CN104321021A

CN104321021A - Expandable tissue thickness compensator

Info

Publication number: CN104321021A
Application number: CN201380027745.0A
Authority: CN
Inventors: J·L·奥尔德里奇; C·杨; C·J·沙伊布; C·W·威登豪斯; W·B·威森伯格二世; J·L·斯塔门; M·H·兰西克; S·A·马奇勒; G·W·奈特
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2012-03-28
Filing date: 2013-03-27
Publication date: 2015-01-28
Anticipated expiration: 2033-03-27
Also published as: RU2648884C2; CN104321021B; JP2015513955A; BR112014024306B1; RU2014143212A; MX2014011667A; JP6193350B2; BR112014024306A2

Abstract

A tissue thickness compensator (70010, 70130, 70150, 70182) may generally comprise a biocompatible material, a first component (70010A), and a second component (70010B), wherein the first component and second component form a reaction product to expand the tissue thickness compensator. The first component may comprise a first hydrogel precursor, the second component may comprise a second hydrogel precursor, and the reaction product may comprise a hydrogel. The reaction product may be formed in vivo and/or in situ by contacting the first component and the second component. The first component and/or second component may be encapsulated and configured to release the components when ruptured. The reaction product may comprise a fluid-swcllablc composition. Articles of manufacture comprising the tissue thickness compensator and methods of making and using the tissue thickness compensator are also described.

Description

Extendible tissue thickness compensating part

The cross reference of related application

The patent application of this non-transitory is the U.S. Patent Application Serial Number 13/097 that the name submitted to according to the 29 days April in 2011 of 35 U.S.C. § 120 is called " Tissue Thickness Compensator For A Surgical Stapler Comprising An Adjustable Anvil ", the part continuation application of 891, this U.S. Patent application is the U.S. Patent application 12/894 that the name submitted to for 30th according in the JIUYUE, 2010 of 35 U.S.C. § 120 is called " Selectively Orientable Implantable Fastener Cartridge ", the part continuation application of 377, whole disclosures of above-mentioned patent application are incorporated herein by reference accordingly.

Background technology

The present invention relates to surgical instruments, and relate to the surgical cutting and suture instruments and nail bin thereof that are designed to cutting and suture tissue.

Summary of the invention

It is below the incomplete list by claims protection or the claimed embodiment of the present invention of possibility.

1. tissue thickness's compensating part, comprises:

Biocompatible materials;

First component; With

Second component;

Wherein said first component and second component are suitable for forming reactions product to make the compensating part expansion of described tissue thickness.

2. the tissue thickness's compensating part according to embodiment 1, also comprise encapsulation component, described package group divides the one comprised in described first component and second component, and the another one in wherein said first component and second component is embedded in described biocompatible materials.

3. the tissue thickness's compensating part according to embodiment 1, wherein said first component comprises the hydrophilic material be embedded in described biocompatible materials, and described second component is body fluid.

4. the tissue thickness's compensating part according to embodiment 1, described tissue thickness compensating part comprises the first encapsulation component containing described first component and the second encapsulation component containing described second component.

5. the tissue thickness's compensating part according to embodiment 4, wherein said biocompatible materials comprises at least one packaging part, and at least one packaging part described comprises described first encapsulation component and described second encapsulation component.

6. the tissue thickness's compensating part according to embodiment 4, wherein when described first encapsulation component is broken loose, described first encapsulation component can discharge described first component, and when described second encapsulation component is broken loose, described second encapsulation component can discharge described second component.

7. the tissue thickness's compensating part according to any one of previous embodiment, wherein said biocompatible materials comprises albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, glucosan, elastin laminin, fibrin, Fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, Merlon, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

8. the tissue thickness's compensating part according to embodiment 1, wherein said product contacts and original position formation with described second component by making described first component.

9. the tissue thickness's compensating part according to any one of previous embodiment, wherein said product is the compositions that fluid-soluble is swollen.

10. the tissue thickness's compensating part according to any one of embodiment 1 and 4-9, wherein said first component comprises the first hydrogel precursor, and described second component comprises the second hydrogel precursor, and described product comprises hydrogel.

11. tissue thickness's compensating parts according to any one of previous embodiment, wherein said first component and second component are independently selected from albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, glucosan, elastin laminin, fibrin, Fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, poly-(lactic acid), poly-(glycolic), Merlon, poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

12. tissue thickness's compensating parts according to any one of previous embodiment, comprise the skin that comprises the impermeable material of water and comprise the internal layer of at least one in described biocompatible materials and described first component and second component.

13. tissue thickness's compensating parts according to embodiment 12, the impermeable material of wherein said water comprises poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, Merlon, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

14. tissue thickness's compensating parts according to any one of previous embodiment, wherein said biocompatible materials comprises embedding reinforcing material wherein, and wherein said reinforcing material comprises the combination of mesh sheet, fiber, granule, powder or above-mentioned substance.

15. tissue thickness's compensating parts according to embodiment 14, wherein said reinforcing material comprises collagen, gelatin, fibrin, Fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl-cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, alginate, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polycaprolactone, polypropylene, aliphatic polyester, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyalkylenes oxalates, polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

16. tissue thickness's compensating parts according to any one of previous embodiment, comprise the combination of hemorrhage, antiinflammatory, antibiotic agent, antimicrobial, antiblocking agent, anticoagulant, medicine, pharmaceutically active agents or above-mentioned substance.

17. 1 kinds of goods, it is selected from the anvil block of robotic suturing device and the nail bin for robotic suturing device, and described goods comprise:

Tissue thickness's compensating part according to embodiment 1, described tissue thickness compensating part comprises:

Skin, it comprises pore-free material;

Internal layer, it comprises: porous material, the first encapsulation component containing described first component and the second encapsulation component containing described second component.

18. goods according to embodiment 17, wherein:

Described skin comprises polyglycolic acid, polylactic acid, poly-dioxanone, polyhydroxyalkanoatefrom, poliglecaprone, polycaprolactone or their combination;

Described porous material comprises oxidized regenerated cellulose, and described first component comprises the first hydrogel precursor, and described second component comprises the second hydrogel precursor; And

Wherein said product is hydrogel, and described first hydrogel precursor and the second hydrogel precursor are suitable for forming described hydrogel, to make the compensating part expansion of described tissue thickness when described first encapsulation component and the second encapsulation component are broken loose.

19. goods according to embodiment 17 or embodiment 18, wherein said goods according to circumstances limit nail from described storehouse to anvil block or the nail forming path that will follow from storehouse to described anvil block at least partially, and wherein said first encapsulation component and the second encapsulation component are alignd with described nail forming path, make the nail following described path pierce through described packaging part or otherwise make it broken loose.

20. 1 kinds of methods using tissue thickness's compensating part of embodiment 4 to carry out tissue thickness's compensating part of original position formation expansion, described method comprises:

Make described first encapsulation component and the second encapsulation component break loose, to allow the reaction in-situ of described first encapsulation component and the second encapsulation component, thus form described product;

Wherein said product makes the compensating part expansion of described tissue thickness to compensate different tissue thicknesses.

21. methods according to embodiment 20, wherein:

Described tissue thickness compensating part comprises:

Skin, it comprises the combination of polyglycolic acid, polylactic acid, poly-dioxanone, polyhydroxyalkanoatefrom, poliglecaprone, polycaprolactone or above-mentioned substance; With

Internal layer, it comprises oxidized regenerated cellulose;

First package group is divided and is comprised the first hydrogel precursor;

Second package group is divided and is comprised the second hydrogel precursor; And

Product comprises hydrogel.

Accompanying drawing explanation

Come in conjunction with the drawings following to illustrate with reference to of the present invention, the features and advantages of the present invention and the mode obtaining them will become more apparent, and the present invention self is also easier to understanding, wherein:

Fig. 1 is the profile of surgical instruments embodiment;

Figure 1A is the perspective view of an embodiment of implanted nail bin;

Figure 1B-Fig. 1 E shows the part of the end effector using the clamping of implanted nail bin and suture tissue;

Fig. 2 is the partial cross-sectional side view of another end effector of the part being connected to surgical instruments, and its end effector supports surgery nail bin and its anvil block is in an open position;

Fig. 3 is the end effector of Fig. 2 another partial cross-sectional side view in the close position;

Fig. 4 is another partial cross-sectional side view that the end effector of Fig. 2 and Fig. 3 starts when being advanced through end effector at knife bar;

Fig. 5 is end effector another partial cross-sectional side view when knife bar is partly advanced through wherein of Fig. 2-Fig. 4;

Fig. 6 is mounted in the perspective view of the nail bin embodiment of the alternative in surgical cutting and stitching devices;

Fig. 7 is the surgery nail bin of Fig. 6 shown device and the top view of elongated passageway;

Fig. 8 is mounted in the top view of another surgery nail bin embodiment in the elongated passageway of end effector;

Fig. 9 is the bottom view of anvil block;

Figure 10 is the fragmentary, perspective view of multiple nails of the part forming nail line;

Figure 11 is another fragmentary, perspective view of the nail line of Figure 10, and the nail of wherein said nail line is formed after contacting with the anvil block of stitching devices with surgical cutting;

Figure 12 is the fragmentary, perspective view of the nail of the alternative of the part forming another nail line;

Figure 13 is the fragmentary, perspective view of the nail of the alternative of the part forming another nail line;

Figure 14 is the fragmentary, perspective view of the nail of the alternative of the part forming another nail line embodiment;

Figure 15 is the profile of the end effector supporting nail bin;

Figure 16 is that the elongated passageway part of the end effector of Figure 15 is removing the profile after implanted nail bin main part and nail from it;

Figure 17 is the profile of the end effector supporting another nail bin;

Figure 18 A-Figure 18 D diagram is positioned at the distortion of the surgical staples can collapsed in nail bin body according at least one embodiment;

Figure 19 A illustrates that be positioned at can the schematic diagram of nail in conquassation nail bin body;

Figure 19 B be illustrate Figure 19 A can conquassation nail bin body by the schematic diagram of anvil block conquassation;

Figure 19 C be illustrate Figure 19 A can conquassation nail bin body by the schematic diagram of the further conquassation of anvil block;

Figure 19 D be illustrate the nail of Figure 19 A be in be fully formed configuration and Figure 19 A can be in the schematic diagram of complete conquassation condition by conquassation nail bin;

Figure 20 is the schematic diagram described the nail of locating against nail bin stayed surface and the potential relative motion between nail with nail bin stayed surface is shown;

Figure 21 is the surface-supported profile of nail bin, and this nail bin stayed surface comprises slit or groove, and it can stablize the base portion of the nail of Figure 20;

Figure 22 is the profile of nail of the embodiment according at least one alternative, and this nail comprises the bizet of overmolding and can receive the slit of part or the groove of this bizet;

Figure 23 is the top view of the nail bin according at least one embodiment, and this nail bin comprises the nail being embedded in and can collapsing in nail bin body;

Figure 24 is the front view of the nail bin of Figure 23;

Figure 25 is the front view of the nail bin according at least one embodiment, and this nail bin comprises the protective layer around being positioned at the nail can collapsed in nail bin body;

Figure 26 is the profile that the nail bin of Figure 25 intercepts along the line 26-26 in Figure 25;

Figure 27 is the front view of the nail bin according at least one embodiment, and this nail bin comprises and extends the nail outside nail bin body of can collapsing and the protective layer around nail bin body at least in part;

Figure 28 is the profile that the nail bin of Figure 27 intercepts along the line 28-28 in Figure 27;

Figure 29 is the partial cutaway view of the nail bin according at least one embodiment, and this nail bin comprises the nail being embedded at least in part and can collapsing in nail bin body, and this nail is positioned in the space, nail chamber in nail bin body at least in part;

Figure 30 is the profile of nail bin of the Figure 29 intercepted along the line 30-30 in Figure 29;

Figure 31 is the partial cutaway view of the nail bin according at least one embodiment;

Figure 32 is the partial cutaway view of the nail bin according at least one embodiment, and this nail bin comprises and is embedded in can collapse nail in nail bin body and connected nail and the alignment matrix that nail is relative to each other alignd at least in part;

Figure 33 is the profile intercepted along the line 33-33 in Figure 32 of the nail bin of Figure 32;

Figure 34 is the partial cut sectional view of the internal layer of compressible nail bin body;

Figure 35 shows between transfer plate and gripper shoe by the schematic diagram of the internal layer of Figure 34 compressed;

Figure 36 illustrates the schematic diagram followed closely and be inserted in the compression internal layer of Figure 35;

Figure 37 is the schematic diagram illustrating that the gripper shoe of Figure 35 is removed from internal layer;

Figure 38 comprises the internal layer of Figure 34 and is inserted into the schematic diagram of sub-component of nail of the Figure 36 in skin;

Figure 39 illustrates that the skin of Figure 38 is sealed to be formed the schematic diagram of sealing nail bin;

Figure 40 is the profile of the sealing nail bin of Figure 39;

Figure 41 is the profile of nail bin according at least one embodiment and nail bin passage;

Figure 42 is the schematic diagram that the part of the nail bin that Figure 41 is shown is in deformation state;

Figure 43 is the front view of the end effector of surgical stapling device, and this end effector comprises anvil block in an open position and is positioned at the nail bin in nail bin passage;

Figure 44 is the front view of the end effector of Figure 43, the nail bin that it illustrates anvil block in the close position and be compressed between anvil block and nail bin passage;

Figure 45 is the front view of the end effector of Figure 43, and the mode that it illustrates to select else is positioned at the nail bin of the Figure 43 in nail bin passage;

Figure 46 is the profile of the end effector of surgical stapling device, and this end effector comprises the compressible nail bin be positioned in nail bin passage and the one piece of buttress material being attached to anvil block;

Figure 47 is the profile of the end effector of Figure 46, it illustrates anvil block in the close position;

Figure 48 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with water impermeable barrier;

Figure 49 is the profile of the embodiment of another alternative of the end effector of surgical stapling device;

Figure 50 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises staged anvil block and has the nail bin of staged warehouse;

Figure 51 is the profile of the embodiment of another alternative of the end effector of surgical stapling device;

Figure 52 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the tissue contacting surface of inclination;

Figure 53 is the profile of the embodiment of another alternative of the end effector of surgical stapling device, and this end effector comprises the tissue contacting surface of inclination;

Figure 54 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the support insert that can support nail bin;

Figure 55 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with multiple compressible stratum;

Figure 56 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with the compressible warehouse of staged;

Figure 57 is the profile of the embodiment of another alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with the compressible warehouse of staged;

Figure 58 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with bending tissue contacting surface;

Figure 59 is the profile of the embodiment of the alternative of the end effector of surgical stapling device, and this end effector comprises the nail bin with inclination tissue contacting surface;

Figure 60 is the profile of compressible nail bin, at least one medicine that this compressible nail bin comprises nail and is stored in wherein;

Figure 61 be illustrate the compressible nail bin of Figure 60 its by compression and wherein the nail that holds deformed after schematic diagram;

Figure 62 is the partial sectional view of the nail bin according at least one embodiment;

Figure 63 is the profile of the nail bin of Figure 62;

Figure 64 is the perspective view of the implantation nail bin according at least one embodiment selected else;

Figure 65 is the profile of the described implantation nail bin of Figure 64;

Figure 66 is the perspective view of the embodiment of the alternative of nail bin, and this nail bin comprises the deformable member extended from the skin of nail bin;

Figure 67 is the perspective view of the embodiment of the alternative of nail bin, and this nail bin comprises the skin of the nail bin being mounted to internal layer;

Figure 68 is the profile of the embodiment of the alternative of nail bin, and this nail bin comprises multiple nail, compressible stratum and degreasing cotton layer;

Figure 69 is the perspective view of the degreasing cotton layer of Figure 68;

Figure 70 is the perspective view of the absorbent cotton be partitioned into from the degreasing cotton layer of Figure 68 and the nail alignd with the groove in absorbent cotton;

Figure 71 is the perspective view of two connected absorbent cottons of degreasing cotton layer from Figure 68;

Figure 72 be the degreasing cotton layer of Figure 68 absorbent cotton support frame by from the perspective view that removes of the absorbent cotton that is partitioned into;

Figure 73 be the embodiment of the alternative of compressible nail bin disassemble perspective view, this compressible nail bin comprises nail wherein and for driving the system of nail against anvil block;

Figure 73 A is the partial sectional view of the embodiment of the alternative of the nail bin of Figure 73;

Figure 74 is the profile of the nail bin of Figure 73;

Figure 75 can traverse the nail bin of Figure 73 and the front view of the sliding part that nail is moved towards anvil block;

Figure 76 is the schematic diagram of staple drivers, and this staple drivers can be promoted towards anvil block by the sliding part of Figure 75;

Figure 77 is the excision view of the nail bin according at least one embodiment selected else, and this nail bin comprises the nail be positioned in staple drivers;

Figure 78 is the profile of the nail bin of Figure 77 when being positioned in nail bin passage;

Figure 79 is the profile of the nail bin of Figure 77, it illustrates the anvil block moved in make position and the nail be contained in nail bin be out of shape by anvil block;

Figure 80 is the profile of the nail bin of Figure 77, it illustrates the nail moved upward towards anvil block;

Figure 81 is the perspective view of the embodiment of the alternative of nail bin, and this nail bin comprises the band of the flexible sides connecting nail bin;

Figure 82 is the perspective view of sliding part and cutting element assembly;

Figure 83 uses the sliding part of Figure 82 and cutting element assembly to promote the schematic diagram of the nail of the nail bin of Figure 77;

Figure 84 is that illustrate can jointing nail promote the sliding part of nail towards anvil block and optionally can allow the schematic diagram of the locking system of sliding part distal motion;

Figure 85 A-Figure 85 C illustrates and nail is inserted the process of following closely in bizet;

Figure 86 is the profile of the nail bin comprising supporting disk or keeper;

Figure 87 is the part sectioned view of the compressible nail bin according at least one embodiment selected else;

Figure 88 be illustrate the nail bin of Figure 87 be in implantation condition under schematic diagram;

Figure 89 is the partial sectional view of the compressible nail bin according at least one embodiment selected else;

Figure 90 is the part sectioned view of the nail bin of Figure 89;

Figure 91 be illustrate the nail bin of Figure 89 be in implantation condition under schematic diagram;

Figure 92 be according to the embodiment of at least one alternative can the part sectioned view of conquassation nail bin;

Figure 93 is the partial sectional view comprising the collapsed nail bin of multiple crushable member according at least one embodiment;

Figure 94 is the perspective view under the crushable member of Figure 93 is in non-collapsed state;

Figure 95 is the perspective view under the crushable member of Figure 94 is in collapsed state;

Figure 96 A is the part sectioned view of the end effector of surgery suturing appliance, and this end effector comprises jaw, the nail bin passage of relatively locating with jaw and the nail bin be positioned in nail bin passage, and wherein jaw comprises the maintenance matrix be attached on it;

Figure 96 B is the part sectioned view of the end effector of Figure 96 A, it illustrates towards the motion of nail bin passage jaw, by anvil block and the nail bin and the nail that keep matrix compression, this nail extends through the tissue being positioned at and keeping between matrix and nail bin at least in part;

Figure 96 C is the part sectioned view of the end effector of Figure 96 A, it illustrates the jaw being in final position and the maintenance matrix closed with the nail joint of Figure 96 B;

Figure 96 D is the part sectioned view of the end effector of Figure 96 A, it illustrates jaw and nail bin passage away from the nail bin implanted with keep matrix motion;

Figure 97 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises multiple retaining member, and this retaining member can engage the fastener leg extended through wherein;

Figure 98 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises six retaining members;

Figure 99 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises eight retaining members;

Figure 100 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises multiple retaining member, and this retaining member can engage the fastener leg extended through wherein;

Figure 101 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises six retaining members;

Figure 102 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises eight retaining members;

Figure 103 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises the multiple retaining members be stamped to form by sheet metal;

Figure 104 is the perspective view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises multiple holes that the periphery around retaining hole extends;

Figure 105 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative;

Figure 106 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative;

Figure 107 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative;

Figure 108 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative;

Figure 109 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative;

Figure 110 is the top view of the retaining hole of maintenance matrix according at least one embodiment, and this retaining hole comprises the maintenance inserted sheet extended in retaining hole;

Figure 111 is the top view of retaining hole of the maintenance matrix of embodiment according at least one alternative, and this retaining hole comprises the maintenance inserted sheet extended in retaining hole;

Figure 112 is the perspective view of fastening system, and this fastening system comprises multiple nail, the maintenance matrix that closes with nail joint and the alignment matrix of following closely of can aliging;

Figure 113 is the perspective view of the maintenance matrix of Figure 112;

Figure 114 is the perspective view of the alignment matrix of Figure 112;

Figure 115 is the partial top view that the maintenance matrix of Figure 112 and the nail joint of Figure 112 are closed;

Figure 116 is the partial bottom view that the maintenance matrix of Figure 112 and the nail joint of Figure 112 are closed;

Figure 117 is the partial elevation view of the fastening system of Figure 112;

Figure 118 is the fragmentary, perspective view of the fastening system of Figure 112;

Figure 119 is the part sectioned view that the maintenance matrix of Figure 112 and the nail joint of Figure 112 are closed;

Figure 120 is the part sectioned view of the fastening system of Figure 112;

Figure 121 is the perspective view of the fastening system of Figure 112, and this fastening system also comprises the protectiveness top cover being assembled to nail lower limb;

Figure 122 is the bottom perspective view of the fastening system structure of Figure 121;

Figure 123 is the fragmentary, perspective view of the fastening system structure of Figure 121;

Figure 124 is the part sectioned view of the fastening system structure of Figure 121;

Figure 125 is the front view of the end effector according at least one embodiment, and this end effector comprises jaw in an open position, the nail bin that is positioned at maintenance matrix in jaw and multiple protectiveness top cover and is positioned in nail bin passage;

Figure 126 be the end effector of Figure 125 in the close position time front view;

Figure 127 is the end effector of Figure 125 front view when being in firing position;

Figure 128 is the maintenance matrix of Figure 125 and protectiveness top cover front view when being assembled to the nail bin of Figure 125;

Figure 129 is the detail drawing of the structure of Figure 128;

Figure 130 is the front view of the end effector of Figure 125, it illustrates jaw in an open position and is positioned to keep the comparatively thin tissue between matrix and nail bin;

Figure 131 is the front view of the end effector of Figure 125, it illustrates the jaw in the close position comparatively thin tissue against Figure 130;

Figure 132 is the front view of the end effector of Figure 125, it illustrates jaw and is in firing position to catch the comparatively thin tissue of Figure 130 between maintenance matrix and nail bin;

Figure 133 is that the maintenance matrix of Figure 125 and protectiveness top cover are assembled to the nail bin of Figure 125 and make the thin tissue of Figure 130 be positioned at front view therebetween;

Figure 134 is the detail drawing of the structure of Figure 133;

Figure 135 is the profile being positioned at the protectiveness top cover on nail lower limb top of the embodiment according at least one alternative;

Figure 136 is the perspective view of the multiple protectiveness top covers in insert material sheet;

Figure 137 is the perspective view of jaw, and this jaw comprises multiple groove, and multiple protectiveness top cover can be received in wherein by this groove;

Figure 138 is the detail drawing of a part for jaw, and this part comprises the thin slice covering the protectiveness top cover be positioned in the jaw of Figure 137;

Figure 139 is the profile being positioned at the protectiveness top cover on nail lower limb top of the embodiment according at least one alternative, and wherein protectiveness top cover comprises inner formation surface;

Figure 140 is another profile of the protectiveness top cover of Figure 139, it illustrates against this formation surface and the nail lower limb of distortion;

Figure 141 is the top view of the embodiment of the alternative keeping matrix, and this maintenance matrix comprises multiple connected matrix element;

Figure 142 is the top view of the embodiment of the alternative keeping matrix, and this maintenance matrix comprises multiple connected matrix element;

Figure 143 is the top view of the embodiment of the alternative keeping matrix, and this maintenance matrix comprises multiple connected matrix element;

Figure 144 is the top view of the embodiment of the alternative of a series of maintenance matrix, and this maintenance matrix array comprises multiple connected matrix element;

Figure 145 is the top view of the embodiment of the alternative keeping matrix, and this maintenance matrix comprises multiple connected matrix element;

Figure 146 is the partial exploded view comprising the jaw keeping matrix, and this maintenance matrix comprises compressible lid;

Figure 147 is the detail drawing of the maintenance matrix of Figure 146;

Figure 148 is the part sectioned view comprising the fastening system keeping matrix, and this maintenance matrix comprises multiple unit of compressible stratum and one or more medicines of encapsulation;

Figure 149 illustrates that nail lower limb pierces through the schematic diagram of the unit of Figure 148 when engaging with maintenance matrix;

Figure 150 is the part sectioned view comprising the fastening system keeping matrix, and this maintenance matrix comprises compressible stratum;

Figure 151 is the front view of fastener cartridge plug-in package, and this fastener cartridge plug-in package comprises clamper, the first fastener cartridge and the second fastener cartridge;

Figure 152 is the front view of the end effector of surgical stapling device, and this end effector comprises the first jaw and the second jaw, and this second jaw is shown in opens configuration;

Figure 153 is the front view of the end effector of Figure 152, it illustrates the second jaw of being in closed configuration and for loading the first jaw with the first storehouse and loading the fastener cartridge plug-in package of Figure 151 of the second jaw with the second storehouse;

Figure 154 is the front view of the end effector of the Figure 153 loaded, it illustrates remove from end effector storehouse plug-in package, be again in the second jaw opening configuration and the tissue be positioned between the first jaw and the second jaw;

Figure 155 is that the end effector that loads of Figure 154 is in the front view of pulling the trigger configuration;

Figure 156 is the front view under the first storehouse and the second storehouse are in implantation condition;

Figure 157 is the front view of the end effector of Figure 152 according at least one embodiment, it illustrates the part in the first storehouse still engaged with the first jaw;

Figure 158 is the front view of the embodiment of the alternative of fastener cartridge plug-in package, and this fastener cartridge plug-in package comprises clamper, the first fastener cartridge and the second fastener cartridge;

Figure 159 is the front view of the fastener cartridge plug-in package of Figure 158, and this fastener cartridge plug-in package is used for loading the first jaw of end effector with the first storehouse and loading the second jaw with the second storehouse;

Figure 160 is the profile loading end effector of Figure 159;

Figure 161 is the perspective view comprising the surgical stapling device of bottom jaw and top jaw according at least one embodiment, and the part showing surgical stapling device is removed;

Figure 162 is the perspective view of the surgical stapling device of the Figure 161 having removed top jaw;

Figure 163 is the perspective view of the slidably anvil block system of the top jaw of the surgical stapling device of Figure 161, this slidably anvil block system comprise the first slidably anvil block and second slidably anvil block;

Figure 164 is the end-view of the slidably anvil block system of Figure 163;

Figure 165 is the top view of the slidably anvil block system of Figure 163;

Figure 166 be illustrate the slidably anvil block system of Figure 163 be in non-percussion condition under schematic diagram;

Figure 167 be the slidably anvil block system that Figure 163 is shown first slidably anvil block be in non-firing position and the nail be positioned in the jaw of bottom is in the schematic diagram of non-deployed position;

Figure 168 be the nail illustrated in the jaw of bottom be in dispose configuration and first of Figure 167 slidably anvil block be pulled to the schematic diagram that nearside is out of shape with the nail lower limb making first group to follow closely;

Figure 169 illustrates that first group of nail of Figure 168 is deformed into the schematic diagram of the state of being badly deformed;

Figure 170 be the slidably anvil block system that Figure 163 is shown second slidably anvil block be pushed to distally with make second group follow closely lower limb distortion schematic diagram;

Figure 171 is the fragmentary, perspective view comprising the anvil block of multiple shaping pit at least one embodiment;

Figure 172 is the section end view of the anvil block of Figure 171;

Figure 173 is the schematic diagram of the first step that the shaping pit manufacturing Figure 171 is shown;

Figure 174 is the schematic diagram of the second step that the shaping pit manufacturing Figure 171 is shown;

Figure 175 is the top view of the shaping pit structure of the anvil block of Figure 171;

Figure 176 is the schematic diagram of the first step of the manufacturing process illustrated for the manufacture of anvil block;

Figure 177 is the schematic diagram of the second step of the manufacturing process that Figure 176 is shown;

Figure 178 is the schematic diagram of the third step of the manufacturing process that Figure 176 is shown;

Figure 179 is surgical stapling and the front, left perspective view cutting off apparatus, and wherein handle portions comprises automatic retracted mechanism and the ratchet manual retrieving mechanism of connecting rod triggering;

Figure 180 is the surgical stapling of Figure 179 and cuts off the right back perspective view of apparatus, and wherein cut the and right side half shell of shank shell of a part for slender axles is removed to show automatic firing end and advances cam mechanism and manually pull the trigger cam mechanism;

Figure 181 is that the surgical stapling of Figure 179 disassembles view with the cut-out handle portions of apparatus and the right back perspective of slender axles;

Figure 182 is the surgical stapling of Figure 31 and cuts off the right back perspective view of apparatus, and wherein the outside of right half shell and execution part is removed to show and is in close mechanism under original state and firing lock;

Figure 183 is the surgical stapling that the part of Figure 182 is disassembled and the right side elevation view cutting off apparatus;

Figure 184 is the surgical stapling that the part of Figure 182 is disassembled and the right back perspective view cutting off apparatus, wherein close mechanism closes and clamping, and gemmule pawl firing lock completes the first stroke, and wherein manual retrieving mechanism is removed the distal link showing link tooth bar, and this distal link triggers the automatic retracted of firing lock;

Figure 185 is the surgical stapling disassembled of the part of Figure 183 and the right back perspective view cutting off apparatus, wherein gemmule pawl firing lock depart from and distal link close to automatic retracted;

Figure 186 is the surgical stapling that the part of the Figure 183 being in original state is disassembled and the left side elevation view cutting off apparatus, and when this original state, end effector is opened and anti-inversion organization is engaged;

Figure 187 is the right side half shell of the handle portions of Figure 186 and the left side detail drawing of anti-reversing trip lever;

Figure 188 is the surgical stapling disassembled of Figure 179 and thin portion, the left side front view of cut-out apparatus, and wherein closure trigger is clamped, percussion trigger performs final stroke and distal link is oriented to trigger automatic retracted;

Figure 189 is that distal link has activated towards anti-reversing trip lever and locked thus make the surgical stapling disassembled of the Figure 188 after link tooth bar retraction and cut off thin portion, the left side front view of apparatus;

Figure 190 is that the surgical stapling of Figure 179 disassembles perspective view with the idler gear of manual retrieving mechanism and the right side of backgear and manual retrieving lever and ratchet pawl cutting off apparatus;

Figure 191 is the right perspective view of the manual retrieving mechanism of Figure 190, and wherein manual retrieving lever is partly cut away the ratchet gear to show small diameter on the backgear of engages ratchet pawl;

Figure 192 is the left side elevation view that the surgical stapling of Figure 179 and the part of cut-out apparatus are disassembled, and wherein anti-inversion organization joins the link tooth bar of pulling the trigger completely to, and before the manual retrieving lever of Figure 190, this link tooth bar and combination tension/Compress Spring disconnect;

Figure 193 is the left side elevation view that the surgical stapling of Figure 192 and the part of cut-out apparatus are disassembled, and wherein the hidden parts of anti-reversing trip lever, backgear and manual percussion trip lever shows with dotted line;

Figure 194 is the left side elevation view that the actuating of manually pulling the trigger trip lever has made the part of the surgical stapling of the Figure 193 after link tooth bar manual retrieving and cut-out apparatus disassemble;

Figure 195 is the left side elevation view that the surgical stapling of Figure 194 and the part of cut-out apparatus are disassembled, and wherein links tooth bar and is omitted, and shows manually percussion trip lever and anti-inversion organization and departs from;

Figure 196 is for the surgical stapling of Figure 179 and the anti-reversing trip lever of alternative of cut-out apparatus and the left side detail drawing of shank shell;

Figure 197 is that the left perspective of anti-reversing release thick stick, backgear axle and the automatic retracted cam of the alternative of Figure 196 disassembles view;

Figure 198 is the right side elevation view of the anti-reversing relieving mechanism of the alternative of Figure 196, and wherein link tooth bar and be in advanced position, and anti-reversing trip lever is proximally located, wherein anti-down flap joins to and excites connecting rod;

Figure 198 A is thin portion, the right side front view of the backgear of Figure 198, automatic retracted cam and farthest side connecting rod;

Figure 199 is the right side elevation view pulling the trigger the anti-reversing relieving mechanism of the Figure 198 after stroke first;

Figure 199 A is thin portion, the right side front view of the backgear of Figure 199, automatic retracted cam and second connecting rod;

Figure 200 is the right side elevation view pulling the trigger the anti-reversing relieving mechanism of the Figure 199 after stroke second;

Figure 200 A is thin portion, the right side front view of the backgear of Figure 200, automatic retracted cam and third connecting rod;

Figure 20 1 is thin portion, the right side front view of the anti-reversing relieving mechanism of Figure 200 after the 3rd percussion and last stroke;

Figure 20 1A is thin portion, the right side front view of the backgear of Figure 20 1, automatic retracted cam and recent side double leval jib;

Figure 20 2 makes automatic retracted cam distad slide at another percussion stroke and locks anti-reversing trip lever, thus the right side elevation view of the automatic releasing mechanism of Figure 20 1 after departing from anti-reversing relieving mechanism;

Figure 20 3 is front, left perspective view that assembly used by the nail opened, and wherein the right half part of replaceable nail bin is included in nail passage;

Figure 20 4 be the nail with the axle configuration of complete replaceable nail bin and non-joint motions of Figure 20 3 use assembly disassemble perspective view;

Figure 20 5 is that the nail of Figure 20 3 uses two cuttves of assembly and the perspective view of trigger shaft (" E type crossbeam ");

Figure 20 6 is perspective views that the wedge-shaped slides of the nail bin of assembly used by nail;

Figure 20 7 is left side elevation view that the centrage 207-207 using assembly along the nail of Figure 20 3 intercepts in longitudinal cross-section;

Figure 20 8 is perspective views that assembly used by the nail opened of Figure 20 3, does not wherein have the part of the nail passage of the intermediate pin of replaceable nail bin, contiguous two cuttves and trigger shaft, and does not follow closely the distal part of passage;

Figure 20 9 is anterior elevational views that the centrage 209-209 using assembly along the nail of Figure 20 3 intercepts in cross-section, it illustrates the inside staple drivers of nail bin and each several part of two cuttves and trigger shaft;

Figure 21 0 is the left side elevation view that the longitudinal axis 207-207 substantially using assembly along the closed nail of Figure 20 3 intercepts, to comprise two center contact point between cutter and wedge-shaped slides, but also laterally offset to illustrate nail in nail bin and staple drivers;

Figure 21 1 is thin portion, the left side front view that assembly used by the nail of Figure 21 0, and wherein two cuttves retractions are slightly many, and this is typical situation for nail bin is replaced;

Figure 21 2 is thin portion, left side front views that assembly used by the nail of Figure 21 1, and wherein two cuttves start percussion, corresponding to the configuration shown in Figure 21 0;

Figure 21 3 is left side cross-section front views that after two cuttves and trigger shaft are distad pulled the trigger, assembly used by the closed nail of Figure 21 0;

Figure 21 4 is left side cross-section front views that assembly used by the closed nail of Figure 21 3 after the percussion of nail bin and the retraction of two cuttves;

Figure 21 5 is left side cross-sectional details front views that assembly used by the nail of Figure 21 4, and wherein two cuttves are allowed to fall into latched position;

Figure 21 6 is perspective views of the nail bin according at least one embodiment of the present invention, and this nail bin comprises the rigid support part and compressible tissue thickness compensating part that use together with surgery suturing appliance;

Figure 21 7 is partial exploded view of the nail bin of Figure 21 6;

Figure 21 8 is complete exploded views of the nail bin of Figure 21 6;

Figure 21 9 is another exploded views of the nail bin of Figure 21 6, and this nail bin does not cover the wrappage of tissue thickness's compensating part;

Figure 22 0 is the warehouse of the nail bin of Figure 21 6 or the perspective view of support section;

Figure 22 1 is the top perspective of sliding part, and this sliding part can move to dispose nail from nail bin in the nail bin of Figure 21 6;

Figure 22 2 is bottom perspective view of the sliding part of Figure 22 1;

Figure 22 3 is front views of the sliding part of Figure 22 1;

Figure 22 4 is top perspective of driver, and this driver can support one or more nail and upwards be promoted to be penetrated from nail bin by nail by the sliding part of Figure 22 1;

Figure 22 5 is bottom perspective view of the driver of Figure 22 4;

Figure 22 6 is can at least in part around the wrappage of the compressible tissue thickness compensating part of nail bin;

Figure 22 7 is partial sectional views of nail bin, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, show nail during First ray never firing position move to firing position;

Figure 22 8 is front views of the nail bin of Figure 22 7;

Figure 22 9 is thin portion front views of the nail bin of Figure 22 7;

Figure 23 0 is the section end view of the nail bin of Figure 22 7;

Figure 23 1 is the bottom view of the nail bin of Figure 22 7;

Figure 23 2 is thin portion bottom views of the nail bin of Figure 22 7;

Figure 23 3 is longitudinal sectional drawings of nail bin and anvil block in the close position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, show nail during First ray never firing position move to firing position;

Figure 23 4 is the anvil block of Figure 23 3 and another profile of nail bin, it illustrates anvil block in an open position after percussion sequence completes;

Figure 23 5 is local detail drawings of the nail bin of Figure 23 3, it illustrates the nail being in non-firing position;

Figure 23 6 is cross-section front views of nail bin, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position;

Figure 23 7 is detail drawings of the nail bin of Figure 23 6;

Figure 23 8 is front views of nail bin and anvil block in an open position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position;

Figure 23 9 is front views of nail bin and anvil block in the close position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position and the tissue be trapped between anvil block and tissue thickness's compensating part;

Figure 24 0 is the anvil block of Figure 23 9 and the detail drawing of nail bin;

Figure 24 1 is the front view of nail bin and anvil block in the close position, and this nail bin comprises rigid support part and compressible tissue thickness compensating part, shows the nail being in non-firing position, shows the thicker tissue be positioned between anvil block and nail bin;

Figure 24 2 is the anvil block of Figure 24 1 and the detail drawing of nail bin;

Figure 24 3 is the anvil block of Figure 24 1 and the front view of nail bin, it illustrates the tissue with different-thickness be positioned between anvil block and nail bin;

Figure 24 4 is the anvil block of Figure 24 1 and the detail drawing of nail bin, as shown in Figure 24 3;

Figure 24 5 shows the schematic diagram to tissue thickness's compensating part that the different tissues thickness be trapped in different nail compensates;

Figure 24 6 shows tissue thickness's compensating part to the schematic diagram being applied compression pressure by one or more blood vessel of nail line crosscut;

Figure 24 7 shows the schematic diagram of the imappropriate situation about being formed of wherein one or more nails;

Figure 24 8 shows the schematic diagram of tissue thickness's compensating part that can compensate appropriately not become staple;

Figure 24 9 shows the schematic diagram of the tissue thickness's compensating part be positioned in tissue regions that wherein multiple nail line intersects;

Figure 25 0 shows the schematic diagram of the tissue be trapped in nail;

Figure 25 1 shows the schematic diagram being trapped in tissue in nail and tissue thickness's compensating part;

Figure 25 2 shows the schematic diagram of the tissue be trapped in nail;

Figure 25 3 shows the schematic diagram being trapped in thick tissue in nail and tissue thickness's compensating part;

Figure 25 4 shows the schematic diagram being trapped in thin tissue in nail and tissue thickness's compensating part;

Figure 25 5 shows the schematic diagram being trapped in the tissue with interior thickness in nail and tissue thickness's compensating part;

Figure 25 6 shows the schematic diagram being trapped in the tissue with another interior thickness in nail and tissue thickness's compensating part;

Figure 25 7 shows the schematic diagram being trapped in thick tissue in nail and tissue thickness's compensating part;

Figure 25 8 is part sectioned views of the end effector of surgery suturing appliance, it illustrates be in retraction, non-firing position trigger shaft and nail percussion sliding part;

Figure 25 9 is another part sectioned views of the end effector of Figure 25 8, it illustrates and is in trigger shaft and the nail percussion sliding part that part advances position;

Figure 26 0 is the profile of the end effector of Figure 25 8, it illustrates the trigger shaft being in propelling or firing position completely;

Figure 26 1 is the profile of the end effector of Figure 25 8, it illustrates and is being in the trigger shaft of advanced position after being pulled the trigger and is staying the nail percussion sliding part of its complete firing position;

Figure 26 2 is detail drawings being in the trigger shaft of advanced position of Figure 26 1;

Figure 26 3 is part sectioned views of the end effector of the surgery suturing appliance comprising nail bin, the nail that this nail bin comprises tissue thickness's compensating part and is positioned at least partly wherein;

Figure 26 4 is another part sectioned views of the end effector of Figure 26 3, it illustrates the nail moving at least in part relative to the anvil block being positioned in nail bin opposite and/or rotate;

Figure 26 5 is part sectioned views of the end effector of surgery suturing appliance according at least one embodiment;

Figure 26 6 is part sectioned views of the end effector according at least one embodiment selected else;

Figure 26 7 is part sectioned views of the end effector according to another embodiment selected else;

Figure 26 8 is perspective views of the end effector of surgery suturing appliance according at least one embodiment;

Figure 26 9 is part sectioned views of the end effector of the Figure 26 8 shown for being in flexing conditions;

Figure 27 0 is the part sectioned view of the end effector of the Figure 26 9 being in release conditions;

Figure 27 1 is the perspective view of the end effector comprising tissue thickness's compensating part cover;

Figure 27 2 is rear views of the tissue thickness's compensating part cover in Figure 27 1;

Figure 27 3 is the perspective views of the end effector comprising multiple guide rail, and described multiple guide rail is from support section and tissue thickness's compensating part extension with the longitudinal cavity be defined in wherein;

Figure 27 4 is perspective views of tissue thickness's compensating part of Figure 27 3;

Figure 27 5 is the perspective views comprising multiple toothed end effector, and described multiple tusk extends from support portion and the tissue thickness compensating part that engages;

Figure 27 6 is the perspective views comprising the anvil block of pit array according at least one embodiment;

Figure 27 7 is local detail drawings of the anvil block of Figure 27 6;

Figure 27 8 is partial longitudinal sectional view of the anvil block of Figure 27 6;

Figure 27 9 is transverse cross-sectional view of the anvil block of Figure 27 6;

Figure 28 0 is the front view of the percussion nail comprising B shape configuration substantially;

Figure 28 1 comprises the front view followed closely with the percussion of the one leg of outwards distortion to enterolithic one leg;

Figure 28 2 is the front views of the percussion nail comprising the two legs outwards formed;

Figure 28 3 is fragmentary, perspective views of the support section of nail bin, and this nail bin comprises detachable and/or interchangeable nail lower limb guider;

Figure 28 4 is part sectioned views of the nail bin of Figure 28 3, it illustrates the nail disposed from nail bin;

Figure 28 5 is by the detail drawing of the profile of Figure 28 4 after pulling the trigger at nail bin;

Figure 28 6 is the exploded views of the nail bin comprising tissue thickness's compensating part, and this tissue thickness's compensating part comprises the space be defined in wherein;

Figure 28 7 shows the schematic diagram against the tissue thickness's compensating part organizing implanted Figure 28 6;

Figure 28 8 shows another schematic diagram against the tissue thickness's compensating part organizing implanted Figure 28 6;

Figure 28 9 is the profile perspectives of the nail bin comprising side direction retaining member, and this side direction retaining member extends from its support section, and tissue thickness's compensating part can be remained on appropriate location by it;

Figure 29 0 is the profile of the nail bin for suture tissue of Figure 28 9;

Figure 29 1 is another profile of the nail bin of Figure 28 9, it illustrates the support section of positive motion away from the tissue thickness's compensating part implanted;

Figure 29 2 is profile perspectives of nail bin, and this nail bin comprises the side direction retaining member that tissue thickness's compensating part can be remained to support section;

Figure 29 3 is profiles of the nail bin for suture tissue of Figure 29 2;

Figure 29 4 is another profiles of the nail bin of Figure 29 2, it illustrates the support section of positive motion away from the tissue thickness's compensating part implanted;

Figure 29 5 is cross-sectional details figure tissue thickness's compensating part being remained to the keeper of the support section of nail bin according at least one embodiment;

Figure 29 6 is the part sectioned views comprising the nail bin of the staple drivers with differing heights according at least one embodiment;

Figure 29 6A show Figure 29 6 staple drivers and support thereon there is different schematic diagram of not pulling the trigger the nail of height;

Figure 29 7 shows the tissue thickness's compensating part comprising variable thickness, the staple drivers with differing heights and has the schematic diagram of nail of different unshaped height;

Figure 29 8 shows the nail of the Figure 29 7 being implanted to tissue and the schematic diagram of tissue thickness's compensating part;

Figure 29 9 is the part sectioned views comprising the nail bin of tissue thickness's compensating part with different-thickness according at least one embodiment;

Figure 30 0 is the profile of the end effector being in the surgery suturing appliance opening configuration;

Figure 30 1 is the profile of the end effector that the Figure 30 0 being in part percussion configuration is shown;

Figure 30 2 is profiles that the end effector being in the Figure 30 0 again opening configuration is shown;

Figure 30 3 is profiles of the end effector of surgery suturing appliance according at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and wavy platform surface;

Figure 30 4 is profiles of the end effector of surgery suturing appliance according at least one embodiment, and this surgery suturing appliance comprises the staple drivers with differing heights and staged platform surface;

Figure 30 5 is the perspective views using nail bin application device to be loaded into the nail bin in the executor of surgery suturing appliance;

Figure 30 6 is bottom perspective view of the nail bin application device of Figure 30 5;

Figure 30 7 is side views of the nail bin application device of the Figure 30 5 being assembled to nail bin;

Figure 30 8 is profiles of the assembly of Figure 30 7;

Figure 30 9 is perspective views of the nail bin application device assembly according at least one embodiment, and thickness compensation part is organized on the top that this nail bin application device assembly also comprises on the top surface being positioned at nail bin application device;

Figure 31 0 is the exploded view that thickness compensation part and nail bin application device are organized in the top of Figure 30 9;

Figure 31 0A is the exploded view of the nail bin application device assembly comprising tractive component, and this tractive component can make the top being attached to nail bin application device organize thickness compensation part to be separated;

Figure 31 1 is the partial exploded view of the nail bin application device assembly according at least one embodiment selected else;

Figure 31 2 is perspective views of nail bin application device assembly, this nail bin application device assembly comprises top and organizes thickness compensation part and nail bin, multiple maintenance feature structure that this top organizes thickness compensation part to comprise to extend from it and this nail bin comprises bottom organizes thickness compensation part;

Figure 31 3 is the nail bin application device assembly of the Figure 31 2 be positioned in nail bin passage and the front view being closed to the anvil block on nail bin application device assembly;

Figure 31 4 is the anvil block of the Figure 31 3 being in again open position and the front view of the nail bin application device of Figure 31 2 that just removing from end effector;

Figure 31 4A is that the top being positioned at Figure 31 2 organizes thickness compensation part and bottom to organize the profile of the tissue in the middle of thickness compensation part;

Figure 31 4B shows and is sewn onto tissue and the top of cut cutting of members organizes thickness compensation part and bottom to organize the profile of thickness compensation part;

Figure 31 5 illustrates the schematic diagram be inserted into by tissue thickness's compensating part according at least one embodiment in anvil block;

Figure 31 6 is profiles of tissue thickness's compensating part of Figure 31 5;

Figure 31 7 is according at least one the tissue thickness's compensating part of embodiment selected else and the exploded view of anvil block;

Figure 31 8 is perspective views of the nail bin application device assembly according at least one embodiment, and this nail bin application device assembly comprises the top that can be attached to anvil block and organizes thickness compensation part;

Figure 31 9 is front views of the nail bin application device assembly of Figure 31 8, and this nail bin application device assembly is positioned in nail bin passage and just towards in the anvil block of top tissue thickness compensating part motion;

Figure 32 0 shows and organizes after thickness compensation part engaged with anvil block on top, from the nail bin application device of Figure 31 8 that end effector is removed;

Figure 32 1 is the section end view of the anvil block organizing thickness compensation part to move towards the top of Figure 31 8;

Figure 32 2 is the section end views of the anvil block organizing thickness compensation part to engage with top;

Figure 32 3 is profiles of the end effector of the surgery suturing appliance comprising nail bin, and this nail bin comprises by the tissue thickness compensating part of multiple fastener attachment to the sectional of the support section of nail bin;

Figure 32 4 is profiles of the end effector of Figure 32 3, it illustrates the firing member being in part firing position;

Figure 32 5 is profiles of the end effector of Figure 32 3, it illustrates the support section of tissue thickness's compensating part that positive motion is implanted away from part;

Figure 32 6 is fragmentary, perspective views of the support section of Figure 32 3;

Figure 32 7 is the perspective views disposing sliding part according to the nail of at least one embodiment;

Figure 32 8 is front views of the sliding part of Figure 32 7;

Figure 32 9 is perspective views of the end effector of the surgery suturing appliance comprising nail bin, and this nail bin comprises tissue thickness's compensating part and is positioned at the multiple nail guiders on tissue thickness's compensating part;

Figure 33 0 is in tissue thickness's compensating part of the Figure 32 9 not pulling the trigger configuration and the part sectioned view of nail guider;

Figure 33 1 is tissue thickness's compensating part of the Figure 32 9 being in percussion configuration and the part sectioned view of nail guider;

Figure 33 2 is the profiles comprising the nail bin of tissue thickness's compensating part and support section according at least one embodiment;

Figure 33 3 is tissue thickness's compensating parts, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 4 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 5 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 6 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 7 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 8 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 33 9 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 34 0 is the detail drawing in the region on the top of nail around Figure 33 9;

Figure 34 1 is tissue thickness's compensating part of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 34 2 is the detail drawings in the region on the top of nail around Figure 34 1;

Figure 34 3 is the tissue thickness's compensating parts of embodiment according at least one alternative, nail guide layer and be in the part sectioned view of nail of non-firing position;

Figure 34 4 is according to the nail guide layer of the embodiment of at least one alternative and the perspective view of multiple nails being in non-firing position;

Figure 34 5 is the end-views of tissue thickness's compensating part that can use together with circular surgical staplers;

Figure 34 6 is tissue thickness's compensating part of Figure 34 5 and the perspective view of circular surgical staplers;

Figure 34 7 is end-views of the tissue thickness's compensating part that can use together with circular surgical staplers according at least one embodiment selected else;

Figure 34 8 is tissue thickness's compensating part of Figure 34 7 and the perspective view of circular surgical staplers;

Figure 34 9 is the end-views of tissue thickness's compensating part that can use together with circular surgical staplers;

Figure 35 0 is the end-view of tissue thickness's compensating part of the Figure 34 9 being in part expanded configuration;

Figure 35 1 is the front view comprising the surgery suturing appliance of nail bin according at least one embodiment;

Figure 35 2 is end-views of the surgery suturing appliance of Figure 35 1 relative to tissue positioned;

Figure 35 3 is end-views of the surgery suturing appliance of Figure 35 1, and this surgery suturing appliance also comprises the tissue thickness's compensating part be positioned between nail bin and tissue;

Figure 35 4 is fragmentary, perspective views that the surgery suturing appliance of the Figure 35 1 never with tissue thickness's compensating part is deployed to the nail in tissue;

Figure 35 5 is the fragmentary, perspective views being deployed to the nail tissue from the surgery suturing appliance of the Figure 35 1 with tissue thickness's compensating part;

Figure 35 6 is part sectioned views of the end effector of the surgery suturing appliance of Figure 35 1, comprises the anvil block plate being in primary importance;

Figure 35 7 is part sectioned views of the end effector of the surgery suturing appliance of Figure 35 1, it illustrates the anvil block plate of the Figure 35 6 being in the second position;

Figure 35 8 is profiles of the end effector of the surgery suturing appliance comprising nail bin, and this nail bin comprises gap setting member;

Figure 35 9 is perspective views that firing member is shown, the gap setting member of this firing member cutting drawing 358 at the end of the percussion stroke of firing member;

Figure 36 0 is the profile of the end effector of the surgery suturing appliance comprising nail bin, and this nail bin comprises flexible nose;

Figure 36 1 is the profile of the end effector of Figure 36 0, it illustrates the nose being in flexure configuration;

Figure 36 2 is profiles of the end effector of the surgery suturing appliance comprising nail bin, and this nail bin comprises slidably part;

Figure 36 3 is profiles of the end effector of Figure 36 2, it illustrates the slidably part of distad sliding;

Figure 36 4 is profiles of the end effector of the surgery suturing appliance comprising support section and tissue thickness's compensating part, and this support section comprises the platform surface of inclination and this tissue thickness's compensating part comprises different-thickness;

Figure 36 5 is profiles of the end effector of the surgery suturing appliance comprising support section and tissue thickness's compensating part, and this support section comprises the platform surface of inclination and this tissue thickness's compensating part comprises homogeneous thickness;

Figure 36 6 is the perspective views of the nail bin comprising tissue thickness's compensating part with different-thickness;

Figure 36 7 is end-views of the nail bin of Figure 36 6;

Figure 36 8 is the profile perspectives of the tissue thickness's compensating part comprising longitudinal layer;

Figure 36 9 is profile perspectives comprising tissue thickness's compensating part of multiple layers of the embodiment according at least one alternative;

Figure 37 0 is the perspective view of disposable loading unit, and this disposable loading unit comprises the retaining member that tissue thickness's compensating part can be remained to releasedly on it;

Figure 37 1 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that this tissue thickness's compensating part can be remained to releasedly disposable loading unit;

Figure 37 2 is perspective views of tissue thickness's compensating part of the Figure 37 1 being attached to disposable loading unit;

Figure 37 3 is end-views of the disposable loading unit of Figure 37 2;

Figure 37 4 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that tissue thickness's compensating part can be remained to releasedly disposable loading unit;

Figure 37 5 is perspective views of tissue thickness's compensating part of the Figure 37 4 being attached to disposable loading unit;

Figure 37 6 is end-views of the disposable loading unit of Figure 37 5;

Figure 37 7 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises the retaining member that tissue thickness's compensating part can be remained to releasedly disposable loading unit;

Figure 37 8 is perspective views of tissue thickness's compensating part of the Figure 37 7 being attached to disposable loading unit;

Figure 37 9 is the perspective views of the tissue thickness's compensating part application device be positioned in the executor of disposable loading unit;

Figure 38 0 is the top perspective of tissue thickness's compensating part application device of Figure 37 9;

Figure 38 1 is the bottom perspective view of tissue thickness's compensating part application device of Figure 37 9;

Figure 38 2 is the perspective views being positioned in the tissue thickness's compensating part application device in the executor of disposable loading unit according to the embodiment of at least one alternative;

Figure 38 3 is top perspective of tissue thickness's compensating part application device of Figure 38 2;

Figure 38 4 is bottom perspective view of tissue thickness's compensating part application device of Figure 38 2;

Figure 38 5 is front views of disposable loading unit, this disposable loading unit comprise can support nail bin can pivotable jaw;

Figure 38 6 is profiles of the nail bin according at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section being attached to nail bin;

Figure 38 7 is profiles of the nail bin according at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section being attached to nail bin;

Figure 38 8 is profiles of the nail bin according at least one embodiment, and this nail bin comprises tissue thickness's compensating part of the support section being attached to nail bin;

Figure 38 9 is perspective views of tissue thickness's compensating part of Figure 38 7;

Figure 39 0 is the perspective view according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 39 1 is the detail drawing of the non-woven material of tissue thickness's compensating part of Figure 39 0;

Figure 39 2 illustrates the front view of tissue thickness's compensating part against organizing implanted and Figure 39 0 from end effector release;

Figure 39 3 is detail drawings of the non-woven material of tissue thickness's compensating part according at least one embodiment;

Figure 39 4 be according at least one embodiment show randomly-oriented crimped fibre bunch schematic diagram;

Figure 39 5 be according at least one embodiment show randomly-oriented crimped fibre bunch schematic diagram;

Figure 39 6 is the schematic diagrams of the structure showing crimped fibre according at least one embodiment;

Figure 39 7 is the schematic diagrams of the structure showing crimped fibre according at least one embodiment;

Figure 39 8 is the schematic diagrams of the structure showing crimped fibre according at least one embodiment;

Figure 39 9 is the section plans according to the coiling fiber in tissue thickness's compensating part of at least one embodiment;

Figure 39 9A is the section plan of the coiling fiber of Figure 39 9;

Figure 39 9B is the cross-sectional details figure of tissue thickness's compensating part of Figure 39 9;

Figure 40 0 is the perspective view according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 40 1 is the schematic diagram of the distortion of tissue thickness's compensating part that Figure 40 0 is shown;

Figure 40 2 weaves sutural schematic diagram according at least one embodiment for tissue thickness's compensating part, it illustrates to be in load to weave stitching thread in configuration;

Figure 40 3 be Figure 40 2 weave sutural schematic diagram, it illustrates be in release configuration weave stitching thread;

Figure 40 4 is the plane graphs weaving sutural tissue thickness compensating part in the end effector of surgical instruments with Figure 40 2;

Figure 40 5 is according to the perspective view of the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 40 6 is partial plan layout of tissue thickness's compensating part of Figure 40 5;

Figure 40 7 is exploded views of the end effector of Figure 39 0 and the fastener cartridge assembly of tissue thickness's compensating part;

Figure 40 8 is part sectioned views of the fastener cartridge assembly of Figure 40 7, it illustrates the securing member of not pulling the trigger, partly pulling the trigger and pulling the trigger;

Figure 40 9 is front views of the fastener cartridge assembly of Figure 40 7, it illustrates driver percussion securing member and enters into tissue thickness's compensating part from the nail chamber of fastener cartridge assembly;

Figure 41 0 is the detail drawing of the fastener cartridge assembly of Figure 40 9;

Figure 41 1 is tissue thickness's compensating part of Figure 39 0 and the front view of tissue that is captured in percussion securing member;

Figure 41 2 is tissue thickness's compensating part of Figure 39 0 and the front view of tissue that is captured in percussion securing member;

Figure 41 3 is the perspective views according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 41 4 is schematic diagrams of the distortion of the deformable tube of tissue thickness's compensating part that Figure 41 3 is shown;

Figure 41 5 is detail drawings of the deformable tube of tissue thickness's compensating part of Figure 41 3;

Figure 41 6 is the schematic diagrams of the distortion that the deformable tube of tissue thickness's compensating part is shown according at least one embodiment;

Figure 41 7 is front views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part comprises the tube element implanted against tissue;

Figure 41 8 is front views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part comprises the multiple tube elements implanted against tissue;

Figure 41 9 is the fragmentary, perspective views comprising the deformable tube of tubulose dot matrix according at least one embodiment;

Figure 42 0 is the front view of the tubulose strand of the deformable tube of Figure 41 9.

Figure 42 1 is the front view of the deformable tube of Figure 41 9;

Figure 42 2 is front views of many tubulose strands of the deformable tube for Figure 41 9 according to various embodiment;

Figure 42 3 is the front views against the tubulose dot matrix organizing the Figure 41 9 implanted;

Figure 42 4 is fragmentary, perspective views of the deformable tube according at least one embodiment;

Figure 42 5 is fragmentary, perspective views of the deformable tube according at least one embodiment;

Figure 42 6 is fragmentary, perspective views of the deformable tube according at least one embodiment;

Figure 42 7 is front views of the deformable tube of Figure 42 6;

Figure 42 8 is fragmentary, perspective views of the deformable tube according at least one embodiment;

Figure 42 9 is fragmentary, perspective views of the deformable tube according at least one embodiment;

Figure 43 0 is the fragmentary, perspective view of the deformable tube according at least one embodiment;

Figure 43 1 is the perspective view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 43 2 is front views of the tube element of tissue thickness's compensating part of Figure 43 1;

Figure 43 3 is tissue thickness's compensating part of Figure 43 1 and the orthogonal view of end effector, it illustrates the end effector being in non-clamping configuration;

Figure 43 4 is tissue thickness's compensating part of Figure 43 1 and the orthogonal view of end effector, it illustrates the end effector being in clamping and percussion configuration;

Figure 43 5 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 43 6 is tissue thickness's compensating part of Figure 43 5 and the orthogonal view of end effector, it illustrates the end effector being in clamping and percussion configuration;

Figure 43 7 is the orthogonal view according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 43 8 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 43 9 is tissue thickness's compensating part of Figure 43 8 and the orthogonal view of end effector, it illustrates the end effector being in clamping and percussion configuration;

Figure 44 0 is the perspective view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 1 is the orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 2 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 3 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 4 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 5 is partial plan layout of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 6 is partial plan layout of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 44 7 is tissue thickness's compensating part of Figure 44 5 and the local orthogonal view of end effector, it illustrates the end effector being in non-clamping configuration;

Figure 44 8 is tissue thickness's compensating part of Figure 44 5 and the local orthogonal view of end effector, it illustrates the end effector being in clamping configuration;

Figure 44 9 is the perspective views according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 45 0 is tissue thickness's compensating part of Figure 44 9 and the front view of end effector;

Figure 45 1 is tissue thickness's compensating part of Figure 44 9 and the perspective view of end effector, it illustrates the anvil block of the end effector towards clamping configuration motion;

Figure 45 2 is tissue thickness's compensating part of Figure 44 9 and the front view of end effector, it illustrates the end effector being in clamping configuration;

Figure 45 3 is orthogonal view of the tube element of tissue thickness's compensating part of the Figure 44 9 being in non-deformed configuration;

Figure 45 4 is orthogonal view of the tube element of tissue thickness's compensating part of the Figure 44 9 being in deformed configuration;

Figure 45 5 is the perspective views according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 45 6 is tissue thickness's compensating part of Figure 45 5 and the orthogonal view of end effector, it illustrates the end effector being in clamping configuration;

Figure 45 7 is tissue thickness's compensating part of Figure 45 5 and the orthogonal view of end effector, it illustrates the end effector being in percussion and the non-clamping configuration of part;

Figure 45 8 is perspective views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 45 9 is orthogonal view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is fixed to the anvil block of the end effector of surgical instruments;

Figure 46 0 is tissue thickness's compensating part of Figure 45 9 and the orthogonal view of end effector, it illustrates the end effector being in clamping configuration;

Figure 46 1 is tissue thickness's compensating part of Figure 45 9 and the orthogonal view of end effector, it illustrates the end effector being in percussion and the non-clamping configuration of part;

Figure 46 2 is tissue thickness's compensating part of Figure 46 1 and the detail drawing of end effector;

Figure 46 3 is the orthogonal view being clamped in the tissue thickness's compensating part in the end effector of surgical instruments according at least one embodiment, it illustrates and disposes nail by nail percussion sliding part;

Figure 46 4 is tissue thickness's compensating part of Figure 46 3 and the orthogonal view of end effector, it illustrates the end effector being in clamping configuration;

Figure 46 5 is tissue thickness's compensating part of Figure 46 3 and the orthogonal view of end effector, it illustrates the end effector being in percussion configuration;

Figure 46 6 is the perspective views according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 46 7 is perspective views of the tube element of tissue thickness's compensating part of Figure 46 6;

Figure 46 8 is perspective views of the tube element of Figure 46 7 cut-off between the first end and the second end;

Figure 46 9 is perspective views of tissue thickness's compensating part of Figure 46 6, it illustrates and cuts off the cutting element of tissue thickness's compensating part and the nail of joining tissue thickness compensation part;

Figure 47 0 is the perspective view can making the framework of tissue thickness's compensating part of Figure 46 6 according at least one embodiment;

Figure 47 1 is the orthogonal view of the framework of Figure 47 0, it illustrates tissue thickness's compensating part of the Figure 46 6 solidified in the frame;

Figure 47 2 removes from the framework of Figure 47 1 and is produced the orthogonal view for the tissue thickness's compensating part being undertaken pruning by least one cutting device;

Figure 47 3 is orthogonal view of tissue thickness's compensating part of Figure 47 2 after at least one cutting device is pruned tissue thickness's compensating part;

Figure 47 4 is the orthogonal view of the tissue thickness's compensating part formed in the framework of Figure 47 1, it illustrates the cut off pipe with various cross-sectional geometries;

Figure 47 5 is the perspective views according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 47 6 is detail drawings of tissue thickness's compensating part of Figure 47 5 according at least one embodiment;

Figure 47 7 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment;

Figure 47 8 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment;

Figure 47 9A is tissue thickness's compensating part of Figure 47 5 and the orthogonal view of end effector, it illustrates the end effector being in non-clamping configuration;

Figure 47 9B is tissue thickness's compensating part of Figure 47 5 and the orthogonal view of end effector, it illustrates the end effector being in clamping configuration;

Figure 47 9C is tissue thickness's compensating part of Figure 47 5 and the orthogonal view of end effector, it illustrates the end effector being in clamping and percussion configuration;

Figure 47 9D is the orthogonal view of tissue thickness's compensating part of the Figure 47 5 be captured in percussion nail;

Figure 47 9E is the orthogonal view of tissue thickness's compensating part of the Figure 47 5 be captured in percussion nail, it illustrates further expanding of tissue thickness's compensating part;

Figure 48 0 is the perspective section view according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 48 1 is the partial elevation view of tissue thickness's compensating part of the Figure 48 0 be captured in percussion nail;

Figure 48 2 is front views of the deformable tube of tissue thickness's compensating part of Figure 48 0;

Figure 48 3 is front views of the deformable tube according at least one embodiment;

Figure 48 4 is perspective section view of tissue thickness's compensating part of Figure 48 0;

Figure 48 5 is the perspective section view according to the tissue thickness's compensating part in the end effector of the surgical instruments of at least one embodiment;

Figure 48 6 is perspective views of the tissue thickness's compensating part according at least one embodiment;

Figure 48 7 is local orthogonal view of tissue thickness's compensating part of Figure 48 6, it illustrates and the securing member organized and engage with tissue thickness compensating part;

Figure 48 8 is perspective section view of the tissue thickness's compensating part according at least one embodiment;

Figure 48 9 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 0 is the front view of the tissue thickness's compensating part according at least one embodiment;

Figure 49 1 is the front view of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the rounded ends executor of surgical instruments;

Figure 49 2 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 3 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 4 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 5 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 6 is front views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 7 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment;

Figure 49 8 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is positioned in the end effector of surgical instruments;

Figure 49 9 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part has the securing member be positioned in its hole;

Figure 50 0 is the fragmentary, perspective view of tissue thickness's compensating part of Figure 49 8, it illustrates the tissue thickness's compensating part being in non-deformed configuration;

Figure 50 1 is the fragmentary, perspective view of tissue thickness's compensating part of Figure 49 8, it illustrates the tissue thickness's compensating part being in portion deforms configuration;

Figure 50 2 is fragmentary, perspective views of tissue thickness's compensating part of Figure 49 8, it illustrates the tissue thickness's compensating part being in deformed configuration;

Figure 50 3 is perspective views of the tissue thickness's compensating part according at least one embodiment;

Figure 50 4 is the perspective views comprising the end effector of the suture instruments of anvil block and nail bin according at least one embodiment;

Figure 50 5 is profiles of the end effector of Figure 50 4, it illustrates the nail being in non-cock be positioned in nail bin and the tissue thickness's compensating part comprising the sealed container being in the state of not piercing through, wherein for illustrative purposes, container is illustrated as its part and is removed;

Figure 50 6 is profiles of the end effector of Figure 50 4, it illustrates the nail of the Figure 50 5 being at least part of cock and is in the container piercing through state at least partly;

Figure 50 7 is perspective views of the end effector of suture instruments according at least one embodiment, and this suture instruments comprises anvil block and nail bin;

Figure 50 8 is profiles of the end effector of Figure 50 7, it illustrates the nail being in non-cock and the sealed container being in the state of not piercing through be positioned in tissue thickness's compensating part of nail bin that are positioned in nail bin, wherein for illustrative purposes, container is illustrated as its part and is removed;

Figure 50 9 is profiles of the end effector of Figure 50 7, it illustrates to be in the container piercing through state at least partly in the nail of the Figure 50 8 being at least part of cock and nail bin;

Figure 51 0 is the perspective view of end effector of the suture instruments of embodiment according at least one alternative, and this suture instruments comprises anvil block and is attached to the sealed container of anvil block, and wherein for illustrative purposes, container is illustrated as its part and is removed;

Figure 51 1 is the profile of the end effector of Figure 51 0, it illustrates at least in part from the nail of nail bin percussion and be attached to anvil block be in the container piercing through state at least partly;

Figure 51 2 is profiles of the container of the anvil block being attached to Figure 51 0, and this anvil block illustrates with extended mode;

Figure 51 3 is detail drawings of the container of the anvil block being attached to Figure 51 2, and this anvil block illustrates with extended mode;

Figure 51 4 shows the container extended on the direction transverse to nail line;

Figure 51 5 shows the multiple containers extended on the direction transverse to nail line;

Figure 51 6 is profiles of the nail bin according to various embodiment;

Figure 51 7 is the part sectioned views of the Figure 51 6 be under implantation condition;

Figure 51 8A is the fragmentary, perspective view of tissue thickness's compensating part before expansion;

Figure 51 8B is the fragmentary, perspective view of tissue thickness's compensating part between Growth period of Figure 51 8;

Figure 51 9 is the fragmentary, perspective views comprising tissue thickness's compensating part of the swollen compositions of fluid-soluble according to various embodiment;

Figure 52 0 is the profile being oriented to the tissue adjacent with tissue thickness compensating part according to various embodiment;

Figure 52 1 is by the part sectioned view of the Figure 52 0 after pulling the trigger at nail bin;

Figure 52 2 illustrates the schematic diagram with tissue thickness's compensating part of the Figure 52 0 organizing adjacent implantation;

Figure 52 3 is fragmentary, perspective views of the tissue thickness's compensating part according to various embodiment;

Figure 52 4 is perspective views of the jaw of tissue thickness's compensating part that can receive Figure 52 3;

Figure 52 5 is part sectioned views of nail bin, it illustrates the nail disposed from nail bin;

Figure 52 6 is that the top be positioned in the executor of disposable loading unit organizes thickness compensation part and bottom to organize the perspective view of thickness compensation part;

Figure 52 7A is the profile organizing thickness compensation part according to the bottom of Figure 52 6 manufactured in a mold of various embodiment;

Figure 52 7B is the profile of the three-layer weave thickness compensation part manufactured in a mold according to various embodiment;

Figure 52 8 is profiles of the anvil block according to various embodiment, and this anvil block comprises the tissue thickness's compensating part comprising reinforcing material;

Figure 52 9 is profiles of the tissue according to various embodiment, and this tissue positioned organizes thickness compensation part and bottom to organize in the middle of thickness compensation part on top;

Figure 53 0 is the profile of Figure 52 9, it illustrates the nail disposed from nail bin;

Figure 53 1 is by the profile of Figure 52 9 after pulling the trigger at nail bin;

Figure 53 2A shows the pin according to various embodiment, and this pin can deliver a fluid to the tissue thickness's compensating part being attached to nail bin;

Figure 53 2B is the profile of the nail bin comprising tissue thickness's compensating part, and this tissue thickness's compensating part can receive the pin of Figure 53 2A;

Figure 53 3 shows the method manufacturing tissue thickness's compensating part according to various embodiment;

Figure 53 4 is the schematic diagram and the method that form the thickness compensation part of expansion according to various embodiment;

Figure 53 5 shows the micelle comprising hydrogel precursor; And

Figure 53 6 is schematic diagrams of the surgical instruments according to various embodiment, and this surgical instruments comprises tissue thickness's compensating part and can be delivered to the fluid of tissue thickness's compensating part;

Figure 53 7 is fragmentary, perspective views of the tissue thickness's compensating part according at least one embodiment, and this tissue thickness's compensating part is fixed to the anvil block of the end effector of surgical instruments.

Figure 53 8 is perspective views of the tube element of tissue thickness's compensating part of Figure 53 7.

Figure 53 9 is perspective views of the tube element of Figure 53 8, it illustrates the tube element being cut into two halves and the fluid contacting hydroaropic substance in every half.

Figure 54 0 is the perspective view of the half of the tube element cut off of Figure 53 9, it illustrates the expansion cutting off tube element.

Run through this some view, the parts that corresponding reference marks instruction is corresponding.The example illustrated herein shows some embodiment of the present invention in one form, and this type of example should be interpreted as and limit the scope of the invention by any way.

Detailed description of the invention

The applicant of the application also has following U.S. Patent application, and these patent applications are incorporated to herein by reference separately in full:

Name is called the U.S. Patent application 12/894,311 (attorney END6734USNP/100058) of " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS ";

Name is called the U.S. Patent application 12/894,340 (attorney END6735USNP/100059) of " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS ";

Name is called the U.S. Patent application 12/894,327 (attorney END6736USNP/100060) of " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS ";

Name is called the U.S. Patent application 12/894,351 (attorney END6839USNP/100524) of " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS ";

Name is called the U.S. Patent application 12/894,338 (attorney END6840USNP/100525) of " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT ";

Name is called the U.S. Patent application 12/894,369 (attorney END6841USNP/100526) of " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER ";

Name is called the U.S. Patent application 12/894,312 (attorney END6842USNP/100527) of " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS ";

Name is called the U.S. Patent application 12/894,377 (attorney END6843USNP/100528) of " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE ";

Name is called the U.S. Patent application 12/894,339 (attorney END6847USNP/100532) of " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT ";

Name is called the U.S. Patent application 12/894,360 (attorney END6848USNP/100533) of " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM ";

Name is called the U.S. Patent application 12/894,322 (attorney END6849USNP/100534) of " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS ";

Name is called the U.S. Patent application 12/894,350 (attorney END6855USNP/100540) of " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT ";

Name is called the U.S. Patent application 12/894,383 (attorney END6856USNP/100541) of " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS ";

Name is called the U.S. Patent application 12/894,389 (attorney END6857USNP/100542) of " COMPRESSIBLE FASTENER CARTRIDGE ";

Name is called the U.S. Patent application 12/894,345 (attorney END6858USNP/100543) of " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT ";

Name is called the U.S. Patent application 12/894,306 (attorney END6859USNP/100544) of " COLLAPSIBLE FASTENER CARTRIDGE ";

Name is called the U.S. Patent application 12/894,318 (attorney END6860USNP/100546) of " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS ";

Name is called the U.S. Patent application 12/894,330 (attorney END6861USNP/100547) of " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX ";

Name is called the U.S. Patent application 12/894,361 (attorney END6862USNP/100548) of " FASTENER SYSTEM COMPRISING A RETENTION MATRIX ";

Name is called the U.S. Patent application 12/894,367 (attorney END6863USNP/100549) of " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX ";

Name is called the U.S. Patent application 12/894,388 (attorney END6864USNP/100550) of " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER ";

Name is called the U.S. Patent application 12/894,376 (attorney END6865USNP/100551) of " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES ";

Name is called the U.S. Patent application 13/097,865 (attorney END6735USCIP1/100059CIP1) of " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS ";

Name is called the U.S. Patent application 13/097,936 (attorney END6736USCIP1/100060CIP1) of " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER ";

Name is called the U.S. Patent application 13/097,954 (attorney END6840USCIP1/100525CIP1) of " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION ";

Name is called the U.S. Patent application 13/097,856 (attorney END6841USCIP1/100526CIP1) of " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF ";

Name is called the U.S. Patent application 13/097,928 (attorney END6842USCIP1/100527CIP1) of " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS ";

Name is called the U.S. Patent application 13/097,891 (attorney END6843USCIP1/100528CIP1) of " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL ";

Name is called the U.S. Patent application 13/097,948 (attorney END6847USCIP1/100532CIP1) of " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION ";

Name is called the U.S. Patent application 13/097,907 (attorney END6848USCIP1/100533CIP1) of " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY ";

Name is called the U.S. Patent application 13/097,861 (attorney END6849USCIP1/100534CIP1) of " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES ";

Name is called the U.S. Patent application 13/097,869 (attorney END6855USCIP1/100540CIP1) of " STAPLE CARTRIDGE LOADING ASSEMBLY ";

Name is called the U.S. Patent application 13/097,917 (attorney END6856USCIP1/100541CIP1) of " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS ";

Name is called the U.S. Patent application 13/097,873 (attorney END6857USCIP1/100542CIP1) of " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION ";

Name is called the U.S. Patent application 13/097,938 (attorney END6858USCIP1/100543CIP1) of " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS ";

Name is called the U.S. Patent application 13/097,924 (attorney END6859USCIP1/100544CIP1) of " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR ";

Name is called the U.S. Patent application 13/242,029 (attorney END6841USCIP2/100526CIP2) of " SURGICAL STAPLER WITH FLOATING ANVIL ";

Name is called the U.S. Patent application 13/242,066 (attorney END6841USCIP3/100526CIP3) of " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT ";

Name is called the U.S. Patent application 13/242,086 (attorney END7020USNP/110374) of " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ";

Name is called the U.S. Patent application 13/241,912 (attorney END7019USNP/110375) of " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT ";

Name is called the U.S. Patent application 13/241,922 (attorney END7013USNP/110377) of " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS ";

Name is called the U.S. Patent application 13/241,637 (attorney END6888USNP3/110378) of " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS "; And

Name is called the U.S. Patent application 13/241,629 (attorney END6888USNP2/110379) of " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR ".

The applicant of the application also has following U.S. Patent application, and these patent applications and the application submit on the same day, and each with way of reference separately entirety be incorporated to herein:

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6864USCIP1/100550CIP1);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6864USCIP2/100550CIP2);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP3/100528CIP3);

Name be called the U.S. Patent application of " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP4/100528CIP4);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP5/100528CIP5);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP6/100528CIP6);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP7/100528CIP7);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP8/100528CIP8);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP9/100528CIP9);

Name be called the U.S. Patent application of " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP10/100528CP10);

Name is called the U.S. Patent application No._______________ (attorney END6843USCIP11/100528CP11) of " TISSUE THICKNESS COMPENSATORS ";

Name be called the U.S. Patent application of " LAYERED TISSUE THICKNESS COMPENSATOR " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP12/100528CP12);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP13/100528CP13);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7100USNP/110601);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7101USNP/110602);

Name be called the U.S. Patent application of " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7107USNP/110603);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7102USNP/110604);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7103USNP/110605);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7104USNP/110606);

Name be called the U.S. Patent application of " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7105USNP/110607); And

Name be called the U.S. Patent application of " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7106USNP/110608).

To describe some exemplary embodiment now, to provide structural principle to apparatus and method disclosed herein, function, the entirety of manufacture and purposes understands.One or more examples of these embodiments are shown in the drawings.Those of ordinary skill in the art should be appreciated that herein specifically describe and the apparatus and method be illustrated in accompanying drawing are unrestriced exemplary embodiment.Carry out the feature of graphic extension or description in conjunction with an exemplary embodiment, can combine with the feature of other embodiments.This type of amendment and modification comprise within the scope of the invention.

Can adopt disclosed herein or claimed for the manufacture of, any one in the method for formation or in other words article of manufacture or product manufactures, form or in other words produce all or part of of the goods considered or product, and manufacture in these class methods of employing, formed or change sentence when changing the part of goods or the product saying that production is considered, can the remainder of article of manufacture or product by any way, comprise by adopt disclosed herein and claimed for the manufacture of, formed or in other words article of manufacture or product additive method in any one, and can be combined in any way the various piece of so producing.Similarly, disclosed herein or claimed any goods or product all can individualisms, or are combined with so disclosed any other goods compatible with it or product and exist or exist as its integral part.Therefore, can by conjunction with shown in a kind of goods, product or method or described special characteristic, structure or characteristic unrestrictedly combine with the feature of all or part of mode and one or more other biocompatible article, product or methods or characteristic.This type of amendment and modification comprise within the scope of the invention.

With reference to certain figures or in other words when specific embodiment of the present invention disclosed herein or some goods, product or method can comprise some structure, characteristic or feature, reader should be appreciated that this represents that those structures, characteristic or feature can be embodied in considered goods, product or method by any compatible combination.Specifically, this type of disclosure of multiple optional structure, characteristic or feature should be understood in addition openly all that structure, characteristic or feature in combination, but as structure, characteristic or the feature disclosed in the form selected else each other situation except.When this class formation, characteristic or feature as disclosed in the form selected else each other, this should be understood to by those select else form be disclosed as replacement each other.

Term used herein " nearside " and " distally " are for the clinician of the handle portions of manipulation of surgical apparatus.Term " nearside " refers to the part near clinician, and term " distally " refers to the part away from clinician.It is also understood that for succinct and clear for the purpose of, the spatial terminology of " vertically ", " level ", "up" and "down" and so on can be used such as herein by reference to the accompanying drawings.But surgical instruments uses with many orientations and position, and these terms not intended to be is limited property processed and/or absolute.

Provide various exemplary means and method to perform abdominal cavity mirror and micro-wound surgical operation operation.But reader is by easy to understand, and various method and apparatus disclosed herein can be used for many surgical procedures and application, comprises and operates with open surgery the application combined.Continue to consult this detailed description of the invention, reader will be further understood that, various apparatus disclosed herein can be inserted in body by any way, such as by natural hole, by being formed at the otch or puncturing hole etc. in tissue.The working portion of apparatus or end effector part can be inserted directly in patient body or insert by the access to plant with service aisle, and the end effector of surgical instruments and slender axles advance by described service aisle.

Forward accompanying drawing to, wherein in multiple view, the assembly that similar numeral is similar, Fig. 1 shows the surgical instruments 10 can putting into practice some unique benefit.Surgery suturing appliance 10 is designed to handle and/or activate operationally be attached to its various forms and the end effector 12 of size.In Fig. 1-Fig. 1 E, such as end effector 12 comprises elongated passageway 14, and this elongated passageway forms the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 and can support the anvil block 20 of the upper jaw 15 as end effector 12 with moving.

Elongated passageway 14 can be made up of such as 300 and 400 serial 17-4 and 17-7 rustless steels, titanium etc., and can be formed with spaced-apart sidewalls 16.Anvil block 20 can be made up of such as 300 and 400 serial 17-4 and 17-7 rustless steels, titanium etc., and can have nail shaped lower face, and described nail shaped lower face is totally denoted as 22, is wherein formed with multiple nail shaping pit 23.See Figure 1B-Fig. 1 E.In addition, anvil block 20 has and is divided into two-part slide assemblies 24 from its proximad projection.Anvil block pin 26, from each cross side projection of slide assemblies 24, to be received in respective slots in the sidewall 16 of elongated passageway 14 or opening 18, thus is conducive to movable for anvil block pin or be attached to described respective slots or opening pivotly.

Various forms of implanted nail bin can use together with surgical instruments disclosed herein.Below will discuss specific nail bin configuration and structure in more detail.But, in figure ia, show implanted nail bin 30.Nail bin 30 has main part 31, and this main part is made up of compressible hemorrhage material (such as oxidized regenerated cellulose (" ORC ") or can the foam of bio-absorbable), is wherein supported with the inchoate peg 32 of multirow.For anti-non-magnetic shim influenced and prevent hemorrhage material introducing and position fixing process during activated, whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade mark the poly-dioxanone film sold or polyglycerol sebacate (PGS) film or by PGA (polyglycolic acid, sell with trade mark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (poliglecaprone 25, sell with trade mark Monocryl) or other biodegradable films of being formed of the complex of PGA, PCL, PLA, PDS, described biodegradable film is only just permeable when broken loose.The size of the main body 31 of nail bin 30 is configured to be supported on removedly in elongated passageway 14 as shown in the figure, make when anvil block 20 be driven to be formed with nail bin 30 contact time, the nail shaping pit 23 that each nail 32 is wherein all corresponding with anvil block aligns.

In use, once the contiguous target tissue of end effector 12 and locating, end effector 12 is just manipulated to be caught target tissue or is clamped between the end face 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 is formed in the following way: make anvil block 20 move to make nail profiled surface 22 in the path being arranged essentially parallel to elongated passageway 14 and more specifically make nail shaping pit 23 wherein substantially contact the end face 36 of nail bin 30 simultaneously.When anvil block 20 continues to move in nail bin 30, the lower limb 34 of nail 32 contacts corresponding nail shaping pit 23 in anvil block 20, and this nail shaping pit is used for making nail lower limb 34 bending to make nail 32 be configured as " B shape ".Anvil block 20 will compress nail 32 with the final forming height " FF " making it be configured as expectation further towards the further motion of elongated passageway 14.

Above-mentioned nail forming process is illustrated in Figure 1B-Fig. 1 E substantially.Such as, Figure 1B illustrates end effector 12, and its target tissue " T " is between anvil block 20 and the end face 36 of implanted nail bin 30.Fig. 1 C illustrates the initial clamped position of anvil block 20, and wherein anvil block 20 has been closed on target tissue " T ", between the end face 36 target tissue " T " being clamped in anvil block 20 and nail bin 30.Fig. 1 D illustrates and initially follows closely shaping, and wherein anvil block 20 has started to compress nail bin 30, makes the lower limb 34 of nail 32 begin through the nail shaping pit 23 in anvil block 20 and be shaped.Fig. 1 E illustrates the nail 32 being in final molding condition through target tissue " T ", has removed anvil block 20 for clarity.Once nail 32 is shaped and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, can keep being attached to target tissue to make warehouse 31 and nail 32 when end effector 12 is withdrawn from from patient.When two jaws 13,15 clamp jointly, end effector 12 makes all nails be shaped simultaneously.All the other " by conquassation " material of main parts 31 are used as hemorrhage (ORC) and nail line enhancing (PGA, PDS or any other film compositions 38 above-mentioned).In addition, need not leave warehouse 31 owing to following closely 32 at shaping, the probability that therefore nail 32 becomes deformity at shaping is minimized.As used herein, term " implanted " refers to except nail, and the warehouse material of support nail also will be maintained in patient body and also can finally be absorbed by patient body.This type of implanted nail bin is different from previous nail bin structure, and this previous nail bin is configured in it and is still intactly positioned in end effector by after percussion.

In various concrete enforcement, end effector 12 can be connected to the axis of elongation assembly 40 from shank assembly 100 projection.End effector 12 (when closed) can have similar shape of cross section with axis of elongation assembly 40, and its size is configured to pass sleeve pipe needle tubing or service aisle with another kind of access instruments formal operations.As used herein, term " operatively passes " and refers to that end effector and inserting by passage or tube opening at least partially of axis of elongation assembly maybe can pass passage or tube opening, and in passage or tube opening, can handle surgery stitching operation to it.When in the closed position, the jaw 13 and 15 of end effector 12 can be end effector provides the shape of cross section of substantial circular to be beneficial to it through circular path/opening.But, end effector of the present invention can be imagined and axis of elongation Assemblies Example is provided with other shape of cross sections, thus can otherwise through inlet passage and the opening with non-circular transverse cross-section.Therefore, the overall dimension of the cross section of closed end effector by end effector intend through passage or the size of opening relevant.Therefore, an end effector such as can be called as " 5mm " end effector, and this refers to that it operatively can be at least the opening of about 5mm through diameter.

Axis of elongation assembly 40 can have the external diameter substantially equal with the external diameter of end effector in the close position 12.Such as, 5mm end effector can be connected to the axis of elongation assembly 40 with 5mm cross-sectional diameter.But continue to consult this detailed description of the invention, it is evident that, the present invention can use in conjunction with the end effector of different size effectively.Such as, 10mm end effector can be attached to the slender axles with 5mm cross-sectional diameter.On the contrary, for the application entering opening or passage wherein providing 10mm or larger, axis of elongation assembly 40 can have the cross-sectional diameter of 10mm (or larger), but also can activate 5mm or 10mm end effector.Therefore, the external diameter of outer shaft 40 can be identical or different with the external diameter of the closed end effector 12 be attached on it.

As shown in the figure, axis of elongation assembly 40 distad extends along straight line substantially from shank assembly 100, to limit longitudinal axis A-A.Such as, axis of elongation assembly 40 can be about 9-16 inch (229-406mm) length.But, axis of elongation assembly 40 can be set to other length, and alternatively, joint can be had in axis of elongation assembly or otherwise can be conducive to end effector 12 and carry out joint motions relative to other parts of axle or shank assembly, as hereafter discussed in more detail.Axis of elongation assembly 40 comprises ridge component 50, and this ridge component extends to end effector 12 from shank assembly 100.The proximal extremity of the elongated passageway 14 of end effector 12 has a pair maintenance gudgeon 17 from its projection, this, in the gudgeon opening keeping the size of gudgeon to be configured to be received in the correspondence provided in the distal end of ridge component 50 or support 52, can connect axis of elongation assembly 40 removedly to make end effector 12.Ridge component 50 can be made up of such as 6061 or 7075 aluminum, rustless steel, titanium etc.

Shank assembly 100 comprises pistol grasping type shell, and this pistol grasping type shell can be made into two or more parts for assembling object.Such as, shank assembly 100 as shown in the figure comprise by polymer or plastic material molding or otherwise make and be designed to the right hand housing member 102 that is combined together and left hand housing member (not shown).By molding or the snap arrangement otherwise formed, bolt and pod wherein and/or together with this type of housing member being attached to by binding agent, screw etc.Ridge component 50 has proximal extremity 54, and this proximal extremity is formed flange 56.Flange 56 can rotatably be supported in groove 106, and this groove is by from housing member 102, and each counterpart ribs 108 to inner process in 104 is formed.This type of is configured with and is beneficial to ridge component 50 and is attached to shank assembly 100, makes ridge component 50 can rotate along 360 ° of paths around longitudinal axis A-A relative to shank assembly 100 simultaneously.

As found out further in FIG, ridge component 50 is through installing axle bush 60 and being supported by installation axle bush 60, and this installation axle bush 60 is rotatably attached to shank assembly 100.Install axle bush 60 and have proximal flange 62 and distal lip 64, it limits rotated trench 65, and the leading edge portion 101 of shank assembly 100 can rotatably be contained in therebetween by this rotated trench.This class formation makes installation axle bush 60 can rotate around longitudinal axis A-A relative to shank assembly 100.Ridge component 50 is by ridge pin 66 non-rotatably pin joint extremely installation axle bush 60.In addition, knob 70 is attached to and installs axle bush 60.Such as, knob 70 has hollow mounting flange portion 72, and the size in this hollow mounting flange portion is configured to a part of installing axle bush 60 to be received in wherein.Knob 70 can by such as glass or carbon filled nylon, Merlon, etc. making, and be also attached to by ridge pin 66 axle bush 60 is installed.In addition, to be formed in mounting flange portion 72 to the maintenance flange 74 of inner process and can to extend in the radial groove 68 being formed at and installing in axle bush 60.Therefore, surgeon by firmly grasping knob 70 and making it rotate relative to shank assembly 100, and makes ridge component 50 (with the end effector 12 be attached on it) rotate around longitudinal axis A-A along 360 ° of paths.

Anvil block 20 remains on open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as the trigger system of 109, anvil block 20 can optionally move to various closed or clamped position and firing position from open position.Trigger system 109 comprises " firing member " 110, and it comprises hollow firing tube 110.Hollow firing tube 110 axially can move on ridge component 50, therefore forms the outside of axis of elongation assembly 40.Firing tube 110 can be made up of polymer or other suitable materials, and has the proximal extremity of the percussion yoke 114 being attached to trigger system 109.Such as, pulling the trigger yoke 114 can the over-molded proximal extremity to firing tube 110.But, other securing members also can be adopted to construct.

As can be seen in Figure 1, percussion yoke 114 rotatably can be supported on and support in lining ring 120, and this support lining ring can axially-movable in shank assembly 100.Support lining ring 120 and have the fin extended laterally for a pair, this is set to the size of fin in the fin slit that is slidably received in and is formed in left hand housing member and right hand housing member.Therefore, supporting lining ring 120 can slide axially in shank shell 100, makes percussion yoke 114 and firing tube 110 can rotate around longitudinal axis A-A relative to support lining ring 120 simultaneously.Firing tube 110 is provided with longitudinal slit, through wherein extending in ridge component 50, firing tube 110 can be conducive to simultaneously and axially advances on ridge component 50 to make ridge pin 66.

Trigger system 109 also comprises percussion trigger 130, and this percussion trigger is advanced for controlling the axis of firing tube 110 on ridge component 50.See Fig. 1.This moving to along distal direction of firing tube 110 is carried out pulling the trigger interactional axially-movable with anvil block 20 and is called as in this article " firing action ".As found out in Fig. 1, percussion trigger 130 is connected to shank assembly 100 movingly or pivotly by pivot pin 132.Adopt torsionspring 135 to be biased percussion trigger 130 and arrive " the opening " or the original position that do not activate away from the pistol grip portion 107 of shank assembly 100.As can be seen in Figure 1, percussion trigger 130 has top 134, and this top is attached (pin joint) movingly to percussion chain link 136, and this percussion chain link is attached (pin joint) movingly to supporting lining ring 120.Therefore, pulling the trigger trigger 130 will make percussion yoke 114 and firing tube 110 move along distal direction " DD " from original position (Fig. 1) towards the motion of the end position in the pistol grip portion 107 of adjacent hub parts 100.Percussion trigger 130 away from the pistol grip portion 107 of shank assembly 100 motion (torsionspring 135 biased under) percussion yoke 114 and firing tube 110 will be made to move along proximal direction " PD " on ridge component 50.

The present invention can use together with the implanted nail bin of configuration with different size.Such as, when using in conjunction with the first percussion adapter 140, surgical instruments 10 can use together with the 5mm end effector 12 of the about 20mm long (or with other length) of support implanted nail bin 30.This end effector size can be particularly well-suited in the dissection and the management of blood vessels that such as realize opposite fine.But, as hereafter institute is described in more detail, such as, also by the first percussion adapter 140 is replaced by the second percussion adapter, the end effector of surgical instruments 10 and other sizes and nail bin are combined.In the form of other alternative, axis of elongation assembly 40 can be attached to the end effector of only a kind of form or size.

Now by a kind of method end effector 12 being connected to removedly ridge component 50 of explaination.Connection process is started by being inserted by the maintenance gudgeon 17 on elongated passageway 14 in the trunnion mounting 52 in ridge component 50.Subsequently, the pistol grip 107 of percussion trigger 130 towards casing assembly 100 advances by surgeon, so that firing tube 110 and the first percussion adapter 140 are distad advanced on the proximal end portions 47 of elongated passageway 14, thus gudgeon 17 is remained in its respective support 52.First percussion adapter 140 this type of position above gudgeon 17 is called as " coupled position " in this article.The present invention also can have end effector locked component, will pull the trigger trigger 130 locks in place after being attached to ridge component 50 at end effector 12.

More specifically, an embodiment of end effector locked component 160 comprises retaining pin 162, and this retaining pin is supported in the top 134 of percussion trigger 130 movingly.As mentioned above, firing tube 110 first distad must be advanced coupled position, and wherein the maintenance gudgeon 17 of end effector 12 remains in the trunnion mounting 52 in ridge component 50 by the first percussion adapter 140.Percussion adapter 140 is distad advanced to coupled position by pulling the trigger trigger 130 from original position towards pistol grip 107 tractive by surgeon.When pulling the trigger trigger 130 and first being activated, retaining pin 162 distal motion, until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162 is biased in the latch well 164 be formed in housing member.When retaining pin 162 enters in latch well 164, pin 162 can send " click clatter " sound or other sound that can hear, and for surgeon provide end effector 12 be " locked " on ridge component 50 sense of touch instruction.In addition, only otherwise wittingly retaining pin 162 is biased out latch well 164, surgeon just can not continue unintentionally to activate percussion trigger 130 to start to make the nail 32 in end effector 12 be shaped.Similarly, if surgeon's release is in the percussion trigger 130 of coupled position, then retaining pin 162 can make percussion trigger 130 remain on this position, is back to original position to prevent percussion trigger 130 and therefore discharges end effector 12 from ridge component 50.

The present invention can also comprise trigger system locking press button 137, and this trigger system locking press button is attached to shank assembly 100 pivotally.In one form, trigger system locking press button 137 has the breech lock 138 formed in its distal end, and this breech lock is oriented to and engages percussion yoke 114 when pulling the trigger when release-push is in the first position latching.As can be seen in Figure 1, late spring 139 is for being biased to the first position latching by trigger system locking press button 137.In all cases, breech lock 138 is for engaging percussion yoke 114 at certain some place, at this some place, the position of the percussion yoke 114 on ridge component 50 corresponds to wherein the first percussion adapter 140 and is about to distally be advanced to the point on the clamping slideway 28 on anvil block 20.Should be appreciated that, along with the first percussion adapter 140 axially advances on clamping slideway 28, anvil block 20 will, along path movement, make to follow closely the end face 36 that forming surface portion 22 is arranged essentially parallel to nail bin 30.

After end effector 12 is connected to ridge component 50, start to follow closely forming process by first depressing trigger system locking press button 137, with make percussion yoke 114 can on ridge component 50 further distal motion and the most at last anvil block 20 be compressed in nail bin 30.After pressure trigger system locking press button 137, surgeon continues to activate percussion trigger 130 towards pistol grip 107, thus by the nail shaping slideway 29 being driven into correspondence of the first nail lining ring 140, to force anvil block 20 and nail 32 shaping contact in nail bin 30.Trigger system locking press button 137 prevents from by mistake making nail 32 be shaped before surgeon is ready to start this process.In this example, surgeon must depress trigger system locking press button 137 to start to follow closely forming process before percussion trigger 130 can be further actuated.

Surgical instruments 10 optionally and only can be used as tissue apposition device.But the present invention also can comprise and organizes diced system, and this tissue diced system is marked as 170 substantially.In at least one form, organize diced system 170 to comprise cutter component 172, it is optionally advanced to actuated position from the unactuated position of the proximal extremity of adjacent side terminal part executor 12 by activating cutter trigger 200 of advancing.Cutter component 172 is supported in ridge component 50 movingly, and is attached to knife bar 180 or otherwise from knife bar 180 projection.Cutter component 172 can be made up of 420 or 440 rustless steels such as with the hardness being greater than 38HRC (RHC), and can have to be formed at its distal end 174 organizes cutting edge 176, and the slit that can extend through slidably in anvil block 20 and the slit 33 arranged placed in the middle in nail bin 30, to cut the tissue worn and be clamped in end effector 12.Knife bar 180 extends through ridge component 50 and has and drives with cutter transporter the proximal end portions joined, and this cutter transporter is operationally attached to cutter and advances trigger 200.Cutter trigger 200 of advancing is attached to pivot pin 132, makes it to carry out pivotable or or in other words to activate when without the need to activating percussion trigger 130.First cutter tooth wheel 192 is also attached to pivot pin 132, makes the advance actuating of trigger 200 of cutter also make the first cutter tooth take turns 192 pivotables.Be attached with between first cutter tooth wheel 192 and shank housing 100 and pull the trigger return spring 202, be biased to original position or unactuated position with trigger 200 of being advanced by cutter.

Cutter transporter also comprises the second cutter tooth wheel 194, and this second cutter tooth is taken turns rotatably to be supported on the second gear shaft and to take turns 192 with the first cutter tooth and engaged.Second cutter tooth wheel 194 is taken turns 196 with the 3rd cutter tooth be supported on the 3rd gear shaft and is engaged.Four blade gear 198 is also supported on the 3rd gear shaft 195.Four blade gear 198 is suitable for being engaged on a series of gear teeth in the proximal extremity of knife bar 180 or ring with driving.Therefore, this structure makes four blade gear 198 axially can drive knife bar 180 along distal direction " DD " or proximal direction " PD ", makes trigger shaft 180 rotate around longitudinal axis A-A relative to four blade gear 198 simultaneously.Therefore, surgeon is by advancing trigger 200 and make trigger shaft 180 axially advance and final distally promote cutter component 172 towards the pistol grip 107 tractive cutter of shank assembly 100.

The present invention also can comprise cutter locking system 210, and this cutter locking system prevents the propelling of cutter component 172, unless percussion trigger 130 has been pulled to complete firing position.Therefore, this feature will prevent the activation of cutter propulsion system 170, unless first nail is pulled the trigger or form in tissue.As can be seen in Figure 1, the various concrete enforcement of cutter locking system 210 comprises cutter securing rod 211, and this cutter securing rod is supported in the pistol grip portion 107 of shank assembly 100 pivotally.Cutter securing rod 211 has activated end 212, and when pulling the trigger trigger 130 and being in complete firing position, activated end 212 is suitable for being pulled the trigger trigger 130 and engages.In addition, cutter securing rod 211 has maintenance suspension hook 214 on the other end thereof, and this maintenance suspension hook is suitable for the latch bar 216 engaged in suspension hook mode on the first cutting gear 192.Adopt cutter locking spring 218 that cutter securing rod 211 is biased to " locking " position, wherein keep suspension hook 214 to keep engaging with latch bar 216, thus prevent cutter to advance the actuating of trigger 200, unless pulled the trigger trigger 130 to be in complete firing position.

After nail is " fired " in (shaping) to target tissue, surgeon can depress percussion trigger release-push 167, with make percussion trigger 130 can torsionspring 135 biased under be back to original position, thus make anvil block 20 can bias downwards into open position the biased of spring 21.When in open position, surgeon can withdraw from end effector 12 and leave implanted nail bin 30 and nail 32.In the application that end effector is inserted into through passage, service aisle etc. wherein, surgeon will make anvil block 20 be back to make position by activating percussion trigger 130, can be withdrawn to make end effector 12 by passage or service aisle.But if surgeon wants to cut target tissue after percussion nail, then surgeon activates cutter in the above described manner and to advance trigger 200, arrives the end of end effector to drive knife bar 172 through target tissue.Subsequently, surgeon can discharge cutter and to advance trigger 200, can make percussion transporter that knife bar 172 is back to initial (actuating) position to make percussion return spring 202.Once knife bar 172 is back to original position, surgeon just can open end effector jaw 13,15, also in patient body, withdraws from end effector 12 subsequently to be released in implanted storehouse 30 in patient body.Therefore, this type of surgical instruments is conducive to using the little implanted nail bin be inserted into by relatively little service aisle and passage, simultaneously for surgeon provides following selection: when not cutting and organizing, percussion is followed closely or also cut and organized after percussion nail.

Various uniqueness of the present invention and new embodiment adopt compressible nail bin, described compressible nail bin support be in substantially fixed position for by the nail of anvil block shaping contact.Be driven into by anvil block in unshaped nail, the degree that wherein such as reached nail is shaped depends on how far anvil block is driven in nail.The amount of the shaping that this class formation makes surgeon to regulate to be applied to nail or percussion pressure, thus change the final forming height of nail.In other embodiments of the invention, surgical stapling structure can adopt nail driving element, and nail can promote towards anvil block by this nail driving element.Hereafter this type of embodiment is described in more detail.

With reference to the embodiment of above-detailed, the amount being applied to the firing action of removable anvil block depends on the degree of the actuating of percussion trigger.Such as, if surgeon goes for only partially-formed nail, then only need towards pistol grip 107 partially to interior pressure percussion trigger.Obtain and more follow closely shaping, surgeon only needs to compress percussion trigger further, anvil block is driven further and contacts to form with nail.As used herein, term " shaping contact " refers to that nail profiled surface or nail shaping pit have also started be shaped by lower limb or be bent to shaping position in the end of contact stud lower limb.The degree that nail is shaped refers to the degree that nail lower limb is folded and finally refers to the forming height of nail referred to above.Those skilled in the art will be further understood that, because when applying firing action to anvil block 20, anvil block 20 moves with the relation substantially parallel with nail bin, so nail is substantially shaped and has substantially the same forming height simultaneously.

Fig. 2 and Fig. 3 shows the end effector 12 of alternative ", except the following difference that can hold knife bar 172 ', end effector 12 " be similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or from knife bar 180 projection, and in addition above to operate about the mode described in knife bar 172.But in this embodiment, knife bar 172 ' long enough is to traverse end effector 12 " whole length, therefore end effector 12 " in do not adopt independent distal blade component.Knife bar 172 ' is formed with cross member 173 ' and lower cross member 175 '.Upper cross member 173 ' is oriented to slidably across anvil block 20 " in corresponding elongated slot 250, and lower cross member 175 ' be oriented to traverse end effector 12 " elongated passageway 14 " in elongated slot 252.Anvil block 20 " in be also provided with and depart from slit (not shown); make when knife bar 172 ' is driven to end effector 12 " in end position time, upper cross member 173 ' falls through corresponding slit, to make anvil block 20 " can open position be moved to, thus depart from the tissue sewed up and cut.Anvil block 20 " can be in addition identical with above-mentioned anvil block 20, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " by spring or other open structure (not shown) be biased to fully open position (Fig. 2).Anvil block 20 " by percussion adapter 150 axial row of carrying out in the above described manner and then at open position and move between clamped position completely.Once percussion adapter 150 is advanced into complete clamped position (Fig. 3), surgeon just distally can advance knife bar 172 subsequently in the above described manner ".If surgeon wants that end effector is used as grasp device carry out manipulating tissue, then percussion adapter proximally can be moved, to allow anvil block 20 " away from elongated passageway 14 " motion, as shown in phantom in figure 4.In this example, along with knife bar 172 " distally move, upper cross member 173 ' pulls anvil block 20 together with lower cross member 175 ' " and elongated passageway 14 ", with at knife bar 172 " through end effector 12 " nail that realizes expecting when distally advancing is shaped.See Fig. 5.Therefore, in this embodiment, nail shaping cut occur simultaneously with tissue, but nail itself can at knife bar 172 " distally driving time be sequentially shaped.

The uniqueness of various surgery nail bin of the present invention and surgical instruments and novel structure enables the nail in described nail bin be arranged to one or more linear or nonlinear line.Each side of elongated slot can be provided with many this nail lines, described elongated slot is medially arranged in nail bin, for receive through wherein organize cutting element.In one structure, nail such as into a line can be substantially parallel to the nail in the adjacent lines of nail but be biased with it.In the form of other alternative, one or more nail line can be essentially nonlinear.That is, follow closely at least one nail in line base portion can along substantially with the Axis Extension of other base portion crosscuts of following closely in same nail line.Such as, as hereafter discussed in more detail, in the embodiment of alternative, the nail line on each side of elongated slot can have sawtooth appearance.Compared with the various linear pin structure adopted in the nail bin of prior art, this type of nonlinear pin structure can use less nail to obtain and better organize tightening results.

Fig. 6 shows the use of end effector embodiment 612 ' Chinese and foreign department nail bin embodiment 900.As found out in figure 6 and figure 7, the embodiment of surgery nail bin 900 has warehouse 902, and this warehouse has the elongated slot 904 arranged placed in the middle, and this elongated slot extends to the region adjacent with distal end 905 through proximal extremity 903.Elongated slot 904 can allow cutter main body through wherein axially-movable during carrying out tissue cutting actions in the above described manner.Warehouse 902 is by such as such as oxidized regenerated cellulose (" ORC ") or such as by PGA (polyglycolic acid, sell with trade mark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PDS (poly-dioxanone), PHA (polyhydroxyalkanoatefrom), PGCL (poliglecaprone 25, sell with trade mark Monocryl) or PGA, PCL, what the complex of PLA and PDS was made can the compressible hemorrhage material of foam of bio-absorbable be formed, the line 920 of unshaped nail 922 is supported with in this compressible hemorrhage material, 930.But warehouse 902 can be made up of other materials, this material is used for unshaped nail 922 to be supported on to expect that in orientation, make when anvil block 910 ' is in contact with it, it can be compressed.The same with other embodiments described, nail bin 900 is implanted, and keeps being attached to the tissue be sewn after suture operation completes.For anti-non-magnetic shim 922 is influenced and hemorrhage material is activated during introducing and position fixing process, whole storehouse 900 can be coated with or be wrapped in biodegradable film 906, such as with trade mark the poly-dioxa cyclohexanone film sold or polyglycerol sebacate (PGS) film or such as by PGA (polyglycolic acid, sell with trade mark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (poliglecaprone 25, sell with trade mark Monocryl) or other biodegradable films of being formed of the complex of PGA, PCL, PLA, PDS, this biodegradable film is only just permeable when broken loose.The size of the warehouse 902 of nail bin 900 is set to and is supported in the elongated passageway of end effector 612 ' removedly.

In Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 is the First Line 920 of support nail 922 on a cross side 907 of elongated slot 904 operationally, and on another cross side 909 of elongated slot 904 the second line 930 of support nail 922.Nail 922 can by such as, and such as titanium, titanium alloy (such as 6Al-4V titanium, 3al-2.5V titanium), stainless steel and other metal materials are made and had nail base portion 924 and from two of its projection upright nail lower limbs 926.Each nail lower limb 926 can be formed and organize penetrating tip 928.In the First Line 920 of nail 922, the nail base portion 924 of at least one nail 922 is overlapping with the nail base portion that another follows closely 922.In a preferred embodiment, except the base portion 924 of the last nail 922 on the first nail each end of line 920, the nail base portion 924 of all adjacent with two nail 922 of nail base portion 924 of each nail 922 is overlapping.See Figure 10.Therefore, the first nail line 920 has nonlinear shape substantially.More specifically, when viewed from above, the first nail line 920 has zigzag outward appearance substantially.

As found out in fig .9, anvil block 90 has the longitudinal direction nail shaping pit 912 of two orders, each longitudinally nail shaping pit has the substantially saw-toothed shape corresponding with the shape of the First Line 920 of nail 922, make when anvil block 910 and nail 922 form contact time, the lower limb 926 of nail is shaped as shown in figure 11.Therefore, the far leg of a nail shares same pit with next near leg followed closely in the vertical.This class formation allows more intensive pit pattern, even reaches nail and self to carry out interacting the degree of (such as stride across each other and fold).In the nail pit structure of prior art, in general, one group of pit and next organize the metal/space that must to have between pit between 0.005 and 0.015 inch.But such as, this embodiment of the present invention has the interference/section gap structure of 0 to 0.02 inch (in essence, a-0.020 "), this is because a nail coordinates with next nail.This structure allows the nail having more 15% to 30% in identical space.In addition, when each nail interlocking, the demand of multiple side direction nail row is reduced.Existing structure adopts three row nails usually on every side of organizing line of cut, to prevent from existing the open approach that blood can flow through.The probability that interlocking nail line forms the path that blood can flow through is less.Another obvious advantage that various interlocking pin structure of the present invention provides relates to the improvement " broken loose intensity " relevant to tearing the amount of following closely power needed for line opening.

Another nail shaping pit structure can comprise shared nail shaping pit.As used herein, term " shared nail shaping pit " refers to, to arrange the independent anvil design forming the prior art of pit different from the every bar lower limb wherein for each preformation staple, and shaping pit can make all nails shapings in single nail line.

Figure 12 illustrates another nail embodiment 922 ', and wherein base portion 924 ' has offset part 929, is beneficial to each base portion 924 ' and carries out more overlapping.As mentioned above, nail bin 900 has the second line 930 of the nail 922 be supported on the second cross side 909 of elongated slot 904.Second line 930 of nail 922 is substantially the same with the First Line 920 of nail 922.Therefore, anvil block 910 has the second shared nail shaping pit 912 corresponding to the second nail line 930, to follow closely line 930 shaping contact with second.But alternatively, the second line 930 of nail 922 also can may be different from the First Line 920 of nail in shape on nail number.

Fig. 8 illustrates except the line 920 ', 930 ' of the nail 922 be supported in wherein, the surgery nail bin 900 ' substantially the same with above-mentioned nail bin 900.Such as, in this embodiment, the line 920 ' following closely 922 is relative to each other configured to make the base portion axis S-S of at least one nail base portion 924 extend substantially transversely to the base portion axis S-S of the nail base portion 924 of at least another adjacent nail 922.When viewed from above, this predetermined nail pattern comprises zigzag structure substantially.In fig. 13, each base portion 924 of nail 922 can there is base support member 927 by overmolding in addition, as shown in the figure.Base support member 927 can be made up of the plastics of such as nonabsorable (such as polyether-ether-ketone " PEEK ") or absorbable plastics (such as the various compound mixtures of polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", poly-dioxanone " PDS ", PCL (polycaprolactone), PHA (polyhydroxyalkanoatefrom), polyglycerol sebacate (PGS), PGCL (poliglecaprone 25 is sold with trade mark Monocryl) or PGS, PDS, PLA, PGA and PCL).Base support member 927 is conducive to making when not making nail overlapping itself to interlock between nail.Therefore, this structure can make when not making the lower limb overlap of nail self nail be configured as " B " shape or fall " W " shape.But, because bizet is connected by base support member, so they work as overlapping nail.This class formation permission combination pit has two discreet paths for every bar lower limb.

Embodiment shown in Figure 14 adopts nail line 920 ", wherein the lower limb 926 of contiguous nail 922 is linked together by the coupling portion 929 being attached to lower limb 926 with molding or other modes.Each coupling portion 929 can be made up of such as polyether-ether-ketone " PEEK " or absorbable plastics (such as the various compound mixtures of polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", poly-dioxanone " PDS ", PCL (polycaprolactone), PHA (polyhydroxyalkanoatefrom), PGCL (poliglecaprone 25 is sold with trade mark Monocryl) or PGS, PDS, PLA, PGA and PCL).When viewed from above, this nail line 920 " there is sawtooth appearance substantially.Although make for explaining various surgery nail bin embodiment 900,900 ' in conjunction with end effector 612 ', but be to be understood that, nail bin 900,900 ' can use effectively together with other end effectors various mentioned above and surgical instruments, suitable nail shaping pit structure is provided with, to move to and the nail shaping amount reaching expectation when following closely shaping contact at anvil block in the anvil block of wherein these apparatuses.

Figure 15 and Figure 16 shows another surgery nail bin 940 embodiment be supported in the elongated passageway 14 of surgical instruments 10.Surgery nail bin 940 comprises warehouse 942, and this warehouse has the elongated slot 944 arranged placed in the middle, and this elongated slot extends through wherein at least in part.Elongated slot 944 can allow the cutter main body of surgical instruments 10 through wherein axially-movable during carrying out tissue cutting actions in the above described manner.Warehouse 942 can the compressible hemostatic material of foam of bio-absorbable form by such as oxidized regenerated cellulose (" ORC ") or above-mentioned or following type, is wherein supported with the line 946,948,950,952 of unshaped nail 922.For anti-non-magnetic shim 922 is influenced and hemorrhage material is activated during introducing and position fixing process, whole storehouse 940 can be coated with or be wrapped in biodegradable film 954, such as with trade mark the poly-dioxa cyclohexanone film sold or polyglycerol sebacate (PGS) film or such as by PGA (polyglycolic acid, sell with trade mark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (poliglecaprone 25, sell with trade mark Monocryl) or other biodegradable films of being formed of the complex of PGA, PCL, PLA, PDS, this biodegradable film is only just permeable when broken loose.

In fig .15, storehouse 940 also comprises the storehouse supporting member 960 being connected to warehouse 942.Storehouse supporting member 960 can be made up of rigid materials such as such as titanium, rustless steel, aluminum, above-mentioned any alloys, and can partly embed in warehouse 942.Storehouse supporting member 960 can remain on appropriate location by such as film 954.When needing the alternative of restricted combination, can sporadically use cyanoacrylate adhesive by two assemblies " gummed " together.In other alternate forms, warehouse 942 can be heated and " welding " or " melting " to storehouse supporting member 960.Storehouse supporting member 960 formed the lower surface of warehouse 942 at least partially to coordinate with elongated passageway 14.Storehouse supporting member 960 has the one or more snap arrangement 962 from its projection, is connected to elongated passageway 14 releasedly for by storehouse supporting member 960.Can adopt other forms of snap arrangement/securing member structure that storehouse supporting member 960 is connected to elongated passageway 14 releasedly.

Storehouse supporting member 960 is formed with a series of support ridge 964,966,968,970,972,974,976, to provide some lateral support to the base portion 924 of the nail 922 in nail line 946,948,950,952, as shown in figure 15.Therefore, such as, support ridge extends substantially jointly with nail line.Figure 17 illustrates the nail bin embodiment 940 ' substantially the same with storehouse 940 of alternative, difference is, nail bin embodiment 940 ' comprise respectively from support ridge 964,966,968,970,972,976 projection to provide the upstanding fins portion 978,979,980,981,982,983 of extra lateral support to nail 922.Fin part can form as one with storehouse supporting member 960, and it highly can be about 1/2 or less of storehouse height.Therefore, such as, any rising structure supporting foam all cannot extend to more than the solid height of foam.Therefore, if storehouse be designed to such as by percussion time be compressed to 1/3 of its original height, then fin by uncompressed height 66% on the way down to uncompressed height 10% between.

In use, once nail 922 is shaped by contacting anvil block 20 in the above described manner, then anvil block 20 is opened and end effector 12 be pulled away from the tissue through sewing up.When end effector 12 is pulled away from through sew up organize time, warehouse 942 keeps the tissue that is fastened to through sewing up and is separated with keeping the storehouse supporting member 960 being connected to elongated passageway 14 subsequently.The color of storehouse supporting member 960 is different from the color of the material comprising warehouse 942 and the color of elongated passageway 14.This type of is configured to surgeon and provides in end effector the instruction that can easily identify that there is not nail bin.Therefore, surgeon can not by mistake attempt again inserting/use end effector when not installing new nail bin in end effector.For this reason, surgeon only needs the snap arrangement of storehouse supporting member 960 to depart from from elongated passageway 14, can be placed on wherein to make the storehouse supporting member 960 of new nail bin 940.Although explain nail bin 940,940 ' with reference to surgical instruments 10, but should be appreciated that without departing from the spirit and scope of the present invention, these storehouses can adopt effectively together with other surgical instruments embodiments many disclosed herein.

Nail bin can comprise warehouse and be stored in the multiple nails in warehouse.In use, nail bin can be introduced in operative site and to be located at the side of handled tissue.In addition, nail shaping anvil block can be positioned on the opposite side of tissue.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, and wherein the first jaw and/or the second jaw can move towards another jaw.Once nail bin and anvil block are located relative to tissue, then can penetrate nail from nail bin body, make nail can piercing tissue contact stud shaping anvil block.Once dispose nail from nail bin body, then then can remove nail bin body from operative site.As described herein, nail bin or the implantable at least partially of nail bin have nail.Such as, as hereafter described in more detail, nail bin can comprise warehouse, and when anvil block moves to make position from open position, this warehouse can be compressed by anvil block, crushes and/or collapse.When warehouse compressed, conquassation and/or collapse time, the nail be positioned in warehouse is out of shape by anvil block.Alternatively, the jaw supporting nail bin can move to make position towards anvil block.Two kinds of situations any one in, when follow closely be positioned in warehouse at least in part time, nail deformable.Nail can not penetrate from nail bin, and nail can penetrate together with a part for warehouse from nail bin.

Referring now to Figure 18 A-Figure 18 D, compressible nail bin (such as nail bin 1000) such as can comprise compressible, implanted warehouse 1010, and the multiple nails 1020 be positioned in addition in compressible warehouse 1010, but Figure 18 A-Figure 18 D only illustrates a nail 1020.Figure 18 A illustrates the nail bin 1000 supported by nail bin support member or nail bin path 10 30, and wherein nail bin 1000 is shown in uncompressed condition.In this uncompressed condition, anvil block 1040 can contact or not contact tissue T.In use, anvil block 1040 can move to contact tissue T from open position, as shown in figure 18b, and tissue T is located against warehouse 1010.Even if tissue T can be positioned to the tissue contacting surface 1019 against nail bin body 1010 by anvil block 1040, but refer again to Figure 18 B, nail bin body 1010 now can stand few (if any) compression stress or pressure, and follows closely 1020 and can remain on unshaped or not pull the trigger condition.As shown in Figure 18 A and Figure 18 B, nail bin body 1010 can comprise one or more layer, and the nail lower limb 1021 following closely 1020 upwards can extend through these layers.Warehouse 1010 can comprise ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, wherein the second layer 1012 can be positioned in the middle of ground floor 1011 and third layer 1013, and wherein third layer 1013 can be positioned in the middle of the second layer 1012 and the 4th layer 1014.Such as, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and follows closely lower limb 1021 and upwards can extend from base portion 1022 and pass the 4th layer 1014, third layer 1013 and the second layer 1012.Each deformable lower limb 1021 can comprise top, such as sharp top 1023, and such as, when nail bin 1000 is in uncompressed condition, this sharp top can be positioned in the second layer 1012.Such as, top 1023 can not extend to and/or pass ground floor 1011, and wherein when nail bin 1000 is in uncompressed condition, top 1023 can be not projecting through tissue contacting surface 1019.Alternatively, when nail bin is in uncompressed condition, sharp top 1023 can be positioned in third layer 1013 and/or any other suitable layer.Alternatively, the warehouse of nail bin can have any suitable number of layers, such as, be less than four layers or more than four layers.

As hereafter described in more detail, ground floor 1011 can be made up of buttress material and/or plastic material (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA)), and the second layer 1012 can by can the foamed materials of bio-absorbable and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) form.Nail 1020 can remain in nail bin body 1010 by one or more in ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, and nail 1020 can be made in addition to keep mutual alignment.Third layer 1013 can be made up of buttress material or quite incompressible or non-elastic material, and the nail lower limb 1021 of nail 1020 relative to each other can be remained on appropriate location by this material.In addition the second layer 1012 and the 4th layer 1014, be positioned at the second layer 1012 on the opposite side of third layer 1013 and the 4th layer of 1014 Absorbable organic halogens or reduce the motion of nail 1020, even if can be made up of compressible foam or elastomeric material.The screw top end 1023 of nail lower limb 1021 can be embedded in ground floor 1011 at least in part.Such as, ground floor 1011 and third layer 1013 can collaboratively and firmly nail lower limb 1021 is remained on appropriate location.Ground floor 1011 and third layer 1013 can respectively by such as can bioabsorbable material (such as with the polyglycolic acid (PGA) that trade name Vicryl sells, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with the poliglecaprone 25 (PGCL) that trade name Monocryl sells, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, the complex of PGCL and/or PCL) thin slice form, and the second layer 1012 and the 4th layer 1014 can be made up of at least one hemorrhage material or hemorrhage respectively.

Although ground floor 1011 can be compressible, but the second layer 1012 can be substantially more compressible than ground floor 1011.Such as, the compression ratio of the second layer 1012 can be ground floor 1011 about twice, about three times, about four times, about five times and/or about ten times.In other words, for given power, the compression degree of the second layer 1012 can be about twice of ground floor 1011, about three times, about four times, about five times and/or about ten times.The compression ratio of the second layer 1012 such as can be between about twice of the compression ratio of ground floor 1011 and about ten times.The second layer 1012 can comprise the multiple air gaps be defined in wherein, and the amount of the air gap wherein in the second layer 1012 and/or size can be controlled to the expectation compression ratio providing the second layer 1012.To similar above, although third layer 1013 can be compressible, but the 4th layer 1014 can have more compression ratio substantially than third layer 1013.Such as, the compression ratio of the 4th layer 1014 can be third layer 1013 about twice, about three times, about four times, about five times and/or about ten times.In other words, for given power, the compression degree of the 4th layer 1014 can be third layer 1013 about twice, about three times, about four times, about five times and/or about ten times.The compression ratio of the 4th layer 1014 can be between about twice of the compression ratio of third layer 1013 and about ten times.Can comprise the multiple air gaps be defined in wherein for 4th layer 1014, amount and/or the size of the air gap wherein in the 4th layer 1014 can be controlled to the expectation compression ratio providing the 4th layer 1014.In all cases, the compression ratio of warehouse or warehouse layer is expressed by compression ratio (that is, layer is for the distance of compressing to the power of sizing).Such as, compared with the layer had compared with little compressible, the layer with high compression rate for be applied to this layer to the compression stress of sizing by distance larger for compression.So, the comparable ground floor of the second layer 1,012 1011 has higher compression ratio; Similarly, the 4th layer of 1014 comparable third layer 1013 has higher compression ratio.The second layer 1012 can be made up of identical material with the 4th layer 1014 and can have identical compression ratio.The second layer 1012 and the 4th layer 1014 can be made up of the material with different compression ratio.Similarly, ground floor 1011 can be made up of identical material with third layer 1013 and can have identical compression ratio.Ground floor 1011 and third layer 1013 can be made up of the material with different compression ratio.

When anvil block 1040 moves towards its make position, anvil block 1040 can contact tissue T apply compression stress to tissue T and nail bin 1000, as shown in figure 18 c.In this case, anvil block 1040 can promote top surface or the tissue contacting surface 1019 of warehouse 1010 downwards towards nail bin support member 1030.Nail bin support member 1030 can comprise storehouse stayed surface 1031, its can between the tissue contacting surface 1041 that nail bin 1000 is compressed in storehouse stayed surface 1031 and anvil block 1040 time support nail bin 1000.Due to anvil block 1040 applied pressures, warehouse 1010 can be compressed and anvil block 1040 can contact stud 1020.More specifically, moving downward of the compression of warehouse 1010 and tissue contacting surface 1019 can make the top 1023 of nail lower limb 1021 pierce through the ground floor 1011 of warehouse 1010, piercing tissue T and entering in the shaping pit 1042 in anvil block 1040.When warehouse 1010 is compressed further by anvil block 1040, top 1023 can contact the wall limiting shaping pit 1042, and such as therefore lower limb 1021 can to internal strain or curling, as shown in figure 18 c.When following closely lower limb 1021 and being deformed, equally as shown in figure 18 c, the base portion 1022 of nail 1020 can contact nail bin support member 1030 or be supported by nail bin support member 1030.As described in greater detail below, nail bin support member 1030 can comprise multiple supporting construction, such as follows closely support trenches, slit or groove 1032, such as described multiple supporting construction can when nail 1020 is deformed support nail 1020 or at least follow closely 1020 base portion 1022.Equally as shown in figure 18 c, the compression stress being applied to nail bin body 1010 can make the cavity 1015 in the 4th layer 1014 collapse.Except cavity 1015, nail bin body 1010 also can comprise one or more space (such as space 1016), such as, can comprise or not comprise a part for the nail be positioned at wherein in described one or more space, described one or more space can allow warehouse 1010 to collapse.Can collapse in cavity 1015 and/or space 1016, the wall limiting cavity and/or wall is bent downwards and contacts the layer be positioned below cavity and/or space of storehouse stayed surface 1031 and/or contact warehouse 1010.

When comparison diagram 18B and Figure 18 C, obviously, the second layer 1012 and the 4th layer 1014 compression pressure that applies by anvil block 1040 substantially compress.Also can note, ground floor 1011 and third layer 1013 are also compressed.When anvil block 1040 moves to its make position, anvil block 1040 continues compression warehouse 1010 further by promoting tissue contacting surface 1019 downwards towards nail bin support member 1030.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into its complete shaping form, as shown in Figure 18 D.See Figure 18 D, the lower limb 1021 of each nail 1020 can be out of shape downwards towards the base portion 1022 of each nail 1020, so that by tissue T, ground floor 1011, the second layer 1012, being captured at least partially between deformable lower limb 1021 and base portion 1022 of third layer 1013 and the 4th layer 1014.When comparison diagram 18C and Figure 18 D, more obviously, the second layer 1012 and the 4th layer 1014 further the compression pressure that applies by anvil block 1040 significantly compress.Also can note when comparison diagram 18C and Figure 18 D, ground floor 1011 and third layer 1013 are also further compressed.After nail 1020 is shaped completely or at least fully, anvil block 1040 can be lifted away from tissue T, and nail bin support member 1030 can away from and/or depart from nail bin 1000 and move.As shown in Figure 18 D and due to mentioned above, warehouse 1010 is implantable nail 1020.In various embodiments, implanted warehouse 1010 can along nail line supporting tissue.In some cases, the hemorrhage comprised in the warehouse 1010 of implantation and/or any other medicine be applicable to can along with passage of time be to process tissue.Hemorrhage as above can reduce sew up and/or cutting organize hemorrhage, simultaneously bonding agent or tissue adhesive can along with passage of time for tissue provide intensity.The warehouse 1010 implanted can by such as ORC (oxidized regenerated cellulose), extracellular protein (such as collagen), with the polyglycolic acid (PGA) that trade name Vicryl sells, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with the poliglecaprone 25 (PGCL) that trade name Monocryl sells, polycaprolactone (PCL), and/or such as PGA, PLA, PDS, PHA, the composite of PGCL and/or PCL is formed.In some cases, warehouse 1010 can comprise antibiosis and/or the anti-biotic material of the probability that such as can reduce surgical site infection, such as collargol and/or triclosan.

The layer of warehouse 1010 can be connected to each other.Such as, can utilize at least one binding agent (such as fibrin and/or protein hydrogel) that the second layer 1012 is adhered to ground floor 1011, third layer 1013 be adhered to the second layer 1012, and adheres to third layer 1013 by the 4th layer 1014.Although not shown, the layer of warehouse 1010 links together by interlocking machine feature structure.Such as, ground floor 1011 and the second layer 1012 can comprise corresponding interlocking features structure separately, such as tenon groove structure and/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can comprise corresponding interlocking features structure separately, and simultaneously third layer 1013 and the 4th layer 1014 can comprise corresponding interlocking features structure separately.Although not shown, nail bin 1000 can comprise such as one or more rivet, and this one or more rivet can extend across one or more layers of warehouse 1010.Such as, each rivet can comprise the second head of the first end or head that adjacent first layer 1011 locates and contiguous 4th layer 1014 and location, and the 4th layer can be mounted to the second end of rivet or be formed by the second end of rivet.Such as, due to the compression ratio matter of warehouse 1010, the compressible warehouse 1010 of rivet, makes the head of rivet can cave in relative to the tissue contacting surface 1019 of warehouse 1010 and/or lower surface 1018.Such as, rivet can by can the material of bio-absorbable form, material such as sell with trade name Vicryl polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or such as PGA, PLA, PDS, PHA, PGCL and/or PCL complex.Except the nail 1020 by holding in warehouse 1010, the layer of warehouse 1010 can not be connected to each other.Such as, the layer of warehouse 1010 such as can keep together by the frictional engagement between nail lower limb 1021 and warehouse 1010, and once nail is shaped, then described layer can be trapped in nail 1020.Roughened surface or the rough coatings that can comprise the frictional force that can increase between nail 1020 and warehouse 1010 at least partially of nail lower limb 1021.

As mentioned above, surgical instruments can comprise the first jaw and the second jaw, and the first jaw comprises nail bin support member 1030, second jaw and comprises anvil block 1040.As hereafter be described in more detail, nail bin 1000 can comprise one or more maintenance feature structure, and this one or more maintenance feature structure can engage nail bin support member 1030 and therefore nail bin 1000 be remained to nail bin support member 1030 releasedly.Such as, by least one binding agent (such as, fibrin and/or protein hydrogel), nail bin 1000 is adhered to nail bin support member 1030.In use, in at least one situation, especially in abdominal cavity mirror and/or endoscopic procedure, the second jaw is moveable to the make position relative with the first jaw, such as, make the first jaw and the second jaw be inserted in operative site by the trocar.Such as, the trocar can limit hole or the intubate of about 5mm, and the first jaw and the second jaw are inserted into by it.Second jaw is moveable to the partial closed position between in an open position and make position, and this partial closed position can allow the first jaw and the second jaw to be inserted into through the trocar, and without the need to making the nail 1020 held in nail bin body 1010 be out of shape.Such as, when the second jaw is in the closed centre position of its part, anvil block 1040 can not apply compression stress to nail bin body 1010, and alternatively, when the second jaw is in the closed centre position of its part, and the compressible nail bin body 1010 of anvil block 1040.Although the compressible nail bin body 1010 when anvil block 1040 is in this centre position, but anvil block 1040 can compress nail bin body 1010 by halves, makes anvil block 1040 contact stud 1020 and/or nail 1020 is out of shape by anvil block 1040.Once the first jaw and the second jaw are inserted into by the trocar in operative site, then the second jaw can be opened again, and anvil block 1040 and nail bin 1000 can position relative to target tissue as mentioned above.

Referring now to Figure 19 A-Figure 19 D, the end effector of surgical stapling device can comprise the implanted nail bin 1100 be positioned in the middle of anvil block 1140 and nail bin support member 1130.To similar above, anvil block 1140 can comprise tissue contacting surface 1141, and nail bin 1100 can comprise tissue contacting surface 1119, and nail bin support member 1130 can comprise the stayed surface 1131 that can support nail bin 1100.See Figure 19 A, anvil block 1140 can be utilized tissue T to be positioned to the tissue contacting surface 1119 against nail bin 1100 and not make nail bin 1100 be out of shape, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be oriented to and nail bin stayed surface 1131 distance 1101a, and tissue contacting surface 1119 can be oriented to and nail bin stayed surface 1131 distance 1102a.Subsequently, when anvil block 1140 moves towards nail bin support member 1130, referring now to Figure 19 B, anvil block 1140 can promote the top surface of nail bin 1100 or tissue contacting surface 1119 downwards and compress ground floor 1111 and the second layer 1112 of warehouse 1110.Refer again to Figure 19 B, along with layer 1111 and layer 1112 are compressed, the second layer 1112 can by conquassation, and the lower limb 1121 following closely 1120 can pierce through ground floor 1111 and enter into tissue T.Such as, nail 1120 can be positioned in nail chamber in the second layer 1112 or space 1115 at least in part, and when the second layer 1112 is by compression, can collapse in nail chamber 1115 and therefore the permission second layer 1112 is collapsed around nail 1120.The second layer 1112 can comprise cover 1116, the extensible also encapsulating or at least in part encapsulating nail chamber 1115 on nail chamber 1115 of this cover.Figure 19 B shows the covering part 1116 being pressed downward and bursting in nail chamber 1115.The second layer 1112 can comprise one or more weakening part, and it can be conducive to collapsing of the second layer 1112.This type of weakening part can comprise cut that such as can be conducive to warehouse 1110 controlled collapse, perforation and/or thin cross section.Ground floor 1111 can comprise and can be conducive to following closely one or more weakening parts that lower limb 1121 penetrates ground floor 1111.This type of weakening part can comprise and such as can align with nail lower limb 1121 or at least cut of substantial alignment, perforation and/or thin cross section.

Refer again to Figure 19 A, when anvil block 1140 is in partly closed non-firing position, anvil block 1140 can be oriented to and storehouse stayed surface 1131 distance 1101a, makes to be limited with gap therebetween.This gap can be filled by the nail bin 1100 and tissue T with nail bin height 1102a.When anvil block 1140 moves downward to compress nail bin 1100, refer again to Figure 19 B, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b being shorter than distance 1101a.In all cases, the gap limited by distance 1101b between the tissue contacting surface 1141 of anvil block 1140 and storehouse stayed surface 1131 can be greater than original undeformed nail bin height 1102a.Referring now to Figure 19 C, when anvil block 1140 moves to closer to storehouse stayed surface 1131, the second layer 1112 can continue to collapse and the distance of following closely between lower limb 1121 and shaping pit 1142 can reduce.Similarly, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be reduced to distance 1101c, and this distance can be greater than, be equal to or less than and original be not out of shape storehouse height 1102a.Referring now to Figure 19 D, anvil block 1140 is moveable to final firing position, wherein follows closely 1120 and is shaped completely or is at least shaped to Desired Height.In this position, the tissue contacting surface 1141 of anvil block 1140 can with storehouse stayed surface 1131 distance 1101d, wherein distance 1101d can be shorter than and original not be out of shape storehouse height 1102a.Same as shown in Figure 19 D, can collapse completely or at least substantially in nail chamber 1115, and follow closely 1120 can completely or at least substantially by the second layer 1112 of collapsing around.In all cases, anvil block 1140 can move away from nail bin 1100 subsequently.Such as, once anvil block 1140 departs from from nail bin 1100, then warehouse 1110 can such as spread in various position (that is, the position between adjacent nail 1120) at least in part again.The warehouse 1110 of conquassation may not resiliently be expanded again.The nail 1120 be shaped and the warehouse 1110 be positioned in addition between adjacent nail 1120 can apply pressure or compression stress to tissue T, and this can provide various treatment benefit.

As mentioned above, refer again to Figure 19 A, each nail 1120 can comprise the nail lower limb 1121 extended from it.Such as, although nail 1120 is shown as comprise two nail lower limbs 1121, but also can utilize the various nails that can comprise a nail lower limb or alternatively comprise more than two nail lower limbs (such as three nail lower limbs or four nail lower limbs).As shown in Figure 19 A, each nail lower limb 1121 all can embed in the second layer 1112 of warehouse 1110, and nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted in the nail chamber 1115 in warehouse 1110, makes top 1123 the advancing in chamber 1115 at base portion 1122 of following closely lower limb 1121.After top 1123 is inserted into chamber 1115, top 1123 can be pressed against in cover 1116 and to cut the second layer 1112.Nail 1120 can be arranged to the enough depths in the second layer 1112, makes nail 1120 not move relative to the second layer 1112 or at least substantially not move.Nail 1120 can be arranged to the enough depths in the second layer 1112, makes base portion 1122 be located or embed in nail chamber 1115.Alternatively, base portion 1122 can not be located or is embedded in the second layer 1112.Refer again to Figure 19 A, base portion 1122 can extend below the lower surface 1118 of warehouse 1110.Base portion 1122 can be bearing on storehouse stayed surface 1130 or directly and locate against storehouse stayed surface 1130.Storehouse stayed surface 1130 can comprise the supporting construction extending from it and/or be defined in wherein, such as, support in one or more support trenches, slit or the groove 1132 that the base portion 1122 of nail 1120 can be positioned in such as nail bin support member 1130 or by this one or more support trenches, slit or groove 1132, as described in more detail below.

Further describe above, referring now to Figure 20, nail 1120 base portion 1122 can directly against nail bin support member 1130 stayed surface 1131 and locate.When following closely base portion 1122 and comprising circle or arcuate shaped bottom surface 1124, such as following closely base portion 1122 can move along nail bin stayed surface 1131 or slide.This slip can be there is when anvil block 1140 is compressed the top 1123 of nail lower limb 1121 during following closely forming process.As mentioned above and referring now to Figure 21, nail bin support member 1130 can comprise one or more support slit 1132 wherein, this one or more support slit can be eliminated or at least reduce the relative motion between nail base portion 1122 and storehouse stayed surface 1131.Such as, each support slit 1132 all can be limited by surface profile, the outline of this surface profile and the nail lower surface be positioned at wherein or at least substantially mate.Such as, the lower surface 1124 of the base portion 1122 shown in Figure 21 can comprise circle or at least substantially circular surface, and supports slit 1132 and also can comprise circle or at least substantially circular surface.Such as, the surface limiting slit 1132 can be limited by the radius of curvature being more than or equal to the radius of curvature limiting lower surface 1124.Although slit 1132 can help prevent or reduce the sliding relative movement between nail 1120 and nail bin support member 1130, but slit 1132 also can prevent or reduce the relative rotary motion between nail 1120 and nail bin support member 1130.More specifically, slit 1132 can closely receive base portion 1122, to prevent or to reduce the rotation of nail 1120 around axis 1129, such as, makes nail 1120 can not rotate or distortion when being out of shape.

To being described further above, each nail 1120 all can by circle or at least substantially round wire rod formed.Such as, multiple lower limb of each nail and base portion all can be formed by the wire rod with non-circular cross sections (such as rectangular cross section).Such as, nail bin support member 1130 can comprise corresponding non-circular slit (such as rectangular slot), and this non-circular slit can receive the base portion of this type of nail.Referring now to Figure 22, each nail 1120 all can comprise overmolding to the bizet on pedestal 1122, such as bizet 1125, and wherein each bizet 1125 all can be positioned in the support slit in nail bin support member 1130.Such as, each bizet 1125 all can comprise such as square and/or the cross section of rectangle, and this cross section can be received in the slit 1134 of square in such as nail bin support member 1130 and/or rectangle.Bizet 1125 can by can the plastics of bio-absorbable form, the complex of the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or such as PGA, PLA, PDS, PHA, PGCL and/or PCL, and formed around the base portion 1122 of nail 1120 by such as injection molding method.Various bizet and be disclosed in the U.S. Patent application 11/541 that name that JIUYUE in 2006 submits on the 29th is called " SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " for the formation of the method for various bizet, in 123, whole disclosures of this patent are incorporated herein by reference.Refer again to Figure 22, slit 1134 also can comprise introduction part or oblique angle 1135, and this introduction part or oblique angle can be conducive to bizet 1125 to insert in slit 1134.When nail bin 1100 is assembled to nail bin support member 1130, base portion and/or the bizet of nail 1120 can be positioned in slit 1134.When nail bin 1100 is assembled to nail bin support member 1130, the bizet 1125 of nail 1120 can align with slit 1134.Such as, bizet 1125 can not enter in slit 1134, until to nail lower limb 1121 apply compression stress and follow closely 1120 base portion and/or bizet be pushed down in slit 1134.

Referring now to Figure 23 and Figure 24, nail bin (such as nail bin 1200) such as can comprise compressible implanted warehouse 1210, and this warehouse comprises outer 1211 and internal layer 1212.To similar above, nail bin 1200 can comprise the multiple nails 1220 be positioned in warehouse 1210.One or more nail lower limbs 1221 that each nail 1220 all can comprise base portion 1222 and extend from it.Such as, follow closely lower limb 1221 can to insert in internal layer 1212 and to be arranged to the degree of depth such as making the lower surface 1218 of the adjacent and/or contiguous internal layer 1212 of base portion 1222 of nail 1220 locate.In Figure 23 and Figure 24, internal layer 1212 does not comprise the nail chamber of the part that can receive nail 1220, and alternatively, internal layer 1212 can comprise this type of nail chamber.To being described further above, internal layer 1212 can be made up of the compressible material that warehouse 1210 can be allowed to collapse when applying compressive load to it (such as can the foam of bio-absorbable and/or oxidized regenerated cellulose (ORC)).Internal layer 1212 can be made up of the freeze dried foam such as comprising polylactic acid (PLA) and/or polyglycolic acid (PGA).ORC can trade name Surgicel commercially available and loose Woven fabric (as surgical sponge), loose fiber (as cotton balls) and/or foam can be comprised.Internal layer 1212 can by wherein to comprise and/or applied atop has the material of medicine (such as cryodesiccated thrombin and/or fibrin) to form, and this medicine such as can by the fluid water activation in patient body and/or activation.Such as, cryodesiccated thrombin and/or fibrin can remain in such as Vicryl (PGA) substrate.Such as, but in some cases, when being inserted into when nail bin 1200 in the operative site in patient body, activable medicine can by mistake be activated.Refer again to Figure 23 and Figure 24, outer 1211 can by water impervious or at least substantially water impervious material form, liquid is not contacted or does not at least substantially contact internal layer 1212, until warehouse 1210 has been compressed and followed closely lower limb penetrated outer 1211 and/or after skin 1211 cut in some manner.Such as, outer 1211 can be made up of buttress material and/or plastic material (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA)).Outer 1211 can comprise the wrappage around internal layer 1212 and nail 1220.More specifically, follow closely 1220 can be inserted in internal layer 1212 and outer 1211 and to be wrapped around the sub-component comprising internal layer 1212 and nail 1220 and to be sealed subsequently.

Referring now to Figure 25 and Figure 26, nail bin (such as nail bin 1300) such as can comprise compressible implanted warehouse 1310, and this warehouse comprises outer 1311 and internal layer 1312.To similar above, nail bin 1300 also can comprise the nail 1320 be positioned in warehouse 1310, and wherein each nail 1320 all can comprise base portion 1322 and the one or more lower limbs 1321 from its extension.Be similar to nail bin 1200, the base portion 1322 of nail 1320 can extend below the lower surface 1318 of internal layer 1312, and outer 1311 can around base portion 1322.Such as, outer 1311 can have enough flexibilities to surround each nail base portion 1322, make skin 1311 conform to the profile of base portion 1322.Alternatively, refer again to Figure 24, outer 1211 can have enough rigidity, make it extend around base portion 1222 and not conform to each base portion 1222.In any case, outer 1311 can be positioned between the base portion 1322 of nail 1320 and the nail bin stayed surface (such as stayed surface 1031 or 1131) supporting nail bin 1300.Such as, outer 1311 can be positioned in base portion 1322 and be limited between the support slit (such as slit 1032 or 1132) in nail bin stayed surface.Such as, to being described further above, outer 1311 can limit the motion of base portion 1322 and/or increase base portion 1322 and nail bin stayed surface and/or the coefficient of friction that supports between slit to reduce relative motion therebetween.Alternatively, referring now to Figure 27 and Figure 28, the skin of nail bin (such as nail bin 1400) such as can by halves around the nail be positioned at wherein.Such as, before the nail lower limb 1421 of nail 1420 inserts in warehouse 1410, the skin 1411 of compressible implanted warehouse 1410 can be assembled to internal layer 1412.Such as, due to mentioned above, the base portion 1422 of nail 1420 is extensible in the outside of outer 1411, and such as base portion 1422 can directly be positioned in the support slit 1032 or 1132 in nail bin stayed surface 1031 or 1131.When following closely lower limb 1421 and being inserted through outer 1411, nail lower limb 1421 can cut outer 1411.In all cases, the hole formed by nail lower limb 1421 can closely around nail lower limb 1421, make to follow closely the fluid leaking few (if present) between lower limb 1421 and outer 1411, this can reduce or prevent the medicine held in nail bin body 1410 from being activated and/or leaking out the probability of warehouse 1410 prematurely.

As mentioned above, refer again to Figure 23 and Figure 24, the lower limb 1221 of nail 1220 can embed in warehouse 1210, and the base portion 1222 following closely 1220 can stretch out from the lower surface 1218 of internal layer 1212.To being described further above, internal layer 1212 can not comprise the nail chamber that can receive nail 1220.Alternatively, referring now to Figure 29 and Figure 30, nail bin (such as nail bin 1500) such as can comprise compressible implanted warehouse 1510, and this warehouse comprises the nail chamber 1515 at least partially that can receive nail 1520 wherein.Such as, the top of nail lower limb 1521 of nail 1520 can embed in internal layer 1512, and follows closely the bottom of lower limb 1521 and base portion 1522 can be positioned in nail chamber 1515.Base portion 1522 can be positioned in nail chamber 1515 completely, and base portion 1522 can extend at least in part below the lower surface 1518 of internal layer 1512.To similar above, outer 1511 can encapsulate internal layer 1512 and be arranged in the nail 1520 of internal layer 1512.Alternatively, referring now to Figure 31, nail bin 1600 can comprise the nail 1620 in the nail chamber 1615 that is positioned in compressible implanted warehouse 1610, wherein follow closely 1620 at least partially not by outer 1611 encapsulatings.Such as, each nail 1620 all can comprise and embeds nail lower limb 1621 in internal layer 1612 at least in part and in addition around outer 1611 outward extending base portions 1622.

Referring now to Figure 32 and Figure 33, multiple nails 1720 that nail bin (such as nail bin 1700) such as can comprise compressible implanted warehouse 1710 and be positioned at least in part in warehouse 1710.Warehouse 1710 can comprise skin 1711, internal layer 1712 and other alignment matrix 1740, and nail 1720 can align and/or remain on appropriate location in warehouse 1710 by this alignment matrix.Internal layer 1712 can comprise the groove 1741 that can receive alignment matrix 1740 wherein.Alignment matrix 1140 can be press-fitted in groove 1741 and/or in other words utilize at least one binding agent (such as fibrin and/or protein hydrogel) to be suitably fixed to internal layer 1712.Groove 1741 can make the lower surface 1742 of alignment matrix 1740 align with the lower surface 1718 of internal layer 1712 or at least substantial alignment.The lower surface 1742 of alignment matrix can cave in relative to the lower surface 1718 of the second layer 1712 and/or from its 1718 extend.One or more lower limbs 1721 that each nail 1720 all can comprise base portion 1722 and extend from base portion 1722, that wherein follows closely lower limb 1721 can extend across alignment matrix 1740 at least partially.Alignment matrix 1740 also can comprise the multiple hole and/or slit that such as extend through wherein, and described multiple hole and/or slit can receive nail lower limb 1721 wherein.Such as, each hole all closely can receive nail lower limb 1721, makes, between nail lower limb 1721 and the sidewall in hole, very little (if any) relative motion occurs.Alignment matrix hole can not exclusively extend through alignment matrix 1740, and when following closely lower limb 1721 and being pushed through wherein, nail lower limb 1721 can need to cut alignment matrix 1740.

Alignment matrix 1740 can be made up of the plasticity main body of molding, and the comparable internal layer 1712 of this main body and/or outer 1711 has more rigidity or compression ratio is lower.Such as, alignment matrix 1740 can be made up of plastic material and/or any other material be applicable to (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA)).Alignment matrix 1740 can be assembled to internal layer 1712, and follows closely lower limb 1721 subsequently and can be embedded in internal layer 1712 inserted through alignment matrix 1740.The lower surface 1742 of alignment matrix 1740 can comprise one or more grooves of the base portion 1722 that can receive nail 1720 at least in part, slit or groove.To similar above, outer 1711 can be placed on comprise internal layer 1712, alignment matrix 1740 and nail 1720 sub-component around.Alternatively, outer 1711 can be placed on comprise internal layer 1712 and alignment matrix 1740 sub-component around, wherein follow closely 1720 and can be inserted through outer 1711, alignment matrix 1740 and internal layer 1712 subsequently.In arbitrary situation, due to mentioned above, nail 1720 can be remained on appropriate location, until and/or be out of shape as noted above by anvil block at nail 1720 by internal layer 1712, alignment matrix 1740 and/or outer 1711.Such as, nail 1720 is remained on appropriate location before being used in the implanted patient body of nail bin 1700 by alignment matrix 1740, and in addition at the tailing edge nail line fixing organization that nail bin 1700 is implanted.Such as, nail 1720 can be fixed in alignment matrix 1740 and not be embedded in internal layer 1712 and/or outer 1711.

Referring now to Figure 34-Figure 40, by compression internal layer 1812, (such as following closely 1820) will be followed closely and insert in internal layer 1812, and assemble nail bin (such as nail bin 1800) by outer 1811 wrapping inner layer 1812.First see Figure 34, compressible internal layer 1812 is shown as including the multiple nail chambeies 1815 be defined in wherein, however also can dream up as mentioned above wherein internal layer 1812 do not comprise other embodiments in nail chamber.Referring now to Figure 35, compressible internal layer 1812 can be positioned between transfer plate 1850 and gripper shoe 1860 and to be compressed in respectively between its compressive surfaces 1852 and 1862.As shown in figure 35, the top surface of internal layer 1812 and lower surface can towards being compressed each other, and in response to this, internal layer 1812 can outwards expand in a lateral direction.Internal layer 1812 can be compressed into the At The Height of about 1/3rd of such as its original height, and the height that can have in its compressive state such as between about 0.06 " to about 0.08 " or thickness.Equally as shown in figure 35, transfer plate 1850 also can comprise the multiple nails be such as positioned in multiple nail well 1853 and such as follows closely 1820.In addition, transfer plate 1850 also can comprise multiple driver 1851, and described multiple driver can by outside nail 1820 upwards push nail well 1853.Referring now to Figure 36, driver 1851 can be utilized to be pushed by the nail lower limb 1821 of nail 1820 in the internal layer 1812 of compression and the internal layer 1812 making it pass compression.Driver 1851 can make when nail 1820 is fully deployed from the nail well 1853 of transfer plate 1850, and the top surface of driver 1851 is oriented to flush with the compressive surfaces 1852 of transfer plate 1850 or at least almost flush.Equally as shown in figure 36, gripper shoe 1860 can comprise multiple receiver hole 1861, and it after nail lower limb 1821 is pushed through internal layer 1812, can receive the top of following closely lower limb 1821 or at least following closely lower limb 1821.When internal layer 1812 has been compressed into the At The Height being shorter than nail 1820 height, it is required that receiver hole 1861 or similar structures can be, and therefore when nail 1820 penetrates completely from nail well 1853, nail lower limb 1821 can from the top surface projection of the internal layer 1812 of compression.Alternatively, internal layer 1812 can be compressed into the At The Height higher than nail 1820 height, does not therefore need the receiver hole 1861 in gripper shoe 1860.

Referring now to Figure 37, after nail 1820 is inserted in internal layer 1812, gripper shoe 1860 can be moved, to allow internal layer 1812 to decompress away from transfer plate 1850.In this case, internal layer 1812 can extend to it initially or at least close to initial uncompressed height by elastic type again.When internal layer 1812 is expanded again, the height of internal layer 1812 can increase to the height that exceedes nail 1820 and make the nail lower limb 1821 of nail 1820 no longer from the top surface projection of internal layer 1812.In all cases, nail lower limb 1821 can be remained on appropriate location by receiver hole 1861, at least until gripper shoe 1860 has moved to enough far away and made lower limb 1821 no longer be positioned in receiver hole 1861.In this case, receiver hole 1861 can keep alignment relative by the nail 1820 contributed in internal layer 1812 when internal layer 1812 is expanded again.In all cases, internal layer 1812 and the nail 1820 be positioned at wherein can comprise sub-component 1801, and referring now to Figure 38, this sub-component can such as be inserted in outer 1811.Such as, outer 1811 can comprise the cavity 1802 be defined in wherein, and this cavity can receive sub-component 1801 wherein.In all cases, instrument (such as tweezers 1855) can be utilized by outer 1811 tractives on sub-component 1801.Referring now to Figure 39, once sub-component 1801 is positioned in outer 1811 completely, then outer 1811 can be sealed.The heat energy that the part to outer 1811 can be utilized to apply carrys out sealable outer 1811.More specifically, outer 1811 can be made up of plastic material, and the opening of its ectomesoderm 1811 can by one or more by the element that heats or ferrum 1856 hot melt, to be combined by the periphery of the opening of outer 1811 and/or to be sealed.Such as, referring now to Figure 40, the redundance 1857 of outer 1811 can be removed, and as described hereinly can use nail bin 1800 subsequently.

As mentioned above, nail bin can be positioned in nail bin attachment and/or is fixed to nail bin attachment.Referring now to Figure 41 and Figure 42, nail bin attachment can comprise nail bin passage (such as nail bin passage 1930), and this nail bin passage such as can receive nail bin (such as nail bin 1900) wherein at least partially.Nail bin passage 1930 can comprise bottom support surface 1931, first lateral support wall 1940 and the second lateral support wall 1941.In use, nail bin 1900 can be positioned in nail bin passage 1930, make nail bin 1900 against and/or adjacent bottom stayed surface 1931 locate, and to be positioned between the first lateral support wall 1940 and the second lateral support wall 1941.First lateral support wall 1940 and the second lateral support wall 1941 can limit sideshake between the two at them.Such as, nail bin 1900 can comprise lateral width 1903, this lateral width is same as and/or wider than the sideshake be limited between supporting walls 1940 and 1941, the compressible implanted warehouse 1910 of nail bin 1900 can be engaged between wall 1940 and 1941 securely.Alternatively, the comparable gap be limited between the first side wall 1940 and the second sidewall 1941 of the lateral width 1903 of nail bin 1900 is short.Such as, can being limited by the metal passage of punching press with bottom support surface 1931 at least partially of wall 1940 and 1941, and can being made up of flexible material (such as elastomeric material) at least partially of lateral support wall 1940 and/or lateral support wall 1941.First see Figure 41, the first side wall 1940 of nail bin passage 1930 and the second sidewall 1941 all can be formed by the rigid element 1933 upwards extended from bottom support surface 1931 and from the flexible portion 1934 that rigid element 1933 upwards extends.

To being described further above, the warehouse 1910 of nail bin 1900 can be made up of one or more compressible layer (such as ground floor 1911 and the second layer 1912).When warehouse 1910 is compressed against bottom support surface 1931 as mentioned above by anvil block, the sidepiece of warehouse 1910 can laterally be expanded.When nail bin 1930 is made up of rigid sidewalls, rigid sidewalls can prevent or at least limit the lateral expansion of warehouse 1910, therefore can produce internal pressure or the stress of significant quantity in warehouse 1910.When being made up of flexible sidewall at least partially of nail bin 1930, flexible sidewall laterally can bend and allow the sidepiece lateral expansion of warehouse 1910, thus reduces the internal pressure that produces in warehouse 1910 or stress.When storehouse passage does not comprise lateral sidewalls or included lateral sidewalls is relatively shorter than nail bin, the sidepiece of nail bin can not suppressed ground or lateral expansion not suppressedly at least substantially.Referring now to Figure 42, in any case, nail bin passage 2030 can comprise lateral sidewalls 2040 and 2041, and this sidewall can be made up of flexible material (such as elastomeric material) completely.Nail bin passage 2030 also can comprise the side direction slit 2033 that the side along the bottom support surface 2031 of nail bin passage 2030 extends, this side direction slit can hold wherein and fixed lateral sidewall 2040 and 2041 at least partially.Lateral sidewalls 2040 and 2041 and/or can be press-fitted structure and be fixed in slit 2033 via snap fit, or lateral sidewalls 2040 and 2041 is fixed in slit 2033 by one or more binding agents.Sidewall 2040 can be separated with bottom support surface 2031 during use with 2041.In any case, when implant in warehouse 2010 have a nail 2020 time, compressible implanted warehouse 2010 can be separated with 2041 with sidewall 2040 and/or depart from.

Referring now to Figure 43, the end effector that surgical instruments can comprise axle 2150 and extend from the distal end of axle 2150.To similar above, the nail bin 2100 that end effector can comprise nail bin passage 2130, the anvil block 2140 that can move between the open position and the closed position and be positioned between nail bin passage 2130 and anvil block 2140.Be similar to above equally, nail bin 2100 can comprise compressible implanted warehouse 2110 and be arranged in multiple nails 2120 of warehouse 2110.Nail bin passage 2130 can comprise 1) bottom support surface 2131, nail bin 2100 can be located, 2 against this bottom support surface) distal end 2135, and 3) proximal extremity 2136.As shown in figure 43, nail bin 2100 can comprise first end 2105 that can be positioned in the distal end 2135 of nail bin passage 2130 and second end 2106 that can be positioned in the proximal extremity 2136 of nail bin passage 2130.The distal end 2135 of nail bin passage 2130 can comprise at least one distally and keep feature structure (such as retaining wall 2137); Similarly, proximal extremity 2136 can comprise such as at least one nearside and keep feature structure (such as retaining wall 2138).Such as, distally retaining wall 2137 and nearside retaining wall 2138 can limit marginal gap, this gap can be equal to or less than the length of nail bin 2100, and make when nail bin 2100 is inserted in nail bin passage 2130, nail bin 2100 can be matched with in nail bin passage 2130 securely.

Refer again to Figure 23 and Figure 24, nail bin (such as nail bin 1200) such as can comprise smooth or at least substantially smooth tissue contacting surface 1219.Such as, the nail bin body 1210 of nail bin 1200 can comprise first end 1205 that can be limited by the first height or thickness 1207 and second end 1206 that can be limited by the second height or thickness 1208, and wherein the first height 1207 can equal or at least be substantially equal to the second height 1208.Warehouse 1210 can comprise height that is constant or at least substantial constant or thickness between the first end 1205 and the second end 1206.Such as, tissue contacting surface 1219 can be parallel or at least substantially parallel to the lower surface 1218 of warehouse 1210.Refer again to Figure 43, the first end 2105 of the warehouse 2110 of nail bin 2100 can be limited by the first height 2107, and this first is highly different from second highly 2108 of the second end 2106.In the embodiment shown, the first height 2107 is greater than the second height 2108, but in the embodiment of alternative, the second height 2108 can be greater than the first height 2107.The height of warehouse 2110 can reduce linearly and/or geometrically between the first end 2105 and the second end 2106.Such as, the tissue contacting surface 2119 extended between the first end 2105 and the second end 2106 can carry out orientation along the angle limited between two ends.Such as, tissue contacting surface 2119 can be not parallel to the lower surface 2118 of warehouse 2110 and/or be not parallel to the stayed surface 2131 of nail bin passage 2130.

Refer again to Figure 43 and Figure 44, anvil block 2140 can comprise tissue contacting surface 2141, and when anvil block 2140 is in the close position, this tissue contacting surface can be parallel to or at least substantially parallel to the stayed surface 2131 of nail bin passage 2130, as shown in figure 44.When anvil block 2140 is in the close position, anvil block 2140 can be greater than the second end 2106 to the degree that the first end 2105 of nail bin 2100 compresses, this is because the height of the first end 2105 is higher, and the height of the second end 2106 is lower.In some cases, comprise the tissue T be wherein positioned between tissue contacting surface 2119 and 2141 and have situation that is constant or at least thickness of substantial constant, the pressure produced at the distal end place of end effector in tissue T and storehouse 2100 can be greater than the pressure produced at the proximal extremity place of end effector.More specifically, when tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant, the tissue T be positioned between the distal end 2145 of anvil block 2140 and the first end 2105 of nail bin 2100 can be greater than the tissue T between proximal extremity 2146 and the second end 2106 of nail bin 2100 being positioned at anvil block 2140 by the degree compressed.Barometric gradient can be produced in the tissue T between the proximal extremity and distal end of end effector.More specifically, tissue T between anvil block 2140 and nail bin 2100 there is the thickness of substantial constant and the height of nail bin 2100 reduces from the distal end of end effector linearly to proximal extremity time, the pressure in tissue T can reduce linearly from the distal end of end effector to the proximal extremity of end effector.Similarly, tissue T between anvil block 2140 and nail bin 2100 there is the thickness of substantial constant and the height of nail bin 2100 geometrically reduces from the distal end of end effector to proximal extremity time, the pressure in tissue T geometrically can reduce from the distal end of end effector to the proximal extremity of end effector.

Refer again to Figure 43, be positioned at nail bin 2100 and can not have throughout constant thickness wherein with the tissue T in the middle of anvil block 2140.At at least one in this case, the tissue T be positioned between the proximal extremity 2146 of anvil block 2140 and the second end 2106 of nail bin 2100 can be thicker than the tissue T between distal end 2145 and the first end 2105 of nail bin 2100 being positioned at anvil block 2140.Therefore, in this case, thicker tissue T can be positioned at above the lower proximal extremity 2106 of nail bin 2100 usually, and thinner tissue T can be usually located at above higher distal end 2105.In use, the percussion lining ring 2152 of axle 2150 distally can advance along axle ridge 2151, makes to pull the trigger the cam part 2143 that lining ring 2152 engages anvil block 2140, and anvil block 2140 is rotated towards nail bin 2100, as shown in figure 44.Once anvil block 2140 rotates to completely closed position, then tissue T can be compressed between tissue contacting surface 2119 and 2141, although and the height of nail bin 2100 can be non-constant between the proximal extremity of end effector and distal end, be applied to the pressure of tissue T or compression stress in tissue T, can be constant or at least substantial constant.More specifically, when thinner tissue T can with the higher height correlation of nail bin 2100 and thicker tissue T can lower height correlation with nail bin 2100 time, the cumulative height of tissue T and nail bin 2100 or height sum can be constant or at least substantial constant between the proximal extremity of end effector and distal end, and therefore anvil block 2140 is to this cumulative being compressed in cumulative height and can be constant or at least substantial constant highly.

Refer again to Figure 43 and Figure 44, nail bin 2100 can comprise asymmetric configuration.Such as, the height of nail bin 2100 at its first end 2105 place can higher than the height of nail bin 2100 at its second end 2106 place.Nail bin 2100 and/or nail bin passage 2130 can comprise one or more alignment and/or keep feature structure, it can guarantee that nail bin 2100 can only be positioned in nail bin passage 2130 in an orientation (that is, wherein the first end 2105 to be positioned in the distal end 2135 of nail bin passage 2130 and the second end 2106 is positioned the orientation in proximal extremity 2136).Alternatively, nail bin 2100 and/or nail bin passage 2130 can comprise one or more alignment and/or keep feature structure, and it can allow nail bin 2100 to be positioned in nail bin passage 2130 in more than one orientation.Referring now to Figure 45, such as nail bin 2100 can be positioned in nail bin passage 2130, the first end 2105 of nail bin 2100 can be positioned in the proximal extremity 2136 of nail bin passage 2130, and the second end 2106 can be positioned in distal end 2135.Therefore, the nail bin 2100 of lower height can be close to distally retaining wall 2137 and locate, and the nail bin 2100 of high height can be close to nearside retaining wall 2138 locates.Such as, nail bin 2100 can be arranged to apply clamping pressure that is constant or at least substantial constant to tissue T suitably, and this tissue T has thicker and divides and in the proximal extremity of end effector, have thinner divide in the distal end of end effector.Nail bin 2100 such as can in nail bin passage 2130 optionally orientation.Such as, the alignment of nail bin 2100 and/or maintenance feature structure can be symmetrical, and surgeon can carry out selectivity orientation to nail bin 2100 along the direction such as shown in Figure 43 and Figure 45 in nail bin passage 2130.

To being described further above, implanted warehouse 2110 can comprise longitudinal axis 2109, and when nail bin 2100 is positioned in nail bin passage 2130, this longitudinal axis can extend between the proximal extremity of end effector and distal end.The thickness of warehouse 2110 can between the first end 2105 and the second end 2106 along the longitudinal axis 2109 substantially reduce and/or substantially increase.Such as, the distance between lower surface 2118 and tissue contacting surface 2119 or height can substantially reduce and/or substantially increase between the first end 2105 and the second end 2106.The thickness of warehouse 2110 along the longitudinal axis 2109 both can increase and also can reduce.Such as, the thickness of warehouse 2110 can be included in one or more part that thickness increases and one or more parts that can reduce on thickness.Nail bin 2100 can comprise the multiple nails 2120 be positioned at wherein.In use, as mentioned above, when anvil block 2140 moves in make position, 2120 deformables are followed closely.Each nail 2120 can have identical or at least substantially the same height.Such as, the height of nail such as can be measured from the bottom of nail base portion to the nail top of the highest lower limb or top.

Nail in nail bin can have different staple heights.Such as, nail bin can comprise first group of nail with the first staple height and second group of nail with the second staple height, and this first group nail is positioned in the Part I of compressible warehouse, and second group of nail is positioned in the Part II of compressible warehouse.First staple height can higher than the second staple height, and first group of nail can be positioned in the first end 2105 of nail bin 2100, and second group of nail can be positioned in the second end 2106.Alternatively, first group of higher nail can be positioned in the second end 2106 of nail bin 2100, and lower second group of nail can be positioned in the first end 2105.Can utilize multiple nail group, wherein often group has different staple heights.Such as, there is the 3rd group of middle staple height can be positioned in first group of nail and follow closely in the warehouse 2110 of centre with second group.Each nail in nail row in nail bin can comprise different staple heights.The highest nail in nail row can be positioned on first end of nail row, and minimum nail can be positioned on the opposing end portions of this nail row.Such as, the nail be positioned between the highest nail and minimum nail can be arranged such that staple height such as declines between the highest nail and minimum nail.

Referring now to Figure 46, the nail bin 2200 that the end effector of surgical stapling device can comprise anvil block 2240, nail bin passage 2230 and be supported by nail bin passage 2230.Multiple nails that nail bin 2200 can comprise compressible implanted warehouse 2210 and such as be positioned in warehouse 2210, such as follow closely 2220a and nail 2220b.Nail bin passage 2230 can comprise storehouse stayed surface 2231 and the multiple nails be such as defined in wherein support slit, such as supports slit 2232a and 2232b.Such as, nail bin 2200 can comprise nail 2220b in two outer nail 2220a and two, and wherein supporting slit 2232a can support nail 2220a, and support slit 2232b can support nail 2220b.See Figure 46 and Figure 47, anvil block 2240 can comprise the multiple nail shaping pits 2242 be defined in wherein, and when anvil block 2240 moves towards nail bin 2200, described multiple nail shaping pit can receive nail 2220a and 2220b and make it be out of shape.Such as, the lower surface supporting slit 2232a can with the top surface of nail shaping pit 2242 at a distance of the first distance 2201a, and support slit 2232b lower surface can with the top surface second distance 2201b apart of nail shaping pit 2242.Such as, due to limit wherein support slit 2232b stayed surface 2231 in there is the step of rising, therefore support slit 2232b and locate closer to anvil block 2240.Owing to having different distance 2201a and 2201b, outer nail 2220a and interior nail 2220b can be deformed to different forming heights.In all cases, the nail being deformed into differing formed height can apply different clamping pressures or power to sewed up tissue T.To being described further above, originally nail can have different unshaped staple heights.Such as, refer again to Figure 46, the initial unshaped height of outside nail 2220a can be greater than the initial unshaped height of inner side nail 2220b.As shown in Figure 46 and Figure 47, unshaped height also can have lower than the inner side nail 2220b of outside nail 2220a the forming height following closely 2220b lower than outside.Alternatively, nail 2220b in inner side can have the distortion staple height had lower than outside nail 2220a higher than the unshaped height of outside nail 2220a.

To being described further above, as shown in figure 47, anvil block 2240 is moveable in make position, to compress warehouse 2210 and to make nail 2220a and 2220b be out of shape.Such as, the surgical stapling device comprising the end effector shown in Figure 46 and Figure 47 also can comprise cutting element, and this cutting element crosscut can be positioned anvil block 2240 tissue T middle with nail bin 2200.Such as, anvil block 2240, nail bin passage 2230 and/or nail bin 2200 can limit slit, and this slit can receive cutting element wherein slidably.More specifically, anvil block 2240 can comprise slot portion 2249, and nail bin passage 2230 can comprise slot portion 2239, and nail bin 2200 can comprise slot portion 2203, when anvil block 2240 is in the close position or at least substantially in the close position time, described slot portion can be alignd or at least substantial alignment mutually.After anvil block 2240 is closed and follows closely 2220a, 2220b distortion, cutting element can move from the proximal extremity of end effector towards the distal end of end effector.Cutting element can move with the incoherent mode of nail deformation process.Cutting element can advance while nail distortion.In any case, cutting element can along the path incision tissue be positioned in the middle of interior nail row 2220b.

As shown in figure 47, inner side nail 2220b can be shaped to the height lower than outside nail 2220a, and the tissue that wherein inner side nail 2220b can be adjacent to the line of cut formed with cutting element applies larger clamping pressure or power.Such as, the larger clamping pressure that inner side nail 2220b is formed or power can provide various treatment benefit, such as make to be cut tissue T and reduce hemorrhage, and the less clamping pressure that outside nail 2220a is formed can provide motility in the tissue sewed up.Refer again to Figure 46 and Figure 47, anvil block 2240 also can comprise at least one the buttress material be such as attached on it, such as buttress material 2260.Such as, incision buttress material 2260 and/or through the hole in buttress material 2260 when the lower limb following closely 2220a, 2220b can be compressed by anvil block 2240 at nail bin 2200 and contact the nail shaping pit 2242 in anvil block 2240 subsequently.When following closely the lower limb distortion of 2220a, 2220b, described lower limb can contact and/or cut buttress material 2260 again.Buttress material 2260 can be improved the hemostatic capability of institute's suture tissue and/or provide intensity for institute's suture tissue.

Refer again to Figure 46 and Figure 47, the lower surface of warehouse 2210 can comprise stepped profile, and this stepped profile is mated with the stepped profile of storehouse stayed surface 2231 or at least substantially mated.The lower surface deformable of warehouse 2210 is with coupling or the profile at least substantially mating storehouse stayed surface 2231.Referring now to Figure 48, the end effector being similar to end effector shown in Figure 46 such as can comprise the nail bin 2300 be positioned at wherein.Nail bin 2300 can comprise the compressible implanted main body 2310 with internal layer 2312 and outer 2311, and wherein to being described further above, outer 2311 can be made up of water impervious material.Outer 2311 can extend around nail 2220a, 2220b and can be positioned at respectively in the middle of nail 2220a, 2220b and support slit 2232a, 2232b.Referring now to Figure 49, the end effector being similar to end effector shown in Figure 46 such as can comprise the nail bin 2400 be positioned at wherein.Be similar to nail bin 2300, the compressible implanted warehouse 2410 of nail bin 2400 can comprise internal layer 2412 and outer 2411; But, cutting element slit can not be comprised in warehouse 2410.Such as, cutting element may need the such as incision internal layer 2412 and/or outer 2411 when it is pushed into through nail bin.

Referring now to Figure 50, the nail bin 2500 that the end effector of surgical stapling device can comprise anvil block 2540, nail bin passage 2530 and be positioned in nail bin passage 2530.To similar above, nail bin 2500 can comprise compressible implanted warehouse 2510, outer nail 2220a and interior nail 2220b.Nail bin passage 2530 can comprise smooth or at least substantially smooth storehouse stayed surface 2531 and the nail be defined in wherein supports slit 2532.Anvil block 2540 can comprise stepped surface 2541 and be defined in multiple nail shaping pits (such as shaping pit 2542a and 2542b) wherein.To similar, distance can be limited with between shaping pit 2542a and support slit 2532, the distance that described distance is greater than shaping pit 2452b and supports between slit 2532 above.Anvil block 2540 also can comprise a buttress material 2560 of the stepped surface 2541 being attached to anvil block 2540.Such as, buttress material 2560 can conform to or at least substantially conform to stepped surface 2541.Buttress material 2560 is attached to surface 2541 removedly by least one binding agent (such as, fibrin and/or protein hydrogel).Warehouse 2510 also can comprise staged profile, and this staged profile is parallel to or at least substantially parallel to the stepped surface 2541 of anvil block 2540.More specifically, anvil block 2540 can comprise the step 2548 extended towards nail bin 2500, and wherein step 2548 can comprise shoulder height, and this shoulder height equals or is at least substantially equal to the shoulder height of the step 2508 extended from warehouse 2510.Such as, due to mentioned above, the amount that such as compressible warehouse 2510 can be captured in the first nail 2220a can be different from the amount that compressible warehouse 2510 can be captured in the second nail 2220b.

Referring now to Figure 51, the nail bin 2600 that end effector can comprise anvil block 2640, nail bin passage 2530 and be positioned at wherein.Nail bin 2600 can comprise compressible implanted warehouse 2610, and this warehouse comprises internal layer 2612, skin 2611 and is positioned at multiple nails (such as following closely 2220a and 2200b) wherein.Anvil block 2640 can comprise multiple nail shaping pit 2642 on surface 2641, and nail bin passage 2530 can comprise the multiple nail formed slots 2532 be limited in stayed surface 2531.As shown in figure 51, anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface 2531, and wherein each shaping pit 2642 can be oriented to support slit 2532 with relative and corresponding nail at a distance of equivalent or at least substantially equivalent distance.Nail bin 2600 can comprise nail, and this nail can have identical or at least substantially the same initial unshaped staple height and identical or at least substantially the same shaping staple height.Alternatively, outer nail row can comprise nail 2220a and interior nail row can comprise nail 2220b, and wherein as mentioned above, nail 2220a and 2220b can have different unshaped staple heights.When anvil block 2640 moves to make position towards nail bin 2600, nail 2220a and 2220b can be so shaped that they have identical or at least substantially the same shaping staple height.Such as, due to mentioned above, the compressible warehouse 2610 of identical or at least substantially the same amount in the outside nail 2220a of shaping and inner side nail 2220b, can be accommodated.Such as, but when outside nail 2220a has the unshaped staple height higher than inner side nail 2220b and can have identical shaping staple height, the clamping pressure produced in outside nail 2220a can be greater than the clamping pressure produced in the nail 2220b of inner side.

Referring now to Figure 52, the nail bin 2700 that the end effector of surgical stapling device can comprise anvil block 2740, nail bin passage 2530 and be positioned in nail bin passage 2530.To similar above, nail bin 2700 can comprise compressible implanted warehouse 2710, and this warehouse comprises internal layer 2712, skin 2711 and is positioned at multiple nails (such as following closely 2220a and 2220b) wherein.The thickness of warehouse 2710 can change on its whole width range.Such as, warehouse 2710 can comprise central part 2708 and sidepiece 2709, and wherein the thickness of central part 2708 can be greater than the thickness of sidepiece 2709.The thickest part of warehouse 2710 can be positioned at central part 2708 place, and the thinnest part of warehouse 2710 can be positioned at sidepiece 2709 place.Such as, the thickness of warehouse 2710 can reduce gradually between central part 2708 and sidepiece 2709.The thickness of warehouse 2710 can reduce linearly and/or geometrically between central part 2708 and sidepiece 2709.Such as, the tissue contacting surface 2719 of warehouse 2710 can comprise tilting or angled surface from central part 2708 towards sidepiece 2709 downward-sloping two.Anvil block 2740 can comprise two tilt or angled surface, this surface be parallel to or at least substantially parallel to tilt tissue contacting surface 2719.Anvil block 2740 also can comprise at least one piece of buttress material 2760 of the inclined surface being attached to anvil block 2740.

To being described further above, the interior nail row in nail bin 2700 can comprise higher nail 2220a and outer nail row can comprise lower nail 2220b.Higher nail 2220a can be positioned in thicker central part 2708 and/or be adjacent, and follows closely 2220b and can be positioned in sidepiece 2709 and/or be adjacent.Such as, due to mentioned above, the nail 2220b that higher nail 2220a can be lower catches the material of more implanted warehouse 2710.This situation can make nail 2220a apply larger clamping pressure than nail 2220b to tissue T.Although the nail 2220b that higher nail 2220a can be lower catches the material of more warehouse 2710, but owing to following closely the oblique structure of shaping pit 2742a and 2742b, the nail 2220b that therefore higher nail 2220a can be lower has higher shaping staple height.Can utilize this type of Consideration in nail 2220a and the 2220b tissue of catching, realize the clamping pressure expected, wherein as a result, the such as clamping pressure followed closely in 2220a can be greater than, is less than or equals to follow closely the clamping pressure that 2220b applies tissue.In the embodiment of the various alternatives of end effector shown in Figure 52, lower nail 2220b can be positioned in the thicker central part 2708 of warehouse 2710 and/or be adjacent, and higher nail 2220a can be positioned in thinner sidepiece 2709 and/or be adjacent.In addition, although nail bin 2700 is shown as including inner side and outside nail row, but nail bin 2700 can comprise the additionally row of nail, is such as positioned at inner side nail row and outside and follows closely the nail between arranging and arrange.Such as, the unshaped staple height of middle nail row can between the unshaped staple height of nail 2220a and the unshaped staple height of nail 2220b, and the shaping staple height of middle nail row is between the shaping staple height and the shaping staple height of nail 2220b of nail 2220a.

Referring now to Figure 53, the nail bin 2800 that the end effector of surgical stapling device can comprise anvil block 2840, nail bin passage 2530 and be positioned in nail bin passage 2530.To similar above, nail bin 2800 can comprise compressible implanted warehouse 2810, and this warehouse comprises internal layer 2812, skin 2811 and is positioned at multiple nails (such as following closely 2220a and 2220b) wherein.The thickness of warehouse 2810 can change on its whole width range.Such as, warehouse 2810 can comprise central part 2808 and sidepiece 2809, and wherein central part 2808 can have the thickness of the thickness being less than sidepiece 2809.The thinnest part of warehouse 2810 can be positioned at central part 2808 place, and the thickest part of warehouse 2810 can be positioned at sidepiece 2809 place.Such as, the thickness of warehouse 2810 can increase gradually between central part 2808 and sidepiece 2809.The thickness of warehouse 2810 can increase linearly and/or geometrically between central part 2808 and sidepiece 2809.Such as, the tissue contacting surface 2819 of warehouse 2810 can comprise upwards tilting or angled surface than two that fall from central part 2808 towards sidepiece 2809.Anvil block 2840 can comprise two tilt or angled surface, described surface be parallel to or at least substantially parallel to tilt tissue contacting surface 2819.Anvil block 2840 also can comprise at least one piece of buttress material 2860 of the inclined surface being attached to anvil block 2840.To being described further above, the outside nail row in nail bin 2800 can comprise higher nail 2220a and inner side nail row can comprise lower nail 2220b.Higher nail 2220a can be positioned in thicker sidepiece 2809 and/or adjacent with thicker sidepiece 2809, and follows closely 2220b and can be positioned in central part 2808 and/or adjacent with central part 2808.Such as, due to mentioned above, the nail 2220b that higher nail 2220a can be lower catches the material of more implanted warehouse 2810.

As described in the embodiment above with reference to Figure 46, such as, nail bin passage 2230 can comprise stepped support surface 2231, and nail 2220a and 2220b can be supported on differing heights place relative to anvil block 2240 by this stepped support surface.Nail bin passage 2230 can be made up of metal, and the step in stayed surface 2231 is formed in stayed surface 2231 by such as grinding operation.Referring now to Figure 54, the end effector of surgical instruments can comprise nail bin passage 2930, and this nail bin passage comprises the support insert 2935 be positioned at wherein.More specifically, nail bin passage 2930 can be formed to make it have such as smooth or at least substantially smooth stayed surface 2931, this stayed surface can support insert 2935, and this insert comprises the stepped surface for nail 2220a and 2220b of nail bin 2200 being supported on differing heights place.Such as, insert 2935 can comprise smooth or at least substantially smooth lower surface, and this lower surface can be located against stayed surface 2931.Insert 2935 also can comprise support slit, groove or groove 2932a and 2932b, and nail 2220a and 2220b can be supported on differing heights place by respectively.To similar above, insert 2935 can comprise the cutter slit 2939 be defined in wherein, and this cutter slit can allow cutting element to pass wherein.Nail bin passage 2930 can be formed by being same or different from the material supporting insert 2935.Nail bin passage 2930 and support both inserts 2935 and all can such as be made up of metal, and alternatively, nail bin passage 2930 can be such as made up of metal, and support insert 2935 and can such as be made up of plastics.Supporting insert 2935 can be fastened and/or be welded in nail bin passage 2930.Supporting insert 2935 can snap fit and/or be press-fitted in nail bin passage 2930.Binding agent can be used to be fixed in nail bin passage 2930 by support insert 2935.

Referring now to Figure 55, the end effector of surgical stapling device can comprise anvil block 3040, nail bin passage 3030 and be positioned the compressible implanted nail bin 3000 in nail bin passage 3030.To similar above, anvil block 3040 can comprise the multiple nail shaping pit 3042 be defined in wherein and the cutter slit 3049 that cutting element can be slidably received within wherein.Be similar to above equally, nail bin passage 3030 can comprise the cutter slit 3039 being defined in multiple nails wherein and supporting slit 3032 and also cutting element can be slidably received within wherein.Nail bin 3000 can comprise ground floor 3011, the second layer 3012 and such as be positioned at multiple nails (such as following closely 3020a and 3020b) wherein.The unshaped staple height of nail 3020a can higher than the unshaped staple height of nail 3020b.Ground floor 3011 can be made up of the first compressible material, and the second layer 3012 can be made up of the second compressible material.The compression ratio of the first compressible material can higher than the second compressible material, and alternatively, the compression ratio of the first compressible material can lower than the second compressible material.First compressible material can be made up of the elastomeric material can with the first device of spring stiffness coefficient, and the second compressible material can be made up of the elastomeric material can with two device of spring stiffness coefficients, described second device of spring stiffness coefficient is different from described first device of spring stiffness coefficient.The device of spring stiffness coefficient of the first compressible material can be greater than the device of spring stiffness coefficient of the second compressible material.Alternatively, the device of spring stiffness coefficient of the first compressible material can be less than the device of spring stiffness coefficient of the second compressible material.First compressible stratum can have the first rigidity, and the second compressible stratum can have the second rigidity, and wherein the first rigidity is different from the second rigidity.The rigidity of the first compressible stratum can be greater than the rigidity of the second compressible stratum.Alternatively, the rigidity of the first compressible stratum can be less than the rigidity of the second compressible stratum.

Refer again to Figure 55, the second layer 3012 of nail bin 3000 can comprise thickness that is constant or at least substantial constant on its whole width.The thickness of ground floor 3011 can change on its whole width.Such as, ground floor 3011 can comprise one or more step 3008, and this step can increase the thickness of warehouse 3010 in some part (such as central part) of warehouse 3010.Refer again to Figure 55, lower nail 3020b can be positioned in step 3008 (namely the thicker of warehouse 3010 is divided) or with step 3008 and align, and the thinner that higher nail 3020a can be positioned in warehouse 3010 divide in or to divide with described thinner and align.The result that thicker as warehouse 3010 is divided and thinner is divided, the rigidity of the inner row along nail 3020b of warehouse 3010 can be greater than the rigidity of the outer row along nail 3020a.Ground floor 3011 can be connected to the second layer 3012.Such as, ground floor 3011 and the second layer 3012 can comprise interlocking features structure, and layer 3011 and 3012 can keep together by this interlocking features structure.Ground floor 3011 can comprise ground floor compound and the second layer 3012 can comprise second layer compound, and wherein ground floor compound adheres to second layer compound by one or more binding agents.Nail bin 3000 can comprise cutter slit 3003, and this cutter slit can hold cutting element wherein slidably.

Referring now to Figure 56, nail bin 3100 can comprise compressible implanted warehouse 3110, multiple nails (such as following closely 3020b) that this warehouse comprises monolayer compressible material and is such as positioned in addition wherein.The thickness of warehouse 3110 can change on its whole width.Such as, warehouse 3110 can comprise the step 3108 extended along its sidepiece.Referring now to Figure 57, nail bin 3200 can comprise compressible implanted warehouse 3210, multiple nails (such as following closely 3020b) that this warehouse comprises monolayer compressible material and is such as positioned in addition wherein.The thickness of warehouse 3210 can change on its whole width.Such as, warehouse 3210 can comprise the step 3208 extended along its sidepiece.Referring now to Figure 58, nail bin 3300 can comprise compressible implanted warehouse 3310, and wherein to similar above, the thickness of warehouse 3310 can change on its whole width.The thickness of warehouse 3310 geometrically can increase between the sidepiece of warehouse 3310 and central part.Such as, the thickness of warehouse 3310 can be limited by arc or bending profile and can comprise arc or bending tissue contacting surface 3319.The thickness of warehouse 3310 and the profile of tissue contacting surface 3319 by a such as radius of curvature, or alternatively can be limited by some radius of curvature.Referring now to Figure 59, nail bin 3400 can comprise compressible implanted warehouse 3410, and wherein the thickness of warehouse 3410 can increase to substantial linear linearly or at least between the sidepiece of warehouse 3410 and central part.

Referring now to Figure 60, multiple nails 3520 that nail bin 3500 can comprise compressible implanted warehouse 3510 and be positioned at wherein.Implanted warehouse 3510 can comprise the first internal layer 3512, second internal layer 3513 and outer 3511.First internal layer 3512 can comprise the first thickness and the second internal layer 3513 can comprise the second thickness, and wherein the second internal layer 3513 can be thicker than the first internal layer 3512.Alternatively, comparable second internal layer 3513 of the first internal layer 3512 is thick.In another alternative form, the first internal layer 3512 can have identical or at least substantially the same thickness with the second internal layer 3513.One or more deformable lower limbs 3521 that each nail 3520 can comprise pedestal 3522 and extend from pedestal 3522.Each lower limb 3521 can comprise the top 3523 in embedding first internal layer 3511, and each base portion 3522 following closely 3520 in addition can embed in the second internal layer 3512.First internal layer 3512 and/or the second internal layer 3513 can comprise at least one medicine that is stored in wherein and outer 3511 can encapsulate and seal the first internal layer 3512 and the second internal layer 3513, make until outer 3511 are pierced through medicine by nail 3520 and just flow out nail bin body 3510.More specifically, to being described further above, the tissue that can abut against tissue contacting surface 3519 against nail bin 3500 and location promotes anvil block downwards, warehouse 3510 is compressed and surface 3519 towards screw top end 3523 moving downward below screw top end 3523 at least in part, top 3523 is made outer 3511 broken loose or pierce through outer 3511.Nail lower limb 3521 make outer 3511 broken loose after, at least one medicine M can flow out the warehouse 3510 around nail lower limb 3521.In all cases, additional medicine M can be extruded warehouse 3510 by the additional compression of warehouse 3510, as shown in Figure 61.

Refer again to Figure 60, outer 3511 can comprise water impervious or impermeable wrappage at least substantially, described wrappage can one, prevent medicine from flowing out nail bin 3500 prematurely; And two, prevent the fluid in such as operative site from entering prematurely in nail bin 3500.First internal layer 3512 can comprise the first medicine storing or be absorbed in wherein, and the second internal layer 3513 can comprise the second medicine storing or be absorbed in wherein, and wherein the second medicine can be different from the first medicine.The outer 3511 broken loose initial compression that make of warehouse 3510 can make the first internal layer 3512 discharge the first medicine usually, and the subsequent compression of warehouse 3510 can make the second internal layer 3513 discharge the second medicine usually.But in this case, the part of the first medicine and the second medicine can be released, but the major part of initial d/d medicine can be made up of the first medicine, and the major part of d/d medicine can be made up of the second medicine subsequently simultaneously.To being described further above, first internal layer 3512 can be made up of the material than the second internal layer 3513 with larger compression ratio, makes can to produce than initial deflection larger in the second internal layer 3513 in the first internal layer 3512 lower than the initial compression force of subsequent compression power or pressure or pressure.This larger initial deflection in first internal layer 3512 can make the part of the first medicine discharged from the first internal layer 3512 be greater than the second medicine discharged from the second internal layer 3513.Comparable second internal layer 3513 of first internal layer 3512 porous and/or have more flexibility more.Such as, first internal layer 3512 can comprise the multiple hole or space 3508 that are defined in wherein, and the second internal layer 3513 can comprise the multiple hole or space 3509 that are defined in wherein, its mesopore 3508 can by the first medicament storage in the first internal layer 3512, and hole 3509 can by the second medicament storage in the second internal layer 3513.Size and the density in the hole 3508 in the first internal layer 3512 and the hole 3509 in the second internal layer 3513 can be selected to provide results needed as herein described.

Refer again to Figure 60 and Figure 61, outer 3511, first internal layer 3512 and/or the second internal layer 3513 can by can the material of bio-absorbable form.First internal layer 3512 can the material of bio-absorbable can be formed by first, second internal layer 3513 can the material of bio-absorbable can be formed by second, and outer 3511 can the material of bio-absorbable can be formed by the 3rd, wherein first can the material, second of bio-absorbable can the material and/or the 3rd of bio-absorbable can the material of bio-absorbable can be made up of different materials.First can bio-absorbable material can first rate by bio-absorbable, second can bio-absorbable material can the second speed by bio-absorbable, and the 3rd can bio-absorbable material can third speed by bio-absorbable, wherein first rate, the second speed and/or third speed can be different.Such as, when material with specific speed by bio-absorbable time, this speed can be defined by the amount of the quality of materials absorbed by patient body within the unit interval.As everyone knows, the health of different patient different speed can absorb different materials, and therefore this speed can be expressed as Mean Speed to explain this transmutability.In any case, compared with slower speed phase, speed can be the wherein absorbed speed of more quality within the unit interval faster.Refer again to Figure 60 and Figure 61, the comparable constituent material of outer 3511 of constituent material of the first internal layer 3512 and/or the second internal layer 3513 is quickly by bio-absorbable.Such as, first internal layer 3512 and/or the second internal layer 3513 can by can the foams of bio-absorbable, tissue seal, and/or hemostatic material (such as oxidized regenerated cellulose (ORC)) is formed, and such as outer 3511 can by buttress material and/or plastic material (such as with the polyglycolic acid (PGA) that trade name Vicryl sells, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with the poliglecaprone 25 (PGCL) that trade name Monocryl sells, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, the complex of PGCL and/or PCL) form.In this case, the first internal layer 3512 and/or the second internal layer 3513 such as can process tissue immediately and can reduce organize hemorrhage, such as its ectomesoderm 3514 long-term support structure can be provided and can be slower speed by bio-absorbable.

To being described further above, due to outer 3511 can the speed of bio-absorbable comparatively slow, therefore outer 3511 can when following closely the organization healing in line supporting tissue or structurally strengthen tissue.The constituent material of the comparable another one of constituent material of one of the first internal layer 3512 and the second internal layer 3513 is quickly by bio-absorbable, one of described layer can provide the initial release for the treatment of material, and another layer can provide the slow release of identical treatment material and/or different treatment material.Such as, material can be depending on the basal layer wherein absorbing or be dispersed with medicine absorbability from the d/d speed of layer 3512,3513 is wherein treated.Such as, comprise the comparable substrate comprising the second internal layer 3513 of the substrate of the first internal layer 3512 quickly by bio-absorbable, therefore such as medicine can faster than the speed of the release from the second internal layer 3513 from the speed that the first internal layer 3512 discharges.As described herein, one or more in the layer 3511,3512 and 3513 of warehouse 3510 adhere to mutually by such as at least one binding agent (such as fibrin and/or protein hydrogel).Binding agent can be can be water-soluble and the connection that can discharge when nail bin 3500 is implanted and/or after implanted certain period between each layer.Such as, binding agent can than outer 3511, first internal layer 3512 and/or the second internal layer 3513 quickly by bio-absorbable.

Referring now to Figure 62 and Figure 63, such as, the nail bin of such as nail bin 3600 can comprise warehouse 3610, and this warehouse comprises compressible ground floor 3611, is attached to the second layer 3612 of ground floor 3611 and is attached to the removable compressible stratum 3613 of the second layer 3612.Such as, ground floor 3611 can be made up of compressible foamed materials, the second layer 3612 can comprise the laminate utilizing one or more binding agents to adhere to ground floor 3611, and third layer 3613 can comprise the compressible foam material utilizing one or more binding agents to adhere to the second layer 3612 removedly.Nail bin 3600 also can comprise the multiple nails (such as following closely 3620) be such as positioned in warehouse 3610.Such as, each nail 3620 can comprise the base portion 3622 be positioned in third layer 3613 and the one or more deformable lower limbs 3621 extended up to ground floor 3611 through the second layer 3612 from base portion 3622.In use, to being described further above, the end face 3619 of nail bin body 3610 can be promoted downwards by anvil block, until nail lower limb 3621 penetrates end face 3619 and target tissue and contacts anvil block.After nail lower limb 3621 is badly deformed, anvil block can move away from nail bin 3600, and the compressible stratum of nail bin 3600 can be expanded at least in part again.In all cases, follow closely can to make when inserting through tissue to organize hemorrhage.Third layer 3613 can be made up of absorbing material (such as protein hydrogel), and described absorbing material such as can absorb blood from the tissue be sewn.Except above or as above substitute, third layer 3613 can be made up of hemostatic material and/or tissue seal (such as through cryodesiccated thrombin and/or fibrin), described hemostatic material and/or tissue seal can reduce organize hemorrhage.Third layer 3613 can provide support structure to ground floor 3611 and the second layer 3612, wherein third layer 3613 can by can bio-absorbable material and/or can not the material of bio-absorbable form.In any case, after nail bin 3610 is implanted, third layer 3613 can be separated with the second layer 3612.When third layer 3613 comprises the material with implanted characteristic, surgeon can select the third layer 3613 whether removing warehouse 3610.Third layer 3613 can remove from the second layer 3612 with integral form.

Ground floor 3611 can be made up of the first foamed materials, and third layer 3613 can be made up of the second foamed materials, and this second foamed materials can be different from the first foamed materials.First foamed materials can have the first density and the second foamed materials can have the second density, and wherein the first density can be different from the second density.Such as, the second density can higher than the first density, and wherein as a result, the compression ratio of the comparable ground floor of third layer 3,613 3611 is less or have lower compression ratio.Alternatively, the first density can higher than the second density, and wherein as a result, the compression ratio of the comparable third layer of ground floor 3,611 3613 is less or have lower compression ratio.Referring now to Figure 64 and Figure 65, be similar to nail bin 3600, nail bin 3700 can comprise warehouse 3710, and this warehouse comprises the first compressible froth bed 3711, is attached to the second layer 3712 of ground floor 3711 and is attached to dismountable 3rd compressible foam foam layer 3713 of the second layer 3712 removedly.Such as, third layer 3713 can comprise multiple nail and hold slit or otch 3709, and it can hold (such as the nail base portion 3622) at least partially of nail 3620 separately wherein.Nail 3620 can hold in slit 3709 at nail and slides, or in other words, and such as, when nail bin 3700 is located against target tissue and compressed by anvil block, third layer 3713 can be slided relative to nail 3620.Hold slit 3709 and can make to there is space between nail 3620 and the sidewall holding slit 3709.Such as, due to mentioned above, when nail 3620 is out of shape, a part for third layer 3713 can not be captured in wherein, as shown in Figure 64 and Figure 65 by nail 3620.Alternatively, the end of the contiguous second layer 3712 that nail holds slit 3709 can be closed by a part for third layer 3713, therefore when nail 3620 is out of shape, third layer 3713 can be trapped in nail 3620 at least partially.In any case, third layer 3713 such as can comprise one or more perforation and/or cut 3708, and it can allow third layer 3713 to be removed from the second layer 3712 with two parts or more part, as shown in Figure 64.In Figure 64, a wherein part for third layer 3713 is illustrated as being removed by instrument 3755.Perforation 3708 can be arranged along being positioned at the first row nail with the line that the second row follows closely centre.

Refer again to Figure 64 and Figure 65, the base portion 3622 of nail 3620 can be arranged in and hold slit 3709, and the sidewall wherein holding slit 3709 can contact stud lower limb 3621 nail lower limb 3621 is remained on appropriate location releasedly.Although not shown, but third layer 3713 can comprise the elongated slot of all nails in nail line.Such as, the nail bin comprising four nail rows such as can comprise the elongated slot of aliging with each row of nail in nail bin bottom.To being described further above, nail bin 3600 and/or nail bin 3700 at least partially can in implanted patient body, and can the removing in patient body at least partially of nail bin.Refer again to Figure 64 and Figure 65, ground floor 3711 and the second layer 3712 can be trapped in also can be implanted together with nail 3620 in nail 3620, and third layer 3713 optionally can be removed or be separated from nail bin 3700.In all cases, remove the amount that the part implanting nail bin can reduce the necessary resorbent material of patient body, this can provide various treatment benefit.Such as by abdominal cavity mirror instrument 3755 part for nail bin to be separated and in the situation removed, the nail bin part be separated is removed from operative site by the trocar (such as having the trocar in 5mm hole).Warehouse can comprise a more than layer that can be removed.Such as, warehouse 3710 can comprise the 4th layer, and wherein the third layer 3713 of warehouse 3710 can be made up of hemostatic material, and the 4th layer can be made up of supporting layer.Such as, surgeon's such as removable supporting layer and select subsequently whether to remove hemostatic layer.

Referring now to Figure 66, nail bin (such as nail bin 3800) such as can comprise warehouse 3810, and this warehouse comprises outer 3811 and internal layer 3812.Internal layer 3812 can be made up of compressible foamed materials, and outer 3811 can wrap up around internal layer 3812 at least in part.Such as, outer 3811 can comprise Part I 3811a and Part II 3811b, this Part I can be positioned on the first side of internal layer 3812, this Part II can be positioned on the second side of internal layer 3812, and wherein Part I 3811a is connected by flexible hinge (such as hinge 3809) with Part II 3811b.Such as, can to the first side of internal layer 3812 and/or the second side coating at least one binding agent (such as fibrin and/or protein hydrogel) so that being fixed to skin 3811 on it.Outer 3811 can comprise the one or more clamp structures extended from it.Such as, outer 3811 can comprise the multiple deformable lower limbs 3821 extending from the side of skin 3811 and also can be placed in compressible internal layer 3812.Such as, lower limb 3821 can not from the second lateral process of internal layer 3812, or alternatively, lower limb 3821 can from internal layer 3812 projection at least in part.When compressible warehouse 3810 is by compression, in use, lower limb 3821 can pierce through the Part II 3811b of internal layer 3812 and outer 3811.The Part II 3811b of outer 3811 can comprise the hole (such as hole 3808) be such as defined in wherein, and this hole can hold nail lower limb 3821.At least some part of nail bin 3800 can comprise cutter slit 3803, and this cutter slit can hold cutting element wherein slidably.Such as, cutter slit 3803 can extend not entirely through the thickness of warehouse 3810, and therefore when cutting element moves relative to warehouse 3810, cutting element can cut warehouse 3810.

Referring now to Figure 67, the nail bin 3900 similar to nail bin 3800 can comprise warehouse 3910, this warehouse comprises internal layer 3812 and outer 3811, the Part II 3811b that its ectomesoderm 3811 can comprise the first side of contiguous internal layer 3812 and the second side of the Part I 3811a that locates and contiguous internal layer 3812 and locate.To similar above, outer 3811 can comprise the one or more clamp structures extended from it.Such as, outer 3811 can comprise the multiple deformable lower limbs 3921 extending from the side of skin 3811 and also can be placed in compressible internal layer 3812.Each deformable lower limb 3921 can comprise at least one suspension hook from its projection or barb 3923, and at least one suspension hook described or barb can engage the Part II 3811b of outer 3811, and therefore skin 3811 are remained to internal layer 3812.Such as, barb 3923 can from the second lateral process of internal layer 3812 and the hole 3808 extended through the Part II 3811b of outer 3811, make barb 3923 can engage the outer surface of outer 3811 and skin 3811 is locked onto internal layer 3812.For structure nail bin 3900, internal layer 3812 can be at least partially compressed, to make barb from its projection and access aperture 3808.Such as, when nail bin 3900 is inserted in nail bin, nail bin 3900 can by precommpression at least in part.To being described further above, lower limb 3921 can embed in the Part I 3811a of outer 3811 at least partially, its ectomesoderm 3811 can be made up of plastic material (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA)), and such as described plastic material can around the overmolding at least partially of lower limb 3921.

Referring now to Figure 68-Figure 72, such as, the nail bin of such as nail bin 4000 can comprise warehouse 4010, multiple nails 4020 that described warehouse comprises compressible ground floor 4011 and the second layer 4012 and is positioned in addition in warehouse 4010.See Figure 70, at least one deformable lower limb 4023 that each nail 4020 can comprise base portion 4022 and extend from base portion 4022.See Figure 68, nail bin 4000 can be positioned between the anvil block 4040 of the end effector of nail bin passage 4030 and surgical stapling device, and wherein the second layer 4012 of warehouse 4010 and/or the base portion 4022 of nail 4020 can be located against nail bin passage 4030.Referring now to Figure 69, the second layer 4012 can comprise one deck absorbent cotton 4060, and it is interconnected amongst one another by absorbent cotton support frame 4061.Such as, absorbent cotton 4060 and absorbent cotton support frame 4061 can be made up of the plastic material of molding (such as polyglycolic acid (PGA)).Each absorbent cotton 4060 can comprise one or more hole or slit 4062, and described one or more hole or slit can hold the nail lower limb 4021 extended through wherein, as shown in Figure 70 and Figure 71.Each absorbent cotton 4060 also can comprise the accommodation slit 4063 be defined in wherein, and this accommodation slit can hold the base portion 4022 of nail 4020.Refer again to Figure 69, absorbent cotton 4060 and/or absorbent cotton support frame 4061 can comprise multiple cut, perforation etc., and it can allow absorbent cotton 4060 to be separated with absorbent cotton support frame 4061 at desired locations place.Similarly, see Figure 71, one or more absorbent cotton 4060 such as can be connected to each other along the line comprising perforation and/or cut 4064.In use, compressible froth bed 4011 can be located against target tissue T, and warehouse 4010 can be compressed by anvil block 4040, makes anvil block 4040 that nail 4020 can be made to be out of shape.When nail 4020 is out of shape, a part for tissue T, ground floor 4011 and absorbent cotton 4060 can be captured in the nail of distortion by the nail lower limb 4021 of each nail 4020.When nail bin passage 4030 moves away from the nail bin 4060 implanted, such as absorbent cotton support frame 4061 can be separated with absorbent cotton 4060 and/or absorbent cotton 4060 can be separated from one another.In some cases, when nail 4020 is out of shape as mentioned above by anvil block 4040, absorbent cotton 4060 can be separated with framework 4061 and/or separated from one another.

When anvil block moves to make position, the nail of nail bin can be shaped completely by anvil block.Alternatively, referring now to Figure 73-Figure 76, such as the nail of the nail bin of nail bin 4100 is such as by the anvil block when anvil block moves to make position, and additionally by making nail be out of shape towards the staple drivers system of closed anvil block motion.Nail bin 4100 can comprise compressible warehouse 4110, and this compressible warehouse can be such as made up of foamed materials and the multiple nails 4120 be positioned at least in part in compressible warehouse 4110.Staple drivers system can comprise driver clamper 4160, be positioned at multiple staple drivers 4162 in driver clamper 4160 and nail bin dish 4180, and staple drivers 4162 can remain in driver clamper 4160 by this nail bin dish.Such as, staple drivers 4162 can be positioned in the one or more slits 4163 in driver clamper 4160, and wherein the sidewall of slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be supported in slit 4163 by staple drivers 4162, and wherein when nail 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be positioned in slit 4163 completely.Alternatively, when nail 4120 and staple drivers 4162 are in its non-firing position, upwards can extending through the opening 4161 of slit 4163 at least partially of nail 4120.Such as, now main see Figure 74, the base portion of nail 4120 can be positioned in driver clamper 4160, and the top of following closely 4120 can embed in compressible warehouse 4110.The height following closely 4120 about 1/3rd can be positioned in driver clamper 4160, and the height following closely 4120 about 2/3rds can be positioned in warehouse 4110.See Figure 73 A, such as nail bin 4100 also can comprise water impervious wrappage around warehouse 4110 and driver clamper 4160 or film 4111.

In use, such as, nail bin 4100 can be positioned in nail bin passage, and anvil block can move to make position towards nail bin 4100.When anvil block moves to its make position, anvil block can contact and compress compressible warehouse 4110.When anvil block is in its make position, anvil block can not contact stud 4120.Alternatively, when anvil block moves to its make position, anvil block can contact stud 4120 lower limb and make nail 4120 be out of shape at least in part.In arbitrary situation, nail bin 4100 also can comprise one or more sliding part 4170, described one or more sliding part longitudinally can advance at nail bin 4100, makes sliding part 4170 can jointing nail driver 4162 and staple drivers 4162 and nail 4120 are moved towards anvil block subsequently.Sliding part 4170 can slide between nail bin dish 4180 and staple drivers 4162.When anvil block closed has made the forming process of nail 4120 start, nail 4120 has moved upward towards anvil block and can complete forming process and make the height that nail 4120 is deformed into its height be shaped completely or at least expects.When anvil block closed does not make nail 4120 be out of shape, follow closely 4120 and to move upward towards anvil block and can start and complete forming process and make the height that nail 4120 is deformed into its height be shaped completely or at least expects.Sliding part 4170 can be advanced to the distal end of nail bin 4100 from the proximal extremity of nail bin 4100, make before the nail 4120 in the distal end being positioned nail bin 4100 is shaped completely, the nail 4120 be positioned in the proximal extremity of nail bin 4100 is shaped completely.See Figure 75, sliding part 4170 can to comprise at least one surface 4711 that is angled or that tilt separately, and it can promote staple drivers 4162 in staple drivers 4162 slid underneath as shown in Figure 76.

To being described further above, nail 4120 can be formed, so as by tissue T at least partially with the compressible warehouse 4110 of nail bin 4100 be captured in wherein at least partially.After nail 4120 is shaped, the anvil block of surgical stapling device and nail bin passage 4130 can move away from the nail bin 4100 implanted.In all cases, storehouse dish 4180 can engage nail bin passage 4130 regularly, and wherein as a result, when nail bin passage 4130 is pulled away from the warehouse 4110 implanted, storehouse dish 4180 can be separated with compressible warehouse 4110.Refer again to Figure 73, storehouse dish 4180 can comprise relative sidewall 4181, and warehouse 4110 can be positioned between this relative sidewall 4181 removedly.Such as, compressible warehouse 4110 can be compressed between sidewall 4181, and warehouse 4110 during use can be remained on therebetween removedly, and when storehouse dish 4180 is pulled away from, warehouse 4110 departs from releasedly from storehouse dish 4180.Such as, driver clamper 4160 can be connected to storehouse dish 4180, and make when storehouse dish 4180 removes from operative site, driver holder 4160, driver 4162 and/or sliding part 4170 can remain in storehouse dish 4180.Alternatively, driver 4162 can penetrate from driver clamper 4160 and stay operative site.Such as, driver 4162 can by can the material (complex of the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) of bio-absorbable be formed.Driver 4162 can be attached to nail 4120, makes driver 4162 be deployed with nail 4120.Such as, each driver 4162 can comprise the groove of the base portion that such as can hold nail 4120, and wherein said groove can hold nail base portion with pressure fitted mode and/or snap fit.

To being described further above, driver clamper 4160 and/or sliding part 4170 can coil 4180 injections from storehouse.Such as, sliding part 4170 can coil between 4180 and driver clamper 4160 in storehouse and slide, make when sliding part 4170 advances upwards to drive staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to outside storehouse dish 4180.Such as, driver clamper 4160 and/or sliding part 4170 can by can the material (such as with polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-dioxanone (PDS) that trade name Vicryl sells, the complex of polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) of bio-absorbable be formed.Sliding part 4170 can integrally form and/or be attached to driving rod or cutting element, and described driving rod or cutting element promote sliding part 4170 through nail bin 4100.In this case, sliding part 4170 can not penetrate from storehouse dish 4180 and can keep together with surgical stapling device, and sliding part 4170 is not attached in other embodiments of driving rod wherein, and sliding part 4170 can be stayed in operative site.In any case, to being described further above, the compression ratio of warehouse 4110 can allow to use thicker nail bin in the end effector of surgical stapling device, this is because when the anvil block of stiching instrument closes, warehouse 4110 is compressible or collapse.As the nail when anvil block closes by the result of being out of shape at least in part, higher nail (such as have about 0.18 " nail of staple height) can be used; such as wherein about 0.12 " staple height can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 can have about 0.14 " uncompressed height.

Referring now to Figure 77-Figure 80, such as, the nail bin of such as nail bin 4200 can comprise compressible warehouse 4210, be positioned multiple nails 4220 wherein and multiple flexible sides to supporting member 4234.Referring now to Figure 78, it is middle with nail bin passage 4230 that nail bin 4200 can be positioned in anvil block 4240, and wherein lateral support component 4234 can be attached to nail bin passage 4230.When anvil block 4240 moves downward to compress warehouse 4210 and makes nail 4220 be out of shape at least in part, as shown in Figure 79, the sidepiece of warehouse 4210 laterally can expand and outwards promote lateral support component 4234.Such as, lateral support component 4234 can be attached to warehouse 4210, and when warehouse 4210 laterally expands as mentioned above, lateral support component 4234 can be separated with warehouse 4210, as shown in Figure 79.Lateral support component 4234 can utilize at least one binding agent (such as fibrin and/or protein hydrogel) to adhere to warehouse 4210.To similar above, the closed of anvil block 4240 can only partly make nail 4220 be out of shape, wherein by such as advancing one or more sliding part 4270 to complete the shaping of nail 4220 through nail bin 4200 shown in Figure 80.Referring now to Figure 82 and Figure 83, sliding part 4270 can be cut component 4280 is advanced to nail bin 4200 distal end from the proximal extremity of nail bin 4200.Such as, cutting element 4280 can comprise cutting element or cutter 4283, and described cutting element or cutter 4283 can advance through tissue T and/or compressible warehouse 4210.Cutting element 4280 can comprise cam member 4282, and this cam member can be advanced along the outer surface of jaw 4230 and 4240 and be moved by jaw or remain on appropriate location.Due to mentioned above, nail 4220 can be shaped to its net shape while tissue T is cut or at least substantially simultaneously.Such as, sliding part 4270 can be positioned in distally relative to cutter 4283, such as make only when the propulsive units organized is sewed up completely tissue T just cut.

Refer again to Figure 82 and Figure 83, sliding part 4270 can comprise independent slidable member, and described slidable member is advanced by cutting element 4280 together.Such as, sliding part 4270 can be accommodated in nail bin 4200, and cutting element 4280 can be advanced in nail bin 4200 by trigger shaft 4281, makes cutting element 4280 engaging slide part 4270 and distally advances sliding part 4270.This sliding part 4270 can be connected to each other.In any one situation, each sliding part 4270 can comprise angled surface or cam 4271, and this angled surface or cam can be lifted at the nail 4220 of alignment in nail row.Angled surperficial 4271 can be integrally formed with cutting element 4280.Refer again to Figure 82 and Figure 83, each nail 4200 can comprise base portion and bizet 4229, at least one deformable member extends from base portion, and bizet 4229 overmolding is to the base portion of nail 4200 and/or going up at least partially of deformable member, and/or around at least partially described and locate.Such as, this bizet 4229 can by sliding part 4270 Direct driver.More specifically, the bizet 4229 of nail 4220 can make when the no-fix between angled surperficial 4271 and bizet 4229 of sliding part 4270 has staple drivers, and angled surperficial 4271 also directly can contact bizet 4229 in bizet 4229 slid underneath.In this case, the surface that each bizet 4229 includes the angled of at least one cooperation or tilts, this surface can be engaged by angled surperficial 4271 of sliding part 4270, and make when sliding part 4270 is in nail 4220 slid underneath, the angled surface of cooperation can upwards drive nail 4220.

Referring now to Figure 81, such as, the nail bin of such as nail bin 4300 can comprise compressible body 4310 and be positioned at the multiple nails 4320 in compressible body 4310.To similar above, nail bin 4300 can comprise flexible lateral supports 4334, and the lateral supports of this flexibility can be attached to nail bin passage and/or adhere to compressible main body 4310.Over and above what is described above, flexible lateral supports 4334 can be connected together by one or more pillar or connecting elements 4335, and lateral supports 4334 can keep together by described one or more pillar or connecting elements.In use, connecting elements 4335 can prevent or at least suppress lateral supports 4334 to be separated with warehouse 4310 prematurely.Lateral supports 4334 can keep together by connecting elements 4335 after nail bin 4300 is compressed by anvil block.In this case, lateral supports 4334 can resist lateral expansion or the displacement of the sidepiece of warehouse 4310.Cutting element (such as cutting element 4280) such as can when cutting element 4280 distally moves in warehouse 4310 crosscut connecting elements 4335.Such as, cutting element 4280 distally can promote one or more sliding part (such as sliding part 4270), to make nail 4320 be shaped against anvil block.The bootable cutting edge 4283 of sliding part 4270, makes cutting element 4280 can not crosscut connecting elements 4335, to be shaped completely or till being at least shaped to Desired Height until the Feng Ding 4320 of contiguous connecting elements 4335.In all cases, connecting elements 4335 cooperates with lateral supports 4334 lateral movement that can prevent or at least reduce compressible warehouse 4310 and prevent simultaneously or at least reduce the lateral movement of the nail 4320 be positioned in warehouse 4310.In this case, nail 4320 can be remained on appropriate location by connecting elements 4335, until nail 4320 distortion, and connecting elements 4335 can cut the sidepiece discharging warehouse 4310 subsequently.As mentioned above, lateral supports 4334 can be connected to nail bin passage, and therefore after nail bin 4300 is implanted, lateral supports 4334 can remove from operative site together with nail bin passage.Lateral supports 4334 can be made up of implanted material and can be left in operative site.Connecting elements 4335 can be positioned in the middle of warehouse 4310 and tissue T, and after connecting elements 4335 is separated with lateral supports 4334, connecting elements 4335 can stay implanted in patient body.Such as, connecting elements 4335 can be made up of implanted material, and connecting elements 4335 can be such as made up of the material identical with lateral supports 4334.Connecting elements 4335 and/or lateral supports 4334 can be made up of the material of flexible bioresorbable (complex of the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL).Connecting elements can comprise the material piece connecting lateral supports 4334.Nail bin can comprise the connecting elements of the top surface extending through warehouse 4310, and the other connecting elements that extends around the lower surface of warehouse 4310.

Referring now to Figure 84, nail bin can comprise nail (such as following closely 4420), and described nail such as can comprise the wire rod portion be inserted in bizet.Wire rod portion can (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA) be formed by metal (such as titanium and/or rustless steel) and/or plastics.Crown moieties can be made up of metal (such as titanium and/or rustless steel) and/or plastics (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA)).The wire rod portion of each nail 4420 can comprise base portion 4422 and the deformable lower limb 4421 from base portion 4422 extension, and wherein the bizet of each nail 4420 can comprise hat 4429, and this hat can hold base portion 4422 at least partially wherein.Referring now to Figure 85 A-Figure 85 C, for assembling the part of each nail 4420, the lower limb 4421 in wire rod portion can be inserted in the opening 4426 in bizet 4429, lower limb 4421 can guide in base portion chamber 4427 by its split shed 4426.Wire rod portion also can be inserted in hat 4429, makes lower limb 4421 leave base portion chamber 4427 and the base portion 4422 in wire rod portion enters in base portion chamber 4427.Such as, base portion chamber 4427 can make when base portion 4422 enters base portion chamber 4427, and wire rod portion rotates in hat 4429, make follow closely lower limb 4421 point to upwards or at least essentially towards upper direction.Refer again to Figure 84, hat 4429 can comprise outlet opening 4425, and this outlet opening can hold nail lower limb 4421 wherein.

To being described further above, surgical stapling device can comprise sliding part 4470, and this sliding part can traverse nail bin 4400 and nail bin passage 4430 and the nail 4420 be contained in warehouse 4410 is moved towards anvil block.In all cases, sliding part 4470 can move to the distal end of storehouse passage 4430 from the proximal extremity of nail bin passage 4430, to implant warehouse 4410 and nail seam 4420.In some cases, sliding part 4470 regracting or turn back to the proximal extremity of storehouse passage 4430, and another nail bin 4400 can be inserted in storehouse passage 4430.Once new nail bin 4400 is positioned in storehouse passage 4430, then sliding part 4470 can distally advance again.Surgical stapling device can comprise one or more latch-up structure, and described one or more latch-up structure can no-fix have when new nail bin 4400 and prevents sliding part 4470 from again distally advancing in storehouse passage 4430.Such as, refer again to Figure 84, nail bin passage 4430 can comprise locking shoulder 4439, and this locking shoulder can prevent or at least limit slippage part 4470 distally moves.More specifically, unless sliding part 4470 is upwards lifted beyond shoulder 4439 at least in part by lift structure 4428, otherwise sliding part 4470 can adjoin shoulder 4439, extends between the recent side nail 4420 of this lift structure 4428 such as in nail bin 4400.In other words, in new nail bin 4400, there is not recent side when following closely 4420, sliding part 4470 cannot advance.Therefore, when there is not nail bin 4400 when there is used nail bin 4400 in storehouse passage 4430 or in storehouse passage 4430, sliding part 4470 cannot advance in storehouse passage 4430.

To being described further above, referring now to Figure 86, nail bin (such as nail bin 4500) such as can be positioned in nail bin passage 4530 and can to comprise compressible warehouse 4510, is positioned at multiple nails 4520 in warehouse 4510 and storehouse dish or keeper 4580.Compressible warehouse 4510 can comprise outer 4511 and internal layer 4512, and its ectomesoderm 4511 can surround internal layer 4512 in a sealing fashion.Such as, outer 4511 can extend between internal layer 4512 and storehouse coil 4580.Alternatively, outer 4511 can only partly around internal layer 4512, and such as, outer 4511 and storehouse dish 4580 can cooperate to surround or at least substantially surround internal layer 4512.To being described further above, nail 4520 can coil 4580 supports by storehouse, and wherein can comprise can one or more nail support passage of support nail 4520 for storehouse dish 4580.Storehouse dish 4580 can be attached to warehouse 4510, and wherein such as warehouse 4510 laterally can be compressed between the relative sidewall that storehouse coils 4580.The sidewall of storehouse dish 4580 can laterally support warehouse 4510, and such as, storehouse dish 4580 can comprise and extends up to one or more wall warehouse 4510 or fin 4582 from bottom support 4583.Such as, can comprise one or more slit or passage in warehouse 4510, wherein said one or more slit or passage can hold wall 4582 and/or interlock with wall 4582.Wall 4582 partly or almost can extend through warehouse 4510 fully.Such as, wall 4582 can extend longitudinally through nail bin 4500 between the first row of nail 4520 and the second row of nail 4520.

Warehouse 4510 and/or storehouse dish 4580 can comprise cooperation and keep feature structure, and this cooperation keeps feature structure can coil between 4580 and warehouse 4510 in storehouse provides snap fit.Nail bin 4500 can be positioned in storehouse passage 4530, makes storehouse dish 4580 locate against storehouse passage 4530 and/or be attached to storehouse passage 4530.Storehouse dish 4580 can be connected to storehouse passage 4530 separably, and make after nail bin 4500 to be compressed by anvil block 4540 and follows closely 4520 distortion, storehouse dish 4580 can be separated with storehouse passage 4530 and can be implanted together with warehouse 4510.Such as, storehouse dish 4580 can by can the material (complex of the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) of bio-absorbable be formed.Surgical stapling device also can comprise firing lock and/or driver, described firing lock and/or driver can be coiled at nail bin passage 4530 and bottom drive surfaces middle slip on 4580 in storehouse, described bottom drive surfaces can promote or penetrate storehouse dish 4580 from storehouse passage 4530.Warehouse 4510 can be connected to storehouse dish 4580 separably, and make after nail bin 4500 to be compressed by anvil block 4540 and follows closely 4520 distortion, warehouse 4510 can coil 4580 with storehouse and be separated.Such as, storehouse dish 4580 can keep engaging storehouse passage 4530 regularly, makes storehouse coil 4580 and is removed from operative site together with storehouse passage 4530.Surgical stapling device also can comprise firing lock and/or driver, this firing lock and/or driver can at nail bin dish 4580 and bottom drive surfaces middle slip on warehouse 4510, and described bottom drive surfaces can be coiled from storehouse 4580 and be promoted or injection warehouse 4510.Such as, nail bin 4500 also can comprise the staple drivers be positioned in the middle of storehouse dish 4580 and nail 4520, makes when firing lock distally slides, and staple drivers and nail 4520 can be driven upwardly towards anvil block.Such as, staple drivers can embed in compressible warehouse 4510 at least in part.

To similar above, nail bin 4500 can comprise latch-up structure, and described latch-up structure can prevent from or at least limit cutting element distally moving, unless be positioned with the nail bin 4500 of not pulling the trigger in nail bin passage 4530.Nail bin dish 4580 can comprise and such as in nail bin passage 4530, upwards promotes cutting element and make it exceed the surface of locking surface.Do not exist in storehouse passage 4530 in the situation of the nail bin 4500 comprising storehouse dish 4580, cutting element cannot advance.Recent side nail in nail bin 4500 and/or any other nail be applicable to can comprise lifting surface, and cutting element can be lifted beyond locking surface by this lifting surface completely.Over and above what is described above or substitute mentioned above, each several part of nail bin 4500 can be made up of the material with different colours.In this case, surgeon can visually identify the nail bin when existing in nail bin passage 4530 and do not pull the trigger and/or pull the trigger.Such as, the skin 4511 of warehouse 4510 can have the first color, and storehouse dish 4580 can have the second color, and nail bin passage 4530 can have the 3rd color.If surgeon sees the first color, then there is the storehouse 4500 of not pulling the trigger in surgeon known road nail bin passage 4530; If surgeon sees the second color, then there is the storehouse 4500 of percussion in surgeon known road nail bin passage 4530 and need remaining storehouse dish 4580 to remove; And if surgeon sees the 3rd color, then surgeon can know any part not remaining with nail bin 4500 in storehouse passage 4530.

Referring now to Figure 87, multiple nails 4620 that nail bin (such as nail bin 4600) such as can comprise compressible implanted warehouse 4610 and be positioned at wherein.Warehouse 4610 can comprise outer 4611 and internal layer 4612.Internal layer 4612 can comprise the multiple pits (such as pit or cavity 4615) be such as defined in wherein, and described multiple pit can be conducive to collapsing of warehouse 4610.Such as, internal layer 4612 can comprise dot matrix that is corrugated or honeycomb configuration, and described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are no more than specific threshold value.When not exceeding threshold value, internal layer 4612 can about applied compression stress or pressure with rate deformation that is linear or at least substantial linear.After compression stress or pressure exceed threshold value, internal layer 4612 can collapse under pressure suddenly due to compressive load to bending greatly and collapsing or bend.The dot matrix of internal layer 4612 can be made up of multiple subgrade 4612a that can link together.Each subgrade 4612a can comprise multiple ditch of replacing and ridge or ripple, and described multiple ditch replaced can align with ridge with the ditch replaced of adjacent sublayers 4612a with ridge or ripple.Such as, the ditch of the first subgrade 4612a can be oriented to adjacent with the ridge of the second subgrade 4612a; And similarly, the ridge of the first subgrade 4612a can be oriented to adjacent with the ditch of the second subgrade 4612a.Adjacent subgrade 4612a adheres to and/or adheres to outer 4611 mutually by least one binding agent (such as fibrin and/or protein hydrogel).Figure 88 shows to have collapsed at warehouse 4610 and followed closely 4620 and has been out of shape to catch against warehouse 4610 and nail bin 4600 after keeping tissue T.

Referring now to Figure 89-Figure 91, such as, nail bin (such as nail bin 4700) multiple nails 4720 that can comprise compressible implanted warehouse 4710 and be positioned in warehouse 4710.To similar above, warehouse 4710 can comprise outer 4711 and internal layer 4712, and wherein internal layer 4712 can comprise multiple subgrade 4712a.Same to similar above, each subgrade 4712a can comprise ditch 4717 alternately and ridge 4718, and the described zastrugi replaced can align to limit pit or cavity 4715 betwixt mutually.Such as, ditch 4717 and/or ridge 4718 can along be parallel to each other and/or the Axis Extension that is parallel to longitudinal axis 4709.Nail 4720 can alignment in multiple nail row, described multiple nail row can along be parallel to each other and/or the Axis Extension that is parallel to longitudinal axis 4709.Alternatively, refer again to Figure 87 and Figure 88, the nail 4620 held in warehouse 4600 can along Axis Extension, the axis that described axis traverses or limits perpendicular to the zastrugi by subgrade 4612a.Refer again to Figure 89-Figure 91, nail 4720 can extend across ditch 4717 and ridge 4718, and wherein nail 4720 can remain in warehouse 4710 by the frictional force of following closely between 4720 and subgrade 4712a.Multiple subgrade 4712a can (such as poly-dioxanone (PDS) and/or polyglycolic acid (PGA) be formed by buttress material and/or plastic material, nail 4720 such as can be remained on upright orientation and/or is held in by nail 4720 and relative to each other align, as shown in Figure 89 and Figure 90 by above support material and/or plastic material.Figure 91 illustrates to have collapsed at warehouse 4710 and followed closely 4720 and has been out of shape to catch against warehouse 4710 and nail bin 4700 after keeping tissue T.

Refer again to Figure 89-Figure 91, when warehouse 4710 by compression time, warehouse 4710 can with resilience ground or collapse with elastic type.Such as, when warehouse 4710 is by compression, the ripple that ditch 4717 and ridge 4718 are formed in each subgrade 4712a can by graduation or at least substantially by graduation, and this can make the cavity 4715 limited between ditch 4717 and ridge 4718 collapse or at least substantially collapse.In all cases, after removing compression stress or pressure from warehouse 4710, warehouse 4710 or warehouse 4710 at least partly can ground with resilience or again expand with elastic type.Such as, when warehouse 4710 is by compression, connection between the ditch 4717 of adjacent sublayers 4712a and ridge 4718 can keep not impaired or at least substantially not impaired, make after removing compression stress from warehouse 4710, subgrade 4712a can be biased ditch 4717 and itself make it away from each other with ridge 4718, and therefore makes warehouse 4710 again expand at least in part.When warehouse 4710 by compression time, its can plastic manner distortion or by conquassation, therefore after removing compression stress or pressure from warehouse 4710, warehouse 4710 can not be expanded again.Referring now to Figure 92, nail bin (such as nail bin 4800) such as can comprise can the warehouse 4810 of conquassation, this warehouse of conquassation can comprise outer 4811 and internal layer 4812, wherein internal layer 4812 can comprise dot matrix that is corrugated, honeycomb configuration, and described dot matrix has the multiple pit or cavity 4815 that limit wherein.That the wall limiting the dot matrix of internal layer 4812 can comprise one or more reduction or thin cross section 4819, described one or more reduction or thin cross section can allow the wall limiting dot matrix to be fallen apart by broken during compression at warehouse 4810.In this case, when nail bin 4800 is implanted, warehouse 4810 can by conquassation.

Referring now to Figure 93-Figure 95, nail bin (such as nail bin 4900) such as can comprise warehouse 4910, this warehouse comprise such as outer 4911 and be positioned at outer 4911 top and bottom between multiple crushable members 4912.First see Figure 93 and Figure 94, nail bin 4900 also can comprise multiple nail 4920, and wherein each nail 4920 can be positioned in crushable member 4912.More specifically, each crushable member 4912 can comprise Part I 4912a, Part II 4012b and Part III 4012c, described Part I 4912a, Part II 4012b and Part III 4012c can cooperate to limit cavity 4915 wherein, and described cavity can hold nail 4920.In use, to being described further above, nail bin 4900 can be positioned in nail bin passage and can to apply compression stress to compress warehouse 4910 to tissue contacting surface 4919.When tissue contacting surface 4919 moves downward, crushable member 4912 can be collapsed.In this case, the Part II 4912b of each crushable member 4912 can be collapsed in corresponding Part I 4912a; Similarly, the Part III 4912c of each crushable member 4912 can be collapsed in corresponding Part II 4912b.When warehouse 4910 is compressed and crushable member 4912 is collapsed, be positioned at nail 4920 deformable in crushable member 4912, as shown in Figure 95.The Part II 4912b of each crushable member 4912 frictionally can engage corresponding Part I 4912a and/or be press-fitted in corresponding Part I 4912a, make once exceed the retentivity for being remained on by Part I 4912a and Part II 4912b in its extended position (Figure 94) to the compression stress of crushable member 4912 applying, then Part I 4912a and Part II 4912b can start relative to each other to slide.Similarly, the Part III 4912c of each crushable member 4912 frictionally can engage corresponding Part II 4912b and/or be press-fitted in corresponding Part II 4912b, make once exceed the retentivity for being remained on by Part II 4912b and Part III 4912c in its extended position (Figure 94) to the compression stress of crushable member 4912 applying, then Part II 4912b and Part III 4912c can start relative to each other to slide.

In many embodiments as herein described, in nail bin, multiple nail can be comprised.This type of nail can by being deformed into U-shaped configuration substantially and the metal wire rods with two nail lower limbs are formed.Other embodiments that wherein nail can comprise different configuration (be such as joined together and have two or more wire rods that three or more are followed closely lower limbs) can be dreamed up.One or more wire rods for the formation of nail can comprise round or at least substantially round cross section.Nail wire rod can comprise any other suitable cross section, such as the cross section of square and/or rectangle.Nail can be made up of plastic wire.Nail can be made up of the metal wire rod being coated with plastics.Substituting except nail or as nail, storehouse can comprise the securing member of any applicable type.Such as, this securing member can comprise pivotable arm, and described arm can be folded when being engaged by anvil block.Two-part securing member can be used.Such as, nail bin can comprise multiple first fastener portion, and anvil block can comprise multiple second fastener portion; When anvil block is compressed against nail bin, the second fastener portion is connected to the first fastener portion.As mentioned above, sliding part or driver can be advanced in nail bin to complete the forming process of nail.Sliding part or driver can be advanced in anvil block, engage with relative nail bin and nail or the securing member be positioned in nail bin to make one or more formed parts move downwardly to.

Nail bin can comprise four the nail rows be stored in wherein.Described four nail rows can be configured to two inner side nail rows and two outside nail rows.Such as, inner side nail row and outside nail are arranged on the first side of cutting element or the cutter slit that can be positioned in nail bin; Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit.Alternatively, nail bin can not comprise cutting element slit; But substituting as nail bin slit, this nail bin can comprise the specified portions can cut by cutting element.Similarly, inner side can be followed closely row and be arranged in nail bin, make itself and cutting element slit equidistantly or at least substantially equidistantly spaced apart.Similarly, outside can be followed closely row and be arranged in nail bin, make itself and cutting element slit equidistantly or at least substantially equidistantly spaced apart.Nail bin can comprise be stored in nail bin greater or less than four nail row.Nail bin can comprise six nail rows.Such as, nail bin can comprise three nail rows on the first side of cutting element slit, and on the second side of cutting element slit, comprise three nail rows.Nail bin can comprise odd number nail row.Such as, nail bin can comprise two nail rows on the first side of cutting element slit, and on the second side of cutting element slit, comprise three nail rows.Nail row can comprise the nail with identical or at least substantially the same unshaped staple height.Alternatively, one or more nail row can comprise the nail having and follow closely different unshaped staple heights from other.Such as, the nail on the first side of cutting element slit can have the first unshaped height, and the nail on the second side of cutting element slit can have the second unshaped height, and this second unshaped height is different from the first height.

Referring now to Figure 96 A-Figure 96 D, the end effector of surgical stapling device can comprise such as storehouse attachment (such as nail bin passage 5030), be positioned at the fastener cartridge (such as nail bin 5000) in nail bin passage 5030 removedly, and the jaw 5040 of relatively locating with nail bin 5000 and nail bin passage 5030.Any other suitable securing member that nail bin 5000 can comprise compressible body 5010 and multiple nail 5020 and/or be positioned at least in part in compressible body 5010.Such as, each nail 5020 can comprise base portion 5022, and the lower limb 5021 upwards extended from base portion 5022 in addition, wherein lower limb 5021 can be embedded in warehouse 5010 at least partially.Compressible body 5010 can comprise top surface or tissue contacting surface 5019 and lower surface 5018, and wherein lower surface 5018 can be located against the stayed surface 5031 of nail bin passage 5030 and be supported by this stayed surface 5031.To similar above, stayed surface 5031 such as can comprise the multiple support slits 5032 (Figure 96 D) be such as defined in wherein, and described multiple support slit 5032 can hold and the base portion 5022 of support nail 5020.The end effector of surgical stapling device also can comprise and keep matrix (such as keeping matrix 5050), and described maintenance matrix can jointing nail 5020, and is trapped in therebetween by tissue.Such as, matrix 5050 is kept to be installed to jaw 5040 removedly.In use, once nail bin 5000 is positioned in nail bin passage 5030, then jaw 5040 and the maintenance matrix 5050 be attached on it can move towards nail bin 5000 and nail bin passage 5030.Jaw 5040 can move downward along axis 5099, makes when jaw 5040 closes, and jaw 5040 and nail bin passage 5030 remain parallel to each other or at least substantially parallel.More specifically, such as, jaw 5040 can close in some way, makes when jaw 5040 moves towards nail bin 5000, keeps the tissue contacting surface 5051 of matrix 5050 to be parallel to or at least substantially parallel to the tissue contacting surface 5019 of nail bin 5000.

Referring now to Figure 96 A, keeping matrix 5050 can be fixed to jaw 5040 separably, making when keeping matrix 5050 to be attached to jaw 5040, keep there is little (if any) relative motion between matrix 5050 and jaw 5040.Jaw 5040 can comprise one or more maintenance feature structure, and maintenance matrix 5050 can be remained on appropriate location by described one or more maintenance feature structure.Such as, keep matrix 5050 can snap fit and/or be pressure fitted in jaw 5040.Can utilize at least one binding agent that maintenance matrix 5050 is adhered to jaw 5040.In any case, jaw 5040 is moveable in the position wherein keeping matrix 5050 contact tissue T and the tissue T location against the tissue contacting surface 5019 of nail bin 5000.When tissue T is positioned to against nail bin 5000 by jaw 5040, the compressible body 5010 of nail bin 5000 can be compressed by jaw 5040 or can not by its compression.In any one situation, the lower limb 5021 of nail 5200 can not pass tissue contacting surface 5019 projection of nail bin 5000, as shown in Figure 96 A.In addition, equally as shown in Figure 96 A, when retain matrix 5050 not jointing nail 5020, jaw 5040 can keep tissue T against compressible body 5010.This type of embodiment can allow surgeon's repeatedly open and close jaw 5040, such as to obtain the expected location of end effector in operative site when not damaging tissue T.But contemplate other embodiments, wherein screw top end 5023 can from tissue contacting surface 5019 projection before warehouse 5010 is compressed by anvil block 5040.Referring now to Figure 96 B, once end effector is properly positioned, then jaw 5040 can move downward towards nail bin passage 5030, and compressible body 5010 is compressed by anvil block 5040, and tissue contacting surface 5019 is pushed down relative to nail 5020.When tissue contacting surface 5019 is pushed down, the top 5023 of nail lower limb 5021 can piercing tissue contact surface 5019 and piercing tissue T at least partially.In this case, keep matrix 5050 can be positioned in above nail 5020, make to keep the retaining hole 5052 of matrix 5050 and follow closely the top 5023 of lower limb 5021 and align or at least substantial alignment.

Referring now to Figure 96 C, when promoting downwards to keep matrix 5050 along axis 5099, the nail lower limb 5021 of nail 5020 can enter in retaining hole 5052.Nail lower limb 5021 can engage the sidewall of retaining hole 5052.As hereafter be described in more detail, keep matrix 5050 to comprise extending in retaining hole 5052 and/or around one or more retaining members of retaining hole 5052, described one or more retaining member can jointing nail lower limb 5021.In any one situation, nail lower limb 5021 can be maintained in retaining hole 5052.In all cases, the top 5023 of following closely lower limb 5021 can enter the sidewall that also frictionally can engage retaining member and/or hole 5052 in retaining hole 5052.When the base portion 5022 keeping matrix 5050 towards nail 5020 is pushed, nail lower limb 5021 can slide relative to sidewall and/or retaining member.Due to mentioned above, can produce force of sliding friction between nail lower limb 5021 and maintenance matrix 5050, wherein this force of sliding friction can be resisted and keep matrix 5050 to be inserted on nail 5020.When keeping matrix 5050 along nail lower limb 5021 slide downward of nail 5020, the force of sliding friction between matrix 5050 and nail 5020 is kept to can be constant or at least substantial constant.Such as, due to nail lower limb 5021, retaining hole 5052 and/or to extend in retaining hole 5052 and/or around the retaining member change in size and geometry of retaining hole 5052, when keeping matrix 5050 along nail lower limb 5021 slide downward, force of sliding friction can increase and/or reduce.The compressible body 5010 of nail bin 5000 also can be resisted and be kept matrix 5050 to be inserted in nail 5020.More specifically, compressible body 5010 can be made up of elastomeric material, and described elastomeric material such as can apply drag to maintenance matrix 5050; When wherein compressible body 5010 is increased by the distance compressed, described drag increases.Such as, the increase of the drag produced by warehouse 5010 can be proportional or at least substantial linear ground is proportional linearly by the distance compressed relative to wherein warehouse 5010.The increase of the drag produced by warehouse 5010 can relative to wherein warehouse 5010 is proportional by the geometric distance ground compressed.

To being described further, and matrix 5050 can be kept to apply enough percussion forces, to overcome above-mentioned drag and frictional force to jaw 5040 above.In use, matrix 5050 is kept can be arranged to any suitable depth relative to nail 5020.Keep matrix 5050 can be arranged to certain depth place relative to the base portion 5022 of nail 5020, so as two-layer or more layer tissue to be secured together and in tissue generation compression stress or pressure.In all cases, the system comprising maintenance matrix 5050 and nail 5020 can allow surgeon to select the amount to the compression stress or pressure organizing applying by the degree of depth that selection wherein keeps matrix 5050 to be placed.Such as, keep matrix 5050 can be pushed down towards the nail base portion 5022 of nail 5020, be arranged to until keeping matrix 5050 and support the bottom of slit 5032 till certain depth 5011, the wherein more shallow degree of depth 5011 can produce the higher compression stress or pressure that are applied to tissue T, and the darker degree of depth 5011 can produce the lower compression stress or pressure that are applied to tissue T.Being applied to the compression stress of tissue T or pressure can be proportional or at least substantial linear ground is proportional linearly with the degree of depth 5011 wherein keeping matrix 5050 to be placed.In all cases, the compression stress or the pressure that are applied to tissue T can be depending on the thickness being positioned at the tissue T kept between matrix 5050 and nail bin 5020.More specifically, for given distance 5011, the existence of thicker tissue T can compare the existence higher compression stress of generation or the pressure of thin tissue T.

In all cases, to being described further above, the degree of depth that surgeon's adjustable wherein keeps matrix 5050 to be placed, the thicker and/or thinner tissue be positioned in end effector to be described, and in the mode had nothing to do with tissue thickness, certain or predetermined pressure is applied to tissue T.Such as, when fastening thinner tissue T, maintenance matrix 5050 can be arranged to the more shallow degree of depth 5011 by surgeon, or is arranged to the darker degree of depth 5011 when the tissue T of fastening thicker, to reach identical or at least substantially the same compression stress in tissue.To being described further above, surgeon optionally determines the amount to being positioned at the compression stress keeping the tissue T between matrix 5050 and nail bin 5010 to apply.In all cases, maintenance matrix 5050 can engage with nail 5020 by surgeon, and will matrix 5050 be kept to be positioned to and follow closely the base portion 5022 of 5020 at a distance of the first distance, to organizing applying first compression pressure.Alternatively, maintenance matrix 5050 can be positioned to base portion 5022 at a distance of second distance by surgeon, and described second distance is shorter than described first distance, to apply to tissue the second compression pressure being greater than the first pressure.Alternatively, maintenance matrix 5050 can be positioned to base portion 5022 at a distance of the 3rd distance by surgeon, and described 3rd distance is shorter than described second distance, to apply to tissue the 3rd compression pressure being greater than the second pressure.Comprise and keep the fastening system of matrix 5050 and nail 5020 that surgeon can be allowed to apply the compression pressure of wide region to target tissue.

Referring now to Figure 96 D, nail lower limb 5021 can be inserted into through keeping matrix 5050, makes to follow closely lower limb top 5023 and extends to above the top surface of maintenance matrix 5050.Refer again to Figure 96 C, jaw 5040 also can comprise the mesopore 5042 be defined in wherein, and when following closely lower limb top 5023 through the retaining hole 5052 kept in matrix 5050, this mesopore can hold nail lower limb top 5023.Such as, mesopore 5042 can align with retaining hole 5052, makes lower limb 5021 not contact jaw 5040.Mesopore 5042 can have enough degree of depth, no matter make wherein why keep the distance that is placed of matrix 5050, and nail lower limb 5021 all not contact jaws 5040.Referring now to Figure 96 D, maintenance matrix 5050 with follow closely 5020 and to engage and after being arranged to desired location, nail bin passage 5030 and jaw 5040 can move away from tissue T.More specifically, nail bin passage 5030 can be separated with implanted nail bin 5000, and anvil block 5040 can be separated with implanted maintenance matrix 5050.When jaw 5040 away from maintenance matrix 5050 move and follow closely support member 5032 away from nail base portion 5022 move time, although jaw 5040 and nail bin passage 5030 no longer provide support maintenance matrix 5050 and base portion 5022, but the distance 5011 between the bottom that still can keep matrix 5050 and base portion 5022.Although apply bias force by the warehouse 5010 that compresses and/or by the tissue T compressed to maintenance matrix 5050, but nail lower limb 5021 and keep the stiction between matrix 5050 that maintenance matrix 5050 can be enough to remain on appropriate location.Such as, warehouse 5010 can be made up of elastomeric material, described elastomeric material can be applied elastic bias forces to maintenance matrix 5050 and nail 5020 in some way when compressing, described elastic bias force is propulsive and keeps matrix 5050 and nail 5020 to make it separately, but this motion is subject to nail lower limb 5021 and keeps the antagonism of the frictional engagement between matrix 5050.

As mentioned above, keep matrix can comprise multiple retaining hole, wherein each retaining hole can hold the lower limb of securing member wherein.Referring now to Figure 97, keep a part for matrix 5150 shown in it, this part can comprise the retaining hole 5152 limited by periphery 5156.The periphery 5156 in hole 5152 can comprise circle or at least substantially circular profile and/or any other suitable profile.Keep matrix 5150 can comprise such as one or more retaining member (such as retaining member 5153), described one or more retaining member to extend in hole 5152 and can engage this fastener leg when fastener leg is inserted wherein.Such as, each retaining member 5153 can comprise the cantilever extended internally towards central axis 5159 (that is, towards the center in hole 5152).Each cantilever can comprise the first end and the second end, and described first end is attached to and keeps matrix main body 5158, and described second end forms the periphery 5156 of retaining hole 5152.The periphery 5156 of retaining hole 5152 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, and wherein Second bobbin diameter can be greater than described first diameter.Such as, fastener leg can contact one or more in retaining member 5153 and make it deflect, to make the diameter of retaining hole 5152 increase when fastener leg is inserted in retaining hole 5152.To being described further above, the periphery that fastener leg limits can be greater than the periphery 5156 of retaining hole 5152, and make when fastener leg is inserted in periphery 5156, fastener leg can make periphery 5156 expand.

Refer again to Figure 97, hole 5152 can be limited by deformable member 5153, wherein each deformable member 5153 can relative to or deflect independent of other deformable members 5153.Such as, adjacent deformable member 5153 can be separated by slit 5154, and this slit 5154 can allow each deformable member 5153 to bend relative to other deformable members 5153.Each slit 5154 can comprise and keeping the first end 5155 in matrix main body 5158, opening to the second end in retaining hole 5152 and the width that is constant or at least substantial constant that extends between the first end 5155 and the second end.Alternatively, the width of each slit 5154 can be inconsistent, and the width of each slit 5154 between its first end and second end can increase and/or reduce.First end 5155 of slit 5154 can comprise enlarging section (such as rounded portions), and described enlarging section both can be to be attached to and kept the base portion of the deformable member 5153 of matrix main body 5158 to provide release of tension, also can increase the flexibility of deformable member 5153.The geometry of deformable member 5153 and/or slit 5154 can be selected to deformable member 5153 provides required flexibility.Such as, slit 5154 can be lengthened out, to form longer deformable member 5153, the comparable deformable member 5153 with shorter length of this longer deformable member has more flexibility.The width of each deformable member 5153 can be selected to it provides required flexibility.More specifically, the comparable deformable member with thicker width of deformable member with thinner width has more flexibility.Refer again to Figure 97, first end being attached to maintenance matrix main body 5158 of the cantilever of deformable member 5153 can wider than the second end of cantilever.Such as, cantilever can the mode with linearly or at least substantial linear between its first end and second end be tapered.

Refer again to Figure 97, keep matrix main body 5158 can comprise smooth or at least substantially smooth material piece, it has tissue contacting surface 5151 and top surface 5157.Such as, tissue contacting surface 5151 and top surface 5157 can be parallel to each other or at least substantially be parallel to each other.Each deformable member 5153 can comprise Part I 5153a and Part II 5153b, and wherein Part I 5153a can extend in a first direction, and Part II 5153b can extend on different directions or second direction.Keep matrix main body 5158 to limit plane, and the Part I 5153a of deformable member 5153 can be positioned at this plane.The Part II 5153b of deformable member 5153 angularly can extend relative to Part I 5153a.Such as, Part II away from keeping, the direction of the top surface 5157 of matrix main body 5158 can extend, and Part II 5153b can assemble towards the central axis 5159 of retaining hole 5152.In any case, Part II 5153b can deflect away from central axis 5159 when fastener leg is inserted through Part II.When the nail lower limb 5021 of nail 5020 inserts in retaining hole 5152, deformable member 5153 can be out of shape on the direction roughly away from the base portion 5122 of nail 5120.Therefore, deformable member 5153 can at the roughly direction upper deflecting identical or at least substantially the same with the direction that is inserted into of nail lower limb 5021.

Refer again to figure BD, the Part II 5153b of deformable member 5153 such as can comprise sharp top separately, can slide against nail lower limb 5021 when following closely lower limb 5021 and inserting wherein in described sharp top.If nail lower limb 5021 in the opposite direction (that is, by the direction that removes from retaining hole 5052 of nail lower limb 5021) be pulled, then the sharp top of Part II 5153b also can be snapped in nail lower limb 5021.In some cases, Part II 5153b can tilt be greater than relative to the limit of nail lower limb 5021 angle of 90 degree, therefore, when following closely lower limb 5021 and being subject to the power being tending towards withdrawing from nail lower limb 5021 from retaining hole 5052, Part II 5153b can dig or be dug in the limit of nail lower limb 5021.Nail lower limb 5021 such as can comprise impression and/or depression (such as micro-indentations) in its surface, and described impression and/or depression such as can hold the top of deformable member 5053 wherein.Such as, when applying to withdraw from power to nail lower limb 5021, the top of deformable member 5053 can be stranded in or be dug in the impression of nail lower limb 5021.Be dug into the result in nail lower limb 5021 as Part II 5153b, Part II 5153b only can be arranged to the more depths in nail lower limb 5021 and increase the power removed needed for nail lower limb 5021 by the power acted on for removing nail lower limb 5021 from retaining hole 5022.In addition, because Part II 5153b is inclined upwardly, Part II 5153b more can allow to follow closely lower limb 5021 and insert in retaining hole 5152 and more the withdrawing from of opposing nail lower limb 5021.Therefore, nail lower limb 5021 is inserted power required in retaining hole 5022 and can be less than the power removing from retaining hole 5022 and follow closely needed for lower limb 5021.Such as, from retaining hole 5022, remove the power of nail needed for lower limb 5021 can be greater than nail lower limb 5021 is inserted power about 50% required in retaining hole 5022.Alternatively, such as, remove the power of nail needed for lower limb 5021 and can be greater than the power about 10% of insertion nail needed for lower limb 5021 to about between 100%.Such as, remove the power of nail needed for lower limb 5021 can be greater than and insert power about 100%, about 150%, about 200% of nail described in lower limb 5021 and/or be greater than 200%.

Refer again to Figure 97, Part II 5153b surrounding hole 5152 circumferentially can arrange and can limit pit between Part II 5153b and hole 5152.More specifically, Part II 5153b can limit pit 5160, and this pit can hold the top of fastener leg when fastener leg is inserted in retaining hole 5152.The Part II 5153b of deformable member 5153 can comprise annular or at least substantially annular profile, that this profile such as can limit the annular of pit 1560 collaboratively or at least substantially annular profile.Such as, Part II 5153b can limit taper or the pit of truncated cone shape.Pit can be limited by the deformable member of suitable number (such as four deformable members 5153 (Figure 97), six deformable members 5153 (Figure 98) or eight deformable members 5153 (Figure 99)).Referring now to Figure 100, keep the deformable member of matrix (such as keeping matrix 5250) such as can form cone shape or at least be essentially the shape of cone.Keep matrix 5250 such as can comprise multiple retaining hole (such as retaining hole 5252), described multiple retaining hole can be limited by periphery 5256.Periphery 5256 can comprise polygonal or at least be essentially polygonal profile and/or other suitable profiles.Keep matrix 5250 can comprise one or more retaining member (such as retaining member 5253), described one or more retaining member to extend in hole 5252 and can in fastener leg patchhole 5252 time engage this fastener leg.Such as, each retaining member 5253 can comprise the cantilever extended internally towards central axis 5259 (that is, towards the center in hole 5252).Each cantilever can comprise the first end and the second end, and described first end is attached to and keeps matrix main body 5258, and described second end forms the periphery 5256 of retaining hole 5252.The periphery 5256 of retaining hole 5252 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, and wherein Second bobbin diameter can be greater than described first diameter.Such as, fastener leg can contact one or more in retaining member 5253 and make it deflect, to make the diameter of retaining hole 5252 increase when fastener leg is inserted in retaining hole 5252.To being described further above, the periphery that fastener leg limits can be greater than the periphery 5256 of retaining hole 5252, and make when fastener leg is inserted in periphery 5256, fastener leg can make periphery 5256 expand.

Refer again to Figure 100, hole 5252 can be limited by deformable member 5253, wherein each deformable member 5253 can relative to or deflect independent of other deformable members 5253.Such as, adjacent deformable member 5253 can be separated by slit 5254, and this slit 5254 can allow each deformable member 5253 to bend relative to other deformable members 5253.Keep matrix main body 5258 can comprise the smooth or at least substantially smooth material piece with tissue contacting surface 5251 and top surface 5257.Such as, tissue contacting surface 5251 and top surface 5257 can be parallel to each other or at least substantially be parallel to each other.Each deformable member 5253 can comprise Part I 5253a and Part II 5253b, and wherein Part I 5253a can extend in a first direction, and Part II 5253b can extend on different directions or second direction.Such as, keep matrix main body 5258 to limit plane, and the Part I 5253a of deformable member 5253 can be positioned at this plane.The Part II 5253b of deformable member 5253 angularly can extend relative to Part I 5253a.Such as, Part II 5253b away from keeping, the direction of the top surface 5257 of matrix main body 5258 can extend, and Part II 5253b can assemble towards the central axis 5259 of retaining hole 5252.In any case, Part II 5253b can deflect away from central axis 5259 when fastener leg is inserted through Part II.Refer again to Figure 100, Part II 5253b surrounding hole 5252 circumferentially can arrange and can limit pit between Part II and hole 5252.More specifically, Part II 5253b can limit pit, and described pit can hold the top of fastener leg when fastener leg is inserted in retaining hole 5252.The Part II 5253b of deformable member 5253 such as can limit polygon or at least be essentially polygonal pit.Pit can be limited by the deformable member of suitable number (such as can limit foursquare four deformable members 5253 (Figure 100), can limit hexagonal six deformable members 5253 (Figure 101), maybe can limit octagonal eight deformable members 5253 (Figure 102)).

Referring now to Figure 103, maintenance matrix (such as keeping matrix 5350) such as can by smooth or at least substantially smooth material piece (such as, titanium and/or rustless steel) formation.Such as, in the main body 5358 keeping matrix 5350, multiple hole 5352 is formed by one or more punching course.Material piece can be positioned in diel, and some part of material can stamp out, to form the such as hole 5355 of slit 5354, slit 5354 and/or the periphery 5356 of retaining hole 5352 when activating by this mould.Deformable member 5353 also can be bent to suitable configuration by diel.Such as, diel can make Part II 5353b upwards be out of shape along crease line 5353c relative to Part I 5353a.Referring now to Figure 104, keep matrix (such as keeping matrix 5450) such as can comprise multiple retaining hole 5452.To similar above, the periphery 5456 of each retaining hole 5452 can limit by by slit or the isolated multiple deformable member 5453 of slit 5454.Such as, the entirety of each deformable member 5453 all can be bent upwards, and the free end comprising the cantilever of deformable member 5453 can limit periphery 5456.Keep matrix 5450 can comprise around or at least substantially around multiple holes 5455 of retaining hole 5452.Such as, hole 5455 can around or surround the periphery that limited by the stiff end of the cantilever of deformable member 5453 and be arranged to circular array.Each hole 5455 can comprise circle or at least substantially circular periphery and/or any other suitable periphery.In use, hole 5455 both can be to be attached to and has kept the base portion of the deformable member 5453 of matrix main body 5458 to provide release of tension, can increase again the flexibility of deformable member 5453.Larger hole 5455 can be the flexibility that deformable member 5453 provides larger compared with less hole 5455.In addition, the hole 5455 closer to deformable member 5453 can provide larger flexibility compared with farther hole 5455.

Referring now to Figure 105, keep matrix (such as keeping matrix 5550) such as can comprise multiple retaining hole 5552.Each retaining hole 5552 all can comprise elongated slot 5554, and this elongated slot has the circle of amplification or at least substantially circular end 5555.Such as, end 5555 can be limited by the diameter wider than slit 5554.Elongated slot 5554 and end 5555 can longitudinally to be located and/or between two parties by axis 5559.Slit 5554 and end 5555 can limit two relative inserted sheets 5553, and described two relative inserted sheets 5553 can the lower limb of jointing fastener, and make two relative inserted sheets 5553 deflect when fastener leg is inserted into through inserted sheet 5553.The end 5555 with larger girth or diameter can limit longer inserted sheet 5553, and the inserted sheet 5553 that the comparable end 5555 with less girth or diameter of described inserted sheet 5553 limits has more flexibility.End 5555 can have identical girth and diameter, and such as, each inserted sheet 5553 can about axisymmetrical that is vertical with longitudinal axis 5559 or at least perpendicular.Alternatively, end 5555 can have different girths and/or diameter, and wherein each inserted sheet 5553 can be not in relation to its axisymmetrical.Such as, when fastener leg is inserted into through retaining hole 5552, inserted sheet 5553 can around its axis distortion.Referring now to Figure 106, keep matrix (such as keeping matrix 5650) such as can comprise multiple retaining hole 5652.Each retaining hole 5652 all can comprise elongated slot 5654, and this elongated slot comprises circle or at least substantially circular end 5655.Such as, elongated slot 5654 and end 5655 can longitudinally to be located and/or between two parties by axis 5659.Each end 5655 all can be limited by identical with the width of slit 5654 or at least substantially the same diameter.

Referring now to Figure 107, keep matrix (such as keeping matrix 5750) such as can comprise multiple retaining hole 5752.Each retaining hole 5752 can comprise multiple slits (such as slit 5754) such as with enlarged end 5755.Such as, slit 5754 and end 5755 can be located and/or between two parties by axis 5759 along the longitudinal.Axis 5759 can mutually vertical or across direction on extend.Slit 5754 and end 5755 such as can limit four inserted sheets 5753, and described four inserted sheets 5753 can jointing fastener supporting leg, and the deflection when fastener leg is inserted into through retaining hole 5752.Such as, each inserted sheet 5753 can comprise leg-of-mutton or at least be essentially leg-of-mutton configuration (such as equilateral triangle).Alternatively, referring now to Figure 108, keep matrix (such as keeping matrix 5850) such as can comprise multiple retaining hole 5852.Each retaining hole 5852 can comprise multiple slits (such as slit 5854) with end 5855, and wherein slit 5854 and end 5855 can longitudinally to be located and/or between two parties by axis 5859.Axis 5859 can mutually vertical or across direction on extend.Slit 5854 and end 5855 can limit inserted sheet 5853, and inserted sheet 5853 can jointing fastener supporting leg, and the deflection when fastener leg is inserted into through retaining hole 5852.Each inserted sheet 5853 can comprise arc profile.More specifically, different from the end of the point shown in Figure 105, each inserted sheet 5853 can comprise bending end, and described end can touch fastener supporting leg.

Referring now to Figure 109, keep matrix (such as keeping matrix 5950) such as can comprise multiple retaining hole 5952.Each retaining hole 5952 such as can comprise multiple slit (such as slit 5954), and wherein each slit 5954 can to extend and/or between two parties along axis 5959.Axis 5959 can transverse to each other, such as, axis 5959 can be arranged such that all axis 5959 extend through retaining hole 5952 center and each other equidistantly or at least substantially equidistantly spaced apart.Each slit 5954 can comprise the second end or the blind end 5955 at the opening towards the center of retaining hole 5952 and the opposite end place at slit 5954.To similar above, slit 5954 and end 5955 such as can limit three inserted sheets 5953, and described three inserted sheets 5953 can jointing fastener supporting leg, and the deflection when fastener leg is inserted into through retaining hole 5952.Each inserted sheet 5953 can be included in the arcuate configuration extended between the adjacent end portion 5955 of slit 5954.Referring now to Figure 110, keep matrix (such as keeping matrix 6050) such as can comprise multiple retaining hole 6052.Each retaining hole 6052 can comprise inserted sheet 6053, and inserted sheet 6053 can jointing fastener supporting leg, and deflects when fastener leg is inserted in retaining hole 6052.Such as, inserted sheet 6053 can comprise being fixed to and keeps the base portion of matrix main body 6058 and comprise free end that is arc or curved profile 6056, and described free end can touch fastener supporting leg.Fastener leg can for the nail lower limb be made up of round wire material, and wherein curved profile 6056 can be mated with the crooked outer surface of circular wire rod or at least substantially mate.

Refer again to Figure 110, keep matrix main body 6058 can comprise multiple slit 6054 and hole 6055, described multiple slit and hole can limit the various piece of inserted sheet 6053 and retaining hole 6052.Inserted sheet 6053 can comprise rectangular configuration, and described rectangular configuration comprises parallel or at least substantially parallel limit.Referring now to Figure 111, keep matrix (such as keeping matrix 6150) such as can comprise multiple retaining hole 6152.Each retaining hole 6152 can comprise inserted sheet 6153, and this inserted sheet can jointing fastener supporting leg, and deflects when fastener leg is inserted in retaining hole 6152.Such as, inserted sheet 6153 can comprise being fixed to and keeps the base portion of matrix main body 6158 and comprise free end that is arc or curved profile 6156, and described free end can touch fastener supporting leg.Keep matrix main body 6158 can comprise multiple slit 6154 and hole 6155, described multiple slit and hole can limit the various piece of inserted sheet 6153 and retaining hole 6152.Inserted sheet 6153 can comprise the configuration of convergent, and the configuration of described convergent comprises arc limit.Such as, inserted sheet 6153 can geometrically be tapered, such as, make base portion wider than free end.

As mentioned above, fastening system can comprise multiple nail, and described multiple nail comprises the nail lower limb inserted through the multiple retaining hole kept in matrix.As hereafter described in more detail, nail can be maintained in the first jaw, and keeps matrix can be maintained in the second jaw, and at least one wherein in the first jaw and the second jaw can be moved towards another one.In all cases, the nail be positioned in the first jaw can be fixed on wherein, and make when keeping matrix to engage with nail lower limb, nail lower limb aligns with retaining hole.See Figure 112 and Figure 113, closure system can comprise the nail bin 6200 be such as positioned in the first jaw of surgical stapling device, and is such as positioned at the maintenance matrix 6250 in the second jaw of surgical stapling device.Referring now to Figure 119 and Figure 120, to being described further above, keep matrix 6250 can comprise multiple retaining hole 6252, wherein each retaining hole 6252 can comprise the periphery 6256 limited by one or more deflection component 6253.Such as, to being described further above, the deflection component 6253 limiting each hole 6252 can limit pit 6201.Each pit 6201 can comprise such as bending and/or concave surface, and described bending and/or concave surface can be unjustified with retaining hole 6252 and first contact in the situation of deflection component 6253 and/or tissue contacting surface 6251 and be directed in hole 6252 on the top of following closely lower limb at nail lower limb.

To being described further above, fastening system also can comprise multiple nail 6220, and described multiple nail 6220 comprises the nail lower limb 6221 that can insert through the retaining hole 6252 kept in matrix 6250.Such as, each nail 6220 can comprise such as the configuration of U-shaped substantially, and described configuration comprises base portion 6222, and nail lower limb 6221 upwards can extend from this base portion 6222.Referring now to Figure 115 and Figure 116, such as, keep the retaining hole 6252 in matrix 6250 can be arranged to two parallel or at least substantially parallel lengthwise rows, described lengthwise rows can along keeping the longitudinal axis of matrix or be parallel to described longitudinal axis extending.Retaining hole 6252 in the first row can offset or stagger arrangement relative to the retaining hole 6252 in the second row.Such as, each nail 6220 can comprise the first nail lower limb 6221 in the retaining hole 6252 be positioned in the first row and the second nail lower limb 6221 in the retaining hole 6252 in a second row of location, wherein as a result, base portion 6222 across keeping, the direction of the longitudinal axis of matrix 6250 can extend.Such as, follow closely 6220 can be parallel to each other or at least substantially be parallel to each other.More specifically, the base portion 6222a such as following closely 6220a can be parallel to or can be parallel at least substantially parallel to the base portion 6222b of nail 6220b, the base portion 6222b of described nail 6220b or at least substantially parallel to the base portion 6222c of nail 6220c.The plane that the nail lower limb 6221a such as following closely 6220a limits can be parallel to or at least substantially parallel to the plane that limits of nail lower limb 6221b of nail 6220b, the plane that the plane that the nail lower limb 6221b of described nail 6220b limits can be parallel to or limit at least substantially parallel to the nail lower limb 6221 of nail 6220c.

Referring now to Figure 112 and Figure 114, nail bin 6200 can comprise multiple nail 6220, and has the alignment matrix 6260 in multiple alignment guider (such as slit, groove and/or hole) in addition, and described multiple alignment guider can align nail 6220.In all cases, alignment matrix 6260 can make before maintenance matrix 6250 jointing nail lower limb 6221, and the nail lower limb 6221 of nail 6220 aligns with the retaining hole 6252 kept in matrix 6250.Referring now to Figure 117 and Figure 118, alignment matrix 6260 can comprise multiple aligned hole 6262, and described multiple aligned hole closely can hold the nail lower limb 6221 of nail 6220.Such as, each nail 6220 can comprise base portion 6222 and from two nail lower limbs 6221 that base portion 6222 extends, the base portion 6222 wherein following closely 6220 can extend around keeping the lower surface 6264 of matrix 6260, and follows closely lower limb 6221 and upwards can extend through aligned hole 6262.Each aligned hole 6262 can be circular or at least substantially circular, and the diameter limiting aligned hole 6262 can be equal to or slightly greater than through the wherein diameter of the nail lower limb 6221 extended.Alignment matrix 6260 also can comprise multiple raised member 6263, described multiple raised member upwards can extend from the top surface 6261 of alignment matrix 6260 and around or at least in part around aligned hole 6262.Raised member 6263 can provide longer aligned hole 6262, wherein in all cases, and the alignment of the hole 6262 that longer hole 6262 can be shorter control nail lower limb 6221 better.

In use, the first jaw supporting nail bin 6200 can be positioned on the side of tissue to be stapled, and the second jaw supporting maintenance matrix 6250 can be positioned on the opposite side of tissue.Once jaw is properly positioned relative to tissue, then the second jaw and maintenance matrix 6250 can move towards nail bin 6200.When following closely lower limb 6221 and being inserted into through keeping the retaining hole 6252 of matrix 6250, keep the tissue contacting surface of matrix 6250 or lower surface 6251 can contact tissue press tissue against the tissue contacting surface of alignment matrix 6260 or top surface 6261.Alternatively, as described in more detail below, nail bin 6200 also can such as comprise be positioned alignment matrix 6260 top surface 6261 above and can the compressible warehouse of contact tissue.Refer again to Figure 114 and Figure 118, alignment matrix 6260 also can comprise and is defined in one or more hole 6203; When alignment matrix 6260 is located against tissue, described one or more hole can hold a part for tissue wherein.When above compressible warehouse is positioned alignment matrix 6260 and/or against alignment matrix 6260, when warehouse is compressed, the part of compressible warehouse can in access aperture 6203.Similarly, keep matrix 6250 can comprise multiple hole 6202, described multiple hole 6202 can hold tissue at least partially wherein when keeping matrix 6250 to locate against tissue.

To being described further above, when the nail lower limb 6221 of nail 6220 inserts through keeping the retaining hole 6252 of matrix 6250, the top of nail lower limb 6221 can from keeping the top surface 6257 of matrix 6250 upwardly.In all cases, as mentioned above, the top of following closely lower limb 6221 can keep not bending after being inserted into through retaining hole 6252.Referring now to Figure 121-Figure 124; comprise nail bin 6200 and keep the fastening system of matrix 6250 also can comprise multiple protectiveness top cover or lid (such as cap 6270), described multiple protectiveness top cover or lid can be assembled on the nail lower limb 6221 that is projected on and keeps above matrix 6250.Each cap 6270 can the sharp end of completely or at least in part covering nail lower limb 6221, makes described sharp end not contact the tissue being adjacent location.Referring now to Figure 124, each cap 6270 can comprise the hole 6271 be defined in wherein, and this hole closely can hold the top of nail lower limb 6221 wherein.Such as cap 6270 can be made up of elastomeric material (such as (santoprene) and/or natural rubber are all put down in siloxanes, polyisoprene, mountain).The girth in hole 6271 or diameter can be less than girth or the diameter of insertion nail lower limb 6221 wherein.Such as, hole 6271 easily extensible in protectiveness top cover 6270 is to hold nail lower limb 6221 wherein.Alternatively, cap 6270 can not comprise hole, and cap 6270 can be cut when lower limb 6221 inserts in cap 6270 in the top of following closely lower limb 6221.Under any circumstance, each cap 6270 all can be arranged on nail lower limb 6221, keeps the top surface 6257 of matrix 6250 until the base portion 6272 of cap 6270 is adjacent or contiguous and locates.In all cases, cap 6270 can make it be closely arranged on the top of nail lower limb 6221, can not be removed from described top easily to make it.That each cap 6270 such as can comprise taper or be at least essentially taper outer surface.Cap 6270 can comprise any suitable shape, such as comprises parabola shaped or is at least essentially the shape of parabola shaped outer surface.

Such as can use the surgical stapling device shown in Figure 125-Figure 127 to dispose such as above-mentioned closure system.End effector can comprise the first jaw or nail bin passage 6230 and the second jaw 6240; nail bin 6200 can be supported on wherein by the first jaw or nail bin passage 6230, and the second jaw 6240 can support maintenance matrix 6250 and described multiple protectiveness top cover 6270.First see Figure 125, it illustrates the second jaw 6240 being in and opening configuration, relative to tissue T, jaw 6230 and 6240 can be positioned such that tissue T is positioned at and keep between matrix 6250 and nail bin 6200.As mentioned above, nail bin 6200 also can comprise compressible warehouse (such as warehouse 6210), such as, wherein can be positioned with nail 6220 and alignment matrix 6260.Such as, tissue T can be located against the top surface of warehouse 6210.Second jaw 6240 can comprise multiple groove or hole 6245 and another one or multiple maintenance feature structure or keeper; described multiple groove or hole 6245 can hold multiple protectiveness top cover 6270, and maintenance matrix 6250 can be remained on appropriate location by described one or more maintenance feature structure or keeper on cap 6270.Such as, matrix 6250 is kept cap 6270 can be remained in hole 6245.Referring now to Figure 137, part or all of cap 6270 all can be accommodated therein by each hole 6245.The size in such as hole 6245 is sufficiently set to and can be made by be press-fitted and/or cap 6270 is fixed in hole 6245 by least one in snap-fit arrangement.At least one binding agent can be utilized to be fixed in hole 6245 by cap 6270.Such as, this binding agent can be selected such that at cap 6270 jointing nail lower limb 6221 and after the second jaw 6240 moves away from the fastener assembly implanted, cap 6270 can be separated with the second jaw 6240.Referring now to Figure 138, the second jaw 6240 also can comprise at least one emulsion sheet 6246, and at least one emulsion sheet described can be assembled to the second jaw 6240 and can extend above cap 6270 and be remained in hole 6245 by cap 6270.Such as can utilize at least one binding agent that emulsion sheet 6246 is fixed to jaw 6240 at least partially.In use, before end effector inserts operative site, emulsion sheet 6246 can be separated with jaw 6240 at least in part.Emulsion sheet 6246 can be made up of implanted material (such as PDS and/or PGA), and such as, when following closely lower limb 6221 and exposing from maintenance matrix 6250, described implanted material can be cut by nail lower limb 6221.Such as, emulsion sheet 6246 can be fixed in fastening system in the middle of lid 6270 with maintenance matrix 6250.

Referring now to Figure 126, to being described further above, jaw 6240 can move to make position from open position, and wherein tissue T is located against maintenance matrix 6250 and warehouse 6210.In this position, maintenance matrix 6250 can not jointing nail 6220.Jaw 6240 moves between its open position and its make position by actuator 6235.Such as, jaw 6240 can comprise the distal pin 6243 and proximal pin 6244 that extend from it, wherein distal pin 6243 can be slided vertically or at least substantially vertically being limited in the distally slit 6233 in storehouse passage 6230, and wherein proximal pin 6244 can be slided vertically or at least substantially vertically being limited to equally in the nearside slit 6234 in nail bin passage 6230.In use, actuator 6235 can proximally be retracted, to be urged to by pin 6243 and 6244 in the upper end of its corresponding slit 6233 and 6234, as shown in Figure 126.Such as, actuator 6235 can comprise distally and drive slit 6236 and nearside to drive slit 6237, wherein drive slit 6236 with 6237 sidewall can contact distal pin 6243 and proximal pin 6244 respectively, and when actuator 6235 proximally moves upwards drive pin 6243 and 6244.More specifically, when actuator 6235 proximally moves, distal pin 6243 can make distally drive the Part I 6236a upward sliding of the inclination of slit 6236 in mid portion or Part II 6236b; Similarly, proximal pin 6244 can make distally drive the Part I 6237a upward sliding of the inclination of slit 6237 in mid portion or Part II 6237b.When both pins 6243 and 6244 all move upward, jaw 6240 can be rotated down to make position towards tissue T.

Referring now to Figure 127; to being described further above, actuator 6235 can proximally be pulled further, to promote the second jaw 6240 downwards towards the first jaw 6230; compression warehouse 6210, and maintenance matrix 6250 and multiple protectiveness top cover 6270 are engaged with the nail lower limb of nail 6220.Such as, the additional proximal movement of actuator 6235 can make the sidewall contact plug 6243 and 6244 respectively of driving slit 6236 and 6237, and respectively towards the downward drive pin 6243 and 6244 in bottom of slit 6233 and 6234.In this case, actuator 6235 can proximally be pulled, distal pin 6243 is left and drives the Part II 6236b of slit 6236 and enter the Part III 6236c of inclination, and similarly, proximal pin 6244 leaves the Part II 6237b the Part III 6237c entering inclination that drive slit 6237.When both pins 6243 and 6244 all move downward, the second jaw 6240 can move downwardly to firing position towards the first jaw 6230.Such as, the second jaw 6240 can move downward, make to keep matrix 6250 to remain parallel to or at least substantially parallel to warehouse 6210 top surface and/or to be parallel to or at least substantially parallel to alignment matrix 6260.In any case, once keep the nail lower limb 6221 of matrix 6250 and protectiveness top cover 6270 jointing nail 6220, as shown in Figure 129, then the second jaw 6240 can be back to position that is that open or that at least substantially open.Such as, actuator 6235 can distally be pushed, pin 6243 and 6244 to be urged to respectively the top of slit 6233 and 6234, and subsequently once pin is through corresponding mid portion 6236b and 6237b driving slit 6236 and 6237, then actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234.Once the second jaw 6240 is opened, then the first jaw 6230 can be separated with the nail bin 6200 implanted, and the first jaw 6230 and the second jaw 6240 can be removed away from the fastener assembly implanted, as shown in Figure 128.

Refer again to Figure 127, although reader it should be noted that keep matrix 6250 and cap 6270 jointing nail lower limb 6221, but pin 6243 and 6244 is not depicted as in the bottommost being placed in its respective slots 6233 and 6234 in figure.When thick tissue T is positioned between maintenance matrix 6250 and warehouse 6210, this thing happens in meeting.Referring now to Figure 130, when being positioned at compared with thin tissue T between maintenance matrix 6250 and warehouse 6210, pin 6243 and 6244 can be driven downwards further to its corresponding slit 6233 and 6234, as shown in Figure 132.In general; such as; actuator 6235 can proximally be pulled; to be come upwards and downward drive pin 6243 and 6244 by the process shown in above-mentioned and Figure 130-Figure 132; and because tissue T is thinner; keep matrix 6250 and protectiveness top cover 6270 can be driven to further on the nail lower limb 6221 of nail 6220, as shown in Figure 133 and Figure 134.As the result of the adjustable keeping matrix 6250 to provide, the tissue no matter be captured in end effector is thick or thin, all can obtain identical or at least substantially the same compression pressure in fastening tissue.The adjustable keeping matrix 6250 to provide can allow surgeon to select to apply the still less compression pressure of larger compression pressure to tissue by selecting the degree of depth keeping matrix 6250 to be placed.Such as, the scope wherein keeping matrix 6250 can be arranged on nail lower limb 6221 is such as determined by the length of slit 6233 and 6234 or scope.

As mentioned above, protectiveness top cover 6270 can by such as promptly can follow closely the softness of the end of lower limb 6221 or the material of flexibility form.Protectiveness top cover 6270 can by can bio-absorbable plastics (such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with the poliglecaprone 25 (PGCL) that trade name Monocryl sells, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, the complex of PGCL and/or PCL) and/or biocompatibility metal (such as titanium and/or rustless steel) formation.As shown in Figure 124, each cap 6270 can be not attached to other caps 6270.Alternatively, one or more cap 6270 can be installed to and keep matrix 6250.Such as, cap 6270 such as can be connected to by least one binding agent and keep matrix 6250, can align with keeping the retaining hole 6252 in matrix 6270 or at least substantial alignment in the hole 6271 wherein in cap 6270.Referring now to Figure 135, protectiveness top cover (such as cap 6370) such as can limit inner chamber or dome 6374, and the top of nail lower limb 6221 such as can be accommodated therein by described inner chamber or dome.Such as, cap 6370 can comprise bottom 6372 and extend through the hole 6371 of bottom 6372.Hole 6371 can be limited by one or more deflection component 6373, deflection when described one or more deflection component 6373 can be inserted into following closely lower limb 6221 and passing wherein.Such as two or more caps 6370 can be joined together to form the array of cap 6370.Such as, referring now to Figure 136, multiple cap 6370 links together by material piece 6375.Sheet 6375 can have enough rigidity to keep arrangement and/or the alignment thereof of the expectation of cap 6370.Cap 6370 can be made up of biocompatibility metal (such as titanium and/or rustless steel), and sheet 6375 can by can the plastics (complex of the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) of bio-absorbable be formed.Sheet 6375 can by wherein storing and/or be dispersed with can the material of bio-absorbable forming of antibacterial (such as collargol and/or triclosan), and such as, when sheet 6375 is by bio-absorbable, described antibacterial can be released.

To being described further above, injection molding method can be utilized by sheet 6375 injection molding around cap 6370, such as, making cap 6370 be embedded in sheet 6375.Alternatively, such as, injection molding method can be utilized to carry out molding sheet 6375, wherein such as during injection molding method and/or after injection molding method, process for stamping can be utilized in sheet 6375 to form hole 6376.In any one situation, can by cap 6370 patchhole 6376 and utilize be press-fitted and/or snap fit interconnection and/or at least one binding agent be fixed in hole 6376.Each cap 6370 can comprise around or at least in part around the ring-shaped groove of cap 6370 periphery, the periphery in hole 6376 can be contained in wherein by described ring-shaped groove.Sheet 6375 can be made up of the flexibility and/or pliable material that can allow to carry out between cap 6370 relative motion.Such as, flexible sheets 6375 can be made up of such as rubber, plastics and/or silicone compositions, and cap 6370 can be made up of rigid material (such as metal).To similar above, flexible material can be molded into around cap 6370.Such as cap 6370 can be pressed in the sheet 6375 of molding in advance.The hardness of flexible material can be chosen to provide the rigidity needed for sheet 6375.Sheet 6375 can make it comprise flexible-belt.In any case, sheet 6375 can be conducive to cap 6370 to be assembled in end effector, this is because can multiple cap 6370 be located and/or is aligned in end effector simultaneously.In addition, the sheet 6375 of attachment cap 6370 once implanted, then can such as be strengthened or supporting tissue along nail line.Except the sheet of attachment cap 6370 or as described substitute, cap 6370 links together by multiple chain link.Such as, this chain link can be flexible and can allow to carry out relative motion between cap 6370.

Referring now to Figure 139 and Figure 140, protectiveness top cover (such as cap 6470) such as can comprise profiled surface, and described profiled surface can make the top of nail lower limb be out of shape.Such as, cap 6470 can comprise base portion 6472, and this base portion can comprise the hole 6471 extended through wherein.Nail lower limb (such as following closely lower limb 6221) can closely be accommodated therein by hole 6471.The diameter of limiting hole 6471 or girth can be equal to or greater than diameter or the girth of nail lower limb 6221.Cap 6470 also can comprise cavity or dome 6474, and this cavity or dome can hold the top of nail lower limb 6221 when following closely lower limb 6221 and inserting in cap 6470.First see Figure 140, cap 6470 also can comprise anvil block or profiled surface 6473, and this anvil block or profiled surface can make nail lower limb 6221 deflect and be out of shape.In all cases, profiled surface 6473 such as can be bending and/or spill, and nail lower limb 6221 can be made curling when following closely lower limb 6221 and being inserted into cap 6470.Nail lower limb 6221 can be deformed sufficiently to make it cannot passing hole 6471 and being withdrawn from, and therefore cap 6470 can be locked to nail lower limb 6221.Such as, the antelabium that the base portion 6472 of cap 6470 can limit surrounding hole 6471 and extend, described antelabium can prevent strained nail lower limb 6221 to be removed from cavity 6474.In all cases, due to mentioned above, one or more cap 6470 can prevent from or suppress keeping matrix (such as keeping matrix 6250) fall back from nail 6220 or depart from.Although not shown, but cap 6470 can be formed symmetrically or at least substantially symmetrically, and hole 6471 can be located along the central axis 6479 extended through cap 6470.Alternatively, refer again to Figure 139, hole 6471 can offset relative to central axis 6479.Such as, the hole 6471 of skew can allow to follow closely lower limb 6221 and contacts the side of profiled surface 6473 and be crimped onto the opposite side of profiled surface 6473, instead of the center of contact profiled surface 6473, as above-mentioned comprise contingent in the embodiment in the placed in the middle hole 6471 arranged.

As mentioned above, matrix (such as keeping matrix 6250) is kept can to form by material piece and through the multiple retaining holes 6252 wherein extended.Form to keep the material piece of matrix 6250 to can be rigidity or not deflection substantially.Alternatively, matrix is kept multiple flexible connecting member of matrix element or chain link can be kept to form by keeping the array of matrix element and connection.Referring now to Figure 141, keep matrix or keep a part for matrix 6550 can comprise multiple element body 6505, described multiple element body can be linked together by one or more connecting link 6507.Each element body 6505 all can comprise multiple deformable member 6553, and described multiple deformable member can limit retaining hole 6552 wherein.Keep the element body 6505 of matrix 6550 and connecting link 6507 can be integrally formed and integral type material block can be comprised.Matrix 6550 is kept such as to be formed by metal material (such as titanium and/or rustless steel) punching press or casting.Keep matrix 6550 can by plastics (such as polyether-ether-ketone (PEEK), the polypropylene sold with trade name Pu Liling (Prolene), polyester, the polyethylene terephthalate of selling with trade name Ethibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride-altogether-hexafluoropropene, the polyhexafluoropropylene-VDF sold with trade name Pronova and/or the long-chain fat race polymer nylon 6 sold with trade name Ethilon & Nurolon and nylon 6,6) form, and formed by such as injection molding method.Element body 6505 can not be integrally formed with connecting link 6507.Can produce multiple single element body 6505, described multiple single element body 6505 is joined together subsequently and embeds and keeps in matrix.Such as, element body 6505 can be stamped to form by metal material (such as titanium and/or rustless steel) and be placed in plastic injection mould, wherein plastic material can be injected mould with formed around or the edge 6506 of encircling element main body 6505 and the connecting link 6507 that extends from edge 6506 at least in part.Alternatively, one or more connector dot matrix can be formed to comprise the hole be limited in multiple edge 6506, and wherein element body 6505 all can be contained in wherein by each this hole.Each element body 6505 can comprise neighboring that is circular or that be at least essentially circle; Similarly, can be limited with hole that is circular or that be at least essentially circle in each edge 6506, the diameter in wherein said hole can be equal to or less than the diameter of element body 6505.Such as, element body 6505 can be press-fitted or in hole in built-in edge 6505.At least one binding agent can be utilized to be fixed in hole by element body 6505.

To being described further above, keep matrix can comprise multiple element body 6505 and multiple connecting link 6507, described multiple connecting link 6507 can carry out Connection Element main body 6505 by any suitable array (such as shown in Figure 142-Figure 145 those).No matter the pattern of array why, connecting link 6507 can allow element body 6505 and retaining hole 6552 relative to each other to move.Such as, form keep the element body 6505 of matrix 6550 and the dot matrix of connecting link 6507 once engages with tissue just can stretch, distortion, retraction and/or otherwise bend so that allow in-house at least some to move and while resisted organize carry out larger motion.Each connecting link 6507 can comprise flexible member, described flexible member can stretch, distortion and/or retraction so that such as allow keep matrix 6550 maintenance matrix element 6505 in the middle of flexure.Refer again to Figure 141, the width limiting each chain link 6507 extended from edge 6506 can be narrower than the width at element body 6505 and/or edge 6506.See Figure 142-Figure 145, one or more chain link 6507 can comprise straight part, and described part directly such as extends along the line between adjacent elements main body 6506.Such as, each chain link 6507 can comprise the first end being attached to the first edge 6506 and the second end being attached to the second edge 6506.Refer again to Figure 141, two or more chain links 6507 can be connected to each other.Such as, two or more chain links 6507 can be connected middle hinge 6509 place.The tranverse sectional thickness of such as hinge 6509 can reduce along one or more direction compared with the tranverse sectional thickness of chain link 6507, and this can allow the chain link 6507 be connected relative to each other to move.Keep matrix 6550 also can comprise hinge 6508, chain link 6507 can be connected to edge 6506 and allow the relative motion between chain link 6507 and edge 6506 by hinge 6508.Similar to hinge 6509, the tranverse sectional thickness of such as hinge 6508 can reduce along one or more direction compared with the tranverse sectional thickness of chain link 6507.

To being described further above, the chain link 6507 be connected can extend in a different direction.Such as, the first chain link 6507 can extend in a first direction, and the second chain link 6507 can extend in a second direction, and wherein said first direction can be different from described second direction.Such as the first chain link 6507 can extend along First Line, and the second chain link 6507 can extend along the second line, wherein said First Line and described second line can angled (such as about 30 degree, about 45 degree, about 60 degree and/or about 90 degree) crossing.Hinge 6508 and/or hinge 6509 can comprise hinges, and described hinges can allow chain link 6507 relative to each other repeatedly move and can not rupture.Hinge 6508 and/or hinge 6509 can comprise part that is frangible or easy fracture, and described part that is frangible or easy fracture can rupture in excessive deflection and/or when crossing repeatedly flexure.Such as, this frangible portion can allow to keep one or more part of matrix 6550 to disconnect with keeping another part of matrix 6550.Hinge 6508 and/or hinge 6509 such as can comprise the section keeping matrix 6550, and this section is easier to incision than keeping other parts of matrix 6550.More specifically, the maintenance matrix implanted and can often being cut by cut for various reasons component by the fastening tissue of the maintenance matrix implanted, and in order to be conducive to carrying out this crosscut, hinge 6508 and/or hinge 6509 such as can provide approach or thin layer, and cutting element can more readily pass through through described approach or thin layer and keep matrix 6550.To being described further above, connecting link 6507 can comprise and is such as defined in one or more cast structure or material upsetting, and described one or more cast structure or material upsetting can be conducive to bending, fracture and/or the incision of connecting link 6507.

Keep matrix can comprise multiple maintenance matrix element (such as matrix element main body 6505), such as described multiple maintenance matrix element can embed in piece of flexible material or material webs.Piece of flexible material can by can the elastomeric material (such as siloxanes) of bio-absorbable be formed, and wherein said flexible sheets can produce the multiple holes be defined in wherein.Such as, mouldable go out solid flexible sheets and multiple hole can be passed in described flexible sheets.Alternatively, mouldable flexible sheets and the hole be defined in wherein can be formed in moulding process.In any one situation, keep matrix element 6505 such as can be inserted into and remain in flexible sheets.Alternatively, to similar above, flexible sheets can be formed at around matrix element 6505.Flexible sheets can be such as made up of woven net and/or any other material be applicable to.To being described further above, this woven net can be easy to crosscut.

Referring now to Figure 146 and Figure 147, comprise and keep the closure system of matrix (such as keeping matrix 6250) also can comprise lid (such as covering 6670), such as when the top of nail lower limb 6221 extends to above the top surface 6257 of maintenance matrix 6250, described lid can cover described top.Lid 6670 can be attached to and keep matrix 6250.Lid 6670 and/or maintenance matrix 6250 can comprise maintenance feature structure, and lid 6670 can remain to and keep matrix 6250 by described maintenance feature structure.At least one binding agent can be utilized to be adhered to by lid 6670 and to keep matrix 6250.Lid 6670 can be made up of single layer, but lid 6670 is shown as and comprises two layers, as hereafter described in more detail.First see Figure 147, the top of nail lower limb 6221 can extend across the lower surface 6673 of lid 6670; But lid 6670 can comprise enough thickness, makes screw top end can not extend through the top surface 6675 of lid 6670.Therefore, such as, the top of following closely lower limb 6221 can not from lid 6670 projection.Lid 6670 can comprise multiple layer.Such as, cover 6670 and can comprise ground floor 6671 and the second layer 6672.Ground floor 6671 and the second layer 6672 can be attached to each other, and wherein the second layer 6672 can comprise the lower surface 6676 being attached to ground floor 6671.Ground floor 6671 and the second layer 6672 can comprise different thickness or it can comprise identical thickness.Ground floor 6671 and the second layer 6672 can comprise substantially the same width and/or length.Alternatively, layer 6671 and 6672 can comprise different width and/or length.

To being described further above, ground floor 6671 can by such as can being formed by compressible foam, Web materials and/or the hydrogel that nail lower limb 6211 is cut.The second layer 6672 can be made up of such as more tough and tensile material or skin (such as PGA and/or PDS) and/or any suitable buttress material.Such as, follow closely lower limb 6221 and can penetrate ground floor 6671; But nail lower limb 6221 possibly cannot penetrate the second layer 6672.The second layer 6672 can be made up of the material with enough elasticity and/or toughness, and described material can allow the second layer 6672 contacted by nail lower limb 6221 and be shifted, but is not entered by the screw top end-grain cutting of nail lower limb 6221 or only marginally cut.Although not shown, but lid can comprise more than two layers, and one or more wherein in these layers can be resistance to infiltration.In use, such as, keep matrix 6250 to locate against tissue to be tightened and to be pushed down, make the nail lower limb 6221 of nail 6220 through tissue T and keep the retaining hole 6252 in matrix 6250 and be pushed, and entering in the ground floor 6271 of lid 6270.The top of nail lower limb 6221 can not enter or at least substantially not enter in the second layer 6272 of lid 6270.After matrix 6250 is properly positioned in maintenance, jaw 6240 can be opened, and covers 6670 and keep matrix 6250 to be separated with jaw 6240, as shown in Figure 146.As shown in Figure 146, jaw 6640 can keep more than one to keep matrix 6250 and lid 6670.Such as, jaw 6640 can comprise two passages 6679, and described two passages 6679 can containment cap 6670 and the maintenance matrix 6250 of locating thereon wherein, and the tissue contacting surface 6251 of each maintenance matrix 6250 is leaned on downwards from the bottom of jaw 6240.Such as, matrix 6250 and lid 6270 is kept can be contained in jaw 6640 on every side of cutter slit 6678.In use, matrix 6250 is kept can be deployed with both lids 6670 simultaneously and/or to be deployed in identical depth relative to the relative nail bin (such as storehouse 6200) of locating through it.Subsequently, can cut fastening tissue by the cutting element traversing cutter slit 6678 along line of cut, wherein jaw 6640 can be opened subsequently again.Lid 6670 can not be attached to and keep matrix 6250.Such as, cover 6670 can be positioned in passage 6679 and to remain in passage 6679 by the maintenance matrix 6250 that can be fixed to jaw 6640.Each maintenance matrix 6250 can wider than and/or be longer than its accordingly lid 6670, make to keep the entirety that matrix 6250 can be covered 6670 to remain on appropriate location.Each maintenance matrix 6250 such as can comprise identical width and/or length by its corresponding lid 6670.

As mentioned above, closure system can comprise the material layer that such as can be attached to and keep matrix (such as keeping matrix 6250).Referring now to Figure 150, material layer 6870 can be attached to the lower surface 6251 keeping matrix 6250.Layer 6870 and/or maintenance matrix 6250 can comprise maintenance feature structure, and layer 6870 can remain to and keep matrix 6250 by described maintenance feature structure.At least one binding agent can be utilized to be adhered to by layer 6870 and to keep matrix 6250.In any case, layer 6870 can comprise lower surface or tissue contacting surface 6873, and this lower surface or tissue contacting surface can move downward make retaining hole 6252 and follow closely contact tissue T when lower limb 6221 engages towards nail 6220 keeping matrix 6250.Such as, layer 6870 can be made up of such as compressible material the foam of bio-absorbable (such as can), described compressible material can be compressed in keep matrix 6250 between lower surface 6251 and tissue T.Layer 6870 also can comprise at least one medicine storing and/or be absorbed in wherein, and described at least one medicine can be discharged by during compression at layer 6870 from layer 6870.Described medicine can comprise such as at least one tissue seal, hemorrhage and/or anti-biotic material (silver such as ionized and/or triclosan).The compression of layer 6870 can extrude medicine from layer 6870, makes the whole of the surface of tissue T or is coated with medicine at least greatly.In addition, when layer 6870 is compressed and follows closely lower limb 6221 penetrate tissue T and layer 6870, medicine can such as flow down along nail lower limb 6221 and treat is just followed closely the tissue cut of lower limb 6221.Keep the main body of matrix 6250 can comprise the ground floor be such as made up of biocompatible materials (such as titanium and/or rustless steel), and bottom 6870 can comprise such as by can the second layer that forms of the material (such as oxidized regenerated cellulose (ORC), as (liquid or be frozen dry) bioactivator such as fibrin and/or thrombin, glycerol, be in the fluffy or Absorbable rod pig gelatin of foam configuration and/or the antibacterial of the silver such as ionized and/or triclosan) of bio-absorbable.In addition can comprise such as Surgicel Nu-Knit by bioabsorbable material, Surgicel Fibrillar, with collagen/ORC (it is the mixture with collagen matrix form construction) that trade name Promogran sells, with the polyglycolic acid (PGA) that trade name Vicryl sells, polylactic acid (PLA or PLLA), poly-dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with the poliglecaprone 25 (PGCL) that trade name Monocryl sells, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, the complex of PGCL and/or PCL.Although only illustrate a layer 6870 in Figure 150, but the layer of any suitable number can be used.The ground floor comprising the first medicine can be attached to and keep matrix 6250, and the second layer comprising the second medicine or different pharmaceutical can be attached to ground floor.Such as, can use multiple layer, wherein each layer can comprise the different pharmaceutical and/or different drug regimens that are contained in wherein.

Referring now to Figure 148, closure system can comprise the material layer 6770 being attached to the lower surface 6251 keeping matrix 6250.Layer 6770 and/or maintenance matrix 6250 can comprise maintenance feature structure, and layer 6770 can remain to and keep matrix 6250 by described maintenance feature structure.At least one binding agent can be utilized to be adhered to by layer 6770 and to keep matrix 6250.In any case, layer 6770 can comprise lower surface or tissue contacting surface 6773, and this lower surface or tissue contacting surface can move downward make retaining hole 6252 and follow closely contact tissue T when lower limb 6221 engages towards nail 6220 keeping matrix 6250.Such as, layer 6770 can be made up of such as compressible material the foam of bio-absorbable (such as can), described compressible material can be compressed in keep matrix 6250 between surface 6251 and tissue T.Layer 6770 also can comprise one or more packaging part or unit 6774, and described one or more packaging part or unit 6774 can store at least one medicine wherein.See Figure 149, packaging part 6774 can align with retaining hole 6252 or at least substantial alignment, makes when following closely lower limb 6221 and being pushed through tissue T and layer 6770, and nail lower limb 6221 can pierce through packaging part 6774 and/or otherwise make packaging part 6774 broken loose.Packaging part 6774 broken loose after, at least one medicine M be stored in packaging part 6774 can flow out in tissue T.Such as, medicine M can comprise fluid, described fluid can along nail lower limb 6221 flow down or wicking downwards and treatment by the tissue T of nail lower limb incision.Due to mentioned above, the medicine be stored in packaging part 6774 can provide topical therapeutic to tissue.The different pharmaceutical be stored in wherein can be comprised in packaging part 6774 in sheet 6770.Such as, in first group of packaging part 6774, the first medicine be stored in wherein or the first drug regimen can be comprised, and the different medicines or different drug regimens that are stored in wherein in second group of packaging part, can be comprised.Layer 6770 can be made up of the siloxane sheet of flexibility, and packaging part 6774 can represent the space in siloxane sheet.Such as, siloxane sheet can comprise two layers that can be attached to each other, and wherein packaging part 6774 can be limited between described two layers.Layer 6770 can comprise such as one or more thin section or weakening part (such as local perforations), and described one or more thin layer or weakening part can be conducive to lower limb 6221 and cut layer 6770 and make packaging part 6774 broken loose.Packaging part 6774 can be positioned in dome 6777 at least partially, wherein dome 6777 upwards can extend from sheet 6770.Such as, can being positioned at least partially in the pit 6201 that keeps being formed in matrix 6250 of dome 6777 and/or packaging part 6774.Packaging part 6774 can comprise the independently unit be not connected to each other.Alternatively, in packaging part 6774 one or more can via such as extend through one or more paths of layer 6770, conduit and/or passage and mutually fluid be communicated with.The disclosure of the United States Patent (USP) 7,780,685 that the name being published on August 24th, 2010 is called " ADHESIVE AND MECHANICAL FASTENER " is incorporated herein by reference accordingly in full.

To being described further above, nail bin comprising warehouse, nail and/or alignment matrix can be loaded in the first jaw of end effector, and similarly, keep matrix and/or one or more lid can be loaded in the second jaw of end effector.Referring now to Figure 151, such as, apparatus (such as storehouse filler 6990) can be used two or more fastener cartridge to be inserted in end effector simultaneously.Such as storehouse loader 6990 can comprise shank 6991 and storehouse carrier 6992; wherein storehouse carrier 6992 can comprise the first maintaining part and the second maintaining part; the warehouse 6210 of nail bin 6200 can be remained to storehouse carrier 6992 by described first maintaining part; and described second maintaining part can keep warehouse 6980 in addition, this warehouse 6980 supports multiple protectiveness top cover 6270 wherein and supports along its lower surface and keeps matrix 6250.First maintaining part and the second maintaining part can comprise one or more retaining member separately, and described one or more retaining member can engage warehouse 6210 and 6980 releasedly.Referring now to Figure 152 and Figure 153, in use, end effector can comprise the first jaw or bottom jaw 6230 and the second jaw or top jaw 6940, and wherein nail bin 6200 can be loaded in the first jaw 6230, and warehouse 6980 can be loaded in the second jaw 6940.In all cases, top jaw 6940 rotates to make position (Figure 153) by actuator 6235 from open position (Figure 152), and wherein the operation of actuator 6235 is described above, repeats no more for simplicity's sake herein.Referring now to Figure 153, once top jaw 6940 is in its make position, then the distal end 6993 of storehouse carrier 6992 can be inserted in end effector, in the first attachment that nail bin 6200 is slid in the first jaw 6230 through the distal end 6938 of the first jaw 6930 or passage 6939.Similarly, the distal end 6993 of storehouse carrier 6992 can be inserted in end effector, in the second attachment that warehouse 6980 is slid in the second jaw 6940 through the distal end 6948 of the second jaw 6940 or passage 6949.The surgeon of the shank 6991 of hand-held storehouse loader 6990 or other clinicians can be each passed through passage 6939 and 6949 and promote nail bin 6200 and warehouse 6980, until nail bin 6200 and warehouse 6980 are fully disposed in passage 6939 and 6949.

When nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage the one or more maintaining parts in its corresponding jaw 6230 and 6940 respectively, as hereafter described in more detail.Referring now to Figure 154, in any case, once nail bin 6200 and warehouse 6980 are placed, then storehouse loader 6990 can be separated with nail bin 6200 and warehouse 6980 and remove from end effector.Such as, the retentivity remained on by nail bin 6200 in first jaw 6230 can be greater than retentivity nail bin 6200 being remained to storehouse carrier 6992, makes when storehouse carrier 6992 is distally pushed out end effector, and nail bin 6200 can remain on the first jaw 6230 rear.Similarly, the retentivity remained on by warehouse 6980 in second jaw 6940 can be greater than retentivity warehouse 6940 being remained to storehouse carrier 6992, make when storehouse carrier 6992 is distally pushed out end effector, warehouse 6940 can remain on the second jaw 6940 rear.Once storehouse loader 6990 is removed from end effector, then the first loaded jaw 6230 and the second jaw 6940 loaded can be located relative to tissue T to be stapled.Referring now to Figure 155; second jaw 6940 can move to firing position (Figure 155) from open position (Figure 154), so that the maintenance matrix 6250 making warehouse 6980 carry and multiple protectiveness top cover 6270 engage with the nail 6220 be positioned in nail bin 6200.

Referring now to Figure 156 and Figure 157, the second jaw 6940 can be opened again, and multiple protectiveness top cover 6270 can be separated with warehouse 6980 with maintenance matrix 6250, makes cap 6270 and keeps matrix 6250 can keep engaging with tissue T and nail bin 6200.Warehouse 6980 can comprise multiple pit and one or more maintenance slit, and multiple cap 6270 can be positioned in described multiple pit removedly, and maintenance matrix 6250 can remain on it by described one or more maintenance slit removedly.After the second jaw 6940 is opened, warehouse 6980 can remain in the second jaw 6940 by the retaining member engaged with warehouse 6980 of the second jaw 6940.Warehouse 6980 can be torn when the second jaw 6940 is opened, and make a part for warehouse 6980 and cap 6270 and keep implanted together with matrix 6250, and a part for warehouse 6980 is retained in the second jaw 6940.Similarly, refer again to Figure 156 and Figure 157, after the second jaw 6940 is opened, warehouse 6210 can remain in the first jaw 6230 by the retaining member engaged with warehouse 6210 of the first jaw 6230.Warehouse 6210 can be torn when the first jaw 6230 is pulled away from the storehouse 6200 of having implanted, and makes a part for warehouse 6210 implanted together with alignment matrix 6260 with nail 6220, and a part for warehouse 6210 remaines in the first jaw 6230.Referring now to Figure 158-Figure 160, what nail bin (the such as nail bin 6900) length that such as can comprise along warehouse 6910 extended one or morely longitudinally keeps slits 6913, when nail bin 6900 is inserted in jaw 6930, described one or more slit 6913 that longitudinally keeps such as can hold the one or more longitudinally maintenance guide rails 6916 extended from jaw 6930 wherein.In use, such as, before passing distal end 6938 slip keeping passage 6939 at nail bin 6900, the end of slit 6913 is kept can to align with keeping the distal end of guide rail 6916.

Refer again to Figure 160, jaw 6940 can comprise two and keep passage 6949, and wherein each maintenance passage 6949 can hold the warehouse 6980 comprising multiple cap 6270 and keep matrix 6250 wherein.Each warehouse 6980 can comprise one or more longitudinally maintenance shoulder 6917, when being inserted into when warehouse 6980 in its corresponding maintenance passage 6949 in jaw 6940, described one or more shoulder 6917 that longitudinally keeps slides along one or more longitudinally maintenance guide rails 6918 of the second jaw 6940.When warehouse 6980 and the cap 6270 be stored in wherein are with when keeping matrix 6250 to be separated, keep guide rail 6918 and keep shoulder 6917 can cooperate to be remained in the second jaw 6940 by warehouse 6980.Referring now to Figure 159, the second jaw 6940 also can comprise the one or more distally projection or retaining member 6915 that extend from it, and warehouse 6980 can be locked in it and keep accordingly in passage by described one or more distally projection or retaining member removedly.Such as, second jaw 6940 can comprise distally projection 6915, distally projection 6915 relative to each maintenance passage 6949 can be located so that when warehouse 6980 is inserted in passage 6949, each warehouse 6980 can bend around projection 6915, wherein just when warehouse 6915 is fully disposed in passage 6949, the distal end of warehouse 6980 can clean projection 6915 and hasp above projection 6915.Removed after being previously used at warehouse 6980, as mentioned above, warehouse 6980 can be withdrawn into above projection 6915 and it is removed from maintenance passage 6949.To similar above, first jaw 6930 can comprise the one or more distally extended from it and keep projections 6914, and described one or more distally keeps projection 6914 can at nail bin 6900 by one or more maintenance groove of being accommodated in during complete anvil block in warehouse 6910 or slit 6912 (Figure 158).

To being described further above, the first fastener cartridge being wherein positioned with multiple first securing member can be positioned in the first jaw of surgical fastening device, and the second fastener cartridge being wherein positioned with multiple second securing member can be positioned in the second jaw of surgical fastening device.In use, the first jaw and/or the second jaw can move towards another one, to make the first securing member engage with the second securing member and be fixed on therebetween by tissue.When the first securing member engages with the second securing member, the first fastener cartridge can be engaged with each other with the second fastener cartridge.The main body of the first fastener cartridge can be made up of the first compressible material, and the main body of the second fastener cartridge can be made up of the second compressible material, and wherein the first main body and/or the second main body can be compressed against fastened tissue.Organize fastened after, the first jaw can away from implanted first fastener cartridge motion, and the second jaw can away from implanted second fastener cartridge motion.Subsequently, the first jaw can be loaded with another the first fastener cartridge or like again, and the second jaw can be loaded with another the second fastener cartridge or like again, and can reuse surgical fasteners tool.Although nail can be used in certain embodiments, but also can dream up other embodiments of the securing member (what such as lock together when being bonded with each other is divided into two-part securing member) comprising other types.Such as, the first fastener cartridge can comprise the first reservoir for storing the first fastener portion, and the second fastener cartridge can comprise the second reservoir for storing the second fastener portion.Fastening system as herein described can utilize and comprise the material of any suitable type and/or the securing member of form.Securing member can comprise and penetrates component.This component that penetrates can be such as made up of polymer, complex and/or multiple field substrate.The example of multiple field substrate can be the wire rod or sheet substrate with elastomer or polymer coating.It can be thin slice, and is formed to make to penetrate component and is oriented to perpendicular to or is at least substantially perpendicular to connecting elements.Penetrate component and can comprise the profile of rectangle, semicircular profile and/or any crossbeam profile.Any applicable method (all wire rod extrusion methods) can be utilized to manufacture securing member as herein described.Another kind of probability uses precision machining method to penetrate component to what form hollow.These penetrate component can by being different from wire rod extrusion method and using the method for combination of materials to process.

As mentioned above, following closely lower limb can by one or more cap and/or blanketing lid through the top of maintenance matrix projection.Top deformable after it is inserted through maintenance matrix of nail lower limb.The anvil block pit keeping the jaw of matrix also can comprise being positioned at above retaining hole and/or align with retaining hole, described anvil block pit can make nail lower limb be out of shape when following closely lower limb and being projected on and keeping above matrix.The nail lower limb of each nail can be such as inwardly curling towards the center each other and/or towards nail.Alternatively, one or more in the nail lower limb of nail can follow closely lower limb and/or outwards curling away from the center of nail away from other.No matter nail lower limb is curling along which direction, the top of nail lower limb all can contact and keep the main body of matrix and can not again enter being clenched in solid tissue.Nail lower limb is can be locked in appropriate location by maintenance matrix through the distortion kept after matrix.

Referring now to Figure 161 and Figure 162, surgery suturing appliance (such as surgical stapling device 7000) can comprise the first jaw 7030 and the second jaw 7040, wherein the second jaw 7040 by the motion of actuator 6235 court and moving away from the first jaw 7030.The operation of actuator 6235 is described above, repeats no more for simplicity's sake herein.First jaw 7030 can comprise distal end 7031 and proximal extremity 7032, and wherein the first jaw 7030 can be limited to the passage extended between distal end 7031 and proximal extremity 7032, and described passage can hold nail bin.For ease of diagram, the warehouse of not shown this nail bin in Figure 161, but the staple drivers 7012 that this nail bin can comprise warehouse, be positioned at the nail 6220 in warehouse and be positioned at below nail 6220.Although for simplicity's sake not shown in Figure 161, but maintenance matrix (such as keeping matrix 6250) can keep such as engaging keeping matrix to move to the lower limb following closely 6220 above nail 6220 and/or as mentioned above by the second jaw 7040.Surgical stapling device 7000 also can comprise the sliding part 7010 be such as positioned in the first jaw 7030, this sliding part 7010 can from the distal end 7031 of the first jaw 7030 proximally end 7032 slide and the nail 6220 promoting staple drivers 7012 towards the maintenance matrix of the second jaw 7040 and support thereon.Alternatively, such as sliding part 7010 can proximally end 7032 distally end 7031 move, to dispose nail 6020.Sliding part 7010 can comprise slope or the cam 7011 of one or more inclination, and the slope of described one or more inclination or cam also upwards can promote staple drivers 7012 in staple drivers 7012 slid underneath.Surgical stapling device 7000 also can comprise the pull bar or push rod that are such as operationally connected to sliding part 7010, and described pull bar or push rod proximally and/or distally move by the actuator that is positioned on the shank of surgical stapling device 7000 and/or axle.

Refer again to Figure 161, the second jaw 7040 of surgical stapling device 7000 can comprise framework 7041, distal end 7048 and the proximal extremity 7049 with distal end 7048 relative localization.Second jaw 7040 also can comprise guidance system, described guidance system comprises one or more guide rails (such as guide rail 7045 and 7046) that the longitudinal axis along framework 7041 extends, as hereafter described in more detail, described one or more guide rail can guide can at the nail lower limb 6221 of nail 6220 through the nail lower limb of jointing nail 6220 after keeping matrix and the one or more anvil block making it be out of shape or cam.Such as, guide rail 7045 and 7046 can comprise and guides wire rod or cable, and described guiding wire rod or cable such as along the top of framework 7041 or top surface around distally post 7047, and return along the top of framework 7041 or top surface and extend.As mentioned above, and now first see Figure 163 and Figure 165, second jaw 7040 also can comprise one or more anvil block or cam (such as the first anvil block 7050 and the second anvil block 7060), described one or more anvil block or cam longitudinally can move along the second jaw 7040, to make described lower limb be out of shape at the lower limb of nail 6220 after keeping matrix.Surgical stapling device 7000 also can comprise the first anvil block driver or actuator 7051 that are connected to and/or are operationally connected to the first anvil block 7050, and described first anvil block driver or actuator can proximally tractive first anvil blocks 7050 and/or distally promote the first anvil block 7050.Similarly, surgical stapling device 7000 also can comprise the second anvil block driver or the actuator being connected to and/or being operationally connected to the second anvil block 7060, and described second anvil block driver or actuator distally can promote the second anvil block 7060 and/or proximally tractive second anvil block 7060.First anvil block 7050 can comprise guide slit 7052, and the second anvil block 7060 can comprise guide slit 7062, and guide rail 7045 or guide rail 7046 can be accommodated therein by described guide slit 7052 and guide slit 7062 separately slidably.Such as, guide rail 7045 and 7046 can be closely received in guide slit 7052 and 7062, makes can prevent or at least limit guide rail 7045 and 7046 and the relative lateral movement between guide slit 7052 and 7062 or side-to-side movement.

To being described further above, can proximally tractive first anvil block 7050 can distally tractive second anvil block 7060.See Figure 161, guide rail 7045 and 7046 and distally post 7047 can comprise pulley system, and described pulley system can distally tractive second anvil block 7060 and/or proximally tractive second anvil block 7060.Such as, guide rail 7045 and guide rail 7046 can comprise the continuous wire or cable that extend around distally post 7047, and a part for wherein said continuous wire can be pulled that wire rod is taken turns around distally post 7047 and turn.Guide rail 7046 such as can be installed to the second anvil block 7060, make when continuous cable take turns in a first direction turn time, second anvil block 7060 can be pulled to distally towards the distal end 7048 of jaw 7040, and when continuous cable turns along second direction or rightabout wheel, the second anvil block 7060 can proximally end 7049 and be pulled to nearside.Referring now to Figure 163, guide rail 7046 can be fixed in guide slit 7062, makes to transmit traction force betwixt.Such as, guide rail 7045 can slide in other guide slit 7062.The mode that first anvil block 7050 can have nothing to do with the second anvil block 7060 works, and pulley system and the guide slit 7052 be limited in the first anvil block 7050 can hold guide rail 7045 and 7046 slidably, make to allow pulley system and the relative motion between guide slit 7052 and guide rail 7045 and 7046.The continuous cable forming guide rail 7045 and 7046 can have enough flexibilities, to adapt to the open and close of top jaw 7040.Continuous cable also can have enough flexibilities in case adapt to the second jaw 7060 towards and moving both vertically away from bottom jaw 7030, hereafter will describe in more detail.

Refer again to Figure 163 and Figure 165, first anvil block 7050 can comprise the cam follower 7055 extended from it, this cam follower 7055 can ride one or more cam slot in the framework 7041 being limited to the second jaw 7040 or guide slit, in such as cam slot 7070 (Figure 166).More specifically, framework 7041 can comprise the second cam 7070 of the first cam slot 7070 along the first side longitudinal extension of framework 7041 and the second side along framework 7041 or opposite side longitudinal extension, the cam follower 7055 wherein extended from the first side of the first anvil block 7050 can ride in the first cam slot 7070, and the cam follower 7055 extended from the second side of the first anvil block 7050 can ride in the second cam slot 7070.Such as, the profile of each cam slot 7070 can be identical or at least substantially the same, and can mutually align or at least substantially mutually align.Similarly, the second anvil block 7060 can comprise the cam follower 7065 extended from it, and this cam follower 7065 can ride in the cam slot 7070 (Figure 166) in the framework 7041 being limited to the second jaw 7040.More specifically, the cam follower 7065 extended from the first side of the second anvil block 7060 can ride in the first cam slot 7070, and the cam follower 7065 extended from the second side of the second anvil block 7060 can ride in the second cam slot 7070.In use, the cam follower 7055 of the first anvil block 7050 and the cam follower 7065 of the second anvil block 7060 can slide in cam slot 7070, make when the first anvil block 7050 and the second anvil block 7060 are pulled to nearside and/or are pushed to distally, the first anvil block 7050 and the second anvil block 7060 advance along the profile of cam slot 7070.Each cam slot 7070 can comprise multiple part or top 7071 and multiple drive portion or bottom 7072 of resting, described multiple rest portion or top 7071 and described multiple driver portion or bottom 7072 can at anvil block 7050 and 7060 longitudinally (namely, between the distal end 7048 and proximal extremity 7049 of framework 7041) move while vertically (namely, court and away from bottom jaw 7030) motion anvil block 7050 and 7060, as hereafter described in more detail.

When surgical stapling device 7000 be in do not pull the trigger condition time, see Figure 166, the first anvil block 7050 can be located in distal end 7048 place of framework 7041, and the second anvil block 7060 can be located in proximal extremity 7049 place of framework 7041; In addition, referring now to Figure 167, when surgical stapling device 7000 be in do not pull the trigger condition time, the nail 6220 being arranged in the first jaw 7030 can not yet be inserted into tissue T and/or be positioned at the maintenance matrix above tissue T.Referring now to Figure 168, in use, staple drivers 7012 can upwards drive nail 6220 in the nail chamber 7033 of nail bin; In addition, the first anvil block 7050 can from the distal end 7048 of framework 7041 distally end 7049 proximal motion, so that the nail lower limb 6221 of jointing nail 6220.Nail 6220 can be upwards driven before the first anvil block 7050 engages with the nail lower limb 6221 of nail 6220.Before the first anvil block 7050 is advanced to contact stud lower limb 6221, sliding part 7010 can to all nail 6220 of deploy, or alternatively, sliding part 7010 proximally can move while the first anvil block 7050 proximally moves, but sliding part 7010 can guide the first anvil block 7050 nail 6220 to be deployed in the first anvil block 7050 front fully.As shown in Figure 168, such as, cam slot 7070 can be arranged such that when the first cam 7050 is through the portion of resting or top, the profiled surface (such as profiled surface or cam face 7053 and 7054) of the first cam 7050 can at least some in contact stud lower limb 6221.In all cases, the cam follower 7055 of the first anvil block 7050 can be positioned in the portion of resting 7071 of cam slot 7070 respectively, make profiled surface 7053 and 7054 be in the position of raising, and make when anvil block 7050 passes in rest position thus, nail lower limb 6221 is only partly out of shape.When the first cam 7050 moves further along cam slot 7070, as shown in Figure 169, in the drive division that the cam follower 7055 of the first anvil block 7050 can be driven to cam slot 7070 or bottom 7072, profiled surface 7053 and 7054 is moved downward vertically, to be urged in its configuration be finally shaped by nail lower limb 6021 towards nail lower limb 6021.Subsequently, when the first anvil block 7050 advances along cam slot 7070 further, the first anvil block 7050 can be rested in portion 7071 by upwards vertical drive another group to cam slot 7070.As shown in Figure 168 and Figure 169, reader it should be noted that the first anvil block 7050 only can engage some nail lower limb and not engage other nail lower limbs.Such as, the first anvil block 7050 such as only can make one group of nail lower limb distortion of the distally nail lower limb 6221 comprising nail 6220.Such as, the first anvil block 7050 can make distally follow closely the center deformation of lower limb 6221 towards nail 6220.Each nearside nail lower limb 6221 all can be contacted by the first anvil block 7050 (that is, by the first profiled surface 7053 and the second profiled surface 7054 of aliging with the first profiled surface 7053) for twice.Such as, when the first anvil block 7050 is in the portion of resting or top, first profiled surface 7053 can make distally follow closely lower limb 6221 and be deformed into portion deforms configuration, and when the first anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 can make distally follow closely lower limb 6221 and be deformed into complete shaped configuration.Referring now to Figure 163 and Figure 164, the first anvil block 7050 can comprise multiple first profiled surface 7053 and multiple second profiled surface 7054, is out of shape to make the distally of nail 6220 follow closely lower limb 6221 when following closely lower limb 6221 and being arranged to more than a line or a row.As hereafter described in more detail, such as the second anvil block 7060 can make the nearside of nail 6020 nail lower limb 6221 be out of shape.

To being described further above, the first anvil block 7050 can move to proximal extremity 7049 from the distal end 7048 of framework 7041, to make all distally nail lower limb 6221 of nail 6220 be out of shape.Reader should note, first anvil block 7050 can move up and down relative to undeformed nearside nail lower limb 6221, and for adapting to this relative motion, first anvil block 7050 can comprise one or more clearance slot 7057 (Figure 165), and described one or more clearance slot 7057 can hold unbent nearside nail lower limb 6221 when the first anvil block 7050 make distally nail lower limb 6221 bend.Similarly, refer again to Figure 163, second anvil block 7060 can comprise clearance slot 7067, and this clearance slot can adapt to moving both vertically of the first cam actuator 7051 moved up and down when it rests and moves between portion and drive division as mentioned above at the first anvil block 7050.After all distally nail lower limb 6221 is bent, anvil block actuator 7061 can make the second anvil block 7060 move to distal end 7048 from the proximal extremity 7049 of framework 7041.To similar above, referring now to Figure 170, the cam follower 7065 of such as the second anvil block 7060 can slide in cam slot 7070, and the second anvil block 7060 is moved between the portion of resting or top and drive division or bottom, to make nearside follow closely the center of lower limb 6221 towards nail 6220 to internal strain.To similar above, second anvil block 7060 can comprise multiple first and to be shaped or cam face 7063 and multiple second is shaped or cam face 7064, and described multiple first is shaped or cam face 7063 and described multiple second is shaped or cam face 7064 can make nearside follow closely in lower limb 6021 respectively is one or morely out of shape at least in part and/or is badly deformed.Refer again to Figure 164, second anvil block 7060 can comprise multiple first profiled surface 7063 and multiple second profiled surface 7064, and described multiple first profiled surface 7063 and described multiple second profiled surface 7064 can make the nearside nail lower limb 6221 of the nail 6220 being arranged to multiple row or many rows be out of shape.Same as shown in Figure 164, first profiled surface 7063 of the second anvil block 7060 and the second profiled surface 7064 can not align with the first profiled surface 7053 of the first anvil block 7050 and the second profiled surface 7054, wherein as a result, the near leg 6221 following closely 6220 can be arranged in different row from the far leg 6221 of nail 6220 or arrange.Reader it shall yet further be noted that the second anvil block 7060 can promote the first anvil block 7050 when the second anvil block 7060 distally moves.Such as, the first anvil block 7050 can back in the distal end 7048 of framework 7041 by the second anvil block 7060, makes the first anvil block 7050 can turn back to its initial position or non-firing position.After all nearside nail lower limbs 6221 of nail 6220 are all out of shape, the second anvil block 7060 proximally can be retracted and is back to its initial position or non-firing position.In this way, surgical stapling device 7000 can reset to and make to locate new nail bin in the first jaw 7030, and can locate new maintenance matrix in the second jaw 7040, to reuse surgical stapling device 7000.

As mentioned above, surgical stapling device can comprise two or more anvil blocks, and two or more anvil blocks described can longitudinally be advanced to engage the lower limb of multiple nail in a lateral direction.Surgical stapling device can comprise the anvil block proximally moved, and such as, to make first group to follow closely lower limb distortion, and such as makes second group to follow closely lower limb distortion.Such as, this anvil block can comprise such as towards the profiled surface of nearside and the profiled surface towards distally.

Referring now to Figure 171, multiple shaping pits 7142 that anvil block (such as anvil block 7140) such as can comprise lower surface or tissue contacting surface 7141 and be defined in wherein.Anvil block 7140 can comprise the more than plate that such as can be soldered in framework 7144, such as crater plate 7143.Such as, framework 7144 is soldered to form longitudinal measure part 7147 by extend through the welding slit 7146 of framework 7144 during each crater plate 7143 all can be positioned in framework 7144 plate passage 7145.In various embodiments, longitudinal measure part 7147 can comprise the sequential welding fitting such as extended along the whole length of welding slit 7146 or a series of spatially isolated pads extended along its length.Each crater plate 7143 all can comprise two or more plate portions be welded together.Such as, all can comprise can along seam 7,148 first plate portion 7143a welded together and the second plate portion 7143b for each crater plate 7143.Be soldered in the plate passage 7145 in framework 7144 at plate 7143 before, together with the first plate portion 7143a of each plate 7143 can be soldered to the second plate portion 7143b.Such as, the first plate portion 7143a and the second plate portion 7143b can comprise may be fitted to together with to form the cooperation profile of impervious seam 7148, the tooth profile such as shown in Figure 171.Each plate 7143 can comprise such as about .02 " height, described height can, higher than the degree of depth of plate passage 7145, make its tissue contacting surface 7141 extend from the framework 7044 of anvil block 7040.Referring now to Figure 172, such as, plate 7143 connects together by least one weldment 7149 at the distal end place at plate 7143.

As shown in Figure 171 and Figure 172, each crater plate 7143 all can comprise the multiple shaping pits 7142 be defined in wherein.By any suitable manufacture method (such as Ginding process and/or electrode combustion method) forming shaped pit 7142 in plate 7143.Such as, referring now to Figure 173 and Figure 174, each shaping pit 7142 is manufactured: first form deep-well 7150, then form arc or curved surface 7151 around deep-well 7150, then in curved surface 7151, form guide groove 7152 by such as the following stated.Alternatively, these steps can any suitable order perform.Referring now to Figure 175, nail shaping pit 7142 can be formed to make with the inward flange 7153 of consistent or at least substantially consistent gap 7154 this shaping pit spaced apart.Such as, gap 7154 can be about .008 ".In addition, such as, shaping pit 7142 can along two or more row or registration, and its centrage can be spaced apart by consistent or at least substantially consistent spacing 7155.Such as, the spacing 7155 between centrage can be about .035 ".Refer again to Figure 175, each shaping pit 7142 can be tapered between narrow width 7156 and wide width 7157.Such as, narrow width 7156 can be about .045 ", and wide width 7157 can be such as approximately .075 ".Plate 7143 can be made up of the material identical with framework 7144.Such as, both plate 7143 and framework 7144 all can be made up of such as rustless steel (such as 300 series or 400 series stainless steels) and/or titanium.Alternatively, plate 7143 and framework 7144 can be made up of different materials.Such as, plate 7143 can be made up of such as ceramic material, and framework 7144 can be made up of such as rustless steel and/or titanium.In all cases, according to used material, such as, substituting except above-mentioned welding method or as above-mentioned welding method, also can use at least one braze welding method to be fixed in framework 7144 by plate 7143.

Referring now to Figure 176-Figure 178, anvil block 7240 can comprise framework 7244 and can be inserted into the multiple crater plate 7243 in framework 7244.To similar above, each crater plate 7243 can comprise the multiple shaping pits 7242 be defined in wherein.Anvil block framework 7244 can comprise the maintenance slit 7246 be defined in wherein, and this maintenance slit can hold the maintenance guide rail 7247 extended from crater plate 7243 separately.For crater plate 7243 is assembled to anvil block framework 7244, the sidewall 7245 of this anvil block framework 7244 can outwards bend or launch, as shown in Figure 177, to make maintenance slit 7246 broaden, make each maintenance slit 7246 can hold the maintenance guide rail 7247 of crater plate 7243 wherein.Keep in slit 7246 once keep guide rail 7247 to be positioned in, sidewall 7245 can be released, and as shown in Figure 178, thus allows framework 7244 retract with elastic type and/or be back to its non-deflected.In this case, keep slit 7246 regracting and therefore maintenance guide rail 7247 be captured in wherein.Keep guide rail 7247 and/or keep slit 7246 can comprise the conical surface of one or more cooperation; After the maintenance slit 7246 of flexure is released, the conical surface of described one or more cooperation can be formed and the taper locking in slit 7246 can be kept to engage by keeping guide rail 7247 to remain on.To similar above, crater plate 7243 can be made up of the material identical or different with framework 7244.Such as, plate 7243 can be made up of such as ceramic material, and framework 7244 can be made up of such as rustless steel and/or titanium.In all cases, according to used material, such as, at least one braze welding method and/or at least one welding method can be used to be fixed in framework 7244 by plate 7243.

In Figure 179 and Figure 180, surgical stapling and cut off apparatus 8010 and can comprise anvil block 8014, this anvil block can around it to the pivotal attachment of elongated nail passage 8016 by open and close repeatedly.Nail is used assembly 8012 and can be comprised anvil block 8014 and passage 8016, and wherein assembly 8012 proximally can be attached to the slender axles 8018 being formed and perform part 8022.When nail use assembly 8012 close time, or time at least substantially closed, perform part 8022 and can present enough little cross section, this cross section is suitable for making nail use assembly 8012 and is inserted by the trocar.Assembly 8012 can be handled by the shank 8020 being connected to axle 8018.Shank 8020 can comprise user control such as knob 8030, and this knob makes slender axles 8018 and nail use assembly 8012 to rotate around the longitudinal axis of axle 8018.Closure trigger 8026 can be depressed and use assembly 8012 with closed nail, and this closure trigger can in pistol grip 8036 front wall around closure trigger pin 8152 (Figure 181) pivotable engaged across shank shell 8154 side direction.When closure trigger 8026 is clamped, closed release-push 8038 can outwards be present on shank 8020, makes release-push 8038 can be depressed to unclamp closure trigger 8026 and open nail to use assembly 8012, as described in more detail below.Can nail can be made to use assembly 8012 cut off simultaneously and sew up the tissue be clamped in wherein by the percussion trigger 8034 of pivotable before closure trigger 8026.In all cases, as described in more detail below, percussion trigger 8034 can be used to adopt multiple percussion stroke to need by the amount of surgical hands applied force to reduce every stroke.Shank 8020 can comprise the rotatable right indicator wheel 8040 and/or left indicator wheel 8041 (Figure 181) that can indicate percussion progress.Such as, pulling the trigger stroke completely may need three of percussion trigger 8034 to pull the trigger stroke completely, thus indicator wheel 8040, and 8041 can rotate 1/3rd turns at the most at every stroke of percussion trigger 8034 separately.As described in more detail below, if needed, manual percussion trip lever 8042 can allow trigger system pulling the trigger retraction before stroke completes completely, and in addition, if trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon or other clinicians that trigger system is bounced back.

In conjunction with Figure 179 and 181, slender axles 8018 can comprise external structure, this external structure comprises reciprocating closure tube 8024 in the vertical, and this closure tube presses down in response to the nearside of the closure trigger 8026 of shank 8020 and makes anvil block 8014 towards its make position pivotable.Elongated passageway 8018 is connected to shank 8020 by the framework 8028 (Figure 181) of closure tube 8024 inside.Framework 8028 is rotatably engaged to shank 8020, makes the rotation of knob 8030 (Figure 179) that execution part 8022 can be made to rotate.Specifically see Figure 181, knob 8030 can be made up of two and half shells, and this two and half shell can comprise one or more inside protuberance 8031, and this protuberance can extend across the one or more elongated sides openings 8070 also engagement frame 8028 in closure tube 8024.Therefore, knob 8030 and framework 8028 can together with or rotated simultaneously, make the position of rotation of knob 8030 determine to perform the position of rotation of part 8022.The longitudinal length long enough of longer opening 8070, to allow longitudinal closing motion of closure tube 8024 and to open motion.About the closing motion producing closure tube 8024, first see Figure 181 and Figure 183, the top 8160 of closure trigger 8026 is by closed connecting rod 8164 driven forward closed yoke 8162.Closed connecting rod 8164 at its distal end place by closed yoke pin 8166 so that the mode of pivotable closed yoke 8162 can be attached to, and at its proximal extremity place by closing link pin 8168 by can the mode of pivotable be attached.Closure trigger 8026 can be closed trigger extension spring 8246 and be advanced into open position, the top 8160 that this extension spring is proximally connected to closure trigger 8026 and the shank shell 8154 formed by right half shell 8156 and left half shell 8158.The closing force that the tension force applied by extension spring 8246 can be applied to closure trigger 8026 overcomes, distally to advance yoke 8162, closed connecting rod 8164 and closure tube 8024.

When closure trigger 8026 activated or depresses, as mentioned above, if needed, closed release-push 8038 can be positioned such that surgeon or other clinicians can press closed release-push 8038, and makes the remainder of closure trigger 8026 and surgical instruments be back to non-actuating state.Closed release-push 8038 is connected to pivoting latch arm 8172 by center side to pivot 8173, and motion can be shifted between release-push 8038 and lock arm 8172.Refer again to Figure 181, closed release-push 8038 can proximally be biased by Compress Spring 8174, that is, as observed from the right side, be biased clockwise around center side to pivot 8173, and the top 8160 of closure trigger 8026 can comprise the nearside tooth top 8170 with rear recess 8171.When closure trigger 8026 is depressed, pivoting latch arm 8172 can straddle on nearside tooth top 8170, and when closure trigger 8026 arrives its complete depressing position, be to be understood that, rear recess 8171 is present in below pivoting latch arm 8172, and this pivoting latch arm falls in forcing of Compress Spring 8174 and locks rear recess 8171.Now, the manual depression of closed release-push 8038 makes pivoting latch arm 8172 upwards and rotates from rear recess 8171, thus is unlocked by closure trigger 8026 and make closure trigger 8026 be back to its non-clamped position.

Once closure trigger 8026 is proximally clamped, as mentioned above, then pull the trigger trigger 8034 and can be pulled to pistol grip 8036, distally to advance percussion connecting rod 8032 from shank 8020.Percussion trigger 8034 can around percussion trigger pin 8202 pivotable, and this percussion trigger pin is horizontally through the right side half shell 8156 of shank 8020 and left half shell 8158 and engages.When activated, pull the trigger trigger 8034 and can advance link transmission firing lock 8150.Link transmission firing lock 8150 can be forced to retraction, non-firing position by spring 8184, this spring one, is attached to the pistol grip 8036 of shank 8020; And two, be attached to one of them connecting rod such as linking transmission firing lock 8150, as described in more detail below.Spring 8184 can comprise the motion end 8188 of the non-athletic end 8186 being connected to shell 8154 and the proximal extremity 8190 being connected to steel band 8192.The end 8194 being arranged at distally of steel band 8192 can be attached to the attachment structure 8195 on the front rod 8196a in multiple connecting rod 8196a-8196d, and described multiple connecting rod forms link tooth bar 8200.Link tooth bar 8200 can be flexible, make it can easily be retracted into pistol grip 8036 and minimize the length of shank 8020, but forming the tooth bar assembly of straight rigidity, significant percussion force can be passed to and/or pass percussion connecting rod 8032 by this tooth bar assembly.As described in more detail below, percussion trigger 8034 can engage with first connecting rod 8196a between the first period of energization of percussion trigger 8034, engage with second connecting rod 8196b between the second period of energization of percussion trigger 8034, engage with third connecting rod 8196c between the 3rd period of energization of percussion trigger 8034, and engage with double leval jib 8196d between the 4th period of energization of percussion trigger 8034, link tooth bar 8200 can distally be advanced the amount increased progressively by each actuating of wherein pulling the trigger trigger 8034.To being described further above, multiple strokes of percussion trigger 1034 can make right indicator wheel 1040 and left indicator wheel 1041 rotate, with the distance indicating link tooth bar 8200 to advance.

Referring now to Figure 181 and Figure 183, anti-inversion organization 8250 can prevent combination stretching/compressing spring 8184 from link tooth bar 8200 is bounced back between percussion stroke.Connect sliding tube 8131 adjoin first connecting rod 8196a and be connected to percussion connecting rod 8032 to transmit percussion motion.Percussion connecting rod 8032 proximally extends the proximal extremity of framework 8028 and extends through the through hole 8408 of anti-down flap 8266.The size of through hole 8408 is set to when pulling the trigger connecting rod 8032 with holding slidably during percussion connecting rod 8032 vertical alignment, and it is tightly motionless to make percussion connecting rod roll in through-holes when inclined.Bottom inserted sheet attachment 8271 proximally extends from the lower lip of the proximal extremity of framework 8028, extends through the hole 8269 on the lower limb of anti-down flap 8266.The bottom of anti-down flap 8266 is drawn to contiguous framework 8028 by this bottom inserted sheet attachment 8271, make the anti-down flap 8266 when pulling the trigger connecting rod 8032 and being distally pushed into be vertical, and tilt backwards to bound state when pulling the trigger anti-permission top when retraction attempted by connecting rod 8032.Anti-reversing Compress Spring 8264 is distally retrained by the proximal extremity of framework 8028, and proximally adjoins the top of anti-down flap 8266, thus anti-down flap 8266 is biased to lock-out state.It is biased and slidably around connection sliding tube 8131 and adjacent anti-down flap 8266 that spring resisted by anti-inverse cam pipe 8268.The proximally outstanding anti-reversing yoke 8256 being attached to anti-inverse cam pipe 8268 extends beyond closed yoke 8162.

See Figure 181, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cuts off in apparatus 8010, bounces back at the end of pulling the trigger stroke completely to make cutter.For this reason, distal link 8196d comprises tang 8290, and when distal link 8196d is advanced in the tooth bar passage 8291 (Figure 181) be formed in closed yoke 8162, this tang upwardly.Align this tang 8290 to start the bottom proximal cam 8292 on anti-reversing trip lever 8248 (Figure 186).Specifically see Figure 186 and Figure 187, be formed at the motion of the anti-reversing trip lever 8248 of structural constraint in right half shell 8156 and left half shell 8158.Be formed at pin socket 8296 between right half shell 8156 and left half shell 8158 respectively and circular pegs 8293 is received through longitudinal slot 8294, this hole is formed in the anti-reversing trip lever 8248 in proximal cam 8292 distally, bottom, thus allows longitudinal translation and rotate around circular pegs 8293.In right half shell 8156, the passage 8295 proximally opened comprises the nearside horizontal component 8295a be communicated with up and distally angled part 8295b, this up and distally angled part 8295b hold the rear pin 8297 (Figure 187) to the right near the proximal extremity of anti-reversing trip lever 8248, thus when anti-reversing trip lever 8248 arrives the farthest side part of its translation, this up and distally angled part 8295b give rotation upwards.Once anti-reversing trip lever 8248 is assembled, the barrier structure be formed in the right side half shell 8156 of contiguous anti-reversing trip lever 8248 prevents anti-reversing trip lever 8248 from proximally moving, with in the passage 8295 making rear pin 8297 to the right remain on proximally to open.

To being described further above, as shown in Figure 187 and Figure 188, thus the distal end 8254 of anti-reversing trip lever 8248 distally and is downwards ordered about, front pin 8298 is to the right fallen into be formed at the hierarchic structure 8299 distally opened of right half shell 8156, this joint is realized by the hook 8301 be left fixed to by Compress Spring 8300 (Figure 188) on the anti-reversing trip lever 8248 before to the right between pin 8298 and longitudinal slot 8294.The other end of Compress Spring 8300 is attached to the hook 8302 (Figure 186,188,189) be formed in the closely immediately above and lower position of closed yoke 8266 in right half shell 8156.Thus Compress Spring 8300 by the distal end 8254 of anti-reversing trip lever 8248 downwards and backward tractive, makes front pin 8298 to the right lock onto when being distally pushed in the hierarchic structure 8299 distally opened.Therefore, once released, see Figure 189, anti-reversing trip lever 8248 keeps forward, vertically keeps anti-down flap 8266, thus link tooth bar 8200 is bounced back.When free end executor 8012, closed yoke 8266 bounces back subsequently, reset tang 8303 upwardly on closed yoke 8266 contacts the bottom distal cam 8305 of anti-reversing trip lever 8248, pin 8298 before is to the right lifted from the hierarchic structure 8299 distally opened, makes anti-reversing Compress Spring 8264 anti-inverse cam pipe 8268 and anti-reversing trip lever 8248 proximally can be pushed to its advanced position (Figure 186).

See Figure 179 and Figure 189, percussion trigger 8034 can be operatively engaged to link tooth bar 8200 in any suitable manner.Specifically see Figure 180 and Figure 185, percussion trigger 8034 is around percussion trigger pin 8202 pivotable being connected to shell 8154.When pulling the trigger trigger 8034 and depressing towards pistol grip 8036, distally move around percussion trigger pin 8202 in the top 8204 of percussion trigger 8034, thus the percussion trigger extension spring 8206 (Figure 181) proximally placed is stretched, between the top 8204 that this extension spring is proximally connected to percussion trigger 8034 and shell 8154.Press down period at each percussion trigger, the top 8204 of percussion trigger 8034 engages link tooth bar 8200 via the side pawl mechanism 8210 that spring is biased.When pulling the trigger trigger and being released, side pawl mechanism with link tooth bar 8200 and be separated, and pull the trigger trigger and can be back to and do not depress or non-firing position.In use, by connecting rod 8196a-8196d each in the right rail of inclination that formed towards nearside and inclined-plane to the right 8284 engaged by side pawl assembly 8285.Specifically, pawl slide block 8270 (Figure 181 and Figure 183) has lower left quarter guider and right lower quadrant guider 8272, slide in right track 8275 in this lower left quarter guider and the right lower quadrant guider left track 8274 (Figure 181) respectively in the closed yoke 8266 be formed at below tooth bar passage 8291 and in closed yoke guide rail 8276, this closed yoke guide rail 8276 is parallel to tooth bar passage 8291 and is attached to tooth bar channel cover 8277, what this tooth bar channel cover closed tooth bar passage 8291 in closed yoke 8266 opens part to the right, described part of opening to the right is positioned at the distally of advancing of pawl slide block 8270.In Figure 181, Figure 182 and Figure 185, between hook 8280 on the right side of the distal end that Compress Spring 8278 is attached at hook 8279 in the top proximal position on closed yoke guide rail 8276 and pawl slide block 8270, this makes pawl slide block 8270 proximally advance to contact with the top 8204 of percussion trigger 8034.

Specifically see Figure 181, pawl block 8318 is positioned on pawl slide block 8270, and around vertical rear pin 8320 pivotable, this rear pin is through the nearside turning, left side of pawl block 8318 and pawl slide block 8270.Kicking out of block groove 8322 is formed in the distal part of the top surface of block 8318, with hold by normal pin 8326 with can the mode of pivotable be fixed on wherein kick out of block 8324, the bottom end of this normal pin extends in the pawl spring groove 8328 on the top surface of pawl slide block 8270.Pawl spring 8330 in pawl spring groove 8328 extends to the right side of vertical front pin 8326, force pawl block 8318 from be rotated counterclockwise during top view to tilt right rail 8282 engage.The little wind spring 8332 kicked out of in block groove 8322 forces kicks out of block 8324 turning clockwise from during top view, makes its proximal extremity be forced to contact with the wavy antelabium 8334 in the closed yoke 8266 be formed at above tooth bar passage 8291.As shown in Figure 184, compared to the stronger mechanical dominance that little wind spring 8332 has, pawl spring 8330 means that pawl block 8318 is easy to engage with the block 8324 of kicking out of turned clockwise.In Figure 185, when pulling the trigger trigger 8034 and being fully depressed and starting to be released, kick out of block 8324 runs into wavy antelabium 8334 ridge 8336 when pawl slide block 8270 bounces back, force and kick out of block 8324 turning clockwise from during top view, thus pawl block 8318 is kicked out of and the joint linking tooth bar 8200.The shape kicking out of block groove 8322 makes the stopping that turning clockwise kicking out of block 8324, makes it be in direction perpendicular to wavy antelabium 8334, keeps this disengaging thus eliminate ratcheting noise during retraction completely.

In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cut-out apparatus 8010 can comprise manual retrieving mechanism 8500, this manual retrieving mechanism provides manual release, the manual retrieving of firing lock, and at the end of pulling the trigger stroke completely, also performs automatic retracted in a kind of pattern (Figure 196-Figure 20 2).Referring now to Figure 181, Figure 190 and Figure 191, specifically, front idler gear 8220 engages with the surface, dentation upper left 8222 linking tooth bar 8200, and wherein front idler gear 8220 also engages the rear idler gear 8230 with less right side ratchet gear 8231.Front idler gear 8220 and rear idler gear 8230 are rotationally attached to the shank shell 8154 laid respectively on front idler axle 8232 and rear idler wheel axle 8234.The often end of rear idler wheel axle 8232 extends through right half shell 8156 and left half shell 8158 accordingly, and be attached to left indicator wheel 8040 and right indicator wheel 8041, and rotate freely in shank shell 8154 due to hind axle 8234 and be engaged to backgear 8230 with bonding pattern, therefore indicator wheel 8040,8041 rotate together with backgear 8230.Can advantageously select to link tooth bar 8200, gear relation between idler gear 8220 and backgear 8230, dentation upper surface 8222 is made to have the suitable teeth size of intensity, and make during the stroke of percussion completely of link transmission firing lock 8150, the rotation of backgear 8230 is no more than a circle.Gear mechanism 8502 is except indicating percussion stroke or progress intuitively, and gear mechanism 8502 also can be used for making cutter manual retrieving.The less right side ratchet gear 8231 of rear idler gear 8230 extends in the wheel hub 8506 of manual retrieving lever 8042, aligns specifically with by wheel hub 8506 to vertical longitudinal aligned slots 8508 (Figure 190) of dividing.The side direction through hole 8510 of wheel hub 8506 is communicated with upper grooves 8512.Front portion 8514 is shaped as the locking pawl 8516 that accommodation proximally guides, and this locking pawl is around lateral pin 8518 pivotable to the right in the distal end being formed at upper grooves 8512.Rear portion 8520 is shaped as and holds L shape spring tab 8522, and this spring tab forces the downward ratchet gear 8231 less with right side of locking pawl 8516 to engage.Barrier structure 8524 (Figure 186 and Figure 193) projects into upper grooves 8512 from right half shell 8156; When manual retrieving lever 8042 is downward (Figure 193), this barrier structure stops locking pawl 8516 to engage less right side ratchet gear 8231.Wind spring 8525 (Figure 181) forces manual retrieving lever 8042 downward.

In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can depart from the tooth bar that links being positioned at distally.In Figure 194 and Figure 195, when manual retrieving lever 8042 lifts, locking pawl 8516 turns clockwise and is no longer stoped by barrier structure 8524, and engages less right side ratchet gear 8231, thus makes rear idler gear 8230 turning clockwise from during left sides.Therefore, front idler gear 8220 responds counterclockwise, and link tooth bar 8200 is bounced back.In addition, curved ridges 8510 is to the right given prominence to from wheel hub 8506, and its size is set to contact and the anti-reversing trip lever 8248 that distally moves, to discharge anti-inversion organization 8250 when manual retrieving lever 8042 rotates.

In Figure 196-Figure 20 2, automatic retracted can be attached to by surgical stapling and the automatic retracted mechanism 8600 cutting off apparatus 8010a at the end of pulling the trigger stroke completely to be had before tooth 8602 in idler gear 8220a; Move in the circular groove 8604 of this front idler gear in cam 8606, until rotate in the whole process nearly corresponding to three percussion strokes the thing 8608 that meets with obstruction.In such cases, ridge 8610 is to the right rotated upwardly to contact bottom cam groove 8612, with the anti-reversing trip lever 8248a that distally moves.Specifically see Figure 197, anti-reversing trip lever 8248a comprises the distal end 8254 operated as described in the preceding.Be formed at circular pegs 8293 between right half shell 8156 and left half shell 8158 and pin socket 8296 to be respectively received through the hole 8294a of the general rectangular in the anti-reversing trip lever 8248a be formed at after bottom cam 8192, thus allow the downward lock motion of the distal end 8254 of longitudinal translation and anti-reversing trip lever 8248a.In right half shell 8156, the passage 8295a proximally opened of level holds the rear pin 8297 to the right near the proximal extremity of anti-reversing trip lever 8248a.

In operation, before the percussion in Figure 198, Figure 198 A, link tooth bar 8200 and anti-inverse cam pipe 8268 are in advanced position, thus when anti-reversing Compress Spring 8264 makes anti-down flap 8266 proximally tilt, anti-inversion organization 8250 is locked.Automatic retracted mechanism 8600 is in original state, and wherein anti-reversing trip lever 8248a bounces back, and connecting rod 8196a contacts with front idler gear 8220a.Tooth 8602 is in the position of six o'clock sharps, and wherein the total travel of circular groove 8604 is carried out counterclockwise, the just adjacent teeth 8602 of ridge 8610 to the right.In Figure 199, Figure 199 A, there is a percussion stroke, a distal link 8196b has been moved upward to and contacts with front idler gear 8220a.Tooth 8602 has advanced 1/3rd turns by the circular groove 8604 of stationary cam 8606.In Figure 200, Figure 200 A, there is second percussion stroke, another connecting rod 8196c has been moved upward to and contacts with front idler gear 8220a.Tooth 8602 has advanced 2/3rds turns by the circular groove 8604 of stationary cam 8606.In Figure 20 1, Figure 20 1A, there is the 3rd percussion stroke, a distal link 8196d has been moved upward to and contacts with front idler gear 8220a.Tooth 8602 has proceeded to around circular groove 8604 whole process and has contacted with blockage 8608, thus being rotated counterclockwise (when observing from right side) of starting cam 8606, thus ridge 8608 is to the right contacted with anti-reversing trip lever 8248a.In Figure 20 2, anti-reversing trip lever 8248a responsively distally moves, thus to be locked onto by pin 8298 before to the right in the hierarchic structure 8299 distally opened and to discharge anti-inversion organization 8250.Similar surgery suturing appliance is disclosed in the United States Patent (USP) 7,083 announced on August 1st, 2006, and in 075, whole disclosures of this patent are incorporated herein by reference.

See Figure 20 3, the nail of surgery suturing appliance 9010 is used assembly 9012 and is realized following function: clamp organizationally, by driving nail and cut-out tissue along axle 9016 relative to two kinds of different motion of the longitudinal going down of pedestal 9070.Pedestal 9070 is proximally attached to the shank of surgery suturing appliance and is attached to it, to rotate around longitudinal axis.To be called the U.S. Patent application 10/374 of " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM " at CO-PENDING and the name owned together for surgical stapling and the illustrative multiple-pass shank that cuts off apparatus, describe in more detail in 026, the disclosure of this patent application is incorporated to way of reference accordingly in full.Other application according to the invention can in conjunction with clicking distribution journey, such as be called " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent application 10/441 at CO-PENDING and the name owned together, described in 632, the disclosure of this patent application is incorporated to way of reference accordingly in full.

Specifically see Figure 20 4, the distal end of pedestal 9070 is attached to nail passage 9018.Anvil block 9022 has nearside hub switch side 9072, and this nearside hub switch side, can the mode of pivotable be contained in the proximal extremity 9074 of nail passage 9018, is just in time positioned at the distally of itself and pedestal 9070 joint.When the downward pivotable of anvil block 9022, anvil block 9022 makes tissue contacting surface 9028 and shaping pit 9026 towards the motion of relative nail bin, as hereafter described in more detail further.The hub switch side 9072 of anvil block 9022 comprises closing structure 9076, this closing structure its pivotal attachment place with nail passage 9018 contiguous but in its distally with nail passage pivotal attachment place.Therefore, closure tube 9078 (its distal end comprises the shape of a hoof hole 9080 engaging this closing structure 9076) optionally will be opened motion and give anvil block 9022 during nearside lengthwise movement, and during the distally lengthwise movement of closure tube 9078, give anvil block 9022 by closing motion, this closure tube 9078 is slided on pedestal 9070 in response to closure trigger, is similar to mentioned above.Pedestal 9070 impels and guides firing action from shank through longitudinal reciprocating two cuttves and trigger shaft 9090.Specifically, pedestal 9070 comprises longitudinal trigger shaft slit 9092, and this longitudinal trigger shaft slit holds the portions of proximal of two cuttves and trigger shaft 9090, in particular to the trigger shaft 9094 of lamination convergent.Should be appreciated that the trigger shaft 9094 of lamination convergent can be replaced by solid trigger shaft and/or any other suitable material.

E type crossbeam 9102 is the distal part of two cuttves and trigger shaft 9090, and it is conducive to separately closed and percussion, and during pulling the trigger by anvil block 9022 and elongated nail passage 9018 spaced apart.Specifically see Figure 20 4 and Figure 20 5, except any attachment processes such as solder brazing or binding agent, cutter and trigger shaft 9090 are also formed by the vertical attachment hole 9104 of the spill be formed in E type crossbeam 9102, this pore volume receives the corresponding convex attachment members 9106 presented in distally by the trigger shaft 9094 of lamination convergent, thus each part is formed by the selected materials and methods being suitable for its difference in functionality (such as intensity, pliability, frictional force).E type crossbeam 9102 can advantageously be formed by the material with desired material properties, to form a pair top pin 9110, a pair intermediate pin 9112 and base pins or leg 9114, and can obtain sharp knife edges 9116.In addition, hold the one-body molded of each vertical end of blade 9116 and proximally outstanding top guide device 9118 and intermediate guide 9120 also define set of organizations tie region 9122, contribute to guiding to sharp knife edges 9116 before cut-out tissue.Intermediate guide 9120 also for being engaged by the staged central member 9124 of adjacent wedge-shaped slides 9126 (Figure 20 6) and pulling the trigger nail application equipment 9012, thus uses by nail the shaping that assembly 9012 realizes nail, as described in more detail below.Carry out assembling compared to by multiple parts, these structures are integrally formed (such as with E type crossbeam 9102, top pin 9110, intermediate pin 9112 and bottom supports 9114) be conducive to manufacturing under the tolerance limit of relative to each other more compactness, thus ensure that the operation expected in percussion and/or carry out during using the effective interaction of the various latch-up structures of assembly 9012 with nail.

In Figure 20 7 and Figure 20 8, nail uses that assembly 9012 is illustrated as opening, and wherein E type crossbeam 9102 bounces back completely.Between erecting stage, the lower leg 9114 of E type crossbeam 9102 falls into nail passage 9018 through expanded hole 9130, and E type crossbeam 9102 is pushed into subsequently, and E type crossbeam 9102 is distally slided along the lower railway 9132 be formed in nail passage 9018.Specifically, lower railway 9132 comprises narrower slots 9133, and it opens as expansion slit 9134 on the lower surface of nail passage 9018, to form the T-shaped of reversion in lateral cross section, as shown in concrete in Figure 20 8 and Figure 20 9; This narrower slots 9133 is communicated with expanded hole 9130.Once be assembled, the assembly being attached to the trigger shaft 9094 of lamination convergent at nearside does not allow lower leg 9114 again proximally to march to expanded hole 9130 to allow to depart from.See Figure 21 0, the trigger shaft 9094 of lamination convergent is conducive to nail being used assembly 9012 and inserts through the trocar.Specifically, when E type crossbeam 9102 bounces back completely, the more downward protuberance 9136 in distally lifts E type crossbeam 9102.This to be a bit subjected to displacement at certain by downward protuberance 9136 and to realize; At this some place, upwards cam in the proximal of the expanded hole 9130 of this protuberance in nail passage 9018.Referring now to Figure 21 1, the trigger shaft 9094 of lamination convergent also strengthens the operation of some latch-up structure, and described latch-up structure is attached in nail passage 9018 by comprising the protuberance 9138 upwards of more nearside; Described protuberance is ordered about downwards by pedestal 9070 during the initial part of percussion stroke.Specifically, lateral rod 9140 is limited between the square holes 9142 in pedestal 9070 (Figure 20 4).The clip springs 9144 of downward encirclement lateral rod 9140 forces a part for the trigger shaft 9094 of lamination convergent distally to be given prominence to from longitudinal trigger shaft slit 9092, and when guaranteeing suitable, some favourable latch-up structure is engaged.When protuberance 9138 contacts clip spring 9144 upwards, this motive force more obviously or is only confined to the part pulling the trigger stroke.

In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and its top pin 9110 is positioned at the anvil block pit 9150 near the pivotable proximal extremity of anvil block 9022.Anvil block 9022 side direction is expanded into anvil block inner tracks 9154 by the vertical anvil slot 9152 (Figure 20 3) opened downwards, when the top pin 9110 of E type crossbeam 9102 distally advances during pulling the trigger, anvil block inner tracks catches the top pin 9110 of E type crossbeam 9102, as shown in Figure 21 0 and 211, anvil block 9022 is absolutely spaced apart with nail passage 9018.Therefore, when after E type crossbeam 9102 retraction, surgeon can use assembly 9012 by open and close nail repeatedly, until to being trapped in the wherein to be stapled and placement of tissue cut off and orientation pleases oneself, and E type crossbeam 9102 even uses for the diameter with minimizing and the nail that correspondingly reduces rigidity the appropriate location also contributing to tissue for assembly 9012.In Figure 20 3, Figure 20 4, Figure 20 6, Figure 20 7, Figure 20 9 and Figure 21 5, nail is used assembly 9012 and is depicted as the replaceable nail bin 9020 having and comprise wedge-shaped slides 9126.Longitudinal direction is alignd and parallel multiple wedge slot 9202 (Figure 20 9) opened downwards hold the required corresponding wedge 9204 of wedge-shaped slides 9126.In Figure 20 9-Figure 21 1, the wedge-shaped slides 9126 therefore upwards multiple staple drivers 9206 of camming movement, described multiple staple drivers can vertical sliding motion in staple drivers groove 9208.In this illustrative pattern, each staple drivers 9206 comprises two vertical contact pins, each vertical contact pin upwards moves in corresponding nail 9210 or cavity 9024, upwards to be extruded and to make it be out of shape by the nail 9023 leaned against on the nail profiled surface 9214 (Figure 21 1) of anvil block 9022.Central authorities' percussion groove 9216 (Figure 20 4) be limited in the nail bin 9020 of contiguous nail passage 9018 allow the bottom horizontal portion 9218 (Figure 20 6) of wedge-shaped slides 9126 and the intermediate pin 9112 of E type crossbeam 9102 to pass through.Specifically, nail bin pallet 9220 (Figure 20 4, Figure 20 9) is attached to polymer nail bin body 9222 and is positioned at below it; This polymer nail bin body has the staple drivers groove 9208, nail 9210 and the central authorities' percussion groove 9216 that are formed at wherein.When therefore nail 9023 is shaped at either side, sharp knife edges 9116 enters vertical groove 9230, and except the only farthest side end of this vertical groove, this vertical groove is through the longitudinal axis of nail bin 9020.

As shown in Figure 21 1, when by two cuttves and trigger shaft 9090 proximally tractive until downward protuberance 9136 by the intermediate guide 9120 on E type crossbeam 9102 upwards and backward cam time, start to pull the trigger nail and use assembly 9012, thus when anvil block 9022 is opened as Figure 20 3 and Figure 20 7, new nail bin 9020 is inserted in nail passage 9018.In Figure 21 2, two cuttves and trigger shaft 9090 are distally pushed into a bit of distance, thus making when clip springs 9144 acts on the protuberance 9138 upwards of trigger shaft 9094 of lamination convergent, downward protuberance 9136 falls into the expanded hole 9130 of lower railway 9132.Intermediate guide 9120 prevent in the staged central member 9124 owing to being resisted against wedge-shaped slides 9126 produce be further rotated down, thus the intermediate pin 9112 of E type crossbeam is remained on central authorities percussion groove 9216 in.In Figure 21 3, two cuttves and trigger shaft 9090 are distally pulled the trigger, thus advance wedge-shaped slides 9126, are shaped to make nail 9023 when being cut off by the tissue be clamped between anvil block 9022 and the nail bin 9020 with sharp knife edges 9,116 9242.Subsequently, in Figure 21 4, two cuttves and trigger shaft 9090 bounce back, and wedge-shaped slides 9126 is located in distally.In Figure 21 5, intermediate pin 9112 is allowed to move to downwards in the latch recess 9240 that is formed in nail passage 9018 (also can see Figure 20 8, Figure 21 1).Therefore, when wedge-shaped slides 9126 (not shown in Figure 21 5) is not located (not such as at nearside, nail bin 9020 lacks or nail bin 9020 exhausts) time, if intermediate pin 9112 runs into the distal side edge of latch recess 9240, then operator will be received into sense of touch instruction.The United States Patent (USP) 7,380 that similar surgery suturing appliance was announced on June 3rd, 2008, disclosed in having in 696, whole disclosures of this patent are incorporated herein by reference.

As mentioned above, nail bin can comprise warehouse, and this warehouse comprises multiple nail chamber be defined in wherein.Warehouse can comprise platform and top platform surface, and wherein each nail chamber can limit the opening in platform surface.Also described above, nail can be positioned in each nail intracavity, and nail is stored in warehouse until it is penetrated from warehouse.Before being penetrated from warehouse, nail can be accommodated in warehouse, makes nail not projectingly exceed platform surface.In this type of embodiment, when nail is positioned in below platform surface, the probability of following closely damaged and/or premature contact destination organization can be reduced.In all cases, nail can move between non-firing position and firing position, and in non-firing position, it is not from warehouse projection, and in firing position, it has exposed from warehouse and can contact the anvil block being positioned in nail bin opposite.Anvil block and/or the shaping pit be defined in anvil block can be oriented to the predetermined distance in anomaly platform surface, and make when nail is deployed from warehouse, nail is deformed into predetermined forming height.In some cases, be trapped in the thickness variable of the tissue between anvil block and nail bin, therefore, thicker tissue can be trapped in thinner tissue in some nail and can be trapped in some other nail.In any one situation, be applied to the clamping pressure of tissue by nail or power such as can be different because of nail, or change between nail on the other end of nail on one end of nail row and nail row.In some cases, the gap between anvil block and nail bin platform can be controlled, make nail in each nail, apply a certain minimum clamping pressure.But in some such cases, the significant change of the clamping pressure in different nails may still exist.

Nail bin can comprise the device that the thickness for the tissue to the nail IT disposed from nail bin compensates.See Figure 21 6, nail bin (such as nail bin 10000) such as can comprise Part I (such as support section 10010) and the such as compressible Part II (such as tissue thickness's compensating part 10020) of rigidity.First see Figure 21 8, support section 10010 can comprise warehouse, top platform surface 10011 and multiple nail chamber 10012.Wherein, be similar to mentioned above, each nail chamber 10012 can limit the opening in platform surface 10011.Nail 10030 such as can be positioned in each nail chamber 10012 removedly.Such as, first see Figure 24 5 and as described in more detail below, each nail 10030 one or more lower limbs 10032 that can comprise base portion 10031 and extend from base portion 10031.Before nail 10030 is deployed, also as described in more detail below, the base portion 10031 of nail 10030 can be supported by the staple drivers be positioned in support section 10010, and simultaneously, the lower limb 10032 of nail 10030 can at least be partly accommodated in nail chamber 10012.Nail 10030 can be deployed between non-firing position and firing position, lower limb 10032 is made to move through tissue thickness's compensating part 10020, the top surface of penetrate tissue thickness compensation part 10020, penetrate tissue T, and contact is positioned in the anvil block on nail bin 10000 opposite.When lower limb 10032 is out of shape against anvil block, the lower limb 10032 of each nail 10030 can the part of tissue T in the part of capture tissue thickness compensation part 10020 and each nail 10030, and compression stress is applied to tissue.To being described further above, the lower limb 10032 of each nail 10030 can be made downwards to be out of shape towards the base portion 10031 of nail, and retain region 10039 to form nail, retain region at this nail, tissue T and tissue thickness's compensating part 10020 can be captured.In all cases, nail retain that region 10039 can be limited at strained lower limb 10032 between inner surface and the inner surface of base portion 10031.The size that nail retains region can be depending on some questions, the width of the length of such as lower limb, the diameter of lower limb, base portion and/or the degree of such as lower limb distortion.

In the past, surgeon usually needed the suitable nail for the organizational choice that will sew up with suitable staple height.Such as, surgeon can select high nail to use together with thick organizing and select low nail to use together with thin tissue.But in some cases, organizing of being just sewn does not have consistent thickness, therefore, some nails cannot realize the percussion configuration of expectation.Such as, Figure 25 0 shows for the high nail in thin tissue.Referring now to Figure 25 1, when tissue thickness's compensating part (such as tissue thickness's compensating part 10020) such as uses together with thin tissue, such as larger nail can be configured as the percussion configuration of expectation.

Due to the compression ratio of tissue thickness's compensating part, tissue thickness's compensating part can compensate the thickness of the tissue be captured in each nail.More specifically, referring now to Figure 24 5 and Figure 24 6, tissue thickness's compensating part (such as tissue thickness's compensating part 10020) such as can retain according to nail the larger and/or less part that nail that the thickness of the tissue held in region 10039 and/or type occupy each nail 10030 retains region 10039.Such as, when thicker tissue T is trapped in nail 10030, if thinner tissue T is trapped in nail 10030, then tissue thickness's compensating part 10020 can occupy the major part that nail retains region 10039.Correspondingly, when thinner tissue T is trapped in nail 10030, if thicker tissue T is trapped in nail 10030, then tissue thickness's compensating part 10020 can occupy the smaller portions that nail retains region 10039.Like this, tissue thickness's compensating part can compensate for slower thin tissue and/or thicker tissue, and guarantees that compression stress is applied to tissue, no matter no matter and or the tissue thickness be at least substantially trapped in nail.In addition to the above, tissue thickness's compensating part 10020 can compensate the tissue that is dissimilar or different compression ratio be trapped in different nail 10030.Referring now to Figure 24 6, compression stress can be applied to the vascular tissue T that can comprise blood vessel V by tissue thickness's compensating part 10020, and therefore limit blood flows through not too compressible blood vessel V, but still the compression stress of expectation is applied to the tissue T of surrounding.In all cases, to being described further above, tissue thickness's compensating part 10020 also can compensate strained nail.See Figure 24 7, the distortion of various nail 10030 can cause the larger nail be limited in this type of nail to retain region 10039.Due to the resilience force of tissue thickness's compensating part 10020, referring now to Figure 24 8, even if be limited at this nail be out of shape in nail 10030 retain region 10039 can be extended, be positioned at this tissue thickness's compensating part 10020 be out of shape in nail 10030 and still enough compression pressures can be applied to tissue T.In all cases, the tissue thickness's compensating part 10020 be positioned in the middle of adjacent nail 10030 can be biased against tissue T by the nail 10030 of the suitable shaping of being out of shape around nail 10030, and therefore compression pressure is applied to such as around and/or be trapped in the tissue be out of shape in nail 10030.In all cases, tissue thickness's compensating part can compensate different tissue densities, and described different tissue density can such as produce due to calcification, zone of fiber and/or the tissue previously having sewed up or processed.

Fixing or unmodifiable interstice can be limited between support section and anvil block, no matter why the thickness being therefore trapped in the tissue in nail all can make nail be deformed into predetermined height.When tissue thickness's compensating part uses together with these embodiments, tissue thickness's compensating part can adapt to be trapped in the tissue between anvil block and support section nail bin, and due to the resilience force of tissue thickness's compensating part, additional compression stress can be applied to tissue by tissue thickness's compensating part.Referring now to Figure 25 2-Figure 25 7, nail 10030 has been shaped to predetermined height H.With reference to Figure 25 2, tissue thickness's compensating part is not used, and tissue T occupies whole nail retains region 10039.With reference to Figure 25 9, a part for tissue thickness's compensating part 10020 has been trapped in nail 10030, tissue T is compressed, and has occupied nail and retain region 10039 at least partially.Referring now to Figure 25 4, thin tissue T has been trapped in nail 10030.In this embodiment, such as, by the tissue T compressed, be there is the height of about 2/9H and be there is by the tissue thickness's compensating part 10020 compressed the height of about 7/9H.Referring now to Figure 25 5, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, such as, by the tissue T compressed, be there is the height of about 4/9H and be there is by the tissue thickness's compensating part 10020 compressed the height of about 5/9H.Referring now to Figure 25 6, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, such as, by the tissue T compressed, be there is the height of about 2/3H and be there is such as by the tissue thickness's compensating part 10020 compressed the height of approximately 1/3H.Referring now to Figure 25 5, thick tissue T has been trapped in nail 10030.In this embodiment, such as, by the tissue T compressed, be there is the height of about 8/9H and be there is by the tissue thickness's compensating part 10020 compressed the height of about 1/9H.In all cases, tissue thickness's compensating part can comprise compression height, and this compression height comprises: the such as nail of about 10% retain height, about 20% nail retain height, about 30% nail retain height, about 40% nail retain height, about 50% nail retain height, about 60% nail retain height, about 70% nail retain height, about 80% nail retain height and/or about 90% nail retain height.

Nail 10030 can comprise any suitable unshaped height.Nail 10030 can comprise such as between about 2mm and the unshaped height approximately between 4.8mm.Nail 10030 can comprise such as the unshaped height of approximately 2.0mm, approximately 2.5mm, about 3.0mm, about 3.4mm, approximately 3.5mm, approximately 3.8mm, approximately 4.0mm, about 4.1mm and/or about 4.8mm.Follow closely the height H that can be deformed to be decided by the distance between the platform surface 10011 of support section 10010 and relative anvil block.Distance between platform surface 10011 and the tissue contacting surface of anvil block can be such as about 0.097 ".Height H also can be determined by the degree of depth of the shaping pit be limited in anvil block.Shaping pit such as can have the degree of depth measured from tissue contacting surface.As described in more detail below, nail bin 10000 also can comprise staple drivers, and nail 10030 can promote towards anvil block by this staple drivers, and will upgrade or " excessively driving " above platform surface 10011.In this case, the distance that the forming height H following closely 10030 also can be overdriven by nail 10030 decides.The height that such as, nail 10030 can be overdriven such as approximately .028 ", and nail 10030 can be caused to be shaped to such as about 0.189 ".Nail 10030 can be shaped as the height of such as about 0.8mm, approximately 1.0mm, approximately 1.5mm, approximately 1.8mm, approximately 2.0mm and/or about 2.25mm.Nail can be shaped as such as between about 2.25mm and the height approximately between 3.0mm.To being described further above, the height that the nail of nail retains region by the forming height followed closely and can comprise the width of wire rod of nail and diameter determined.The forming height H that the height that the nail of nail 10030 retains region 10039 can comprise nail deducts two diameter widths of wire rod.Nail line can comprise such as about 0.0089 " diameter.Nail line can comprise the diameter such as between about 0.0069 " and about 0.0119 ".Such as, the forming height H of nail 10030 can be about 0.189 ", and follow closely linear diameter can be about 0.0089 ", thus such as produces about 0.171 " nail retain height.

To being described further above, tissue thickness's compensating part can comprise the height of unpressed or pre-deployment, and can be deformed in multiple compression height.Tissue thickness's compensating part can comprise such as about 0.125 " uncompressed height.The compensating part of tissue thickness can comprise and is such as more than or equal to about 0.080 " uncompressed height.Tissue thickness's compensating part can comprise the height of unpressed or pre-deployment, and this is highly greater than not pulling the trigger highly of nail.Not pulling the trigger of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly such as high about 10%, high about 20%, high about 30%, high about 40%, high about 50%, high about 60%, high about 70%, high by about 80%, high about 90% and/or high about 100%.Not pulling the trigger of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly high by such as at the most about 100%.Not pulling the trigger of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is highly high such as more than 100%.Tissue thickness's compensating part can comprise the uncompressed height of not pulling the trigger height equaling to follow closely.Tissue thickness's compensating part can comprise the uncompressed height of not pulling the trigger height being less than nail.The comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part do not pull the trigger highly such as low about 10%, low about 20%, low about 30%, low about 40%, low about 50%, low about 60%, low about 70%, low about 80% and/or low by about 90%.Compressible Part II can comprise uncompressed height, and this uncompressed height is higher than the uncompressed height of the tissue T be just sewn.Tissue thickness's compensating part can comprise uncompressed height, and this uncompressed height equals the uncompressed height of the tissue T be just sewn.Tissue thickness's compensating part can comprise uncompressed height, and this uncompressed height is lower than the uncompressed height of the tissue T be just sewn.

As mentioned above, no matter be that thick tissue or thin tissue are trapped in nail, tissue thickness's compensating part all can be compressed in multiple one-tenth staple.Such as, can make the nail distortion in nail line or nail row, the height making the nail of each nail retain region to comprise such as approximately 2.0mm, wherein tissue T and tissue thickness's compensating part can be compressed in this height.In some cases, tissue T can be included in the compression height that nail retains the about 1.75mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 0.25mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 1.50mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 0.50mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 1.25mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 0.75mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 1.0mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 1.0mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 0.75mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 1.25mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 1.50mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 0.50mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.In some cases, tissue T can be included in the compression height that nail retains the about 0.25mm in region, and tissue thickness's compensating part can be included in the compression height that nail retains the about 1.75mm in region, thus the nail obtaining adding up to such as approximately 2.0mm retains region height.

To being described further above, tissue thickness's compensating part can comprise the uncompressed height of the percussion height being less than nail.Tissue thickness's compensating part can comprise the uncompressed height of the percussion height equaling to follow closely.Or tissue thickness's compensating part can comprise the uncompressed height of the percussion height higher than nail.Such as, the uncompressed height of tissue thickness's compensating part can comprise such as following thickness: this thickness is about 180%, about 190% of shaping staple height and/or about 200% of shaping staple height of about 170%, the shaping staple height of about 160%, the shaping staple height of about 150%, the shaping staple height of about 140%, the shaping staple height of about 130%, the shaping staple height of about 120%, the shaping staple height of about 110%, the shaping staple height of shaping staple height.Tissue thickness's compensating part can comprise uncompressed height, and this is highly more than the twice of percussion height of nail.Tissue thickness's compensating part can comprise compression height, and this is highly about 85% of such as shaping staple height to about 150%.As mentioned above, tissue thickness's compensating part can be compressed between uncompressed thickness and compressed thickness.The compressed thickness of tissue thickness's compensating part can be such as about 70%, about 80% of its uncompressed thickness and/or about 90% of its uncompressed thickness of about 60%, its uncompressed thickness of about 50%, its uncompressed thickness of about 40%, its uncompressed thickness of about 30%, its uncompressed thickness of about 20%, its uncompressed thickness of about 10%, its uncompressed thickness of its uncompressed thickness.The uncompressed thickness of tissue thickness's compensating part can such as about twice thicker in its compressed thickness, about ten times, about 50 times and/or about 100 times.The compressed thickness of tissue thickness's compensating part can between about 60% of its uncompressed thickness to about 99%.Uncompressed thickness its compressed thickness thick at least 50% comparable of tissue thickness's compensating part.The thick most as many as 100 times of uncompressed thickness its compressed thickness comparable of tissue thickness's compensating part.Compressible Part II can be elastic, or elastic at least partly, and the strained lower limb of tissue T against nail can be biased.Such as, compressible Part II can between tissue T and the base portion of nail resilient expansion so that against nail lower limb promote tissue T.As hereafter will discussed in detail further, tissue thickness's compensating part can be positioned in the middle of the nail lower limb of tissue T and distortion.In all cases, due to mentioned above, tissue thickness's compensating part can eliminate any gap of following closely and retaining in region.

Any tissue thickness as herein described compensating part can comprise one or more the material be characterised in that in following characteristic: such as, biocompatibility, bioresorbable, bioresorbability, biodurable, biological degradability, compression ratio, fluid absorbability, swellability, from autgmentability, biological activity, Drug, pharmaceutically active, resistance to blocking, hemostatic, antibiosis disposition, antibiotic property, antiviral property, trophism, adhesiveness, permeability, hydrophilic and/or hydrophobicity.In all cases, any surgical stapling or the fastening instrument that comprise anvil block and nail bin or fastener cartridge also can comprise the tissue thickness's compensating part be associated with anvil block and/or nail bin.This type of tissue thickness's compensating part can be any tissue thickness compensating part of tissue thickness as herein described compensating part, and at least one that of course, or in addition can comprise in hemorrhage (such as fibrin and thrombin), antibiotic (such as doxycpl) and medicine (such as matrix metalloproteinase (MMPs)).

Tissue thickness's compensating part can comprise synthesis and/or non-synthetic materials.Tissue thickness's compensating part can comprise polymer composition, and described polymer composition comprises one or more synthetic polymers and/or one or more non-synthetic polymer.Synthetic polymer can comprise the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition can comprise such as biocompatible foam.Biocompatible foam can comprise the open celled foam of such as porous and/or the closed-cell foam of porous.Biocompatible foam can have uniform bore form maybe can have gradient pore form (that is, on the whole depth of foam in a direction, orifice size increases gradually and becomes macropore).Polymer composition can comprise the combination of one or more and they in porous support, porous matrix, gel-type vehicle, hydrogel matrix, solution substrate, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and biodegradable polymer.Such as, tissue thickness's compensating part can comprise the foam by thread matrix enhancement, maybe can comprise the foam with additional hydrogel layer, and the expansion under body fluid exists of this additional hydrogel layer, to provide compression further organizationally.Tissue thickness's compensating part also can be made up of the coating on material and/or the second layer or third layer, and this coating is expansion under body fluid exists, to provide compression further organizationally.This type of layer can be hydrogel, this hydrogel can be synthesis and/or natural source material, and such as can be biological durable and/or biodegradable.Tissue thickness's compensating part can comprise microgel or nanogel.Hydrogel can comprise to come microgel and/or the nanogel of self-carbon water compound.Can use and the fibrous nonwoven material of additional flexibility, rigidity and/or intensity or fiber mesh type element can be provided to strengthen tissue thickness's compensating part.Tissue thickness's compensating part has porous form, and this porous form shows gradient-structure, such as aperture on a surface and larger hole on the other surface.This type of form is even more ideal for tissue growth or hemostasis behavior.In addition, gradient also can be combined with the bio-absorbable section of change.Short-term absorption profile can be preferably, to solve hemostasis problem, and the problem that Long-term absorption section makes tissue better heal under can solving ne-leakage situation.

The example of non-synthetic materials includes but not limited to lyophilizing polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin, Fibrinogen, elastin laminin, Dan Baiduotang proteoglycan PG, keratin, albumin, hydroxyethyl-cellulose, cellulose, oxidized cellulose, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, casein, alginate and their combination.

The example of synthesis absorbable material includes but not limited to gather (lactic acid) (PLA), PLLA (PLLA), pla-pcl (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoatefrom (PHA), the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone (PGCL), the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and trimethylene carbonate, poly-(decanedioic acid glyceride) (PGS), poly-(dioxanone) (PDS), polyester, poly-(ortho esters), poly-esters of oxyacids, polyether ester, Merlon, polyesteramide, condensing model, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based gathers imido-carbonic ester, tyrosine-based polycarbonate, poly-(D, L-lactide-carbamate), poly-(butyric ester), poly-(B-butyric ester), poly-(E-caprolactone), Polyethylene Glycol (PEG), poly-[two (carboxyphenoxy) phosphonitrile], poly-(aminoacid), intend poly-(aminoacid), Absorbable rod polyurethane, poly-(phosphazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly-(caprolactone), polyacrylic acid, poly-acetas, polypropylene, aliphatic polyester, glycerol, copolymerization (ether-ester), poly-oxalic acid alkylidene diol ester, polyamide, poly-(iminocarbonic ester), poly-oxalic acid alkylidene diol ester and their combination.Polyester is optional from polylactide, PGA, trimethylene carbonate, poly-dioxanone, polycaprolactone, polybutester and their combination.

Synthesis absorbable polymer can comprise such as can brand name VICRYL (polyglactic 910) from Ethicon, Inc. 90/10 commercially available poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide) copolymer, can brand name DEXON from the commercially available PGA of American Cyanamid Co., can brand name PDS from Ethicon, Inc. commercially available poly-dioxanone, can brand name MAXON from commercially available poly-(Acetic acid, hydroxy-, bimol. cyclic ester-trimethylene carbonate) statistic copolymer of American Cyanamid Co., can brand name MONOCRYL from one or more commercially available 75/25 poly-(glycolide-s-caprolactone-poliglecaprolactone 25) copolymer of Ethicon company.

The non-absorbable material of synthesis includes but not limited to polyurethane, polypropylene (PP), polyethylene (PE), Merlon, polyamide, such as nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyether-ether-ketone (PEEK), politef (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones, silicon and their combination.The non-absorbable polymer of synthesis can including but not limited to foam elastomer and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer can comprise can brand name GORE-TEX Soft Tissue Patch from W.L.Gore & Associates, Inc. commercially available expanded PTFE (ePTFE), and can brand name NASOPORE from Polyganics commercially available altogether-polyether ester urethane foam.

Polymer composition can comprise such as by weight about 50% to about 90% the polymer composition of PLLA, and by weight about 50% to about 10% the polymer composition of PCL.Polymer composition can comprise such as by weight about 70% PLLA, and by weight about 30% PCL.Polymer composition can comprise such as by weight about 55% to about 85% the polymer composition of PGA, and by weight 15% to 45% the polymer composition of PCL.Polymer composition can comprise such as by weight about 65% PGA, and by weight about 35% PCL.Polymer composition can comprise such as by weight about 90% to about 95% the polymer composition of PGA, and by weight about 5% to about 10% the polymer composition of PLA.

Synthesis absorbable polymer can comprise can bio-absorbable, biocompatible elastomers copolymer.Suitable can bio-absorbable, biocompatible elastomers copolymer includes but not limited to that (mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is preferably about 30:70 to about 70:30 for the copolymer of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester, be preferably 35:65 to about 65:35, and be more preferably 45:55 to 35:65); The elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and is more preferably 45:55 to 30:70) of 6-caprolactone and lactide (comprising L-lactide, D-lactide, their blend or lactic acid copolymer); To the elastomer copolymer (being preferably about 40:60 to about 60:40 to the mol ratio of dioxanone and lactide) of dioxanone (Isosorbide-5-Nitrae-dioxane-2-ketone) and lactide (comprising L-lactide, D-lactide and lactic acid); 6-caprolactone and the elastomer copolymer (6-caprolactone is preferably about 30:70 to about 70:30 with to the mol ratio of dioxanone) to dioxanone; To the elastomer copolymer (being preferably about 30:70 to about 70:30 to the mol ratio of dioxanone and trimethylene carbonate) of dioxanone and trimethylene carbonate; The elastomer copolymer (mol ratio of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester is preferably about 30:70 to about 70:30) of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester; The elastomer copolymer of trimethylene carbonate and lactide, comprises L-lactide, D-lactide, their blend or lactic acid copolymer (mol ratio of trimethylene carbonate and lactide is preferably about 30:70 to about 70:30); And their blend.δ elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone.And for example, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

The name being published in November 21 nineteen ninety-five is called the United States Patent (USP) 5 of " ELASTOMERIC MEDICAL DEVICE ", 468,253 and be published in the United States Patent (USP) 6 that the calendar year 2001 December name of 4 days is called " FOAM BUTTRESS FOR STAPLING APPARATUS ", the disclosure of 325,810 is incorporated herein by reference accordingly separately in full.

Tissue thickness's compensating part can comprise emulsifying agent.The example of emulsifying agent can include but not limited to water-soluble polymer, such as polyvinyl alcohol (PVA), vinylpyrrolidone (PVP), Polyethylene Glycol (PEG), polypropylene glycol (PPG), pluronic (PLURONICS), tween (TWEENS), polysaccharide and their combination.

Tissue thickness's compensating part can comprise surfactant.The example of surfactant can include but not limited to polyacrylic acid, methylase, methylcellulose, ethyl cellulose, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, Polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxethylene octylphenyl ether, NONIN HS 240, polyoxyethylene oleyl ether, Tween 20, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkyl group phenoxy group gathers (ethyleneoxy) ethanol, with poloxamer (polyoxamer).

Polymer composition can comprise pharmaceutically active agents.Polymer composition can discharge the pharmaceutically active agents of therapeutically effective dose.When polymer composition is desorbed/absorbs, pharmaceutically active agents can be released.Pharmaceutically active agents can be released to fluid and such as flow through on polymer composition or through in the blood of polymer composition.The example of pharmaceutically active agents can include but not limited to hemorrhage and medicine, such as fibrin, thrombin and oxidized regenerated cellulose (ORC); Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and hydrocortisone; Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B, chloromycetin; And anticarcinogen, such as cisplatin, mitomycin, amycin.

Polymer composition can comprise hemostatic material.Tissue thickness's compensating part can comprise hemostatic material, and it comprises poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(caprolactone), poly-(dioxanone), polyoxyalkylene, copolymerization (ether-ester), collagen, gelatin, thrombin, fibrin, Fibrinogen, FN, elastin laminin, albumin, hemoglobin, ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, hetastarch, hydroxyethyl-cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, maltodextrin, alginate, thrombin, methacrylate, polyurethane, acrylate, platelet agonist, vasoconstrictor, vitriol, calcium, RGD peptide, protein, Protamine sulfates., episilon amino caproic acid, iron sulfate, ferric subsulfate, iron chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfate, aluminum acetate, permanganate, tannin, bone wax, Polyethylene Glycol, fucosan and their combination.The feature of tissue thickness's compensating part can be haemostatic properties.

The feature of the polymer composition of tissue thickness's compensating part is such as percent porosity, hole dimension and/or hardness.Polymer composition can have such as about 30 volume % to the percent porosity of about 99 volume %.Polymer composition can have such as about 60 volume % to the percent porosity of about 98 volume %.Polymer composition can have such as about 85 volume % to the percent porosity of about 97 volume %.Polymer composition can comprise such as about PLLA of 70 % by weight and about PCL of 30 % by weight, and can comprise the porosity of such as about 90 volume %.Such as, therefore polymer composition will comprise the copolymer of about 10 volume %.Polymer composition can comprise such as about PGA of 65 % by weight and about PCL of 35 % by weight, and can have such as about 93 volume % to the percent porosity of about 95 volume %.Polymer composition can comprise the porosity being greater than 85 volume %.Polymer composition can have the hole dimension of such as about 5 microns to about 2000 microns.Polymer composition can have the hole dimension such as between about 10 microns to about 100 microns.Such as, polymer composition such as can comprise the copolymer of PGA and PCL.Polymer composition can have the hole dimension such as between about 100 microns to about 1000 microns.Such as, polymer composition such as can comprise the copolymer of PLLA and PCL.

According to some aspect, the hardness of polymer composition can Shore hardness represent, this Shore hardness can be defined as the toleration of the permanent indenture to material such as measured by sclerometer.In order to assess the durometer value of given material, the ASTM program D2240-00 of " Standard Test Method for Rubber Property-Durometer Hardness " is called according to name, with penetrator foot, pressure is applied to material, it is incorporated to herein in full by reference.Penetrator foot can be administered to material and continue enough a period of times, such as 15 seconds, such as, wherein reading read from suitable scale.According to scale type used, when the complete penetrable material of pressure head foot, reading 0 can be obtained, and when material is not penetrated, reading 100 can be obtained.This reading dimensionless.Such as can decide durometer according to ASTMD2240-00 according to any suitable scale such as category-A and/or OO class scale.The polymer composition of tissue thickness's compensating part can have the Durometer A hardness value of about 4A to about 16A, and this Durometer A hardness value is such as in the Shore OO scope of about 45OO to about 65OO.Such as, polymer composition can comprise such as PLLA/PCL copolymer or PGA/PCL copolymer.The polymer composition of tissue thickness's compensating part can have the Durometer A hardness value being less than 15A.The polymer composition of tissue thickness's compensating part can have the Durometer A hardness value being less than 10A.The polymer composition of tissue thickness's compensating part can have the Durometer A hardness value being less than 5A.Polymeric material can have the Shore OO compositions value of such as approximately 35OO to about 75OO.

Polymer composition can have at least two kinds in the above-mentioned characteristic identified.Polymer composition can have at least three kinds in the above-mentioned characteristic identified.Polymer composition can have the Shore hardness OO value of the porosity of such as 85 volume % to 97 volume %, the hole dimension of 5 microns to 2000 microns and the Durometer A hardness value of 4A to 16A and 45OO to 65OO.Polymer composition can comprise the polymer composition of the polymer composition of the PLLA of 70 % by weight and the PCL of 30 % by weight; Described polymer composition has the such as porosity of 90 volume %, the hole dimension of 100 microns to 1000 microns and the Durometer A hardness value of 4A to 16A and the Shore hardness OO value of 45OO to 65OO.Polymer composition can comprise the polymer composition of the polymer composition of the PGA of 65 % by weight and the PCL of 35 % by weight; Described polymer composition has such as from 93 volume % to the Shore hardness OO value of the porosity of 95 volume %, the hole dimension of 10 microns to 100 microns and the Durometer A hardness value of 4A to 16A and 45OO to 65OO.

Any tissue thickness as herein described compensating part can comprise the material of expansion.As mentioned above, the compression material expanded when tissue thickness's compensating part can be included in uncompressed or deployment.In addition or alternatively, this type of tissue thickness's compensating part any can comprise can original position formed from expansion material.Such as, tissue thickness's compensating part can comprise at least one precursor, and this precursor is selected with spontaneous crosslinked when contacting with at least one in another precursor or other precursors, water and/or body fluid.See Figure 53 4, the first precursor can contact other precursors one or more to form tissue thickness's compensating part of extendible and/or swellable.Tissue thickness's compensating part can comprise the swollen compositions of fluid-soluble, the compositions of such as water-swellable and/or comprise the gel of water.

See Figure 51 8A and Figure 51 8B, such as, the tissue thickness's compensating part 70000 representing any tissue thickness as herein described compensating part can comprise at least one hydrogel precursor 70010, this hydrogel precursor 70010 is selected with original position and/or is formed hydrogel in vivo, thus tissue thickness's compensating part 70000 is expanded.Figure 51 8A illustrates that this type of comprises tissue thickness's compensating part 70000 of packaging part, and this packaging part comprised the first hydrogel precursor 70010A and the second hydrogel precursor 70010B before expansion.As shown in Figure 51 8A, the first hydrogel precursor 70010A and the second hydrogel precursor 70010B can be physically separated from one another in identical packaging part.Alternatively, the first packaging part can comprise the first hydrogel precursor 70010A and the second packaging part can comprise the second hydrogel precursor 70010B.When Figure 51 8B illustrates when hydrogel original position and/or formed in vivo, thickness organizes the expansion of compensating part.As shown in Figure 51 8B, packaging part can break loose, and the first hydrogel precursor 70010A can contact the second hydrogel precursor 70010B to form hydrogel 70020.As shown in the figure, hydrogel can comprise extendible material.Such as, its easily extensible reaches 72 hours.

Any one in those the tissue thickness's compensating part discussed in the previous paragraphs comprised as herein described can comprise biodegradable foam, and this biodegradable foam has the packaging part comprising dried hydrogel granule or embed granule wherein.Packaging part in foam is formed by the contact aqueous solution of hydrogel precursor and the organic solution of biocompatible materials, thus forms foam.As shown in Figure 53 5, aqueous solution and organic solution can form micelle.Aqueous solution and organic solution can be dried to encapsulate dried hydrogel precursor in foam or granule.Such as, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form the dispersion of micelle.Aqueous solution can contact the organic solution of the dioxane comprising poly-(glycolic) and polycaprolactone.Aqueous solution and organic solution can be lyophilized thus be formed has dispersion hydrogel particle wherein or the biodegradable foam of granule.It is believed that micelle can form the packaging part having and be dispersed in dried hydrogel granule in foaming structure or granule.This packaging part can break loose subsequently, and hydrogel particle or granule then can contacting with fluid (such as body fluid) expanding.

In general, such as, when contacting with activator (such as fluid), any tissue thickness as herein described compensating part can be configured to expand.See Figure 51 9, such as, the tissue thickness's compensating part 70050 representing any tissue thickness as herein described compensating part can comprise swellable material, such as hydrogel, and described swellable material such as (is such as expanded when body fluid, saline solution, water and/or activator at contacting with fluid 70055.The example of body fluid can include but not limited to blood, blood plasma, peritoneal fluid, cerebrospinal fluid, urine, lymph fluid, synovial fluid, vitreous humor, saliva, gastrointestinal cavity content, bile and/or gas (such as CO ₂).In some cases, when tissue thickness's compensating part 70050 absorption fluids, tissue thickness's compensating part 70050 easily extensible.In other cases, tissue thickness's compensating part 70050 can comprise non-cross-linked hydrogels, and this non-cross-linked hydrogels is expanded when contacting and comprising the activator 70 055 of cross-linking agent to form cross-linked hydrogel.In all cases, tissue thickness's compensating part can be configured to from contact expansion or swelling most as many as 72 hours, such as from 24 hours to 72 hours, most as many as 24 hours, most as many as 48 hours and most as many as 72 hours, thus the pressure and/or compression that increase continuously are such as provided to tissue.As shown in Figure 51 9, after fluid 70055 contact tissue thickness compensation part 70050, therefore the original depth of tissue thickness's compensating part 70050 is less than expansion thickness.

See Figure 51 6 and Figure 51 7, nail bin 70100 can comprise the tissue thickness's compensating part 70105 representing any tissue thickness as herein described compensating part and the multiple nails 70110 comprising nail lower limb 70112 separately.As shown in Figure 51 6, tissue thickness's compensating part 70105 can have original depth or the compression height of the percussion height being less than nail 70110.Tissue thickness's compensating part 70100 can when contacting with fluid 70102 (such as body fluid, saline solution and/or activator) original position and/or expand in vivo, thus such as promote tissue T against the lower limb 70112 of nail 70110.As shown in Figure 51 7, tissue thickness's compensating part 70100 easily extensible and/or swelling when contacting with fluid 70102.Tissue thickness's compensating part 70105 can compensate the thickness of the tissue T at each nail 70110 IT.As shown in Figure 51 7, tissue thickness's compensating part 70105 can have the expansion thickness of the percussion height being less than nail 70110 or uncompressed height.

Described herein or claimed any tissue thickness compensating part can comprise original depth and expansion thickness.In all cases, the original depth of tissue thickness's compensating part can be about 90% of about 80%, its expansion thickness of about 70%, its expansion thickness of about 60%, its expansion thickness of about 50%, its expansion thickness of about 40%, its expansion thickness of about 30%, its expansion thickness of about 20%, its expansion thickness of about 10%, its expansion thickness of about 1%, its expansion thickness of about 0.1%, its expansion thickness of about 0.01%, its expansion thickness of about 0.001%, its expansion thickness of its expansion thickness.Alternatively, in all cases, the expansion thickness of tissue thickness's compensating part its original depth comparable thick about 2 times, about 5 times, about 10 times, about 50 times, about 100 times, about 200 times, about 300 times, about 400 times, about 500 times, about 600 times, about 700 times, about 800 times, about 900 times, about 1000 times.Alternatively, in all cases, tissue thickness's compensating part original depth can its expansion thickness of most as many as 1%, 5% of most its expansion thickness of as many as, 10% of most its expansion thickness of as many as or most its expansion thickness of as many as 50%.Alternatively, in all cases, the expansion thickness of tissue thickness's compensating part its original depth comparable thick at least 50%, thicker than its original depth at least 100%, than its original depth thick at least 300% or than its original depth thick at least 500%.Therefore, tissue thickness's compensating part can eliminate any gap of following closely and retaining in region.

Any tissue thickness as herein described compensating part can comprise hydrogel.Hydrogel can comprise homopolymer hydrogel, copolymer aquagel, multipolymer hydrogel, interpenetrating polymer hydrogel or their combination.Hydrogel can comprise microgel, nanogel or their combination.Hydrogel can comprise the hydrophilic polymer network that can absorb and/or retain fluid substantially.Hydrogel can comprise noncrosslinking hydrogel, crosslinked hydrogel or their combination.Hydrogel can comprise chemical cross-linking agent, physical crosslinking agent, hydrophobic fragment and/or the undissolved fragment of water.By polyreaction, micromolecule, crosslinked and/or Polymer-Polymer is cross-linked and is chemically cross-linked hydrogel.Hydrogel is physically cross-linked by ionic interaction, hydrophobic interaction, hydrogen bonded interaction, stereocomplex and/or supramolecular chemistry.Due to cross-linking agent, hydrophobic fragment and/or the undissolved fragment of water, hydrogel can be essentially undissolved, but due to the absorption of fluid and/or maintenance, hydrogel easily extensible and/or swelling.In addition, what hydrogel precursor can be used for endogenic material and/or tissue is crosslinked.

In any one in the tissue thickness's compensating part comprising hydrogel, hydrogel can comprise enviromental sensitive hydrogel (ESH).ESH can comprise the material with the fluid swollen characteristic relevant to environmental condition.Environmental condition can include but not limited at the physical condition of operative site, biotic factor and/or electrochemical conditions.Such as, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, or other physiological and variablees that are environment, hydrogel swellable or contraction.ESH can comprise polyfunctional acrylate, hydroxyethyl methylacrylate (HEMA), elastomeric acrylate or relevant monomer.

Any one (comprise and comprise hydrogel or be modified to comprise the described herein of hydrogel or claimed any tissue thickness compensating part) comprised in tissue thickness's compensating part of hydrogel can comprise at least one in above-mentioned non-synthetic materials and synthetic material.Hydrogel can comprise synthetic water gel and/or non-synthetic hydrogel.Or alternatively, tissue thickness's compensating part can comprise multiple layer in addition.Multiple layer can comprise porous layer and/or non-porous layer.Such as, tissue thickness's compensating part can comprise non-porous layer and porous layer.And for example, tissue thickness's compensating part can comprise the porous layer in the middle of the first non-porous layer and the second non-porous layer.And for example, tissue thickness's compensating part can comprise the non-porous layer in the middle of the first porous layer and the second porous layer.Non-porous layer and porous layer can be located relative to the surface of nail bin and/or anvil block in any order.

Previous paragraphs in the example of non-synthetic materials that is mentioned to include but not limited to albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, glucosan, elastin laminin, fibrin, Fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum and starch.Cellulose can comprise hydroxyethyl-cellulose, oxidized cellulose, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose and their combination.Collagen can comprise bovine pericardium.Carbohydrate can comprise polysaccharide, such as lyophilizing polysaccharide.Protein can comprise glycoprotein, Dan Baiduotang proteoglycan PG or their combination.

Equally, the example of the synthetic material before mentioned includes but not limited to gather (lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, poly(ethylene oxide), poly(ethylene oxide)-polypropylene oxide copolymers, copolymerization oxirane, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, aliphatic polyester, glycerol, poly-(aminoacid), copolymerization (ether-ester), poly-oxalic acid alkylidene diol ester, polyamide, poly-(iminocarbonic ester), poly-esters of oxyacids, poe, polyphosphazene and their combination.Conventional method can be used to prepare these non-synthetic materials synthetically, such as, synthesize hyaluronic acid.

In any one (comprise and comprise hydrogel or be modified to comprise the described herein of hydrogel or claimed any tissue thickness compensating part) in the tissue thickness's compensating part comprising hydrogel, hydrogel can be made up of one or more hydrogel precursor.This type of precursor can comprise monomer and/or macromonomer.Hydrogel precursor can comprise electrophile functional group and/or the electrophile functional group of nucleophile.In general, electrophilely can react to form chemical bond with nucleophile.Term used herein " functional group " refers to electrophilic group or the nucleophilic group that can react to be formed chemical bond each other.The example of Qin electricity functional group includes but not limited to N-hydroxy-succinamide (" NHS "), sulfosuccinimide, carbonyl dimidazoles, sulfonic acid chloride, aryl halide, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, such as succinimidyl succinate and/or succinimidyl propionate, isocyanide ester, sulfocyanic ester, carbodiimides, Benzotriazole carbonate, epoxide, aldehyde, maleimide, imino-ester, their combination etc.In an instantiation, Qin electricity functional group can comprise succinimide ester.The example of nucleophilic functional group includes but not limited to-NH ₂,-SH ,-OH ,-PH ₂with-CO-NH-NH ₂.

Hydrogel can be formed by single precursor or multiple precursor.Such as, hydrogel can be formed by the first precursor and the second precursor.First hydrogel precursor and the second hydrogel precursor can original positions or form hydrogel in vivo when contacting.Hydrogel precursor generally can refer to polymer, functional group, macromole, micromolecule and/or can participate in reaction with the cross-linking agent forming hydrogel.Precursor can comprise such as homogeneous solution, solution that is uneven or that be separated in appropriate solvent, such as water or buffer.The pH of buffer can be such as about 8 to about 12, and all according to appointment 8.2 to about 9.The example of buffer includes but not limited to borate buffer solution.In some cases, precursor can in emulsion.Therefore, the first precursor can with the second precursors reaction to form hydrogel.Such as, the first precursor can with during the second precursor thereof spontaneously crosslinked and/or the first Zu Qin electricity functional group on the first precursor can with group electric functional group reactions of parent of second on the second precursor.When precursor is blended in the environment allowing reaction (such as, when relevant to pH, temperature and/or solvent), functional group can react to form covalent bond each other.When at least some in precursor and unnecessary other a precursors reaction, precursor can become crosslinked.

Tissue thickness's compensating part can comprise at least one monomer, and described monomer is selected from 3-sulfopropyl acrylic acid potassium salt (" KSPA "), sodium acrylate (" NaA "), N-(three (hydroxymethyl) methyl) acrylamide (" triacryl ") and 2-acrylamide-2-methyl isophthalic acid-propane sulfonic acid (AMPS).Tissue thickness's compensating part can comprise copolymer, and this copolymer comprises two or more monomer being selected from KSPA, NaA, triacryl, AMPS.Tissue thickness's compensating part can comprise the homopolymer deriving from KSPA, NaA, triacryl, AMPS.Tissue thickness's compensating part can comprise can with the hydrophilically modified monomer of its copolymerization.Hydrophilically modified monomer can comprise methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

Tissue thickness's compensating part can comprise cross-linking agent.Cross-linking agent can comprise low-molecular-weight two or polyvinyl crosslinking agents, such as glycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethylacrylate, pi-allyl (methyl) acrylate, C ₂-C ₈-alkylidene diacrylate or dimethylacrylate, divinyl ether, divinyl sulfone, two and trivinylbenzene, trimethylolpropane triacrylate or trimethyl acrylic ester, tetramethylol methane tetraacrylate or tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or DMAA, ethylene bisacrylamide or ethylene DMAA, triallyl phthalate or diallyl phthalate.As instantiation, cross-linking agent can comprise N, N'-methylene-bisacrylamide (" MBAA ").

Tissue thickness's compensating part can comprise acrylate and/or methacrylate official energy hydrogel, biocompatibility light trigger, alkyl-cyanoacrylate, at least one in isocyanate-functional macromonomer, optionally comprise amine official energy macromonomer, succinimide ester official energy macromonomer, optionally comprise amine and/or Mercaptofunctional macromonomer, epoxy functional macromonomer, optionally comprise amine official energy macromonomer, the mixture of protein and/or polypeptide and aldehyde cross-linking agent, the carbodiimides of genipin (Genipin) and water dissolvable, anion polysaccharide and polyvalent cation.

Tissue thickness's compensating part can comprise undersaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.Tissue thickness's compensating part can comprise methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2-HEMA, 2-2-(Acryloyloxy)ethanol, 2-(dimethyl aminoethyl) methacrylate, NVP, Methacrylamide and/or N,N-DMAA poly-(methacrylic acid).

Tissue thickness's compensating part can comprise reinforcing material.Reinforcing material can comprise at least one in above-described non-synthetic materials and synthetic material.Reinforcing material can comprise collagen, gelatin, fibrin, Fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl-cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, alginate, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, pla-pcl, polypropylene, aliphatic polyester, glycerol, poly-(aminoacid), copolymerization (ether-ester), poly-oxalic acid alkylidene diol ester, polyamide, poly-(iminocarbonic ester), poly-oxalic acid alkylidene diol ester, poly-esters of oxyacids, poe, polyphosphazene and their combination.

Tissue thickness's compensating part can comprise the layer comprising reinforcing material.The porous layer of tissue thickness's compensating part and/or non-porous layer can comprise reinforcing material.Such as, porous layer can comprise reinforcing material and non-porous layer can not comprise reinforcing material.Back-up coat can comprise the internal layer in the middle of the first non-porous layer and the second non-porous layer.Reinforcing material can form the skin of tissue thickness's compensating part and/or the outer surface of tissue thickness's compensating part.

Reinforcing material can comprise mesh sheet, monofilament, multifilament weave fabric, fiber, pad, felt, granule and/or powder.Reinforcing material can be attached in the layer of tissue thickness's compensating part.Reinforcing material can be attached at least one in non-porous layer and porous layer.Can use routine techniques, such as knitting, braiding, tatting and/or knitting, form the mesh sheet comprising reinforcing material.Multiple reinforcing material can random direction and/or common direction orientation.Common direction can such as with nail line parallel or with nail line vertical.Monofilament and/or multifilament weave fabric can random direction and/or common direction orientations.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness's compensating part can comprise multiple in non-porous layer with multiple reinforced fibers of random direction or common direction orientation.

See Figure 52 8, anvil block 70300 can comprise the tissue thickness's compensating part 70305 representing any tissue thickness as herein described compensating part, and tissue thickness's compensating part 70305 comprises the first non-porous layer 70307 and the second non-porous layer 70309 of hermetically sealed back-up coat 70310.Back-up coat 70310 can comprise hydrogel, and this hydrogel comprises embedding ORC granule wherein or fiber, and non-porous layer can comprise ORC.As shown in Figure 52 8, the tissue thickness's compensating part 70305 representing any tissue thickness as herein described compensating part can conform to the profile of anvil block 70300.The internal layer of tissue thickness's compensating part 70305 can conform to the inner surface of anvil block 70300, and it comprises formation pit 70301.

Under all situations that reinforced fibers is used in tissue thickness's compensating part, fiber can form such as non-woven material, such as pad or felt.Fiber can have any suitable length, such as, from 0.1mm to 100mm and 0.4mm to 50mm.Alternatively, reinforcing material can be ground into powder.Powder can have such as from the granularity of 10 microns to 1 centimetre.Powder can be attached in tissue thickness's compensating part.

Any one in described herein or claimed tissue thickness compensating part can original position be formed or part formation.Such as, when tissue thickness's compensating part comprises hydrogel, hydrogel can original position be formed.Tissue thickness's compensating part is formed by covalency ion and/or hydrophobic bond original position.Physics (non-covalent) is crosslinked can be caused by complexation, hydrogen bonding, desolvation, Van der Waals interaction, ionic bonding or their combination.Chemistry (covalency) is crosslinked to be realized by any one in multiple mechanism, and described mechanism comprises: Raolical polymerizable, polycondensation reaction, anion or cationic polymerization, step growth polyreaction, electrophile-nucleophile reaction and their combination.

Such as, the original position of tissue thickness's compensating part is formed to comprise and makes two or more precursors reaction, and described precursor is physically separated until original position contacts and/or reacts to environmental condition thus react each other to form hydrogel.The polymerisable polymer of original position can be prepared by precursor, and described precursor can react to form polymer at operative site.Tissue thickness's compensating part is formed by precursor cross-linking reaction in position.At least one precursor can comprise the initiator of the polyreaction of the formation that can cause for original position tissue thickness compensating part.The precursor that tissue thickness's compensating part can be activated when can be included in the application forming such as cross-linked hydrogel.The original position of tissue thickness's compensating part is formed to comprise and activates at least one precursor to form chemical bond, thus formative tissue thickness compensation part.This activation realizes by the change at operative site physical condition, biotic factor and/or electrochemical conditions, described condition change includes but not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, and other physiological and environmental variables.Alternatively, precursor can be touched at body exterior and can be introduced in operative site.

Original position or to be formed in vivo or the another kind of method of part formative tissue thickness compensation part relates to using to comprise and can store wherein one or more packaging part of at least one component or tissue thickness's compensating part of unit, described method is applicable to any tissue thickness as herein described compensating part.Such as, packaging part can store hydrogel precursor wherein.Packaging part can by two kinds of component storage wherein, such as already described above.Packaging part can store the first hydrogel precursor wherein and the second hydrogel precursor.Alternatively, the first packaging part can store the first hydrogel precursor wherein and the second packaging part can store the second hydrogel precursor wherein.As mentioned above, these packaging parts can with nail lower limb align or at least substantial alignment thus pierce through packaging part when follow closely lower limb and contact packaging part and/or otherwise make packaging part break fall apart.When disposing nail, this packaging part can compress, conquassation, collapse and/or in other words brokenly to fall apart.After packaging part breaks and falls apart, the component stored wherein can flow out packaging part.Store component wherein and can contact other components, the layer of tissue thickness's compensating part and/or tissue.These other component can from identical or different packaging part, provide in tissue thickness's compensating part or provide in the layer of tissue thickness's compensating part and/or by clinician for operative site.As above-described result, the component be stored in packaging part can provide the expansion of tissue thickness's compensating part and/or swelling.

Tissue thickness's compensating part can comprise the layer comprising these packaging parts.This class wrapper can comprise be associated with layer space, pit, dome, pipe and their combination.This packaging part can comprise the space in layer.Such as, layer can comprise two layers that can invest each other, and wherein packaging part can be defined between two layers.Packaging part can comprise the dome on layer surface.Such as, can being positioned at least partially in the dome that upwards extends from layer of packaging part.Packaging part can be included in the pit formed in layer.Such as, the Part I of packaging part can comprise dome, and the Part II of packaging part can comprise pit.Packaging part can be included in the pipe that layer is embedded in.This pipe can comprise any non-synthetic materials as herein described and/or synthetic material, such as PLA.Tissue thickness's compensating part can comprise the foam of biological absorbable, such as ORC, and the foam of described biological absorbable comprises embedding PLA pipe wherein, and this pipe can encapsulate such as hydrogel.Packaging part can comprise mutual unconnected separate unit.Alternatively, in packaging part one or more can via extend through one or more paths of layer, conduit and/or passage and mutually fluid be communicated with.

Release rate from the component of packaging part can be controlled by the following stated: the thickness of such as tissue thickness's compensating part, the ingredient of tissue thickness's compensating part, the size of component, the hydrophilic of component and/or the physics in component and/or chemical interaction, the ingredient of tissue thickness's compensating part and/or surgical instruments.Layer can comprise one or more thin section or weakening part (such as local perforations), and such as described one or more thin section or weakening part can be conducive to incision layer and make packaging part broken loose.These local perforations can the only part of extending through layer, or alternatively, perforation can extending through layer completely.

See Figure 52 3 and Figure 52 4, the tissue thickness's compensating part 70150 representing any tissue thickness as herein described compensating part can comprise outer 70152A and comprise the internal layer 70152B of packaging part 70154.Packaging part can comprise the first encapsulation component and the second encapsulation component.Alternatively, packaging part can comprise the one in the first encapsulation component and the second encapsulation component independently.First encapsulation component can encapsulate component and separates with second.Outer 70152A can comprise tissue contacting surface.Internal layer 70152B can comprise device contacts surface.Device contacts surface 70152B can be attached to anvil block 70156 releasedly.Outer 70152A can be attached to internal layer 70152B to limit space between outer 70152A and internal layer 70152B.As shown in Figure 52 3, each packaging part 70154 can be included in the dome on the device contacts surface of internal layer 70152B.This dome can comprise local perforations with the incision of the broken loose promoting layer by nail lower limb and packaging part.As shown in Figure 52 4, anvil block 70156 can comprise multiple shaping pit row 70158, and wherein the dome of packaging part 70154 can align with shaping pit 70158.Tissue contacting surface can comprise the flat surfaces lacking dome, and/or tissue contacting surface can comprise one or more packaging part, such as from the packaging part 70154 that it extends.

The anvil block of any surgery suturing appliance can comprise tissue thickness's compensating part, and described tissue thickness compensating part comprises the encapsulation component with at least one microsphere particle.According to the above, tissue thickness's compensating part can comprise packaging part, and described packaging part comprises the first encapsulation component and the second encapsulation component, and/or tissue thickness's compensating part can comprise the packaging part with the first microsphere particle and the second microsphere particle.

See Figure 52 5, robotic suturing device can comprise anvil block 70180 and nail bin (being shown in other accompanying drawings).The nail 70190 of nail bin can be out of shape by anvil block 70180 when anvil block 70180 moves into make position and/or pass through the staple drivers system 70192 of nail 70190 to the movement of closed anvil block 70180 to be out of shape.The lower limb 70194 of nail can contact anvil block 70180, and nail 70190 is out of shape at least in part.Anvil block 70180 can comprise tissue thickness's compensating part 70182, and it comprises outer 70183A, internal layer 70183B.Tissue thickness's compensating part 70182 can comprise the first encapsulation component and the second encapsulation component.Packaging part 210185 can align or at least substantial alignment, makes when following closely lower limb 70194 and being pushed through tissue T and outer 70183A, and nail lower limb 70194 can pierce through packaging part 70185 and/or otherwise make packaging part 70185 broken loose.As shown in Figure 52 5, nail 70190C is in complete firing position, nail 70190B is in just by the process pulled the trigger, and follows closely 70190A and be in its non-firing position.The lower limb of nail 70190C and 70190B has moved through the internal layer 70183B of tissue T, outer 70183A and tissue thickness's compensating part 70182, and has contacted the anvil block 70180 being positioned at nail bin opposite.After packaging part 70185 breaks and falls apart, such as, encapsulation component can flow out and contact with each other body fluid and/or tissue T.Encapsulation component can be reacted with forming reactions product (such as hydrogel), such as to expand between tissue T and the base portion of nail and to promote tissue T against the lower limb followed closely.Therefore, tissue thickness's compensating part can eliminate any gap of following closely and retaining in region.

As herein described comprise all original positions or in vivo formed part formed or extendible tissue thickness compensating part can be suitable for using together with any surgical instruments.As mentioned above, tissue thickness's compensating part can be associated with nail bin and/or anvil block.Tissue thickness's compensating part can be configured to any shape, size and/or the dimension that are suitable for coordinating nail bin and/or anvil block.As described herein, tissue thickness's compensating part can be attached to nail bin and/or anvil block releasedly.Before sewing process and during sewing process, any machinery that tissue thickness's compensating part can keep tissue thickness's compensating part to contact with nail bin and/or anvil block and/or the mode of chemistry be attached to nail bin and/or anvil block.After nail piercing tissue thickness compensation part, can remove from nail bin and/or anvil block or discharge tissue thickness's compensating part.When nail bin and/or anvil block motion are away from tissue thickness's compensating part, can remove from nail bin and/or anvil block or discharge tissue thickness's compensating part.

See Figure 52 0-Figure 52 2, any robotic suturing device 70118 can comprise anvil block 70120 and nail bin 70122, and described nail bin 70122 comprises firing member 70124, multiple nail 70128, blade 70129 and tissue thickness's compensating part 70130.The tissue thickness's compensating part 70130 representing any tissue thickness as herein described compensating part can comprise at least one encapsulation component.When tissue thickness's compensating part is compressed, sews up and/or cuts, encapsulation component can be broken loose.See Figure 52 1, such as, nail 70128 can be deployed between non-firing position and firing position, make the motion of nail lower limb through tissue thickness's compensating part 70130, the lower surface of penetrate tissue thickness compensation part 70130 and top surface, penetrate tissue T, and contact is positioned in the anvil block 70120 on nail bin 70118 opposite.Encapsulation component can interreaction, with embedding and the lyophilic powder be dispersed in tissue thickness's compensating part reacts and/or with humoral response to make tissue thickness's compensating part 70130 expand or swelling.When lower limb is out of shape against anvil block, the lower limb of each nail can tissue T in the part of capture tissue thickness compensation part 70130 and each nail 70128 a part and compression stress is applied to tissue T.As shown in Figure 52 1 and Figure 52 2, tissue thickness's compensating part 70130 can compensate the thickness of the tissue T at each nail 70128 IT.

See Figure 52 6, surgical instruments 70200 can comprise anvil block 70205 and nail bin 70215, and described anvil block 70205 comprises top and organizes thickness compensation part 70210, and described nail bin 70215 comprises the bottom with outer 70200 and internal layer 70225 and organizes thickness compensation part.Top organizes thickness compensation part 70210 can be positioned on the first side of destination organization, and bottom organizes thickness compensation part can be positioned on the second side of tissue.Top organizes thickness compensation part 70210 to comprise ORC, and the hydrogel of embedding ORC granule is wherein organized the skin of thickness compensation part to comprise to have in bottom, and bottom organizes the internal layer of thickness compensation part can comprise such as ORC.

See Figure 52 9-Figure 53 1, surgical instruments 70400 can comprise nail bin 70405 and anvil block 70410.Nail bin 70405 can comprise tissue thickness's compensating part 70415, and it comprises can the foam of bio-absorbable.The foam of bio-absorbable can comprise packaging part, it comprises encapsulation component 70420.The foam of bio-absorbable can comprise ORC and encapsulate component and can comprise such as medicine.Tissue thickness's compensating part 70415 of anvil block 70410 can comprise internal layer 70425 and outer 70430.Internal layer 70425 can comprise can the foam of bio-absorbable, and outer 70430 can comprise the hydrogel such as optionally comprising reinforcing material.During exemplary percussion sequence, first see Figure 53 0, sliding part 70435 can first contact stud 70440A and start nail upwards to promote.When sliding part 70435 is towards when more distally is further promoted, sliding part 70435 can start nail 70440B-D and any other follow-up nail to promote with sequential order.Sliding part 70435 can upwards drive nail 70440, makes the lower limb followed closely contact relative anvil block 70410 and be deformed into required shape.With reference to the percussion sequence shown in Figure 53 0, nail 70440A-C has been moved to their complete firing position, and nail 70440D is in just by the process pulled the trigger, and follows closely 70420E and be still in its non-firing position.During exemplary percussion sequence, encapsulation component 70470 is broken loose by nail lower limb.Encapsulation component 70420 can from the packaging part around nail lower limb with contact tissue T.In all cases, extra medicine can be extruded packaging part by the compression that tissue thickness's compensating part is extra.This medicine can treated tissue and can reducing be organized hemorrhage immediately.

In all cases, surgeon or other clinician can will be included in tissue thickness's compensating part of at least one medicine wherein storing and/or absorb with manufacture in liquid delivery to tissue thickness's compensating part.Nail bin and/or anvil block can comprise the mouth that can provide and enter tissue thickness's compensating part.See Figure 53 2B, nail bin 70500 can comprise such as at the mouth 70505 of its distal end.Mouthfuls 70505 can receive pin 70510, have vent needle such as shown in Figure 53 2A.Clinician pin 70510 can be inserted through mouth 70505 enter into tissue thickness's compensating part 70515 with by liquid delivery to tissue thickness's compensating part 70515.Fluid can comprise such as medicine and hydrogel precursor.As mentioned above, when tissue thickness's compensating part breaks loose and/or compression, fluid can be discharged into tissue from tissue thickness's compensating part.Such as, when tissue thickness's compensating part 70515 carries out biodegradation, medicine can discharge from tissue thickness's compensating part 70515.

Referring now to Figure 21 6, nail bin (such as nail bin 10000) such as can comprise support section 10010 and compressible tissue thickness compensating part 10020.Referring now to Figure 21 8-Figure 22 0, multiple nail chambeies 10012 that support section 10010 can comprise platform surface 10011 and be limited in support section 10010.The size in each nail chamber 10012 such as can be set to and can store nail removedly wherein, such as follows closely 10030.Nail bin 10000 also can comprise multiple staple drivers 10040, and when nail 10030 and staple drivers 10040 are in its non-firing position, each staple drivers can one or more nails 10030 in support nail chamber 10012.Such as, first see Figure 22 4 and Figure 22 5, each staple drivers 10040 can comprise such as one or more support or groove 10041, and this support or groove can support nail the relative motioies limited between nail 10030 and staple drivers 10040.Refer again to Figure 21 8, nail bin 10000 also can comprise nail percussion sliding part 10050; This nail percussion sliding part can move to the distal end 10002 of nail bin from the proximal extremity 10001 of nail bin, staple drivers 10040 and nail 10030 to be promoted from its non-firing position to the anvil block being positioned in nail bin 10000 opposite successively.First see Figure 21 8 and Figure 22 0, one or more lower limbs 10032 that each nail 10030 can comprise base portion 10031 and extend from base portion 10031, wherein each nail can be at least one in such as basic U-shaped and basic V-arrangement.Nail 10030 can make when nail 10030 is in its non-firing position, caves in relative to the platform surface 10011 of support section 10010 in the top of nail lower limb 10032.Nail 10030 can make when nail 10030 is in its non-firing position, and the top of nail lower limb 10032 flushes relative to the platform surface 10011 of support section 10010.Nail 10030 can make when nail 10030 is in its non-firing position, and the top of nail lower limb 10032 or at least certain part of nail lower limb 10032 extend above the platform surface 10011 of support section 10010.In such cases, when nail 10030 is in its non-firing position, nail lower limb 10032 may extend into and be embedded in tissue thickness's compensating part 10020.Such as, follow closely lower limb 10032 and such as can to extend beyond above platform surface 10011 about 0.075 ".Nail lower limb 10032 such as can extend beyond the distance above platform surface 10011 between about 0.025 " and about 0.125 ".To being described further above, tissue thickness's compensating part 10020 can comprise the uncompressed thickness such as between about 0.08 " and about 0.125 ".

In use, to be described further above and first see Figure 23 3, anvil block (such as anvil block 10060) is such as moveable to the make position relative with nail bin 10000.As described in more detail below, tissue can be located against tissue thickness's compensating part 10020 and such as tissue thickness's compensating part 10020 be pressed to the platform surface 10011 of support section 10010 by anvil block 10060.Once anvil block 10060 is appropriately located, then can dispose nail 10030, equally as shown in Figure 23 3.As mentioned above, nail percussion sliding part 10050 can move, as shown in Figure 23 4 from proximal extremity 10001 distal end 10002 of nail bin 10000.When sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 and nail chamber 10012 in staple drivers 10040 is upwards promoted.Sliding part 10050 and staple drivers 10040 can comprise one or more slope or inclined-plane separately, and this one or more slope or inclined-plane can cooperate staple drivers 10040 is moved upward from its non-firing position.Such as, see Figure 22 1-Figure 22 5, each staple drivers 10040 can comprise at least one inclined-plane 10042, and sliding part 10050 can comprise one or more inclined-plane 10052, it can make when sliding part 10050 is distally pushed in nail bin, and inclined-plane 10052 is in inclined-plane 10042 lower slider.When staple drivers 10040 is moving upward in its respective nail chamber 10012, nail 10030 can upwards promote by staple drivers 10040, and nail 10030 is exposed from its nail chamber 10012 by the opening in nail platform 10011.During exemplary percussion sequence, first see Figure 22 7-Figure 22 9, sliding part 10050 can first contact stud 10030a and start nail 10030a upwards to promote.When sliding part 10050 is distally further promoted, sliding part 10050 can start to follow closely 10030b, and 10030c, 10030d, 10030e and 10030f and any other follow-up nail promote in order.As shown in Figure 22 9, nail 10030 can upwards drive by sliding part 10050, makes the lower limb 10032 of the nail contacted with relative anvil block be deformed into the shape of expectation, and is penetrated from support section 10010.In all cases, as a part for percussion sequence, sliding part 10030 can make multiple nail move upward simultaneously.With reference to the percussion sequence shown in Figure 22 9, nail 10030a and 10030b has moved to its complete firing position and has been penetrated from support section 10010, nail 10030c and 10030d is in and is at least partly accommodated in support section 10010 in the process pulled the trigger, and follows closely 10030e and 10030f and be still in its non-firing position.

As mentioned above and see Figure 23 5, when nail 10030 is in its non-firing position, the nail lower limb 10032 of nail 10030 can extend over the platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 22 9, nail 10030e and 10030f is depicted as and is in its non-firing position, and its nail lower limb 10032 extends beyond platform surface 10011 and extends in tissue thickness's compensating part 10020.When nail 10030 is in its non-firing position, the top tissue contacting surface 10021 of the top of nail lower limb 10032 or any other part possibility Bu Tuchuan tissue thickness compensating part 10020 of nail lower limb 10032.As shown in Figure 22 9, when nail 10030 moves to its firing position from its non-firing position, the end of nail lower limb convexly can wear tissue contacting surface 10032.The top of nail lower limb 10032 can comprise the sharp top can cut with penetrate tissue thickness compensation part 10020.Tissue thickness's compensating part 10020 can comprise multiple hole, and described multiple hole can receive nail lower limb 10032 and allow nail lower limb 10032 to slide relative to tissue thickness's compensating part 10020.Support section 10010 also can comprise the multiple guiders 10013 extended from platform surface 10011.Guider 10013 can be oriented to the nail chamber opening of contiguous platform surface 10011, and nail lower limb 10032 can be supported by guider 10013 at least in part.Guider 10013 can be positioned in proximal extremity and/or the distal end place of nail chamber opening.First guider 10013 can be positioned in the first end of each nail chamber opening, and the second guider 10013 can be positioned in the second end of each nail chamber opening, make each first guider 10013 can support nail 10030 first nail lower limb 10032, and each second guider 10013 can support nail second nail lower limb 10032.See Figure 23 5, each guider 10013 can comprise groove or slit, such as groove 10016, such as, follow closely lower limb 10032 and can be slidably received in this groove 10016.Each guider 10013 can comprise and can extend from platform surface 10011 and may extend into anti-skid stud, projection and/or the spike tissue thickness's compensating part 10020.As described in more detail below, anti-skid stud, projection and/or spike can reduce the relative motion between tissue thickness's compensating part 10020 and support section 10010.The top of nail lower limb 10032 can be positioned in guider 10013 and can not to extend beyond the top surface of guider 10013 when nail 10030 is in its non-firing position.In at least this type of embodiment, guider 10013 can limit guiding height, and can not extend beyond this guiding height when nail 10030 is in its non-firing position.

Tissue thickness's compensating part (such as tissue thickness's compensating part 10020) such as can be made up of single material piece.Tissue thickness's compensating part can comprise continuous sheet, and this continuous sheet can cover the whole top platform surface 10011 of support section 10010, or alternatively, covers and be less than whole platform surface 10011.Material piece can cover the nail chamber opening in support section 10010, but alternatively, material piece can comprise can with nail chamber register or the opening that aligns at least partly.Tissue thickness's compensating part can be made up of multilayer material.Referring now to Figure 21 7, tissue thickness's compensating part can comprise compressible core and the wrappage around compressible core.Compressible core can be remained to support section 10010 by wrappage 10022 releasedly.Such as, support section 10010 can comprise such as from one or more protuberances that it extends, such as protuberance 10014 (Figure 22 0), this protuberance can be received in one or more hole and/or slit, is such as limited in the hole 10024 in wrappage 10022.Protuberance 10014 and hole 10024 can make protuberance 10014 wrappage 10022 can be remained to support section 10010.The end of protuberance 10014 can be such as out of shape by hot melt process, such as, to expand the end of protuberance 10014, and therefore limits the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 can comprise one or more perforation 10025, and it can be conducive to being discharged from support section 10010 by wrappage 10022, as shown in Figure 21 7.Referring now to Figure 22 6, tissue thickness's compensating part can comprise wrappage 10222, and this wrappage comprises multiple hole 10223, and its mesopore 10223 with the nail chamber register in support section 10010 or can align at least partly.The core of tissue thickness's compensating part also can comprise the hole of aliging with the hole 10223 in wrappage 10222 or aliging at least partly.Alternatively, the core of tissue thickness's compensating part can comprise continuous main body and can extend below hole 10223, makes the nail chamber opening in continuous main body covering platform surface 10011.

As mentioned above, tissue thickness's compensating part can comprise the wrappage for compressible core being remained to releasedly support section 10010.Such as, see Figure 21 8, nail bin also can comprise keeper fixture 10026, and this keeper fixture can suppress wrappage and compressible core to be separated with support section 10010 prematurely.Each keeper fixture 10026 can comprise the hole 10028 that can receive the protuberance 10014 extended from support section 10010, makes keeper fixture 10026 can be held support section 10010.Keeper fixture 10026 can comprise at least one flat of bottom 10027 separately, and this flat of bottom can to extend and to keep staple drivers 10040 in support section 10010 inner support below support section 10010.As mentioned above, tissue thickness's compensating part is attached to support section 10010 removedly by following closely 10030.More specifically, also as mentioned above, when nail 10030 is in its non-firing position, the lower limb of nail 10030 may extend in tissue thickness's compensating part 10020, and therefore tissue thickness's compensating part 10020 is remained to support section 10010 releasedly.The lower limb of nail 10030 can the sidewall contact in its corresponding nail chamber 10012, and wherein, due to the friction between nail lower limb 10032 and sidewall, nail 10030 and tissue thickness's compensating part 10020 can be maintained at appropriate location, until nail 10030 is deployed from nail bin 10000.After nail 10030 is deployed, tissue thickness's compensating part 10020 can be trapped in nail 10030 and to be kept against the tissue T sewed up.When anvil block to move in open position to discharge tissue T subsequently, the movable tissue thickness's compensating part 10020 away from being fixed to tissue of support section 10010.Binding agent can be used so that tissue thickness's compensating part 10020 is remained to support section 10010 removedly.Two-part adhesive can be used, wherein, the Part I of binding agent can be placed on platform surface 10011, and the Part II of binding agent can be placed on tissue thickness's compensating part 10020, make when tissue thickness's compensating part 10020 be close to platform surface 10011 place time, Part I can contact Part II with activated adhesive and tissue thickness's compensating part 10020 is removably bonded to support section 10010.Any other suitable method can be used tissue thickness's compensating part to be remained to separably the support section of nail bin.

To being described further above, sliding part 10050 proximally can be advanced to distal end 10002 to dispose all nails 10030 be accommodated in nail bin 10000 completely by end 10001.Referring now to Figure 25 8-Figure 26 2, sliding part 10050 distally can be advanced by the knife bar 10052 of firing member or surgical stapling device in the longitudinal cavity 10016 in support section 10010.In use, nail bin 10000 can be inserted in the nail bin passage in the jaw of surgical stapling device, and such as, in such as nail bin path 10 070, and firing member 10052 can be advanced to and contacts with sliding part 10050, as shown in Figure 25 8.When sliding part 10050 is distally advanced by firing member 10052, sliding part 10050 can contact staple drivers or the driver 10040 of recent side, and nail 10030 is pulled the trigger from warehouse 10010 or penetrated, as mentioned above.As shown in Figure 25 8, firing member 10052 also can comprise cutting blade 10053, and when nail 10030 is by percussion, this cutting blade is distally pushed into by the cutter slit in support section 10010.Corresponding cutter slit can extend across the anvil block being positioned in nail bin 10000 opposite, cutting blade 10053 can be extended between anvil block and support section 10010 and cut the tissue and tissue thickness's compensating part that are positioned in therebetween.In all cases, sliding part 10050 distally can be advanced by firing member 10052, until sliding part 10050 arrives the distal end 10002 of nail bin 10000, as shown in Figure 26 0.Now, firing member 10052 can proximally bounce back.Referring now to Figure 26 1, sliding part 10050 proximally can bounce back with firing member 10052, but when firing member 10052 bounces back, sliding part 10050 can be left in the distal end 10002 of nail bin 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue thickness's compensating part 10020 can be separated with support section 10010, and the remaining non-implanted portion of the nail bin 10000 exhausted, comprise support section 10010, can be removed from nail bin path 10 070.

After the nail bin 10000 exhausted is removed from nail bin passage, to being described further above, new nail bin 10000 or any other suitable nail bin can be inserted in nail bin path 10 070.To being described further above, nail bin path 10 070, firing member 10052 and/or nail bin 10000 can comprise cooperation feature structure, and this cooperation feature structure can prevent firing member 10052 again or to be subsequently distally pushed in new not pulling the trigger when nail bin 10000 is not positioned in nail bin path 10 070.More specifically, refer again to Figure 25 8, when firing member 10052 be advanced to contact with sliding part 10050 time, and when sliding part 10050 is in the non-firing position of its nearside, the support nose 10055 of firing member 10052 can be positioned on the support lugn 10056 on sliding part 10050 and/or above it, make firing member 10052 be maintained at enough positions upwards, fall into prevent the lock that extends from firing member 10052 or crossbeam 10054 the lock groove be limited in nail bin passage.Due to lock 10054 can not fall into lock groove time, in such cases, when firing member 10052 is pushed into, lock 10054 can not adjoin locks the distally sidewall 10057 of groove.When sliding part 10050 distally promotes by firing member 10052, firing member 10052 can be supported on its upwards firing position due to the support nose 10055 leaned against on support lugn 10056.When firing member 10052 bounces back relative to sliding part 10050, as mentioned above and as shown in Figure 26 1, when supporting nose 10055 and not relying on the support lugn 10056 of sliding part 10050, firing member 10052 upwards can fall position from it.Such as, surgical staples can comprise and firing member 10052 can be biased to it to the spring 10058 in upper/lower positions and/or any other suitable biasing element.Once firing member 10052 bounces back completely, as shown in Figure 26 2, firing member 10052 can not distally be pushed into through the nail bin 10000 used up again.More specifically, when the sliding part 10050 being now in operating sequence has been left on distal end 10002 place of nail bin 10000, firing member 10052 can not have been remained on its upper position by sliding part 10050.Therefore, as mentioned above, if firing member 10052 is advanced again when not replacing nail bin, then lock crossbeam 10054 by the sidewall 10057 of contact lock groove, this will prevent firing member 10052 to be again distally advanced in nail bin 10000.In other words, once the nail bin 10000 used up is replaced by new nail bin, new nail bin will have the sliding part 10050 of nearside location, and firing member 10052 can be remained on its upwards position by the sliding part of this nearside location, and firing member 10052 is distally pushed into again.

As mentioned above, staple drivers 10040 can move by sliding part 10050 between the first non-firing position and the second firing position, to be penetrated from support section 10010 by nail 10030.After nail 10030 is penetrated from support section 10010, staple drivers 10040 can be accommodated in nail chamber 10012.Support section 10010 can comprise one or more maintenance feature structures that staple drivers 10040 can be stoped to penetrate or drop out from nail chamber 10012.Alternatively, staple drivers 10040 can penetrate by sliding part 10050 from the support section 10010 with nail 10030.Such as, staple drivers 10040 can by such as can bio-absorbable and/or biocompatible materials form, such as Polyetherimide (Ultem).Staple drivers can be attached to nail 10030.Such as, on the base portion that staple drivers can be molded into each nail 10030 and/or around, driver and nail are integrally formed.The name of JIUYUE in 2006 submission on the 29th is called that " SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent application 11/541,123 is incorporated herein by reference in full.

In various embodiments, to being described further above, compressible tissue thickness compensating part can relative to the rigid support componental movement below nail bin, distortion and/or flexure.Any other suitable part of support section and/or nail bin can comprise one or more feature structures that can limit and organize relative motion between thickness compensation part and support section.As mentioned above, the platform surface 10011 that can extend over support section 10010 at least partially of nail 10030, referring now to Figure 26 3 and Figure 26 4, wherein, in some cases, the side force being applied to tissue thickness's compensating part 10120 such as can be kept out by the nail 10030 that extends from support section 10010 and/or anti-skid stud 10013.In all cases, nail 10030 can be tilted and/or bending in nail chamber 10012 when keeping out the lateral movement of tissue thickness's compensating part 10120, wherein, the size of nail chamber 10012 and nail 10030 can be set and can keep the alignment relative between the shaping pit 10062 in the lower limb 10032 of nail 10030 and relative anvil block 10060, and nail 10000 is correctly shaped during nail forming process.Nail 10030 and/or anti-skid stud 10013 can prevent or at least restriction organizes lateral deformation in thickness compensation part 10020, as shown in Figure 26 4.Such as, follow closely 10030 and/or anti-skid stud 10013 such as can strengthen or limit the first surface of organizing thickness compensation part or tissue contacting surface 10021 relative to the side direction of second surface or lower surface 10029 and/or lengthwise movement.Nail bin and/or the nail bin passage being wherein positioned with nail bin can comprise at least one minimizing twisting component, and this minimizing twisting component can upwards extend to limit the side direction and/or lengthwise movement or distortion of organizing thickness compensation part.As mentioned above, also can prevent around the wrappage of tissue thickness's compensating part or at least limit the side direction and/or lengthwise movement or distortion of organizing thickness compensation part at least in part.

Refer again to Figure 26 3 and Figure 26 4, tissue thickness's compensating part (such as tissue thickness's compensating part 10120) such as can comprise core 10128 and crust 10122.Crust 10122 and compressible core 10128 can be made up of different materials or same material.In any one situation, crust 10122 can have the density higher than core 10128.When crust 10122 comprises the top of tissue thickness's compensating part 10120, the top of nail lower limb 10032 can embed in crust 10122.Wherein crust comprises the bottom of tissue thickness's compensating part 10120, and nail lower limb 10032 can extend across crust and enters in core.In any one situation, the outer micromicro of tissue thickness's compensating part contributes to keeping nail lower limb 10032 to align with the shaping pit 10062 of anvil block 10060.Crust 10122 can comprise as lower density: this density such as than the density of core 10128 larger about 10%, than the density of core 10128 larger about 20%, than the density of core 10128 larger about 30%, than the density of core 10128 larger about 40%, than the density of core 10128 larger about 50%, than the density of core 10128 larger about 60%, than the density of core 10128 larger about 70%, than the density of core 10128 larger about 80%, than the density of core 10128 larger about 90%, than the density of core 10128 larger about 100%.Crust 10122 can comprise as lower density, and this density is such as greater than the density of core 10128 and is less than the twice of the density of core 10128.Crust 10122 can comprise as lower density, and this density is such as greater than the twice of the density of core 10128.To being described further above, crust 10122 and core 10128 can be formed simultaneously or manufacture.Such as, the fluid comprising any suitable material disclosed herein can be introduced in dish or by molding, and when fluid sets, and fluid can be formed to be had than the more highdensity crust of surplus material or layer.Multiple layers in material are by making to be formed with the following method: in the method, and one or more succeeding layers of material are poured on the layer of prior cured.Two or more layers can utilize such as binding agent to be bonded to each other.Two or more layers are attached to each other by such as one or more securing member and/or one or more mechanical interlocking features structure.Such as, adjacent layer is bonded together by such as one or more dovetail joint.Outer micromicro comprise can prevent or at least limit fluid through the sealing surfaces that wherein flows.Alternatively, outer micromicro comprises the loose structure of such as perforate.

To being described further, crust can be cut from tissue thickness's compensating part above.Tissue thickness's compensating part can excise from larger material block, makes tissue thickness's compensating part not comprise crust.Such as, tissue thickness's compensating part can be made up of the homogeneous material or at least substantially homogeneous material such as comprising macropore.

Nail bin can comprise multiple nail chamber, and each nail chamber holds the nail be positioned at wherein, wherein follow closely chamber and can be arranged to many rows, and the anvil block being wherein positioned in nail bin opposite can comprise the multiple shaping pits corresponding with the nail chamber in nail bin.In other words, anvil block can comprise multiple shaping pit row, and wherein each shaping pit can be positioned in the opposite in the nail chamber in nail bin.Each shaping pit can comprise two shaping cups of the nail lower limb 10032 that can receive nail 10030, and wherein each shaping cup can receive nail lower limb 10032, and nail lower limb 10032 to be such as shaped or curling towards other nail lower limbs 10032.In all cases, lower limb 10032 may not enter shaping cup or does not correctly enter shaping cup, and therefore following closely lower limb 10032 may deform during percussion sequence.Anvil block can comprise shaping pit array or grid, and it can receive separately and form nail lower limb.Such as, shaping pit array can comprise a certain amount of shaping pit, and the quantity of this shaping pit exceedes the quantity of the nail held in nail bin.Nail bin can comprise the nail chambeies of such as six longitudinal rows, wherein anvil block can comprise align with six nail chambeies six line up shape pit, and shaping pit is positioned in the centre of shaping pit row in addition.Such as, on the side of anvil block, anvil block can comprise can be positioned in first row shaping pit above the first nail chamber, can be positioned in the second row shaping pit above the second nail chamber in contiguous first nail chamber and be positioned in one in the middle of first row shaping pit and second row shaping pit in addition and line up shape pit.Referring now to Figure 27 6-Figure 27 9, anvil block 10260 can comprise six and line up shape pit 10261, and it can be placed on the corresponding six nail chambeies in nail bin 10200.Such as, in the middle of many rows, shaping pit 10262 can be positioned in and lines up in the middle of shape pit 10261 and/or vicinity lines up shape pit 10261 more more.Referring now to Figure 27 7, Figure 27 8 and Figure 28 0, each shaping pit 10261 and 10262 can comprise two shaping cups, and wherein each shaping cup comprises and nail lower limb 10032 can be made proximally to be shaped or curling distal part 10263 and nail lower limb 10032 can be made distally to be shaped or curling portions of proximal 10264.In other situations various, nail 10030 can be shaped in many other ways.Such as, nail 10030 can be shaped a lower limb 10032 is outwards shaped and another lower limb 10032 to internal shaping (Figure 28 1), or make two lower limbs 10032 all outwards be shaped (Figure 28 2), this depends on such as 1) nail lower limb 10032 enters shaping cup, and/or 2) whether lower limb 10032 enter portions of proximal 10263 or the distal part 10064 of each shaping cup.

To being described further above, each shaping pit 10261 and/or shaping pit 10262 can comprise such as triangle or diamond shape.Each distal part 10263 and/or each portions of proximal 10264 of shaping pit can comprise triangular shaped, and wherein such as, distal part 10263 and the triangular shaped of portions of proximal 10264 are arranged such that it has the summit pointing to relative direction.Anvil block can comprise such as a series of foursquare shaping pit substantially.Such as, the profiled surface of each foursquare shaping pit can be included in the arcuate surfaces extended between foursquare side.Anvil block can comprise such as a series of circle or spherical pit.Be described further above, shaping pit 10261 can be located along one or more line, and similarly, shaping pit 10262 also can be located along one or more line.Alternatively, shaping pit 10261 and/or shaping pit 10262 can be arranged to one or more circular row.Such as, shaping pit 10261 can be arranged along main circumference, and the pit 10262 that is shaped can be arranged along different circumference.Main circumference and different circumference can be concentric or substantially concentric.Shaping pit 10262 can such as along the inner periphery of radially-inwardly locating relative to main circumference and/or be arranged relative to the excircle that main circumference is radially outward located.Main circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can be limited by overall diameter.Such as, interior diameter can be shorter than full diameter, and overall diameter can be longer than full diameter.

As mentioned above, anvil block such as can move to make position from open position, to carry out compress tissue against tissue thickness's compensating part such as tissue thickness's compensating part 10020 of nail bin.In all cases, before tissue thickness's compensating part is relative to tissue positioned, tissue thickness's compensating part can be close to the support section location of nail bin.Tissue thickness's compensating part 10020 can be in as upper/lower positions: in this position, and before anvil block moves to its make position, tissue thickness's compensating part adjoins support section 10018.Alternatively, tissue thickness's compensating part 10020 can be in as upper/lower positions: in this position, and gap is present between tissue thickness's compensating part 10020 and support section 10018.Such as, anvil block can make tissue and tissue thickness's compensating part 10020 be shifted downwards, until tissue thickness's compensating part 10020 adjoins support section 10018, wherein during this time, anvil block is now moveable to its make position and produces compression in tissue.If surgeon feels dissatisfied in the location to the tissue between anvil block and nail bin, then surgeon can open anvil block, the position of adjustment anvil block and nail bin, and again closes anvil block.Because nail bin is located relative to this type of organizing and reorientates, in all cases, the distal end of tissue thickness's compensating part 10020 can such as be separated with support section 10010.In some such cases, the distal end of tissue thickness's compensating part 10020 can contact tissue, and peels off from support section 10010 or roll relative to support section 10010.As hereafter further describe in detail, nail bin can comprise one or more feature structures that tissue thickness's compensating part can be remained to releasedly the support section below nail bin.

Referring now to Figure 26 5, nail bin 10300 can comprise support section 10310, the tissue thickness's compensating part 10320 supported by support section 10310 and the distal end 10302 comprising nose 10303, and the distal end 10325 of tissue thickness's compensating part 10320 can be remained on appropriate location by this nose releasedly.Nose 10303 can comprise can the slit 10305 of distal end 10325 of tissue receiving thickness compensation part 10320.Distal end 10325 can be compressed or be wedged in slit 10305, and make when nail bin 10300 is relative to tissue positioned, distal end 10325 can be maintained at appropriate location.Such as, slit 10305 can along the direction orientation of platform surface 10311 being parallel to or being at least basically parallel to support section 10310.Slit 10305 can be level relative to platform surface 10311.Alternatively, referring now to Figure 26 6, nail bin 10400 can comprise support section, the tissue thickness's compensating part 10420 supported by support section and the distal end 10402 comprising nose 10403, and the distal end 10425 of tissue thickness's compensating part 10420 can be remained on appropriate location by this nose releasedly.Distal end 10425 can comprise the protuberance extended from it, and nose 10403 can comprise the vertical slit 10405 of the protuberance that can receive distal end 10425.Distal end 10425 and/or from its extend protuberance can be compressed or be wedged in slit 10405, make when nail bin 10400 is relative to tissue positioned, distal end 10425 can be maintained at appropriate location.Tissue thickness's compensating part 10420 can comprise such as slit such as slit 10429, and this slit can receive nose 10403 at least partially wherein.Slit 10405 can along perpendicular to or be at least basically perpendicular to the direction orientation of platform surface 10411 of support section.Referring now to Figure 26 7, nail bin 10500 can comprise support section, the tissue thickness's compensating part 10520 supported by support section and the distal end 10502 comprising nose, and the distal end 10525 of tissue thickness's compensating part 10520 can be remained on appropriate location by this nose releasedly.Nose can comprise can the slit 10505 of distal end 10525 of tissue receiving thickness compensation part 10520.Distal end 10525 can be compressed or be wedged in slit 10505, and make when nail bin 10500 is relative to tissue positioned, distal end 10525 can be maintained at appropriate location.

Refer again to Figure 26 5, tissue thickness's compensating part 10320 can comprise top surface 10324, and this top surface can be positioned in above the top surface 10304 of nose 10303.Figure 23 8 shows another exemplary embodiment, such as in this exemplary embodiment, the top surface of tissue thickness's compensating part is positioned in above the nose of nail bin, and wherein the top surface 10721 of tissue thickness's compensating part 10720 is positioned in above the top surface 10004 of nose 10003.In use, refer again to Figure 26 5, tissue can slide above the top surface 10304 of nose 10303, and in some cases, tissue can the distal end 10325 of contact tissue thickness compensation part 10320, and power can be applied to tissue thickness's compensating part 10320, thus tissue thickness's compensating part 10320 is peeled off from support section 10310.In the embodiments described herein, this peeling force can resist by the part of the distal end 10325 of wedging in nose 10303.Under any circumstance, appropriately locate relative to nail bin 13000 once organize, anvil block can be rotated to make position with against support section 10310 compress tissue and tissue thickness's compensating part 10320.Such as, anvil block can be rotated to as in upper/lower positions: in this position, the top surface 10304 of anvil block contact nose 10303, and therefore can prevent anvil block from further rotating.In all cases, top surface 10324 due to tissue thickness's compensating part 10320 is positioned in above the top surface 10304 of nose 10303, when anvil block is just closed, top surface 10324 can be pushed down towards support section 10310, and in some cases, top surface 10324 such as can be pushed to below the top surface 10304 of nose 10303.As described herein, when be contained in the nail in nail bin 10300 and be deployed and tissue thickness's compensating part 10320 cut after, support section 10310 and nose 10303 movable away from tissue thickness's compensating part 10320, make the distal end 10325 of tissue thickness's compensating part 10320 can skid off slit 10305.

As mentioned above, anvil block (such as anvil block 10060) such as can be rotated to make position, and wherein anvil block 10060 contacts the top nose surface 10004 of nail bin (such as nail bin 10000).Once anvil block has arrived its make position, then tissue thickness's compensating part (such as tissue thickness's compensating part 10020) by the amount compressed inter alia by the thickness of the uncompressed thickness or height and tissue that depend on tissue thickness's compensating part.Referring now to Figure 23 6 and Figure 23 7, tissue thickness's compensating part 10920 can comprise the top surface flushing with the top surface 10004 of nose 10003 or at least substantially flush.In such cases, the top surface of tissue thickness's compensating part 10920 can promote below the top surface 10004 of nose 10003.Referring now to Figure 24 1 and Figure 24 2, tissue thickness's compensating part (such as tissue thickness's compensating part 10820) such as can comprise top surface 10821, before tissue thickness's compensating part 10820 is compressed by tissue T and anvil block 10060, this top surface is positioned in below top nose surface 10004.As shown in Figure 23 9 and Figure 24 0, when tissue T is relatively thin, tissue thickness's compensating part 10920 may stand relatively little compression.Referring now to Figure 24 1 and Figure 24 2, when tissue T is relatively thick, tissue thickness's compensating part 10820 may stand larger compression.As shown in Figure 24 3 and Figure 24 4, when tissue T has thin section and thicker simultaneously, tissue thickness's compensating part 10820 can be worked as and compressed relatively large when it is positioned in below thicker tissue T, and is compressed less amount when it is positioned in compared with time below thin tissue.As mentioned above, by this way, tissue thickness's compensating part can compensate different tissue thicknesses.

Referring now to Figure 26 8-270, surgery suturing appliance can comprise one, can receive the storehouse passage 16670 of nail bin 16600, and two, can the anvil block 16660 that storehouse passage 16670 is attached to of pivotable.Nail bin 16600 can comprise support section 16610 and tissue thickness's compensating part 16620, and wherein the distal end 16625 of tissue thickness's compensating part 16620 can remain to support section 16610 with discharging by the nose 16603 of the distal end 16602 of nail bin 16600.Nose 16603 can comprise slit 16605, and can be made up of flexible material.In use, first see Figure 26 9, nose 16603 can bend downwards, to expand the opening of slit 16605.Nose 16603 can comprise recess or otch 16606, and this recess or otch can make nose 16603 bend downwards.In any case in all cases, the opening of the expansion of slit 16605 can be conducive to the distal end 16625 of tissue thickness's compensating part 16620 to be inserted in slit 16605.Once tissue thickness's compensating part 16620 is appropriately located, nose 16603 can be released, and the resilience force of the material due to composition nose 16603, nose 16603 can return or at least substantially be back to its non-deflected, and on platform surface 16611 distal end 16625 of capture tissue thickness compensation part 16620, as shown in graph 270.In use, be similar to mentioned above, when support section 16610 move away from sew up organize time, distal end 16625 can be pulled out slit 16605.In all cases, when tissue thickness's compensating part 16620 is separated with support section 16610, flexible nose 16603 can deflect.Refer again to Figure 27 0, tissue thickness's compensating part 16620 can comprise the top surface 16621 aliging with the top surface 16604 of nose 16603 or at least substantially align.

See Figure 27 1, surgery suturing appliance can comprise 1) path 10 770 of nail bin 10700 can be received, and 2) anvil block 10760 of path 10 770 can be attached to rotatably.Nail bin 10700 can comprise support section 10710 and tissue thickness's compensating part 10720.Tissue thickness's compensating part 10720 can overlap 10703 by nose and remain on appropriate location, and this nose cover can slide on support section 10710.First see Figure 27 2, nose cover 10703 can comprise one or more sides slit 10707, and this one or more sides slit can receive removedly such as along one or more attachment guide rails that support section 10710 extends.Tissue thickness's compensating part 10720 can be positioned in the middle of side slit 10707.Nose cover 10703 also can comprise distal end 10702 and be limited to the chambeies 10706 in distal end 10702, and its lumen 10706 can also receive such as that support section 10710 is at least partially wherein.In use, nose cover 10703 can slide in the direction distally to nearside on support section 10710.Tissue thickness's compensating part 10720 can be mounted to nose cover 10703 removedly, make to have pulled the trigger after through tissue thickness's compensating part 10720 at nail, when support section 10710 and nose cover 10703 motion are away from tissue thickness's compensating part 10720, tissue thickness's compensating part 10720 can overlap 10703 with nose and be separated.The top surface 10721 of tissue thickness's compensating part 10720 can be positioned in below the top surface 10704 of nose 10703.

Referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance can comprise 1) the nail bin passage 11070 of nail bin 11000 can be received, and 2) anvil block 11060 of passage 11070 can be attached to rotatably.Nail bin 11000 can comprise support section 11010 and tissue thickness's compensating part 11020.One or more longitudinal rails 11019 that tissue thickness's compensating part 11020 can be extended by the platform 11011 from support section 11010 remain on appropriate location.Longitudinal rail 11019 can be embedded in tissue thickness's compensating part 11020.First see Figure 27 4, tissue thickness's compensating part 11020 can comprise the longitudinal fluting 11029 that can receive longitudinal rail 11019.Such as, the size of groove 11029 can be set and can receive the guide rail 11019 of such as press-fit structure.To being described further above, this type of feature structure can prevent or at least lateral movement relative between thickness compensation part 11020 and support section 11010 is organized in restriction, and in addition, restriction organizes thickness compensation part 11020 such as to be discharged from support section 11010 prematurely.Referring now to Figure 27 5, surgery suturing appliance can comprise 1) the nail bin passage 11170 of nail bin 11100 can be received, and 2) anvil block 11160 of passage 11170 can be attached to rotatably.Nail bin 11100 can comprise support section 11110 and tissue thickness's compensating part 11120.One or more tandem spike that tissue thickness's compensating part 11120 can be extended by the platform 11111 from support section 11110 or tusk 11119 remain on appropriate location.Longitudinal platoon leader follows closely 11119 and can be embedded in tissue thickness's compensating part 11120.

With reference to Figure 27 3, to being described further above, when nail is penetrated from the nail chamber 10012 be defined in wherein, tissue thickness's compensating part 11020 of nail bin 11000 can be discharged gradually from support section 11010.More specifically, to being described further above, the nail be positioned in nail chamber 10012 can be penetrated successively between the proximal extremity 11001 of nail bin 11000 and the distal end 11002 of nail bin 11000, make when following closely by injection, bias force is upwards applied to tissue thickness's compensating part 11020 by nail, and this bias force is done in order to tissue thickness's compensating part 11020 is pushed away guide rail 11019.In such cases, when nail is penetrated from recent side nail chamber 10012, the proximal extremity 11006 of tissue thickness's compensating part 11020 can be released from support section 11010.When nail is penetrated gradually from the support section 11010 between the proximal extremity 11001 and distal end 11002 of nail bin 11000, tissue thickness's compensating part 11020 can be discharged from support section 11010 subsequently gradually.When being positioned at the nail in farthest side nail chamber 10012 and being penetrated from support section 11010, the distal end 11007 of tissue thickness's compensating part 11020 can be released from support section 11010.With reference to Figure 27 5, when following closely the nail bin proximally between end 11101 and distal end 11102 and being penetrated gradually, the spike 1119 that tissue thickness's compensating part 11120 can extend from self-supporting part 11110 is discharged gradually.

As mentioned above, when follow closely from support section by gradually injection and contact tissue thickness compensation part time, tissue thickness's compensating part can be discharged gradually from the support section of nail bin.Such as when not discharged from support section by tissue thickness's compensating part, the lower limb (such as following closely lower limb 10032) such as followed closely can pass tissue thickness's compensating part.In such cases, tissue thickness's compensating part can keep engaging with support section, until nail base portion (such as base portion 10031) contact tissue thickness compensation part and by it upwardly.But anti-skid stud and/or other maintenance feature structures from support section extension such as can hinder tissue thickness's compensating part from the release of support section.As described in more detail below, support section can comprise maintenance feature structure, and when nail is pulled the trigger gradually from nail bin, tissue thickness's compensating part can discharge from support section by this maintenance feature structure gradually.Referring now to Figure 28 3, nail bin (such as nail bin 11200) such as can comprise support section 11210, and this support section comprises the maintenance feature structure 11213 that tissue thickness's compensating part 11220 (Figure 28 4) can be remained to releasedly support section 11210.Keep feature structure 11213 can be positioned in the end in such as each nail chamber 11212, wherein each maintenance feature structure 11213 can comprise the guide groove 11216 be defined in wherein, and this guide groove can receive the nail lower limb 10032 of nail 10030 slidably.In such cases, follow closely lower limb 10032 and keep feature structure 11213 tissue thickness's compensating part 11220 can be remained to support section 11210 releasedly.In use, referring now to Figure 28 4, the staple drivers 10040 be contained in support section 11210 upwards can be driven by sliding part 10050, as mentioned above, wherein staple drivers 10040 can contact and keep feature structure 11213, maintenance feature structure 11213 is separated at least in part with support section 11210, and makes maintenance feature structure 11213 outwards and be shifted away from nail 10030 and nail chamber 11212.When keeping feature structure 11213 be separated with support section 11210 and/or be outwards shifted, as shown in Figure 28 4, keep feature structure 11213 no longer tissue thickness's compensating part 11220 can be remained to support section 11210, therefore, tissue thickness's compensating part 11220 can be released from support section 11210.Be similar to mentioned above, when such as from nail bin, towards anvil block, such as anvil block 11260 is penetrated nail 10030 gradually, tissue thickness's compensating part 11220 can be discharged gradually from support section 11210.When the top surface of staple drivers 10040 is such as coplanar or at least substantially coplanar with the platform surface 11211 of support section 11210, staple drivers 10040 can contact and keep feature structure 11213.In such cases, be shaped as it at nail 10030 and be shaped completely or while pulling the trigger configuration completely and/or be just shaped as before it is shaped completely or pulls the trigger configuration completely at nail 10030, tissue thickness's compensating part 11220 can discharge from support section 11210.Such as, first see Figure 28 5, driver 10040 can be overdriven, and makes it be pushed nail 10030 is shaped completely above platform surface 11211, and during the process be overdriven, maintenance feature structure 11213 and support section 11210 are departed from.Refer again to Figure 28 4, keep feature structure 11213 in separation or outwards to may extend into before displacement or to enter into nail chamber on nail chamber 11212 of dangling, make just when driver 10040 arrives platform surface 11211, driver 10040 can contact and keep feature structure 11213.Under any circumstance, once tissue thickness's compensating part 11220 is released from support section 11210, referring now to Figure 28 5, then the movable tissue thickness's compensating part 11220 away from implanting of support section 11210.

As mentioned above, when following closely from nail bin percussion or disposing, the compressible tissue thickness compensating part of nail bin can be discharged gradually from the support section of nail bin or warehouse.In all cases, this type of release can comprise makes tissue thickness's compensating part unclamp gradually from support section, wherein in some cases, until anvil block be opened and support section motion away from implant tissue thickness's compensating part, tissue thickness's compensating part just may be separated with support section completely.Referring now to Figure 28 9, nail bin (such as nail bin 11300) such as can comprise the tissue thickness's compensating part 11320 remaining to support section 11310 releasedly.Support section 11310 can comprise the multiple retaining members 11313 extended from it, and longitudinal side of tissue thickness's compensating part 11320 can be compressed and remain to support section 11310 by the plurality of retaining member releasedly.Such as, each retaining member 11313 can comprise can wherein tissue receiving thickness compensation part 11320 longitudinal side towards interior passage or slit 11316.In all cases, multiple retaining member 11313 can extend along the longitudinal side of first of support section 11310, and multiple retaining member 11313 can extend along the longitudinal side of second of support section 11310.Wherein, in some cases, retaining member 11313 can prevent or at least lateral movement relative between thickness compensation part 11320 and support section 11310 is organized in restriction, and prevents from addition or at least limit organizing thickness compensation part 11320 to discharge too early from support section 11310.Retaining member 11313 can be one-body molded with support section 11310, and see Figure 29 0, retaining member 11313 can be separated with support section 11310 or be separated at least partly, such as, to make tissue thickness's compensating part 11320 be separated with support section 11310, as shown in Figure 29 1.Anvil block (such as anvil block 11360) such as can compress tissue thickness compensation part 11320, and in response to the pressure produced in tissue thickness's compensating part 11320, tissue thickness's compensating part 11320 lateral expansion can be separated to making retaining member 11313 with tissue thickness compensating part 11320 or departs from least in part.As mentioned above, advance cutter component through anvil block 11360 and nail bin 11300, the nail be accommodated in nail bin can be disposed, and extruding anvil block 11360 and nail bin 11300 makes it closer to each other simultaneously, the compression stress of increase can be applied to tissue thickness's compensating part 11320 by this, thus when cutter component makes retaining member 11313 be separated successively through during nail bin 11300.

Referring now to Figure 29 2-294, nail bin such as nail bin 11400 such as can comprise the tissue thickness's compensating part 11420 being attached to support section 11410 removedly.Nail bin 11400 can comprise one or more keeper bars 11413 that longitudinal side of tissue thickness's compensating part 11420 can be remained to platform surface 11411.Such as, each keeper bar 11413 can comprise opposing arms 11418, and this opposing arms can limit passage 11416 therebetween.In such cases, one in arm 11418 can extend on tissue thickness's compensating part 11420, and another arm 11418 can extend below the antelabium 11419 extended from support section 11410.First see Figure 29 2, the size of the passage 11416 of each keeper bar 11413 can be set and compression stress can be applied to longitudinal side of tissue thickness's compensating part 11420 before using nail bin 11400.During use, first see Figure 29 3, nail bin 11400 can be positioned in nail bin passage, and once nail bin 11400 is appropriately located, anvil block (such as anvil block 11460) is such as moveable in the position of its compressible tissue thickness compensating part 11420.Be similar to mentioned above, when pressurised, tissue thickness's compensating part 11420 can side direction or to external expansion, and therefore makes keeper bar 11413 be separated with nail bin 11400.Alternatively, the closed of anvil block 11460 can make keeper bar 11413 not be separated with nail bin or not be separated completely with nail bin.Such as, as mentioned above, advance trigger shaft can dispose nail 10030 from support section 11410 through nail bin 11400, and extruding anvil block 11460 and nail bin 11400 makes it closer to each other simultaneously, compression stress to be applied to tissue thickness's compensating part 11420, this compression stress is enough to make tissue thickness's compensating part 11420 lateral expansion, and keeper bar 11413 is separated with nail bin 11400.Once keeper bar 11413 is separated with nail bin 11400, see Figure 29 4, the movable tissue thickness's compensating part 11420 away from implantation of support section 11410 also removes from operative site.In the embodiment of some alternative, referring now to Figure 29 5, nail bin 11400 ' can comprise keeper bar 11413 ', and this keeper bar is similar to the arm 11418 ' comprised from its extension mentioned above.Such as, each in arm 11418 ' comprises the wedge-lock inclined-plane 11417 ' that keeper bar 11413 ' can be latchable to releasedly nail bin 11400 '.More specifically, the support section 11410 ' of nail bin 11400 ' can comprise undercutting 11419 ', this undercutting cooperates with wedge-lock inclined-plane 11417 ', keeper bar 11413 ' can be remained to nail bin 11400 releasedly, and suppress tissue thickness's compensating part 11420 to be separated with support section 11410 ' prematurely.During use, be similar to mentioned above, when enough compression stresses are applied to tissue thickness's compensating part 11420, keeper bar 11413 ' can be separated with nail bin 11400 '.

In all cases, as mentioned above and refer again to Figure 25 9 and 260, the sliding part 10050 of nail bin 10000 and the firing member 10052 of surgery suturing appliance can move to the distal end 10002 (Figure 21 9) of nail bin 10000 from the proximal extremity 10001 of nail bin 10000, to dispose nail 10030 from support section 10010.In this type of situation of at least one, each nail 10030 never can move to firing position by firing position, and penetrates to catch whole tissue thickness compensating part 10020 being positioned the tissue between anvil block 10060 and nail bin 10000 from support section 10010.In some cases, surgeon may not need from nail bin 10000, pull the trigger all nails 10030, and surgeon may make the advance of sliding part 10050 and trigger shaft 10052 be barred from is positioned at some place in the middle of the proximal extremity 10001 of nail bin 10000 and distal end 10002.In this case, tissue thickness's compensating part 10020 can only by part implanting tissue T, to make the non-implant part of tissue thickness's compensating part 10020 be separated with support section 10010.Tissue thickness's compensating part 10020 tractive that support section 10010 can be implanted away from part by surgeon, makes non-implant part peel off from support section 10010 or come off.Although this type of embodiment is suitable for various situation, Figure 30 0-302 shows improvement, and wherein tissue thickness's compensating part 11520 of tissue thickness's compensating part such as nail bin 11500 such as can comprise multiple junction fragments that can be separated from one another.Such as, tissue thickness's compensating part 11520 can comprise first or recent side fragment 11520a, be connected to removedly the first fragment 11520a the second fragment 11520b, be connected to removedly the second fragment 11520b the 3rd fragment 11520c, be connected to the 4th fragment 11520d of the 3rd fragment 11520c and be connected to the 5th fragment 11520e of the 4th fragment 11520d removedly removedly.Tissue thickness's compensating part 11520 can comprise at least one thin section 11529 that can limit predetermined broken loose point or burble point be positioned in the middle of any two adjacent segment 11520a-11520e, tissue thickness's compensating part fragment can this broken loose point or burble point separated from one another.Tissue thickness's compensating part can comprise any suitable perforation configuration, thin section and/or any other device for producing burble point in tissue thickness's compensating part.First see Figure 30 1, anvil block 11560 shows in the close position, and firing member 10052 shows for being partly advanced through nail bin 11500, the nail 10030 below the first fragment 11520a, the second fragment 11520b and the 3rd fragment 11520c is pulled the trigger with capture tissue thickness compensation part 11520 in tissue T.In this type of position, firing member 10052 is not also pushed into dispose the nail 10030 below such as the 4th fragment 11520d and the 5th fragment 11520e.Referring now to Figure 30 2, anvil block 11560 has been moved in open position, and the support section 11510 of nail bin 11500 has moved away from the implant part of tissue thickness's compensating part 11520.As shown in Figure 30 2, be positioned at the 3rd fragment 11520c and be separated with implant part with the non-implant part of thin section 11529 (Figure 30 0) the Yi Shi tissue thickness compensating part 11520 in the middle of the 4th fragment 11520d.

To being described further above, nail bin can comprise multiple securing member, and tissue thickness's compensating part can be remained to the support section of nail bin by the plurality of securing member releasedly.Support section can comprise the multiple holes be such as limited in platform surface, and wherein securing member can extend across tissue thickness's compensating part and can be releasably retained in support section hole.In use, when nail is penetrated gradually from support section, securing member can be discharged gradually from support section.Such as, securing member can be implanted with tissue thickness's compensating part, and securing member can such as can the material of bio-absorbable be made up of at least one.After tissue thickness's compensating part is implanted at least partly, and when support section motion is away from the tissue thickness's compensating part implanted, securing member can be separated with support section.Referring now to Figure 32 3-325, nail bin (such as nail bin 11600) such as can comprise the tissue thickness's compensating part 11620 being releasably attached to support section 11610 by multiple securing member 11613.Each securing member 11613 can comprise the first end 11618, the second end 11618 engaged with support section 11610 and the adapter 11616 the first end 11618 being connected to the second end 11618 that embed in tissue thickness compensating part 11620 and/or engage with tissue thickness compensating part 11620.Securing member 11613 can extend across the cutter slit 11615 be limited in support section 11610.In use, as mentioned above, firing member 10052 can make blade move through the cutter slit 11615 in support section 11610 and cut securing member 11613, to discharge tissue thickness's compensating part 11620 from support section 11610.Such as, trigger shaft 10052 can be advanced to the distal end 11602 of nail bin 11600 from the proximal extremity 11601 of nail bin 11600,1) sliding part 10050 distally advanced and to pull the trigger nail 10030 gradually, as mentioned above, and 2) cut securing member 11613 and/or make securing member 11613 rupture to discharge tissue thickness's compensating part 11620 gradually from support section 11610 gradually.Be similar to mentioned above, tissue thickness's compensating part 11620 can comprise multiple separable fragment 11620a-11620e, and the plurality of separable fragment such as can remain to support section 11610 each via one or more securing member 11613.As shown in Figure 32 4, if firing member 10052 is barred from proximal extremity 11601 and distal end 11602 centre of nail bin 11600, after anvil block 11660 is opened and support section 11610 moves away from tissue T, as shown in Figure 32 5, securing member 11613 can contribute to the non-implant part of tissue thickness's compensating part 11620 to remain to support section 11610.To being described further above, the cutting blade 10053 of firing member 10052 can cut securing member 11613 and/or securing member 11613 is ruptured.In the embodiment of some alternative, referring now to Figure 32 7 and 328, sliding part such as sliding part 11650 disposed by nail such as can comprise blade 11653, and when sliding part 11650 traverses nail bin 11600, this blade can cut the adapter 11616 of securing member 11613.Such as, each adapter 11616 can be included in the cylindrical member extended between the T-shaped end 11618 of securing member 11613, and wherein blade 11653 can comprise concave profile 11653, and this concave profile such as can receive cylinder shape connector 11616.

As mentioned above, nail bin can be loaded onto in the nail bin passage of surgery suturing appliance.In all cases, nail bin inserts in nail bin passage by downward power being applied on nail bin so that nail bin is locked in appropriate location by surgeon or other clinicians.In some this type of situation, the top surface that its thumb such as can be placed on nail bin by clinician applies this type of downward power.The top surface of nail bin can comprise the top surface of tissue thickness's compensating part, wherein, as mentioned above, tissue thickness's compensating part can be compressible, and the downward power the being applied to tissue thickness's compensating part thumb that tissue thickness's compensating part can be made to be compressed to clinician and the point of tip contact being stored in the nail in support section.Nail bin application device can be utilized to be inserted by nail bin in nail bin passage, and this nail bin application device can prevent or at least limit the probability that clinician touches the nail in nail bin.After nail bin has been correctly positioned in nail bin passage, as described in more detail below, application device can be separated with nail bin.

Referring now to Figure 30 5 and 306, nail bin application device such as can comprise the rigid cap that can be attached to nail bin 10000 and such as cover 10080.To being described further above, when nail bin 10000 is inserted in nail bin passage, such as, cover 10080 can prevent or at least suppress the thumb contact of clinician to be positioned at the top of the nail 10030 in nail bin 10000.Referring now to Figure 30 7 and 308, lid 10080 may extend into the top surface 10021 of tissue thickness's compensating part 10020 or top surface 10021 at least partially on, and can 1 be comprised) may extend on tissue thickness's compensating part 10020 and/or the lower surface 10081 of subjacent tissue's thickness compensation part 10020, and 2) can be clinician and provide pressing surface to apply the top surface 10082 of downward power to it.In use, clinician can grasp the handle portions 10084 of lid 10080, is alignd by the support section 10010 of nail bin 10000, and inserted in nail bin passage by nail bin 10000 at least in part with nail bin passage.Then, clinician is placed in nail bin passage by applying downward power to the top surface 10082 of lid 10880 to make nail bin 10000 completely, and this downward power can be directly transferred to support section 10010.Such as, lid 10080 can comprise proximal supports 10087, and this support member can contact the platform surface 10011 of support section to downward-extension.Lid 10080 also can comprise the distally support section 10083 that can adjoin nose 10003.When applying downward power to lid 10080, this downward power is passed by proximal supports 10087 and/or distally support section 10083, and or at least substantially this downward power can not can not be delivered to support section 10010 by tissue thickness's compensating part 10020.In all cases, due to mentioned above, clinician can not direct contact tissue thickness compensation part 10020.Also due to mentioned above, when nail bin 10000 is inserted in nail bin passage, lid 10080 can not compress or not compress tissue thickness compensation part 10020 at least substantially.Lid can comprise the support member of any suitable quantity, and downward power can be delivered to support section by this support member, and or at least substantially can not can not transmit this downward power by tissue thickness's compensating part.Support member may extend into around the proximal extremity of tissue thickness's compensating part, distal end and/or longitudinal side.Support member can extend across tissue thickness's compensating part.Such as, support member can extend across the hole in tissue thickness's compensating part and adjoins the platform of support section.Before downward power is applied to lid, at least some in support member can not with contact with platform; But lid can bend downwards or move, until the platform of support member contact support section.Now, can stop or at least substantially stop the downward flexure of lid or motion to bend further.

As mentioned above, cover 10080 can be attached to nail bin 10000 and can be used for regulating and controlling the position of nail bin 10000.Lid 10080 can comprise the clamping components of any suitable quantity, and lid 10080 such as can be remained to the support section 10010 of nail bin 10000 by this clamping components releasedly.Such as, cover 10080 and such as also can comprise one or more retaining member, such as latch arms 10088 and/or 10089.Latch arms 10089 can extend to the side periphery of nose 10003 and engage the lower surface 10009 (Figure 30 6) of nose 10003.Similarly, latch arms 10088 may extend into the side periphery of lock protuberance 10008, and this lock protuberance extends from support section 10010 and engages the lower surface of lock protuberance 10008.Lid 10080 can be positioned at as on inferior segment or region by these latch arms: in this district or region, and nail is stored in support section 10010.Under any circumstance, once nail bin 10000 is properly oriented, lid 10080 can be separated with nail bin 10000.The lifting force that clinician can apply upwards to shank 10084, to be separated the distal end of lid 10080 with the distal end 10002 of nail bin 10000.Such as, when shank 10084 is moving upward, latch arms 10088 and 10089 can outwards bend, and latch arms 10088 and 10089 can be bent around lock protuberance 10008 and nose 10003 respectively.Then, the proximal extremity of lid 10080 can be subsequently lifted the proximal extremity 10001 of nail bin, and covers 10080 movable away from nail bin 10000.

Referring now to Figure 30 9 and Figure 31 0, except being such as positioned at by nail bin (such as nail bin 10600) except in nail bin passage, top such as can also organize thickness compensation part such as tissue thickness's compensating part 10690 such as to locate relative to anvil block by nail bin application device (such as nail bin application device 10680).Be similar to mentioned above, application device 10680 can comprise the latch arms 10688 that can engage releasedly with lock protuberance 10608, this lock protuberance extends from the support section 10610 of nail bin 10600, makes application device 10680 can be maintained at position on tissue thickness's compensating part 10620 of nail bin 10600.Top organizes thickness compensation part 10690 can be attached to nail bin application device 10680 removedly, the anvil block (such as anvil block 10060) of surgical instruments such as can be closed on application device 10680, joining tissue thickness compensation part 10690, and tissue thickness's compensating part 10690 is separated with application device 10680.Tissue thickness's compensating part 10690 and/or anvil block 10060 can comprise one or more maintenance feature structure, and tissue thickness's compensating part 10690 can be remained to anvil block 10060 by this maintenance feature structure releasedly.Such as, tissue thickness's compensating part 10690 can comprise such as from the longitudinal rail 10695 that the top surface 10691 of tissue thickness's compensating part 10690 extends, and this longitudinal rail can be received in the longitudinal knife slit 10065 be limited in anvil block 10060.Tissue thickness's compensating part 10690 and longitudinal rail 10695 can be such as made up of any suitable compressible material, and be such as described in those in this patent application, wherein longitudinal rail 10695 such as can be compressed and/or be wedged in cutter slit 10065.Once anvil block 10060 engages with tissue thickness compensating part 10690, then anvil block 10060 can turn back to open position, and in this case, tissue thickness's compensating part 10690 can be separated with application device 10680.Then, application device 10680 can be separated with nail bin 10600, makes anvil block 10060 and nail bin 10600 can relative to the tissue positioned that will be sewn and/or cut.In use, sliding part such as sliding part 10050 (Figure 23 6) disposed by nail such as can distally be advanced through nail bin 10600 by firing member 10052 (Figure 23 6), such as, to be penetrated from nail bin 10060 by nail, as mentioned above.Due to nail distortion, therefore each nail can be caught the part against tissue thickness's compensating part 10690 of the top surface organized and be caught a part for tissue thickness's compensating part 10620 of the lower surface against tissue.Simultaneously, firing member 10052 can advance blade 10053 (Figure 23 6) through tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690, wherein blade 10053 is pushed into by longitudinal rail 10695, to cut guide rail 10695 and to make tissue thickness's compensating part 10690 be separated gradually with anvil block 10060.After nail has been deployed, anvil block 10060 again can have been opened and moved away from the tissue thickness's compensating part 10690 implanted, and similarly, the movable tissue thickness's compensating part 10620 away from implanting of support section 10610 of nail bin 10600.To being described further above, tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690 can comprise multiple separable fragment.If when only the part of tissue thickness's compensating part 10620 and 10690 is implanted by nail, separable fragment can be separated from one another.

To being described further above, application device 10680 can comprise one or more maintenance feature structures that tissue thickness's compensating part 10690 can be remained to releasedly application device 10680.Such as, first see Figure 31 0, application device 10680 can comprise the longitudinal direction maintenance guide rail 10685 that can be received in and longitudinally keep in slit 10694, and this longitudinal direction keeps slit to be limited in the lower surface 10692 of tissue thickness's compensating part 10690 with press-fit manner.In all cases, keep guide rail 10685 and keep slit 10694 tissue thickness's compensating part 10690 can be remained to application device 10680, until apply enough lifting forces upwards by anvil block 10060 to tissue thickness's compensating part 10690, as mentioned above.Such as, also can comprise being positioned at from the maintenance guide rail 10685 of application device 10680 extension and keep the proximal extremity of guide rail 10685 and the end stop 10686 of distal end, this end stop can prevent or at least the relative longitudinal motion between thickness compensation part 10690 and application device 10680 is organized in restriction.Refer again to Figure 31 0, one or more binding agents such as longitudinal adhesive tape 10693 such as can be placed on the contact surface 10691 of tissue thickness's compensating part 10690, make when anvil block 10060 contact tissue thickness compensation part 10690, as mentioned above, tissue thickness's compensating part 10690 can be attached to anvil block 10060 by binding agent releasedly.Except above-mentioned compressible maintenance feature structure or replace above-mentioned compressible maintenance feature structure, such as, can use one or more binding agents.Can use one or more binding agents that tissue thickness's compensating part is remained to nail bin application device releasedly.Referring now to Figure 31 0A, such as cover 10080 and can comprise one or more adhesive pad 12185, top can organize thickness compensation part such as tissue thickness's compensating part 12190 such as to remain to the top surface 10082 of lid 10080 releasedly by this one or more adhesive pad.Such as, be similar to above-described embodiment, anvil block can be closed and keep guide rail 12195 with the longitudinal direction of joining tissue thickness compensation part 12190 on tissue thickness's compensating part 12190.Relieving mechanism can be positioned in the middle of tissue thickness's compensating part 12190 and lid 10080.This relieving mechanism can be used for breaking bonding tissue thickness's compensating part 12190 being remained to lid 10080, and tissue thickness's compensating part 12190 is separated with lid 10080.Relieving mechanism can comprise pull tab 12196 and the collar 12197, and wherein the collar 12197 can comprise the first end and the second end that are attached to pull tab 12196.The collar 12197 such as can comprise stitching thread, and this stitching thread can limit the periphery defining adhesive pad 12185, makes when pull tab 12196 is distally pulled, and stitching thread can slide and contact tissue pad 12185 between tissue thickness's compensating part 12190 and lid 10080.In such cases, stitching thread such as can complete following at least one: adhesive pad 12185 is separated with tissue thickness compensating part 12190; Adhesive pad 12185 is separated with lid 10080; And/or cut off adhesive pad 12185.

Referring now to Figure 31 1, nail bin can such as comprise support section 10710.Be similar to mentioned above, this support section can comprise the longitudinal knife slit 10715 running through extension.Such as, nail bin application device such as application device 10780 such as can comprise and longitudinally keeping and alignment member 10786, and this longitudinal direction keeps and alignment member may extend in the cutter slit 10715 in support section 10710.Retaining member 10786 such as can engage the sidewall of cutter slit 10715 with press-fit manner, make application device 10780 can be releasably retained support section 10710.Although not shown, the Part I of tissue thickness's compensating part can be positioned on the first side of retaining member 10786, and the Part II of tissue thickness's compensating part can be positioned in the relative of retaining member 10786 or on the second side.Be similar to mentioned above, the Part I of tissue thickness's compensating part and Part II are such as installed to the support section 10710 of nail bin by retaining member 10013.Also be similar to mentioned above, top organizes thickness compensation part 10790 can be removably attachable to application device 10780 by the longitudinal retaining member 10785 extended from the loading of application device 10780 surface 10782, wherein retaining member 10785 such as can by be press-fitted into releasedly be limited to tissue thickness's compensating part 10790 lower surface 10792 in longitudinal slit 10794 in.Also be similar to mentioned above, tissue thickness's compensating part 10790 also can comprise the longitudinal retaining member 10795 extended from the top surface 10791 of tissue thickness's compensating part 10790, and this longitudinal retaining member such as can be releasably retained being defined in the longitudinal knife slit 10065 in anvil block 10060.Such as, longitudinal retaining member 10795 can comprise wedge-shaped cross-section, and this wedge-shaped cross-section comprises the top being greater than bottom, and wherein retaining member 10795 such as can be attached to tissue thickness's compensating part 10790 by bottom.

Referring now to Figure 31 2 and Figure 31 3, nail bin application device 10880, such as, can be used to be loaded in nail bin passage by the nail bin 10800 comprising support section 10810 and tissue thickness's compensating part 10820.Be similar to mentioned above, top such as can also organize thickness compensation part 10890 to locate relative to anvil block such as anvil block 10060 by nail bin application device 10880, such as make when anvil block 10060 closes, anvil block 10060 can contact and joining tissue thickness compensation part 10890.Tissue thickness's compensating part 10890 can comprise the multiple maintenance lower limbs 10895 extended from the top surface 10891 of tissue thickness's compensating part 10890, and this maintenance lower limb can engage anvil block 10060 and tissue thickness's compensating part 10890 is remained to anvil block 10060 releasedly.Such as, lower limb 10895 can be arranged to longitudinal row, and wherein each lower limb 10895 can comprise at least one foot, and this at least one foot can enter and engage the cutter slit 10065 be limited in anvil block 10060.Some feet of lower limb 10895 can extend along a direction, and other feet can extend along another direction.Some feet can extend along relative direction.Referring now to Figure 31 3 and 314, under any circumstance, once anvil block 10060 engages with tissue thickness compensating part 10890, anvil block 10060 can be opened again, and nail bin application device 10880 can be moved apart tissue thickness's compensating part 10820 and 10890 by clinician.Then, see Figure 31 4A, top organizes thickness compensation part 10890 can be positioned in the first side of destination organization, and can comprise bottom and organize tissue thickness's compensating part 10820 of thickness compensation part can be positioned on the second side of tissue.Referring now to Figure 31 4B, after tissue thickness's compensating part 10820 and 10890 is properly oriented, the blade such as blade 10053 of firing member such as can be pushed into through tissue and tissue thickness's compensating part.Referring now to Figure 31 8, nail bin application device such as application device 12280 such as can comprise the tissue thickness's compensating part 12290 being installed to it separably.As shown in Figure 31 9, when anvil block 10060 moves in make position, this tissue thickness's compensating part can be similar to and to be mentioned abovely inserted in nail bin passage and to be engaged by anvil block 10060.Such as, tissue thickness's compensating part 12290 can comprise the multiple retaining members 12295 upwards extended from the top surface 12291 of tissue thickness's compensating part 12290.Wherein each retaining member 12295 can comprise multiple flexible leg 12296, and the plurality of flexible leg can insert in the cutter slit 10065 in anvil block 10060.First see Figure 32 1 and 322, the flexible leg 12296 of each retaining member 12295 can be separated by gap 12298, make when lower limb 12296 inserts in cutter slit 10065, lower limb 12296 can inwardly bend, and once the foot of the expansion of flexible leg 12296 is through cutter slit 10065, then lower limb 12296 is subsequently to returning elastically outward.The foot of the expansion of flexible leg 12296 can be defined to the flexure below of the relative maintenance antelabium 12297 in anvil block 10060, and due to the interaction of lower limb 12296 and antelabium 12297, tissue thickness's compensating part 12290 can be held anvil block 10060.Then, nail bin application device 12280 is movable away from tissue thickness's compensating part 12290, as shown in Figure 32 0.In use, once the nail of tissue thickness's compensating part 12290 such as by disposing from nail bin 10000 is implanted against tissue, then anvil block 10060 can be opened again, and when anvil block 10060 moves away from the tissue thickness's compensating part 12290 implanted, the lower limb 12296 of retaining member 12995 can inwardly bend, and it can be pulled out from cutter slit 10065.

Referring now to Figure 31 5 and Figure 31 6, tissue thickness's compensating part such as tissue thickness's compensating part 11990 such as can by longitudinal load in anvil block such as anvil block 11960.More specifically, tissue thickness's compensating part 11990 can comprise one or more longitudinal rail 11995, this one or more longitudinal rail can insert in the distal openings in the cutter slit 11965 of anvil block 11960, and proximally promote subsequently, until tissue thickness's compensating part 11990 is placed in anvil block 11960 rightly.Such as, each guide rail 11995 can comprise can be positioned in longitudinally maintenance antelabium 11997 longitudinal direction maintenance foot 11996 below, and this longitudinally keeps antelabium such as to limit cutter slit 11965 at least partly.As shown in Figure 31 6, foot 11996 can extend along relative direction, and keep after antelabium 11997 to be positioned in, this maintenance antelabium is positioned on the opposite side of cutter slit 11965.Axial clearance 11998 can be limited between guide rail 11995, and when tissue thickness's compensating part 11990 is separated with anvil block 11960, this axial clearance can make guide rail 11995 towards inwardly bending each other.Referring now to Figure 31 7, tissue thickness's compensating part such as tissue thickness's compensating part 12090 such as can comprise one or more hammerlocks 12098 of the side periphery extending to anvil block such as anvil block 12060.In use, hammerlock 12098 can engage anvil block 12060 and tissue thickness's compensating part 12090 is remained to anvil block 12060 releasedly.Such as, anvil block 12060 such as can comprise one or more recess or lock shoulder 12097, and this one or more recess or lock shoulder can receive the foot extended from hammerlock 12098 separately.In use, after tissue thickness's compensating part 12090 is at least partly implanted, when anvil block 12060 moves away from tissue thickness's compensating part 12090, arm 12098 outwards can bend and be separated with anvil block 12060.

As mentioned above, surgery suturing appliance can comprise can receive nail bin nail bin passage, be rotatably connected to the anvil block of nail bin passage and comprise the firing member of blade, this firing member relative to anvil block and nail bin passage movable.In use, nail bin can be positioned in nail bin passage, and after nail bin is consumed at least in part, nail bin can remove from nail bin passage and be replaced by new nail bin.In some these type of embodiments, the nail bin passage of surgery suturing appliance, anvil block and/or firing member can be reused together with replacement nail bin.Alternatively, nail bin can comprise a part for disposable loading unit assembly, this disposable loading unit assembly such as can comprise nail bin passage, anvil block and/or firing member, and these can be used as a part of replacing disposable loading unit assembly and are replaced with nail bin.Some disposable loading unit assembly is disclosed in the U.S. Patent application 12/031 that the name submitted on February 15th, 2008 is called " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT ", in 817, whole disclosures of this patent application are incorporated herein by reference.Referring now to Figure 37 0, the axis of elongation 12570 that disposable loading unit such as disposable loading unit 12500 such as can comprise support section 12510, rotatably be connected to the anvil block 12560 of support section 12510 and extend from support section 12510.Be similar to nail bin as herein described, support section 12510 can comprise multiple nail chamber 10012 and nail, such as, be positioned at the nail 10030 in each nail chamber 10012.Disposable loading unit 12500 also can comprise firing member 12552, and this firing member can distally be pushed into anvil block 12560 is moved to make position from open position, as shown in Figure 37 0.Disposable loading unit 12500 also can comprise the tissue thickness's compensating part 12520 being positioned on support section 12510 and/or being attached to support section 12510.Wherein, when anvil block 12560 is in its make position, anvil block 12560 can be positioned in the opposite of tissue thickness's compensating part 12520, and when anvil block 12560 is in its make position, and anvil block 12560 can compress tissue thickness compensation part 12520 at least in part.In any one situation, firing member 12552 can be further promoted, to be penetrated from support section 12510 by nail.After nail is penetrated, follow closely and be out of shape by anvil block 12560, and catch tissue thickness's compensating part 12520 wherein at least partially.Then, firing member 12552 can proximally bounce back, and anvil block 12560 can be opened again, and the movable tissue thickness's compensating part 12520 away from implanting of support section 12510.

To being described further above, tissue thickness's compensating part 12520 can be detachably mounted to support section 12510.Such as, support section 12510 can comprise the longitudinal direction being installed to its each side and keep guide rail 12526, wherein each guide rail 12526 can comprise one or more hole 12528, and this one or more hole can tissue receiving thickness compensation part 12520 be at least partially wherein.Once tissue thickness's compensating part 12520 is at least partly implanted, then tissue thickness's compensating part 12520 tractive from hole 12528 can be gone out when support section 12510 moves apart.Referring now to Figure 37 1-373, disposable loading unit 12600 can comprise support section 12610, be installed to tissue thickness's compensating part 12620 of support section 12610 separably, with one or more maintenance guide rail 12626, this one or more maintenance guide rail can extend below tissue thickness's compensating part 12620, and tissue thickness's compensating part 12620 is installed to support section 12610.Each maintenance guide rail 12626 such as can comprise multiple maintenance hook 12628, and the plurality of maintenance hook joins support section 12610 to by the maintenance slit 12614 be such as limited in support section 12610.In use, such as, after tissue thickness's compensating part 12620 is at least partly implanted and support section 12610 moves away from tissue thickness's compensating part 12620, tissue thickness's compensating part 12620 can be separated with maintenance guide rail 12626.Referring now to Figure 37 4-376, disposable loading unit 12700 can comprise one or more maintenance guide rail 12726, and this one or more maintenance guide rail can comprise the bottom bar 12725 that can extend below tissue thickness's compensating part 12720 and the push rod 12727 that can extend above the top surface 12621 of tissue thickness's compensating part 12620 separately.Tissue thickness's compensating part 12620 at least can be partially compressed between push rod 12727 and bottom bar 12725, makes to keep guide rail 12726 to keep tissue thickness's compensating part 12620 releasedly relative to support section 12610.Such as, each maintenance guide rail 12726 can comprise one or more maintenance hook 12728, with support section 12610, this one or more maintenance hook can engage that maintenance guide rail 12726 is remained to support section 12610.

Referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800 can comprise retaining member 12822, and tissue thickness's compensating part 12620 can be installed to support section 12610 by this retaining member.Such as, retaining member 12822 can comprise the material piece that the platform surface 12611 against support section is located, and wherein tissue thickness's compensating part 12620 is such as attached to material piece by least one binding agent.Retaining member 12822 also can comprise and longitudinally keep guide rail 12825, and this longitudinal direction keeps guide rail can extend downwardly in the cutter slit 12615 be limited in support section 12610.Such as, the size of guide rail 12825 is kept can be set and can to become to make it to be compressed between the sidewall of cutter slit 12615.In use, firing member 12552 can comprise blade, firing member 12552 be distally pushed into and longitudinal cutting tissue thickness compensating part 12620 and keep guide rail 12825 time, this blade can pass cutter slit 12615.In addition, in use, the tissue that the nail penetrated from support section 12610 can penetrate retaining member 12822, tissue thickness's compensating part 12820 and be positioned between tissue thickness's compensating part 12820 and anvil block 12560.Retaining member 12822 by biocompatibility and/or can the material of bio-absorbable can be formed.Retaining member 12822 can by forming by compressed sufficiently material, to comprise the tissue thickness's compensating part below tissue thickness's compensating part 12620.Referring now to Figure 37 9-381, disposable loading unit 12900 can comprise charging assembly, this charging assembly comprises the base section 12922 that can be attached to support section 12610 removedly, the top section 12990 that can be attached to anvil block 12560 removedly, and connects the flexible joint 12991 of base section 12922 and top section 12990.Be similar to mentioned above, longitudinally keep guide rail 12825 can to extend in the cutter slit 12615 that is limited to support section 12610 from base section 12922 to downward-extension, make base section 12922 can be releasably retained support section 12610.Similarly, longitudinally keep guide rail 12995 can extend up in the cutter slit that is limited to anvil block 12560 from top section 12990, make top section 12990 can be releasably retained anvil block 12560.As shown in Figure 38 0 and 381, tissue thickness's compensating part 12620 can be installed to the base section 12922 of charging assembly, wherein, in order to relative to support section 12610 position tissue thickness compensation part 12620, clinician can make top section 12990 and base section 12922 towards flex relative to each other, charging assembly is positioned between anvil block 12560 and support section 12610, and the charging assembly of release flexure, make charging assembly can come resilient expansion and biased top section 12990 against anvil block 12560, and come resilient expansion and biased base section 12922 against support section 12610.Referring now to Figure 38 2-384, charging assembly also can comprise such as from one or more latch hooks such as latch hook 12994 that it extends, top section 12990 can be connected to anvil block 12560 by this latch hook releasedly, and/or base section 12922 is connected to support section 12610 releasedly.

Referring now to Figure 38 5, disposable loading unit 15900 such as can comprise anvil block 15960 and nail bin passage 15970, and wherein nail bin passage 15970 can rotate relative to anvil block 15960.Such as, anvil block 15960 may not rotate.Tissue can be positioned between anvil block 15960 and nail bin passage 15970, and nail bin passage 15970 can rotate towards tissue with against anvil block grasping tissue subsequently.Such as, also can comprise can tissue thickness's compensating part 15920 of contact tissue for disposable loading unit 15900.

As mentioned above and see Figure 33 2, nail bin such as nail bin 10000 such as can comprise support section 10010 and tissue thickness's compensating part 10020, wherein multiple nail 10030 can at least by section store in support section 10010, and to may extend in tissue thickness's compensating part 10020 when nail 10030 is in its non-firing position.When nail 10030 is in its non-firing position, the top of nail 10030 is not from tissue thickness's compensating part 10020 projection.When nail 10030 is moved to its firing position by staple drivers 10040 from its non-firing position, as mentioned above, the top of following closely 10030 can through tissue thickness's compensating part 10020 and/or through upper strata or crust 10022.In the embodiment of some alternative, when nail 10030 is in its non-firing position, the top of nail 10030 can the top surface of Tu Chuan tissue thickness compensating part 10020 and/or crust 10022.In any one situation, when nail 10030 extended upward support section 10010 before being deployed, nail 10030 can tilt and/or deflection relative to support section, similarly, as described above.Referring now to Figure 32 9, nail bin such as nail bin 13000 such as can comprise multiple ways or keeper, and the plurality of ways or keeper can be limited in the relative motion between the support section 13010 of nail bin 13000 and the top being positioned at the nail in nail bin.First see Figure 33 0, nail bin 13000 can comprise the tissue thickness's compensating part 13020 being installed to support section 13010, and is attached to multiple absorbent cottons 13022 of top surface 13021 of tissue thickness's compensating part 13020 in addition.Each absorbent cotton 13022 can comprise the multiple holes 13029 be defined in wherein, and the plurality of hole can receive and/or guide the lower limb 13022 of nail 13030 wherein slidably.Except hole or replace hole, absorbent cotton such as can comprise any suitable opening, such as slit, guider and/or groove, and it can hold and/or lead leg 13022 slidably.As shown in Figure 33 0, when nail 13030 is in its non-firing position, the top of nail lower limb 13032 can be positioned in hole 13029.Such as, when nail is in its non-firing position, the top of nail lower limb 13032 can project into above absorbent cotton 13022.Alternatively, when nail 13030 is in its non-firing position, the top of nail lower limb 13032 can be positioned in the below being just positioned at absorbent cotton 13022, make when nail 13030 is moved upwardly through tissue thickness's compensating part 13020, nail lower limb 13032 can to enter in the hole 13029 of absorbent cotton 13022 and to slide through this hole.Under any circumstance, when the lower limb 13032 of nail 13030 is positioned in absorbent cotton, side direction and/or the lengthwise movement of nail lower limb 13032 can be limited, and do not stop moving upward of nail lower limb 13032 when nail 13030 is deployed.When nail 13030 is deployed, referring now to Figure 33 1, nail lower limb 13032 can upward sliding through absorbent cotton 13022, with penetrate tissue T, contact is positioned at the anvil block on nail bin 13030 opposite, and distortion is downwards to catch tissue T wherein and tissue thickness's compensating part 13030.

To being described further above, absorbent cotton 13022 such as can use at least one biocompatibility and/or the binding agent of bio-absorbable can be attached to tissue thickness's compensating part 13020.Absorbent cotton 13022 and/or can be embedded at least partly in tissue thickness's compensating part 13020 from the retaining member that each absorbent cotton extends.Such as, tissue thickness's compensating part 13020 can comprise the pit that can receive absorbent cotton 13022 be at least partly defined in wherein.In molding manufacture process, tissue thickness's compensating part 13020 by molding integratedly or can be shaped around absorbent cotton 13022.Absorbent cotton 13022 can comprise the discrete keeper that can move independently of one another.First see Figure 33 0, each absorbent cotton 13022 can comprise interlocking and/or keyed feature structure, and this interlocking and/or keyed feature structure can allow and limit relative side direction and lengthwise movement between absorbent cotton 13022 to a certain extent.Such as, each absorbent cotton 13022 such as can comprise protuberance 13026 and one or more groove 13027, wherein the protuberance 13026 of the first absorbent cotton 13022 can be positioned in the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022, and/or aligns relative to the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022.Gap can be present between adjacent absorbent cotton 13022, and this gap can make absorbent cotton 13022 relative to each other move or slide, until it contacts adjacent absorbent cotton 13022.Absorbent cotton 13022 can loosely interconnection.Absorbent cotton 13022 can be connected to each other separably.Such as, absorbent cotton 13022 can be manufactured to the absorbent cotton of a slice interconnection, and wherein, when applying enough power to this sheet, one or more in absorbent cotton 13022 can depart from other absorbent cottons.Refer again to Figure 32 9, the first 13024 of absorbent cotton 13022 can be positioned on the first side of longitudinal slit 13025, and second of absorbent cotton 13,022 13024 can be positioned on the second side of slit 13025.To being described further above, the longitudinal slit 13025 extending through tissue thickness's compensating part 13020 can be conducive to the blade of firing member through tissue thickness's compensating part 13020, and when firing member is through tissue thickness's compensating part, firing member can apply compression stress to described 13024, and makes at least some in absorbent cotton 13022 separate or be separated.

Absorbent cotton 13022 such as by biocompatibility and/or can the plastics of bio-absorbable can be formed.Absorbent cotton 13022 such as can by solid material, semisolid material, and/or flexible material is formed.Absorbent cotton 13022 can be embedded in tissue thickness's compensating part, and absorbent cotton 13022 is moved with tissue thickness's compensating part.Such as, absorbent cotton 13022 can be enough flexible, and it can be bent with the top surface of tissue thickness's compensating part.Absorbent cotton 13022 can keep being embedded in tissue thickness's compensating part, and alternatively, and absorbent cotton 13022 can eject from tissue thickness's compensating part or be separated with tissue thickness compensating part.Absorbent cotton 13022 can comprise the top surface flushed with the top surface of tissue thickness compensating part.Above the top surface that the top surface of absorbent cotton 13022 can be positioned in tissue thickness's compensating part and/or below.The top surface of absorbent cotton 13022 can be configured such that it is for visible when observing from the top surface of tissue thickness's compensating part, and alternatively, the top surface of absorbent cotton 13022 such as can be positioned in the below of the layer of tissue thickness's compensating part.Guidance feature structure example is as being molded onto in the top surface of tissue thickness's compensating part.Such as, tissue thickness's compensating part can not comprise composite, and such as can comprise integral piece material.

Referring now to Figure 33 8, nail bin such as can comprise tissue thickness's compensating part 13620 and crust or top layer 13621.Such as, one or more absorbent cotton or keeper 13622 such as can embed in crust 13621.Each keeper 13622 can be included in the one or more holes 13629 wherein limited, and when nail 13030 is in its non-firing position, this one or more hole can receive the nail lower limb 13032 of nail 13030 wherein, as shown in Figure 33 8.To being described further above, in use, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 10032 can be slid through hole 13629, until the base portion 13031 contact tissue thickness compensation part 13620 of nail 13030, and such as carry out compress tissue thickness compensation part 13620 at least partially against the lower surface of absorbent cotton 13622.Referring now to Figure 33 3, nail bin such as can comprise tissue thickness's compensating part 13120 and crust or top layer 13122.Such as, tissue thickness's compensating part 13120 such as can comprise taper lug, the protuberance that upwards can extend from the top surface 13121 of tissue thickness's compensating part 13120, and/or projection 13128.When nail 13030 is in its non-firing position, protuberance 13128 can receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 33 3.Top layer 13122 also can comprise to align with protuberance 13128 or at least the taper lug of substantial alignment, protuberance and/or projection 13129 in use, nail lower limb 10032 can penetrate protuberance 13128 and 13129, and exposes from tissue thickness's compensating part 13120.Referring now to Figure 33 7, nail bin such as can comprise tissue thickness's compensating part 13520 and crust or top layer 13522.Such as, crust 13522 such as can comprise taper lug, the protuberance that upwards can extend from the top surface 13521 of tissue thickness's compensating part 13520, and/or projection 13529.Be similar to mentioned above, when nail 13030 is in its non-firing position, protuberance 13529 can receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 33 7.In use, follow closely lower limb 10032 can penetrate protuberance 13529 and expose from crust 13522.

Referring now to Figure 33 4, nail bin such as can comprise tissue thickness's compensating part 13220 and crust or top layer 13222.Such as, tissue thickness's compensating part 13220 such as can comprise and can extend downwardly into pyramidal pits in the top surface 13221 of tissue thickness's compensating part 13220 and/or groove 13128.When nail 13030 is in its non-firing position, the top of nail lower limb 13032 can extend across groove 13128, as shown in Figure 33 4.Top layer 13222 also can comprise and can align with groove 13228 or at least pyramidal pits of substantial alignment and/or groove 13229.Referring now to Figure 33 5, nail bin such as can comprise tissue thickness's compensating part 13320 and crust or top layer 13322.Such as, crust 13320 can comprise the thick part 13329 that can extend downwardly in the top surface 13321 of tissue thickness's compensating part 13320.In various embodiments, when nail 13030 is in its non-firing position, thick part 13329 can receive the nail lower limb 13032 of nail 13030 wherein at least partially, as shown in Figure 33 5.In such cases, nail lower limb 13032 can be remained on appropriate location by thick part 13329, lower limb 13032 is alignd or at least substantial alignment with the nail shaping pit of the anvil block being positioned at tissue thickness's compensating part 13320 opposite.Referring now to Figure 33 6, nail bin such as can comprise tissue thickness's compensating part 13420 and crust or top layer 13422.Such as, crust 13422 can comprise the thick part 13429 that upwards can extend from the top surface 13421 of tissue thickness's compensating part 13420.In various embodiments, when nail 13030 is in its non-firing position, thick part 13429 can receive the nail lower limb 13032 of nail 13030 wherein at least partially, as shown in Figure 33 6.In such cases, nail lower limb 13032 can be remained on appropriate location by thick part 13429, lower limb 13032 is alignd or at least substantial alignment with the nail shaping pit of the anvil block being positioned at tissue thickness's compensating part 13420 opposite.

Referring now to Figure 33 9 and 340, nail bin such as can comprise tissue thickness's compensating part 13720 and crust or top layer 13721.Such as, tissue thickness's compensating part 13720 such as can comprise the taper and/or staged lug, protuberance that upwards can extend from the top surface 13721 of tissue thickness's compensating part 13720, and/or projection 13728.When nail 13030 is in its non-firing position, protuberance 13728 can receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 34 0.Similarly, top layer 13721 can comprise and can align with protuberance 13728 or at least taper of substantial alignment and/or staged lug, protuberance and/or projection 13729.Crust 13721 also can comprise the one or more tusks 13727 upwards extended from protuberance 13729, this tusk can engage the tissue of locating against top layer 13721, and prevent or be at least limited in tissue, top layer 13721, and/or relative side direction and/or lengthwise movement between the top of nail lower limb 13032.In use, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 13032 can penetrate protuberance 13728 and 13729 and expose from tissue thickness's compensating part 13720.Referring now to Figure 34 1 and 342, nail bin such as can comprise tissue thickness's compensating part 13820 and crust or top layer 13821.Such as, tissue thickness's compensating part 13820 such as can comprise the taper and/or staged lug, protuberance that upwards can extend from the top surface 13821 of tissue thickness's compensating part 13820, and/or projection 13828.When nail 13030 is in its non-firing position, protuberance 13828 can receive and encapsulate the top of the nail lower limb 13032 of nail 13030, as shown in Figure 34 2.Similarly, top layer 13821 can comprise and can align with protuberance 13828 or at least taper of substantial alignment and/or staged lug, protuberance and/or projection 13829.Top layer 13821 also can comprise the one or more tusks 13827 extended downwardly in tissue thickness's compensating part 13820, and this tusk such as can prevent or at least limit relative side direction and/or lengthwise movement between top layer 13821 and tissue thickness's compensating part 13820.In use, when nail 13030 moves to its firing position from its non-firing position, nail lower limb 10032 can penetrate protuberance 13828 and 13829 and expose from tissue thickness's compensating part 13820.

Referring now to Figure 34 3, nail bin can comprise tissue thickness's compensating part such as tissue thickness's compensating part 13920, and this tissue thickness's compensating part such as can comprise the ridge 13923 and paddy 13924 that are defined in wherein, and paddy 13924 can be limited between ridge 13923.Each ridge 13923 can comprise identical height, substantially the same height or different height.Similarly, each paddy 13924 can comprise the identical degree of depth, the substantially the same degree of depth or the different degree of depth.Multiple nail 13030 can be stored in tissue thickness's compensating part 13920 at least partly, and the top of nail 13030 can be positioned in ridge 13923.Such as, when nail 13030 is stored in its non-firing position, the nail lower limb 13032 of nail 13030 such as can not from tissue thickness's compensating part 13920 and/or the crust or top layer 13921 projection that are attached to tissue thickness's compensating part 13920.Ridge 13923 and/or paddy 13924 can extend laterally across nail bin.Such as, nail bin can comprise longitudinal knife slit, its median ridge 13923 and paddy 13924 can transversely in and/or direction perpendicular to cutter slit extend.In all cases, the top of nail lower limb 13032 can be remained on appropriate location by ridge 13923, until nail 13030 moves to its firing position from its non-firing position.Referring now to Figure 34 4, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part comprises longitudinal ridge and/or paddy.Such as, tissue thickness's compensating part can comprise the top surface limited by ridge 14023 and paddy 14024, and its two-story valley 14024 such as can be limited between ridge 14023.Tissue thickness's compensating part can comprise crust 14021, and this outer micromicro comprises the multiple holes 14029 be defined in wherein, and each hole can receive nail lower limb 13032 separately.Hole 14029 can be limited in ridge 14023, wherein follows closely below peak 14028 that the top of lower limb 13032 can be positioned in ridge 14029, is oriented to flush with peak 14028, and/or be positioned in above peak 14028.In addition to the above or replace mentioned above, hole 14029 such as can be limited in paddy 14024.Each hole such as can embossed around or at least partly around, this embossing can strengthen crust and/or tissue thickness's compensating part of surrounding hole.Under any circumstance, to being described further above, crust 14021 can be attached to tissue thickness's compensating part in any suitable manner, such as, comprise and use at least one binding agent.

As mentioned above and refer again to Figure 23 3, surgery suturing appliance such as can comprise anvil block such as anvil block 10060, and this anvil block can move between the open and the closed positions, so that such as against tissue thickness's compensating part 10020 compress tissue T of nail bin 10000.In all cases, anvil block 10060 can rotate towards nail bin 10000, until its move downward by certain part of nail bin 10000 and/or be positioned with nail bin 10000 passage certain part stop.In at least one this type of embodiment, anvil block 10060 can be rotated down, until its move downward by the nose 10003 of nail bin 10000 and/or be positioned at tissue T in the middle of nose 10003 and nail bin 10000 resist.In some cases, anvil block 10060 can abundant compress tissue thickness compensation part 10020, to make the top of tissue T contact stud 10030.In some cases, according to the thickness of tissue T, anvil block 10060 can abundant compress tissue thickness compensation part 10020, during such that anvil block 10060 has arrived its complete make position by the time, anvil block 10060 with follow closely 10030 and contact.In other words, in such cases, be advanced to before pulling the trigger nail 10030 in nail bin 10000 at firing member 10052, anvil block 10060 can make nail 10030 be out of shape.This type of situation is acceptable in certain embodiments; But referring now to Figure 35 8 and 359, contemplate other embodiments.In other embodiments described, such as, distant gap setting member such as element 10059 can be used to limit following distance: before trigger shaft 10052 is advanced in nail bin 10000, anvil block 10060 can be closed in this distance.Element 10059 upwards can extend from the top surface 10021 of tissue thickness's compensating part 10020, and make when tissue T rest element 10059 is compressed and produced drag therebetween, moving downward of anvil block 10060 can be prevented from.In use, as mentioned above, firing member 10052 can distally be advanced in nail bin 10000 towards the distal end 10002 of nail bin 10000, to be penetrated from support section 10010 by nail 10030.Meanwhile, firing member 10052 can engage anvil block 10060, and is positioned at by anvil block 10060 on the nail 10030 that is just being formed, apart from platform surface 10011 (Figure 21 8) desired distance of support section 10010.Like this, firing member 10052 can control the tissue contacting surface of anvil block 10060 and the distance between the platform surface 10011 of particular locations or gap.Wherein, when firing member 10052 is distally pushed into, this particular location can distally be pushed into.In all cases, this clearance distance can be shorter than the gap between anvil block 10060 and platform surface 10011, this gap by the distal end of tissue thickness's compensating part 10020 distant gap setting member 10059 control or determine.Referring now to Figure 35 9, when firing member 10052 arrives the distal end of tissue thickness's compensating part 10020, the blade 10053 of firing member 10052 can crosscut distant gap setting member 10059, make after element 10059 has been crosscut, firing member 10052 can by anvil block 10060 towards support section 10010 tractive downwards, and when when the distal end place of nail bin 10000 percussion nail 10030, by gap-closing to the clearance height expected.In the embodiment of some alternative, when the distal end of firing member close to nail bin, distant gap setting member can be collapsed.Such as, distant gap setting member can comprise pillars, this pillars can provide the resistance for anvil block as mentioned above, and when the distal end of firing member close to nail bin once reach the fastening intensity of gap setting member, then then this pillars fastens suddenly.This tightening force such as can be about 10 ft lbfs.When applying such as to exceed the power of scheduled volume to gap setting member, gap setting member can in the platform falling into support section.Alternatively, distant gap can be controlled by the nose of nail bin.Such as, moving downward of anvil block 10060 can be limited by nose, until firing member has arrived the distal end in storehouse, wherein, the compression stress being applied to nose now can make nose collapse.Nose can comprise the chamber limited by chamber wall.Once the compression stress being applied to chamber exceedes predetermined power, then chamber can be made to collapse.Such as, chamber can be limited by the wall that can collapse.

As mentioned above, anvil block such as anvil block 10060 such as can move between the open and the closed positions, so as between anvil block and the support section of nail bin compress tissue thickness compensation part.In some cases, referring now to Figure 36 0 and 361, when tissue thickness's compensating part 14120 against nail bin 14100 support section 14110 by compression time, tissue thickness's compensating part 14120 of tissue thickness's compensating part such as nail bin 14100 of nail bin such as can side direction and/or Longitudinal Extension.The end of tissue thickness's compensating part 14120 and/or side can not supported portion divide 14110 and/or anvil block 10060 retrain.Therefore, when not producing compression pressure or at least unexpected compression pressure in tissue thickness's compensating part 14120, tissue thickness's compensating part 14120 can along those Directional Extensions.In such cases, firing member such as such as can the improper prevention by compression stress unexpected in tissue thickness's compensating part 14120 through the firing member 10052 (Figure 23 6) of tissue thickness's compensating part 14120.Alternatively, refer again to Figure 36 0, the distal end 14125 of tissue thickness's compensating part 14120 such as can be retrained by the nose 14103 of nail bin 14100.In this specific embodiment, be similar to mentioned above, the distal end 14125 of tissue thickness's compensating part 14120 can be retrained by nose 14103, to reduce the probability of tissue thickness's compensating part 14120 and support section 14110 premature disengagement.Under any circumstance, due to mentioned above, large internal pressure can result from distal end 14125, and this internal pressure can stop the propelling of firing member 10052, especially when firing member 10052 arrives distal end 14125.More specifically, in some cases, when firing member 10052 transecting patient tissue thickness compensation part 14120, firing member can distally promote, plough except and/or transfer tissue thickness compensating part 14120.Therefore, even larger internal pressure can result from the distal end 14125 of tissue thickness's compensating part 14120.In order to eliminate this pressure in tissue thickness's compensating part 14120 at least partly, nose 14103 can be made up of flexible material.This flexible material can make nose 14103 such as distally bend, and is that tissue thickness's compensating part 14120 produces additional space.Referring now to Figure 36 2 and Figure 36 3, the nose of nail bin can comprise the part that can distally slide.More specifically, the nose 14203 of nail bin 14200 can comprise slidably part 14204, this slidably partly can be connected to nose 14203 slidably, make when anvil block 10060 is closed and/or firing member 10052 is advanced in the distal end of nail bin 14200, slidably part 14204 distally can be slided and is that tissue thickness's compensating part 14200 produces additional space, and alleviates internal pressure wherein at least partly.One in nose 14203 and slidably part 14204 can comprise one or more guide rail, and the another one in nose 14203 and slidably part 14204 can comprise one or more passages that can receive guide rail wherein slidably.Such as, passage and guide rail such as can cooperate and limit the motion of slidably part 14204 to longitudinal distal channel.

In all cases, to being described further above, such as farthest side in nail bin nail such as can the larger part of nearside nail in the ratio nail bin of capture tissue thickness compensation part.In this case, therefore, compared to nearside nail, the tissue of catching in can distad following closely applies large clamping pressure.As mentioned above, although tissue thickness's compensating part can be made up of the material of the homogeneity substantially with substantial constant thickness, but when being transferred to during use at least partially and/or being gathered in the distal end place of nail bin of tissue thickness's compensating part, these situations can be there are.In all cases, expect that some nail applies larger clamping pressure to organizing compared with other are followed closely, wherein support section and/or tissue thickness's compensating part can be configured to and be arranged to control which nail can apply less clamping pressure to tissue to the tissue larger clamping force of applying and which nail.Referring now to Figure 36 4, nail bin 14300 can comprise support section 14310, and is in addition positioned at the tissue thickness's compensating part 14320 on the platform surface 14311 of support section 14310.Compared with other embodiments comprising the support section 14310 with smooth or at least substantially smooth platform surface disclosed in present patent application, platform surface 14311 can tilt and/or decline between the distal end 14305 of support section 14310 and proximal extremity 14306.The platform surface 14311 of support section 14310 can comprise the podium level at its distal end 14305 place, and this podium level is lower than the podium level at its proximal extremity 14306 place.Such as, the nail 10030 at the distal end place of nail bin 14300 may extend into distance larger above platform surface 14311 compared to the nail 10030 at proximal extremity place.In the embodiment of various alternative, the platform surface of support section can comprise the height at its distal end place, and this height is higher than the height at its proximal extremity place.Refer again to Figure 36 4, tissue thickness's compensating part 14320 can comprise along the different thickness of its longitudinal length.Tissue thickness's compensating part 14320 such as can comprise the thickness at its distal end 14325 place, and this thickness is thicker than its proximal extremity 14326.Such as, tissue thickness's compensating part 14322 can comprise lower surface 14322, this lower surface tiltable or decline, to mate or at least substantially to mate the inclination of support section 14310 or the platform surface 14311 of decline.Therefore, the top of tissue thickness's compensating part 14320 or tissue contacting surface 14321 can be positioned with the smooth or at least substantially smooth surface of tissue T above can comprising.Under any circumstance, because tissue thickness's compensating part 14320 is thicker at its distal end 14325 place, therefore distally nail 10030 can catch the major part of tissue thickness's compensating part 14320 wherein compared to nearside nail 10030.Therefore, distally nail 10030 can apply larger compression stress to tissue T, and the clearance distance especially between anvil block 10060 and platform surface 14311 is constant or at least during substantial constant in the proximal extremity of nail bin and distal end place.But in some cases, anvil block 10060 possibly cannot arrive complete make position, and the clearance distance therefore between anvil block 10060 and platform surface 14311 is larger at the comparable proximal extremity place of distal end place of nail bin 14300.In all cases, distally nail 10030 may not be shaped completely, and therefore distally nail 10030 may not apply the clamping pressure of expectation to tissue T.At tissue thickness's compensating part in the thicker embodiment in the distal end place of nail bin, tissue thickness's compensating part can compensate unshaped nail and apply enough pressure to tissue T.

Referring now to Figure 36 5, tissue thickness's compensating part 14420 that nail bin such as nail bin 14400 such as can comprise support section 14410 and in addition be positioned on the platform surface 14411 of support section 14410.Be similar to mentioned above, platform surface 14411 tiltable and/or decline, make the distal end 14405 of support section 14410 such as can have the podium level of the podium level lower than proximal extremity 14406 place.Tissue thickness's compensating part 14420 can comprise thickness that is constant or at least substantial constant along its length.And therefore, tissue thickness's compensating part 14420 top or tissue contacting surface 14421 can be parallel to or at least substantially parallel to the profile of platform surface 14411.When nail 10030 is in its non-firing position, the nail 10030 of nail bin 14400 can embed in tissue thickness's compensating part 14420 and support section 14410 completely.When nail 10030 is in its non-firing position, the nail 10030 being positioned in the proximal extremity place of nail bin 14400 can embed in tissue thickness's compensating part 14420 and support section 14410 completely; And due to the decline slope of platform 14411 and top surface 14421, when nail 10030 is in its non-firing position, the top of 10030 (comprising the nail 10030 at the distal end place being positioned in nail bin 14400) of some nails, can the top surface 14421 of Tu Chuan tissue thickness compensating part 14420.

As mentioned above, tissue thickness's compensating part can be made up of homogenous material, and wherein whole tissue thickness compensating part such as can have identical or at least substantially the same material behavior from start to finish, such as density, rigidity, device of spring stiffness coefficient, hardness, and/or elasticity.Alternatively, referring now to Figure 36 8, tissue thickness's compensating part such as tissue thickness's compensating part 14520 such as can comprise multiple material or material layer.Tissue thickness's compensating part 14520 can comprise first or central stratum 14520a, be attached to second or the intermediate layer 14520b of ground floor 14520a on opposite sides thereof, and is attached to each the 3rd or outer 14520c in second layer 14520b.Can use at least one binding agent that intermediate layer 14520b is attached to central stratum 14520a, and similarly, can use at least one binding agent that outer 14520c is attached to the second layer 14520.Than adhesives or replace binding agent, such as by one or more interlocking features structure and/or securing member, layer 14520a-14520c is kept together.Under any circumstance, internal layer 14520a such as can be made up of first material with first group of material behavior; Intermediate layer 14520b can be made up of second material with second group of material behavior; And outer 14520c can be made up of the 3rd material with the 3rd group of material behavior.These several groups of material behaviors such as can comprise density, rigidity, device of spring stiffness coefficient, hardness and/or elasticity.Nail bin such as can comprise six nails 10030, wherein a nail 10030 such as can at least by be partly positioned in outer 14520c each in and in each in internal layer 14520b, and wherein two row nails 10030 can be at least partly positioned in internal layer 14520a.In use, be similar to mentioned above, nail 10030 can penetrate from nail bin, make the top surface 14521 of the nail lower limb 10032 penetrate tissue thickness compensation part 14520 of nail 10030, penetrate the tissue of being located against top surface 14521 by anvil block and contact anvil block subsequently, making lower limb 10032 be out of shape to catch the tissue thickness's compensating part 14520 in nail 10030 and tissue.Also be similar to mentioned above, when firing member is pushed into through nail bin, tissue thickness's compensating part 14520 can by firing member crosscut.Such as, firing member such as can along the path crosscut internal layer 14520a limited by axis 14529 and tissue.

To being described further above, the many nails 10030 be positioned in internal layer 14520a can comprise the nail row closest to the edge of the tissue be crosscut.Correspondingly, the many nails 10030 be positioned in outer 14520c can comprise the edge nail row farthest from the tissue be crosscut.The first material forming internal layer 14520a such as can comprise the density of the second material higher than formation intermediate layer 14520b; And similarly, the density of the second material can higher than the density of the 3rd material of the outer 14520c of formation.In all cases, therefore, the compression stress produced in the nail 10030 be positioned in intermediate layer 14520b and outer 14520c, larger compression stress can produce in the nail 10030 be located in internal layer 14520a.Similarly, the compression stress produced in the nail 10030 be positioned in outer 14520c, larger compression stress can produce in the nail 10030 be located in the 14520b of intermediate layer.Alternatively, the first material forming internal layer 14520a such as can comprise the density of the second material lower than formation intermediate layer 14520b; And similarly, the density of the second material can lower than the density of the 3rd material of the outer 14520c of formation.In all cases, therefore, the compression stress produced in the nail 10030 be positioned in intermediate layer 14520b and internal layer 14520a, larger compression stress can produce in the nail 10030 be located in outer 14520c.Similarly, the compression stress produced in the nail 10030 be positioned in internal layer 14520a, larger compression stress can produce in the nail 10030 be located in the 14520b of intermediate layer.Alternatively, the layer of any other suitable constructions, material can be used, and/or material behavior.Under any circumstance, the layer 14520a-14520c of tissue thickness's compensating part 14520 can be attached to one another in implanted rear maintenance.Alternatively, the layer 14520a-14520c of tissue thickness's compensating part 14520 can implanted rear separated from one another.Such as, layer 14520a-14520c can utilize one or more binding agent of bio-absorbable to combine, these one or more can the binding agent of bio-absorbable can first layer be remained to together, then pass in time and make layer from discharging each other.

As mentioned above, tissue thickness's compensating part of nail bin such as tissue thickness's compensating part 14520 such as can comprise multiple longitudinal layer.Alternatively, referring now to Figure 36 9, nail bin can comprise tissue thickness's compensating part such as tissue thickness's compensating part 14620, and this tissue thickness's compensating part such as can comprise multiple level course.Such as, tissue thickness's compensating part 14620 can comprise first or bottom 14620a, be attached to second or the intermediate layer 14620b of bottom 14620a, and is attached to the 3rd or the top layer 14620c of intermediate layer 14620b.Ground floor 14620a such as can comprise smooth or substantially smooth lower surface 14626a and triangle or taper top surface 14625a.Such as, second layer 14620b can comprise the lower surface 14626b of triangle or taper, and this lower surface can be parallel to and adjoin the top surface 14625a of ground floor 14620a.Be similar to mentioned above, second layer 14620b can comprise the top surface 14625b of triangle or taper, and this top surface such as can be parallel to and adjoin the bottom triangle of third layer 14620c or the lower surface 14626c of taper.The top surface of third layer 14626c can comprise smooth or at least substantially smooth tissue contacting surface 14621.Also be similar to mentioned above, tissue thickness's compensating part 14620 such as can store six row nails wherein at least in part and such as follow closely 10030, and wherein firing member such as can along the tissue thickness's compensating part 14620 between the nail row of the passage crosscut two extending through axis 14629 inner side.Be similar to mentioned above, each layer of 14620a, 14620b, and 14620c can be made up of the different materials comprising dissimilar material properties, and due to triangle or the conical configuration of layer 14620a-14620c, tissue thickness's compensating part 14620 can have different overall characteristic in each position within it.Such as, outermost nail row 10030 can the more third layer 14620c of capture ratio ground floor 14620a wherein, and the nail row 10030 of inner side can the less third layer 14620c of capture ratio ground floor 14620a.Therefore, although tissue thickness's compensating part 14620 can have the identical or at least substantially the same general thickness across it, the mode that tissue thickness's compensating part 14620 such as can be different from the tissue that compression is trapped in inner side nail 10030 compresses the tissue be trapped in outermost nail 10030.

Referring now to Figure 28 6, the space that the thickness that tissue thickness's compensating part 14720 of tissue thickness's compensating part such as nail bin 14700 of nail bin such as can comprise the made tissue thickness compensating part 14720 be defined in wherein changes, pit, passage, and/or groove.Such as, tissue thickness's compensating part 14720 can be located against the platform surface 14711 of the support section 14710 of nail bin 14700, and the space 14723 be limited in the lower surface 14722 of tissue thickness's compensating part 14720 can be overlayed on above some nail chamber 10012 instead of on other nail chambeies.Space 14723 such as can transverse to the cutter slit 14715 of support section 14710, perpendicular to cutter slit 14715, and/or is parallel to cutter slit 14715 and extends.Space 14723 can limit bearing-surface pattern in the lower surface 14722 of tissue thickness's compensating part 14720.Under any circumstance, when such as nail 10030 is such as deployed from support section 14710 nail, referring now to Figure 28 7 and 288, some nail 10030 can comprise the region IT tissue thickness compensating part 14720 in space 14723; And other nails 10030 can be located in the region IT tissue thickness compensating part 14720 in the middle of space 14723.In addition to the above or replace mentioned above, tissue thickness's compensating part 14720 such as can comprise the space be limited in top or tissue contacting surface 14721, pit, passage and/or groove.Referring now to Figure 36 6 and Figure 36 7, nail bin 14800 can comprise tissue thickness's compensating part 14820, this tissue thickness's compensating part can comprise multiple bearing-surface 14823, the plurality of bearing-surface is such as at least one in following situation: upwards extend from the top surface 14821 of tissue thickness's compensating part 14820, extend internally towards central groove 14825, and/or distally extend towards the distal end of nail bin 14800.Such as, bearing-surface 14823 such as can by passage, slit, and/or groove such as passage 14824 is separately.In all cases, due to mentioned above, the general thickness of tissue thickness's compensating part can change between change and/or the nail in nail row between nail row.In some cases, bearing-surface or thick part can be constructed to and be arranged so that when tissue thickness's compensating part is compressed, and bearing-surface or thick part such as inwardly can flow along the direction expected.

Referring now to Figure 30 3, nail bin such as nail bin 14900 such as can comprise support section 14910 and in addition against support section 14910 by tissue thickness's compensating part 14920 of locating.Be similar to mentioned above, support section 14910 can comprise the staple drivers that upwards can be lifted by nail deployment sliding part, to lift nail such as follow closely 10030, this nail, such as towards anvil block, is such as positioned in the anvil block 10060 on nail bin 14900 opposite and is at least partly positioned in support section 14910.Support section 14910 such as can comprise six nail chambeies, the such as two nail chambeies in outside, the nail chamber of inner side, and the nail chamber, centre two be positioned in the middle of inboard row and outboard row, wherein anvil block 10060 can comprise to align with nail chamber or at least substantial alignment six line up shape pit 10062.Nail chamber, inner side can comprise the staple drivers 14940a be positioned at wherein; Middle nail chamber can comprise the staple drivers 14940b be positioned at wherein; And nail chamber, outside can comprise the staple drivers 14940c be positioned at wherein.Each wherein in staple drivers 14940a can comprise can the support 14949a of support nail 10030; Each wherein in staple drivers 14940b can comprise can the support 14949b of support nail 10030; And each wherein in staple drivers 14940c can comprise can the support 14949c of support nail 10030.At its non-firing position place, namely, when staple drivers 14940a-14940c is placed on the driver support member 14926 extended to below support section 14910, can locate closer to anvil block 10060 compared to the support 14949a of the support 14949b of staple drivers 14940b and the support 14949c of staple drivers 14940c, staple drivers 14940a.In this type of position, the first shaping distance can be limited at support 14949a and be positioned between the shaping pit 10062 above support 14949a; Second shaping distance can be limited at support 14949b and be positioned between the shaping pit 10062 above support 14949b; And the 3rd shaping distance can be limited at support 14949c and be positioned between the shaping pit 10062 above support 14949c.Wherein such as the first shaping distance can be shorter than the second shaping distance, and the second shaping distance can be shorter than the 3rd shaping distance.When staple drivers 14940a-14940c moves to its firing position from its non-firing position (Figure 30 3), each staple drivers 14940a-14940c can be disposed sliding part by nail and move upward equal or at least substantially equal distance towards anvil block 10060, makes the first driver 14940a that its respective nail 10030 is driven the first forming height; Its respective nail 10030 is driven the second forming height by the second driver 14940b; And its respective nail 10030 is driven the 3rd forming height by the 3rd driver 14940c.Wherein, such as the first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Contemplate other embodiments various, wherein the first staple drivers 14940a is by upward displacement first distance; Second staple drivers 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacement the 3rd distance.Wherein, one or more in the first distance, second distance, the 3rd distance can be different.

Refer again to Figure 30 3, relative to the tissue contacting surface 10061 of anvil block 10060, the platform surface 14911 of support section 14910 can in height change to some extent.This height change can produce in side direction, and such as can higher than the height of the platform surface 14911 around nail chamber, outside around the height of the platform surface 14911 in nail chamber, inner side.The lower surface 14922 of tissue thickness's compensating part 14920 can be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910.To being described further above, tissue thickness's compensating part 14920 also can change to some extent on thickness.Wherein the top of tissue thickness's compensating part 14920 or tissue contacting surface 14921 can slope inwardly from its outward flange or lateral edge.Such as, due to mentioned above, tissue thickness's compensating part 14920 such as can be located in inner side nail chamber above region in thinner, and be located in outside nail chamber above region in thicker.Referring now to Figure 30 4, the platform surface of support section 15010 such as can comprise staged platform surface, and wherein the highest step of stepped surface such as can around nail chamber, inner side, and the minimum step of stepped surface can around nail chamber, outside.Such as, the step with intermediate altitude can around middle nail chamber.Tissue thickness's compensating part such as tissue thickness's compensating part 15020 such as can comprise lower surface, and this lower surface can be parallel to and the platform surface of adjacent support section 15010.The top of tissue thickness's compensating part or tissue contacting surface 15021 such as can comprise arc, parabolical, and/or curved surface, this surface can extend to the second cross side of tissue thickness's compensating part 15020 from the first cross side of tissue thickness's compensating part 15020, wherein such as align with the center of nail bin 15000 or at least substantial alignment in summit.Referring now to Figure 29 9, nail bin 15300 such as can comprise support section 15310, be positioned at multiple staple drivers 15340 of the nail intracavity be defined in support section 15310 movingly, and the tissue thickness's compensating part 15320 above the platform surface 15311 being positioned at support section 15310.Nail bin 15300 also can comprise one or more flat of bottom 15326, and this flat of bottom can be attached to support section 15310 and extend to the bottom periphery of support section 15310, and supporting driver 15340 and the nail 15330 being in its non-firing position.When following closely deployment sliding part and being pushed into through nail bin, along with staple drivers 15340 and nail 15330 upwards lift through tissue thickness's compensating part 15320 by sliding part, sliding part also can be supported by bottom flat of bottom 15326.Tissue thickness's compensating part 15320 can comprise and is positioned at first or interior section 15322a above nail chamber, inner side, is positioned at second or mid portion 15322b above middle nail chamber, and is positioned at the 3rd above a nail chamber or exterior section 15322c.Wherein, such as interior section 15322a can be thicker than mid portion 15322b, and mid portion 15322b can be thicker than exterior section 15322c.Tissue thickness's compensating part 15320 such as can comprise the vertical passage be defined in wherein, and the thinner that this vertical passage can produce tissue thickness's compensating part 15320 divides 15322b and 15322c.Alternatively, in the vertical passage top surface that can be limited at tissue thickness's compensating part and/or lower surface.The top surface 15321 of tissue thickness's compensating part 15320 such as can comprise smooth or at least substantially smooth surface.

Referring now to Figure 29 6, nail bin such as can comprise tissue thickness's compensating part such as tissue thickness's compensating part 15120, and this tissue thickness's compensating part can comprise multiple parts with different-thickness.Tissue thickness's compensating part 15120 can comprise first or the interior section 15122a can with the first thickness, second or the mid portion 15122b can separately with the second thickness that extend from Part I 15122a, and from the 3rd or the exterior section 15122c can separately with the 3rd thickness that Part II 15122b extends.Such as, the 3rd thickness can be thicker than the second thickness, and the second thickness can be thicker than the first thickness, but such as can use any suitable thickness in other embodiments various.The part 15122a-15122c of tissue thickness's compensating part 15120 can comprise the step with different-thickness.Be similar to mentioned above, nail bin can comprise some nails 10030 and have multiple staple drivers of differing heights, and this staple drivers can make nail 10030 be deformed into different forming heights.Also be similar to mentioned above, nail bin can comprise the first staple drivers 15140a, it can drive support nail 10030 to the first forming height thereon, the second staple drivers 15140b, it can drive support nail 10030 to the second forming height thereon and the 3rd staple drivers, and it can drive support nail 10030 thereon to the 3rd forming height.Wherein, such as the first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.As shown in Figure 29 6, each nail 10030 can comprise identical or substantially the same unshaped or not pull the trigger height.Alternatively, referring now to Figure 29 6A, the first driver 15140a, the second driver 15140b and/or the 3rd driver 15140c can support the nail with different unshaped height.Such as, first staple drivers 15140a can support the nail 15130a with the first unshaped height, second staple drivers 15140b can support the nail 15130b with the second unshaped height, and the 3rd staple drivers 15140c can support the nail 15130c with the 3rd unshaped height, wherein, such as the first unshaped height can be shorter than the second unshaped height, and the second unshaped height can be shorter than the 3rd unshaped height.Refer again to Figure 29 6A, the top of nail 15130a, 15130b and/or 15130c can be arranged in or at least be located substantially on identical plane, and alternatively, the top of nail 15130a, 15130b and/or 15130c can not be arranged in identical plane.Referring now to Figure 29 7, nail bin can comprise tissue thickness's compensating part 15220 with multiple part, and the plurality of part has different thickness, and this tissue thickness's compensating part is implanted by against tissue T by nail 15130a, 15130b and 15130c, as mentioned above.Referring now to Figure 29 8, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights, wherein the first nail 15130a can be configured as the first forming height, second nail 15130b can be configured as the second forming height, and the 3rd nail 15130c can be configured as the 3rd forming height, and wherein the first forming height such as can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Contemplate other embodiments, wherein follow closely 15130a, 15130b and can be configured as any suitable forming height and/or any relative forming height with 15130c.

As mentioned above, the anvil block of surgery suturing appliance can move between the open and the closed positions.In this case, when anvil block moves to its make position, the tissue contacting surface of anvil block is moveable to its final or shaping position.Once anvil block is in its make position, tissue contacting surface can be no longer adjustable.Alternatively, referring now to Figure 35 1, surgical stapling device such as surgical stapling device 15500 such as can comprise anvil channel 15560 and be positioned at the adjustable tissue contact anvil block adjustable plate 15561 in anvil channel 15560.In such cases, anvil block plate 15561 can be promoted and/or be reduced in anvil channel 15560, so that relative to being positioned at the nail bin on anvil block plate 15561 opposite to regulate the position of the tissue contacting surface of anvil block plate 15561.Surgical stapling device 15500 can comprise adjusting slider 15564.See Figure 35 6 and 357, this adjusting slider can at anvil channel 15560 and anvil block plate 15561 middle slip, to control the distance between anvil block plate 15561 and nail bin.Refer again to Figure 35 1 and 352, surgical stapling device 15500 also can comprise the actuator 15562 being attached to adjusting slider 15564, this actuator can proximally slide to make adjusting slider 15564 proximally slide, and/or distally slides to make adjusting slider 15564 distally slide.Refer again to Figure 35 6 and 357, slide between the position that actuator 15562 can limit in advance at two or more, to regulate anvil block plate 15561 respectively between two or more positions.This type of position limited in advance such as can be divided into demarcation line 15563 (Figure 35 1) on surgical stapling device 15500.See Figure 35 7, adjusting slider 15564 such as can comprise multiple stayed surface, such as the first stayed surface 15565a, the second stayed surface 15565b and the 3rd stayed surface 15565c, the plurality of stayed surface can align with the multiple plate locating surfaces on the back side of anvil block plate 15561 respectively, such as the first locating surface 15569a, the second locating surface 15569b and the 3rd locating surface 15569c, to be positioned at primary importance by anvil block plate 15561.In order to anvil block plate 15561 is located in the second position, actuator 15562 and slide block 15564 such as can proximally slide, again to be alignd relative to the locating surface 15569a-15569c of anvil block plate 15561 by the stayed surface 15565a-15565c of slide block 15564.More specifically, see Figure 35 6, slide block 15564 can distally slide, make the first stayed surface 15565a of slide block 15564 can be positioned in after the second locating surface 15569b of anvil block plate 15561, and make the second stayed surface 15565b of slide block 15564 can be positioned in after the 3rd locating surface 15569c of anvil block plate 15561, to move to anvil block plate 15561 closer to nail bin.When anvil block plate 15561 moves to its second position from its primary importance, in this case, adjustable anvil block plate 15561 can the tissue T of compression set between anvil block plate 15561 and nail bin further.In addition to the above, when anvil block plate 15561 be conditioned and the shaping pit be limited in anvil block plate 15561 will move to closer to and/or further from nail bin time, the forming height of nail can be controlled by the position of anvil block plate 15561 relative to nail bin.Although foregoing describes only two positions, slide block 15564 slidably in the position of suitable quantity, with anvil block plate 15561 is moved to closer to and/or further from nail bin.Under any circumstance, once anvil block plate 15561 is properly oriented, nail is disposed sliding part 15550 and distally can be slided in nail bin, staple drivers 15540 and nail 15530 to be lifted and suture tissue T, as shown in Figure 35 4 towards anvil block plate 15561.Similar surgical stapling device is disclosed in the U.S. Patent application 13/036,647 that the name submitted on February 28th, 2011 is called " SURGICAL STAPLING INSTRUMENT ", and its whole disclosure is incorporated herein by reference.

Referring now to Figure 35 3, nail bin can be positioned in the nail bin passage 15570 of surgical stapling device 15500, and this nail bin passage such as can comprise tissue thickness's compensating part, such as tissue thickness's compensating part 15520.As mentioned above, when anvil block plate 15561 moves towards nail bin, anvil block plate 15561 compressible tissue thickness compensating part 15520 and/or the tissue T be positioned in the middle of anvil block plate 15561 and tissue thickness's compensating part 15520.See Figure 35 5, when nail 15530 is deployed from nail bin, nail 15530 can against tissue T compression also implanting tissue thickness compensation part 15520.When anvil block plate 15561 against slide block 15564 locate and organize also be not placed between anvil block plate 15561 and tissue thickness's compensating part 15520 time, can work as when anvil block plate 15561 is in primary importance and limit gap between anvil block plate 15561 and the top surface 15521 of tissue thickness's compensating part 15520.When anvil block plate 15561 moves to the second position, anvil block plate 15561 can contact tissue thickness compensation part 15520.Alternatively, when anvil block plate 15561 against slide block 15564 locate and organize also be not placed between anvil block plate 15561 and tissue thickness's compensating part 15520 time, can work as when anvil block plate 15561 is in primary importance and/or the second position and limit gap between anvil block plate 15561 and the top surface 15521 of tissue thickness's compensating part 15520.Such as, anvil block plate 15561 can not contact with tissue thickness compensating part 15520.In the embodiment of other alternative, when anvil block plate 15561 against slide block 15564 locate and organize also be not placed between anvil block plate 15561 and tissue thickness's compensating part 15520 time, anvil block plate 15561 such as can contact, no matter and whether anvil block plate 15561 is in primary importance and/or the second position with the top surface 15521 of tissue thickness compensating part 15520.Although only describe two positions of anvil block plate 15611 herein, anvil block plate 15611 can be located or be indexed in the position of any suitable quantity.

Due to mentioned above, surgery suturing appliance can comprise the device of the forming height for regulating nail, and this device can compensate different tissue thicknesses in all cases.In addition, surgery suturing appliance such as can comprise the device for compensating different tissue thicknesses and/or in-house varied in thickness.Such as, anvil block plate 15561 can upwards be regulated or be adjusted to away from relative nail bin, to increase shaping or the percussion height of nail.Correspondingly, anvil block plate 15561 can be regulated downwards or be regulated towards relative nail bin, to reduce shaping or the percussion height of nail.The adjustment such as scalable of anvil block plate 15561 is limited to the percussion height of gap between the shaping pit in anvil block plate 15561 and staple drivers or the percussion height of more specifically such as staple drivers support.Even if this type of ability with the forming height of regulating nail is to be such as responsible for the thicker and/or thinner tissue of process, tissue thickness's compensating part also can the thick and/or thinner tissue of compensate for slower, and/or compensates in-house varied in thickness, as mentioned above.In such cases, can for surgeon provides some compensation arrangements in same surgery suturing appliance.

As mentioned above and as shown in multiple embodiment, surgery suturing appliance can use nail bin, this nail bin has nail chamber and the nail of lineament, and wherein firing member can distally be pushed into through nail bin to dispose nail from nail chamber.Nail bin can comprise bending many nails chamber and nail.Referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance is stiching instrument 15600 such as, such as, can comprise and be limited to one or more circle in circle or annular support portion 15610 or ring-shaped staple chamber row.This type of circular staple row such as can comprise circular nail chamber 15612, inner side row and circular nail chamber, outside 15613 is arranged.Such as, circular nail chamber seniority among brothers and sisters can around the circle be limited in stiching instrument 15600 or looping pit 15615, and this hole can hold the circle or endless knife that are positioned at movingly wherein.In use, tissue can be located against the platform surface 15611 of support section 15610, and anvil block (not shown) is assembled to surgical stapling device 15600 by the actuator extending through and/or be positioned in hole 15615, make when actuator activated, anvil block can be clamped towards support section 15610, and against platform surface 15611 compress tissue.Be sufficiently compressed once organize, the nail be positioned in nail chamber 15612 and 15613 can penetrate from support section 15610 and pass tissue, makes nail can contact anvil block and is fully out of shape to catch tissue wherein.When nail just pulled the trigger and/or when nail by pulled the trigger after, circular knife can be pushed into transecting patient tissue.Then, anvil block is movable to be separated away from support section 15610 and/or with surgical stapling device 15600, and anvil block and surgical stapling device 15600 can be removed from operative site.This type of surgical stapling device 15600 and this type of surgical technic can be used for the two parts being such as connected large intestine.In all cases, multiple parts of large intestine can keep together when organization healing by circular staple line, and meanwhile make multiple partial elastic expansions of large intestine.Similar surgery suturing appliance and surgical technic are disclosed in the United States Patent (USP) 5,285 that the name submitted on February 15th, 1994 is called " SURGICAL ANASTOMOSIS STAPLING INSTRUMENT ", and in 945, its whole disclosure is incorporated herein by reference.

To being described further above, the support section 15610 of surgical stapling device 15600 such as can be located against the support section 15610 of surgical stapling device 15600 and/or be attached to tissue thickness's compensating part.Tissue thickness's compensating part can be made up of circular or annular material ring, and this rings of material such as comprises inside radius and outer radius.In some cases, tissue can be located against this rings of material, and when anvil block is used for tissue to move towards support section 15610, tissue thickness's compensating part can be compressed between tissue and platform surface 15611.During use, nail by percussion through tissue thickness's compensating part and tissue, can make nail to contact anvil block and is deformed into its firing position, the part of tissue and tissue thickness's compensating part to be captured in nail.In all cases, to being described further above, the rings of material comprising tissue thickness's compensating part is sufficiently flexible, to make multiple part expansions of the large intestine around nail line.Refer again to Figure 34 5 and Figure 34 6, flexible tissue thickness's compensating part 15620 such as can comprise the flexible internal ring 15624 of circle or annular, and this internal ring can limit circle or looping pit 15625.Internal ring 15624 can make it not be trapped in from the nail of surgical stapling device 15600 deployment; On the contrary, internal ring 15624 radially-inwardly can be located relative to nail chamber, inner side 15612.Such as, tissue thickness's compensating part 15620 can comprise such as from multiple attachments that it extends, attachment 15622 and outer attachment 15623 such as, makes the attachment when following closely distortion to be at least partly captured in nail.More specifically, first see Figure 34 5, each interior attachment 15622 can comprise the head on the nail chamber 15612 that is positioned in and is defined in surgical stapling device 15600, and wherein head is such as attached to internal ring 15624 by cervical region 15626; And similarly each outer attachment 15623 can comprise the head on the nail chamber 15613 that is positioned in and is defined in surgical stapling device 15600, and wherein head is such as attached to internal ring 15624 by cervical region 15627.The head of interior attachment 15622 and outer attachment 15623 such as can comprise any suitable shape, such as circular, avette and/or oval.Cervical region 15626 and/or 15627 also can comprise any suitable shape, wherein, the cervical region 15627 head of outer attachment 15623 being connected to internal ring 15624 can extend between the adjacent nail chamber, inner side 15612 in support section 15610, and cervical region 15627 is not trapped in from the nail of nail chamber 15612, inner side deployment.

Referring now to Figure 34 7 and Figure 34 8, flexible tissue thickness's compensating part 15720 such as can comprise flexible outer shroud 15724 that is circular or annular.Outer shroud 15724 can make it not be trapped in from the nail of surgical stapling device 15600 deployment; On the contrary, outer shroud 15724 radially outward can be located relative to nail chamber, outside 15613.Such as, tissue thickness's compensating part 15720 can comprise such as from multiple attachments that it extends, attachment 15622 and outer attachment 15623 such as, makes the attachment when following closely distortion to be at least partly captured in nail.More specifically, first see Figure 34 7, each interior attachment 15622 can comprise as head portion: this head is positioned on the nail chamber 15612 that is defined in surgical stapling device 15600, and wherein head is such as attached to outer shroud 15724 by cervical region 15726; And similarly each outer attachment 15623 can comprise as head portion: this head is positioned on the nail chamber 15613 that is defined in surgical stapling device 15600, and wherein head is such as attached to outer shroud 15724 by cervical region 15727.The head of interior attachment 15622 and outer attachment 15623 such as can comprise any suitable shape, such as circular, avette and/or oval.Cervical region 15726 and/or 15727 also can comprise any suitable shape, wherein, the cervical region 15726 head of interior attachment 15622 being connected to outer shroud 15724 can extend between adjacent nail chamber, outside 15613, and cervical region 15726 is not trapped in from the nail of nail chamber 15613, outside deployment.In the embodiment of some alternative, tissue thickness's compensating part can comprise the flexible internal ring of circle or annular, circle or annular flexible outer shroud and in addition can be connected to multiple attachments of internal ring and/or outer shroud.Some attachment can be connected to internal ring, and some other attachment can be connected to outer shroud.At least some in attachment can be connected to internal ring and outer shroud.Under any circumstance, to being described further above, the internal ring 15624 of tissue thickness's compensating part 15620, the outer shroud 15724 of tissue thickness's compensating part 15720 and/or any other suitable tissue thickness's compensating part can resilient expansion and/or contractions, to adapt to expansion and/or the contraction of tissue, this tissue thickness's compensating part is implanted against this tissue.In addition, although various embodiment is described to herein comprise circle or annular brace ring, tissue thickness's compensating part can comprise the supporting construction of any suitable shape for attachment being connected to it.To being described further above, being advanced by surgical stapling device and also can cut backing material with the circular knife of cutting the tissue be trapped between anvil block and support section.Such as, inside support ring and attachment can such as be separated by the cervical region cutting attachment by cutter.

To being described further above, tissue thickness's compensating part can comprise separable and/or relatively movable position, this position can make tissue thickness's compensating part expansion and/or shrink, to adapt to the motion of tissue, this tissue thickness's compensating part is implanted against this tissue.Referring now to Figure 34 9 and 350, when tissue thickness's compensating part 15820 is just against when organizing implanted, circular or annular tissue thickness's compensating part 15820 can be located against the platform surface 15611 of the surgical stapling device 15600 that can be maintained at non-expanding location (Figure 34 9), and/or is supported by the platform surface 15611 of the surgical stapling device 15600 that can be maintained at non-expanding location; After tissue thickness's compensating part 15820 is implanted, tissue thickness's compensating part 15820 can to external expansion, as shown in Figure 35 0.Tissue thickness's compensating part 15820 can comprise multiple arcuate section 15822, and the plurality of arcuate section is such as joined together by internal ring 15824.Arcuate section 15822 can be separated from one another by seam 15828.In at least one other embodiment, arcuate section 15822 can be connected to each other, and wherein such as perforation configuration can make arcuate section 15822 separated from one another.In either case, arcuate section 15822 such as can comprise interlocking features structure separately, such as protuberance 15826 and recess 15823, this interlocking features structure can cooperate before tissue thickness's compensating part 15820 is implanted, limit the relative motion between arcuate section 15822.To being described further above, each arcuate section 15822 is such as connected to internal ring 15824 by one or more adapter 15827, and arcuate section 15822 can be remained on appropriate location by this one or more adapter releasedly.Nail 10030 in support section 15610 is such as stored in against after organizing implanting tissue thickness compensation part 15620 when using nail, first see Figure 35 0, adapter 15827 can be separated with internal ring 15824, and tissue thickness's compensating part 15820 is expanded at least partly to adapt to in-house motion below.In all cases, all arcuate sections 15822 can be separated with internal ring 15824, and in other cases, more only can be separated with internal ring 15824 in arcuate section 15822.In the embodiment of some alternative, arcuate section 15822 can be connected by flexible portion, and this flexible portion can make arcuate section 15822 relative to each other move but not separated from one another.Such as, flexible portion can not receive nail wherein, and can expand and/or shrink the relative motion to adapt to arcuate section 15822.In Figure 34 9 and Figure 35 0, tissue thickness's compensating part 15820 such as can comprise eight arcuate sections 15822.Alternatively, tissue thickness's compensating part such as can comprise the arcuate section of any suitable quantity, such as two or more arcuate sections.

To being described further above, tissue thickness's compensating part 15620,15720 and/or 15820 such as can compensate the thicker and/or thinner tissue between the support section 15610 being trapped in anvil block and surgical instruments 15600.Be similar to mentioned above, by making anvil block court and/or carrying out the shaping of regulating nail away from support section 15610 motion or pull the trigger height.More specifically, anvil block is moveable to closer to support section 15610 to reduce the forming height of nail, and correspondingly, anvil block can be moved to away from support section 15610 further to increase the forming height of nail.In such cases, therefore, anvil block can be adjusted to away from support section 15610 with the thick tissue of responsible process by surgeon, and is adjusted to towards support section 15610 with responsible process thin tissue.In other embodiments various, surgeon can determine not regulate anvil block, and relies on tissue thickness's compensating part to be responsible for processing thinner and/or thicker tissue.Therefore, surgical instruments 15600 can comprise at least two devices for compensating different tissue thicknesses and/or tissue thickness's change.

As mentioned above, tissue thickness's compensating part can be attached to the support section of nail bin.The lower surface of tissue thickness's compensating part can comprise the one in hook layer or cover circular layer, and the platform surface of support section can comprise the another one in hook layer and cover circular layer.Such as, hook and the collar can be engaged with each other and tissue thickness's compensating part is remained to support section releasedly.Each hook such as can comprise the head of the expansion from neck extension.The multiple pads comprising the collar such as can be adhered to the lower surface of tissue thickness's compensating part, and the multiple pads comprising hook can be adhered to the platform surface of support section.Support section such as can comprise one or more hole and/or depressed part, and this one or more hole and/or depressed part can receive the insert comprising hook and/or the collar wherein.In addition to the above or replace mentioned above, tissue thickness's compensating part such as can use this type of hook and collar structure to be removably attachable to anvil block.Hook and the collar such as can comprise fiber surface.

As mentioned above, nail bin can comprise support section and be attached to tissue thickness's compensating part of support section.Also described above, support section can comprise longitudinal slit that can receive cutting element wherein, and tissue thickness's compensating part can comprise the retaining member that can be maintained in longitudinal slit.Referring now to Figure 38 6, nail bin 16000 can comprise support section 16010, and this support section comprises platform surface 16011 and longitudinal slit 16015.Nail bin 16000 also can comprise the tissue thickness's compensating part 16020 be positioned at above platform surface 16011.Tissue thickness's compensating part 16020 can comprise the longitudinal retaining member 16025 extended downwardly in longitudinal slit 16015.Such as, retaining member 16025 can be pressed down in slit 16015, makes the interaction between retaining member 16025 and slit 16015 can resist relative motion between support section 16010 and tissue thickness's compensating part 16020.The main body of tissue thickness's compensating part 16020 can be made up of the first material, and retaining member 16025 can be made up of second or different materials.The main body of tissue thickness's compensating part 16020 can be made up of the material with the first hardness, and retaining member 16025 can be made up of the material with the second hardness, and wherein the second hardness such as can higher than the first hardness.In use, nail 10030 can by staple drivers 10040 upwardly, the top of nail 10030 is made to pass the main body of tissue thickness's compensating part 16020 and to expose from tissue contacting surface 16021, and against destination organization capture tissue thickness compensation part 16020 at least partially.When nail 10030 is just deployed, the cutting element through slit 16015 can crosscut retaining member 16025.Once tissue thickness's compensating part 16020 is implanted, various retaining member 16025 can be pulled out slit 16015.Alternatively, the main body of tissue thickness's compensating part 16020 can be separated with retaining member 16025.

Referring now to Figure 38 7 and 389, nail bin 17000 can comprise support section 17010, and this support section comprises platform surface 17011 and longitudinal slit 17015.Nail bin 17000 also can comprise the tissue thickness's compensating part 17020 be positioned at above platform surface 17011.Tissue thickness's compensating part 17020 can comprise the longitudinal retaining member 17025 extended downwardly in longitudinal slit 17015.Such as, retaining member 17025 can be pressed against in slit 17015, makes the interaction between retaining member 17025 and slit 17015 can resist relative motion between support section 17010 and tissue thickness's compensating part 17020.Retaining member 17025 can extend across whole tissue thickness compensating part 17020 to its top surface 17021, and wherein the main part 17024 of tissue thickness's compensating part 17020 can be attached to the opposite side of retaining member 17025.Such as, retaining member 17025 such as can also resist the lateral deflection of tissue thickness's compensating part 17020.Main part 17024 can be made up of the first material, and retaining member 17025 can be made up of second or different materials.Main part 17024 can be made up of the material with the first hardness, and retaining member 17025 can be made up of the material with the second hardness, and wherein the second hardness such as can higher than the first hardness.To being described further above, when nail 10030 is just deployed, the cutting element through slit 17015 can crosscut retaining member 17025.Once tissue thickness's compensating part 17020 is implanted, various retaining member 17025 can be pulled out slit 17015.Alternatively, main part 17024 can be separated with retaining member 17025.

Referring now to Figure 38 8, nail bin 18000 can comprise support section 18010, and this support section comprises platform surface 18011 and longitudinal slit 18015.Nail bin 18000 also can comprise the tissue thickness's compensating part 18020 be positioned at above platform surface 18011.Tissue thickness's compensating part 18020 can comprise the longitudinal retaining member 18025 extended downwardly in longitudinal slit 18015.Such as, retaining member 18025 can be pressed down in slit 18015, makes the interaction between retaining member 18025 and slit 18015 can resist relative motion between support section 18010 and tissue thickness's compensating part 18020.Retaining member 18025 can extend across whole tissue thickness compensating part 18020 to its top surface 18021, and wherein the main part 18024 of tissue thickness's compensating part 18020 can be attached to the opposite side of retaining member 18025.Retaining member 18025 can comprise the part 18026 of amplification, and this amplifier section can be received in the cavity 18016 that is defined in slit 18015.Such as, amplifier section 18026 can resist retaining member 18025 and withdraws from from slit 18015.

Tissue thickness's compensating part can comprise can be extruded, can cast and/or mouldable compositions, and it comprises at least one in synthetic material as herein described and/or non-synthetic materials.Tissue thickness's compensating part can comprise the film or sheet with two-layer or more layer.Tissue thickness's compensating part can use conventional method to obtain, such as mix, blended, combination, spraying, wicking, solvent evaporation, dipping, brushing, gaseous phase deposition, extrude, roll, cast, molding etc.When extruding, the form that opening can comprise the mould of at least one opening is that the extrudate exposed gives shape.During calendering, opening can comprise the roll gap between two rollers.Conventional molding methods can include but not limited to blowing, injection moulding, foam injection, compression moulding, hot forming, extrude, foam extrude, thin film blowing, calendering, spinning, solvent welding, coating process such as dip-coating and spin coating, solution casting and film casting, plastisol processing (comprising scraper for coating, roller coat and casting), and their combination.During injection moulding, opening can comprise nozzle and/or passage/runner and/or cavity body of mould and feature structure.During compression moulding, compositions can be positioned in cavity body of mould, is heated to suitable temperature, and by being compressed at relatively high pressure and being shaped.During casting, compositions can comprise liquid or serosity, and it injects or is otherwise provided to the inside of mould or object, and/or around above, with the feature structure of copy mold or object.After casting, compositions can dried, cooling and/or solidification to form solid.

The method manufacturing tissue thickness compensating part can comprise substantially: provide tissue thickness's compensating part compositions, liquified composition makes it flow, and is formed as the compositions of melting, semi-molten or mecystasis having the layer and/or film of expecting thickness.See Figure 52 7A, tissue thickness's compensating part is made by following steps: dissolved water gel precursors in aqueous, disperse biocompatible particles and/or fiber wherein, the mould wherein with biocompatible particles is provided, solution is provided in mould, activator is contacted with solution, and curing solution is with formative tissue thickness compensation part, this tissue thickness's compensating part comprises containing the skin of biocompatible particles and the internal layer containing the biocompatible particles embedded wherein.As shown in Figure 52 7A, biocompatible layer 70250 can be provided in the bottom of mould 70260, then the aqueous solution of the hydrogel precursor 70255 being wherein provided with biocompatible particles 70257 can be provided to mould 70260, then can by aqueous solution solidification with formative tissue thickness compensation part, this tissue thickness's compensating part has the ground floor comprising biocompatible materials such as ORC, and comprises the second layer being wherein provided with the biocompatible fibres such as hydrogel of ORC fiber.Tissue thickness's compensating part can comprise foam, and described foam comprises containing the skin of biocompatible particles and the internal layer containing the biocompatible particles embedded wherein.Tissue thickness's compensating part is by following steps manufacture: in water, dissolve sodium alginate, disperse ORC granule wherein, the mould wherein with ORC granule is provided, pour solution into mould, spraying or injection calcium chloride are to contact solution, thus causing the crosslinked of sodium alginate, lyophilization hydrogel is with formative tissue thickness compensation part, and it comprises the skin comprising ORC and the internal layer comprising hydrogel and the ORC granule be embedded in wherein.

See Figure 52 7B, the method manufacturing three-layer weave thickness compensation part can comprise substantially: in the first aqueous solution, dissolve the first hydrogel precursor, biocompatible particles and/or fiber is disperseed in the first aqueous solution, the mould 70260 of the ground floor 70250 wherein with biocompatible particles is provided, first aqueous solution is provided in mould, activator is contacted with the first aqueous solution, solidify the first aqueous solution to form the second layer 70255, the second hydrogel precursor is dissolved in the second aqueous solution, second aqueous solution is provided in mould, solidify the second aqueous solution to form third layer 70265.Three-layer weave thickness compensation part is by following methods manufacture: in water, dissolve sodium alginate to form the first aqueous solution, ORC granule is disperseed in the first aqueous solution, the mould of the ground floor wherein with ORC granule is provided, pour the first aqueous solution into mould, spraying or injection calcium chloride are to contact the first aqueous solution, thus cause the crosslinked of sodium alginate, lyophilization first aqueous solution comprises the second layer of the hydrogel with embedding ORC granule wherein to be formed, sodium alginate is dissolved to form the second aqueous solution in water, pour the second aqueous solution into mould, spraying or injection calcium chloride are to contact the second aqueous solution, thus cause the crosslinked of sodium alginate, lyophilization second aqueous solution comprises the third layer of hydrogel to be formed.

The method manufacturing the tissue thickness's compensating part comprising at least one preservation and/or be absorbed in medicine wherein can comprise substantially provides tissue thickness's compensating part, and makes tissue thickness's compensating part and medicament contact to retain the dose in tissue thickness's compensating part.Manufacture comprise antibacterial materials microstructure thickness compensation part method can comprise hydrogel, dried hydrogel are provided, in silver nitrate aqueous solution swollen hydrogel, hydrogel is contacted, to form tissue thickness's compensating part with antibacterial characteristics with sodium chloride solution.Tissue thickness's compensating part can comprise the silver be dispersed in wherein.

See Figure 53 3, the method manufacturing tissue thickness's compensating part can comprise coetrusion and/or Method for bonding.Such as, tissue thickness's compensating part 70550 can comprise lamilated body, and described lamilated body comprises ground floor 70555 and comprises the second layer 70560 of internal layer 70565 of hydrogel in a sealing manner.Hydrogel can comprise such as dry film, dry foam, powder and/or granule.Hydrogel can comprise super-absorbent material, such as polyvinylpyrrolidone, carboxymethyl cellulose, poly-thiopropyl acrylate.By by the raw material of ground floor and the second layer respectively from hopper feed in extruder, then provide ground floor and the second layer to carry out order and manufacture ground floor and/or the second layer.The raw material of internal layer 70565 can be added extruder hopper.Raw material at high temperature can disperse mixing and compound in an extruder.Along with raw material leaves mould 70570 at opening part, internal layer 70565 can deposit on the surface of ground floor 70555.Tissue thickness's compensating part can comprise foam, film, powder and/or granule.Ground floor 70555 and the second layer 70560 can be located face-to-face.The second layer 70560 aligns with ground floor 70555 face-to-face by roller 70575.Ground floor 70555 can be attached to the second layer 70560, and wherein ground floor 70555 and the second layer 70560 can Physical entrapment internal layers 70565.Layer can such as optical pressure, conventional hot calendering bonding technique and/or by use adhesive bond together, with formative tissue thickness compensation part 70550.As shown in Figure 40 7, ground floor 70555 and the second layer 70560 can by such as utilizing the operation of rolling of grooved roller 70580 to be bonded together.Due to mentioned above, hold by the ground floor 70555 and the second layer 70560 that jointly can form skin or barrier and/or seal internal layer 70565.Skin can stop or reduce internal layer 70565 contact wetting, until outer broken loose.

See Figure 39 0, the end effector 12 (Fig. 1) of surgical instruments 10 can receive fastener cartridge assembly, such as nail bin 20000.As shown in Figure 39 0, nail bin 20000 can be engaged in the nail bin passage 20072 of the jaw 20070 of end effector 12.Alternatively, nail bin 20000 can be in aggregates with end effector 12, makes nail bin 20000 and end effector 12 be formed as individual unit structure.Nail bin 20000 can comprise such as the first main part, such as rigid support part 20010.Nail bin 20000 also can comprise such as the second main part, such as compressible portion or tissue thickness's compensating part 20020.Alternatively, tissue thickness's compensating part 20020 can not comprise the integral part of nail bin 20000, but otherwise can locate relative to end effector 12.Such as, tissue thickness's compensating part 20020 can be fixed to the anvil block 20060 of end effector 12 or can otherwise remain in end effector 12.See Figure 40 7, nail bin also can comprise keeper fixture 20126, and it can suppress tissue thickness's compensating part 20020 to be separated from support section 20010 prematurely.Reader will know, tissue thickness as herein described compensating part can be arranged in various end effector or in other words and engage with various end effector, and this type of embodiment within the scope of the invention.

Be similar to tissue thickness as herein described compensating part, referring now to Figure 40 7, tissue thickness's compensating part 20020 can discharge from surgical end-effector 12 or depart from.Such as, the rigid support part 20010 of nail bin 20000 can keep engaging with the fastener cartridge passage 20072 of end effector jaw 20070, and tissue thickness's compensating part 20020 departs from from rigid support part 20010.Be similar to various embodiment as herein described, by nail 20030 (Figure 40 7-412) from rigid support part 2010 nail chamber 20012 dispose after, tissue thickness's compensating part 20020 can discharge from end effector 12.Nail 20030 can be pulled the trigger from nail chamber 20012, makes nail 20030 joining tissue thickness compensation part 20020.Also be similar to various embodiment as herein described, generally see Figure 39 2,411 and 412, nail 20030 can capture tissue thickness compensation part 20020 a part together with sew up tissue T.Tissue thickness's compensating part 20020 can be deformable, and the part being captured in the tissue thickness's compensating part 20020 in percussion nail 20030 can be compressed.Be similar to tissue thickness as herein described compensating part, tissue thickness's compensating part 20020 can compensate the tissue T be trapped in each nail 20030 of different-thickness, compressibility and/or density.In addition, also as described herein, tissue thickness's compensating part 20020 can compensate the gap that distortion nail 20030 produces.

Tissue thickness's compensating part 20020 can compress between uncompressed height and compression height.See Figure 40 7, tissue thickness's compensating part 20020 can have top surface 20021 and lower surface 20022.The height of tissue thickness's compensating part can be the distance between top surface 20021 and lower surface 20022.When applying minimum force to tissue thickness's compensating part 20020 or not applying power, namely when tissue thickness's compensating part 20020 is not by compression, the uncompressed height of tissue thickness's compensating part 20020 can be the distance between top surface 20021 and lower surface 20022.Such as when applying power to tissue thickness's compensating part 20020, such as when pulling the trigger nail 20030 capture tissue thickness compensation part 20020 a part of, the compression height of tissue thickness's compensating part 20020 can be the distance between top surface 20021 and lower surface 20022.Tissue thickness's compensating part 20020 can have distal end 20025 and proximal extremity 20026.As shown in Figure 40 7, the uncompressed height of tissue thickness's compensating part 20020 can be homogeneous between the distal end 20025 of tissue thickness's compensating part 20020 and proximal extremity 20026.Alternatively, uncompressed height can change between distal end 20025 and proximal extremity 20026.Such as, the top surface 20021 of tissue thickness's compensating part 20020 and/or lower surface 20022 can angulation and/or stageds relative to other parts, and uncompressed height is changed between proximal extremity 20026 and distal end 20025.The uncompressed height of tissue thickness's compensating part 20020 can be such as about 0.08 inch.Alternatively, the uncompressed height of tissue thickness's compensating part 20020 can such as change between about 0.025 inch and about 0.10 inch.

As described in more detail herein, tissue thickness's compensating part 20020 can be compressed to different compression heights between its proximal extremity 20026 and distal end 20025.Alternatively, tissue thickness's compensating part 20020 can compress equably under its whole length.The compression height of tissue thickness's compensating part 20020 can be depending on geometry, the characteristic of tissue thickness's compensating part 20020, the tissue T of joint of such as end effector 12 and/or follows closely 20030.The compression height of tissue thickness's compensating part 20020 can be relevant with the interstice in end effector 12.When anvil block 20060 is clamped towards nail bin 20000, interstice can be limited between the top platform surface 20011 (Figure 40 7) of such as nail bin 20000 and the tissue contacting surface 20061 (Figure 39 0) of anvil block 20060.Interstice can be such as about 0.025 inch or be about 0.100 inch.Interstice can be such as about 0.750 millimeter or be about 3.500 millimeters.The compression height of tissue thickness's compensating part 20020 can such as equal or be substantially equal to interstice.When in the interstice that tissue T is positioned at end effector 12, the compression height of tissue thickness's compensating part can reduce, to adapt to tissue T.Such as when interstice is about 0.750 millimeter, the compression height of tissue thickness's compensating part can be about 0.500 millimeter.Such as, when interstice is about 3.500 millimeters, the compression height of tissue thickness's compensating part 20020 can be about 2.5mm.In addition, tissue thickness's compensating part 20020 can comprise minimal compression height.Such as, the minimal compression height of tissue thickness's compensating part 20020 can be about 0.250 millimeter.The interstice be limited between the platform surface of nail bin and the tissue contacting surface of anvil block can such as equal or at least substantially equal the uncompressed height of tissue thickness's compensating part.

Main see Figure 39 1, tissue thickness's compensating part 20020 can comprise the fibrous nonwoven material 20080 of fibre-bearing 20082.Tissue thickness's compensating part 20020 can comprise the material of felt or similar felt.Fiber 20082 in non-woven material 20080 tightens together by any method as known in the art, includes but not limited to needle point method, heat bonding, water entanglement, ultrasonic bonds, chemical adhesion and meltblowing adhesive.In addition, the layer of non-woven material 20080 tightens together by machinery, heating or chemical method with formative tissue thickness compensation part 20020.As described in more detail herein, the non-woven material 20080 of fiber can be compressible, and it can make tissue thickness's compensating part 20020 compressible.Tissue thickness's compensating part 20020 also can comprise uncompressed part.Such as, tissue thickness's compensating part 20020 can comprise compressible non-woven material 20080 and uncompressed part.

Still main see Figure 39 1, non-woven material 20080 can comprise multiple fiber 20082.At least some fiber 20082 in non-woven material 20080 can be crimped fibre 20086.Crimped fibre 20086 can be in non-woven material 20080 such as curling, distortion, coiling, bending, distortion, spiral, around and/or arc.As described in more detail herein, crimped fibre 20086 can any suitable shape be formed, and makes the distortion of crimped fibre 20086 produce load on spring power or restoring force.Crimped fibre 20086 by thermoforming to form the shape of coiling or coiled type substantially.Crimped fibre 20086 can be formed by uncrimped fibers 20084.Such as, uncrimped fibers 20084 can be wrapped in around the mandrel that is heated to form the shape of coiled type substantially.

Tissue thickness's compensating part 20020 can comprise the absorbable polymer matrix of homogenization.Even absorbable polymer matrix can comprise such as foam, gel and/or film.In addition, multiple fiber 20082 dispersibles in whole even absorbable polymer matrix.At least some fiber 20082 in even absorbable polymer matrix can be such as crimped fibre 20086.As described in more detail, the even absorbable polymer matrix of tissue thickness's compensating part 2002 can be compressible.

See Figure 39 4 and 395, crimped fibre 20086 can random dispersion in whole non-woven material 20080 at least partially in.Such as, crimped fibre 20086 can random dispersion in whole non-woven material 20080, make a part for non-woven material 20080 comprise more crimped fibres 20086 than other parts of non-woven material 20080.In addition, crimped fibre 20086 can be gathered in such as fiber cluster 20085a, 20085b, 20085c, 20085d and the 20085e in non-woven material 20080.The entanglement of fiber 20086 during the shape of crimped fibre 20086 can cause non-woven material 20080 to manufacture; The entanglement of crimped fibre 20086 can cause the formation of fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e then.In addition or alternatively, crimped fibre 20086 can in whole non-woven material 20080 random orientation.Such as, see Figure 39 1, the first crimped fibre 20086a can along first direction orientation, and the second crimped fibre 20086b can along second direction orientation, and the 3rd crimped fibre 20086c can along third direction orientation.

Crimped fibre 20086 can systematically distribute and/or be arranged in whole non-woven material 20080 at least partially.Such as, referring now to Figure 39 6, crimped fibre 20186 can be positioned in structure 20185, and wherein multiple crimped fibre 20186a arranges along first direction, and other multiple crimped fibre 20186b arrange along second direction.Crimped fibre 20186 can be overlapping, makes them mutually tangle or interconnect.Crimped fibre 20186 can systematicness be arranged, makes crimped fibre 20186a be arranged essentially parallel to another crimped fibre 20186a.Another crimped fibre 20186b can extend substantially transversely to some crimped fibres 20186a.Crimped fibre 20186a can align with first axle Y substantially, and crimped fibre 20186b can align with the second axis X substantially.Such as first axle Y vertically or can be substantially perpendicular to the second axis X in some cases.

Main see Figure 39 7, crimped fibre 20286 can be arranged in structure 20285.Each crimped fibre 20286 can comprise the longitudinal axis be limited between the first end 20287 of crimped fibre 20286 and the second end 20289.Crimped fibre 20286 can systematically be distributed in non-woven material 20080, makes the first end 20287 of a crimped fibre 20286 be positioned at the position of the second end 20289 adjacent to another crimped fibre 20286.And for example, referring now to Figure 39 8, fibrous structure 20385 can comprise such as along the first crimped fibre 20386a of first direction orientation, along the second crimped fibre 20386b of second direction orientation, and along the 3rd crimped fibre 20386c of third direction orientation.Single pattern or the layout of crimped fibre 20286 can repeat in whole non-woven material 20080.Crimped fibre can be arranged with different pattern in whole non-woven material 20080.In other alternate forms, non-woven material 20080 can comprise at least one crimped fibre pattern, and the crimped fibre of multiple random orientation and/or random.

Refer again to Figure 39 1, the multiple fibers 20082 in non-woven material 20080 can comprise at least some uncrimped fibers 20084.Uncrimped fibers 20084 in non-woven material 20080 and crimped fibre 20086 can tangle or interconnect.Crimped fibre 20086 can be such as about 25:1 with the ratio of uncrimped fibers 20084.And for example, crimped fibre 20086 can be such as about 1:25 with the ratio of uncrimped fibers 20084.Alternatively, crimped fibre 20086 can be such as about 1:1 with the ratio of uncrimped fibers 20084.As described in more detail, when non-woven material 20080 is out of shape, in the per unit volume of non-woven material 20080, the quantity of crimped fibre 20086 can affect the restoring force that non-woven material 20080 produces.As described equally in more detail herein, the restoring force of non-woven material 20080 generation also can be depending on the material of crimped fibre 20086 and uncrimped fibers 20084 in such as non-woven material 20080, shape, size, position and/or orientation.

The fiber 20082 of non-woven material 20080 can comprise polymer composition.The polymer composition of fiber 20082 can comprise the polymer of nonabsorable, absorbable polymer or their combination.Absorbable polymer can comprise can bio-absorbable, biocompatible elastomers polymer.In addition, the polymer composition of fiber 20082 can comprise synthetic polymer, non-synthetic polymer or their combination.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly-(lactic acid) (PLA), polycaprolactone (PCL), poly-dioxanone (PDO) and their copolymer.Such as, fiber 20082 can comprise 90/10 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide) copolymer, such as this copolymer can brand name VICRYL (polyglactic 910) commercially available from Ethicon, Inc..The example of non-synthetic polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and oxidized regenerated cellulose (ORC).Be similar to the polymer composition in tissue thickness as herein described compensating part, the polymer composition of fiber 20082 can the absorbable polymer of the amount of comprising difference (such as by weight percentage), the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

The crimped fibre 20086 of non-woven material 20080 can comprise the first polymer composition, and the uncrimped fibers 20084 of non-woven material 20080 can comprise different polymer compositions.Such as, crimped fibre 20086 can comprise synthetic polymer, such as 90/10 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide), and uncrimped fibers 20084 can comprise non-synthetic polymer, such as oxidized regenerated cellulose.Alternatively, crimped fibre 20086 and uncrimped fibers 20084 can comprise identical polymer composition.

As described herein, crimped fibre 20086 and uncrimped fibers 20084 can be tightened together by such as needle point method, heat bonding, water entanglement, ultrasonic bonds, chemical adhesion and meltblowing adhesive.Comprise the crimped fibre 20086 of synthetic fibers such as " VICRYL (polyglactic 910) ", and the uncrimped fibers 20084 comprising oxidized regenerated cellulose forms non-woven material 20080 by acupuncture together.It is such as curling " VICRYL (polyglactic 910) " fiber 20086 of about 5% to 50% (by weight) that non-woven material 20080 can comprise, and is non-crimping oxidized regenerated cellulose (ORC) fiber 20084 of about 5% to 50% (by weight).Such as non-woven material 20080 contact tissue T, non-crimping ORC fiber 20084 can react to form gel block with the blood plasma in tissue rapidly.The formation of gel ORC block can instantaneous or almost instantaneously with contact tissue.In addition, after gel ORC block is formed, curling " VICRYL (polyglactic 910) " fiber 20086 still can be distributed in whole non-woven material 20080.Such as, crimped fibre 20086 can be suspended in gel ORC block.Because gel ORC block can bio-absorbable, curling " VICRYL (polyglactic 910) " fiber 20086 can apply resilience force in adjacent tissue, as described in more detail.In addition, tissue can start at " VICRYL (polyglactic 910) " fiber and/or become healing around staple 30030, also as described in more detail.

Main see Figure 40 7-410, the support section 20010 of nail bin 20000 can comprise warehouse 20017, top platform surface 20011 and multiple nail chamber 20012.Each nail chamber 20012 can limit the opening in platform surface 20011.Nail 20030 can be positioned in nail chamber 20012 removedly.Single nail 20030 is arranged in each nail chamber 20012.Main see Figure 41 1 and 412, and be similar to nail as herein described, each nail 20030 can comprise the base portion 20031 with the first end 20035 and the second end 20036.Nail lower limb 20032 can extend from the first end 20035 of base portion 20031, and another nail lower limb 20032 can extend from the second end 20036 of base portion 20031.Refer again to Figure 40 7-410, before deployment nail 20030, the base portion 20031 of each nail 20030 can be supported by staple drivers 20040, and this staple drivers is positioned in the rigid support part 20010 of nail bin 20000.In addition, before deployment nail 20030, the lower limb 20032 of each nail 20030 can be at least partially contained within nail chamber 20012.

Nail 20030 can be deployed between initial position and firing position.Such as, mainly see Figure 41 0, nail 20030 can be positioned at initial position (nail 20030e, 20030f), part percussion or centre position (nail 20030c, 20030d) or firing position (nail 20030a, 20030b).Driver 20040 can drive the nail be between initial position and firing position.Such as, the base portion 20031 of each nail 20030 can be supported by driver 20040.The lower limb 20032 of nail (nail 20030e, 20030f in such as Figure 40 9) can be positioned in nail chamber 20012.When firing member or nail percussion sliding part 20050 are from proximal extremity 20001 distal end 20002 translation of nail bin 20000, inclined surface 20051 on sliding part 20050 can contact the inclined surface 20042 in driver 20040, with dispose be positioned at the nail 20030 on contact driver 20040.Nail 20030 can be deployed between initial position and firing position, lower limb 20032 is made to move through the non-woven material 20080 of tissue thickness's compensating part 20020, the top surface 20021 of penetrate tissue thickness compensation part 20020, penetrate tissue T, and contact is positioned in end effector 12 anvil block 20060 (Figure 39 0) following closely opposite, chamber 20000.Nail lower limb 20032 can be directed to anvil block 20060 and be out of shape, and the lower limb 20032 of each nail 20030 can catch a part for non-woven material 20080 and a part for tissue T.

In percussion configuration (Figure 41 1 and 412), each nail 20030 can apply compression stress to tissue T and the tissue thickness's compensating part 20020 be captured in nail 20030.Main see Figure 40 9 and 410, the lower limb 20032 of each nail 20030 can be out of shape downwards towards the base portion 20031 of nail 20030, retains region 20039 to form nail.Nail retain region 20039 can be tissue T and tissue thickness's compensating part 20020 can by percussion nail 20030 the region of catching.In all cases, nail retain region 20039 can be limited to strained lower limb 20032 inner surface and nail 20030 base portion 20031 inner surface between.The size retaining region 20039 of nail 20030 can be depending on some questions, the degree of the width of the length of such as lower limb, the diameter of lower limb, base portion and/or lower limb distortion.

When non-woven material 20080 be trapped in nail retain region 20039 time, the captured part of non-woven material 20080 can be compressed.Be trapped in the compression height following closely the non-woven material 20080 retained in region 20039 can retain the tissue T in region 20039 according to identical nail and change in nail bin 20000.Such as, when tissue T is thinner, nail retains region 20039 and can have the space giving non-woven material 20080 more, therefore, non-woven material 20080 by the degree compressed may thicker unlike tissue T time its by large being compressed.Such as when tissue T is thicker, non-woven material 20080 can be more by what compress, to adapt to thicker tissue T.Such as, see Figure 41 1, non-woven material 20080 such as can retain in the 20039a of region at the first nail and be compressed to the first height, retain in the 20039b of region at the second nail and be compressed to the second height, retain in the 20039c of region at the 3rd nail and be compressed to third high degree, the 4th nail retain in the 20039d of region be compressed to the 4th height, and the 5th nail retain in the 20039e of region be compressed to the 5th height.Similarly, as shown in Figure 41 2, non-woven material 20080 can retain in the 20039a of region at the first nail and be compressed to the first height, retain in the 20039b of region at the second nail and be compressed to the second height, retain in the 20039c of region at the 3rd nail and be compressed to third high degree, retain in the 20039d of region at the 4th nail and be compressed to the 4th height.Alternatively, the compression height of non-woven material 20080 can be homogeneous in whole nail bin 20010.

Applied force can make non-woven material 20080 move to compressed configuration from initial uncompressed configuration.In addition, non-woven material 20080 can have elasticity, makes non-woven material 20080 can be produced resilience force or restoring force by during compression.During distortion, this non-woven material 20080 can attempt resilience from the configuration compressed or be out of shape.When non-woven material 20080 attempts resilience, it can apply resilience force or restoring force being also trapped in the nail tissue retained in region 30039, as described in more detail.When the power applied is removed subsequently, restoring force can make non-woven material resilience from the configuration of compression.Non-woven material 20080 can recoil to initial uncompressed configuration maybe can recoil to the configuration being substantially similar to initial uncompressed configuration.The distortion of non-woven material 20080 can be elastic.The distortion of non-woven material can be partial elastic and part plasticity.

When the part of non-woven material 20080 be compressed in nail retain in region 20039 time, the crimped fibre 20086 in this part in non-woven compensating part 20039 can also compress or otherwise be out of shape.The deflection of crimped fibre 20086 can be corresponding with the decrement of the captured part of non-woven material 20080.Such as, see Figure 39 2, the nail 20030 that non-woven material 20080 can be deployed is caught.Non-woven material 20080 is compressed more by the nail being disposed 20030, and the average deformation of crimped fibre 20086 just can be larger.In addition, non-woven material 20080 is compressed fewer by the nail being disposed, and the average deformation of crimped fibre 20086 just can be less.Similarly, see Figure 41 1 and 412, retain in the 20039d of region at nail, non-woven material 20080 is compressed more, and the nail crimped fibre 20086 retained in the 20039d of region can be out of shape more usually.In addition, retain in the 20039a of region at nail, non-woven material 20080 is compressed fewer, and the nail crimped fibre 20086 retained in the 20039a of region can be out of shape fewer usually.

Non-woven material 20080 is from the ability of the configuration resilience of distortion, that is, the resilience force of non-woven material 20080, can be depending on the resilience force of crimped fibre 20086 in non-woven material 20080.Crimped fibre 20086 can be out of shape with resiliencely.The distortion of crimped fibre 20086 can be partial elastic and part plasticity.The compression of each crimped fibre 20086 can make the crimped fibre 20086 by compressing produce resilience force or restoring force.Such as, when fiber 20086 is attempted, from its compressed configuration when resilience, can be produced restoring force by the crimped fibre 20086 compressed.Fiber 20086 can attempt the configuration returning to its initial uncompressed configuration or be substantially similar to its configuration.Crimped fibre 20086 can be attempted part and return to its initial configuration.In non-woven material 20080, an only part for crimped fibre 20086 can have elasticity.When crimped fibre 20086 comprises linear elastic material, be can be depending on such as crimped fibre 20086 by the device of spring stiffness coefficient of the quantity compressed and crimped fibre 20086 by the restoring force of the crimped fibre 20086 compressed.The device of spring stiffness coefficient of crimped fibre 20086 at least can depend on the orientation of such as crimped fibre 20086, material, shape and/or size.

Crimped fibre 20086 in non-woven material 20080 can comprise homogeneous device of spring stiffness coefficient.Alternatively, the device of spring stiffness coefficient of the crimped fibre 20086 in non-woven material 20080 can be change.When the crimped fibre 20086 with big spring stiffness factor is greatly compressed, crimped fibre 20086 can produce large restoring force.When the crimped fibre 20086 with device of spring stiffness coefficient large is equally compressed less, crimped fibre 20086 can produce less restoring force.The summation of the restoring force produced by the crimped fibre 20086 of the compression in non-woven material 20080 can produce the merging restoring force on the whole non-woven material 20080 of tissue thickness's compensating part 20020.Non-woven material 20080 can apply to merge restoring force in the tissue T in the percussion nail 20030 being trapped in the non-woven material 20080 with compression.

In addition, the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 can affect the device of spring stiffness coefficient of non-woven material 20080.Such as, when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is lower, the resilience force in non-woven material 20080 can be lower; Such as, when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is higher, the resilience force of non-woven material 20080 can be higher; Such as, and when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is even higher, the resilience force of non-woven material 20080 can be higher.When the resilience force of non-woven material 20080 is lower, such as, when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is lower, the merging restoring force be applied in caught tissue T by tissue thickness's compensating part 20020 also can be less.When the resilience force of non-woven material 20080 is higher, such as, when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is higher, the restoring force summation be applied in caught tissue T by tissue thickness's compensating part 20020 also can be higher.

Main see Figure 39 3, the non-woven material 20080 ' of tissue thickness's compensating part 20020 ' can comprise therapeutic agent 20088, such as medicine and/or pharmaceutically active agents.Non-woven material 20080 ' can discharge the therapeutic agent 20088 of therapeutically effective dose.Such as, when non-woven material 20080 ' is by absorption, therapeutic agent 20088 can be released.Therapeutic agent 20088 can be released to the fluid flowing through on non-woven material 20080 ' or pass non-woven material 20080 ', such as blood.The example of therapeutic agent 20088 can include but not limited to hemorrhage and medicine, such as, and fibrin, thrombin and/or oxidized regenerated cellulose (ORC); Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone; Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B and/or chloromycetin; And anticarcinogen, such as cisplatin, mitomycin and/or amycin.Therapeutic agent 20088 can comprise biological preparation, such as stem cell.The fiber 20082 of non-woven material 20080 ' can comprise therapeutic agent 20088.Alternatively, therapeutic agent 20088 can be added into non-woven material 20080 ' or otherwise be incorporated in tissue thickness's compensating part 20020 '.

Main see Figure 39 9-399B, the tissue thickness's compensating part 20520 for end effector 12 (Figure 39 0) can comprise multiple spring or coiling fiber 20586.Similar with crimped fibre 20086 as herein described, coiling fiber 20586 can be in tissue thickness's compensating part 20520 (such as) curling, distortion, coiling, bending, distortion, spiral, around and/or arc.Coiling fiber 20586 can be wrapped in around mandrel and coil or the shape of coiled type substantially to be formed.Coiling fiber 20586 can on whole tissue thickness compensating part 20520 random orientation and/or random.Alternatively, coil fiber 20586 systematicness to arrange and/or heterogeneity distribution on whole tissue thickness compensating part 20520.Such as, see Figure 39 9, coiling fiber 20586 can comprise the longitudinal axis between the first end 20587 of coiling fiber 20586 and the second end 20589.The longitudinal axis of the coiling fiber 20520 in tissue thickness's compensating part 20520 can be parallel or substantially parallel.First end 20587 of each coiling fiber 20520 can be located along the longitudinal side of first of tissue thickness's compensating part 20,520 20523 and the second end 20589 of each coiling fiber 20586 can be located along the longitudinal side 20524 of second of tissue thickness's compensating part 20520.In this class formation, coiling fiber 20586 can laterally traverse tissue thickness's compensating part.Alternatively, coil fiber 20586 and longitudinally or diagonally can traverse tissue thickness's compensating part 20520.

Similar with crimped fibre 20086 as herein described, coiling fiber 20586 can comprise polymer composition.Crimped fibre 20586 can have elasticity at least in part, makes the distortion of crimped fibre 20586 produce restoring force.The polymer composition of coiling fiber 20586 can comprise such as polycaprolactone (PCL), makes coiling fiber 20586 in chlorophyll solvent for insoluble.See Figure 39 9A, spring or coiling fiber 20520 can remain in compensative material 20580.Coiling fiber 20586 can be remained on loading position by compensative material 20580, makes coiling fiber 20586 pairs of compensative materials 20580 apply load on spring and apply load on spring in compensative material 20580.Coiling fiber 20586 can be remained on neutral position by compensative material 20580, coils fiber 20586 in this case and can not apply load on spring to compensative material 20580 or apply load on spring in compensative material 20580.Compensative material 20580 can be can bio-absorbable, and can comprise foam, such as polyglycolic acid (PGA) foam.In addition, compensative material 20580 can be solvable in such as chlorophyll solvent.Tissue thickness's compensating part can comprise the coiling fiber 20586 such as containing polycaprolactone (PCL) and the compensative material 20580 containing polyglycolic acid (PGA) foam, make coiling fiber 20520 for insoluble in chlorophyll solvent, and compensative material 20580 is solvable in chlorophyll solvent.Compensative material 20580 can have elasticity at least in part, makes the compression of compensative material 20580 produce restoring force.In addition, see Figure 39 9B, the compensative material 20580 of tissue thickness's compensating part 20520 can comprise therapeutic agent 20588, such as stem cell.When compensative material 20580 is absorbed, compensative material 20580 can discharge the therapeutic agent 20588 of therapeutically effective dose.

Similar with tissue thickness as herein described compensating part 20020, tissue thickness's compensating part 20520 can be compressible.Such as, when nail 20030 (Figure 40 7-410) is deployed to firing position from initial position, nail 20030 can the part of joining tissue thickness compensation part 20520.Nail 20030 can the part of capture tissue thickness compensation part 20520 and adjacent tissue T.Nail 20030 can apply compression stress to the captured part of tissue thickness's compensating part 20520 and tissue T, makes tissue thickness's compensating part 20520 be compressed to compression height by never compression height.The compression of tissue thickness's compensating part 20520 can cause the correspondence of coiling fiber 20586 to be wherein out of shape.As described in more detail, the distortion of each coiling fiber 20586 all can produce restoring force, and this restoring force can be depending on the resilience force of coiling fiber, such as, and the deflection of coiling fiber 20586 and/or the device of spring stiffness coefficient of coiling fiber 20586.The device of spring stiffness coefficient of coiling fiber 20586 at least can depend on orientation, material, shape and/or the size of such as coiling fiber 20586.The distortion of coiling fiber 20586 in tissue thickness's compensating part 20520 can produce restoring force on whole tissue thickness compensating part 20520.Tissue thickness's compensating part 20520 can apply the restoring force summation produced by the coiling fiber 20586 be out of shape and/or elastic compensating material 20586 to the captured tissue T in percussion nail 20030.

Main see Figure 40 0 and 401, the tissue thickness's compensating part 20620 for end effector 12 can comprise multiple spring coil 20686.With crimped fibre as herein described 20086 with coil fiber 20586 similar, spring coil 20686 can be in tissue thickness's compensating part 20620 (such as) curling, distortion, coiling, bending, that be out of shape, spiral, around and/or arc.With fiber as herein described and coil similar, spring coil 20686 can comprise polymer composition.In addition, spring coil 20686 can have elasticity at least in part, makes the distortion of spring coil 20686 produce restoring force.Spring coil 20686 can comprise the first end 20687, second end 20689 and longitudinal axis between the two.See Figure 40 0, first end 20686 of spring coil 20686 can be positioned on tissue thickness's compensating part proximal extremity 20626 place or near, and the second end 20689 of identical springs coil 20686 can be positioned on tissue thickness's compensating part 20620 distal end 20625 place or near, make such as spring coil 20686 longitudinally traverse tissue thickness's compensating part 20620.Alternatively, coil fiber 20686 and laterally or diagonally can traverse tissue thickness's compensating part 20620.

Tissue thickness's compensating part 20620 can comprise adventitia 20680, and this adventitia 20680 is at least in part around at least one spring coil 20686.See Figure 40 0, adventitia 20680 can extend around the periphery of the multiple spring coils 20686 in tissue thickness's compensating part 20620.Alternatively, adventitia 20680 can encapsulate completely and organize spring coil 20686 in thickness compensation part 20620 or at least one spring coil 20686.Spring coil 20686 can remain in end effector 12 by adventitia 20680.Spring coil 20686 can be remained on loading position by adventitia 20680, makes spring coil 20686 produce load on spring and external membrane 20680 applies resilience force.Alternatively, spring coil 20686 can be remained on neutral position by adventitia 20680.Tissue thickness's compensating part 20620 also can comprise packing material 20624.Packing material 20624 can remain in spring coil 20686 and/or surrounding by adventitia 20680.Packing material 20624 can comprise therapeutic agent 20688, is similar to therapeutic agent as herein described.In addition, packing material 20624 can spring coil 20686 in supporting tissue thickness compensation part 20620.Packing material 20624 can be compressible and have elasticity at least in part, the resilience force making packing material 20624 contribute to being produced by tissue thickness's compensating part 20620 or restoring force, as described in more detail.

Similar with tissue thickness as herein described compensating part, tissue thickness's compensating part 20620 can be compressible.When nail 20030 (Figure 40 7-410) is deployed to firing position from initial position, nail 20030 can the part of joining tissue thickness compensation part 20620.Each nail 20030 can the part of capture tissue thickness compensation part 20620 together with adjacent tissue T.Nail 20030 can apply compression stress to the captured part of tissue thickness's compensating part 20620 and captured tissue T, and tissue thickness's compensating part 20620 is compressed between uncompressed height and compression height.The compression of tissue thickness's compensating part 20620 can cause the correspondence of the spring coil 20686 remained on wherein to be out of shape (Figure 40 1).As described in more detail, the distortion of each spring coil 20686 all can produce restoring force, and this restoring force depends on the resilience force of spring coil 20686, such as, and the deflection of spring coil 20686 and/or the device of spring stiffness coefficient of spring coil 20686.The device of spring stiffness coefficient of spring coil 20686 at least can depend on the material of such as spring coil 20686, shape and/or size.In addition, according to the resilience force of packing material 20624 and adventitia 20680, the compression of packing material 20624 and/or adventitia 20680 also can produce restoring force.The summation of the restoring force at least produced by the distortion spring coil 20686 in tissue thickness's compensating part 20620, packing material 20624 and/or adventitia 20680 can produce restoring force on whole tissue thickness compensating part 20620.Tissue thickness's compensating part 20620 can apply the restoring force summation produced by distortion spring coil 20686 to the captured tissue T in percussion nail 20030.

Main see Figure 40 2-404, the tissue thickness's compensating part 20720 for end effector 12 can comprise multiple spring coil 20786.With coiling fiber as herein described and spring-like seemingly, spring coil 20786 can be in tissue thickness's compensating part 20720 (such as) curling, distortion, coiling, bending, distortion, spiral, around and/or arc.Spring coil 20786 can have elasticity at least in part, makes the distortion of spring coil 20786 produce restoring force.In addition, spring coil 20786 can comprise the first end 20787, second end 20789 and longitudinal axis between the two.Main see Figure 40 4, first end 20787 of spring coil 20786 can be positioned on tissue thickness's compensating part 20720 proximal extremity 20726 place or near, and the second end 20789 of spring coil 20786 can be positioned on tissue thickness's compensating part 20720 distal end 20725 place or near, make spring coil 20786 longitudinally traverse tissue thickness's compensating part 20720.Spring coil 20786 can along two parallel row longitudinal extensions in tissue thickness's compensating part 20720.Tissue thickness's compensating part 20720 can be positioned in end effector 12, makes sliding part 20050 (Figure 39 0) or cutting element 20052 can along slit 20015 translation between the spring coil 20786 of parallel row.Alternatively, spring coil 20786 laterally or diagonally can traverse tissue thickness's compensating part 20720.

Refer again to Figure 40 4, spring coil 20786 can keep or embed in compensative material 20780.Compensative material 20780 can be can bio-absorbable, and can comprise foam, such as polyglycolic acid (PGA) foam.Compensative material 20780 can have elasticity, makes the distortion of compensative material 20780 produce resilience force.Compensative material 20780 can be solvable in such as chlorophyll solvent.Such as, tissue thickness's compensating part such as can comprise the spring coil 20786 containing polycaprolactone (PCL) and the compensative material 20780 containing polyglycolic acid (PGA) foam, make spring coil 20786 in chlorophyll solvent for insoluble, and compensative material 20780 is solvable in chlorophyll solvent.Compensative material 20780 can have elasticity at least in part, makes the distortion of compensative material 20780 produce load on spring or restoring force.

Tissue thickness's compensating part 20720 can comprise plait 20790, and it can extend between the spring coil 20786 of parallel row.Such as, see Figure 40 4, the first plait 20790 can traverse the spring coil 20786 of two parallel row diagonally, and the second plait 20790 also can traverse the spring coil 20786 of two parallel row diagonally.First and second plaits 20790 can intersect.Plait 20790 repeatedly can intersect along the length of tissue thickness's compensating part 20720.Spring coil 20786 can remain on and load in configuration by plait 20790, makes spring coil 20786 be maintained at substantially flat position in tissue thickness's compensating part 20720.The plait 20790 traversing tissue thickness's compensating part 20720 can directly be attached to spring coil 20786.Alternatively, plait 20790 can be connected to spring coil 20786 via support member 20792, and this support member 20792 extends through each spring coil 20786 along the longitudinal axis of spring coil 20786.

As described in more detail, nail bin 20000 can comprise slit 20015, and it can receive the translation gliding part 20050 (Figure 39 0) comprising cutting element 20052.When sliding part 20050 is along slit 20015 translation, nail 20030 can penetrate by sliding part 20050 from the securing member chamber 20012 nail bin 20000, and cutting element 20052 simultaneously or almost simultaneously can cut off tissue T.Refer again to Figure 40 4, when cutting element 20052 translation, it also can be breaking at the plait 20790 intersected between the parallel row spring coil 20786 in tissue thickness's compensating part 20720.When plait 20790 is cut off, each spring coil 20786 can load configuration from it and be released, and makes substantially flat location restore that each spring coil 20786 loads from tissue thickness's compensating part 20720 to expanding location.When spring coil 20786 is expanded, around the compensative material 20780 also easily extensible of spring coil 20786.

When nail 20030 (Figure 40 7-410) is deployed to firing position from initial position, nail 20030 can the part of joining tissue thickness compensation part 20720, and expansion can be expanded or attempt to tissue thickness's compensating part 20720 in nail 20030, and can apply compression stress to tissue T.At least one nail 20030 can the part of capture tissue thickness compensation part 20720 together with adjacent tissue T.Nail 20030 can apply compression stress to the captured part of tissue thickness's compensating part 20720 and captured tissue T, and tissue thickness's compensating part 20720 is compressed between uncompressed height and compression height.The compression of tissue thickness's compensating part 20720 can cause spring coil 20786 and remain on the correspondence distortion of compensative material 20780 wherein.As described in more detail, the distortion of each spring coil 20786 all can produce restoring force, and this restoring force can be depending on the resilience force of spring coil, such as, and the deflection of spring coil 20786 and/or the device of spring stiffness coefficient of spring coil 20786.The device of spring stiffness coefficient of spring coil 20786 at least can depend on the orientation of such as spring coil 20786, material, shape and/or size.The summation of the restoring force produced by least distortion spring coil 20786 in tissue thickness's compensating part 20720 and/or compensative material 30380 can produce restoring force on whole tissue thickness compensating part 20720.Tissue thickness's compensating part 20720 can apply to captured tissue T and percussion nail 20030 the restoring force summation that produced by the distortion spring coil 20786 in tissue thickness's compensating part 20720.

Main see Figure 40 5 and 406, the tissue thickness's compensating part 20820 for surgical end-effector 12 can comprise spring coil 20886.With fiber as herein described and coil similar, spring coil 20886 can be in tissue thickness's compensating part 20820 (such as) curling, distortion, coiling, bending, distortion, spiral, around and/or arc.Spring coil 20886 can comprise polymer composition and can have elasticity at least in part, makes the distortion of spring coil 20886 produce resilience force.In addition, spring coil 20886 can comprise the first end 20887 and the second end 20889.See Figure 40 5, the first end 20887 can be positioned on tissue thickness's compensating part 20820 proximal extremity 20826 place or near, and the second end 20889 can be positioned on tissue thickness's compensating part 20820 distal end 20825 place or near.Spring coil 20886 can be wound around or be folded into distal end 20826 from the proximal extremity 20825 of tissue thickness's compensating part 20820.

Refer again to Figure 40 5, spring coil 20886 can keep or embed in compensative material 20880.Compensative material 20880 can be can bio-absorbable, and can comprise foam, such as polyglycolic acid (PGA) foam.Compensative material 20880 can be solvable in such as chlorophyll solvent.Tissue thickness's compensating part such as can comprise the spring coil 20886 containing polycaprolactone (PCL) and the compensative material 20880 containing polyglycolic acid (PGA) foam, make spring coil 20886 in chlorophyll solvent for insoluble, and compensative material 20880 is solvable in chlorophyll solvent.Compensative material 20880 can have elasticity at least in part, makes the distortion of compensative material 20880 produce load on spring or restoring force.

Similar with tissue thickness as herein described compensating part, such as, tissue thickness's compensating part 20820 can be compressible.The compression of tissue thickness's compensating part 20820 can cause the distortion at least partially of the spring coil 20886 in the compensative material 20880 keeping or embed in tissue thickness's compensating part 20820.As described in more detail, the distortion of spring coil 20886 can produce restoring force, and this restoring force can be depending on the device of spring stiffness coefficient of the resilience force of such as spring coil 20886, the deflection of spring coil 20886 and/or spring coil 20886.The summation of the restoring force produced by distortion spring coil 20886 and/or deformation-compensated material 20880 can produce restoring force on whole tissue thickness compensating part 20820.Tissue thickness's compensating part 20820 can apply restoring force summation to the captured tissue T in percussion nail 20030.

Referring now to Figure 41 3, surgical end-effector 12 can comprise tissue thickness's compensating part 30020 with at least one tube element 30080.Tissue thickness's compensating part 30020 can remain in surgical end-effector 12.As described in more detail, the securing member in end effector 12 can be disposed, make securing member move to firing position and make the distortion at least partially of the tube element 30080 in tissue thickness's compensating part 30020.Reader will know, the tissue thickness's compensating part comprising at least one tube element as described herein can be arranged on or otherwise be engaged in multiple surgical end-effector, and this type of embodiment within the scope of the invention.

Still see Figure 41 3, tissue thickness's compensating part 30020 can be located relative to the anvil block 30060 of end effector 12.Alternatively, tissue thickness's compensating part 30020 can be located relative to the fastener cartridge assembly of end effector 12 (such as nail bin 30000).Nail bin 30000 can be engaged in the storehouse passage 30072 of the jaw 30070 of end effector 12.Such as, tissue thickness's compensating part 30020 can be fixed to nail bin 30000 releasedly.The tube element 30080 of tissue thickness's compensating part 30020 can be close to the top platform surface 30011 of the rigid support part 30010 of nail bin 30000 and locate.Tube element 30080 is fixed to top platform surface 30011 by binding agent or by wrappage (similar with at least one in wrappage as herein described) (such as, Figure 21 8).Tissue thickness's compensating part 30020 can be in aggregates with the assembly comprising nail bin 30000, makes nail bin 30000 and tissue thickness's compensating part 30020 be formed as individual unit structure.Such as, nail bin 30000 can comprise such as the first main part, such as rigid support part 30010, and the second main part, such as tissue thickness's compensating part 30020.

See Figure 41 3-415, the tube element 30080 in tissue thickness's compensating part 30020 can comprise elongated portion 30082, and this elongated portion 30082 has at least one tube chamber 30084 extended through at least in part wherein.Main see Figure 41 5, the elongated portion 30082 of tube element 30080 can comprise weaves or weaves strand 30090, as described in more detail.Alternatively, elongated portion 30082 can comprise solid construction, such as polymer extrudate, instead of weaves strand 30090.The elongated portion 30082 of tube element 30080 can comprise thickness.The thickness of elongated portion 30082 can in whole length and be substantially uniform around its diameter; In other cases, thickness can be change.Elongated portion 30082 can be elongated, makes the length of such as elongated portion 30082 be greater than the diameter of elongated portion 30082.Elongated portion can comprise the length of such as about 1.20 inches to about 2.60 inches and the diameter of about 0.10 inch to about 0.15 inch.The length of tube element 20080 can be such as about 1.40 inches, and the diameter of tube element 20080 can be such as about 0.125 inch.In addition, elongated portion 30082 can limit such as shape of cross section that is circular or ellipse substantially.Alternatively, shape of cross section can comprise polygonal shape, such as triangle, hexagon and/or octagon.Refer again to Figure 41 3, tube element 30080 can comprise the first distal end 30083 and the second proximal extremity 30085.The shape of cross section of elongated portion 30082 can narrow at the first end 30083 and/or the second end 30085 place, and wherein at least one end 30083,30085 of tube element 30080 can close and/or seal.Alternatively, tube chamber 30084 can continue across the distal end 30083,30085 of tube element 30080, makes end 30083, and 30085 is open.

Tube element 30080 can comprise the single central lumen 30084 extending through elongated portion 30084 at least in part.Tube chamber 30084 can extend across the whole length of elongated portion 30084.In other alternate forms, tube element 30080 can comprise the multiple tube chambers 30084 extended through wherein.The tube chamber 30084 extending through tube element 30080 can be circle, semicircle, wedge shape and/or their combination.Tube element 30080 also can comprise support fleece, and it can form " T " or " X " shape of such as modification in tube chamber 30084.Size in tube element 30080, tube chamber and/or support fleece can limit the shape of cross section of tube element 30080.The shape of cross section of tube element 30080 can be consistent in its whole length, or alternatively, the shape of cross section of tube element 30080 can be change along its length.As described in more detail, the shape of cross section of tube element 30080 can affect compression ratio and the resilience force of tube element 30080.

Tube element 30080 can comprise perpendicular diameter and horizontal diameter; The expection geometry that its size can retain region 30039 according to the size of the structure of the tube element 30080 in end effector 12, end effector 12 (comprising the interstice of end effector 12) and nail is selected.Such as, the perpendicular diameter of tube element 30080 can be highly relevant with the expection of one-tenth staple.In such cases, can select the perpendicular diameter of tube element 30080, make when tube element 30080 is trapped in in staple 30030, perpendicular diameter can reduce about 5% to about 20%.Such as, perpendicular diameter is that the tube element 30080 of about 0.100 inch can be used for expecting that forming height is the nail of about 0.080 inch to about 0.095 inch.Therefore, when tube element 30080 is trapped in in staple 30030, even if do not catch any tissue T wherein, the perpendicular diameter of tube element 30080 also can reduce about 5% to about 20%.When tissue T is trapped in in staple 30030, the compression of tube element 30080 even can be larger.Perpendicular diameter can be homogeneous in the whole length of tube element 30080, or alternatively, perpendicular diameter can be change along its length.

When tube element 30080 be in be not out of shape or resilience configuration time, the horizontal diameter of tube element 30080 can be greater than, be equal to or less than the perpendicular diameter of tube element 30080.Such as, see Figure 41 4, large such as about three times of the comparable perpendicular diameter of horizontal diameter.In some cases, such as, horizontal diameter can be about 0.400 inch and perpendicular diameter can be about 0.125 inch.Alternatively, referring now to Figure 41 6, when tube element 31080 be in be not out of shape or resilience configuration time, the horizontal diameter of tube element 31080 can equal or be substantially equal to the perpendicular diameter of tube element 31080.In some cases, such as, horizontal diameter can be about 0.125 inch and perpendicular diameter also can be about 0.125 inch.Tube element 30080 can comprise the length of the perpendicular diameter of about 0.125 inch, the horizontal diameter of about 0.400 inch and about 1.400 inches.As described in more detail, when power A being put on tube element 30080 and/or 31080, tube element deformable, makes cross-sectional geometry (comprising horizontal and vertical diameter) alterable.

Refer again to Figure 41 3-415, the tube element 30080 in tissue thickness's compensating part 30020 can be deformable.Whole tube element 30080 can be deformable.Such as, tube element 30080 can be deformable around its whole girth from proximal extremity 30083 to the distal end 30085 of elongated portion 30082.Alternatively, an only part for tube element 30080 can be deformable.Such as, an only part for the only intermediate length of elongated portion 30082 and/or the girth of tube element 30080 can be deformable.

When compression stress being put on the contact point on the elongated portion 30082 of tube element 30080, contact point can offset, and this can change the cross sectional dimensions of tube element 30080.Such as, refer again to Figure 41 4, tube element 30080 can comprise summit, top 30086 on elongated portion 30082 and bottom apex 30088.In first beginning and end deformed configuration, tube element 30080 can comprise non-deformed cross sections size, comprises not being out of shape perpendicular diameter between summit, top 30086 and bottom apex 30088.When compression stress A being put on summit 30086, top, tube element 30080 is moveable to deformed configuration.In deformed configuration, the cross sectional dimensions of pipe 30080 can change.Such as, pipe 30086 can comprise the distortion perpendicular diameter between summit, top 30086 and bottom apex 30088, and this distortion perpendicular diameter can be less than is not out of shape perpendicular diameter.Such as, see Figure 41 6, when never deformed configuration moves to deformed configuration to tube element 30080, the horizontal diameter of converting pipe 30080 can be lengthened out.The deformed cross sections size of converting pipe 30080 at least can depend on the position of exerted forces A, angular orientation and/or size.As described in more detail, the distortion of tube element 30080 can produce resilience force or restoring force, and it can be depending on the resilience force of tube element 30080.

Still see Figure 41 4, tube element 30080 can be produced resilience force or restoring force when compressing.In such cases, as described herein, when power A being put on the contact point on the elongated portion 30082 of tube element 30080, tube element 30080 can move to deformed configuration from first beginning and end deformed configuration.When removing applied force A, converting pipe 30080 can from deformed configuration resilience.Converting pipe 30080 can recoil to just beginning and end deformed configuration maybe can recoil to the configuration substantially similar with first beginning and end deformed configuration.Tube element 30080 is relevant to the resilience force of tube element 30080 from the ability of deformed configuration resilience.

Refer again to Figure 41 4, tube element 30080 can apply resilience force or restoring force.When such as applying applied force A by nail 30030 (Figure 41 7 and 418) to tube element 30080, restoring force can be produced by tube element 30080, as described in more detail.Applied force A can change the cross sectional dimensions of tube element 30080.In addition, in linear elastic material, the restoring force of each crushed element of tube element 30080 can be depending on the device of spring stiffness coefficient of the distortion size of tube element 30080 and this part of tube element 30080.The device of spring stiffness coefficient of tube element 30080 at least can depend on the orientation of such as tube element 30080, material, cross-sectional geometry and/or size.Tube element 30080 in tissue thickness's compensating part 30020 can comprise homogeneous device of spring stiffness coefficient.Alternatively, device of spring stiffness coefficient can change along the length of tube element 30080 and/or around the diameter of tube element 30080.When a part for the tube element 30080 with the first device of spring stiffness coefficient is greatly compressed, tube element 30080 can produce larger restoring force.When a part for the tube element 30080 with identical first device of spring stiffness coefficient is compressed less, tube element 30080 can produce less restoring force.

Refer again to Figure 41 3, the tube element 30080 in tissue thickness's compensating part 30020 can comprise polymer composition.The elongated portion 30082 of tube element 30080 can comprise this polymer composition.In addition, this polymer composition can comprise at least part of elastomeric material, makes the distortion of tube element 30080 produce restoring force.This polymer composition can comprise the polymer of such as nonabsorable, absorbable polymer or their combination.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly-(lactic acid) (PLA), polycaprolactone (PCL), poly-dioxanone (PDO) and their copolymer.Such as, can comprise can the biocompatible elastomers polymer of bio-absorbable for absorbable polymer.In addition, the polymer composition of tube element 30080 can comprise synthetic polymer, non-synthetic polymer or their combination.The polymer composition of tube element 30080 can comprise such as not commensurability by weight percentage absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

See Figure 41 3 and 414, tube element 30080 such as can comprise therapeutic agent 30098, such as pharmaceutically active agents or medicine.Therapeutic agent 30098 can remain in the tube chamber 30084 of tube element 30080.Elongated portion 30082 can encapsulate or partial encapsulation therapeutic agent 30098.Or alternatively, the polymer composition of elongated portion 30082 can comprise therapeutic agent 30098 in addition.Tube element 30080 can discharge the therapeutic agent 30098 of therapeutically effective dose.Can at tube element 30080 by release therapeutic agent 30098 during absorption.Such as, therapeutic agent 30098 can be discharged on flowing pipe linear element 30080 or pass the fluid of tube element 30080, such as blood.In other alternative form, can such as when nail 30030 (Figure 41 7 and 418) pierce through tube element 30080 and/or when follow closely percussion sliding part 30050 on cutting element 30052 (Figure 41 3) cutting tube element 30080 a part of time, release therapeutic agent 30098.The example of therapeutic agent 30098 can include but not limited to hemorrhage and medicine, such as, and fibrin, thrombin and/or oxidized regenerated cellulose (ORC); Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone; Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B and/or chloromycetin; Anticarcinogen, such as cisplatin, mitomycin and/or amycin; And/or biological preparation, such as stem cell.

Refer again to Figure 41 3,417 and 418, such as securing member (such as following closely 30030) can be deployed from nail bin 30000, makes nail 30030 joining tissue thickness compensation part 30020 and applies power A to tube element 32080 wherein.As described herein, power A is applied to tube element 30080 tube element 30080 can be caused to be out of shape.Similar with end effector 12 as herein described, the rigid support part 30010 of nail bin 30000 can comprise warehouse 30017, platform surface 30011 and multiple nail chambeies 30012 wherein.Each nail chamber 30012 can limit the opening in platform surface 30011 and follow closely 30030 and can be positioned at removedly in nail chamber 30012 (Figure 43 3).Main see Figure 41 7 and 418, two nail lower limbs 30032 that each nail 30030 can comprise base portion 30031 and extend from base portion 30031.Before deployment nail 30030, the base portion 30031 of each nail 30030 can be supported by the staple drivers 30040 (Figure 43 3) be positioned in the rigid support part 30010 of nail bin 30000.In addition before deployment nail 30030, the lower limb 30032 of each nail 30030 can be at least partially contained within nail chamber 30012 (Figure 43 3).

As described in more detail, follow closely 30030 can be deployed between initial position and firing position.Such as, nail percussion sliding part 30050 can engagement with driver 30040 (Figure 43 3) move between initial position and firing position to make at least one nail 30030.Main see Figure 41 7, nail 30030 is moveable to firing position, wherein follows closely the tube element 32080 of the lower limb 30032 joining tissue thickness compensation part 32020 of 30030, penetrate tissue T and contact and the anvil block 30060 (Figure 43 3) of locating relative with the nail bin 30000 in surgical end-effector 12.Nail shaping pit 30062 in anvil block 30060 can make nail lower limb 30032 bend, and makes the part being retained the tissue T in region 30039 by the part and nail pulling the trigger nail 30030 capture duct linear element 32080.As described in more detail, when nail 30030 moves between initial position and firing position, at least one nail lower limb 30032 can the tube element 32080 of piercing tissue thickness compensation part 32020.Alternatively, nail lower limb 30032 can, around the peripolesis of tube element 32080, make nail lower limb 30032 avoid piercing through tube element 32080.Similar with securing member as herein described, the lower limb 30032 of each nail 30030 can retain region 30039 towards the distortion downwards of the base portion 30031 of nail 30030 to form nail between the two.Nail retain region 30039 can be the part of wherein tissue T and tissue thickness's compensating part 32020 can by the region that catch of percussion nail 30030.In firing position, tissue thickness's compensating part 32020 that each nail 30030 can retain in region 30039 to tissue T and the nail being trapped in nail 30030 applies compression stress.

Still see Figure 41 7, when tube element 32080 be trapped in nail retain in region 30039 time, the captured part deformable of tube element 32080, as described herein.In addition, tube element 32080 can be deformed into according to being such as trapped in this identical nail and retaining the thickness of the tissue T in region 30039, compression ratio and/or density and differently follow closely the different distortion configuration retained in region 30039.Tube element 32080 in tissue thickness's compensating part 32080 can extend longitudinally through continuous print nail and retain region 30039.In this class formation, tube element 32080 can be repelled and attacked along one and be sent out nail 30030 and be deformed into each nail and retain different distortion configuration in region 30039.Referring now to Figure 41 8, the tube element 33080 in tissue thickness's compensating part 33020 can be repelled and attacked along one and be sent out a nail 30030 and be laterally arranged in nail and retain in region 30039.Tube element 33080 can be kept by soft shell 33210.In this class formation, tube element 33080 and soft shell 33210 can be deformed to each nail and retain different distortion configuration in region 30039.Such as, when tissue T is thinner, tube element 33080 is lessly compressible, and when tissue T is thicker, tube element 33080 is compressible must comparatively mainly with the thicker tissue T of adaptation.Alternatively, the distortion size of tube element 33080 can be homogeneous in the whole length and/or width range of tissue thickness's compensating part 33020.

See Figure 41 9-421, the tube element 34080 in tissue thickness's compensating part 34020 can comprise many strands 34090.Main see Figure 41 9, strand 34090 can be woven or be woven in the tubulose dot matrix 34092 of formation tube element 34080.The tubulose dot matrix 34092 formed by strand 34090 can be hollow substantially.The strand 34090 of tube element 34080 can be solid strand, tubulose strand and/or other suitable shapes another kind of.Such as, see Figure 42 0, the single strand 34090 of tubulose dot matrix 34092 can be pipe.See Figure 42 2, strand 34090 can comprise at least one tube chamber 34094 extended through wherein.The quantity of tube chamber 34094, geometry and/or size can determine the shape of cross section of strand 34090.Such as, strand 34090 can comprise circular tube chamber, semicircle tube chamber, wedge shape tube chamber and/or their combination.Strand 34090 also can comprise the support fleece 34096 of " T " or " X " shape that can form such as modification.At least strand 34090 diameter, extend through tube chamber wherein and support the shape of cross section that fleece can characterize strand 34090.As described in more detail, the shape of cross section of each strand 34090 can affect the resilience force or restoring force that are produced by strand 34090 and the corresponding resilience force produced by tube element 34080 or restoring force.

See Figure 42 3, the tubulose dot matrix 34092 of strand 34090 can be deformable.Tubulose dot matrix 34092 can produce or contribute to deformability and/or the resilience force of tube element 34080.Such as, the strand 34090 of tubulose dot matrix 34092 can be woven in together, strand 34090 relative to each other can be slided and/or bend.When applying power to the elongated portion 34082 of tube element 34080, strand 34090 wherein slidably and/or bending, makes tubulose dot matrix 34092 move to deformed configuration.Such as, still see Figure 42 3, follow closely 30030 compressible tubulose dot matrix 34092 and be trapped in the tissue T of following closely and retaining in region 34039, this can cause the strand 34090 of tubulose dot matrix 34092 relative to each other to slide and/or bend.When tubulose dot matrix 34092 is compressed into deformed configuration, can move towards the bottom apex 34088 of tubulose dot matrix 34092 in the summit, top 34086 of tubulose dot matrix 34092, to adapt to follow closely the captured tissue T retained in region 30039.In all cases, the tubulose dot matrix 34092 be trapped in percussion nail 30030 regains its non-deformed configuration by attempting and can apply restoring force to captured tissue T.In addition, be positioned at the part that nail to retain between region 30039 the tubulose dot matrix 34092 of (that is, not being captured in percussion nail 30030) to be also out of shape because nail retains the distortion of the adjacent part of the tubulose dot matrix 34092 in region 30039.When tubulose dot matrix 34092 is out of shape, tubulose dot matrix 34092 can be attempted from deformed configuration resilience or partly resilience.The part of tubulose dot matrix 34092 can recoil to its initial configuration and other parts of tubulose dot matrix 34092 only can partly be compressed completely in resilience and/or maintenance.

Similar with the description of tube element herein, each strand 34090 also can be deformable.In addition, the distortion of strand 34090 can produce restoring force, and this restoring force depends on the resilience force of each strand 34090.Main see Figure 42 0 and 421, each strand 34090 of tubulose dot matrix 34092 can be tubulose.Alternatively, each strand 34090 of tubulose dot matrix 34092 can be solid.In other alternative form, tubulose dot matrix 30092 can comprise at least one tubulose strand 34090, at least one solid strand 34090, at least one " X " or "T"-shaped shape strand 34090 and/or their combination.

Strand 34090 in tube element 34080 can comprise polymer composition.The polymer composition of strand 34090 can comprise the polymer of nonabsorable, absorbable polymer or their combination.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly-(lactic acid) (PLA), polycaprolactone (PCL), poly-dioxanone (PDO) and their copolymer.Such as, can comprise can the biocompatible elastomers polymer of bio-absorbable for absorbable polymer.In addition, the polymer composition of strand 34090 can comprise synthetic polymer, non-synthetic polymer and/or their combination.The polymer composition of strand 34090 can comprise such as not commensurability by weight percentage absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

Strand 34090 in tube element 34080 also can comprise such as therapeutic agent 34098 (Figure 42 0), such as pharmaceutically active agents or medicine.Strand 34090 can discharge the therapeutic agent 34098 of therapeutically effective dose.Can at tubulose strand 34090 by release therapeutic agent 34098 during absorption.Such as, therapeutic agent 30098 can be discharged into the fluid flowing through on strand 34090 or pass strand 34090, such as blood.In other alternative form, can such as when nail 30030 pierces through strand 34090 and/or when following closely cutting element 30052 (Figure 41 3) the cutting tubulose dot matrix 34092 on percussion sliding part 30050 a part of, release therapeutic agent 34098.The example of therapeutic agent 34098 can include but not limited to hemorrhage and medicine, such as, and fibrin, thrombin and/or oxidized regenerated cellulose (ORC); Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone; Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B and/or chloromycetin; Anticarcinogen, such as cisplatin, mitomycin and/or amycin; And/or biological preparation, such as stem cell.

See Figure 42 4 and 425, tube element 35080 can comprise multiple layers 35100 of strand 35090.Tube element 35080 can comprise multiple layers 35100 of tubulose dot matrix 35092.See Figure 42 4, tube element 35080 can comprise ground floor 35100a and the second layer 35100b of such as strand 35090.Referring now to Figure 42 5, the tube element 35180 of tissue thickness's compensating part 35120 can comprise the third layer 35100c of such as strand 35090.In addition, the different layers 35100 in tube element 35180 can comprise different materials.Each layer of 35100a, 35100b, 35100c can be can bio-absorbable, and wherein each layer of 35100a, 35100b, 35100c can comprise different polymer compositions.Such as, ground floor 35100a can comprise the first polymer composition; Second layer 35100b can comprise the second polymer composition; And third layer 35100c can comprise terpolymer compositions.In such cases, layer 35100a, 35100b, 35100c of tube element 35180 can by different rates by bio-absorbable.Such as, ground floor 35100a can absorb fast, the comparable ground floor 35100a of second layer 35100b more slow trapping, and the comparable ground floor 35100a of third layer 35100c and/or second layer 35100b more slow trapping.Alternatively, ground floor 35100a can slowly absorb, and the comparable ground floor 35100a of second layer 35100b absorbs sooner, and third layer 35100c comparable ground floor 35100a and/or second layer 35100b absorbs sooner.

Similar with strand 34090 as herein described, the strand 35090 in tube element 35180 can comprise medicine 35098.Refer again to Figure 42 4, in order to control eluting or the release of medicine 35098, the ground floor 35100a comprising the strand 35090 of medicine 35098a can by first rate by bio-absorbable and the second layer 35100b comprising the strand 35090 of medicine 30098b can by the second speed by bio-absorbable.Such as, ground floor 35100a can absorb to allow the quick initial release of medicine 35098a fast, and second layer 35100b can comparatively slow trapping to allow medicine 30098b controlled release.Medicine 35098a in the strand 35090 of ground floor 30100a can be different from the medicine 35098b in the strand 35090 of second layer 35100b.Such as, the strand 35090 in ground floor 35100a can comprise oxidized regenerated cellulose (ORC) and strand 35090 in second layer 35100b can comprise solution, and this solution comprises hyaluronic acid.In such cases, the initial absorption of ground floor 35100a can discharge oxidized regenerated cellulose to help Bleeding control, and the subsequent absorption of second layer 35100b can discharge comprise hyaluronic solution with help suppress tissue apposition.Alternatively, layer 35100a, 35100b can comprise same medicine 35098a, 35098b.Such as, refer again to Figure 42 5, the strand 35090 in layer 35100a, 35100b and 35100c can comprise anticarcinogen, such as cisplatin.In addition, ground floor 35100a can absorb to allow the quick initial release of cisplatin fast, second layer 35100b can comparatively slow trapping to allow cisplatin controlled release, and third layer 35100c can most slow trapping to allow the controlled release more extended of cisplatin.

See Figure 42 6 and 427, tissue thickness's compensating part 36020 can comprise overmolding material 36024.Overmolding material 36024 can be formed at outside tube element 36080, inside tube element 36080 or both tube element 36080 inner side and outer side.See Figure 42 6, overmolding material 36024 can simultaneously in tube element 36080 inner side and outer side coextrusion, and tube element 36080 can comprise the tubulose dot matrix 36092 of strand 36090.Similar with polymer composition as herein described, overmolding material 36024 can comprise such as polyglycolic acid (PGA), poly-(lactic acid) (PLA) and/or any other suitable can the biocompatible elastomers polymer of bio-absorbable.In addition, overmolding material 36024 can be atresia, makes overmolding material 36024 to form the layer of the fluid impermeable in tube element 36080.Overmolding material 36024 can be defined through tube chamber 36084 wherein.

As discussed further above, the strand 36090 in tube element 36080 and/tubulose dot matrix 36092 can comprise therapeutic agent 36098.Still see Figure 42 6 and 427, atresia overmolding material 36024 can comprise medicine 36098 in interior lumen 36084a.Alternatively or in addition, atresia overmolding material 36024 can comprise medicine 36098 in intermediary canal 36084b, the intermediary canal 36084b of the tubulose dot matrix 36092 of the strand 36090 containing medicine is such as comprised.Similar to the above, tube element 36080 can be located (Figure 41 3) relative to the cutting element 30052 in nail chamber 30012 and nail bin 30000.Such as, the nail deployment of 30030 and/or the translation of cutting element 30052 can pierce through or make atresia overmolding material 36024 broken loose, make to discharge from tube chamber 30084 medicine 36098 be accommodated at least one tube chamber 36084 of tube element 30080.See Figure 42 8, tube element 37080 can comprise non-porous film 37110.Non-porous film 37110 can at least in part around the ground floor 37100a of tubulose dot matrix 37092 or tubulose dot matrix 30092 and second layer 37100b to provide the covering of the fluid impermeable similar with overmolding material 36024 as herein described.

As described herein, tube element can comprise can the material of bio-absorbable, therapeutic agent, many strands, tubulose dot matrix, the layer of tubulose dot matrix, overmolding material, at least one in non-porous film or its combination.Such as, see Figure 42 9, the many strands 38090 that tube element 38080 can comprise overmolding material 38024 and locate through the central lumen 38084 of tube element 38080.Strand 38090 can comprise therapeutic agent 38098.Alternatively, such as, see Figure 43 0, tube element 39080 can comprise such as overmolding material 39024 and the therapeutic agent 39098 be positioned in the central lumen 39084 of tube element 39080.At least one in tube element 39080 and overmolding material 39024 can comprise fluid treatment agent 39098.

Mainly refer again to Figure 41 3, tube element 30080 can be located relative to the rigid support part 30010 of nail bin 30000.Tube element 30080 can be close to rigid support part 30010 longitudinal register.Tube element 30080 can be arranged essentially parallel to or align with the longitudinal slit in rigid support part 30010 or cavity 30015.Tube element 30080 can align with longitudinal slit 30015, makes a part for tube element 30080 overlapping with a part for longitudinal slit 30015.In such cases, the cutting element 30052 on nail percussion sliding part 30050 can cutting edge 30052 along the longitudinal slit 30015 translation time cut off the part of tube element 30080.Alternatively, on tube element 30,080 first side that can be longitudinal positioning of longitudinal slit 30015 or the second side.In other alternative form, tube element 30080 can be located relative to the rigid support part 30010 of nail bin 30000, makes tube element 30080 laterally or diagonally traverse rigid support part 30010 at least partially.

See such as Figure 43 1, tissue thickness's compensating part 40020 can comprise multiple tube element 40080.Tube element 40080 can comprise such as different length, shape of cross section and/or material.In addition, tube element 40080 can be located relative to the rigid support part 40010 of nail bin 30000, makes the tubulose axis of tube element 40080 parallel to each other.The tubulose axis of tube element 40080 can longitudinally align, and the first tube element 40080 is positioned in another tube element 40080.Alternatively, parallel tubular elements 40080 longitudinally can traverse such as nail bin 30000.In other alternative form, parallel tubular elements 40080 laterally or diagonally can traverse nail bin 30000.Alternatively, non-parallel tube element 40080 can be oriented relative to one another to angular orientation, its tubulose axis is intersected each other and/or not parallel.

See Figure 43 1-434, tissue thickness's compensating part 40020 can have two tube elements 40080; First tube element 40080a can be longitudinal positioning of the first side of the longitudinal slit 30015 in rigid support part 30010, and the second tube element 40080b can be longitudinal positioning of the second side of longitudinal slit 30015.Each tube element 40080 can comprise the tubulose lattice 40092 of strand 40090.Nail bin 30000 can comprise six nail chambeies 30012 altogether, and wherein such as three nail chambeies 30012 are positioned on every side of longitudinal slit 30015.In such cases, the translation cutting edge 30052 followed closely on percussion sliding part 30050 may not be needed to cut off a part for tube element 40080.

Similarly, referring now to Figure 43 5-436, tissue thickness's compensating part 41020 can comprise two tube elements 41080a, 41080b being longitudinally arranged in nail bin 30000.Similar to the above, a tube element 41080a can be engaged from the nail 30030 in three nail chambeies 30012 and another tube element 41080b can be engaged from the nail 30030 in three different nail chambeies 30012.Still see Figure 43 5-436, the nail 30030 be deployed can at the diverse location place joining tubular element 40080 of the cross section across tube element 40080.As described herein, the resilience elasticity applied by tube element 41080 and corresponding restoring force can be depending on shape of cross section of tube element 41080 etc.Be positioned at the nail 30030 that the comparable nail be positioned near non-arch section of nail 30030 that the curved portions office that is arranged in tube element 41080 or neighbouring nail retain region 30039 retains region 30039 and stand larger restoring force.Similarly, the nail be positioned in the non-arch section of tube element 41080 retains the nail 30030 in region 30039, can stand the restoring force less than the restoring force experienced by the curved portions office or neighbouring nail 30030 that are positioned at tube element 30080.In other words, owing to may catch the elastomeric material of larger amt along the nail 30030 of this type of part, the non-arch section of the comparable tube element of arch section 41080 of tube element 41080 has more big spring stiffness factor.Therefore, mainly see Figure 43 6, the restoring force produced by tissue thickness's compensating part 41020 can be larger and less near nail 30030b near nail 30030a and 30030c in tube element 30080a.Correspondingly, the restoring force produced by tissue thickness's compensating part 41020 can than larger near nail 30030e near nail 30030d and 30030f in tube element 30080b.

Refer again to Figure 43 1-434, the cross-sectional geometry of the strand 40090 comprising tubulose dot matrix 40092 can be selected, to provide resilience elasticity and corresponding restoring force needed for tubulose dot matrix 40092 applies.Such as, refer again to Figure 43 2, the strand 40090a be positioned in the arch section of tube element 40080 can comprise X-shaped shape cross section, and the strand 40090b be positioned in the non-arch section of tube element 40080 can comprise tubular cross-section.To form tubulose dot matrix 40092 together with strand 40090a with 40090b comprising varying cross-section geometry can be woven in.Alternatively, strand 40090a and 40090b can be attached to each other with such as binding agent.See Figure 43 3 and 434, the restoring force optimization that the varying cross-section geometry of the strand 40090 in tube element 40080 can make the nail across nail bin 30000 retain to stand in region 30039.Certain cross section geometry can be selected, the resilience constant retained in region 30039 of the nail across nail bin is balanced substantially or equal.

See Figure 43 7, tube element 41080a, 41080b of tissue thickness's compensating part 41120 tighten together by adjacent part 41126.Although translation cutting element 30052 can pass through between tube element 41080a and 41080b, cutting element 30052 may be needed to cut off adjacent part 41126 at least partially.Adjacent part 41126 can comprise flexible material, such as foam or gel, and it is easily cut off by translation cutting element 30052.Tissue thickness's compensating part 41120 can be fixed to surgical end-effector 12 by adjacent part 41026 releasedly.Adjacent part 41126 can be fixed to the top platform surface 30011 of rigid support part 30010, makes still to remain in surgical end-effector 12 at adjacent part 41126 after surgical end-effector 12 releasing tube linear element 41080a, 41080b.

See Figure 43 8-439, tissue thickness's compensating part 42020 can comprise multiple tube element 42080, makes the quantity of such as tube element 42080 identical with the line number in the nail chamber 30012 in nail bin 30000.Nail bin 30000 can comprise six nail chambeies 30012 and tissue thickness's compensating part 42020 can comprise six tube elements 42080.Each tube element 42080 can with nail chamber 30012 substantial alignment.When nail 30030 is penetrated from a nail chamber 30012, each nail 30030 from this row can pierce through same pipe linear element 42080 (Figure 43 9).The distortion of a pipe 42080 can have minimum impact or not impact to the distortion of adjacent tubes 42080.Therefore, tube element 42080 can retain at the nail across nail bin 30030 width in region 30039 and apply the discrete resilience force with customizing substantially.When the nail 30030 of pulling the trigger from many nails chamber 30012 engages same pipe linear element 35080 (Figure 43 6), the distortion of tube element 35080 can lessly customize.Such as, the distortion retained in region 30039 of tube element 35080 nail in the first row can affect the nail of this tube element 35080 in another row and retains distortion in region 30039.Translation cutting edge 30052 can be avoided cutting off tube element 42080.Alternatively, see Figure 44 0, tissue thickness's compensating part 43020 can comprise the tube element 43080 of more than six, such as seven tube elements 44080.In addition, tube element 43080 can symmetrical or asymmetric arrangement in end effector 12.When odd number tube element 43080 longitudinally and when being arranged symmetrically in end effector 12, translation cutting element 30052 can cut off the intermediate tubular element covered on vertical passage 30015.

See Figure 44 1, tissue thickness's compensating part 44020 can comprise central tubular element 44080b, and it aligns with the longitudinal slit 30015 in the rigid support part 33010 of nail bin 30000 at least in part.Tissue thickness's compensating part 44020 also can comprise at least one peripheral tubular element 44080a, 44080c of being positioned on longitudinal slit 30015 side.Such as, tissue thickness's compensating part 44020 can comprise three tube element 44080: the first peripheral tubular element 44080a and can be longitudinal positioning of on the first side of longitudinal slit 30015 of nail bin 30000, central tubular element 44080b can be positioned substantially at above longitudinal slit 30015 and/or with longitudinal slit 30015 and align, and the second periphery tube element 44080c can be longitudinal positioning of on the second side of longitudinal slit 30015.It is the horizontal diameter of substantially extending that central tubular element 44080b can comprise relative to perpendicular diameter.Central tubular element 44080b and/or any other tube element can be overlapping with many nails chamber 30012.Still see Figure 44 1, such as, central tubular element 44080b can follow closely re-scheduling with nail four of chamber 30012 and to fold and each peripheral tubular element 44080a, 44080c can be overlapping with single nail chamber 30012.Alternatively, central tubular element 44080b can be such as overlapping with being less than four nail chambeies 30012, such as, and two nail chambeies 30012.In addition, peripheral tubular element 44080a, 44080c can be overlapping with more than a nail chamber 30012, such as two nail chambeies 30012.Referring now to Figure 44 2, the central tubular element 44180b of tissue thickness's compensating part 44120 can comprise therapeutic agent 44198 in the tube chamber 44184 of central tubular element 44180b.Central tubular element 44180b and/or at least one peripheral tubular element 44080a, 44080c can comprise therapeutic agent 44198 and/or any other suitable therapeutic agent.

See Figure 44 3, tissue thickness's compensating part 44220 can comprise shell 44224, and this shell can be similar with overmolding material 32024 as herein described.Multiple tube element 44080 is remained on appropriate location by shell 44224 in end effector 12.Shell 44224 can with tube element 44080 coextrusion.Tube element 44080 can comprise the tubulose dot matrix 44092 of strand 44090.Be similar to polymer composition as herein described, shell 44224 can such as comprise polyglycolic acid (PGA), poly-(lactic acid) (PLA) and/or any other suitable can the biocompatible elastomers polymer of bio-absorbable.In addition, shell 44224 can be atresia, makes shell 44224 such as form the layer of fluid impermeable in tissue thickness's compensating part 44220.As discussed herein further, the strand 44090 in tube element 44080 and/or tubulose dot matrix 44092 can comprise therapeutic agent 44098.The shell 44224 of atresia can comprise therapeutic agent 44098 in tissue thickness's compensating part.As described herein, tube element 44080 can be positioned in nail bin 30000 relative to nail chamber 30012 and cutting element 30052.Such as, the nail deployment of 30030 and/or the translation of cutting element 30052 can be pierced through the shell 44224 of atresia or be made it broken loose, and the therapeutic agent 44198 wherein comprised can be discharged from tissue thickness's compensating part 44020.

See Figure 44 4, tissue thickness's compensating part 44320 can comprise central tubular element 44380b, and this central tubular element comprises tubulose dot matrix 44392.Tubulose dot matrix 44392 can have nonwoven part or gap 44381, aligns with longitudinal slit 30015 of rigid support part 30010 substantially in described nonwoven part or gap.In this case, the woven portion of the tubulose dot matrix 44092 of tube element 44380b is not overlapping with longitudinal slit 30015.Therefore, the cutting element 30052 on translation nail percussion sliding part 30052 can longitudinally slit 30015 translation and do not cut off the overlap of the woven portion of tubulose dot matrix 44392.Although nail 30030c and 30030d that locate of gap 44381 in adjacent tubular element 44380b can from the less support of tubulose dot matrix 44392 Structure Receive, other feature structure can be these nails 30030 and provides support and/or retain in region 30039 at its nail and provide other restoring force.Such as, as described in more detail, other tube element, support belt, spring and/or stay material such as can be positioned at least one place in the inside and outside tube element 44380b near gap 44381.

Referring now to Figure 44 5-448, tissue thickness's compensating part 45020 can comprise the multiple tube elements 45080 laterally traversing nail bin 30000.Tube element 45080 can be oriented to the longitudinal axis perpendicular to the nail row in chamber 30012 and/or the rigid support part 30010 of nail bin 30000.See Figure 44 5, tube element 45080 can traverse the longitudinal slit 30015 in nail bin 30000, makes the cutting element 30052 followed closely on percussion sliding part 30050 can cut off tube element 45080 when following closely percussion sliding part 30050 longitudinally slit 30015 translation.Alternatively, referring now to Figure 44 6, tissue thickness's compensating part 46020 can comprise two groups of tube elements laterally traversed 46080.First group of tube element 46080a laterally traversed can be positioned on the first side of longitudinal slit 30015, and second group of tube element 46080b laterally traversed can be positioned on the second side of longitudinal slit 30015.In this class formation, cutting element 30052 can pass between two groups of tube elements 46080, and does not cut off a part for tube element 46080.Alternatively, when at least one other tube element 46080 does not traverse longitudinal slit 30015 and not cut element 30052 cuts off, cutting element 30052 can cut off at least one tube element 46080 traversing longitudinal slit 30015.

When tube element 45080 laterally traverses nail bin 30000, see Figure 44 7 and Figure 44 8, nail 30030 can engage each nail and retain at least one tube element 45080 in region 30039.In this class formation, each tube element 45080 can provide discrete restoring force along the length of nail bin 30000.Such as, main see Figure 44 8, with organizing compared with the tube element 45080 of locating near the distal end of tissue thickness's compensating part 45020 at thinner place, can greatly be compressed organizing the tube element 45080 of locating near the proximal extremity of tissue thickness's compensating part 45020 at thicker place.Therefore, compared with the restoring force produced with the tube element 46080 can located by the distal end closer to tissue thickness's compensating part 45020, the tube element 45080 that the proximal extremity closer to tissue thickness's compensating part 45020 is located can provide larger restoring force.In addition, still see Figure 44 8, the distortion of a pipe 45080 can have minimum impact or not impact for the distortion of adjacent tubes 45080.Therefore, tube element 45080 can retain in region 30039 at the nail of the length along nail bin 30030 and apply the discrete resilience force with customizing substantially.When multiple nails 30030 of percussion from single nail chamber 30012 engage same pipe linear element 35080, the distortion of tube element 35080 can lessly customize.Such as, the distortion of tube element 35080 that nail retains in region 30039 can affect this tube element 35080 and follow closely at another distortion retained in region 30039.

In other alternate forms, see Figure 44 9-454, the tube element 47080 of tissue thickness's compensating part 47020 can traverse nail bin 30000 diagonally.Tube element 47080 can traverse the longitudinal slit 30015 in nail bin 30000, makes the cutting element 30052 followed closely on percussion sliding part 30050 can cut off when following closely percussion sliding part 30052 longitudinally slit 30015 translation the tube element 47080 traversed diagonally.Alternatively, tissue thickness's compensating part 47020 can comprise two groups of tube elements traversed diagonally 47080.First group of tube element traversed diagonally 47080 can be positioned on the first side of longitudinal slit 30015, and second group of tube element traversed diagonally 47080 can be positioned on the second side of longitudinal slit 30015.In this class formation, cutting element 30052 can pass between two groups of tube elements 47080, and can not cut off any tube element 47080.

Still see Figure 44 9-452, the tube element 47080 traversed diagonally can be positioned in nail bin 30000, and gap is limited between tube element 47080.When such as by applying compression stress in the tissue T becoming the nail of staple 30030 to retain region 30039 IT to adjacent tubular elements 47080, the horizontal extension that the gap between adjacent tubular elements can be tube element 47080 provides space.Tube element 47080 connects by material membrane or material piece 47024 spanning gap.Material piece can be positioned at least one in the platform surface 30011 of rigid support part 30010 and/or the tissue contact side of tube element 47080.

See Figure 45 3 and Figure 45 4, at least one tube element 47080 traversed diagonally can be positioned in nail bin 30000 relative to nail chamber 30012, and tube element 47080 is positioned between the lower limb 30032 of the nail 30030 disposed from many nails chamber 30012.When nail 30030 moves to firing position from initial position, as described in more detail, follow closely lower limb 30032 can remain positioned in around tube element 47080.In addition, such as, nail can be out of shape, and nail lower limb 30032 is wrapped up around the periphery of tube element 47080.In this class formation, nail 30030 can move to firing position or shaping position, and does not pierce through tube element 47080.In some cases, nail lower limb 30032 can prevent from by mistake discharging around the motion of tube element 47080 therapeutic agent 47098 remained on wherein.Each tube element 47080 relative to nail bin 30000 longitudinal slit 30015 selected by angular orientation can be depending on nail the position of chamber 30012 in nail bin 30000.Such as, tube element 47080 can relative to longitudinal slit 30015 of nail bin 30000 into about 45 (45) location, degree angle.Alternatively, tube element 47080 such as can spend location, angle relative to longitudinal slit 30015 one-tenth ten five (15) to 75 (75) of nail bin 30000.

Be similar to disclosure description in the whole text, the multiple tube elements in tissue thickness's compensating part connect by such as binding agent, wrappage, band, overmolding material, compensative material and/or any other suitable connection binding agent or structure.See Figure 45 5-457, soft shell 48024 can around or encapsulation organize tube element 48080 in thickness compensation part 48020.Soft shell 48024 can tube element 48080 in confinement end executor 12, and each tube element 48080 can be made to remain on appropriate location, such as longitudinally aligns with a nail chamber 30012.Such as, tissue thickness's compensating part 48020 can comprise six tube elements 48080.Soft shell 48024 can be fully deformable and resilient, to limit the tube element 48020 wherein wrapped up, allows distortion and the resilience of tube element 48080 simultaneously.In addition, soft shell 48024 can tighten around tube element 48080, and can tube element 48080 be out of shape and/or resilience time keep with tube element tighten joint.

See Figure 45 6, before deployment nail 30030, anvil block 30060 can pivotable or rotation downwards, to compress tissue thickness's compensating part 48020 between anvil block 30060 and nail bin 30000 and tissue T.The compression of tissue thickness's compensating part 48020 can comprise the correspondence compression of soft shell 48024 and wherein tube element 48020.When tube element 48020 is out of shape, soft shell 48024 can similarly be out of shape.Tube element 48020 can compress equably on the whole width of nail bin 30000, and soft shell 48024 can experience the similar homogeneous compaction on whole tube element 48080.See Figure 45 7, when anvil block 30060 is from when opening after nail bin 30000 disposes nail 30030, tube element 48080 can from compressed configuration resilience or partly resilience (Figure 45 6).Tube element 48080 can resilience, makes tube element 48080 turn back to its just beginning and end deformed configuration.Tube element 48080 can partly resilience, makes tube element 48080 partly turn back to its just beginning and end deformed configuration.Such as, the distortion of tube element 48080 can be partial elastic and part plasticity.When tube element 48080 resilience, soft shell 48024 can keep tightening joint with each tube element 48080.Tube element 48080 and soft shell 48024 can recoil to such degree, and described degree makes tube element 48080 and tissue T fill nail and retains region 30039, tube element 48080 tissue T wherein apply suitable restoring force simultaneously.See Figure 45 8, alternatively, comprise six tissue thickness's compensating parts 48120 remaining on the tube element 48180 in soft shell 48124 can such as be positioned on the anvil block 30060 of end effector 12.

See Figure 45 9-462, tissue thickness's compensating part 49020 can comprise tube element 49080, and this tube element is along the longitudinal axis longitudinal register of anvil block 30060.Tissue thickness's compensating part 49020 is fixed to the anvil block 30060 of end effector 12 by compressible compensative material 49024.In addition, compressible compensative material 49024 can around or package tube linear element 49080.Be similar to description herein, tube element 49080 can comprise at least one therapeutic agent 49098, and this therapeutic agent is by discharging with under type: the various components of absorptive tissue thickness compensation part 49020, pierce through tube element 49080 by the nail 30030 of being pulled the trigger by nail bin 30000 and/or cutting element 30052.

See Figure 46 0, nail bin 30000 can comprise the nail 30030 be positioned in nail chamber 30012, wherein before deployment nail 30030, anvil block 30060 and attachment tissue thickness's compensating part 49020 thereon can compress towards nail bin 30000 pivotable the tissue T be captured between the two.The tube element 49080 of tissue thickness's compensating part 49020 by pivotal anvil 30060 along nail bin 30000 uniform length be out of shape (Figure 46 0).See Figure 46 1 and 462, nail percussion sliding part 30050 can along longitudinal slit 30015 translation in nail bin 30000 and engage be positioned at nail chamber 30010 in nail 30030 below each driver 30040, wherein each joint driver 30040 can from nail chamber 30012 percussion or injection nail 30030.When anvil block 30060 discharges the pressure on tissue T and tissue thickness's compensating part 49020, tissue thickness's compensating part 49020 (comprising tube element 49080 and compressible compensative material 49024) from compressed configuration (Figure 46 0) resilience or can partly recoil to resilience configuration (Figure 46 1 and 462).Tube element 49080 and compressible compensative material 49024 can recoil to such degree, described degree makes tissue thickness's compensating part 49020 and tissue T fill nail and retains region 30039, and restoring force is applied in captured tissue T by tissue thickness's compensating part 49020 simultaneously.

See Figure 46 3-465, Liang Ge tissue thickness compensating part 50020a, 50020b can be positioned in the end effector 12 of surgical instruments.Such as, the first tissue thickness compensating part 50020a can be attached to the nail bin 30000 in lower jaw 30070, and minor microstructure thickness compensation part 50020b can be attached to anvil block 30060.First tissue thickness compensating part 50020a can comprise multiple tube element 50080, and the plurality of tube element is longitudinally arranged and remained in the first compensative material 50024a.At least one tube element 50080 can comprise therapeutic agent 50098, is similar to therapeutic agent as herein described.First compensative material 50024a can be deformable or cardinal principle rigidity.In addition, the first compensative material 50024a can make tube element 50080 remain on appropriate location relative to nail passage 30000.Such as, the first compensative material 50024a can make each tube element 50080 keep longitudinally aliging with a nail chamber 30012.Minor microstructure thickness compensation part 50020b can comprise the first compensative material 50024a, the second compensative material 50024b and/or the 3rd compensative material 50024c.Second compensative material 50024b and the 3rd compensative material 50024c can be deformable or cardinal principle rigidity.

Anvil block 30060 can pivotable and compression stress is applied to tissue thickness compensating part 50020a, 50020b and the tissue T between anvil block 30060 and nail bin 30000.First tissue thickness compensating part 50020a and minor microstructure thickness compensation part 50020b does not all need for compressible.Alternatively, at least one assembly in the first tissue thickness compensating part 50020a and/or minor microstructure thickness compensation part 50020b can be compressible.Referring now to Figure 46 4 and 465, when nail 30030 is pulled the trigger from nail bin 30000, each nail 30030 can pierce through the tube element 50080 remained in the first tissue thickness compensating part 50020a.As shown in Figure 46 4, the therapeutic agent 50098 remained in tube element 50080 can discharge when nail 30030 pierces through tube element 50080.When discharging, therapeutic agent 50098 can apply nail lower limb 30032 and the tissue T around percussion nail 30030.When nail 30030 is pulled the trigger from nail bin 30000, nail 30030 also can pierce through minor microstructure thickness compensation part 50020b.

See Figure 46 6-469, the tissue thickness's compensating part 51020 representing any tissue thickness described herein compensating part can comprise at least one tube element 51080 laterally traversing tissue thickness's compensating part 51020.Such as, see Figure 46 6, tissue thickness's compensating part 51020 can be located relative to nail bin 30000, first end 51083 of the tube element 51080 laterally traversed can be positioned near first longitudinal side of nail bin 30000, and the second end 51085 of the tube element 51080 laterally traversed can be positioned near second longitudinal side of nail bin 30000.Such as, tube element 51080 can comprise capsule shape shape.As shown in Figure 46 7, tube element 51080 can be perforated between the first end 51083 and the second end 51085, and tube element 51080 can center 51087 place of tube element 51080 or near be perforated.Such as, tube element 51080 can comprise polymer composition, such as can the biocompatible elastomers polymer of bio-absorbable.In addition, refer again to Figure 46 6, tissue thickness's compensating part 51020 can comprise multiple tube element 51080 laterally traversed.Such as, 13 tube elements 51080 can be laterally arranged in tissue thickness's compensating part 51020.

Refer again to Figure 46 6, tissue thickness's compensating part 51020 also can comprise at least in part around the compensative material 51024 of tube element 51080.Compensative material 51024 can comprise can the polymer of bio-absorbable, such as lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensative material 51024 can make tube element 51080 be held in place in tissue thickness's compensating part 51020.In addition, compensative material 51024 can be fixed to the top platform surface 30011 of the rigid support part 30010 of nail bin 30000, and compensative material 51020 is positioned in end effector 12 securely.Compensative material 51024 can comprise at least one medicine 51098.

Still see Figure 46 6, the tube element 51080 of lateral register can be located relative to translation cutting element 30052, makes cutting element 30052 can cut off tube element 51080.Cutting element 30052 can perforation place wherein or neighbouring cut-out tube element 51080.When tube element 51080 is cut to two halfs, the cut-off part of tube element 51080 can swelling or expansion, as shown in Figure 46 8.Such as, tube element 51080 can comprise hydroaropic substance 51099, and this hydroaropic substance can discharge when tube element 51080 is cut off and/or expose.In addition, when body fluid in hydroaropic substance 51099 contact tissue T, hydroaropic substance 51099 can attract described fluid, and this can cause the swelling or expansion of tube element 51080.When tube element 51080 is expanded, the compensative material 51024 around tube element 51080 can offset or adjust to adapt to swelling tube element 51080.Such as, when compensative material 51024 comprises gelatin, described gelatin can offset to adapt to swelling tube element 51080.Referring now to Figure 46 9, the expansion of tube element 51080 and the skew of compensative material 51024 can cause the correspondence of tissue thickness's compensating part 51020 to be expanded.

Be similar to other tissue thickness's compensating parts that the disclosure is discussed in the whole text, tissue thickness's compensating part 51020 is by applied force distortion or compression.In addition, tissue thickness's compensating part 51020 can be fully resilient, makes it produce resilience force when being out of shape by applied force, and can resilience or partly resilience when removing applied force subsequently.When tissue thickness's compensating part 51020 retains captured in region 30039 at nail, nail 30030 can make tissue thickness's compensating part 51020 be out of shape.Such as, follow closely 30030 can make to be out of shape at the tube element 51080 of tissue thickness's compensating part 51020 of percussion nail 30030 IT and/or compensative material 51024.Not not the catching part and can be out of shape because following closely the distortion that retain in region 30039 yet of tissue thickness's compensating part 51020.When being out of shape, tissue thickness's compensating part 51020 can attempt resilience from deformed configuration.Before this type of resilience can occur in the hydrophilic expansion of tube element 51080, while the expansion of the hydrophilic of tube element 51080, and/or after the hydrophilic expansion of tube element 51080.When tissue thickness's compensating part 51020 attempts resilience, it can apply restoring force being also trapped in the nail tissue retained in region 30039, as described in more detail.

At least one in tissue thickness's compensating part 51020 in tube element 51080 and/or compensative material 51024 can comprise therapeutic agent 51098.When the tube element 51080 comprising therapeutic agent 51098 is cut off, the therapeutic agent 51098 be included in tube element 51080 can be released.In addition, when compensative material 51024 comprises therapeutic agent 51098, therapeutic agent 51098 can bio-absorbable compensative material 51024 by absorption time discharge.Tissue thickness's compensating part 51020 can provide the quick initial release of therapeutic agent 51098, is the controlled release of therapeutic agent 51098 afterwards.Such as, when the tube element 51080 comprising therapeutic agent 51098 is cut off, tissue thickness's compensating part 51020 can provide the quick initial release of the therapeutic agent 51098 from tube element 51080 to tissue T along line of cut.In addition, when comprise therapeutic agent 51098 can bio-absorbable compensative material 51024 by absorption time, tissue thickness's compensating part 51020 can provide the controlled release of the prolongation of therapeutic agent 51098.Before therapeutic agent 51098 flows into compensative material 51024, at least some in therapeutic agent 51098 can keep shorter a period of time in tube element 51080.Alternatively, at least some in therapeutic agent 51098 can remain in tube element 51080 until tube element 51080 is absorbed.Therapeutic agent 51098 and the compensative material 51024 of release from tube element 51080 can be identical.Alternatively, such as tube element 51080 and compensative material 51024 can comprise different therapeutic agents or different therapeutic combinations.

Still see Figure 46 9, end effector 12 can almost simultaneously or fast successive ground cut and organize T and pull the trigger nail 30030 and enter in the tissue T of cut-out.In this case, follow closely 30030 to be deployed in immediately in tissue T after cutting element 30052 has cut off the tube element 51080 of adjacent tissue T.In other words, nail 30030 can after the expansion of the swelling of tube element 51080 and tissue thickness's compensating part 51020 joining tissue thickness compensation part 51020 immediately, or to carry out with it simultaneously.After nail 30030 is entered in tissue T by percussion, tissue thickness's compensating part 51020 can continue to increase or expansion.When disposing nail 30030, nail 30030 can pierce through tube element 51080.In this case, the therapeutic agent 51098 still remained in cut-off tube element 51080 can discharge from tube element 51080, and can cover the lower limb 30031 of percussion nail 30030.

See Figure 47 0, tissue thickness's compensating part 51020 can such as be manufactured by molding technology.Framework or mould 51120 can comprise the first longitudinal side 51122 and second longitudinal side 51124.Each longitudinal side 51124 can comprise one or more recess 51130, and described one or more recess can separately can the first end 50183 or the second end 50185 of receiving tube linear element 51080.First end 50183 of tube element 51080 can be positioned in the first recess 51130a on first longitudinal side 51122, and the second end 50183 of tube element 51080 can be positioned in the second recess 51130b on second longitudinal side 51124, makes tube element 51080 laterally traverse framework 51120.Recess 51180 can comprise semi-circular grooves, and this semi-circular grooves can be fitted the first end 50183 or the second end 50185 of wherein tube element 51080 securely.First recess 51130a can be oriented to directly on the opposite of the second recess 51130b, and tube element 51080 can be oriented to perpendicular to or at least be substantially perpendicular to the longitudinal axis of framework 51120.Alternatively, the first recess 51130a can offset from the second recess 51130b, makes tube element 51080 relative to the angled location of the longitudinal axis of framework 51120.In other alternative form, at least one tube element 51080 can be longitudinal positioning of in framework 51120, makes tube element at the cross side 51126 of framework 51120, extends between 51128.In addition, such as, at least one tube element angularly can be positioned at the cross side 51126 of framework, between two recesses on 51128, and/or in the recess on cross side 51126 and the framework between the recess on longitudinal side 51124.Framework 51120 can comprise support lugn 51136, and this support lugn can the tube element 51080 of supporting and location in framework 51120.

Such as, framework 51120 can comprise recess 51130 to hold 12 tube elements 51080.Framework recess 51130 can be filled by tube element 51080, and alternatively, and not all recess 51130 all can be filled.At least one tube element 51080 can be positioned in framework 51120.Such as, at least half recess 51130 can receiving tube linear element 51080.Once tube element 51080 is positioned in framework 51120, compensative material 51024 can be added to framework 51120.When being added to framework 51120, compensative material 51024 can be fluid.Such as, compensative material 51024 can be poured in framework 51120 and can to flow around the tube element 51080 be positioned wherein.See Figure 47 1, the compensative material 51024 of flowing can flow around the tube element 51080 supported by the recess 51130 in framework 51120.Solidify at compensative material 51024, or after solidifying at least fully, referring now to Figure 47 2, the tissue thickness's compensating part 51020 comprising compensative material 51024 and tube element 51080 can be removed from framework 51120.Can prune tissue thickness's compensating part 51020.Such as, unnecessary compensative material 51024 can be removed from tissue thickness's compensating part 51020, make longitudinal side of compensative material be substantially smooth.In addition, see Figure 47 3, the first end 50183 of tube element 51080 and the second end 50185 can be pressed together, or make it closed with sealed tubular element 51080.Can before being placed in framework 51120 by tube element 51080, described end be closed.Alternatively, process of pruning can crosscut end 51083,51085 and hot stack process can be used for sealing and/or the end 51083,51085 of closure tube linear element 51080.

Refer again to Figure 47 0, rigid pins 51127 can be positioned in each tube element 51080.Such as, rigid pins 51127 can extend across longitudinal tube chamber of tube element 51080.Rigid pins 51127 can extend over each tube element 51080, in the recess 51130 that rigid pins 51127 can be positioned in framework 51120.Such as, in the embodiment with rigid pins 51127, when to be poured in framework 51120 when compensative material 51204 and to flow around tube element 51080 when the compensative material 51024 flowed, rigid pins 51127 can stay pipe linear element 51080.Once compensative material 51024 solidifies, hardens and/or lyophilizing, or solidify fully, harden and/or lyophilizing, tissue thickness's compensating part 51020 can be removed from framework 51120, and rigid pins 51127 can be removed from longitudinal tube chamber of tube element 51080.Then such as medicine filling tube linear element 51080 can be used.After with medicine filling tube linear element 51080, can prune tissue thickness's compensating part 51020 of the end 51083,51085 such as comprising tube element 51080.Tissue thickness's compensating part 51020 can be such as punched, and/or such as by heat and/or wiper seal.

As described herein, tissue thickness's compensating part 52020 can comprise multiple tube element 51080.Referring now to Figure 47 4, tube element 51080 can comprise different material behaviors, size and geometry.Such as, the first tube element 51080a can comprise the first thickness and the first material, and the second tube element 51080b can comprise the second thickness and the second material.At least two tube elements 51080 in tissue thickness's compensating part 52020 can comprise identical material.Alternatively, each tube element 51080 in tissue thickness's compensating part 5202 can comprise different materials.Similarly, at least two tube elements 51080 in tissue thickness's compensating part 52020 can comprise identical geometry.Alternatively, each tube element 51080 in tissue thickness's compensating part 52020 can comprise different geometries.

Referring now to Figure 53 7-540, tissue thickness's compensating part 51220 can comprise at least one tube element 51280 laterally traversing tissue thickness's compensating part 51220.See Figure 53 7, tissue thickness's compensating part 51220 can be located relative to the anvil block 30060 of end effector 12.Such as, tissue thickness's compensating part 51220 can be fixed to the fixed surface 30061 of the anvil block 30060 of end effector 12.Main see Figure 53 8, such as, tube element 51280 can comprise capsule shape shape.Such as, tube element 51280 can comprise polymer composition, such as can the biocompatible elastomers polymer of bio-absorbable.

Refer again to Figure 53 7, tissue thickness's compensating part 51220 also can comprise at least in part around the compensative material 51224 of tube element 51280.Such as, compensative material 51224 can comprise can the polymer of bio-absorbable, such as lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Similar as above, compensative material 51024 can make tube element 51280 be held in place in tissue thickness's compensating part 51220.In addition, compensative material 51224 can be fixed to the fixed surface 30061 of anvil block 30060, and compensative material 51220 is positioned in end effector 12 securely.Compensative material 51224 can comprise at least one medicine.

Still see Figure 53 7, the tube element 51280 of lateral register can be located relative to the cutting element 30252 on translation gliding part 30250, makes the cutting element 30252 of translation can to cut off tube element 51280.Such as, cutting element 30252 can each tube element 51280 center or near cut-out tube element 51280.When tube element 51280 is cut to two halfs, the cut-off part of tube element 51280 can swelling or expansion, as shown in Figure 53 7.Main see Figure 53 9, tube element 51280 can comprise hydroaropic substance 51099, and this hydroaropic substance can discharge when tube element 51280 is cut off and/or expose.In addition, referring now to Figure 54 0, when body fluid in hydroaropic substance 51099 contact tissue T, hydroaropic substance 51099 can attract described fluid, and this can cause the swelling or expansion of tube element 51280.When tube element 51280 is expanded, the compensative material 51224 around tube element 51280 can offset or adjust to adapt to swelling tube element 51280.Such as, when compensative material 51224 comprises gelatin, described gelatin can offset to adapt to swelling tube element 51280.Refer again to Figure 53 7, the expansion of tube element 51280 and the skew of compensative material 51224 can cause the correspondence of tissue thickness's compensating part 51220 to be expanded.

Be similar to other tissue thickness's compensating parts that the disclosure is discussed in the whole text, tissue thickness's compensating part 51220 is by applied force distortion or compression.In addition, tissue thickness's compensating part 51220 can be fully resilient, makes it produce resilience force when being out of shape by applied force, and can resilience or partly resilience when removing applied force subsequently.When tissue thickness's compensating part 51220 be trapped in nail retain in region 30039 (Figure 41 7) time, nail 30030 can make tissue thickness's compensating part 51220 be out of shape.Such as, follow closely 30030 can make to be out of shape at the tube element 51280 of tissue thickness's compensating part 51220 of percussion nail 30030 IT and/or compensative material 51224.Not not the catching part and can be out of shape because following closely the distortion that retain in region 30039 yet of tissue thickness's compensating part 51220.When being out of shape, tissue thickness's compensating part 51220 can attempt resilience from deformed configuration.Before this type of resilience can occur in the hydrophilic expansion of tube element 51280, while the expansion of the hydrophilic of tube element 51280, and/or after the hydrophilic expansion of tube element 51280.When tissue thickness's compensating part 51220 attempts resilience, it can apply restoring force being also trapped in the nail tissue retained in region 30039, as described in more detail.

See Figure 47 5-478, tissue thickness's compensating part 52020 can comprise the one or more tube elements 52080 laterally traversing tissue thickness's compensating part 52020 (being similar at least one tissue thickness's compensating part as herein described).Tissue thickness's compensating part 52020 can comprise multiple tube element 52080 laterally traversed.Tissue thickness's compensating part 52020 also can comprise one or more material piece 52024, and this material piece keeps or retains at least one tube element 52080 in tissue thickness's compensating part 52020.One or more material piece 52024 can be positioned in top and/or the below of tube element 52080, and can keep each tube element 52080 in tissue thickness's compensating part 52020 securely.Main see Figure 47 5, tissue thickness's compensating part can comprise the first material piece 52024a and the second material piece 52024b.Tube element 52080 can be positioned between the first material piece 52024a and the second material piece 52024b.In addition, still can be fixed to the top platform surface 30011 of the rigid support part of nail bin 30000 see Figure 47 5, material piece 52024b, tissue thickness's compensating part 52020 is positioned in end effector 12 securely.Alternatively, one or more material piece 52024 can be fixed to anvil block 30060 or otherwise remain in end effector 12.

Main see Figure 47 6, tissue thickness's compensating part 52020 can be porous and/or permeable.Such as, material piece 52024 can comprise multiple hole 52026.Hole 52026 can be substantially circular.Hole 52036 can be visible in material piece 52024.Alternatively, hole 52036 can be microcosmic.Still see Figure 47 6, tube element 52080 also can comprise multiple hole 52026.See Figure 47 7, tissue thickness's compensating part 52120 can comprise material piece 52124, and this material piece comprises multiple non-circular hole 52126.Such as, hole 52126 can comprise rhombus and/or fluting shape.Alternatively, see Figure 47 8, tissue thickness's compensating part 52220 can comprise tube element 52280, and this tube element comprises permeable tubulose dot matrix 52292.Such as, material piece 52224 can comprise can bio-absorbable biocompatible elastomers polymer and can medicine be comprised.

In any tissue thickness as herein described compensating part, at least one tube element 52080 can swelling or expansion, as shown in Figure 47 9A-479D.Such as, see Figure 47 9A, tube element 52080 can be positioned in the middle of the first material piece 52024a in tissue thickness's compensating part 52020 and the second material piece 52024b.As tissue thickness's compensating part 52020 contact tissue T, as shown in Figure 47 9B, tissue thickness's compensating part 52020 can be expanded.Such as, tube element 52080 can be included in be exposed within tissue T and/or on fluid time the hydroaropic substance 52099 expanded.In addition, material piece 52024 and tube element 52080 can be permeable, as described herein, make the fluid penetrable tissue thickness compensating part 52020 from tissue T thus allow the hydroaropic substance 52099 in fluid contact tube element 52080.When tube element 52080 is expanded, the material piece 52024 around tube element 52080 can offset or adjust to adapt to swelling tube element 52080.Be similar to the various tissue thicknesses compensating part that the disclosure is discussed in the whole text, tissue thickness's compensating part 52020 of expansion is out of shape or compression, as shown in Figure 47 9C by applied force (such as by the compression stress of percussion nail applying).In addition, tissue thickness's compensating part 52020 can be fully resilient, makes it produce resilience force when being out of shape by applied force, and can the resilience when removing applied force subsequently.Referring now to Figure 47 9D and 479E, tissue thickness's compensating part 52020 can recoil to the different configurations that different nail retains in region 30039, to adapt to the tissue T be captured suitably.

See Figure 48 0-485, tissue thickness's compensating part 53020 can comprise the tube element 53080 of multiple vertical location.Each tube element 53080 can comprise tubulose axis, and this tubulose axis is substantially perpendicular to the top platform surface 30011 of the rigid support part 30010 of nail bin 30000.In addition, the first end of each tube element 53080 can such as be located by adjacent top platform surface 30011.Tube element 53080 can be such as deformable and can comprise elastomer polymer.As shown in Figure 48 1, tube element 53080 can be captured in the tissue T be sewn when nail retains in region 30039 and be compressed.Tube element 53080 can comprise elastomeric material, makes when tube element 53080 is attempted from deformed configuration resilience, and the distortion of tube element 53080 produces restoring force.The distortion of tube element 53080 can be at least part of elasticity and at least part of plasticity.Tube element 53080 can serve as spring under applied force, and can not fastening.See Figure 48 2, tube element 53080 can be substantially cylindrical.See Figure 48 3, tube element 53180 can comprise fasten area 53112.When applying compression stress to tube element 53180, it can in fasten area 53112 place's fastening or distortion.Tube element 53180 can flexibly and/or plastically be out of shape, and is then designed under the tightening force selected in advance in the unexpected fastening in fasten area 53112 place.

Main see Figure 48 4, the first tube element 53080 can be positioned in first end in nail chamber 30012, and another tube element 53080 can be positioned in second end in nail chamber 30012.As shown in Figure 48 2, tube element 53080 can comprise the tube chamber 53084 extended through wherein.Refer again to Figure 48 1, when nail 30030 moves to firing position from initial position, each nail lower limb 30032 can through the tube chamber 53084 of each tube element 53080.Alternatively, mainly see Figure 48 5, vertically the tube element 54080 of location can be disposed in tissue thickness's compensating part 54020, makes the adjacent to each other or contact of tube element 54080.In other words, tube element 54080 can be trooped or be concentrated in together.Tube element 54080 can be systematically arranged in tissue thickness's compensating part 54020; But alternatively, tube element 54080 can randomly be arranged.

Refer again to Figure 48 0,484 and 485, tissue thickness's compensating part 53020 also can comprise material piece 53024, and this material piece makes tube element 53080 keep or is retained in tissue thickness's compensating part 53020.Material piece 53024 can be positioned in top and/or the below of tube element 53080, and can keep each tube element 53080 in tissue thickness's compensating part 53020 securely.Tissue thickness's compensating part 53020 can comprise the first and second material piece 53024.Tube element 53080 can be positioned between the first and second material piece 53024.In addition, material piece 53024 can be fixed to the top platform surface 30011 of the rigid support part of nail bin 30000, and tissue thickness's compensating part 53020 is positioned in end effector 12 securely.Alternatively, material piece 53024 can be fixed to anvil block 30060 or in other words remain in end effector 12.Material piece 53024 can be fully deformable, is out of shape when the spring 55080 of material piece 53024 in tissue thickness's compensating part is out of shape.

See Figure 48 6 and 487, tissue thickness's compensating part 55020 can comprise at least one spring 55080, and described spring is fully resilient, makes it can produce resilience force when being out of shape.Main see Figure 48 6, tissue thickness's compensating part 55020 can comprise multiple spring 55080, such as three row springs 55080.Spring 55080 can systematically and/or be randomly arranged in tissue thickness's compensating part 55020.Such as, spring 55080 can comprise elastomer polymer.The shape of spring 55080 can allow it to be out of shape.Spring 55080 can be deformed into deformed configuration from initial configuration.Such as, when the part of tissue thickness's compensating part 55020 be trapped in nail retain in region 30039 time, nail retains within region 30039 and/or spring 55080 around can be out of shape.Such as, spring 55080 can fastening or collapse under the compression stress applied for percussion nail 30030, and spring 55080 can produce restoring force, and described restoring force depends on the device of spring stiffness coefficient of distortion spring 55080 and/or the deflection of spring 55080.Spring 55080 can serve as sponge under the compression stress applied by percussion nail 30030.In addition, spring 55080 can comprise compensative material, as the disclosure describes in the whole text in more detail.

Tissue thickness's compensating part 55020 also can comprise one or more material piece 55024, and this material piece keeps or retains at least one spring 55080 in tissue thickness's compensating part 55020.Material piece 55024 can be positioned in top and/or the below of spring 55080, and can keep the spring 55080 in tissue thickness's compensating part 55020 securely.Tissue thickness's compensating part 55020 can comprise the first material piece 55024a and the second material piece 55024b.Tube element 52080 can be positioned between the first material piece 55024a and the second material piece 55024b.Main see Figure 48 7, tissue thickness's compensating part 55020 also can comprise the 3rd material piece 55024c, and the contiguous first material piece 55024a or the second material piece 55024b of the 3rd material piece locates.At least one material piece 55024 can be fixed to the top platform surface 30011 of the rigid support part of nail bin 30000, and tissue thickness's compensating part 55020 is positioned in end effector 12 securely.Alternatively, at least one material piece 55024 can be fixed to anvil block 30060 or otherwise remain in end effector 12.

Referring now to Figure 48 7, when nail 30030 is pulled the trigger from nail bin 30000 (Figure 48 5), nail 30030 can joining tissue thickness compensation part 55020.A part for tissue T and tissue thickness's compensating part 55020 can be captured in nail and retain in region 30039 by percussion nail 30030.Spring 55080 can be deformable, makes tissue thickness's compensating part 55020 compression when being caught by percussion nail 30030.Spring 55080 can be positioned between the percussion nail 30030 in tissue thickness's compensating part 55020.Alternatively, at least one spring 55080 of region 30039 IT can be retained at nail.

See Figure 48 8, tissue thickness's compensating part 60020 can comprise at least two layers of compensation 60022.Tissue thickness's compensating part 60020 can comprise multiple layer of compensation 60022, and the plurality of layer of compensation can stack and registration in top of each other, or their combination.As described in more detail, the layer of compensation 60022 of tissue thickness's compensating part 60020 can comprise such as different geometries and/or material behavior.In addition, as described in more detail, pit and/or passage can be present between the adjacent layer of compensation 60022 stacked.Such as, tissue thickness's compensating part 62020 can comprise six layer of compensation 62022a, 62022b, 62022c, 62022d, 62022e, 62022f, and described six layers of compensation can adjacently in top of each other stack (Figure 50 3).

See Figure 48 9,490 and 492-497, tissue thickness's compensating part can comprise the first layer of compensation 60122a and the second layer of compensation 60122b.First layer of compensation 60122a can stack the top of the second layer of compensation 60122b is adjacent.The adjacent layer of compensation 60122 stacked can be separated by Separation or pit 60132.Main see Figure 48 9, tissue thickness's compensating part 60120 also can comprise and is positioned at least one cantilever beam between the first layer of compensation 60122a and the second layer of compensation 60122b or support member 60124.Support member 60124 can locate the first layer of compensation 60122a relative to the second layer of compensation 60122b, and layer of compensation 60122 is separated by Separation 60132.As described in more detail, the variation of support member 60124 and/or layer of compensation 60122a, 60122b is as reduced Separation 60132.

The brace summer of tissue thickness's compensating part can comprise multiple geometry and size.Such as, brace summer can be simple I ellbeam, the curved brace summer of list placed in the middle 60124 (Figure 48 9), the eccentric curved brace summer of list 60224 (Figure 49 0), oval brace summer 60324 (Figure 49 2), how curved brace summer 60424 (Figure 49 3), and/or two cantilever support beams 60524 (Figure 49 4) of symmetry.In addition, referring now to Figure 48 9,495 and 496, such as, brace summer 60624 can be thinner than at least one layer of compensation 60122 (Figure 49 5), brace summer 60724 can be thicker than at least one layer of compensation 60122 (Figure 49 6), and/or brace summer 60124 can be the thickness substantially the same with at least one layer of compensation 60122 (Figure 48 9).The material of brace summer 60124, geometry and/or size such as can affect deformability and the resilience elasticity of tissue thickness's compensating part 60120.

Still see Figure 48 9, such as, layer of compensation 60122 and the brace summer 60124 of tissue thickness's compensating part 60120 can comprise different materials, such as structured material, biomaterial and/or electric material.Such as, at least one layer of compensation 60122 can comprise polymer composition.Polymer composition can comprise at least part of elastic material, makes the distortion of layer of compensation 60122 and/or brace summer 60124 to produce resilience force.The polymer composition of layer of compensation 60122 can comprise the polymer of nonabsorable, absorbable polymer or their combination.Such as, can comprise can the biocompatible elastomers polymer of bio-absorbable for absorbable polymer.In addition, the polymer composition of layer of compensation 60122 can comprise synthetic polymer, non-synthetic polymer or their combination.The example of synthetic polymer includes but not limited to polyglycolic acid (PGA), poly-(lactic acid) (PLA), polycaprolactone (PCL), poly-dioxanone (PDO) and their copolymer.The example of non-synthetic polymer includes but not limited to polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and oxidized regenerated cellulose (ORC).Such as, by weight percentage, the polymer composition of layer of compensation 60122 can comprise not commensurability absorbable polymer, the polymer of nonabsorable, synthetic polymer and non-synthetic polymer.Each layer of compensation 60022 in tissue thickness's compensating part 60120 can comprise different polymer compositions, or alternatively, at least two layers of compensation 60122 can comprise identical polymer composition.

Refer again to Figure 48 8, such as, at least one layer of compensation 60022 can comprise therapeutic agent 60098, such as medicine or pharmaceutically active agents.Layer of compensation 60022 can discharge the therapeutic agent 60098 of therapeutically effective dose.Therapeutic agent 60098 can be discharged by during absorption at layer of compensation 60022.The example of therapeutic agent 60098 can include but not limited to hemorrhage and medicine, such as, and fibrin, thrombin and/or oxidized regenerated cellulose (ORC); Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone; Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B and/or chloromycetin; And/or anticarcinogen, such as cisplatin, mitomycin and/or amycin.Such as, therapeutic agent 60098 can comprise biological preparation, such as stem cell.Each layer of compensation 60022 in tissue thickness's compensating part 60020 can comprise different therapeutic agents 60098, or alternatively, at least two layers of compensation 60022 can comprise identical therapeutic agent 60098.Such as, the layer of compensation 60022 comprising therapeutic agent 60098 (such as biological preparation) such as can be wrapped between two structuring layers of compensation 60022, described two structuring layers of compensation comprise polymer composition, such as polyglycolic acid (PGA) foam.Layer of compensation 60022 also can comprise conductive material, such as copper.

Refer again to Figure 50 3, the layer of compensation 62022 in tissue thickness's compensating part 62020 can have different geometries.When layer 62022 is adjacent to be positioned in tissue thickness's compensating part 62020, layer of compensation 62022 can form at least one three dimensional catheter 62032 between layer 62022.Such as, when the second layer of compensation 62022b comprising passage is positioned in the top of the 3rd substantially smooth layer of compensation 62022c, the passage of the 3rd layer of compensation 62022c and flat surfaces can limit three dimensional catheter 62032a between the two.Similarly, such as, when the 5th layer of compensation 62022e comprising passage is positioned in the below of the 4th layer of compensation 62022d comprising respective channel, described passage can be formed by the contiguous layer of compensation 62022d stacked, the three dimensional catheter 62032b that the passage in 62022e limits.When fluid flows through tissue thickness's compensating part 62020, conduit 62032 can guide therapeutic agent and/or body fluid.

See Figure 49 9, tissue thickness's compensating part 61020 can comprise layer of compensation 61022, such as layer 60122a and 21022b, and described layer can hold the nail 30030 disposed from nail bin 20000 (Figure 49 8).When nail 30030 moves to firing position from initial position, nail lower limb 30032 can be guided to firing position by the geometry of at least one layer of compensation 61022.At least one layer of compensation 61022 can comprise the hole 61030 extended through wherein, its mesopore 61030 can be arranged in nail 30030 and be received by during percussion the nail lower limb 30032 having disposed nail 30030 from nail bin 20000 (Figure 49 8), as described in more detail.Alternatively, refer again to Figure 50 3, such as, nail lower limb 30032 can pierce through at least one layer of compensation, such as layer of compensation 62022f, and is received at least one layer of compensation by hole 62030, such as layer of compensation 62022a.

Main see Figure 49 9, tissue thickness's compensating part 60120 can comprise layer of compensation 61022a, at least one support tabs 61026 in the one in 61022b.Support tabs 61026 can protrude into the Separation 61032 be limited between adjacent layer of compensation, the gap 61032 such as between the first layer of compensation 61020a and the second layer of compensation 61020b.Support tabs 61026 can be given prominence to from longitudinal side of the first layer of compensation 61022a.In addition, support tabs 61026 can longitudinally side length extend or only along its a part extend.At least one support tabs 61026 can be given prominence to from two of layer of compensation 61022a, 61022b longitudinal side.In addition, the layer of compensation 61022a of adjacent positioned, 61022b can comprise corresponding support tabs 60126, and the support tabs 60126 extended from the first layer of compensation 60122a can be alignd with the support tabs 60126 extended from the second layer of compensation 60122b at least in part.Refer again to Figure 49 7, tissue thickness's compensating part 60820 can comprise and is positioned at adjacent layer of compensation 60122a, the restrictor plate 60828 between 60122b.Such as, restrictor plate 60828 can be positioned in the gap 60132 be defined between the first layer of compensation 60122a and the second layer of compensation 60122b.As described in more detail, support tabs 61026 and/or restrictor plate 60828 can control distortion and/or the flexure of support member 60124 and/or layer of compensation 60122a, 60122b.

As described herein, the layer of compensation 60022 of tissue thickness's compensating part 60020 can comprise different materials, geometry and/or size.This type of tissue thickness's compensating part 60020 assembles by multiple manufacturing technology.Main see Figure 48 8, tissue thickness's compensating part 60022 manufactures by lithographic printing, stereolithography (SLA) or silk-screen printing technique.Such as, stereolithography manufacturing process can formative tissue thickness compensation part 60020, and wherein each layer of compensation 60022 comprises different materials and/or geometric form feature structure.Such as, the ultraviolet light in stereo lithography machine can draw the geometry of the first layer of compensation 60022, makes the first layer of compensation 60022 comprising the first material, geometry and/or size pass through ultraviolet light polymerization.Ultraviolet light can draw the geometry of the second layer of compensation 60022 subsequently, makes the second layer of compensation 60022 comprising the second material, geometry and/or size pass through ultraviolet light polymerization.Stereo lithography machine can on top of each other, side by side or the mode of their combination draw layer of compensation 60022.In addition, layer of compensation 60022 can be plotted as and pit 60132 is present between adjacent layer of compensation 60022.Because stereo lithography machine can form the very thin layer with unique geometry, the tissue thickness's compensating part 60020 therefore manufactured by stereolithography processes can comprise very complicated 3 dimensional coil geometry.

See Figure 49 8, tissue thickness's compensating part 60920 can be positioned on (Fig. 1) in the end effector 12 of surgical instruments 10.Tissue thickness's compensating part 60920 can be located relative to the nail bin 20000 of end effector 12.Such as, tissue thickness's compensating part 60920 can be fixed to nail bin 20000 releasedly.At least one layer of compensation 60922 of tissue thickness's compensating part 60920 can be close to the location, top platform surface 20011 (Figure 40 8) of nail bin 20000.Such as, the second layer of compensation 60922b is fixed to top platform surface 20011 by binding agent or by wrappage (similar with at least one in wrappage as herein described) (Figure 21 8).Tissue thickness's compensating part 60920 can be in aggregates with nail bin 20000, makes nail bin 20000 and tissue thickness's compensating part 60920 be formed as individual unit structure.Such as, nail bin 20000 can comprise the first main part, such as rigid support part 20010 (Figure 40 8), and the second main part, such as tissue thickness's compensating part 60920.

Still see Figure 49 8, tissue thickness's compensating part 60920 can comprise the first compensating part part 60920a and the second compensating part part 60920b.First compensating part part 60920a can be positioned on first longitudinal side of nail bin 20000, and the second compensating part part 60920b can be positioned on second longitudinal side of nail bin 20000.When tissue thickness's compensating part 60920 is located relative to nail bin 20000, the longitudinal slit 20015 (Figure 40 7) in rigid support part 20010 (Figure 40 7) can extend between the first compensating part part 60920a and the second compensating part part 60920b.Such as, when following closely the cutting element 20052 in percussion sliding part 20050 (Figure 40 7) and being translated across end effector 12, cutting element 20052 through the longitudinal slit 20015 the first compensating part part 60920a and the second compensating part part 60920b, and can not cut off a part for tissue thickness's compensating part 60920.Alternatively, cutting element 20052 can cut off a part for tissue thickness's compensating part 60920.

Referring now to Figure 49 1, tissue thickness's compensating part 63020 can fit in the end effector 12 ' of circular surgical apparatus.Tissue thickness's compensating part 62030 can comprise the first circular layer of compensation 63022a and the second circular layer of compensation 63022b.Second layer of compensation 63022b can be positioned on the circular top platform surface 20011 ' of circular nail bin 20000 ', and wherein the second layer of compensation 63022b can comprise the geometry of the geometry corresponding to platform surface 20011 '.Such as, platform surface 20011 ' can comprise stepped portion, and the second layer of compensation 63022b can comprise corresponding stepped portion.Tissue thickness's compensating part also can comprise, such as, and at least one support member 63024 extended around tissue thickness's compensating part 63020 and/or support tabs 63026.

Refer again to Figure 49 9, percussion nail 30030 can joining tissue thickness compensation part 60920.As the disclosure in the whole text as described in, percussion nail 30030 can the part of capture tissue thickness compensation part 60920 and tissue T, and compression stress is applied to tissue thickness's compensating part 60920.In addition, mainly see Figure 50 0-502, tissue thickness's compensating part 60920 can be deformable.As described herein, the first layer of compensation 60920a separates by Separation 60932 and the second layer of compensation 60920b.See Figure 50 0, before compress tissue thickness compensation part 60920, gap 60932 can comprise the first distance.When such as compression stress A being applied to tissue thickness's compensating part 60920 and tissue T by percussion nail 30030 (Figure 49 9), support member 60924 can be out of shape.Referring now to Figure 50 1, single bent support beam 60924 can bend under compression stress A, makes the Separation 60932 between the first layer of compensation 60920a and the second layer of compensation 60920b be reduced to second distance.Main see Figure 50 2, the first layer of compensation 60922a and the second layer of compensation 60922b also can be out of shape under compression stress A.Support tabs 60926 can the distortion of control and compensation layer 60920.Such as, support tabs 60926 can prevent the overbending of layer of compensation 60920 by supporting its longitudinal side when layer of compensation 60920 contacts with each other.Support tabs 60926 also can bend or archwise under compression stress A.Or alternatively, when layer of compensation 60920 and/or support tabs 60926 contact restrictor plate 60128, restrictor plate 60128 (Figure 49 7) can limit the distortion of layer of compensation 60920 in greater detail in this article in addition.

In addition, be similar to various tissue thicknesses as herein described compensating part, tissue thickness's compensating part 60920 can produce resilience force or restoring force when being out of shape.The restoring force that the tissue thickness compensating part of distortion produces can depend on the orientation of tissue thickness's compensating part 60920, size, material and/or geometry at least in part, and the amount of the tissue thickness's compensating part 60920 be out of shape because of applied force.In addition, tissue thickness's compensating part 60920 can have elasticity at least partially, make tissue thickness's compensating part 60920 produce load on spring or restoring force when being out of shape by percussion nail 30030.Support member 60924 can comprise elastomeric material and/or at least one layer of compensation 60922 can comprise elastomeric material, makes tissue thickness's compensating part 60920 have elasticity.

Referring now to Figure 50 4, the end effector of surgery suturing appliance can comprise the first jaw and the second jaw, and at least one wherein in the first jaw and the second jaw can relative to each other be moved.Such as, end effector can have the first jaw comprising nail bin passage 19070 and the second jaw comprising anvil block 19060, wherein anvil block 19060 can towards and/or away from nail bin passage 19070 pivotable.Nail bin passage 19070 can receive nail bin 19000, and such as, it can remain in nail bin passage 19070 removedly.Nail bin 19000 can comprise warehouse 19010 and tissue thickness's compensating part 19020, and wherein tissue thickness's compensating part 19020 can be attached to warehouse 19010 removedly.Referring now to Figure 50 5, the nail 19030 that warehouse 19010 can comprise multiple nail chamber 19012 and be positioned in each nail chamber 19012.In addition, nail 19030 can be supported by the staple drivers 19040 be positioned in warehouse 19010, wherein sliding part and/or firing member such as can be pushed into through nail bin 19000 upwards to promote the staple drivers 19040 in nail chamber 19012, as shown at block 506 *, and from nail chamber 19012 penetrate nail 19030.

Main see Figure 50 4 and Figure 50 5, tissue thickness's compensating part 19020 can comprise the container 19024 of elastic component 19022 and encapsulation elastic component 19022.Container 19024 can be sealed and can be limited the cavity comprising internal gas, and this internal gas has the pressure being different from ambient atmospheric pressure.The pressure of internal gas can be greater than the pressure of ambient atmosphere, and alternatively, the pressure of internal gas can be less than the pressure of ambient atmosphere simultaneously.When container 19024 comprises the pressure being less than ambient atmospheric pressure, the sidewall of container 19024 can wrapped vacuum.In this case, described vacuum can cause container 19024 to be out of shape, collapse and/or graduation, and the elastic component 19022 be wherein positioned in container 19024 can be elastically compressed in container 19024.When on container 19024 during extracting vacuum, elastic component 19022 can bend downwards or be out of shape and under compression or vacuum seal state, can remain on appropriate location by the sidewall of container 19024.

Elastic component 19022 and container 19024 are made up of biocompatible materials.Such as, elastic component 19022 and/or container 19024 can by can the material (such as PLLA, PGA and/or PCL) of bio-absorbable form.Elastic component 19022 can be made up of elastomeric material.Elastic component 19022 also can comprise structuring elasticity.Such as, elastic component 19022 can be the form of hollow pipe.

To being described further above, tissue thickness's compensating part 19020 can against or the platform surface 19011 of contiguous warehouse 19010 locate.Referring now to Figure 50 6, when nail 19030 is at least in part by percussion, the lower limb of nail 19030 can pierce through container 19024 or make it broken loose.Container 19024 can comprise core 19026, this core can be positioned on the top of the cutting slit 19016 of warehouse 19010, make when cutting element 19080 is advanced into the tissue T cut and be positioned between nail bin 19000 and anvil block 19060, cutting element 19080 also can cut the core 19026 of container 19024, thus pierces through container 19024 or make it broken loose.In any one situation, once container 19024 is broken loose, internal gas then in container 19024 can average out with the air around tissue thickness's compensating part 19020, and allow elastic component 19022 resilient expansion, be not out of shape and/or the configuration of non-graduation again to obtain or again to obtain at least in part it.In this case, bias force can be applied to the tissue T be trapped in the nail 19020 of distortion by elastic component 19022.More specifically, after the profiled surface distortion by being limited to the pit 19062 in anvil block 19060, tissue T and elastic component 19022 can be captured in nail 19030 by the lower limb of nail 19030 at least partially, make when container 19024 breaks loose, tissue thickness's compensating part 19020 can compensate the thickness of the tissue T be trapped in nail 19030.Such as, when being trapped in the tissue T in nail 19030 and being thinner, the elastic component 19022 be trapped in this nail 19030 can be expanded to fill the gap in nail 19030, and enough compression stresses are applied to tissue T.Correspondingly, when being trapped in the tissue T in nail 19030 and being thicker, the elastic component 19022 be trapped in this nail 19030 can keep compressing the thicker tissue thought in nail 19030 and abdicate space, and equally, enough compression stresses is applied to tissue T.

When container 19024 is pierced, as mentioned above, elastic component 19022 can attempt expansion to be elastically returned to its initial configuration.In some cases, the part being trapped in the elastic component 19022 in nail 19030 possibly cannot turn back to its just beginning and end deformed shape.In this case, elastic component 19022 can comprise spring, and compression stress can be applied to the tissue T be trapped in nail 19030 by this spring.Elastic component 19022 can analog linearity spring, and the compression stress wherein applied by elastic component 19022 and amount or distance Linear proportional, its elastic member 19022 remains on flexure in nail 19030.Alternatively, elastic component 19022 can simulate nonlinear spring, and the compression stress wherein applied by elastic component 19022 is not with amount or apart from Linear proportional, and its elastic member 19022 remains on flexure in nail 19030.

Main see Figure 50 7 and Figure 50 8, nail bin 19200 can comprise tissue thickness's compensating part 19220, and this tissue thickness's compensating part can comprise the container 19222 of one or more sealing wherein.Each in container 19222 can be sealed and can be comprised internal gas.The pressure of the internal gas in sealed container 19222 can exceed atmospheric pressure, and alternatively, the pressure of the internal gas in sealed container 19222 can lower than atmospheric pressure simultaneously.The pressure of the internal gas in container 19222 is lower than atmospheric pressure, container 19222 can be described to comprise vacuum.Such as, one or more container 19222 can be wrapped or be included in oversheath, case, wrappage and/or film 19224, and wherein tissue thickness's compensating part 19220 can be positioned in above the platform surface 19011 of warehouse 19010.Such as, each container 19222 can be made up of the pipe with circle or circular cross section (such as, having closing end and opening) at least substantially.Can on the opening of pipe extracting vacuum, and when reaching enough vacuum in pipe, opening can be closed and seal.Such as, pipe can be made up of such as polymeric material, and wherein the opening of pipe can by hot melt to close and to seal this opening.Under any circumstance, the vacuum in each container 19222 can inwardly tractive pipe sidewall and make tubular elastic be out of shape and/or graduation.Container 19222 is shown in the state being at least part of graduation in Figure 50 8.

When nail 19030 is in its non-firing position, as shown in Figure 50 8, the top of nail 19030 can be positioned in below tissue thickness's compensating part 19220.Such as, nail 19030 can be positioned in its respective nail chamber 19012, and nail 19030 is not contacted with container 19222, until nail 19030 moves to its firing position shown in Figure 50 9 from the non-firing position shown in Figure 50 8.The wrappage 19224 of tissue thickness's compensating part 19220 can protect container 19220 not pierced through prematurely by nail 19030.Referring now to Figure 50 9, when nail 19030 is pulled the trigger at least in part, the lower limb of nail 19030 can pierce through container 19222 or make it broken loose.In this case, the internal gas in container 19222 can with container 19222 around air average out, and resilient expansion is again to obtain or again to obtain at least in part the configuration of its undeformed and/or non-graduation.In this case, bias force can be applied to the tissue be trapped in the nail 19030 of distortion by the container 19222 be pierced.More specifically, after the profiled surface distortion by being limited to the pit 19062 in anvil block 19060, tissue T and container 19222 can be captured in nail 19030 by the lower limb of nail 19030 at least partially, make when container 19222 breaks loose, container 19222 can compensate the thickness of the tissue T be trapped in nail 19030.Such as, when being trapped in the tissue T in nail 19030 and being thinner, the container 19222 be trapped in this nail 19030 can be expanded to fill the gap in nail 19030, and enough compression stresses is applied to tissue T simultaneously.Correspondingly, when being trapped in the tissue T in nail 19030 and being thicker, the container 19222 be trapped in this nail 19030 can keep compressing the thicker tissue thought in nail 19030 and abdicate space, and enough compression stresses is applied to tissue T simultaneously.

When container 19222 is pierced, as mentioned above, container 19222 can attempt expansion to be elastically returned to its initial configuration.The part be trapped in nail 19030 of container 19222 possibly cannot turn back to its just beginning and end deformed shape.In this case, container 19222 can comprise spring, and compression stress can be applied to the tissue T be trapped in nail 19030 by this spring.Container 19222 can analog linearity spring, and the compression stress wherein applied by container 19222 and amount or distance Linear proportional, wherein container 19222 remains on flexure in nail 19030.Alternatively, container 19222 can simulate nonlinear spring, and the compression stress wherein applied by container 19222 is not with amount or apart from Linear proportional, and wherein container 19222 remains on flexure in nail 19030.Container 19222 can be hollow when it is in its sealed configuration with sky.Alternatively, each the limited chamber in container 19222, and at least one medicine wherein comprised can be comprised.Such as, container 19222 can comprise at least one medicine, and this at least one medicine can be released and/or bio-absorbable.

The container 19222 of tissue thickness's compensating part 19220 can be arranged in any suitable manner.As shown in Figure 50 7, be limited to the nail chamber 19012 in warehouse 19010, and the nail 19030 be positioned in nail chamber 19012 in a row can be arranged.Such as, as shown in the figure, follow closely chamber 19012 and can be arranged to six longitudinal straight line rows; But, any suitably-arranged mode in nail chamber 19012 can be adopted.Also as shown in Figure 50 7, tissue thickness's compensating part 19220 can comprise six containers 19222, and each wherein in container 19222 can be alignd with a nail chamber 19012, or location above it.Each in nail 19030 in one nail chamber 19012 can pierce through identical container 19222.In some cases, some the nail lower limbs following closely 19030 can not pierce through location container 19222 thereon; But, when container 19222 limits continuous inner chamber, such as, pierce through cavity fully by least one of following closely in 19030, to allow the atmospheric pressure around the pressure of inner chamber gas and container 19222 to average out.Referring now to Figure 51 4, tissue thickness's compensating part such as can comprise container, such as container 19222 ', and it can transversely extend in the direction of nail line 19030.Such as, container 19222 ' can extend across multiple nail row.Referring now to Figure 51 5, tissue thickness's compensating part 19220 " multiple container 19222 can be comprised ", its along perpendicular to or the direction that is at least substantially perpendicular to nail line 19030 extend.Such as, container 19222 " some can be pierced through by nail 19030, and other can not be pierced through by nail 19030.Such as, container 19222 " can across or extend through cutting path, wherein cutting element can crosscut container 19222 " and make it broken loose.

As mentioned above, such as, tissue thickness's compensating part such as tissue thickness's compensating part 19220 such as can comprise multiple sealed container, such as container 19222.Also described above, each of sealed container 19222 can comprise independently internal gas.Container 19222 can have different internal pressures.Such as, the first container 19222 can comprise the inner vacuum with the first pressure, and second container 19222 can comprise the inner vacuum with the second different pressures.Such as, the distortion of container 19222 or graduation amount can be depending on the vacuum pressure of the internal gas wherein comprised.Such as, compared with the container 19222 with less vacuum, there is the amount that container 19222 can be out of shape or graduation is larger of larger vacuum.The cavity of container can be segmented into two or more independently seal chambers, and wherein each independently seal chamber can comprise independently internal gas.Such as, some nails in nail row such as can pierce through restriction the first cavity in a reservoir with being arranged as, and other nails simultaneously in nail row can pierce through restriction the second cavity in a reservoir with being arranged as.In this case, the nail especially in the row of nail is sequentially pulled the trigger another end from an end of nail row, as mentioned above, the one in cavity can keep complete when another cavity breaks loose and can maintain its internal gas.Such as, the first cavity can have internal gas, and it has the first vacuum pressure, and the second cavity can have internal gas, and it has the second different vacuum pressure.Keep complete cavity can maintain its internal pressure, until container is by bio-absorbable, thus form timing earth pressure release.

Referring now to Figure 51 0 and Figure 51 1, tissue thickness's compensating part such as tissue thickness's compensating part 19120 such as can be attached to anvil block 19160.Similar as above, multiple elastic components 19122 that tissue thickness's compensating part 19120 can comprise container 19124 and be positioned wherein.Also similar as above, container 19124 can limit the cavity comprising internal gas, and this internal gas has the pressure of the atmospheric pressure be less than or greater than around tissue thickness's compensating part 19120.Internal gas in container 19124 comprises vacuum, container 19124 and the elastic component 19122 be positioned wherein can be out of shape by the vacuum in container 19124 and the pressure reduction between the atmospheric pressure of container 19124 outside, collapse and/or graduation.In use, anvil block 19160 can move to make position, wherein anvil block is located relative to nail bin 19100, and the tissue engagement surface 19121 wherein on container 19124 can engage the tissue T be positioned in the middle of tissue thickness's compensating part 19120 and nail bin 19100.In use, firing member 19080 can distally advance to pull the trigger nail 19030, as mentioned above, and cuts tissue T simultaneously.Tissue thickness's compensating part 19120 also can comprise mid portion 19126, this mid portion can align with the cutting slit be limited in anvil block 19160, wherein when firing member 19080 is distally advanced through tissue thickness's compensating part 19120, firing member 19080 can pierce through container 19124 or make it broken loose.In addition, similar as above, firing member 19080 can upwards promote staple drivers 19040 and pull the trigger nail 19030, makes nail 19030 can contact anvil block 19160 and is deformed to its deformed configuration, as shown in Figure 51 2.When nail 19030 is by percussion, then nail 19030 can pierce through container 19124 or makes it broken loose by piercing tissue T, the elastic component 19122 be positioned in container 19124 can be expanded at least in part, as mentioned above.

To being described further above, tissue thickness's compensating part can be made up of biocompatible materials.Biocompatible materials (such as foam) can comprise viscosifier, surfactant, filler, cross-linking agent, pigment, dyestuff, antioxidant and other stabilizing agents and/or their combination, thinks that material provides desirable characteristics.Biocompatible foam can comprise surfactant.Surfactant can be applied to material surface and/or be dispersed in material.Do not wish to be limited to any particular theory, the surfactant being applied to biocompatible materials can reduce the surface tension of the fluid of contact material.Such as, surfactant can reduce the surface tension of the water of contact material, infiltrates material to accelerate water.Water can serve as catalyst.Surfactant can improve the hydrophilic of material.

Surfactant can comprise anion surfactant, cationic surfactant and/or non-ionic surface active agent.The example of surfactant includes but not limited to poly-(ethyleneoxy) ethanol of polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethyl cellulose, propyl cellulose, hydroxyethyl-cellulose, carboxymethyl cellulose, Polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxethylene octylphenyl ether, NONIN HS 240, polyoxyethylene oleyl ether, Tween 20, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkyl group phenoxy group and poloxamer, and their combination.Surfactant can comprise the copolymer of Polyethylene Glycol and polypropylene glycol.Surfactant can comprise non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or is dispersed in biocompatible materials by other materials.Tissue thickness's compensating part can comprise at least one medicine.Tissue thickness's compensating part can comprise in natural material as herein described, non-synthetic materials and/or synthetic material one or more.Tissue thickness's compensating part can comprise biocompatible foam, and described biocompatible foam comprises gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polylactic acid, poly-dioxanone, polyhydroxyalkanoatefrom, poliglecaprone and their combination.Tissue thickness's compensating part can comprise film, and described film comprises at least one medicine.Tissue thickness's compensating part can comprise Biodegradable films, and described Biodegradable films comprises at least one medicine.Medicine can comprise liquid, gel and/or powder.Medicine can comprise anticarcinogen, such as cisplatin, mitomycin and/or amycin.

Tissue thickness's compensating part can comprise biodegradation material, to provide the controlled eluting of at least one medicine when biodegradation material is degraded.When biodegradation material contact activation agent such as activating solution, biodegradation material can be degraded, and can decompose, or loses structural intergrity.Such as, activating solution can comprise saline solution or any other electrolyte solution.Biodegradation material can carry out contact activation liquid by routine techniques, and described technology includes but not limited to spraying, dipping and/or brushes.In use, such as, the end effector and/or nail bin that comprise tissue thickness's compensating part (it comprises at least one medicine) can immerse in activating solution by surgeon, and described activating solution comprises saline solution, such as sodium chloride, calcium chloride and/or potassium chloride.Tissue thickness's compensating part can discharge medicine when tissue thickness's compensating part degraded.Medicine can be initial eluting rate and at a slow speed lasting eluting rate fast from the feature of the eluting of tissue thickness's compensating part.

Tissue thickness's compensating part such as can be made up of biocompatible materials, and described biocompatible materials can comprise oxidant.Oxidant can be organic peroxide and/or inorganic peroxide.The example of oxidant can include but not limited to hydrogen peroxide, urea peroxide, calper calcium peroxide and Magnesium dioxide, and SODIUM PERCARBONATE.Oxidant can comprise peroxy oxidant and hypohalogenous acids base oxidizer, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidant can comprise alkali metal chlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and Dexol.Oxidant can comprise vanadate.Oxidant can comprise ascorbic acid.Oxidant can comprise active oxygen generator.Organization bracket can comprise biocompatible materials, and described biocompatible materials comprises oxidant.

Biocompatible materials can comprise liquid, gel and/or powder.Such as, oxidant can comprise microgranule and/or nano-particle.Such as, oxidant can grind to form microgranule and/or nano-particle.In a polymer solution oxidant is attached in biocompatible materials by being suspended by oxidant.Oxidant can be attached in biocompatible materials during freeze-dry process.After lyophilizing, oxidant can be attached to the cell wall of biocompatible materials, with contact time and tissue interaction.Oxidant can not be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, to provide long-acting biological effect by slow releasing oxygen.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structure, to provide long-acting biological effect by slow releasing oxygen.Biocompatible materials can comprise oxidant and medicine, such as doxycycline and ascorbic acid.

Biocompatible materials can comprise release oxidant and/or at a slow speed sustained release oxidant fast.Oxidant can be initial eluting rate and at a slow speed lasting eluting rate fast from the feature of the eluting of biocompatible materials.When oxidising agent body fluid (such as water), oxidant can generate oxygen.The example of body fluid can include but not limited to blood, blood plasma, peritoneal fluid, cerebrospinal fluid, urine, lymph fluid, synovial fluid, vitreous humor, saliva, gastrointestinal cavity content and/or bile.Do not wish to be limited to any particular theory, oxidant can reduce cell death, strengthens organizational vitality and/or maintains the mechanical strength being organized into tissue that can be destroyed in cutting and/or sewing process.Biocompatible materials can comprise at least one microgranule and/or nano-particle.Biocompatible materials can comprise in natural material as herein described, non-synthetic materials and synthetic material one or more.Biocompatible materials can comprise average diameter for about 10nm is to about 100nm and/or about 10 μm to about 100 μm, the such as granule of 45-50nm and/or 45-50 μm.Biocompatible materials can comprise biocompatible foam, and described biocompatible foam comprises embedding at least one microgranule wherein and/or nano-particle.Microgranule and/or nano-particle can not be chemically bonded to biocompatible materials.Microgranule and/or nano-particle can provide the controlled release of medicine.Microgranule and/or nano-particle can comprise at least one medicine.Such as, microgranule and/or nano-particle can comprise hemorrhage, antimicrobial and/or oxidant.Tissue thickness's compensating part can comprise biocompatible foam, and described biocompatible foam comprises hemorrhage (it comprises oxidized regenerated cellulose), antimicrobial (it comprises doxycycline and/or gentamycin) and/or oxidant (it comprises percarbant).Such as, microgranule and/or nano-particle can provide the controlled release of the most as many as medicine of three days.

Microgranule and/or nano-particle can be embedded in biocompatible materials in the fabrication process.Such as, biocompatible polymer (such as PGA/PCL) can solvent contact (such as dioxane) to form mixture.Biocompatible polymer can be ground to form granule.The dry granule or do not have with ORC granule can contact to form suspensoid with mixture.This suspensoid can be lyophilized to form biocompatible foam, and this biocompatible foam comprises and has embedding dry granule wherein and/or the PGA/PCL of ORC granule.

Such as, tissue thickness disclosed herein compensating part or layer can be made up of absorbable polymer.Such as, tissue thickness's compensating part can be made up of following material: foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly-(glycolic-altogether-caprolactone)), PLA/PCL (poly-(lactic acid-altogether-polycaprolactone)), PLLA/PCL, PGA/TMC (poly-(glycolic-altogether-trimethylene carbonate)), PDS, PEPBO or other absorbable polyurethane, polyester, Merlon, poe, condensing model, polyesteramide and/or poly-esters of oxyacids.Such as, tissue thickness's compensating part can be made up of PGA/PLA (poly-(glycolic-altogether-lactic acid)) and/or PDS/PLA (poly-(to dioxanone-altogether-lactic acid)).Such as, tissue thickness's compensating part can be made up of organic material.Such as, tissue thickness's compensating part can be made up of carboxymethyl cellulose, sodium alginate, cross-linked-hyaluronic acid and/or oxidized regenerated cellulose.Such as, tissue thickness's compensating part can comprise the hardness in 3-7 Shore A (30-50 Shore OO) scope, and wherein maximum rigidity is 15 Shore A (65 Shore OO).Such as, tissue thickness's compensating part can stand the compression of 40% under 3 ft lbf loads, stands the compression of 60%, and/or stand the compression of 80% under 6 ft lbf loads under 20 ft lbf loads.One or more gases (such as air, nitrogen, carbon dioxide and/or oxygen) such as can blast and/or be included in tissue thickness's compensating part.Tissue thickness's compensating part can comprise the globule forming tissue thickness compensating part wherein, and described globule comprises between about 50% and material stiffness about between 75%.

Such as, tissue thickness's compensating part can comprise hyaluronic acid, nutritional labeling, fibrin, thrombin, be rich in hematoblastic blood plasma, sulfasalazine ( – 5ASA+ sulfapyridine diazonium key) – Qian body Yao Wu – colon bacteria (azo reductase), aminosalicylic acid (5ASA has the different prodrug configurations for delayed release), (5ASA+ is strange-S Bao Yi – pH>7 (coat dissolves) especially), (5ASA+ ethyl cellulose Bao Yi – based on time/slow releasing of pH), (5ASA+ is strange-L Bao Yi – pH>6 especially), Olsalazine (5ASA+5ASA – colon bacteria (azo reductase)), balsalazide (5ASA+4 aminobenzoyl-B-alanine)-colon bacteria (azo reductase)), pelletize mesalazine, Lialda (delaying and controlled-release formulation of mesalazine), HMPL-004 (can suppress TNF-α, the herbal mixture of the activation of Interleukin-1β and core-κ B), CCX282-B (interference T lymphocyte enters the oral chemokine receptor anagonists of intestinal mucosa), rifaximin (non-absorbability broad ectrum antibiotic), infliximab, mouse chimera antibodies (directly for the monoclonal antibody of TNF-α, it is approved for alleviate suffers from the sign/symptom of the adult/pediatric patient of moderate/severe tube chamber and fistula type Crohn disease to conventional therapy is hyporeactive and maintains clinical remission), adalimumab, people's total IgG 1 (monoclonal antibody of anti-tnf-alpha, it is approved for the sign/symptom alleviating Crohn disease, and for inducing and maintaining conventional therapy underaction, or become the clinical remission suffering from the adult patient of moderate/severe activeness Crohn disease not tolerating infliximab), match trastuzumab, the anti-TNF FAB ' of humanization (is connected to the monoclonal antibody fragment of Polyethylene Glycol, it is approved for the sign/symptom alleviating Crohn disease, and for inducing and maintaining the hyporeactive reaction suffering from the adult patients of moderate/severe disease of conventional therapy), natalizumab, first non-TNF-alpha inhibitor (approval is used for the biologic artifact of Crohn disease), Humanized monoclonal IgG4 antibody (directly for α-4 integrin, obtaining FDA approval has inflammation and the clinical response suffering from the patient of moderate/severe disease and the alleviation that maybe cannot tolerate the grace treatment of conventional Crow and TNF-alpha inhibitor to the treatment of conventional Crow grace and TNF-alpha inhibitor underaction for inducing and maintaining confirmation), the given concomitant immunity regulator having infliximab of possibility, azathioprine 6-MP (purine synthesis Yi Ji – prodrug), methotrexate (in conjunction with dihydrofolate reductase (DHFR) enzyme, it participates in the synthesis of tetrahydrofolic acid, suppresses the synthesis of all purine), allopurinol and the treatment of sulfur purine, PPI, for acid suppression to protect the H2 of healing line, clostridium difficile (C-Diff) – metronidazole, vancomycin (feces transposition process, probiotic bacteria, intracavity normal flora is educated again) and/or rifaximin (bacterial overgrowth process (especially hepatic encephalopathy), do not absorb in the gastrointestinal tract and intracavity antibacterial is worked).

As described herein, such as, tissue thickness's compensating part can compensate the change of thickness of the tissue be trapped in nail that is that penetrate from nail bin and/or that be included in nail line.In other words, some nail in nail line can the thickness portion of capture tissue, and follow closely other nails in line can the thin section of capture tissue.In this case, tissue thickness's compensating part can present differing heights or thickness in nail, no matter and compression stress be applied to and be trapped in tissue in nail and captured tissue is thick or thin.Tissue thickness's compensating part can compensate the change organizing hardness.Such as, some nail in nail line can the height compressible portion of capture tissue, and follow closely other nails in line can the compression ratio more fraction of capture tissue.In this case, such as, tissue thickness's compensating part can present comparatively low height or higher hardness in nail (it has caught the tissue had compared with little compressible), and correspondingly, larger height or comparatively soft can be presented in nail (it has caught the tissue with higher compression ratio).Under any circumstance, such as, no matter whether tissue thickness's compensating part compensates the change of tissue thickness and/or organizes the change of hardness, and it all can be called as " tissue compensating part " and/or " compensating part ".

Can be namely process apparatus design disclosed herein after single uses, or they can be designed to can repeatedly use.But in any one situation, described device all can be repaired, to reuse after using at least one times.The combination in any that reparation can comprise the steps: dismantle described device, then cleaning or displacement particular elements and ressemble subsequently.Particularly, described device can be disassembled, and combination in any can optionally replace or take out particular elements or the part of the arbitrary number of described device.Cleaning and/or displacement particular elements after, described device can be ressembled to use subsequently by operating team at restoration facilities place or before being about to carry out surgical operation.One of skill in the art will appreciate that, the reparation of device can utilize the multiple technology for dismantling, cleaning/replace and ressemble.The use of this type of technology and gained prosthetic device are all in the scope of the application.

Preferably, the present invention as herein described will be processed before surgery.First, obtain new or with the apparatus crossed, and where necessary apparatus is cleaned.Then apparatus is carried out disinfection.In a kind of disinfection technology, device is placed on and closes and in the container sealed, such as plastic bag or TYVEK bag.Then container and apparatus are placed in the radiation field that can penetrate described container, such as gamma-radiation, x-ray or high energy electron.Antibacterial on apparatus and in container kills by radiation.Then the apparatus after sterilization is stored in sterile chamber.Apparatus is kept aseptic by sealing container, until open this container in medical facilities.

With way of reference in full or be partly incorporated to open or other the open materials of any patent herein, patent and all only with in existing definition of the present invention, statement or the afoul scope of other open materials be not incorporated to herein at be incorporated to material.Thus, under necessary degree, the disclosure clearly set forth herein will replace any afoul material be incorporated herein by reference.If according to state be incorporated to by reference herein but with existing definition described herein, statement or the afoul any material of other open materials or its part, be incorporated to herein under only not producing the degree of conflicting between be incorporated to material with existing open material.

Although by the present invention exemplarily property design be described, in spirit and scope of the present disclosure, other amendment can also be carried out to the present invention.Therefore present patent application is intended to contain any modification, purposes or the adaptive version that adopt its general principles.In addition, present patent application be intended to contain in field belonging to the present invention come from known or used have deviate from pattern of the present disclosure in practical framework.

Claims

1. tissue thickness's compensating part, comprises:

Biocompatible materials;

First component; With

Second component;

2. tissue thickness according to claim 1 compensating part, also comprise encapsulation component, described package group divides the one comprised in described first component and second component, and the another one in wherein said first component and second component is embedded in described biocompatible materials.

3. tissue thickness according to claim 1 compensating part, wherein said first component comprises the hydrophilic material be embedded in described biocompatible materials, and described second component is body fluid.

4. tissue thickness according to claim 1 compensating part, described tissue thickness compensating part comprises the first encapsulation component containing described first component and the second encapsulation component containing described second component.

5. tissue thickness according to claim 4 compensating part, wherein said biocompatible materials comprises at least one packaging part, and at least one packaging part described comprises described first encapsulation component and described second encapsulation component.

6. tissue thickness according to claim 4 compensating part, wherein when described first encapsulation component is broken loose, described first encapsulation component can discharge described first component, and when described second encapsulation component is broken loose, described second encapsulation component can discharge described second component.

7., according to tissue thickness in any one of the preceding claims wherein compensating part, wherein said biocompatible materials comprises albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, glucosan, elastin laminin, fibrin, Fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, Merlon, poly-hydroxyethyl methacrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

8. tissue thickness according to claim 1 compensating part, wherein said product contacts and original position formation with described second component by making described first component.

9., according to tissue thickness in any one of the preceding claims wherein compensating part, wherein said product is the compositions that fluid-soluble is swollen.

10. the tissue thickness's compensating part according to any one of claim 1 and 4-9, wherein said first component comprises the first hydrogel precursor, and described second component comprises the second hydrogel precursor, and described product comprises hydrogel.

11. according to tissue thickness in any one of the preceding claims wherein compensating part, and wherein said first component and second component are independently selected from albumin, alginate, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, glucosan, elastin laminin, fibrin, Fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, Merlon, poly-hydroxyethyl methacrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

12. according to tissue thickness in any one of the preceding claims wherein compensating part, comprises the skin that comprises the impermeable material of water and comprises the internal layer of at least one in described biocompatible materials and described first component and second component.

13. tissue thickness according to claim 12 compensating parts, the impermeable material of wherein said water comprises poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, Merlon, poly-hydroxyethyl methacrylate, PVP, polyvinyl alcohol, poly-(caprolactone), poly-(dioxanone), polyacrylic acid, poly-acetas, polypropylene, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

14. according to tissue thickness in any one of the preceding claims wherein compensating part, and wherein said biocompatible materials comprises embedding reinforcing material wherein, and wherein said reinforcing material comprises the combination of mesh sheet, fiber, granule, powder or above-mentioned substance.

15. tissue thickness according to claim 14 compensating parts, wherein said reinforcing material comprises collagen, gelatin, fibrin, Fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl-cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin (chitan), chitosan, alginate esters, poly-(lactic acid), poly-(glycolic), poly-(butyric ester), poly-(phosphazine), polyester, Polyethylene Glycol, polyalkylene oxides, polyacrylamide, poly-hydroxyethyl methacrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly-(caprolactone), poly-(Lanthanum Isopropoxide), polyacrylic acid, poly-acetate, polycaprolactone, polypropylene, aliphatic polyester, glycerol, poly-(aminoacid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly-(iminocarbonic ester), poly-oxalate, polyoxaesters, poe, the combination of polyphosphazene or above-mentioned substance.

16., according to tissue thickness in any one of the preceding claims wherein compensating part, comprise the combination of hemorrhage, antiinflammatory, antibiotic agent, antimicrobial, antiblocking agent, anticoagulant, medicine, pharmaceutically active agents or above-mentioned substance.

Tissue thickness according to claim 1 compensating part, described tissue thickness compensating part comprises:

Skin, it comprises pore-free material;

18. goods according to claim 17, wherein:

19. according to claim 17 or goods according to claim 18, wherein said goods according to circumstances limit nail from described storehouse to anvil block or the nail forming path that will follow from storehouse to described anvil block at least partially, and wherein said first encapsulation component and the second encapsulation component are alignd with described nail forming path, make the nail following described path pierce through described packaging part or otherwise make it broken loose.

20. 1 kinds of methods using tissue thickness according to claim 4 compensating part to carry out tissue thickness's compensating part of original position formation expansion, described method comprises:

21. methods according to claim 20, wherein:

Described tissue thickness compensating part comprises:

Internal layer, it comprises oxidized regenerated cellulose;

Described first package group is divided and is comprised the first hydrogel precursor;

Described second package group is divided and is comprised the second hydrogel precursor; And

Described product comprises hydrogel.