface a distance of about 0.007 inches to 0.015 inches.

[0095] Additionally, in some embodiments, these surface features may extend in a direction that is substantially lateral to a longitudinal geometric axis (L) of a body, like the 606 cartridge body shown in Figure 6. In another embodiment, at least a portion of the surface resources may include a plurality of ridges and a plurality of defined ridges between the ridges. In yet another embodiment, these surface features may include a plurality of steps extending in a direction that runs at least upward from a body, inwardly towards a central groove and distally towards a second end of the body. Further details on non-slip elements in the form of ridges and ridges or in the form of steps can be found in US publication No. 2015/0034696, which is incorporated herein in its entirety, for reference.

[0096] In some embodiments, the plurality of surface features can be configured to pull the fabric in opposite directions, and thereby provide an opposite resistance (for example, lateral tilt) to prevent the fabric from slipping during stapling. For example, the fabric contact layer can include a first plurality of surface features that can extend in a first direction and a second plurality of surface features that can extend in a second direction that is different from the first direction. As a result, the first and second pluralities of surface features can create a tension between the surface features that actively prevents tissue movement in at least one direction. In one embodiment, the first plurality of surface features may extend in a first direction and the second plurality of surface features may extend in a second opposite direction. In such cases, these surface features can be configured to pull the fabric in opposite directions simultaneously.

[0097] An opposite resistance can also be created by surface curvature. For example, the fabric contact layer, or alternatively, for example, the entire accessory, can be designed to have a resilient convex shape, and the surface features can extend radially outward from the contact layer. fabric. In use, as the surgical stapler anvil moves from an open to a closed position, as discussed above, the tissue contact layer can deform (for example, be compressed to a substantially straight configuration), and the surface features, now extending in a substantially vertical direction and out of the fabric contact layer, engage the fabric. When the anvil returns to its open position, the contact layer with the tissue returns to its convex shape creating a surface tension between the surface resources, causing the engaged tissue to be pulled in opposite directions simultaneously.

[0098] On the other hand, in certain modalities, it may be desirable for the fabric to slide in a predefined plane during stapling. Thus, in some embodiments, the fabric contact layer may include surface features that can be designed to promote the sliding (for example, a sliding movement) of the fabric relative to the accessory in a first predetermined direction and to limit movement in a second direction that is different from the first direction. Alternatively or additionally, the fabric contact layer can be coated with a material to increase lubricity (for example, sodium stearate or lauric arginate ethyl ester).

[0099] As discussed above, the accessory is positioned on a body, such as the 606 cartridge body (Figure 6). Before and during stapling, attachment of the accessory to the body can be improved.

For example, the body contact layer (for example, a cartridge contact layer) can include surface features that are configured to engage the body and thereby substantially prevent the accessory from sliding in relation to the body. Such surface features can have a variety of configurations. For example, in modalities where the body includes fastening features, the contact layer with the body may have surface features in the form of recesses that are configured to receive these fastening features. Other fixation features will be discussed in more detail below.

[0100] As indicated above, the elongated body can be formed from a plurality of struts. These struts can form geometric repeating units interconnected to each other. As discussed in more detail below, the plurality of struts and / or the array of repetition units can be structurally configured to give the fitting a variable compressibility, and thus the fitting may have a variable stiffness profile. For example, the accessory may have a first stiffness when compressed in a first quantity and a second stiffness when compressed in a second quantity. The second quantity may be greater than the first quantity, or vice versa. Thus, the rigidity of the accessory may vary as a function of compression. As discussed in more detail below, the greater the amount of compression, the greater the rigidity of the accessory. Consequently, a single accessory can be adapted to provide a varied response that ensures that a minimum amount of tension is applied to the fabric (for example, 3 g / mm2) for at least a predetermined period of time (for example, 3 days) under various stapling conditions (eg thickness of fabric, height of staple formed, intratide pressure). In addition, this varied response provided by the accessory can also, desirably, maintain the minimum amount of applied tension (for example, 3 g / mm2) when the accessory is stapled to the fabric and is exposed to fluctuations in the intracted pressure.

[0101] These struts can be designed in various configurations. For example, these struts can produce lattice structures or lattice-like structures, as shown in Figures 8A to 9C and Figures 11A to 15, spiral-shaped structures, as shown in Figure 16, or columns, as shown in Figures 17 to 19.

[0102] The geometry of the struts, as well as the geometry of the repetition units formed on the struts, can control the movement of the accessory in several planes. For example, the interconnectivity of the struts can create geometric units that can be configured to allow the attachment to compress in a first predetermined direction and to limit movement in a second direction that is different from the first direction. As discussed in more detail below, in some embodiments, the second direction can be transversal to the first predetermined direction. Alternatively, or in addition, the geometric units can be configured to limit the rotating movement of the accessory around a geometric axis that is perpendicular to the first predetermined direction.

[0103] In some modalities, a strut may have a substantially uniform cross section, while in other modalities, the strut may have a variable cross section. In addition, the strut material can also play a role in defining the movement of the attachment in predetermined planes.

[0104] Figures 8A to 9C and 11A to 19 illustrate several examples of accessories that include a fabric contact surface, a cartridge contact surface that is opposite the fabric contact surface and an elongated body formed from struts positioned between these surfaces. Each exemplary accessory is illustrated in a partial way (for example, not in its total length), and therefore an element skilled in the art will recognize that the accessory may be longer in length, that is, along its longitudinal geometric axis L , as identified in each modality. The length may vary based on the length of the staple cartridge. In addition, each example accessory is configured to be positioned on the cartridge body so that the longitudinal geometric axis L of each accessory is aligned with and extends along the longitudinal geometric axis (LC) of the cartridge body. Each of these accessories can be formed from one or more matrices that include at least one fused bioabsorbable polymer. These accessories are structured to compress when exposed to compressive forces (for example, tension or load). As further discussed in detail below, these accessories are also designed to promote internal growth in tissue and cells.

[0105] Figures 8A and 8B illustrate an exemplary embodiment of an accessory 800 that has a contact surface with the fabric 802, an opposite contact surface with the cartridge 804 and an elongated body 806. Although it is contemplated that the contact surface with the fabric 802, the contact surface with the cartridge 804 and the elongated body 806 can each be formed of different materials, in this illustrated embodiment, they are formed of the same fused bioabsorbable polymer. That is, accessory 800 is formed from a matrix of the same fused bioabsorbable polymer.

[0106] As shown in Figure 8A, the elongated body 806 includes a flat matrix 808 of repetition units 810 interconnected to each other at the joints or nodes 814. The repetition units 810 are each formed of a plurality of struts interconnected 816 which each have a first portion 818 and a second portion 820. Some of the struts 816 may also include a third portion 821 which extends from its respective second portion and which interconnect to form joints or nodes 814. As discussed in more detail below, accessory 800 may exhibit varying stiffness and movement based on the amount and direction of tension applied to it during use. In this way, the accessory has a variable stiffness profile such that, when the accessory is stapled to the fabric, the accessory can be configured to apply a tension equal to or greater than a minimum tension limit for a predetermined time (for example, a tension 3 g / mm2 for 3 days).

[0107] Additionally, as shown, the elongate body 806 includes a first flat array 808 of struts and additional flat arrays 808N positioned parallel to each other and to the flat array 808 (for example, extending in the x direction). In each matrix 808, 808N, the struts 816 are substantially flat and extend coplanarly with respect to each other in a respective plane. In addition, although each matrix 808, 808N may have a variety of configurations, in this illustrated embodiment, each matrix 808, 808 N is substantially symmetrical about an intermediate plane. That is, each array 808, 808N has two substantially identical rows 824a, 824b of repeating units 810.

[0108] Although the struts 816 can have a variety of configurations, in this illustrated embodiment, each strut 816 has a generally elongated flat configuration, with the first portion 818 of each strut 816 having a narrower width than a wide section of the second portion 820. As a result, struts 816 are wider in the central region, preferably along most of the length, and narrower at the ends. Alternatively, the first portion 818 may have a cross section that is equal to or greater than the cross section of the second portion 820. Additionally, as shown in Figure 8B, the second portion 820 of each strut 816 may have a substantially cross-sectional shape rectangular. It should be noted that other shapes in cross section of the struts, and portions thereof, are also contemplated by the present invention. The cross-sectional shapes of the struts can be used to limit the movement of the attachment in certain directions.

[0109] In Figure 8A, struts 816 are interconnected to one another at one end of their first portion 818 to form joints or nodes 822. In the illustrated embodiment, struts 816 and joints or nodes 822 can be formed from the same material . Thus, to improve the compression of the accessory 800 under tension, the cross section of the first portion 818, also called the narrowing region, can flex, as described in more detail below. In addition, the third portion 821 of the respective struts 816 is structured similarly to the first portion 818 of the struts 816, and therefore this third portion 821, also called the narrowing region, can also flex, as described in more detail below .

[0110] The material of the joints or knots 822 in relation to the struts 816 (for example, more or less flexible) can control, in part, the amount and / or direction in which the accessory 800 moves under tension during use. Similarly, the material of the joints or nodes 814 can control, in part, the amount and / or the direction in which the accessory 800 moves under tension during use. The joints or nodes 814, 822 can be of any suitable shape.

For example, in certain embodiments, the joints or nodes 814, 822 may be in the form of a spherical element. In other embodiments, the joints or nodes 814, 822 may take the form of other geometric shapes.

[0111] The struts 816 can be interconnected to each other at various angles. For example, in this illustrated embodiment, struts 816 intersect at angles of about 90 degrees in relation to adjacent struts 816. In other embodiments, struts 816 can intersect at angles in a range of about 40 degrees to 130 degrees. In another embodiment, the 816 struts can cross at angles in a range of about 10 degrees to 90 degrees. The angles at which the struts 816 connect to each other can control, at least in part, the manner and quantity in which the accessory 800 responds under tension. That is, the movement and stiffness of accessory 800 can be, at least in part, a function of these angles.

[0112] As mentioned above, the first portion 818 (and the third portion 821 where present) of each strut 816 can act as a flexible region for the attachment (for example, a deflection point). The first portion 818 of each strut provides each repetition unit 812 with one or more flexion zones, as illustrated in Figures 9A to 9C. That is, these narrowing regions allow struts 816 to flex around or in a position adjacent to joints or knots 822 when accessory 800 is under tension, and therefore repeating units 810 can flatten out partially or completely over themselves. Similarly, the narrowing regions that form the third portion 821 allow the repeating units to flex around or in a position adjacent to the joints or nodes 814 when the attachment is under tension. The compressibility of accessory 800 can therefore vary based on different amounts and different directions of applied stress. This variation in compressibility may be desirable, for example, when the accessory is stapled to the fabric and is exposed to fluctuations in intracted pressure.

[0113] Figures 9A to 9C illustrate the compression behavior of a repetition unit 810 of accessory 800 described here under different stresses. In particular, the repetition unit 810 is shown in a pre-compressed (not deformed) state in Figure 9A, in a first compressed state under a first tension (S1) in Figure 9B and in a second compressed state (C) under a second voltage (S2) in Figure 9C. In this way, the repetition unit 810, and therefore the accessory 800, has a variable stiffness profile under different stresses. One skilled in the art will recognize that the accessory may have a variety of heights implanted throughout its use, and that the implanted heights are a function, at least in part, of the specific stresses that are applied to the accessory over its use.

[0114] As shown in Figures 9A and 9B, when the repeating unit 810, and therefore accessory 800 in Figure 8A, is under a first tension S1, the first portion 818 (for example, the narrowing region) of each strut 816 can flex around the joint or knot 822. This allows the repeating unit 810 to compress from a pre-compressed state (Figure 9A) to a first compressed state (Figure 9B), and thus accessory 800 moves from a pre-compressed height to a first implanted height. In addition, depending on the amount of tension applied to the attachment, the second portions 820 of adjacent struts 816 may come into contact with each other. This is illustrated in Figure 9B. In such cases, the first portion 818 of each strut 816 thus reaches a point of maximum deflection, creating a greater stiffness resistance within the repetition unit 810. This is due to the fact that the stiffness of the repetition unit 810, and therefore of accessory 800, increases as accessory 800 compresses. Figure 10 is an illustrative graphic representation of the relationship between compression and stiffness of an accessory. Thus, any additional compression of the repetition unit 810, and therefore of accessory 800, would require the application of additional tension.

[0115] In circumstances where a higher tension (for example, a second tension, S2) is applied to the repetition unit 810, and therefore to accessory 800 in Figure 8A, the increase in stiffness resistance can be overcome. To do this, struts 816 can be configured so that when additional tension is applied, struts 816 can flex even more around the joint or knot 822. As shown in Figure 9C, this additional flexing can cause the struts 816 further expand outwardly in a lateral direction (L) in relation to the direction of applied stress, thereby causing the second portions 820 of adjacent struts 816 to come into further contact with each other. As a result, this allows the repeating unit 810 to be compressed to a second compressed state (Figure 9C), and in this way, accessory 800 passes to a second implanted height.

[0116] In some embodiments, the accessory may include additional components that can prevent movement of the fabric that is stapled to the accessory. For example, Figures 11A and 11B illustrate an exemplary accessory 1100 that includes a plurality of surface features 1128 defined within the fabric contact layer 1102. As described in more detail below, surface features 1128 can prevent sliding movement of the accessory in relation to the fabric stapled to the accessory. In one embodiment, at least a portion of the 1128 surface features can prevent the 1100 accessory from sliding sideways relative to the fabric. Alternatively, or in addition, at least a portion of the surface features 1128 can prevent the longitudinal sliding of the accessory 1100 relative to the fabric.

[0117] The illustrated example accessory 1100 includes a contact layer with fabric 1102 and an opposite contact layer with cartridge 1104. Accessory 1100 also includes an elongated body 1106 with a plurality of struts 1116 that extend between the fabric contact layer 1102 and the cartridge contact layer 1104. As shown, the fabric contact layer 1102 includes a plurality of surface resources 1128a, 1128b defined therein. These 1128 surface features have a grid-like pattern with a first series 1128a that extends longitudinally (for example, parallel to the longitudinal geometric axis of the attachment) and a second series 1128b that extends laterally (for example, transversely to the longitudinal geometric axis accessory). Each surface feature 1128a, 1128b can have a triangular profile or at least two surfaces that are arranged at an angle to each other and join to form an edge in order to penetrate and engage the fabric. These edges can collectively define the outermost surface of the fabric contact layer 1102. These surface features 1128a, 1128b can engage the fabric when it is compressed into the fabric contact layer 1102 as a result of the attachment being stapled to the fabric. The orientation of the edges of the first series 1128a can prevent the lateral sliding of the accessory in relation to the fabric, and the orientation of the edges of the second series 1128b can prevent the longitudinal sliding of the accessory 1100 in relation to the fabric. Additionally, the fabric contact layer 1102 includes a plurality of openings 1144 that are formed between these surface features

1128. In this way, the plurality of openings 1144 can receive the fabric inside when the accessory is stapled to the fabric to allow the surface resources 1128 to engage the fabric.

[0118] Although the struts of the plurality of struts 1116 can be interconnected to form a variety of configurations, in this illustrated embodiment, the plurality of struts 1116 form repetitive X patterns. In particular, the plurality of struts 1116 form cubic repetition units. Each cubic unit includes a top surface 1130 and an opposite bottom surface 1132. In this illustrated embodiment, the top and bottom surfaces 1130, 1132 are substantially identical. The cubic unit also includes four side surfaces 1134 which extend between and connect to the top and bottom surfaces 1130, 1132. In this illustrated embodiment, the side surfaces 1134 are substantially identical. For the sake of clarity, not all surfaces of each illustrated cubic unit are identified in Figures 11A and 11B. The side surfaces 1134 can have a variety of shapes, for example, as shown, each side surface 1134 has an X-shape that extends from the top surface 1130 to the bottom surface

1132. Thus, the first end of each strut 1116, 1116a ends at the contact layer with the fabric 1102 and the second end of each strut 1116, 1116a ends at the contact layer with the cartridge 1104. Each X can be formed by two elongated and generally flat struts that intersect in an intermediate portion. In addition, each cubic repeating unit can also include an internal strut that extends between two opposite side surfaces 1134 of the cubic unit to form an internal connectivity feature 1138. As shown, the internal connectivity feature 1138 can extend from the top 1134a of a side surface 1134 to the bottom 1134b of an opposite side surface 1134. As shown in addition, the internal connectivity features 1138 can extend in alternating directions between adjacent cubic units. For example, as shown in Figure 11B, a first internal connectivity feature 1138 may have an upper end 1138a that extends from the top 1134a of a side surface 1134 to a lower end 1138b at the bottom 1134b of the opposite side surface 1134, and the unit adjacent cubic can have a second internal connectivity feature 1138 with a lower end 1138c extending from the same bottom 1134b of the side surface 1134 to an upper end 1138d on the top 1134c of an opposite side surface 1134. The internal connectivity features 1138 can provide to accessory 1100 a geometry that can promote a predetermined directional movement of accessory 1100 under the applied tension. For example, in one embodiment, the internal connectivity features 1138 can substantially prevent the rupture of accessory 1100 under the applied voltage.

[0119] While each strut and the 1138 interconnect features may have a variety of configurations, in this illustrated embodiment, the struts 1116, 1116a and the 1138 interconnect features are each in the form of a beam or column with a width (W) that is greater than a depth (D), so that each strut / interconnect feature is limited to flex in a predetermined direction, that is, in and out of the plane that extends along the width ( W). Additionally, struts 1116, 1116a and interconnect features 1138 may each include at least one opening 1140 which extends through them to facilitate bending in a predetermined direction. For the sake of clarity, not all openings 1140 that extend through each strut 1116 and interconnectivity features 1138 are identified in Figures 11A and 11B. These 1140 openings can have a variety of shapes, for example, as shown, 1140 openings are diamond-shaped. The invention also contemplates that the shape of the 1140 openings can vary between the struts. The 1140 openings can also be aligned along the entire accessory. For example, openings that extend through opposing side walls spaced longitudinally along the length of the fitting in adjacent cubic units can be aligned longitudinally, and, similarly, openings that extend through opposite side walls spaced laterally along the width of the attachment in adjacent cubic units can be aligned laterally.

[0120] Alternatively or additionally, the fitting may include connecting members that connect at least a portion of the joints or knots to each other, thereby increasing the rigidity of the fitting. That is, the connecting members can be incorporated into the attachment to prevent movement (for example, widening) of the attachment on the planes on which the connecting members extend.

[0121] For example, Figures 12A and 12B illustrate an exemplary embodiment of an accessory 1200 that has connecting members

1246. In particular, accessory 1200 includes an elongated body 1206 formed from a plurality of struts 1216 which are interconnected in joints or knots 1222. The elongated body 1206 has a fabric contact surface 1202 and a cartridge contact surface opposite 1204. As shown, at least a portion of these joints or nodes 1222 are interconnected to each other by link members 1246. In this illustrated embodiment, link members 1230 extend in a first direction (for example, the y direction, as shown in Figure 12) and the struts 1216 extend in a second direction that is different from the first direction (for example, a transverse direction, such as about 45 degrees from the y direction, as shown in Figure 12). In this way, the position of the connecting members 1246 in relation to the struts 1216 can provide the accessory 1200 with a geometry that can be configured to prevent the movement of the accessory 1200 in at least one direction (for example, a direction parallel to the direction in which the link members 1246 extend).

[0122] In some modalities, joints or knots may be formed from a material that is different from the material of the struts. For example, the material of the joints or knots can be more flexible than the material of the struts, thus increasing the compressibility of the accessory. In addition, the more flexible joints or knots can still allow the attachment to compress without substantially breaking. This is due to the fact that the most flexible joints or knots provide preferential flex zones for the fitting, thereby decreasing the rigidity of the fitting. In one embodiment, the joints or nodes may be formed from a polycaprolactone copolymer and the struts may be formed from polyglactin or polydioxanone.

[0123] Figures 13A and 13B illustrate another exemplary embodiment of an accessory 1300 that includes repetition units 1310 interconnected to each other at joints or nodes 1314. Repeating units 1310 are each formed from a plurality of struts 1316 , for example, four struts, which interconnect at joints or nodes 1322. In addition to the differences detailed below, accessory 1300 may be similar to accessory 800 (Figure 8A) and will therefore not be described in detail. In this illustrated embodiment, the joints or knots 1314, 1322 are formed from a material different from the material of the struts 1316. The material of the joints or knots 1314, 1322 can be more flexible than the material of the struts 1316. As shown, each joint or knot 1314, 1322 may be in the form of a stem 1348 that extends through all matrices 1308, 1308N in a direction that is generally perpendicular to the plane in which the struts extend (for example, the stems may extend at x direction, as shown in Figures 13A and 13B). That is, when the accessory 1300 is attached to a cartridge body, the rods 1348 can extend laterally in relation to the longitudinal geometric axis of the cartridge body, as the cartridge body 606 shown in Figure 6.

[0124] In some embodiments, as shown in Figures 13A and 13B, the ends of the first portions 1318 of the struts 1316 can also be directly connected to each other within the joints or nodes 1322. Alternatively or additionally, the ends of the third portions 1321 the struts 816 can also be directly connected to each other within the joints or nodes 1314. This direct connection can help prevent the struts 1316 from coming out of the joints or nodes 1322 as the struts 1316 flex when the accessory 1300 is under tension. As a result of this direct connection, the flexion of one strut can also influence the flexion of another. In addition, compared to the joints or nodes 822 in Figure 8A, these joints or nodes 1322 may be more flexible, therefore more malleable, and accessory 1300 can then compress more easily compared to accessory 800. Thus, under the same given tension, accessory 1300 will achieve a greater displacement (that is, it will compress to a lower implanted height) compared to accessory 800 shown in Figure 8A.

[0125] Alternatively, the struts can be unconnected to each other within the joints or nodes, for example, as shown in Figure 14. For the sake of simplicity, Figure 14 illustrates a single repetition unit 1400. In this illustrated embodiment , struts 1416 do not directly connect to each other within the joint or knot 1422. As a result, the flexing of one strut can occur regardless of the flexing of another strut. To prevent struts 1416 from escaping the joint or knot 1422 when they flex around the joint or knot, each strut 1416 can have an end shape 1450 configured to maintain its connection to the joint or knot 1422. Additionally, compared to the joints or knots 1322 in Figures 13A and 13B, this joint or knot 1422 can be more flexible, and therefore more malleable, thus allowing an accessory formed of several repetition units 1400 to be compressed more easily under a given tension. That is, under the same given tension, an accessory with this illustrated strut and joint or knot configuration can achieve a greater displacement (that is, if it compresses at a lower height) compared to the accessory 800 in Figures 13 and 13A.

[0126] In some embodiments, the accessory may also include at least one locking element that is configured to limit the amount of compression of the accessory. Figure 15 illustrates an exemplary embodiment of an accessory 1500 that has at least one locking element 1552. In addition to the differences detailed below, accessory 1500 may be similar to accessory 1300 (Figures 13A and 13B) and will therefore not be described in Details.

[0127] In Figure 15, each strut 1516 can have a locking element 1552 that extends from or is positioned adjacent to a surface of its second portion 1520. As attachment 1500 is compressed, struts 1516 can flex when around the joints or nodes 1514, 1522 until the locking elements 1552 come into contact with each other. When these locking elements 1552 are in contiguity with each other, any further flexing of the struts 1516 will be inhibited. That is, these locking elements 1552 act as deflection locks that allow the accessory 1500 to compress under a given tension to a first height implanted to a first stiffness. After reaching the first compressed height, the locking elements 1552 reach the flattening limit and inhibit the additional deflection of the struts 1516, and therefore the additional compression of the attachment 1500. When the locking elements 1552 reach the flattening limit, it is necessary that a greater amount of tension be applied to exert additional flexion of the struts 1516 around the joints or knots 1514, 1522 and thus further compress the accessory

1500.

[0128] It should be noted that although several locking elements 1552 are shown in Figure 15, the present invention also contemplates that fewer or more locking elements can be included throughout the accessory 1500. In addition, the shape, size and the location of the locking elements 1552 are not limited by this illustrated embodiment, and can therefore vary to control the desired amount of compression.

[0129] As mentioned above, the elongated body can include a plurality of struts which can have a variety of shapes. For example, Figure 16 illustrates an exemplary accessory 1600 that has an elongated body 1606 that includes a plurality of struts 1616 having a substantially spiral shape. In this way, each repetition geometric unit has the shape of a spiral. In this embodiment, the elongated body 1606 is positioned between a layer of contact with fabric 1602 and a layer of contact with cartridge 1604. As shown, layers 1602, 1604 are each solid, generally flat layers with openings 1626. When at least a portion of these openings 1626 are aligned with the openings 1615 defined by each strut 1116. The thickness of each layer may vary. The 1616 struts are configured to have predetermined compressed heights to limit an amount of compression for the attachment. Additionally, given their shape, these 1616 struts can be configured to function as a spring. Thus, similar to an elastic constant, a specific stiffness can be given to each strut 1616 based on its shape. As a result, the compressibility of accessory 1600 may also depend on the specific stiffness of each strut 1616, which depends on both the material and the shape of the strut 1616.

[0130] As shown in Figures 8A, 11A to 13B and 15 to 16, each accessory 800, 1100, 1200, 1300, 1500, 1600 can include openings 826, 1140, 1144, 1226, 1326, 1526, 1626. These openings can configured to promote the internal growth of cells within each accessory. The openings can define an empty space content of the accessory. In some embodiments, the void content can be about 15% to 95%, while in other embodiments, the void content can be about 75% to 90%. For use in the present disclosure, the term "openings" is synonymous with "empty spaces". Additionally, the accessory can have a surface area to volume ratio of about 1: 100 to 1: 5. In some embodiments, the accessory may have a ratio of surface area to volume of about 1:10.

[0131] The openings may additionally be located within various components of the accessories. Each opening can have a dimension that extends at least partially through the component. In certain embodiments, as shown in Figures 8A, 11A to 13B and 15 to 16, openings 826, 1140, 1444, 1226, 1326, 1526, 1615, 1626 may be present within the fabric contact surface or layer, from surface or contact layer with the cartridge and / or the elongated body. In these illustrated modalities, each of these openings extends completely through its respective component. Within the elongated body, these openings can be defined by the interconnected struts. In addition, these openings can also be interconnected throughout the accessory to thereby form a substantially continuous network of openings or channels. Additionally, as shown in Figures 11A and 11B, openings 1126 may additionally be present within the internal connectivity features 1138.

[0132] The openings can have variable sizes and / or shapes. For example, larger openings can allow tissue (and cells) to penetrate the accessory, while smaller openings can trap cells within the accessory to promote internal cell growth. In this way, the variable sizes of the openings in all accessories can promote extracellular remodeling. That is, the variable sizes of the openings can facilitate revascularization, as well as the mobility of cells within the accessory when the accessory is implanted, thus stimulating the internal growth of both tissue and cells. In addition, the variable sizes of the openings can also facilitate the extraction of by-products and cellular residues from the implanted accessory, and therefore from the implantation site. In some embodiments, the openings are substantially circular in shape.

[0133] In modalities in which the openings are located within the surface or contact layer with the fabric and the elongated body, such as the openings shown in Figures 8A, 11A to 13B and 15 to 16, the openings can each have a diameter that is about 70% to 170% of a diameter of a staple leg of a staple, such as staple 406 shown in Figures 4 and 5. The openings within the tissue contact surface and within the elongated body can have a variety of sizes. For example, in some modalities,

the openings in the tissue contact surface can each have a diameter in the range of about 100 µm to 1,000 µm. In one embodiment, the openings in the tissue contact surface can each have a diameter that is at least about 14 µm. The openings in the elongated body can each have a diameter in the range of about 200 µm to 610 µm or from about 400 µm to 1,000 µm. For use in the present disclosure, the "diameter" of an opening is the largest distance between any pair of vertices in the opening.

[0134] Additionally, in some embodiments, the openings within the fabric contact surface or layer can be configured to allow one or more portions of fabric to penetrate or compress into the fabric contact surface or layer (eg for example, openings 1144, 1226, 1626). Thus, as discussed above, when the accessory is stapled to the fabric and the fabric is compressed into the opening, the sliding movement of the accessory in relation to the fabric can be substantially avoided.

[0135] In other modalities, the accessory can be configured to improve the advance of the clamp legs through the accessory. For example, the accessory may have openings that are aligned with the direction of advancement of the staple legs inward and partially through the accessory. The openings can extend partially or completely through the accessory. In this way, as the clamp legs advance through the attachment, the openings can act as a guide to minimize damage to the clamp, as well as the attachment, as the clamp passes through the attachment.

[0136] In some embodiments, as shown in Figures 17 to 19, the accessory may include a plurality of struts that are shaped like columns. For example, in Figure 17, the columns can be substantially vertical and have varying heights. In addition, in other embodiments, as shown in Figure 19, a first set of columns can be substantially vertical and a second set of columns can be curved. The struts may be formed from the same material or a different material. In some embodiments, the accessory may include a first plurality of struts that are formed from a first material and a second plurality of struts that are formed from a second material.

[0137] In Figure 17, accessory 1700 includes a plurality of struts 1716 that have a substantially vertical column shape. In particular, these struts 1716 extend from a layer of contact with the cartridge 1704 towards, and in some cases even, the layer of contact with the opposite fabric 1702. The plurality of struts 1716 includes a first plurality of vertical struts 1716a with a first height (Y), a second plurality of struts 1716b with a second height (Y1) which is less than the first height (Y) and a third plurality of struts 1716c with a third height (Y3) which is less than the second height (Y2). For the sake of simplicity, only a portion of the plurality of struts 1716 is shown in Figure 17. Although not shown, one skilled in the art will recognize that the layers of contact with the fabric and / or the cartridge 1702, 1704 may include openings as discussed here.

[0138] The variable heights of this plurality of 1716 struts can provide the accessory with variable compressibility. Figures 18A to 18C illustrate the compression behavior of accessory 1700 under different stresses. In particular, accessory 1700 is shown at a pre-compressed height in Figure 18A, a first compressed height (H1) under a first tension (S1) in Figure 18B and at a second compressed height (H2) under a second tension (S2 ) in Figure 18C. As shown, the first compressed height (H1) is greater than the second compressed height (H2), and therefore the first stress (S1) is less than the second stress (S2). One skilled in the art will recognize that the accessory may have a variety of compressed heights over its use, and that the compressed heights are a function, at least in part, of the specific stresses that are applied to the accessory over its use.

[0139] As shown in Figures 18A to 18C, as the compression of accessory 1700 increases, the amount of tension required to achieve such compressions also increases. This is due to the fact that additional struts are engaged as the 1700 accessory compresses, thereby increasing the stiffness resistance of the 1700 accessory. For example, as shown in Figure 18B, in a first tension S1 applied to the 1700 accessory, the first and second pluralities of struts 1716a, 1716b are engaged. In comparison, when accessory 1700 is under a second tension S2, the first, second and third pluralities of struts 1716a, 1716b, 1716c are engaged, thus creating greater stiffness resistance.

[0140] Figure 19 illustrates another exemplary embodiment of an accessory 1900 that has a plurality of struts 1916 in the form of substantially vertical columns 1916a or curved columns 1916b. The substantially vertical columns 1916a can be configured to withstand the initial stress applied to accessory 1900 and then deflect or deform (for example, at deflection point D in Figure 20) as the accessory compresses. The curved columns 1916b can be configured to provide approximately constant stiffness (i.e., essentially the displacement of the entire curve shown in Figure 20 from the zero geometric axis). This mechanical behavior of the 1916 props, and therefore of the 1900 accessory, is represented graphically in Figure 20.

[0141] In other modalities, the accessory may include additional features. The following figures illustrate features that can be included in any of the accessories disclosed here, and therefore the specific configuration of the accessory, that is, the configuration of the repetition units, will not be shown. Figure 21A illustrates an embodiment of an accessory 2100 that has a channel 2108 formed inside it that is configured to receive a cutting element, such as a knife.

[0142] As shown in Figure 21A, accessory 2100 includes a first portion 2104 and a second portion 2106, each having outer and inner edges. The inner edges 2104a, 2106a define a channel 2108 that extends between the first and second portions and along the longitudinal geometric axis (L) of the accessory

2100. Channel 2108 is configured to receive a cutting member, such as a knife. As shown in Figure 21B, channel 21 does not fully extend through the height of accessory 2100. In particular, channel 2108 does not extend through the contact surface with cartridge 2110. In this way, accessory 2100 is configured for integrity structural enough to thus be effectively manipulated and attached to the cartridge body, as the cartridge body 2214 shown in Figure 21B. In use, when the cutting member is initially fired and moves along the attachment, the cutting member performs the cut through the channel, thereby separating the first and second portions, and dividing the 2100 attachment into two parts different.

[0143] Additionally, as shown in Figure 21A, accessory 2100 includes flanges 2112 that are configured to fit with the 2214 cartridge body in Figure 21B, as described in more detail below. Although Figure 21A illustrates accessory 2100 with flanges 2112 on one side of accessory 2100, additional flanges 2112 may be present on the opposite side of accessory 2100. One skilled in the art will recognize that the number and arrangement of flanges 2112 are not limited to which is shown in Figure 21A. Although flanges 2112 can be produced from a variety of materials, in some implementations, as shown in Figure 21A, flanges 2112 can be an extension of the contact surface with the 2110 cartridge. One skilled in the art will recognize that flanges they can be formed in line with the accessory (for example, as part of the 3D printing process), or, alternatively, they can be formed offline and then applied to the accessory secondarily.

[0144] Figure 21B illustrates one embodiment of a staple cartridge assembly 2200. In addition to the differences detailed below, the staple cartridge assembly 2200 may be similar to the staple cartridge assembly 600 (Figure 6) and will therefore not be , described in detail. In addition, for the sake of simplicity, certain components of the staple cartridge assembly 2200 are not illustrated in Figure 21B.

[0145] Staple cartridge assembly 2200 includes accessory 2100 in Figure 21A attached to a 2214 cartridge body. Accessory 2100 can be attached to the 2214 cartridge body using any suitable methods, as described in more detail below. . In this embodiment, the cartridge body 2214 includes recessed channels 2216 that are configured to receive flanges 2112 on the accessory so that flanges 2112 can engage the side (s) of the cartridge body 2214. Thus, the accessory 2100 can be fixed more firmly to the cartridge body, thus preventing unwanted movements of the 2100 accessory during use.

[0146] In another embodiment, as shown in Figure 22, accessory 3000 may have a channel 3008 with one or more openings 3010 that extend through it (for example, perforated),

thus creating at least one connecting member 3012. In this way, the first and second portions 3014, 3016 of accessory 3000 are selectively connected to at least one connecting member

3012. In use, when the cutting member is initially fired and moves along accessory 3000, the cutting member performs the cutting through at least one connecting member 3012, thereby separating the first and second portions 3014, 3016, and thus dividing accessory 3000 into two distinct parts.

[0147] In some embodiments, the cartridge body, such as the 2214 cartridge body shown in Figure 21B, and the accessory, such as the 3000 accessory shown in Figure 22, may include complementary reinforcement features that can be configured to prevent tearing of the accessory out of the channel when the cutting element moves through the accessory 3000. For example, the reinforcement features of the cartridge body can be recessed cylindrical openings positioned close to the slot inside the cartridge body, and the reinforcement features of the cartridge body. accessory may be cylindrical protrusions positioned within the first and second portions of the accessory adjacent to at least one connecting member. Thus, when the accessory is placed on the cartridge body, these cylindrical protuberances of the accessory extend into these recessed openings in the cartridge body. The present invention further contemplates that these protrusions and recessed openings can have several other shapes.

[0148] The frames can be applied to a cartridge body to form a staple cartridge assembly using any suitable method. For example, in some embodiments, the method may include attaching a bioabsorbable compressible attachment to a surgical stapler cartridge body. In one embodiment, as discussed above, attachment of the attachment to the cartridge body may include placing a contact surface with the attachment cartridge against a surface of the cartridge body to insert the attachment flanges into the recessed channels of the body. cartridge. In another embodiment, the method may also include coating a surface of the cartridge body with an adhesive before the accessory is attached to it.

[0149] The devices disclosed here can be designed to be discarded after a single use, or they can be designed to be used multiple times. In any case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing specific parts and subsequent reassembly. In particular, the device can be disassembled and any number of specific parts or parts of the device can be selectively replaced or removed, in any combination. By cleaning and / or replacing specific parts, the device can be reassembled for subsequent use in the reconditioning facilities or by a surgical team, immediately before a surgical procedure. Those skilled in the art will understand that reconditioning a device can use a variety of techniques to disassemble, clean / replace and reassemble. The use of these techniques, as well as the resulting refurbished device, are all within the scope of this application.

[0150] The person skilled in the art will understand other features and advantages of the invention based on the modalities described above. Consequently, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited are expressly incorporated herein in full, by way of reference.

Any patent, publication or information, in whole or in part, that is taken as incorporated by reference to the present invention, is incorporated into the present invention only to the extent that the incorporated material does not conflict with definitions, statements or other existing disclosure materials presented in this document.

Accordingly, the disclosure as explicitly presented herein replaces any conflicting material incorporated into the present invention by reference.

Claims (18)

1. Three-dimensional bioabsorbable accessory for use with a stapling assembly, characterized by comprising: a plurality of resilient struts that are formed from a first matrix comprising at least one fused bioabsorbable polymer, the plurality of resilient struts forming repetitive geometric units, and the struts of the plurality of resilient struts are configured to deform when compressed, where the accessory is configured to be releasably retained in the staple body, and to enable the struts of a plurality of staples disposed in the staple body to pass through likewise so that the accessory can be fixed to the fabric by the plurality of clips. 2. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that the struts of the plurality of resilient struts are interconnected in nodes to form lattice-like structures that are configured to flex when compressed. 3. Three-dimensional bioabsorbable accessory according to claim 2, characterized in that the interconnectivity of the plurality of resilient struts and nodes form a geometry that is configured to allow the accessory to compress in a first predetermined direction and to limit movement in a second direction that is different from the first predetermined direction. A three-dimensional bioabsorbable accessory according to claim 2, characterized in that the nodes are formed from a second matrix comprising at least one fused bioabsorbable polymer that is different from at least one fused bioabsorbable polymer from the first matrix. 5. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that the struts of the plurality of struts have a substantially spiral shape. 6. Three-dimensional bioabsorbable accessory, according to claim 1, characterized by empty spaces of varying sizes being present in the accessory. 7. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that the at least one fused bioabsorbable polymer of the first matrix is selected from the group consisting of: thermoplastic bioabsorbable polyurethane, ultraviolet light-curable bioabsorbable polyurethane, poly (lactic acid), polycaprolactone, polyglycolide, polydioxanone, poly (lactic-co-glycolic acid), polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, copolymers thereof and combinations thereof. 8. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that the plurality of struts define a first portion, a second opposite portion of the accessory, and a channel between said portions that is configured to receive a cutting element, wherein the first and second portions are selectively connected by at least one connecting member extending through the channel. 9. Three-dimensional bioabsorbable accessory, according to claim 1, characterized in that the plurality of struts allow a contact surface with the fabric and a contact surface with the accessory body to compress towards each other. 10. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that it additionally comprises at least one locking element configured to limit a compression amount of the accessory. 11. Three-dimensional bioabsorbable accessory according to claim 1, characterized in that it is configured to apply a tension of at least about 3 g / mm2 to the fabric stapled to the accessory for at least 3 days when the accessory is in a state implanted in the fabric . 12. Three-dimensional bioabsorbable accessory for use with a stapling set, characterized by comprising: a plurality of resilient struts that are connected at joints to form a lattice structure, the lattice structure being formed from at least one matrix comprising at least minus a fused bioabsorbable polymer, in which the interconnectivity of the plurality of struts and the joints is configured to allow the accessory to compress, and in which the lattice structure includes a contact surface with the fabric and a contact surface with the set which is opposite the contact surface with the fabric, and the lattice structure is configured to allow a plurality of staples arranged in the stapling assembly to pass through it so that the accessory can be attached to the fabric by the plurality of staples . 13. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that the plurality of resilient struts is formed from a first matrix comprising at least one fused bioabsorbable polymer and the joints are formed from a second matrix comprising at least one bioabsorbable polymer melt that is different from at least one melt bioabsorbable polymer from the first matrix. 14. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that voids are present in the lattice structure, and in which the voids form a substantially continuous network of openings throughout the accessory. 15. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that the lattice structure has a first end, a second end and a longitudinal geometric axis that extends between them, and the lattice structure additionally comprises empty spaces that are they extend at least partially through the lattice structure. 16. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that the plurality of struts define a first side portion, a second side opposite the portion of the lattice structure, and a channel between said portions that is configured to receive a cutting element, wherein the first and second side portions are selectively connected by a plurality of connecting members extending through the channel. 17. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that it additionally comprises at least one locking element configured to limit a compression amount of the accessory. 18. Three-dimensional bioabsorbable accessory according to claim 12, characterized in that it is configured to apply a tension of at least about 3 g / mm2 to the fabric stapled to the accessory for at least 3 days when the accessory is in a state implanted in the fabric .