CN104349726B

CN104349726B - Tissue thickness compensation part and its manufacture method

Info

Publication number: CN104349726B
Application number: CN201380027502.7A
Authority: CN
Inventors: R·W·蒂姆; M·D·蒂默; T·威登豪斯; M·M·朗; J·L·斯塔门; G·W·奈特; C·W·威登豪斯; W·B·威森伯格二世; S·A·马奇勒; M·H·兰西克; K·J·施米德; F·E·谢尔顿四世; C·O·巴克斯特三世
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2012-03-28
Filing date: 2013-03-27
Publication date: 2017-11-24
Anticipated expiration: 2033-03-27
Also published as: RU2641853C2; RU2014143228A; CN104349726A; JP2015513961A; JP6293727B2; BR112014024283A2; BR112014024283B1; MX2014011772A

Abstract

The invention discloses a kind of tissue thickness compensation part (33420), and it includes the film main body (33426) formed by continuous extruded shape and fiber drug core (33425).

Description

Tissue thickness compensation part and its manufacture method

Background technology

The present invention relates to a kind of surgical instruments, and in various embodiments, the present invention relates to be designed to cut With the surgery cuts and suture instruments and its nail bin of suture tissue.

The content of the invention

Below for it is claimed or can claimed invention embodiment incomplete row Table.

1. a kind of method for manufacturing tissue thickness compensation part, methods described include：

Extrusion includes the pipe in hole, and the hole includes the first openend and the second openend；

The strand of fibrous material is prepared, the fibrous material includes medicinal property；

The strand is positioned relative to first openend in the hole；

Grasper is inserted in the hole by second openend；

The strand is firmly grasped using the grasper；

The strand is drawn through the hole；

Discharge the strand；And

The grasper is removed from the hole by second openend.

2. according to the method described in embodiment 1, in addition to flatten the pipe.

3. according to the method described in embodiment 2, it is included in the strand and is drawn across flattening the pipe after the hole.

4. the method according to any one of previous embodiment, be additionally included in the strand be drawn across the hole it After split the pipe and the strand.

5. the method according to any one of previous embodiment, in addition to the strand of shaking up.

6. according to the method described in embodiment 5, including the strand of being shaken up during pulling the strand and passing through the hole.

7. the method according to any one of previous embodiment, it is additionally included in the strand and makes otch.

8. the method according to any one of previous embodiment, in addition to closure first openend and closure institute State the second openend.

A kind of 9. tissue thickness compensation part that method by any one of previous embodiment manufactures.

10. a kind of compensating part, it can be attached to the anvil block of fastening instrument, wherein the anvil block includes profiled surface, and And wherein described compensating part includes：

Pipe, the pipe include hole, first end and second end；

Strands line, the strands line are positioned in the hole；With

Attachment part, the attachment part can be attached to the anvil block.

11. according to the compensating part described in embodiment 10, wherein the strands line is made up of oxidized regenerated cellulose.

12. according to the compensating part described in embodiment 10 or embodiment 11, wherein the pipe is made up of polymeric material.

13. according to the compensating part any one of embodiment 10-12, wherein the first end and the second end It has been sealed and closed.

14. according to the compensating part any one of embodiment 10-13, wherein the attachment portion, which includes, can engage institute The first flank for stating the first side of anvil block and the second flank of the second side that can engage the anvil block.

15. according to the compensating part any one of embodiment 10-14, wherein the pipe includes flexure joints.

16. a kind of method for manufacturing tissue thickness compensation part, methods described include：

Material layer is provided；

Fiber hemostasis agent material is positioned in the material layer；And

Stop blooding agent material around the fiber to fold the material layer.

17. according to the method described in embodiment 16, be additionally included in around layer described in the fiber styptic folding of material it After flatten the material layer and the fiber hemostasis agent material.

18. according to the method described in embodiment 16 or embodiment 17, in addition to around fiber hemostasis agent material sealing The material layer.

19. according to the method any one of embodiment 16-18, it is additionally included in around fiber hemostasis agent material folding Split the material layer and fiber hemostasis agent material after lamination.

A kind of 20. tissue thickness compensation part that method by any one of embodiment 16-19 manufactures.

21. a kind of tissue thickness compensation part, including：

The film main body formed by continuous extruded shape；With

Fiber drug core.

Brief description of the drawings

Refer to the following explanation of the embodiment of the present invention, feature of the invention and advantage and its acquisition side in conjunction with the accompanying drawings Method will become more apparent, and be better understood invention in itself, wherein：

Fig. 1 is the sectional view of surgical instrument embodiment；

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

Figure 1B-Fig. 1 E show the part for the end effector that tissue is clamped and sutured with implanted nail bin；

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

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

The end effector that Fig. 4 is Fig. 2 and Fig. 3 begins to pass another local horizontal stroke when end effector promotes in knife bar Side cross-sectional view；

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

Fig. 6 A- Fig. 6 D describe the deformation for the surgical staples being positioned in staple cartridge body according at least one embodiment；

Fig. 7 A are the schematic diagrames for showing to be positioned at nail that can be in conquassation staple cartridge body；

Fig. 7 B be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of anvil block conquassation；

Fig. 7 C be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of the further conquassation of anvil block；

Fig. 7 D be show Fig. 7 A nail in be fully formed configuration and Fig. 7 A can conquassation nail bin be in complete conquassation bar The schematic diagram of part；

Fig. 8 is according to the top view of the nail bin of at least one embodiment, and the nail bin is included in embedded staple cartridge body Nail；

Fig. 9 is the front view of Fig. 8 nail bin；

Figure 10 is the decomposition diagram of the alternative embodiment of compressible nail bin, and the compressible nail bin includes following closely and being used for The system for driving nail against anvil block；

Figure 10 A are the partial sectional views of the alternative embodiment of Figure 10 nail bin；

Figure 11 is the sectional view of Figure 10 nail bin；

Figure 12 is the front view that can be traversed Figure 10 nail bin and make the sliding part that nail moves towards anvil block；

Figure 13 is the schematic diagram of staple drivers, and the staple drivers can be lifted by Figure 12 sliding part towards anvil block；

Figure 14 is that the nail bin includes and surgical stapling device according to the perspective view of the nail bin of at least one embodiment of the present invention The rigid support portion and compressible tissue thickness compensation part that tool is used together；

Figure 15 is the partial exploded view of Figure 14 nail bin；

Figure 16 is the complete exploded view of Figure 14 nail bin；

Figure 17 is another exploded view of Figure 14 nail bin, and the nail bin is not covered with the wrappage of tissue thickness compensation part；

Figure 18 is the warehouse of Figure 14 nail bin or the perspective view of support section；

Figure 19 is the top perspective of sliding part, and the sliding part can be moved to be followed closely from cartridge deployment in Figure 14 nail bin；

Figure 20 is the bottom perspective view of Figure 19 sliding part；

Figure 21 is the front view of Figure 19 sliding part；

Figure 22 is the top perspective of driver, and the driver can support one or more follow closely and by Figure 19 sliding part It is lifted up so that nail to be projected from nail bin；

Figure 23 is the bottom perspective view of Figure 22 driver；

Figure 24 is can be at least partly around the wrappage of the compressible tissue thickness compensation part of nail bin；

Figure 25 is the partial sectional view of nail bin, and the nail bin includes rigid support portion and compressible tissue thickness compensates Part, show that never firing position moves to firing position to nail during First ray；

Figure 26 is the front view of Figure 25 nail bin；

Figure 27 is the thin portion front view of Figure 25 nail bin；

Figure 28 is the section end view of Figure 25 nail bin；

Figure 29 is the bottom view of Figure 25 nail bin；

Figure 30 is the thin portion bottom view of Figure 25 nail bin；

Figure 31 is nail bin and the longitudinal sectional view of anvil block in the close position, and the nail bin includes rigid support portion and can The tissue thickness compensation part of compression, show that never firing position moves to firing position to nail during First ray；

Figure 32 is Figure 31 anvil block and another sectional view of nail bin, in opening after being completed it illustrates percussion sequence The anvil block of position；

Figure 33 is the local detail drawing of Figure 31 nail bin, and it illustrates the nail in non-firing position；

Figure 34 is the cross-section front view of nail bin, and the nail bin includes rigid support portion and compressible tissue thickness compensates Part, show the nail in non-firing position；

Figure 35 is the detail drawing of Figure 34 nail bin；

Figure 36 is nail bin and the front view of anvil block in an open position, and the nail bin includes rigid support portion and compressible Tissue thickness compensation part, show the nail in non-firing position；

Figure 37 is nail bin and the front view of anvil block in the close position, and the nail bin includes rigid support portion and compressible Tissue thickness compensation part, show in non-firing position nail and be trapped between anvil block and tissue thickness compensation part Tissue；

Figure 38 is Figure 37 anvil block and the detail drawing of nail bin；

Figure 39 is nail bin and the front view of anvil block in the close position, and the nail bin includes rigid support portion and compressible Tissue thickness compensation part, show the nail in non-firing position, show be positioned in it is thicker between anvil block and nail bin Tissue；

Figure 40 is Figure 39 anvil block and the detail drawing of nail bin；

Figure 41 is Figure 39 anvil block and the front view of nail bin, and it illustrates be positioned in having not between anvil block and nail bin The tissue of stack pile；

Figure 42 is Figure 39 anvil block and the detail drawing of nail bin, as shown in figure 41；

Figure 43 is to show the tissue thickness compensation part compensated to the different tissues thickness being trapped in different nails Schematic diagram；

Figure 44 is to show that tissue thickness compensation part applies compression pressure to by one or more crosscutting blood vessel of staple line Schematic diagram；

Figure 45 is the schematic diagram for being shown in which the situation that one or more nails do not shape appropriately；

Figure 46 is the schematic diagram for showing the tissue thickness compensation part that can compensate for imappropriate forming nail；

Figure 47 is to show showing for the tissue thickness compensation part being positioned in the intersecting tissue regions of plurality of staple line It is intended to；

Figure 48 is the schematic diagram for showing the tissue being trapped in nail；

Figure 49 is to show the tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

Figure 50 is the schematic diagram for showing the tissue being trapped in nail；

Figure 51 is the schematic diagram for showing the thick tissue being trapped in nail and tissue thickness compensation part；

Figure 52 is to show the thin tissue being trapped in nail and the schematic diagram of tissue thickness compensation part；

Figure 53 is the signal for the tissue for showing the tissue thickness compensation part being trapped in nail and having interior thickness Figure；

Figure 54 is to show the tissue thickness compensation part being trapped in nail and the tissue with another interior thickness Schematic diagram；

Figure 55 is the schematic diagram for showing the thick tissue being trapped in nail and tissue thickness compensation part；

Figure 56 is the partial sectional view of the end effector of surgery suturing appliance, it illustrates in retraction, do not fire position The trigger shaft and nail percussion sliding part put；

Figure 57 is another partial sectional view of Figure 56 end effector, and it illustrates promote hitting for position in part Send out bar and nail percussion sliding part；

Figure 58 is the sectional view of Figure 56 end effector, and it illustrates in being fully advanced or the percussion of firing position Bar；

Figure 59 is the sectional view of Figure 56 end effector, and it illustrates the trigger shaft that advanced position is in after being fired And stay in the nail percussion sliding part of its complete firing position；

Figure 60 is the detail drawing of Figure 59 trigger shaft in advanced position；

Figure 61 is the holding device assembly for including retainer and two tissue thickness compensation parts according at least one embodiment Exploded view；

Figure 62 is the perspective view of the holding device assembly shown in Figure 61；

Figure 63 is the perspective view for the anvil block that can be used together with Figure 61 holding device assembly；

Figure 64 is the diagram for showing the holding device assembly shown in Figure 61, and the holding device assembly is inserted into surgical stapling device In end effector, the end effector includes anvil block and nail bin；

Figure 65 is the side view of the holding device assembly shown in the Figure 61 engaged with Figure 64 nail bin；

Figure 66 is the side view of the holding device assembly shown in the Figure 61 engaged with Figure 64 nail bin and anvil block, and it illustrates place In the anvil block of closing position；

Figure 67 is the side view from Figure 61 of Figure 64 end effector removal holding device assembly；

Figure 68 is to maintain the perspective view of device；

Figure 69 is Figure 68 retainer and is attached to the side of its lower surface and the tissue thickness compensation part of top surface View, it illustrates one in the tissue thickness compensation part engaged with the nail bin in the surgical stapling device including anvil block；

Figure 70 is the side view for the anvil block for showing Figure 69 in the close position；

Figure 71 is the decomposition diagram of the retainer and tissue thickness compensation part according at least one embodiment；

Figure 72 be Figure 71 tissue thickness compensation part and surgical stapling device anvil block decomposition diagram；

Figure 73 is the exploded top perspective view of the retainer and tissue thickness compensation part according at least one embodiment；

Figure 74 is Figure 73 retainer and the exploded bottom perspective view of tissue thickness compensation part；

Figure 75 is the Figure 73 engaged with surgical stapling device retainer and the top perspective of tissue thickness compensation part；

Figure 76 is the Figure 73 engaged with Figure 75 surgical stapling device retainer and the bottom perspective of tissue thickness compensation part Figure；

Figure 77 is the Figure 73 engaged with Figure 75 surgical stapling device retainer and the side view of tissue thickness compensation part；

Figure 78 is Figure 73 retainer and the bottom perspective view of tissue thickness compensation part, and it illustrates be attached to the outer of Figure 75 The tissue thickness compensation part of section's stitching unstrument；

Figure 79 is Figure 73 retainer and the top perspective of tissue thickness compensation part, and it illustrates the anvil for being attached to Figure 78 The tissue thickness compensation part of seat；

Figure 80 is attached to the side view of Figure 73 of Figure 78 anvil block tissue thickness compensation part；

Figure 81 is attached to retainer and the tissue thickness's compensation of the nail bin of surgical stapling device and Figure 73 of passage and Figure 74 The sectional view of part；

Figure 82 is attached to the retainer and tissue thickness of the nail bin of Figure 81 surgical stapling device and Figure 73 of passage and Figure 74 The sectional view of compensating part is spent, it illustrates the anvil block of the surgical stapling device engaged with tissue thickness compensation part；

Figure 83 is attached to the anvil block of surgical stapling device and just moves away from Figure 73 of retainer tissue thickness's compensation The sectional view of part；

Figure 84 is to include keeping according to the sectional view of the holding device assembly of at least one embodiment, the holding device assembly Device, the tissue thickness compensation part on the first surface and second surface of retainer and the company through the hole in retainer Connect device；

Figure 85 is the perspective view of Figure 84 holding device assembly, there is shown with a part for tissue thickness compensation part because illustrating mesh And be removed；

Figure 86 is the side view of the Figure 84 engaged with surgical stapling device holding device assembly, and the surgical stapling device includes quilt It is shown in the anvil block of open position；

Figure 87 is Figure 84 holding device assembly and is shown in the side view of Figure 86 of closing position anvil block；

Figure 88 is the side view of Figure 84 holding device assembly, and it illustrates just from the tissue thickness compensation part for keeping device assembly Between the retainer that removes；

Figure 89 is the side view from the retainer of Figure 84 tissue thickness compensation part removal；

Figure 90 is the perspective view according to the retainer of the anvil block that can engage surgical stapling device of at least one embodiment；

Figure 91 is the top view of Figure 90 retainer；

Figure 92 is the side view of Figure 90 retainer；

Figure 93 is the bottom view of Figure 90 retainer；

Figure 94 shows holding device assembly, described to keep the retainer that device assembly includes Figure 90 and be attached to for surgery seam The tissue thickness compensation part of the nail bin of clutch；

Figure 95 shows Figure 94 of the anvil block of the end effector of engagement surgical stapling device holding device assembly and nail bin；

Figure 96 show engagement Figure 95 surgical stapling device end effector anvil block Figure 94 holding device assembly and Nail bin；

Figure 97 shows the holding device assembly and nail bin of Figure 94 on the anvil block for the surgical stapling device for being bonded on Figure 95；

Figure 98 show Figure 94 on the anvil block for the surgical stapling device for being bonded on Figure 95 holding device assembly and nail bin and Just it is being moved to the anvil block of closing position；

Figure 99 shows the anvil block of Figure 95 in an open position surgical stapling device, and the anvil block, which has, is attached to its Tissue thickness compensation part and the retainer engaged with the staple cartridge channel of surgical stapling device；

Figure 100 shows the Figure 94 engaged with the staple cartridge channel of Figure 95 surgical stapling device retainer and in open position The anvil block put；

Figure 101 is the sectional view for the retainer for including tissue thickness compensation part, and the tissue thickness compensation part includes can Engage the projection or the wing of the anvil block of surgical stapling device；

Figure 102 is the sectional view for the retainer for including tissue thickness compensation part, and the tissue thickness compensation part includes can Engage the bearing sleeve of the anvil block of surgical stapling device；

Figure 103 is to be included according at least one embodiment by the perspective view of the retainer of hinged two plates；

Figure 104 is the side view of Figure 103 retainer；

Figure 105 is the rear view of the embodiment for the insertion instrument that can be used together with Figure 103 retainer；

Figure 106 is the top perspective of Figure 105 insertion instrument；

Figure 107 is the rear view of Figure 105 insertion instrument, wherein a part for insertion instrument is moved because of diagram purpose Remove；

Figure 108 is the side view of Figure 105 insertion instrument, wherein a part for insertion instrument is moved because of diagram purpose Remove；

Figure 109 is the top view of Figure 105 insertion instrument；

Figure 110 is to maintain the perspective view of device assembly, the retainer for keeping device assembly to include Figure 103, is positioned within The insertion instrument of tissue thickness compensation part, the nail bin being positioned within device and the Figure 105 engaged with retainer on device, The part for wherein inserting instrument is removed because of diagram purpose；

Figure 111 is to maintain the side view of device assembly, the retainer for keeping device assembly to include Figure 103, is positioned within The insertion instrument of tissue thickness compensation part and the Figure 105 engaged with retainer on device, wherein insertion instrument it is a part of because Illustrate purpose and be removed；

Figure 112 shows the holding device assembly for the Figure 110 being inserted into the surgical instruments including anvil block and staple cartridge channel, its A part for middle insertion instrument is removed because of diagram purpose；

Figure 113 shows the holding device assembly for the Figure 110 being inserted into the surgical instruments including anvil block and staple cartridge channel, its A part for middle insertion instrument is removed because of diagram purpose；

Figure 114 is shown just relative to retainer movement to engage the nail bin in staple cartridge channel and engage in company with anvil block Figure 105 of tissue thickness compensation part insertion instrument a, wherein part for insertion instrument is removed because of diagram purpose；

Figure 115 shows just mobile relative to retainer so that the figure that retainer departs from from tissue thickness compensation part and nail bin 105 insertion instrument a, wherein part for insertion instrument is removed because of diagram purpose；

Figure 116 is the tissue thickness compensation part according to the anvil block for being attached to surgery suturing appliance of at least one embodiment Sectional view；

Figure 117 is the schematic diagram for showing to become staple, the tissue thickness for becoming staple and capturing Figure 116 at least in part wherein Spend compensating part；

Figure 118 is the end effector according to the surgery suturing appliance for including nail bin and anvil block of at least one embodiment Sectional view, the nail bin include the first tissue thickness compensation part, and the anvil block includes minor microstructure thickness compensation part；

Figure 119 is the sectional view of Figure 118 end effector, and it illustrates the never firing position derived from nail bin to be moved to The nail of firing position；

Figure 120 is according to the saturating of the tissue thickness compensation part of the anvil block for being attached to end effector of at least one embodiment View, wherein tissue thickness compensation part include multiple capsules；

Figure 120 A are the fragmentary, perspective views of Figure 120 tissue thickness compensation part；

Figure 121 is that just never firing position is being moved to firing position to pierce through the capsule of Figure 120 tissue thickness compensation part The sectional view of nail；

Figure 122 is the exploded view of the anvil block and tissue thickness compensation part according at least one embodiment；

Figure 123 is the sectional view of the anvil block and tissue thickness compensation part according at least one embodiment, and the anvil block includes Multiple nail shapes pits, the tissue thickness compensation part include the multiple capsules to be alignd with forming pit；

Figure 124 is the detail drawing of the capsule of Figure 123 tissue thickness compensation part；

Figure 125 is to show Figure 123 anvil block and the schematic diagram of tissue thickness compensation part relative to organizing to be positioned, institute Tissue is stated to be sutured the nail by the nail bin derived from the opposite side for being positioned at tissue；

Figure 126 is Figure 123 anvil block and the showing for the nail that is partly fired from nail bin for showing just moving towards Figure 125 nail bin It is intended to；

Figure 127 is the tissue thickness of the nail and Figure 123 in state of rupture that show Figure 126 in complete firing configuration The schematic diagram of the capsule of compensating part；

Figure 128 is the schematic diagram for the nail for showing Figure 126 in non-cock；

Figure 129 is the nail for showing Figure 126 in complete firing configuration and Figure 123 at least partly crosscutting state The schematic diagram of tissue thickness compensation part；

Figure 130 is the profile perspective according to the alternative embodiment of the tissue thickness compensation part of at least one embodiment；

Figure 131 is the perspective view of the alternative embodiment of tissue thickness compensation part, the tissue thickness compensation part include with Multiple capsules of the cutting element alignment of surgery suturing appliance；

Figure 132 is the detail drawing of Figure 131 capsule；

Figure 133 is the sectional view of Figure 131 tissue thickness compensation part, and the tissue thickness compensation part includes and surgical stapling Multiple capsules of the cutter slit alignment of the anvil block of apparatus；

Figure 134 and Figure 135 shows the alternative embodiment for the tissue thickness compensation part for being just attached to anvil block；

Figure 136 is the sectional exploded view of the anvil block and compensating part according at least one embodiment；

Figure 137 shows the compensating part for the Figure 136 for being attached to anvil block；

Figure 138 is the cutting structure of the tissue thickness compensation part and incision tissue thickness compensation part according at least one embodiment The fragmentary, perspective view of part；

Figure 139 is the partial sectional view according to the alternative embodiment of the tissue thickness compensation part of at least one embodiment；

Figure 140 is the partial cutaway according to another alternative embodiment of the tissue thickness compensation part of at least one embodiment View；

Figure 141 is the schematic diagram for showing the tissue thickness compensation part according to various embodiments, the tissue thickness compensation part Including multiple irregular and/or asymmetrical cavity；

Figure 142 is the tissue thickness compensation part according to the anvil block for being attached to surgery suturing appliance of at least one embodiment Partial sectional view；

Figure 143 is the perspective according to seamless the extrusion housing or outer tube of the tissue thickness compensation part of at least one embodiment Figure；

Figure 144 is another seamless extrusion housing or outer tube according to the tissue thickness compensation part of at least one embodiment Perspective view；

Figure 145 is the perspective view of oxidized regenerated cellulose fiber；

Figure 146 is shorter than the perspective view of the oxidized regenerated cellulose fiber of Figure 145 fiber；

Figure 147 is to show just to utilize Figure 146 fiber weaving into the schematic diagram of Figure 145 of strand fiber；

Figure 148 shows the strand for the Figure 147 for just being shaken up and just being cut at least in part；

Figure 149 shows the housing for being inserted through tissue thickness compensation part or outer tube and is oriented to promptly Figure 147 strand Grasper；

Figure 150 shows the Figure 149 just exited from sleeve pipe grasper and is just drawn across Figure 147 of housing stock Line；

Figure 151 shows just divided Figure 150 housing and strand；

Figure 152 shows the end for the housing for just carrying out heating welding and/or sealing；

Figure 153 shows the method for producing the tissue thickness compensation part without transverse joint；

Figure 154 shows the anvil block of surgical stapling device and is optionally attached to multiple compensating parts of anvil block, wherein mending Each repaid in part includes the array of capillary channel；

Figure 155 is attachable to the plan of the compensating part of anvil block；

Figure 156 is the detail drawing of a part for Figure 155 compensating part；

Figure 157 is the perspective view of the end effector of surgery suturing appliance；

Figure 158 is another perspective view of Figure 157 end effector, and it illustrates the tissue for being arranged in end effector Fluid in thickness compensation part；

Figure 159 is another perspective view of Figure 159 end effector, and it illustrates the anvil block for being attached to end effector Compensating part；

Figure 160 is the detail drawing of the capillary channel array on Figure 159 compensating part；

Figure 161 is the exploded view for including multiple layers of compensating part according at least one embodiment；

Figure 162 is the exploded view of the compensating part and anvil block according to the surgery suturing appliance of at least one embodiment；

Figure 163 is Figure 162 compensating part and the partial sectional view of anvil block；

Figure 164 is the exploded view according to the compensating part including cell ingrowth matrix of at least one embodiment；

Figure 165 is the perspective view of Figure 164 compensating part；

Figure 166 is the perspective view of the fibrous material layer for compensating part；

Figure 167 is the perspective view for overlieing one another multiple fibrous layers together according at least one embodiment；

Figure 168 is the perspective view for overlieing one another another multiple fibrous layers together according at least one embodiment；

Figure 169 is the perspective view of the fibrous material layer for compensating part；

Figure 170 is the perspective view for overlieing one another multiple fibrous layers together according at least one embodiment, wherein institute Fiber is stated to be arranged along different directions；

Figure 171 is the perspective view for overlieing one another another multiple fibrous layers together according at least one embodiment；

Figure 172 is according to the saturating of the end effector insert of the surgical instruments of at least one embodiment and end effector View；

Figure 173 is compensated according to the tissue thickness being positioned in the end effector of surgical instruments of at least one embodiment The front view of part；

Figure 174 is compensated according to the tissue thickness being positioned in the end effector of surgical instruments of at least one embodiment The front view of part；

Figure 175 is the sleeve pipe on the anvil block according to the end effector for being positioned at surgical instruments of at least one embodiment Perspective view；

Figure 176 is the plan of the furcation of Figure 175 sleeve pipe；

Figure 177 is the front view of the furcation of Figure 175 sleeve pipe；

Figure 178 is the end-view of the furcation of Figure 175 sleeve pipe；

Figure 179 is the perspective view of the furcation of Figure 175 sleeve pipe；

Figure 180 is the plan according to the Tissue compensating part of the sleeve pipe of at least one embodiment；

Figure 181 is the perspective view of Figure 180 Tissue compensating part；

Figure 182 is the front view of Figure 180 Tissue compensating part；

Figure 183 is the plan according to the Tissue compensating part of the sleeve pipe of at least one embodiment；

Figure 184 is the perspective view of Figure 183 Tissue compensating part；

Figure 185 is the front view of Figure 183 Tissue compensating part；

Figure 186 is the perspective view of the nose of Figure 175 sleeve pipe；

Figure 187 is another perspective view of Figure 186 nose；

Figure 188 is the plan of Figure 186 nose, and it show in phantom internal geometry；

Figure 189 is the front view of Figure 186 nose, and it show in phantom internal geometry；

Figure 190 is located at another perspective view of the sleeve pipe of Figure 175 on anvil block；

Figure 191 is located at the plan of the sleeve pipe of Figure 175 on anvil block；

Figure 192 is located at the front view of the sleeve pipe of Figure 175 on anvil block；

Figure 193 is located at the plan of the sleeve pipe of Figure 175 on anvil block, and it illustrates the translation being shown in phantom percussion Bar；

Figure 194 is located at the front view of the sleeve pipe of Figure 175 on anvil block, and it illustrates the translation being shown in phantom percussion Bar；

Figure 195 is located at the plan of the sleeve pipe of Figure 175 on anvil block, and it illustrates the nose discharged from sleeve pipe；

Figure 196 is located at the front view of the sleeve pipe of Figure 175 on anvil block, and it illustrates the nose discharged from sleeve pipe；

Figure 197 is located at the plan of the sleeve pipe of Figure 175 on anvil block, and it show in phantom trigger shaft and shows From the nose of sleeve pipe release；

Figure 198 is located at the front view of the sleeve pipe of Figure 175 on anvil block, and it show in phantom trigger shaft and shows From the nose of sleeve pipe release；

Figure 199 is the fragmentary, perspective view of Figure 197 sleeve pipe, anvil block and trigger shaft；

Figure 200 is another fragmentary, perspective view of Figure 197 sleeve pipe, anvil block and trigger shaft；

Figure 20 1 is Figure 175 sleeve pipe and the positive view of anvil block；

Figure 20 2 is the positive view of Figure 175 anvil block, and it illustrates the Tissue compensating part discharged from sleeve pipe；

Figure 20 3 is the plan according to the end effector insert of at least one embodiment；

Figure 20 4 is the front view of Figure 20 3 end effector insert；

Figure 20 5 is the perspective view of Figure 20 5 end effector insert；

Figure 20 6 is the fragmentary, perspective view of Figure 20 3 end effector insert, and it illustrates the end of engagement surgical instruments The end effector insert of the anvil block of actuator；

Figure 20 7 is the fragmentary, perspective view of Figure 20 3 end effector insert, and it illustrates the end of engagement surgical instruments The end effector insert of the nail bin of actuator；

Figure 20 8 is the front view of Figure 20 3 end effector insert, and it illustrates the end execution of engagement surgical instruments The end effector insert of device；

Figure 20 9 is located at the front view of the end effector insert of Figure 20 3 in the end effector of surgical instruments；

Figure 21 0 is the perspective according to the tissue thickness compensation part being positioned in end effector of at least one embodiment Figure, there is shown with a part for tissue thickness compensation part to be removed；

Figure 21 1 is the perspective of the Figure 21 0 for the anvil block that end effector is fixed to by electrostatic charge tissue thickness compensation part Figure；

Figure 21 2 is the saturating of the Figure 21 0 for the anvil block that end effector is fixed to by suction element tissue thickness compensation part View；

Figure 21 3 is the Figure 21 0 for the anvil block that end effector is fixed to by hook-loop securing member tissue thickness compensation part Perspective view；

Figure 21 4 is the partial perspective of the Figure 21 0 for the anvil block that end effector is fixed to by band tissue thickness compensation part Figure；

Figure 21 5 is the figure of anvil block of the bearing sleeve fixed to end effector at the distal end by tissue thickness compensation part The fragmentary, perspective view of 210 tissue thickness compensation part；

Figure 21 6 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The partial perspective sectional view of compensating part；

Figure 21 7 is the positive view of Figure 21 6 tissue thickness compensation part；

Figure 21 8 is another positive view of Figure 21 6 tissue thickness compensation part；

Figure 21 9 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The positive view of compensating part, it illustrates breech lock in the close position；

Figure 22 0 is the positive view of Figure 21 9 tissue thickness compensation part, and it illustrates breech lock in an open position；

Figure 22 1 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The positive view of compensating part；

Figure 22 2 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The positive view of compensating part；

Figure 22 3 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The positive view of compensating part；

Figure 22 4 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The positive view of compensating part；

Figure 22 5 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The perspective sectional exploded view of compensating part；

Figure 22 6 is the perspective view of Figure 22 5 tissue thickness compensation part, and it illustrates the tissue thickness moved towards anvil block compensation Part；

Figure 22 7 is the positive view of the Figure 22 5 engaged with anvil block tissue thickness compensation part；

Figure 22 8 is the tissue thickness according to the anvil block of the end effector fixed to surgical instruments of at least one embodiment The perspective cut-away schematic view of compensating part；

Figure 22 9 is Figure 22 8 tissue thickness compensation part and the perspective sectional exploded view of anvil block；

Figure 23 0 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 23 1 is the perspective view of Figure 23 0 tissue thickness compensation part；

Figure 23 2 is another perspective view of Figure 23 0 tissue thickness compensation part；

Figure 23 3 is the perspective view of Figure 23 0 tissue thickness compensation part, and it illustrates the end effector towards surgical instruments The tissue thickness compensation part of anvil block movement；

Figure 23 4 is located at the sectional view of the tissue thickness compensation part of Figure 23 0 on anvil block；

Figure 23 5 is located at the perspective view of the tissue thickness compensation part of Figure 23 0 on anvil block；

Figure 23 6 is located at the perspective view of the tissue thickness compensation part of Figure 23 0 on anvil block, and it illustrates cut-out tissue is thick Spend the cutting element of compensating part；

Figure 23 7 be according to the sectional front view of the end effector of the surgery suturing appliance of at least one embodiment, it is described End effector includes anvil block and charged layer；

Figure 23 8 is Figure 23 7 anvil block and the bottom view of charged layer；

Figure 23 9 is Figure 23 7 anvil block and charged layer and the tissue thickness compensation part for being releasably attached to charged layer Exploded view；

Figure 24 0 is the perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 24 1 is the plan of Figure 24 0 tissue thickness compensation part；

Figure 24 0A are the perspective views according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 24 1A are the plans of Figure 24 0A tissue thickness compensation part；

Figure 24 2 is the perspective view according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 24 3 is the plan of Figure 24 2 tissue thickness compensation part；

Figure 24 4 is the perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 24 5 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one embodiment；

Figure 24 6 is Figure 24 5 anvil block and the sectional view of tissue thickness compensation part；

Figure 24 7 is the cross-sectional view of Figure 24 5 tissue thickness compensation part；

Figure 24 8 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one alternative embodiment；

Figure 24 9 is Figure 24 8 anvil block and the sectional view of tissue thickness compensation part；

Figure 25 0 is the sectional view of the tissue thickness compensation part of Figure 24 8 in open configuration；

Figure 25 1 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one alternative embodiment；

Figure 25 2 is Figure 25 1 anvil block and the sectional view of tissue thickness compensation part；

Figure 25 3 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one alternative embodiment；

Figure 25 4 is Figure 25 3 anvil block and the sectional view of tissue thickness compensation part；

Figure 25 5 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one alternative embodiment；

Figure 25 6 is Figure 25 5 anvil block and the sectional view of tissue thickness compensation part；

Figure 25 7 is the perspective view according to the tissue thickness compensation part for being attached to anvil block of at least one alternative embodiment； And

Figure 25 8 is Figure 25 7 anvil block and the sectional view of tissue thickness compensation part.

Through multiple views, part corresponding to corresponding reference symbol instruction.Example as shown herein shows in one form Certain embodiments of the present invention, and the scope that such example should not be construed as in any way limiting the present invention are gone out.

Embodiment

Present applicant also possesses following U.S. Patent application, and these patent applications are each complete by reference It is incorporated herein entirely：

Entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " (agencies People file number END6734USNP/100058) U.S. Patent Application Serial Number 12/894,311；

Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS” The U.S. Patent Application Serial Number 12/894,340 of (attorney END6735USNP/100059)；

Entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " (attorney dockets Number END6736USNP/100060) U.S. Patent Application Serial Number 12/894,327；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " (attorneys END6839USNP/100524 U.S. Patent Application Serial Number 12/894,351)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT " (attorney END6840USNP/100525) U.S. Patent Application Serial Number 12/894,338；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " The U.S. Patent Application Serial Number 12/894,369 of (attorney END6841USNP/100526)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " (generations Manage people file number END6842USNP/100527) U.S. Patent Application Serial Number 12/894,312；

Entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " (agents File number END6843USNP/100528) U.S. Patent Application Serial Number 12/894,377；

Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT " (attorney END6847USNP/100532) U.S. Patent Application Serial Number 12/894,339；

Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM " (attorney END6848USNP/100533) U.S. Patent Application Serial Number 12/894,360；

Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS " (attorney END6849USNP/100534) U.S. Patent Application Serial Number 12/894,322；

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT " (attorney END6855USNP/100540) U.S. State's patent application serial number 12/894,350；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS " (attorney END6856USNP/100541) U.S. Patent Application Serial Number 12/894,383；

Entitled " COMPRESSIBLE FASTENER CARTRIDGE " (attorney END6857USNP/ 100542) U.S. Patent Application Serial Number 12/894,389；

Entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " (attorneys Reel number END6858USNP/100543) U.S. Patent Application Serial Number 12/894,345；

Entitled " COLLAPSIBLE FASTENER CARTRIDGE " (attorney END6859USNP/ 100544) U.S. Patent Application Serial Number 12/894,306；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS " (attorney END6860USNP/100546) U.S. Patent Application Serial Number 12/894, 318；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX " (attorney END6861USNP/100547) U.S. Patent Application Serial Number 12/894,330；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " (attorneys END6862USNP/100548 U.S. Patent Application Serial Number 12/894,361)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " (attorneys END6863USNP/100549 U.S. Patent Application Serial Number 12/894,367)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " (generations Manage people file number END6864USNP/100550) U.S. Patent Application Serial Number 12/894,388；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " The U.S. Patent Application Serial Number 12/894,376 of (attorney END6865USNP/100551)；

Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS " (attorney END6735USCIP1/100059CIP1) U.S. Patent Application Serial Number 13/097,865；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " (attorneys Reel number END6736USCIP1/100060CIP1) U.S. Patent Application Serial Number 13/097,936；

Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION " (attorney END6840USCIP1/100525CIP1) U.S. Patent Application Serial Number 13/097,954；

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF " (attorney END6841USCIP1/100526CIP1) United States Patent (USP) Patent application serial numbers 13/097,856；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS " The U.S. Patent Application Serial Number 13/097,928 of (attorney END6842USCIP1/100527CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL " (attorney END6843USCIP1/100528CIP1) U.S. Patent Application Serial Number 13/097,891；

Entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " (agencies People file number END6847USCIP1/100532CIP1) U.S. Patent Application Serial Number 13/097,948；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY " (attorneys END6848USCIP1/100533CIP1 U.S. Patent Application Serial Number 13/097,907)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES " (attorney END6849USCIP1/100534CIP1) U.S. Patent Application Serial Number 13/097,861；

Entitled " STAPLE CARTRIDGE LOADING ASSEMBLY " (attorney END6855USCIP1/ U.S. Patent Application Serial Number 13/097,869 100540CIP1)；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS " (generations Manage people file number END6856USCIP1/100541CIP1) U.S. Patent Application Serial Number 13/097,917；

Entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " (attorneys END6857USCIP1/100542CIP1 U.S. Patent Application Serial Number 13/097,873)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS " (attorney END6858USCIP1/100543CIP1) U.S. Patent Application Serial Number 13/097, 938；

Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END6859USCIP1/100544CIP1) U.S. Patent Application Serial Number 13/097,924；

Entitled " SURGICAL STAPLER WITH FLOATING ANVIL " (attorneys END6841USCIP2/100526CIP2 U.S. Patent Application Serial Number 13/242,029)；

Entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " (attorneys END6841USCIP3/100526CIP3 U.S. Patent Application Serial Number 13/242,066)；

Entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " (attorneys END7020USNP/110374 U.S. Patent Application Serial Number 13/242,086)；

Entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " (agencies People file number END7019USNP/110375) U.S. Patent Application Serial Number 13/241,912；

Entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " (attorneys END7013USNP/110377 U.S. Patent Application Serial Number 13/241,922)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS " (attorney END6888USNP3/110378) U.S. Patent application sequence Row number 13/241,637；With

Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR " (attorney END6888USNP2/110379) U.S. Patent Application Serial Number 13/241,629.

Present applicant also possesses following U.S. Patent application, and these patent applications carry on the same day with the application Hand over, and each is each integrally incorporated herein by reference：

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES " (attorney END6864USCIP1/100550CIP1) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " The U.S. Patent Application Serial Number of (attorney END6864USCIP2/100550CIP2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " (attorneys END6843USCIP2/100528CIP2 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " (attorneys Reel number END6843USCIP3/100528CIP3) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END6843USCIP4/100528CIP4) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT " (attorney END6843USCIP5/100528CIP5) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION " (attorney END6843USCIP6/100528CIP6) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD " (attorney END6843USCIP7/100528CIP7) U.S. Patent application Sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD " (attorney END6843USCIP8/100528CIP8) U.S. Patent application Sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " (attorney END6843USCIP9/100528CIP9) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " (attorney END6843USCIP10/100528CP10) U.S. Patent application sequence Row number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATORS " (attorney END6843USCIP11/ U.S. Patent Application Serial Number 100528CP11) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " LAYERED TISSUE THICKNESS COMPENSATOR " (attorneys END6843USCIP12/100528CP12 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " The U.S. Patent Application Serial Number of (attorney END6843USCIP13/100528CP13) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " (attorney END7100USNP/110601) U.S. is special Sharp patent application serial numbers _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS " (attorney END7101USNP/110602) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END7107USNP/110603) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS " (attorney END7102USNP/110604) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " (agencies People file number END7104USNP/110606) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES " (attorney END7105USNP/110607) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _； With

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " (attorneys END7106USNP/110608 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Some exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are shown in the drawings.Those of ordinary skill in the art It should be understood that the apparatus and method for specifically describing and being illustrated by drawings in text are unrestricted exemplary embodiment.With reference to one The structure that exemplary embodiment shows or described can be combined with the structure of other embodiments.This modification and variations It is included within the scope of the invention.

It is disclosed herein or claimed be used to manufacturing, formed or in other words preparing product or product Any one in method can be used for manufacturing, formed or in other words preparing whole or the portion in considered product or product Point, and be used to manufacture, in the case of the part that is formed or in other words prepare considered product or product in such method, The remainder of product or product can be in any way (including the use of disclosed herein or claimed for making Make, formed or in other words prepare any one in other methods of product or product) prepare, and can will so prepare Various pieces be combined in any way.Similarly, disclosed herein or claimed any product or Product can individualism, or can exist with reference to any other product or product disclosed in this invention that are compatible with, or Person can exist as the integral part of any other product or product disclosed in this invention that are compatible with.Therefore, with reference to Special characteristic, structure or the characteristic that a kind of product, product or method show or described can completely or partially (without limitation) It is combined with feature, structure or the characteristic of one or more other compatible products, product or method.This modification and Variations are included within the scope of the invention.

Herein by reference to the open the particular embodiment of the present invention of certain figures or other means, or particular product, product Or in the case that method may include specific structure, characteristic or feature, reader should be understood, it means that these structures, characteristic, Or feature can be implemented in considered product, product or method in any suitable combination.Specifically, multiple optionally knots Such disclosure of structure, characteristic or feature should be understood to disclose whole combinations of these structures, characteristic or feature, exception Situation is to be published as the structure, characteristic or feature of mutual alternative form.It is disclosed in this class formation, characteristic or feature In the case of mutual alternative form, this should be understood open these alternative forms as mutual alternative.

Terms used herein " nearside " and " distal side " be relative to the clinician of the handle portions of manipulation of surgical apparatus and Speech.Term " nearside " refers to that near the part of clinician term " distal side " refers to the part away from clinician.Should also Work as understanding, for the sake of succinct and be clear, such as " vertical ", " level ", "up" and "down" etc can be used with reference to accompanying drawing herein Spatial terminology.However, surgical instruments uses in many directions and position, and these terms and it is nonrestrictive and/or Absolute.

Various exemplary means and method are provided to perform laparoscopic type and minimally invasive surgical procedures.However, reader Will readily appreciate that, various method and apparatus disclosed herein can be used for a variety of surgical operations and application (including with it is open outer Section's operation combines) in.With continued reference to present embodiment, reader will be further understood that, various apparatuses disclosed herein can In any way in insertion body, for example, by natural cavity, pass through the otch being formed in tissue or puncturing hole etc..The work of apparatus Patient's body can be inserted directly into or can be inserted by the device that enters with service aisle by making part or end effector portion, outside The end effector and slender axles of section's apparatus can be promoted by the service aisle.

Accompanying drawing is gone to, wherein in multiple views, similar numeral represents similar component, and Fig. 1, which is shown, to be put into practice The surgical instruments 10 of some unique benefits.Surgery suturing appliance 10 is designed to manipulate and/or activated and is operationally attached Arrive the end effector 12 of various forms and size thereon.In Fig. 1-Fig. 1 E, such as end effector 12 includes elongated lead to Road 14, the elongated passageway form the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 simultaneously And support the anvil block 20 of the upper jaw 15 as end effector 12 with can also moving.

Elongated passageway 14 can be made up of such as 300＆400 series, 17-4＆17-7 stainless steels, titanium etc., and can be with being spaced apart Side wall 16 formed together.Anvil block 20 can be made up of such as 300＆400 series, 17-4＆17-7 stainless steels, titanium etc., and can have There is nail shaped lower face (being generally designated as 22), the nail shaped lower face has multiple nail shapes pits formed therein 23.Referring to Figure 1B-Fig. 1 E.In addition, anvil block 20 have from its to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 from each side extending projections of slide assemblies 24, to receive the respective slots or opening 18 in the side wall 16 of elongated passageway 14 It is interior, so as to be advantageous to by anvil block pin it is movable or be pivotably attached to the respective slots or opening on.

Various forms of implanted nail bins can be used together with surgical instruments disclosed herein.It will discuss in more detail below State specific nail bin configuration and construction.However, in figure ia, show implanted nail bin 30.Nail bin 30 has main part 31, The main part is by compressible hemostasis agent material (such as oxidized regenerated cellulose (" ORC ") or bioabsorbable foam) structure Into wherein being supported by the unfashioned peg 32 of multirow.It is impacted and the agent material that prevents from stopping blooding is introducing and fixed for anti-non-magnetic shim It is activated during the process of position, whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markSell Six cyclic ketones films or polyglycerol sebacate (PGS) film or oneself (is gathered by PGA (polyglycolic acid, with trade mark Vicryl sell), PCL Lactone), PLA or PLLA (PLA), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, go out with trade mark Monocryl Sell) or PGA, PCL, PLA, PDS compound formed other biodegradable films, the film only rupture when can just ooze Thoroughly.The main body 31 of nail bin 30 is sized to removedly be supported in elongated passageway 14 as depicted so that works as anvil Seat 20, which is driven to, to be formed with nail bin 30 when contacting, and 32 nail shapes pits 23 corresponding with anvil block of each nail therein are right Together.

In use, once end effector 12 positions adjacent to target tissue, end effector 12 is just manipulated to target Tissue capture is clamped between the top surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 is in the following way Shaping：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated passageway 14, so that nail profiled surface 22 and more specifically Nail shapes pit 23 therein is set substantially simultaneously to contact the top surface 36 of nail bin 30.When anvil block 20 continues to move to nail bin 30 When middle, follow closely 32 leg 34 contacted in anvil block 20 corresponding to nail shapes pit 23, the nail shapes pit be used for bend nail leg 34 So that nail 32 is configured to " B shapes ".The further motion of anvil block 20 towards elongated passageway 14 will compress further nail 32 and make its shaping For desired final forming height " FF ".

Above-mentioned nail forming process is substantially illustrated in Figure 1B-Fig. 1 E.For example, Figure 1B shows end effector 12, wherein target Tissue " T " is located between anvil block 20 and the top surface 36 of implanted nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, Wherein anvil block 20 is closed up to target tissue " T ", and target tissue " T " is clamped in the top surface 36 of anvil block 20 and nail bin 30 Between.Fig. 1 D show initial nail shaping, and wherein anvil block 20 has started to compress nail bin 30 so that the leg 34 for following closely 32 begins through anvil block Nail shapes pit 23 in 20 and shape.Fig. 1 E are shown through target tissue " T " and the nail 32 in final molding condition, are clear For the sake of removed anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position Put, to enable warehouse 31 and nail 32 remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws During 13,15 common clamping, end effector 12 makes all nails while shaped.Remaining " by conquassation " material of main part 31 is used as only Blood agent (ORC) and staple line reinforcing agent (other film compositions 38 of PGA, PDS or any of above).Further, since nail 32 is in the shaping phase Between need not leave warehouse 31, therefore follow closely 32 possibilities for being changed into deformity during shaping and be minimized.As used herein, term " implanted " refers in addition to nail, and the warehouse material of support nail also would be held in patient's body and finally can be inhaled by patient body Receive.Such implanted nail bin is different from previous nail bin structure, and the previous nail bin construction is still complete afterwards by percussion at it Site preparation is positioned in end effector.

In various specific implementations, end effector 12 can be connected to the Slender axles assembly from the projection of shank assembly 100 40.End effector 12 (in closure) and Slender axles assembly 40 can have similar shape of cross section, and its size is set It is fixed into passing through trocar tube or service aisle with another access instruments formal operations.As used herein, term is " operationally Through " refer to that passage can be inserted or may pass through at least a portion of end effector and Slender axles assembly by passage or tube opening Or tube opening, and it can be manipulated to complete surgery stitching operation if necessary in passage or tube opening.When in closure During position, the jaw 13 and 15 of end effector 12 can provide the shape of cross section of substantial circular in favor of it for end effector Through path/opening of circle.It is contemplated, however, that the end effector and Slender axles assembly of the present invention are provided with other cross sections Shape, entering path and opening with non-circular transverse cross-section are passed through so as to other modes.Therefore, the end of closure The overall dimension of the cross section of actuator by end effector intend through passage or opening size it is related.Therefore, one Individual end effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it can be operationally at least big through diameter About 5mm opening.

Slender axles assembly 40 can have the external diameter of substantially equal with the external diameter of end effector 12 in the close position.Example Such as, 5mm end effectors can be connected to the Slender axles assembly 40 with 5mm cross-sectional diameters.It is however, specific real with continued reference to this Apply mode, it will be apparent that, the present invention can be effectively combined various sizes of end effector and use.For example, 10mm ends Portion's actuator could attach to the slender axles with 5mm cross-sectional diameters.On the contrary, opened for wherein providing 10mm or bigger entrance For the application of mouth or passage, Slender axles assembly 40 can have 10mm (or bigger) cross-sectional diameter, but can also activate 5mm Or 10mm end effectors.Therefore, the external diameter of outer shaft 40 can be with the external diameter phase for the end effector 12 for being attached to closure thereon It is same or different.

As illustrated, Slender axles assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal direction Axis A-A.For example, Slender axles assembly 40 can be about 9-16 inches (229-406mm) length.However, Slender axles assembly 40 is settable For other length, or there can be joint wherein or can otherwise be advantageous to end effector 12 relative to axle or handle The other parts of parts carry out joint motions, and following article will be discussed in more detail.Slender axles assembly 40 includes ridge component 50, should Ridge component extends to end effector 12 from shank assembly 100.The proximal extremity of the elongated passageway 14 of end effector 12 has Lug 17 is kept from a pair of its projection, this is sized to receive in the distal end of ridge component 50 to holding lug In the corresponding lug opening or support 52 that are provided, so that end effector 12 can removedly couple Slender axles assembly 40.Ridge component 50 can be by being made such as 6061 or 7075 aluminium, stainless steel, titanium.

Shank assembly 100 includes pistol grasping type shell, and the pistol grasping type shell can be made into for assembling purpose Two or more parts.For example, shank assembly 100 as depicted is included by polymer or plastic material molding or with other Mode is manufactured and is designed to right hand housing member 102 and the left hand housing member (not shown) being combined together.It can pass through The snap in features structure, bolt and the pod that mold or otherwise formed wherein, and/or will by adhesive, screw etc. Such housing member is attached together.Ridge component 50 has proximal extremity 54, formed with flange 56 in the proximal extremity.Flange 56 can be pivotally supported in groove 106, and the groove is by from each cooperation to inner process in housing member 102,104 Rib 108 is formed.Such construct is advantageous to ridge component 50 and is attached to shank assembly 100, while enables ridge component 50 relative to handle Parts 100 rotate along 360 ° of paths around longitudinal axis A-A.

As in Fig. 1 it can further be shown that ridge component 50 is through axle bush 60 and is supported by axle bush 60, the installation Axle bush 60 is pivotally attached to shank assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, and it limits rotation Turn groove 65, the leading edge portion 101 of shank assembly 100 can be rotatably received in therebetween by the rotated trench.This construction Axle bush 60 are enable to be rotated relative to shank assembly 100 around longitudinal axis A-A.Ridge component 50 can not be revolved by ridge pin 66 Turn ground pin joint to axle bush 60.In addition, knob 70 is attached to axle bush 60.For example, knob 70 has hollow mounting flange Portion 72, the hollow mounting flange portion are sized to receive a part for axle bush 60 wherein.Knob 70 can be by Such as glass or carbon filled nylon, makrolon,Etc. being made, and axle bush 60 are attached to also by ridge pin 66. In addition, the holding flange 74 to inner process is formed in mounting flange portion 72 and can extend to and is formed in axle bush 60 In radial groove 68.Therefore, surgeon can be by firmly grasping knob 70 and it is rotated relative to shank assembly 100, and makes ridge Component 50 (and be attached to end effector 12) thereon rotates around longitudinal axis A-A along 360 ° of paths.

Anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as 109 trigger system, anvil block 20 can optionally move to various closures or clamped position and firing position from open position. Trigger system 109 includes " firing member " 110, and it includes hollow firing tube 110.Hollow firing tube 110 can be in ridge component 50 It is axially movable, therefore forms the outside of Slender axles assembly 40.Firing tube 110 can be by polymer or other suitable material systems Into, and with the proximal extremity for the percussion yoke 114 for being attached to trigger system 109.For example, percussion yoke 114 is moldable to arrive firing tube 110 proximal extremity.However, it can also use other securing members constructions.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, the support lining ring energy It is enough to be axially moved in shank assembly 100.Support lining ring 120 has a pair of fins extended laterally, and the size to fin is set It is fixed into being slidably received in the fin slit being formed in left hand housing member and right hand housing member.Therefore, support lining Circle 120 can slide axially in shank shell 100, while enable percussion yoke 114 and firing tube 110 relative to support lining ring 120 rotate around longitudinal axis A-A.According to the present invention, firing tube 110 is provided with longitudinal slit, so that ridge pin 66 can Pass through and extend in ridge component 50, while be advantageous to firing tube 110 and axially advanced in ridge component 50.

Trigger system 109 also includes firing trigger 130, and the firing trigger is used to control firing tube 110 in ridge component Axial direction traveling on 50.Referring to Fig. 1.The such axial direction for firing and interacting with anvil block 20 is formed along the distal direction of firing tube 110 Motion is referred to herein as " firing action ".As can be seen in Figure 1, firing trigger 130 by pivot pin 132 movingly Or it is pivotally coupled to shank assembly 100.Firing trigger 130 is biased away from shank assembly using torsionspring 135 100 pistol grip portion 107 and reach " opening " or original position not activated.As can be seen in Figure 1, firing trigger 130 have top 134, and the top is movingly attached (pin joint) and arrives percussion chain link 136, and the percussion chain link is movingly attached (pin joint) arrives support lining ring 120.Therefore, firing trigger 130 is from original position (Fig. 1) towards the pistol of neighbouring shank assembly 100 The motion of the final position of formula grip portion 107 will cause percussion yoke 114 and firing tube 110 to be moved along distal direction " DD ".Hit The motion (under bias force of torsionspring 135) for sending out pistol grip portion 107 of the trigger 130 away from shank assembly 100 will Percussion yoke 114 and firing tube 110 is caused to be moved in ridge component 50 along proximal direction " PD ".

The present invention can be used together from different sizes with the implanted nail bin of configuration.For example, it is connected when combining the first percussion Son 140 is in use, surgical instruments 10 can be held with the 5mm ends for the about 20mm length (or with other length) for supporting implanted nail bin 30 Row device 12 is used together.This end effector size can be particularly well-suited in for example realizing dissection and the blood vessel of opposite fine Processing.However, following article institute is described in more detail, such as can also be held in the mouth by the way that the first percussion adapter 140 is replaced by into the second percussion Connect son and surgical instruments 10 is used in combination with the end effector and nail bin of other sizes.As other alternative form, carefully Long axis component 40 can be attached to the end effector of only a kind of form or size.

A kind of method that end effector 12 is removably coupled to ridge component 50 will be explained now.By that elongated will lead to Start connection process in the lug support 52 in holding lug 17 insertion ridge component 50 on road 14.Then, surgeon will Firing trigger 130 promotes towards the pistol grip 107 of casing assembly 100, by the percussion adapter of firing tube 110 and first 140 are advanced distally on the proximal end portions 47 of elongated passageway 14, so as to which lug 17 is maintained at into its respective support In 52.This position of first percussion adapter 140 on lug 17 is referred to herein as " coupled position ".The present invention can also have There is end effector locked component for firing trigger 130 being locked after being attached to ridge component 50 in end effector 12 It is scheduled on appropriate location.

More particularly, one embodiment of end effector locked component 160 includes retaining pin 162, the retaining pin quilt It is movably supported in the top 134 of firing trigger 130.As described above, firing tube 110 must be distad pushed into first To coupled position, wherein the holding lug 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140 In lug support 52.Surgeon is held in the mouth by pulling firing trigger 130 from original position towards pistol grip 107 and will fire Connect son 140 and be advanced distally into coupled position.When firing trigger 130 is activated first, the distal motion of retaining pin 162, Until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162, which is biased to, is formed at shell In latch well 164 in body component.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and provide the tactile that end effector 12 has been " locked " in ridge component 50 for surgeon Instruction.As long as in addition, retaining pin 162 intentionally is not biased out into latch well 164, surgeon just will not continue unintentionally to activate Firing trigger 130 is to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection The firing trigger 130 of position, then retaining pin 162 firing trigger 130 can be made to be maintained at the position, to prevent firing trigger 130 are back to original position and therefore discharge end effector 12 from ridge component 50.

The present invention may also include trigger system locking press button 137, and the trigger system locking press button is with can be pivotably It is attached to shank assembly 100.In one form, trigger system locking press button 137 has the door bolt formed in its distal end Lock 138, the breech lock are oriented to engage percussion yoke 114 when firing release button and being in the first position latching.As in Fig. 1 may be used Find out, late spring 139 is used to trigger system locking press button 137 being biased to the first position latching.In all cases, breech lock 138 are used to engage percussion yoke 114 at following point：At this point, the position correspondence of the percussion yoke 114 in ridge component 50 is in wherein First percussion adapter 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that with first Axially to promoting in clamping slideway 28, anvil block 20 will move percussion adapter 140 along path so that nail forming surface portion 22 It is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by depressing trigger system locking press button 137 first Begin nail forming process so that percussion yoke 114 can in ridge component 50 further distal motion and most anvil block 20 compresses at last Into nail bin 30.After trigger system locking press button 137 is depressed, surgeon, which continues to activate towards pistol grip 107, to be fired Trigger 130, so as to which the driving of the first nail lining ring 140 is shaped on slideway 29 to corresponding nail, to force anvil block 20 and nail bin The shaping contact of nail 32 in 30.Trigger system locking press button 137 prevents from being not intended to before surgeon is ready to start the process Ground shapes nail 32.In this embodiment, surgeon must depress before firing trigger 130 can be further actuated and hit System lock button 137 is sent out to start to follow closely forming process.

Surgical instruments 10 optionally can be used only as tissue apposition device.However, the present invention may also comprise tissue cutting system System, the tissue diced system are substantially marked as 170.In at least one form, tissue diced system 170 includes cutter component 172, can be by activating cutter traveling trigger 200 by the cutter component optionally from the nearside end of adjacent side terminal part actuator 12 The unactuated position at end is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50, and is attached to knife bar 180 or otherwise from the projection of knife bar 180.Cutter component 172 can be by for example with hard more than 38HRC (RHC) 420 or 440 stainless steels of degree are made, and can have and be formed at tissue cutting edge 176 in its distal end 174, and can The slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are slidably extended through, end is clamped in cut through and holds Tissue in row device 12.Knife bar 180 extends through ridge component 50 and with the proximal extremity with Cutter conveyer transmission handing-over Part, the Cutter conveyer are operably attached to cutter traveling trigger 200.Cutter traveling trigger 200 is attached to pivot pin 132 so that it can be pivoted in the case where that need not activate firing trigger 130 or otherwise activated.According to this Invention, first cutter tooth wheel 192 are also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes first cutter tooth wheel 192 pivot.Percussion return spring 202 is attached between first cutter tooth wheel 192 and shank housing 100, by cutter traveling trigger 200 are biased to original position or unactuated position.

Cutter conveyer also includes the second cutter tooth wheel 194, and second cutter tooth wheel is pivotally supported on second gear axle And engaged with first cutter tooth wheel 192.Second cutter tooth wheel 194 engages with the 3rd gear shaft 196 being supported on the 3rd gear shaft.The Four cutter tooth wheels 198 are also supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 can be driven the nearside for being bonded on knife bar 180 A series of gear teeths or ring on end.Therefore, this construction enable 4th cutter tooth wheel 198 along distal direction " DD " or Proximal direction " PD " axially trigger shaft 180, while make trigger shaft 180 surround longitudinal axis relative to 4th cutter tooth wheel 198 A-A rotates.Therefore, surgeon can by towards shank assembly 100 pistol grip 107 pull cutter traveling trigger 200 and Make trigger shaft 180 axially promote and most all morning distal side promote cutter component 172.

Present invention additionally comprises cutter locking system 210, the cutter locking system prevents the propulsion of cutter component 172, unless percussion is touched Hair device 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of knife propulsion system 170, unless nail is Fired or formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 are locked including knife Fixed pole 211, the cutter securing rod is can pivotably be supported in the pistol grip portion 107 of shank assembly 100.Knife locks Bar 211 has activated end 212, and when firing trigger 130 is in complete firing position, activated end 212 can be triggered by percussion Device 130 engages.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, the holding suspension hook can be with suspension hook side Latch bar 216 on formula engagement the first cutting gear 192.Cutter securing rod 211 is biased to by " lock using Lock spring 218 It is fixed " position, wherein keep suspension hook 214 to keep engaging with latch bar 216, so as to prevent the actuating of cutter traveling trigger 200, unless Firing trigger 130 is in complete firing position.

After nail is " fired " (shaping) into target tissue, surgeon can depress percussion trigger release button 167, So that firing trigger 130 can be back to original position under the biasing of torsionspring 135, so that anvil block 20 can be in bullet The biasing of spring 21 biases downwards into open position.When in open position, surgeon can withdraw from end effector 12 and leave Implanted nail bin 30 and nail 32.In the application for passing through passage, service aisle etc. in wherein end effector and being inserted into, surgery doctor Life will make anvil block 20 be back to closing position by activating firing trigger 130, so that end effector 12 can be by logical Road or service aisle are withdrawn by.However, if surgeon wants to cut target tissue after percussion nail, more than surgeon The mode of stating activates cutter traveling trigger 200, reaches the end of end effector through target tissue with trigger shaft 172.Then, outside The releasable cutter traveling trigger 200 of section doctor, so that percussion return spring 202 can make percussion conveyer return knife bar 172 It is back to starting and (does not activate) position.Once knife bar 172 is back to original position, surgeon can open end effector jaw 13rd, 15, implanted storehouse 30 is released to patient's body and then withdraws from end effector 12 from patient's body.Therefore, it is such Surgical instruments be advantageous to using can be by relatively small service aisle and passage to be inserted into small implanted nail bin, simultaneously Following selection is provided for surgeon：Also cut after percussion nail in the case of not cutting tissue or if necessary in percussion nail Tissue.

The various unique and new embodiments of the present invention use compressible nail bin, and the compressible nail bin support is in Substantially fixed position is for by the nail of anvil block shaping contact.During anvil block driving is followed closely to unshaped, wherein for example being reached Nail shaping degree depend on anvil block be driven to follow closely in how far.Such construct allows a surgeon to regulation and applied to nail Shaping or percussion pressure amount, so as to change the final forming height of nail.In other embodiments of the invention, surgical stapling Construction can use nail driving element, and the nail driving element can lift nail towards anvil block.Hereafter these embodiments have been carried out more Detailed description.

Optionally, the amount with reference to the firing action for above, being applied to removable anvil block depends on the actuating of firing trigger Degree.If for example, surgeon go for only part shaping nail, only need towards pistol grip 107 partly to Interior pressure firing trigger.More nail shapings are obtained, surgeon only needs further to compress firing trigger so that anvil block Contacted by further driving with being formed with nail.As used herein, term " shaping contact " refer to follow closely profiled surface or nail into Shape pit has contacted the end of nail leg and has had started to that leg is shaped or bent to shaping position.The degree of nail shaping refers to nail leg quilt The degree of folding and the forming height for finally referring to nail referred to above.Those skilled in the art will further manage Solution, because when applying firing action to anvil block 20, anvil block 20 is moved with the relation substantially parallel with nail bin, so Nail substantially simultaneously shapes and has substantially the same forming height.

Fig. 2 and Fig. 3 shows alternative end effector 12 ", except the following difference that can accommodate knife bar 172 ' Outside, end effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or prominent from knife bar 180 Rise, and in addition operated in a manner of above in connection with described in knife bar 172.However, in this embodiment, knife bar 172 ' long enoughs do not use single distal blade to traverse the whole length of end effector 12 " in end effector 12 " Component.Formed with upper cross member 173 ' and lower cross member 175 ' on knife bar 172 '.Upper cross member 173 ' is oriented to slide The respective elongated slit 250 in anvil block 20 " is traversed dynamicly, and lower cross member 175 ' is oriented to traverse end effector Elongated slot 252 in 12 " elongated passageway 14 ".Depart from slit (not shown) to be also disposed in anvil block 20 " so that work as knife bar 172 ' when being driven to the final position in end effector 12 ", upper cross member 173 ' be dropped through corresponding to slit with Anvil block 20 " is allowed to move to open position to depart from the tissue of suture and cutting.Anvil block 20 " can in addition with above-mentioned anvil block 20 It is identical, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " is biased to fully open position by spring or other open configuration (not shown) (Fig. 2).Advance and in open position and clamping completely the axial direction that anvil block 20 " is carried out in the above described manner by percussion adapter 150 Moved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon can be then with above-mentioned Mode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device, Percussion adapter can proximally be moved, to allow anvil block 20 " to be moved away from elongated passageway 14 ", as shown in phantom in figure 4. In this embodiment, as knife bar 172 " moves towards distal side, upper cross member 173 ' and lower cross member 175 ' pull anvil together Seat 20 " and elongated passageway 14 ", to realize that desired nail shapes when knife bar 172 " promotes through end effector 12 " towards distal side. Referring to Fig. 5.Therefore, in this embodiment, nail shaping is and tissue cutting while occurred, but nail in itself can be in knife bar 172 " towards remote Side sequentially shapes when driving.

The various surgery nail bins of the present invention and unique and new structure of surgical instruments enable the nail in the nail bin It is arranged in one or more line linearly or nonlinearly.A plurality of this staple line can be provided with each side of elongated slot, it is described thin Long slit is centrally arranged in nail bin, for receiving the tissue cutting element passed through.In one kind constructs, such as into The nail of one line can be substantially parallel to the nail in the adjacent lines of nail but deviate with it.As other alternative form, one Or a plurality of staple line can be essentially nonlinear.That is, the base portion of at least one nail in staple line can along substantially with together The axis that the base portion of other nails in one staple line is crosscutting extends.For example, staple line of the elongated slot per side can have sawtooth appearance.

According to the present invention, nail bin may include warehouse and the multiple nails being stored in warehouse.In use, nail bin can be introduced In operative site and it is located at the side of handled tissue.In addition, can be by nail shaping anvil positioning in the relative of tissue On side.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw can Moved towards another jaw.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from staple cartridge body so that nail can pierce Wear tissue and contact stud shaping anvil block.Once disposing nail from staple cartridge body, then and then staple cartridge body can be removed from operative site.Nail bin Or implantable at least a portion of nail bin there is nail.For example, following article is more fully described, nail bin may include warehouse, work as anvil When seat moves to closing position from open position, the warehouse can be compressed by anvil block, crushes and/or collapse.When warehouse compressed, is pressed When bursting and/or collapsing, the nail being positioned in warehouse can be deformed by anvil block.Alternatively, the pincers of nail bin are supported Mouth can move to closing position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nail It is deformable.In some cases, nail can not project from nail bin, and in other cases, nail can in company with warehouse a part together Projected from nail bin.

Referring now to Fig. 6 A- Fig. 6 D, compressible nail bin (such as nail bin 1000) for example may include compressible, implanted warehouse 1010, and the multiple nails 1020 being also located in compressible warehouse 1010, but Fig. 6 A- Fig. 6 D only show a nail 1020. Fig. 6 A show the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, and wherein nail bin 1000 is shown in uncompressed Condition.In this uncompressed condition, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 can be from opening Position moves to contact tissue T, as shown in Figure 6B, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 can be by group Knit the tissue contacting surface 1019 that T is located against staple cartridge body 1010, but referring again to Fig. 6 B, staple cartridge body 1010 now can be through By few (if any) compression stress or pressure, and follow closely 1020 and be positively retained at unshaped or do not fire condition.Such as Fig. 6 A Shown in Fig. 6 B, staple cartridge body 1010 may include one or more layers, and follows closely 1020 nail leg 1021 to may pass through these layers upward Extension.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer of 1014, the wherein second layer 1012 can be positioned among first layer 1011 and third layer 1013, and wherein third layer 1013 can be positioned on the second layer 1012 and the 4th Among layer 1014.For example, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and nail leg 1021 It can upwardly extend from base portion 1022 and through the 4th layer 1014, third layer 1013 and the second layer 1012.Optionally, it is each variable Shape leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is in uncompressed condition, this is sharp Top can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or through first layer 1011, wherein working as nail When storehouse 1000 is in uncompressed condition, top 1023 not projecting can pass through tissue contacting surface 1019.When nail bin is in uncompressed During condition, sharp top 1023 can be positioned in third layer 1013 and/or any other suitable layer.Alternatively select To select, the warehouse of nail bin can have any suitable number of layers, such as less than four layers or more than four layers.

Optionally, following article is more fully described, and first layer 1011 can be by buttress material and/or plastic material (example Such as, polydioxanone (PDS) and/or polyglycolic acid (PGA)) form, and the second layer 1012 can be by bioabsorbable Foamed material and/or compressible hemostasis agent material (for example, oxidized regenerated cellulose (ORC)) are formed.Optionally, first layer 1011st, nail 1020 can be maintained at staple cartridge body by the second layer 1012, third layer 1013 and the 4th layer one or more of 1014 In 1010, and nail 1020 can be made to keep being mutually aligned in addition.Third layer 1013 can be by buttress material or quite incompressible Or non-elastic material form, the material can by follow closely 1020 nail leg 1021 be held in place by relative to each other.In addition, The second layer 1012 being positioned on the opposite side of third layer 1013 and the 4th layer of 1014 motion that can stablize or reduce nail 1020, i.e., Make the second layer 1012 and the 4th layer 1014 can be made up of compressible foam or elastomeric material.The screw top end 1023 of nail leg 1021 can It is at least partially embedded in first layer 1011.For example, first layer 1011 and third layer 1013 can collaboratively and firmly Nail leg 1021 is held in place by.First layer 1011 and third layer 1013 can be (all by such as bioabsorbable material respectively It is the polyglycolic acid (PGA) such as sold with trade name Vicryl, PLA (PLA or PLLA), polydioxanone (PDS), poly- Hydroxy alkane acid ester (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) thin slice form, and the second layer 1012 and the 4th layer 1014 can It is made up of respectively at least one hemostasis agent material or styptic.

Although first layer 1011 can be compressible, but the second layer 1012 can more be pressed substantially than first layer 1011 Contracting.For example, the compressibility of the second layer 1012 can be first layer 1011 approximately twice as, 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 the big of first layer 1011 About twice, about three times, about four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can be First layer 1011 approximately twice as between about ten times.The second layer 1012 may include to be defined in multiple air gaps therein, wherein The amount and/or size of air gap in the second layer 1012 can be controlled to provide the expectation compressibility of the second layer 1012.With it is above Similar, although third layer 1013 can be compressible, but the 4th layer 1014 substantially be able to can more press than third layer 1013 Contracting.For example, the 4th layer 1014 of compressibility can be third layer 1013 approximately twice as, about three times, about four times, about Five times, and/or about ten times.In other words, for given power, the 4th layer 1014 of compression degree can be third layer 1013 Approximately twice as, about three times, about four times, about five times, and/or about ten times.4th layer 1014 of compressibility can be Three layer 1013 approximately twice as between about ten times.It may include for 4th layer 1014 to be defined in multiple air gaps therein, wherein the The amount and/or size of air gap in four layer 1014 can be controlled to provide the 4th layer 1014 of expectation compressibility.Various In the case of, can come express warehouse or warehouse layer by compression ratio (that is, layer is for giving the distance compressed of power of size) Compressibility.For example, compared with the layer compared with little compressible, there is the layer of high compression rate for applying to the given size of this layer Compression stress will compress bigger distance.For so, the second layer 1012 has higher compression ratio than first layer 1011；Phase As, the 4th layer 1014 has higher compression ratio than third layer 1013.The second layer 1012 and the 4th layer 1014 can be by identical Material form and can have an identical compression ratio.The second layer 1012 and the 4th layer 1014 can be by the materials with different compression ratios Material is formed.Similarly, first layer 1011 and third layer 1013 can be made up of identical material and can have identical compression ratio. First layer 1011 and third layer 1013 can be made up of the material with different compression ratios.

When anvil block 1040 is advanced towards its closing position, anvil block 1040 can contact tissue T and tissue T and nail bin 1000 applied Compressive forces, as shown in Figure 6 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030 Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, and it can be in nail bin 1000 support nail bin 1000 when being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to The pressure applied of anvil block 1040, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More particularly, warehouse The moving downward of 1010 compression and tissue contacting surface 1019 can make the top 1023 of nail leg 1021 pierce through the of warehouse 1010 In forming pit 1042 in one layer 1011, puncture tissue T and entrance anvil block 1040.When warehouse 1010 enters one by anvil block 1040 During step compression, the accessible wall for limiting forming pit 1042 in top 1023, and for example therefore leg 1021 can be deformed inward or roll up Song, as shown in Figure 6 C.When nail leg 1021 is deformed, equally as shown in Figure 6 C, the base portion 1022 for following closely 1020 can contact nail bin branch Support member 1030 is supported by nail bin supporting member 1030.Optionally, as described in greater detail below, nail bin supporting member 1030 may include Multiple supporting constructions, such as nail support trenches, slit or groove 1032, such as the multiple supporting construction can be become in nail 1020 During shape support nail 1020 or at least nail 1020 base portion 1022.Equally as shown in Figure 6 C, apply to the compression stress of staple cartridge body 1010 The cavity 1015 in the 4th layer 1014 can be made to collapse.In addition to cavity 1015, staple cartridge body 1010 may also include one or more skies Gap (such as space 1016), such as may include in one or more of spaces or do not include one of nail being positioned in Point, one or more of spaces can allow for warehouse 1010 to collapse.Cavity 1015 and/or space 1016 can collapse so that The wall for limiting cavity and/or wall deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 is positioned at cavity And/or the layer below space.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer of 1014 compression applied by anvil block 1040 Pressure is substantially compressed.It may also be noted that first layer 1011 and third layer 1013 are also compressed.When anvil block 1040 moves to its closure During position, anvil block 1040 can continue further compression by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Warehouse 1010.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into it to be fully formed shape, such as scheme Shown in 6D.Referring to Fig. 6 D, the leg 1021 of each nail 1020 can deform downwards towards the base portion 1022 of each nail 1020, so as to by tissue T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least a portion are captured in deformable leg 1021 Between base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 are further by anvil block 1040 compression pressures applied are significantly compression.In relatively Fig. 6 C and Fig. 6 D it may also be noted that first layer 1011 and third layer 1013 are also further compressed.Nail 1020 by completely or at least fully shape after, anvil block 1040 can away from tissue T and by Lift, and nail bin supporting member 1030 can it is remote and/or depart from nail bin 1000 move.As shown in Figure 6 D and due to described above, Warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be along staple line supporting tissue.At some In the case of, the styptic and/or any other suitable medicine that are included in the warehouse 1010 of implantation can elapse over time To handle tissue.Styptic as described above can reduce the tissue bleeding of suture and/or cutting, while bonding agent or tissue adhesion Agent can over time elapse and provide intensity for tissue.The warehouse 1010 being implanted into can be by such as ORC (oxidized regenerated cellulose), thin Extracellular protein (such as collagen), the polyglycolic acid (PGA) sold with trade name Vicryl, PLA (PLA or PLLA), poly- dioxy Heterocycle hexanone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), gather oneself The material of lactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound is formed.In some cases, storehouse Body 1010 may include the antibiosis and/or anti-biotic material that can for example reduce the possibility of surgical site infection, such as collargol and/ Or triclosan.

The layer of warehouse 1010 can be connected with each other.For example, using at least one adhesive (such as fibrin and/or Protein hydrogel) second layer 1012 is adhered to first layer 1011, third layer 1013 is adhered to the second layer 1012, and by It is adhered to third layer 1013 for four layer 1014.Although being not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structure Together.For example, first layer 1011 and the second layer 1012 can each include corresponding interlocking features structure, such as tenon groove structure And/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can each include corresponding interlocking features structure, Third layer 1013 and the 4th layer 1014 can each include corresponding interlocking features structure simultaneously.Although being not shown, nail bin 1000 may include for example one or more rivets, and one or more rivets can extend across the one or more of warehouse 1010 Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 and Second head of positioning, the 4th layer of second end that can be assembled into rivet or is formed by the second end of rivet.For example, by In the compressible character of warehouse 1010, rivet compressible warehouse 1010 so that the head of rivet can be relative to the group of warehouse 1010 Knit contact surface 1019 and/or lower surface 1018 is recessed.For example, rivet can be by bioabsorbable material (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.In addition to nail 1020 accommodated in by warehouse 1010, warehouse 1010 Layer can not be connected to each other.For example, being frictionally engaged between nail leg 1021 and warehouse 1010 can for example protect the layer of warehouse 1010 Hold together, and once nail shaping, then the layer, which can be trapped in, follows closely in 1020.At least a portion of nail leg 1021 may include The roughened surface or rough coatings of the frictional force between nail 1020 and warehouse 1010 can be increased.

As described above, surgical instruments may include the first jaw and the second jaw, the first jaw includes nail bin supporting member 1030, Second jaw includes anvil block 1040.Optionally, described in greater detail below, nail bin 1000 may include that one or more holdings are special Structure is levied, one or more holding feature structure can engage nail bin supporting member 1030 and therefore that nail bin 1000 is releasable Ground remains to nail bin supporting member 1030.For example, at least one adhesive (such as, fibrin and/or albumen water-setting can be passed through Glue) nail bin 1000 adhered into nail bin supporting member 1030.In use, in the case of at least one, especially in laparoscopic type And/or in endoscopic procedure, the second jaw is moveable to the closing position relative with the first jaw, such as causes the first jaw It can be inserted into the second jaw by trochar in operative site.For example, trochar can limit about 5mm hole or intubation, the One jaw and the second jaw can be inserted into by it.Second jaw is moveable in an open position between closing position Partial closed position, the partial closed position can allow the first jaw and the second jaw to be inserted into through trochar, without making Nail 1020 accommodated in staple cartridge body 1010 deforms.For example, when the second jaw is in the centre position of its part closure, anvil block 1040 can not apply compression stress to staple cartridge body 1010, but when the second jaw is in the centre position of its part closure, anvil block 1040 compressible nail bin bodies 1010.Although the compressible nail bin body 1010 when anvil block 1040 is in this centre position, but anvil Seat 1040 can incompletely compress staple cartridge body 1010 so that the contact stud 1020 of anvil block 1040 and/or cause nail 1020 by anvil block 1040 deformations.Once the first jaw and the second jaw are inserted into operative site by trochar, then the second jaw can be by again Secondary opening, and anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.

Referring now to Fig. 7 A- Fig. 7 D, the end effector of surgical stapling device may include to be positioned at anvil block 1140 and nail bin branch Implanted nail bin 1100 among support member 1130.Similar to the above, anvil block 1140 may include tissue contacting surface 1141, nail bin 1100 may include tissue contacting surface 1119, and nail bin supporting member 1130 may include the support surface that can support nail bin 1100 1131.Referring to Fig. 7 A, tissue T is located against the tissue contacting surface 1119 of nail bin 1100 without making using anvil block 1140 Nail bin 1100 deforms, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and nail bin branch The distance 1101a of surface 1131 is supportted, and tissue contacting surface 1119 can be positioned so that with nail bin support surface 1131 apart Distance 1102a.Then, when anvil block 1140 moves towards nail bin supporting member 1130, referring now to Fig. 7 B, anvil block 1140 can push down on The top surface or the first layer 1111 and the second layer 1112 of tissue contacting surface 1119 and nail bin support member 1110 of dynamic nail bin 1100. As layer 1111 and layer 1112 are compressed, referring again to Fig. 7 B, the second layer 1112 can be by conquassation, and the leg 1121 of nail 1120 can Pierce through first layer 1111 and enter in tissue T.For example, nail 1120 can be positioned at least partially at the nail cavity in the second layer 1112 Or in space 1115, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer 1112 to surround Nail 1120 is collapsed.The second layer 1112 may include cover 1116, and the cover may extend away on nail cavity 1115 and surround or extremely Partially surround nail cavity 1115.Fig. 7 B show the covering part 1116 for being pressed downward and bursting in nail cavity 1115.The second layer 1112 It may include one or more weakening parts, it can be advantageous to collapsing for the second layer 1112.Optionally, such weakening part may include Such as the controllable cut collapsed, perforation and/or the thin cross section of warehouse 1110 can be advantageous to.First layer 1111 may include energy Enough be advantageous to one or more weakening parts that nail leg 1121 penetrates first layer 1111.Optionally, such weakening part may include Such as cut, perforation and/or the thin cross section that can be alignd with nail leg 1121 or at least substantially align.

Referring again to Fig. 7 A, when anvil block 1140 is in the non-firing position of part closure, anvil block 1140 can be positioned so that With the distance 1101a of storehouse stayed surface 1131 so that define gap therebetween.This gap can be by with nail bin height 1102a Nail bin 1100 and tissue T filling.When anvil block 1140 is moved downward to compress nail bin 1100, referring again to Fig. 7 B, tissue connects Touching the distance between surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b for being shorter than distance 1101a.In various feelings Under condition, the gap limited by distance 1101b between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can More than original undeformed nail bin height 1102a.Referring now to Fig. 7 C, when anvil block 1140 is moved to closer to storehouse stayed surface When 1131, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.Similarly, The distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be reduced to distance 1101c, and the distance can be greater than, equal to Or less than original not deformed storehouse height 1102a.Referring now to Fig. 7 D, anvil block 1140 is moveable to final firing position, its Middle nail 1120 is fully formed or is at least shaped to Desired Height.In this position, the tissue contacting surface 1141 of anvil block 1140 Can be with the distance 1101d of storehouse stayed surface 1131, wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Together As illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially be collapsed sample, and nail 1120 can completely or at least substantially be collapsed The second layer 1112 of contracting surrounds.In all cases, anvil block 1140 can be moved then away from nail bin 1100.Once for example, anvil block 1140 depart from from nail bin 1100, then warehouse 1110 for example, at least can partly spread over various positions (that is, adjacent nail again Position between 1120) in.The warehouse 1110 of conquassation may not extend resiliently again.The nail 1120 of shaping is determined with other Warehouse 1110 of the position between adjacent nail 1120 can apply pressure or compression stress to tissue T, and this can provide various treatment benefits.

As described above, referring again to Fig. 7 A, each nail 1120 may include the nail leg 1121 extended from.For example, although nail 1120 to be shown be to include two nail legs 1121, but can also be used may include a nail leg or alternatively include The various nails of more than two nail legs (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded in In the second layer 1112 of warehouse 1110 so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into warehouse 1110 Nail cavity 1115 in so that the top 1123 of nail leg 1121 is advanced into cavity 1115 base portion 1122.In the quilt of top 1123 Insert after cavity 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be sat Put enough depths in the second layer 1112 so that nail 1120 is not moved relative to the second layer 1112 or do not transported at least substantially It is dynamic.Nail 1120 can be rested upon enough depths into the second layer 1112 so that base portion 1122 is positioned or embedded nail cavity 1115 In.Alternatively, base portion 1122 can not be positioned or be embedded in the second layer 1112.Referring again to Fig. 7 A, base portion 1122 can extend below the lower surface 1118 of warehouse 1110.Base portion 1122 can be bearing in storehouse stayed surface 1130 or directly Positioned against storehouse stayed surface 1130.Storehouse stayed surface 1130 may include from its extension and/or is limited to supporting construction therein, For example, the base portion 1122 of nail 1120 can be positioned in such as one or more of nail bin supporting member 1130 support trenches, slit Or supported in groove 1132 or by one or more support trenches, slit or groove 1132, as described in more detail below.

Referring now to Fig. 8 and Fig. 9, nail bin (such as nail bin 1200) for example may include compressible implanted warehouse 1210, The warehouse includes outer layer 1211 and internal layer 1212.Similar to the above, nail bin 1200 may include to be positioned at multiple in warehouse 1210 Nail 1220.Optionally, each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 from its extension.Example Such as, nail leg 1221 can be inserted into internal layer 1212 and be rested upon to for example making the base portion 1222 of nail 1220 abut and/or neighbouring internal layer The depth that 1212 lower surface 1218 positions.In figs. 8 and 9, internal layer 1212 does not include can receive nail 1220 one The nail cavity divided, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 can be by can allow for the compressible material that warehouse 1210 is collapsed when applying compressive load to it (such as bioabsorbable Foam and/or oxidized regenerated cellulose (ORC)) form.Internal layer 1212 can be by for example comprising PLA (PLA) and/or PVOH The freeze dried foam of sour (PGA) is formed.ORC can be commercially available with trade name Surgicel and may include the Woven fabric shaken up (as surgical sponge), the fiber shaken up (as cotton balls) and/or foam.Internal layer 1212 can by wherein include and/or on Material of the face coated with medicine (fibrin ferment and/or fibrin that are such as freeze-dried) is formed, and the medicine can for example be suffered from Fluid water activation and/or activation in person's body.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for example In Vicryl (PGA) matrix.However, in some cases, such as when nail bin 1200 is inserted into the operative site of patient's body When, activable medicine can be activated inadvertently.Referring again to Fig. 8 and Fig. 9, outer layer 1211 can be by fluid-tight or at least basic Upper material impervious to water is formed so that liquid does not contact or not contacted at least substantially internal layer 1212, until warehouse 1210 by Compress and nail leg has been penetrated after outer layer 1211 and/or after outer layer 1211 cut in some manner.For example, outer layer 1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) structure Into.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More particularly, nail 1220 can be inserted into internal layer 1212 and outer layer 1211 in and around include internal layer 1212 and follow closely 1220 sub-component and be wrapped and be subsequently sealed.

As described herein, when anvil block moves to closing position, the nail of nail bin can be fully formed by anvil block.As other one Kind selection, referring now to Figure 10-Figure 13, such as nail of the nail bin of nail bin 4100 for example can be by moving to closing position when anvil block When anvil block, and additionally by make nail towards closure anvil block move Staple drivers system and deform.Nail bin 4100 may include Compressible warehouse 4110, the compressible warehouse for example by foamed material and can be positioned at least partially at compressible warehouse Multiple nails 4120 in 4110 are formed.Staple drivers system may include driver clamper 4160, be positioned at driver clamper Staple drivers 4162 can be maintained at driving by multiple staple drivers 4162 and cartridge tray 4180 in 4160, the cartridge tray In device clamper 4160.For example, staple drivers 4162 can be positioned on one or more of driver clamper 4160 slit In 4163, wherein the side wall of slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be by staple drivers 4162 are supported in slit 4163, wherein when following closely 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be complete It is positioned at entirely in slit 4163.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, The openend 4161 that at least a portion of nail 4120 may pass through slit 4163 upwardly extends.For example, referring now primarily to Figure 11, nail 4120 base portion can be positioned in driver clamper 4160, and the top of nail 4120 can be embedded in compressible warehouse 4110 It is interior.About 1/3rd height of nail 4120 can be positioned in driver clamper 4160, and follow closely about three points of 4120 Two height can be positioned in warehouse 4110.It is may also include referring to Figure 10 A, such as nail bin 4100 around warehouse 4110 and driving The water impervious wrappage or film 4111 of device clamper 4160.

In use, for example, nail bin 4100 can be positioned in staple cartridge channel, and anvil block can be moved to towards nail bin 4100 and closed Close position.When anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.When anvil block is in it During closing position, anvil block can not contact stud 4120.When anvil block moves to its closing position, the leg of the accessible nail 4120 of anvil block is simultaneously And at least in part deform nail 4120.In any case, nail bin 4100 may also include one or more sliding parts 4170, institute Stating one or more sliding parts can be in nail bin 4100 along being longitudinally propelling so that sliding part 4170 can then engage staple drivers 4162 And staple drivers 4162 and nail 4120 is set to be moved towards anvil block.Sliding part 4170 can cartridge tray 4180 and staple drivers 4162 it Between slide.In the case where the closure of anvil block starts the forming process of nail 4120, nail 4120 moves upwards towards anvil block can be complete Into forming process and nail 4120 is set to be deformed into height or at least desired height that it is fully formed.Do not make nail in the closure of anvil block In the case of 4120 deformations, nail 4120 moves upwards towards anvil block can start and complete forming process and nail 4120 is deformed into it The height or at least desired height being fully formed.Sliding part 4170 can be advanced to nail bin 4100 from the proximal extremity of nail bin 4100 Distal end so that before the nail 4120 in the distal end for being positioned at nail bin 4100 is fully formed, be positioned at nail bin Nail 4120 in 4100 proximal extremity is fully formed.Referring to Figure 12, sliding part 4170 can each include at least one angled Or inclined surface 4711, it can slide below staple drivers 4162 and lift staple drivers 4162 as shown in figure 13.

Further described above, nail 4120 can be formed, so as to by least a portion of tissue T and nail bin 4100 Compressible warehouse 4110 at least a portion capture wherein.After the shaping of nail 4120, the anvil block and nail of surgical stapling device Warehouse channel 4130 can move away from the nail bin 4100 being implanted into.In all cases, nail bin can be fixedly engaged in storehouse dish 4180 Passage 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can be with that can press The warehouse 4110 of contracting separates.Referring again to Figure 10, storehouse dish 4180 may include relative side wall 4181, and warehouse 4110 can be removed Ground is positioned between the relative side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181 so that Warehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouse dish 4180 releasedly depart from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from Surgery When displacement removes, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.Driver 4162 can project and stay in operative site from driver clamper 4160.For example, driver 4162 can be by bioabsorbable Material (such as with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.Driver 4162 could attach to nail 4120 so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example receive nail 4120 The groove of base portion, wherein the groove can in a manner of pressure cooperation and/or snap fit receive base portion.

Further described above, driver clamper 4160 and/or sliding part 4170 can project from storehouse dish 4180. For example, sliding part 4170 can slide between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote with When driving up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to storehouse dish Outside 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cut Cut component, the driving rod or cutting element and promote sliding part 4170 through nail bin 4100.In this case, sliding part 4170 can not be projected from storehouse dish 4180 and can be kept together with surgical stapling device, and sliding part 4170 is not attached to wherein In other situations of driving rod, sliding part 4170 can be stayed in operative site.In any case, to further being retouched above To state, the compressibility of warehouse 4110 can allow to use thicker nail bin in the end effector of surgical stapling device, because When the anvil block closure of stitching unstrument, warehouse 4110 is compressible or collapses.Deformed at least in part as being followed closely when anvil block closes Result, higher nail (such as with about 0.18 " nail of staple height), such as wherein about 0.12 can be used " staple height Can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " uncompressed height.

As described herein, nail bin can include multiple nails wherein.Optionally, such nail can be substantially U-shaped by being deformed into Configuration and the metal wire rod composition with two nail legs.It is contemplated that wherein nail may include that various configuration (is such as engaged with one Rise and there are two or more wire rods of three or more nail legs) alternative form.For forming the one or more of nail Wire rod may include cross section that is circle or at least substantially justifying.Staple line material may include any other suitable cross section, such as just Square and/or rectangle cross section.Nail can be made up of plastic wire.Nail can be made up of the metal wire rod coated with plastics.According to The present invention, storehouse may include the fastener for any suitable type that in addition to nail or substitution is followed closely.For example, may include can for this fastener The arm of pivot, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin may include it is more Individual first fastener portion, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, second is tight Firmware portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin so as to complete nail into Shape process.Sliding part or driver can be promoted in anvil block, so as to make one or more formed parts move downwardly to relatively Nail bin and nail or be positioned in nail bin fastener engagement.

As described herein, nail bin may include to be stored in four nail therein.Four nail can be configured to two inner sides Nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in cutting element or cutter slit in nail bin The first side on；Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit.Nail bin It may not include cutting element slit wherein；However, the replacement as nail bin slit, this nail bin may include to be cut by cutting element Specified portions.Similarly, inner side nail row can be arranged in nail bin so that its equidistantly or at least base with cutting element slit wherein It is equally spaced on this.Similarly, can by outside follow closely row be arranged in nail bin so that its with cutting element slit wherein equidistantly or At least substantially it is equally spaced.According to the present invention, nail bin, which may include to be stored in nail bin, is more or less than four nails.Nail Storehouse may include six nails.For example, nail bin can include three nails on the first side of cutting element slit wherein, and it is narrow in cutting element Include three nails on second side of groove.Nail bin may include odd number nail.For example, nail bin can be on the first side of cutting element slit wherein Including two nails, and include three nails on the second side of cutting element slit wherein.Staple may include to have identical or at least base The nail of identical unshaped staple height in sheet.Alternatively, one or more staples may include have and other nails The nail of different unshaped staple heights.For example, the nail on the first side of cutting element slit wherein can have the first unshaped height, and And the nail on the second side of cutting element slit wherein can have the second unshaped height, it is high that second unshaped is highly different from first Degree.

Optionally, as described above, nail bin may include warehouse, the warehouse is limited to nail cavity therein including multiple.Warehouse can Including platform and top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be determined Position is in each nail cavity so that nail is stored in warehouse until it is shot up from warehouse.Before being shot up from warehouse, nail can It is accommodated in warehouse so that nail is not projecting to platform surface top.In such cases, when nail is positioned under platform surface Fang Shi, nail can be reduced and be damaged and/or the possibility of premature contact destination organization.In all cases, nail can not fire position Put and moved between firing position, in non-firing position, it is not from warehouse projection, and in firing position, it reveals from warehouse Go out and can contact the anvil block for being positioned in nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be positioned so that away from Preset distance above platform surface so that when nail is disposed from warehouse, nail is deformed into predetermined forming height.In certain situation Under, the thickness variable for the tissue being trapped between anvil block and nail bin, therefore, thicker tissue can be trapped in some nails And relatively thin tissue can be trapped in other some nails.In either case, by nail be applied to tissue clamping pressure or Power for example can be different because of nail, or changes between the nail on the nail and the other end of nail row on one end of nail row.In some situations Under, it can control the gap between anvil block and nail bin platform so that nail applies a certain minimum clamping pressure in each nail.But In some such cases, the significant changes of the clamping pressure in different nails may possibly still be present.Surgery suturing appliance exists The United States Patent (USP) No.7 that on June 3rd, 2008 announces, has in 380,696 disclosed, and the complete disclosure of the patent is with the side of reference Formula is incorporated herein.For the illustrative multi-stroke handle of surgical stapling and cutting off apparatus in CO-PENDING and jointly owned name Referred to as " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION Carried out in INDICATOR AND RETRACTION MECHANISM " U.S. Patent application No.10/374,026 in more detail Description, the disclosure of the patent application is incorporated by reference in its entirety accordingly.Meeting the other application of the present invention can combine Single firing schedule, such as in CO-PENDING and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent applications No.10/441,632 Described in, the disclosure of the patent application is incorporated by reference in its entirety accordingly.

As described herein, nail bin may include following device：The device is used for the tissue to being captured out of cartridge deployment nail Thickness compensate.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include that rigid Part I (such as supports Part 10010) and compressible Part II (such as tissue thickness compensation part 10020).Referring first to Figure 16, support section 10010 may include warehouse, top platform surface 10011 and multiple nail cavities 10012.Wherein, it is similarly as described above, each nail cavity 10012 can limit the opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012 In.For example, each nail 10030 may include base portion 10031 and the one or more deformation legs 10032 extended from base portion 10031. Nail 10030 is by before deployment, and also as described in more detail below, the base portion 10031 for following closely 10030 can be by being positioned at support section Staple drivers support in 10010, while, following closely 10030 leg 10032 can at least be partly accommodated in nail cavity 10012. Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thickness compensation part 10020, the top surface of tissue thickness compensation part 10020 is penetrated, penetrates tissue T, and contacts that to be positioned in nail bin 10000 right The anvil block in face.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness compensation part A part for 10020 part and the tissue T in each nail 10030, and apply compressive force to tissue.To entering above Row further describes, and the leg 10032 of each nail 10030 can be made to be deformed downwardly toward the base portion 10031 of nail, to form nail retention region 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In all cases, nail retention area Domain 10039 can be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention region Size may depend on a number of factors, such as the diameter of the length of leg, leg, the width of base portion, and/or such as degree of leg deformation.

Before this, surgeon usually needs to select to have the appropriate nail of appropriate staple height for the tissue being just sewn. It is used together and select low nail to be used together with thin tissue with thick tissue for example, high nail may be selected in surgeon.But In some cases, the tissue being just sewn does not have consistent thickness, and therefore, some nails can not realize desired percussion structure Type.For example, Figure 48 is shown for the high nail in thin tissue.Referring now to Figure 49, when tissue thickness compensation part (is such as organized Thickness compensation part 10020) for example when thin tissue is used together, such as larger nail can shape as desired percussion configuration.

Due to the compression ratio of tissue thickness compensation part, the thickness for the tissue that tissue thickness compensation part can be to capture in each nail Degree compensates.More specifically, referring now to Figure 43 and Figure 44, tissue thickness compensation part (such as tissue thickness compensation part 10020) each nail 10030 can be for example occupied according to the thickness and/or type of the tissue accommodated in nail retention region 10039 The larger and/or smaller portions of nail retention region 10039.For example, it is trapped in the situation in nail 10030 in thicker tissue T Under, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region 10039 major part.Correspondingly, the situation in nail 10030 is trapped in compared to relatively thin tissue T, if thicker group Knit T to be trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.This Sample, tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compression stress is applied to tissue, regardless of whether No matter the or tissue thickness being at least substantially trapped in nail.In addition to the above, tissue thickness compensation part 10020 can compensate to the different type or the tissue of different compression ratios being trapped in different nails 10030.Referring now to figure 44, tissue thickness compensation part 10020 can apply compressive force to the vascular tissue T that may include blood vessel V, and therefore limit blood stream Less compressible blood vessel V is crossed, but desired compression pressure is still applied to the tissue T of surrounding.In all cases, it is right It is described further above, tissue thickness compensation part 10020 can also compensate for strained nail.Referring to Figure 45, various nails 10030 Deformation can cause to be limited to larger nail retention region 10039 in such nail.Due to returning for tissue thickness compensation part 10020 Elastic force, it is fixed even if being limited at such nail retention region 10039 become in staple 10030 can be extended referring now to Figure 46 Enough compression stresses can be still applied to tissue having become the tissue thickness compensation part 10020 in staple 10030 by position.In various feelings Under condition, the tissue thickness compensation part 10020 among adjacent nail 10030 can have been become appropriate shaping around staple 10030 Nail 10030 biased against tissue T, and therefore compression pressure is applied to for example to surround and/or be trapped in and has become staple Tissue in 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the different tissue Density can be produced for example due to calcification, zone of fiber, and/or the previous tissue for having sutured or having handled.

According to the present invention, tissue space fix or unmodifiable can be limited between support section and anvil block, because No matter how the thickness of this tissue being trapped in nail can make nail be deformed into predetermined height.When tissue thickness compensation part is used When such situation, tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin, and by In the screen resilience of tissue thickness compensation part, additional compression stress can be applied to tissue by tissue thickness compensation part.Referring now to figure 50-55, formed nail 10030 is predefined height H.Reference picture 50, tissue thickness compensation part is not used, and is organized T occupies whole nail retention region 10039.Reference picture 57, a part for tissue thickness compensation part 10020 have been trapped in nail In 10030, tissue T is compressed, and has occupied at least a portion of nail retention region 10039.Referring now to Figure 52, thin group T is knitted to be trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/9H height, and is pressed The tissue thickness compensation part 10020 of contracting has such as about 7/9H height.Referring now to Figure 53, the tissue with interior thickness T has been trapped in nail 10030.In this embodiment, the tissue T compressed has about 4/9H height, and is compressed Tissue thickness compensation part 10020 have such as about 5/9H height.Referring now to Figure 54, the tissue T with interior thickness It has been trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/3H height, and compressed Tissue thickness compensation part 10020 has such as about 1/3H height.Referring now to Figure 53, thick tissue T has been trapped in nail In 10030.In this embodiment, the tissue T compressed has about 8/9H height, and the tissue thickness's compensation compressed Part 10020 has such as about 1/9H height.In all cases, tissue thickness compensation part may include compression height, the pressure Contracting height includes：Such as about 10% nail retention height, about 20% nail retention height, the retention of about 30% nail it is high Degree, about 40% nail retention height, about 50% nail retention height, about 60% nail retention height, about 70% Nail retention height, about 80% nail retention height, and/or about 90% nail retention height.

Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and about Unshaped height between 4.8mm.Nail 10030 may include such as about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm unshaped height.Nail can The height H of deformation can be determined by the distance between the platform surface 10011 of support section 10010 and relative anvil block.Platform The distance between tissue contacting surface of surface 10011 and anvil block may be, for example, about 0.097 ".Height H can also be by being limited to anvil The depth of forming pit in seat determines.Forming pit can be for example with the depth measured from tissue contacting surface.Optionally, such as Described in greater detail below, nail bin 10000 may also include staple drivers, and the staple drivers can lift nail 10030 towards anvil block, and Nail is lifted or " excessively driving " arrives the top of platform surface 10011.In this case, following closely 10030 forming height H can also be by 10030 distances being overdriven are followed closely to determine.For example, nail 10030 can be overdriven such as about .028 ", and can lead Cause nail 10030 to be shaped as such as about 0.189 " height.Nail 10030 can be shaped as such as about 0.8mm, about 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm, and/or about 2.25mm height.Nail, which can be shaped as, to be for example situated between Height between about 2.25mm and about 3.0mm.Further described above, the height of the nail retention region of nail can Determined by the width and diameter of the forming height followed closely and the wire rod including nail.The height of the nail retention region 10039 of nail 10030 Degree may include that the forming height H of nail subtracts two diameter widths of wire rod.Staple line material may include such as about 0.0089 " it is straight Footpath.Staple line material may include the diameter for example between about 0.0069 " and about 0.0119 ".For example, the shaping of nail 10030 Height H may be about 0.189 ", and follow closely gauge or diameter of wire may be about 0.0089 ", so as to for example produce about 0.171 " nail Retention height.

Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, and Can be deformed into multiple compression heights one.Tissue thickness compensation part may include such as about 0.125 " uncompressed height Degree.Tissue thickness compensation part may include to be greater than or equal to about 0.080 " uncompressed height.Tissue thickness compensation part can Including height that is unpressed or disposing in advance, this is highly more than the non-firing height of nail.Tissue thickness compensation part it is unpressed Or the height disposed in advance is for example high by about 10% than the non-firing height of nail, high by about 20%, high by about 30%, high about 40%th, height about 50%, height about 60%, height about 70%, height about 80%, height about 90%, and/or height about 100%. The non-firing height height such as up to about 100% of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part. The non-firing height height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part is for example more than 100%.Tissue Thickness compensation part may include the uncompressed height of the non-firing height equal to nail.Tissue thickness compensation part may include to be less than nail not The uncompressed height of firing height.The non-firing height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part Such as low about 10%, it is low about 20%, low about 30%, low about 40%, low about 50%, low about 60%, low about 70%th, low about 80%, and/or low about 90%.Compressible Part II may include uncompressed height, the uncompressed height Higher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, the uncompressed height etc. In the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, and the uncompressed height is less than The uncompressed height for the tissue T being just sewn.

As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multiple Compressed in forming nail.For example, the nail deformation in staple line or nail row can be made so that the nail retention region each followed closely includes for example big About 2.0mm height, wherein tissue T and tissue thickness compensation part can be compressed within the height.In some cases, organize T may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include to retain area in nail The compression height of about 0.25mm in domain, so as to obtain adding up to such as about 2.0mm nail retention region height.Some Under situation, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may include The compression height of about 0.50mm in nail retention region, so as to obtain adding up to such as about 2.0mm nail retention region Highly.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness Compensating part may include the compression height of the about 0.75mm in nail retention region, so as to obtain adding up to such as about 2.0mm Nail retention region height.In some cases, tissue T may include the compression height of the about 1.0mm in nail retention region, And tissue thickness compensation part may include the compression height of the about 1.0mm in nail retention region, so as to obtain adding up to for example About 2.0mm nail retention region height.In some cases, tissue T may include the about 0.75mm in nail retention region Compression height, and tissue thickness compensation part may include the compression height of the about 1.25mm in nail retention region, so as to To the nail retention region height for adding up to such as about 2.0mm.In some cases, tissue T may include in nail retention region About 1.50mm compression height, and tissue thickness compensation part may include the compression of the about 0.50mm in nail retention region Highly, so as to obtain adding up to such as about 2.0mm nail retention region height.In some cases, tissue T may include following closely The compression height of about 0.25mm in retention area, and tissue thickness compensation part may include in nail retention region about 1.75mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.

Further described above, tissue thickness compensation part may include the uncompressed height of the firing height less than nail Degree.Tissue thickness compensation part may include the uncompressed height of the firing height equal to nail.Tissue thickness compensation part may include to be higher than The uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thickness, should Thickness for forming nail height about 110%, about the 120% of forming nail height, forming nail height about 130%, shaping About the 140% of staple height, about the 150% of forming nail height, about the 160% of forming nail height, forming nail height it is big About 170%, about the 180% of forming nail height, about the 190% of forming nail height, and/or forming nail height be about 200%.Tissue thickness compensation part may include uncompressed height, and the uncompressed height is more than twice of the firing height of nail.Group Knitting thickness compensation part may include compression height, and the compression height is about the 85% to about 150% of such as forming nail height.Appoint Selection of land, as described above, tissue thickness compensation part can be compressed between uncompressed thickness and compressed thickness.Tissue thickness is mended The compressed thickness for repaying part may be, for example, about the 20% of about the 10% of its uncompressed thickness, its uncompressed thickness, its is uncompressed About the 30% of thickness, about the 40% of its uncompressed thickness, about the 50% of its uncompressed thickness, its uncompressed thickness it is big About 60%, about the 70% of its uncompressed thickness, about the 80% of its uncompressed thickness, and/or its uncompressed thickness is about 90%.The uncompressed thickness of tissue thickness compensation part can it is for example thicker than its compressed thickness approximately twice as, about ten times, about 50 Times, and/or about 100 times.The compressed thickness of tissue thickness compensation part can between its uncompressed thickness about 60% and about Between 99%.The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.Tissue thickness compensation part Uncompressed thickness is than at most 100 times of its compressed thickness thickness.Compressible Part II can be elastic, or at least part bullet Property, and tissue T can be biased against the deformation leg of nail.For example, compressible Part II can be in tissue T and the base portion of nail Between resilient expansion, so as to against the leg pushes against tissue T of nail.As described in further detail below, tissue thickness compensation part can quilt It is positioned among tissue T and deformation nail leg.In all cases, due to described above, tissue thickness compensation part can eliminate nail Any gap in retention area.

Tissue thickness compensation part may include the material characterized by one or more of following characteristics：For example, bio-compatible Property, bioresorbable, bioresorbability, biological durability, biological degradability, compressibility, fluid absorbency, swellability, Self-expanding, bioactivity, medicine, pharmaceutical activity, Adhesion Resistance, hemostatic, antibiotic property, microbial resistance, antiviral property, battalion Nourish one's nature, cohesive, permeability, hydrophily, and/or hydrophobicity.It can be wrapped according to the present invention, including the surgical instruments of anvil block and nail bin The tissue thickness compensation part related to anvil block and/or nail bin is included, the tissue thickness compensation part is included in following material at least It is a kind of：Styptic (for example, fibrin and fibrin ferment), antibiotic (for example, doxycpl) and medicine are (for example, matrix is golden Proteases (MMP)).

Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer group Compound, the polymer composition include one or more synthetic polymers and/or one or more non-synthetic polymers.Synthesis Polymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition may include example Such as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed-cell foam.It is raw Thing biocompatible foam can be with uniform pore morphology or can be with gradient pore form (whole depth of foam i.e., in one direction On, gradually increase becomes macropore to orifice size).Polymer composition may include porous support, porous matrix, gel-type vehicle, water Gel-type vehicle, solution matrix, thread matrix, tubulose matrix, composite interstitial substance, membrane matrix, Biostatic polymer and can biology drop One or more and combinations thereof in the polymer of solution.For example, tissue thickness compensation part may include to pass through thread matrix The foam of enhancing, or may include the foam with additional hydrogel layer, the additional hydrogel layer extends in the presence of body fluid, Organizationally to further provide for compressing.According to the present invention, tissue thickness compensation part can also be by material and/or the second layer or the 3rd Coating on layer is formed, and the coating extends in the presence of body fluid, organizationally to further provide for compressing.Such layer can be water-setting Glue, the hydrogel can be synthesize and/or natural source material, and for example can be that biology is durable and/or biodegradable. Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include the microgel for carrying out self-carbon water compound and/or Nanogel.The usable fibrous nonwoven material that additional flexibility, rigidity, and/or intensity can be provided or fiber mesh type Element strengthens tissue thickness compensation part.According to the present invention, tissue thickness compensation part has porous form, porous form performance Go out gradient-structure, such as aperture on a surface and larger hole on the other surface.Such form is for group Knit growth or hemostasis behavior for it is even more ideal.In addition, gradient can also be combined with the bio-absorbable section of change.It is short-term to absorb Section can be preferable, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue more preferably heal under ne-leakage situation The problem of.

The example of non-synthetic materials includes but is not limited to lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin Albumen, fibrinogen, elastin laminin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized fibre Element, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated shell Polysaccharide, casein, alginates and combinations thereof.

Synthesize the example including but not limited to poly- (lactic acid) (PLA) of absorbable material, PLLA (PLLA), poly- interior Ester (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), poly- hydroxyl The copolymerization of phenylalkanoic acid ester (PHA), the copolymer of glycolide and 6-caprolactone (PGCL), glycolide and trimethylene carbonate Thing, poly- (decanedioic acid glyceride) (PGS), poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, poly- Ether-ether, makrolon, polyesteramide, condensing model, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based are gathered Imido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- hydroxyls Base butyrate), poly- (E- caprolactones), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), intend it is poly- (amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, Polyvinylpyrrolidone, polyvinyl alcohol, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, altogether Poly- (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and it Combination.Polyester may be selected from polylactide, PGA, trimethylene carbonate, polydioxanone, polycaprolactone, Polybutester and combinations thereof.

The absorbable polymer of synthesis may include for example can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly- (glycolide-L- lactides) copolymer, can with brand name DEXON from Commercially available American Cyanamid Co. PGA, can be commercially available from Ethicon, Inc. with brand name PDS Polydioxanone, can with brand name MAXON from American Cyanamid Co. it is commercially available it is poly- (glycolide- Trimethylene carbonate) statistic copolymer, can with brand name MONOCRYL from Ethicon companies it is commercially available 75/ One or more in 25 poly- (glycolide-s-caprolactone-poliglecaprolactone 25) copolymers.

Synthesis non-absorbable material include but is not limited to polyurethane, polypropylene (PP), polyethylene (PE), makrolon, Polyamide, z such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyethers Ether ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones, silicon and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to elastomer Foamed plastics and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include can be with brand name GORE-TEX soft-tissue patch is from W.L.Gore＆Associates, expanded PTFE commercially available Inc. (ePTFE), And can be with brand name NASOPORE from co-poly ether-ether urethane foam plastic commercially available Polyganics.

Polymer composition may include such as by weight about 50% to about 90% PLLA polymer composition, And by weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weight The PLLA and by weight about 30% PCL of gauge about 70%.Polymer composition may include for example big by weight About 55% to about 85% PGA polymer composition and by weight 15% to 45% PCL combination of polymers Thing.Polymer composition may include such as by weight about 65% PGA and by weight about 35% PCL.Polymerization Compositions may include such as by weight about 90% to about 95% PGA polymer composition and by weight About 5% to about 10% PLA polymer composition.

The absorbable polymer of synthesis may include bioabsorbable, biocompatibility elastomer copolymer.Suitably Bioabsorbable, biocompatibility elastomer copolymer include but is not limited to 6-caprolactone and glycolide copolymer (ε- The mol ratio of caprolactone and glycolide is preferably about 30:70 to about 70:30, it is therefore preferable to 35:65 to about 65:35, more preferably Ground is 45:55 to 35:65)；6-caprolactone and lactide (including L- lactides, D- lactides, their blend or lactic acid are total to Polymers) elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and it is more excellent Selection of land is 45:55 to 30:70)；To dioxanone (1,4- dioxane -2- ketone) and lactide, (including L- third is handed over Ester, D- lactides and lactic acid) elastomer copolymer (40 are preferably about to the mol ratio of dioxanone and lactide: 60 to about 60:40)；6-caprolactone and to the elastomer copolymer of dioxanone (6-caprolactone with to dioxanone Mol ratio be preferably about 30:70 to about 70:30)；The elastomer of dioxanone and trimethylene carbonate is copolymerized Thing (is preferably from about 30 to the mol ratio of dioxanone and trimethylene carbonate:70 to about 70:30)；Trimethylene carbonic acid (mol ratio of trimethylene carbonate and glycolide is preferably from about 30 to the elastomer copolymer of ester and glycolide:70 to about 70: 30)；The elastomer copolymer of trimethylene carbonate and lactide, including L- lactides, D- lactides, they blend or (mol ratio of trimethylene carbonate and lactide is preferably from about 30 to lactic acid copolymer:70 to about 70:30)；And they are total to Mixed thing.Elastomer copolymer can be the copolymer of glycolide and 6-caprolactone.Alternatively, elastomer copolymer is Lactide and

The copolymer of 6-caprolactone.It is published in entitled " the ELASTOMERIC MEDICAL on 21 days November nineteen ninety-five DEVICE " United States Patent (USP) 5,468,253 and entitled " the FOAM BUTTRESS FOR for being published on December 4th, 2001 The disclosure for the United States Patent (USP) 6,325,810 that STAPLING APPARATUS " are used for each is herein incorporated by reference in full Herein.

Tissue thickness compensation part can include emulsifying agent.The example of emulsifying agent may include but be not limited to water-soluble polymer, all Such as polyvinyl alcohol (PVA), vinylpyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), pluronic (PLURONICS), tween (TWEENS), polysaccharide and combinations thereof.

Tissue thickness compensation part can include surfactant.

The example of surfactant may include but be not limited to polyacrylic acid, methylase, methylcellulose, ethyl cellulose Element, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, PCE, polyoxyethylene laural base Ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan Yue Cinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethanol, He Bo Luo Shamu.

Polymer composition may include pharmaceutically active agents.The pharmaceutical activity of the releasable therapeutically effective amount of polymer composition Agent.Pharmaceutically active agents can discharge when polymer composition is desorbed or is absorbed.Pharmaceutically active agents, which can be released to, flows through polymerization It is on compositions or interior through the fluid (for example, blood) of polymer composition.The example of pharmaceutically active agents may include but not It is limited to styptic and medicine, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, for example, it is double Chlorine sweet smell acid, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, example Such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol；And anticancer, such as cis-platinum, mitogen Mycin, adriamycin.

Polymer composition may include the agent material that stops blooding.Tissue thickness compensation part can include hemostasis agent material, and it includes poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (caprolactone), poly- (dioxanone), polyoxyalkylene, copolymerization It is (ether-ester), collagen, gelatin, fibrin ferment, fibrin, fibrinogen, FN, elastin laminin, albumin, blood red Albumen, ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, HES, hydroxyethyl cellulose, cellulose, oxidation are fine Tie up element, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, malt Sugar, maltodextrin, alginate, clotting factor, methacrylate, polyurethane, acrylate, platelet agonist, blood Pipe contracting agent, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, ferric sulfate, ferric subsulfate, chlorination Iron, zinc, zinc chloride, aluminium chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucosan and Combinations thereof.The feature of tissue thickness compensation part can be haemostatic properties.

The polymer composition of tissue thickness compensation part is characterised by such as percent porosity, hole size, and/or hard Degree.Polymer composition can have such as about 30% to about 99% percent porosity by volume.Polymer composition There can be such as about 60% to about 98% percent porosity by volume.Polymer composition can have for example by volume The percent porosity of meter about 85% to about 97%.Polymer composition may include such as by weight about 70% PLLA By weight about 30% PCL, and may include such as about 90% porosity by volume.For example, therefore, polymerization Compositions by include by volume about 10% copolymer.Polymer composition may include such as by weight about 65% PGA and by weight about 35% PCL, and can have such as about 93% to about 95% percentage hole by volume Gap rate.Polymer composition may include to be more than 85% porosity by volume.Polymer composition can be micro- with such as about 5 Rice arrives about 2000 microns of hole size.Polymer composition can have for example between about 10 microns to about 100 microns it Between hole size.For example, polymer composition may include such as PGA and PCL copolymer.Polymer composition can have for example Hole size between about 100 microns to about 1000 microns.For example, polymer composition may include such as PLLA and PCL copolymer.

According to some aspects, the hardness of polymer composition can be represented with Shore hardness.The Shore hardness can be defined as The tolerance of the permanent indenture to material such as determined by sclerometer.In order to assess the durometer value of given material, According to entitled " Standard Test Method for Rubber Property-Durometer Hardness " ASTM Program D2240-00, material is applied pressure to hardness head pressure feet, its full text is hereby incorporated herein by.Can be by firmly Degree meter pressure head pin is administered to material and continues enough a period of times, such as 15 seconds, for example, wherein reading is read from suitable scale Take.According to scale type used, when pressure head pin completely penetrates through material, reading 0 can be obtained, and when material is not pierced When, reading 100 can be obtained.The reading dimensionless.Can for example according to ASTM D2240-00 using any suitable scale (for example, A classes and/or OO classes scale) determine hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16A Shore A Hardness value, the Shore A Hardness value is for example in about 45OO to about 65OO Shore OO scopes.For example, polymerization Compositions may include such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part There can be the Shore A Hardness value less than 15A.The polymer composition of tissue thickness compensation part can have hard less than 10A Shore A Angle value.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 5A.Polymeric material can have example Such as about 35OO to about 75OO Shore OO composition values.

Polymer composition can have at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentioned At least three kinds in the characteristic identified.Polymer composition can have such as 85% to 97% porosity, 5 micro- by volume Rice is to 2000 microns of hole size and 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymerization Compositions may include by weight 70% PLLA polymer composition and by weight 30% PCL polymer group Compound；The polymer composition have for example by volume 90% porosity, 100 microns to 1000 microns of hole size, With 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include by weight The polymer composition of 65% PGA polymer composition and by weight 35% PCL；The polymer composition tool There are such as 93% to 95% porosity, 10 microns to 100 microns of hole size and 4A to 16A Xiao A hardness by volume The shore OO hardness value of value and 45OO to 65OO.

Thickness Tissue compensating part may include the material of extension.As described above, tissue thickness compensation part can be included in it is uncompressed Or the compression material extended during deployment.Tissue thickness compensation part can include be formed in situ from expansion material.Tissue thickness compensates Part can include at least one precursor, and the precursor is chosen so as to contacting at least one of other precursors, water, and/or body fluid When be spontaneously crosslinked.According to the present invention, other accessible one or more precursors of the first precursor are expansible and/or can be formed The tissue thickness compensation part of swelling.Tissue thickness compensation part can include the swollen composition of fluid-soluble, for example, the group of water-swellable Compound.Tissue thickness compensation part can include aqueous gel.

Tissue thickness compensation part may include the biodegradable foam with packaging part, and the packaging part includes being embedded Dried hydrogel particle or granule.Without wishing to be bound by any specific theory, the packaging part in foam can be by making hydrogel The organic solution contact of the aqueous solution and biocompatible materials of precursor is formed with forming foam.Aqueous solution and organic molten Liquid can form micella.Aqueous solution and organic solution can be dried to encapsulate the dried hydrogel particle or granule in foam. For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form the dispersion of micella.Aqueous solution can contact The organic solution of dioxane comprising poly- (glycolic) and polycaprolactone.Aqueous solution and organic solution can be lyophilized from And formed with the biodegradable foam for disperseing dried hydrogel particle therein or granule.Not by any particular theory Constraint, it is believed that micelle forma-tion packaging part, the packaging part have the dried hydrogel particle that is dispersed in foaming structure or Granule.The packaging part is rupturable, and dried hydrogel particle or granule can contact fluid (such as body fluid) and extend.

Optionally, as described above, tissue thickness compensation part may include original depth and extension thickness.Tissue thickness compensation part Original depth may be, for example, its extend thickness about 0.001%, its extend thickness about 0.01%, its extend thickness About 0.1%, its extend thickness about 1%, its extend thickness about 10%, its extend thickness about 20%, its expansion Open up thickness about 30%, its extend thickness about 40%, its extend thickness about 50%, its extend thickness about 60%th, it extends about the 70% of thickness, about the 80% of its extension thickness, and/or about the 90% of its extension thickness.Tissue The extension thickness of thickness compensation part can it is for example thicker than its original depth 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, and/or about 1000 times. The original depth of tissue thickness compensation part may be up to it and extend the 1% of thickness, be up to the 5% of its extension thickness, be up to its extension Thickness 10% and up to its extend thickness 50%.The extension thickness of tissue thickness compensation part is than its original depth thickness extremely Few 50%, it is thicker than its original depth by least 100%, thicker than its original depth at least 300% and thicker than its original depth at least 500%.As described above, in all cases, tissue thickness compensation part can eliminate any gap in nail retention region.

As described above, tissue thickness compensation part can include hydrogel.Hydrogel may include homopolymer hydrogel, copolymer water Gel, multipolymer hydrogel, interpenetrating polymer hydrogel and combinations thereof.Hydrogel may include microgel, nanometer Gel and combinations thereof.Hydrogel can generally include the hydrophilic polymer network that can absorb and/or retain fluid. Hydrogel may include noncrosslinking hydrogel, the hydrogel of crosslinking and combinations thereof.Hydrogel may include to be chemically crosslinked Agent, Physical crosslinking agent, hydrophobic patch and/or the undissolved fragment of water.Hydrogel can by polymerisation, small molecule crosslinking and/ Or Polymer-Polymer is crosslinked to be chemically crosslinked.Hydrogel can pass through ionic interaction, hydrophobic interaction, hydrogen bond knot Interaction, stereocomplex and/or supramolecular chemistry are closed to be physically crosslinked.Hydrogel can because crosslinking agent, hydrophobic patch and/or The undissolved fragment of water and be essentially insoluble solution, but be expansible because absorbing and/or keeping fluid and/or swelling. Precursor can be crosslinked with endogenous material and/or tissue.

Hydrogel may include enviromental sensitive hydrogel (ESH).ESH may include molten with the fluid related to environmental condition The material of swollen property characteristic.Environmental condition may include but be not limited to the physical condition in operative site, biotic factor and/or chemical bar Part.For example, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, and other lifes Reason and environment variable, hydrogel is swellable or shrinks.ESH may include polyfunctional acrylate, hydroxyethyl methacrylate second The monomer of ester (HEMA), elastomeric acrylate and correlation.

Tissue thickness compensation part comprising hydrogel can be included in non-synthetic materials and synthetic material described above extremely Few one kind.Hydrogel may include to synthesize hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.It is more Individual layer may include porous layer and/or non-porous layer.For example, tissue thickness compensation part may include non-porous layer and porous layer.And for example, organize Thickness compensation part may include the porous layer among the first non-porous layer and the second non-porous layer.And for example, tissue thickness compensation part may include Non-porous layer among first porous layer and the second porous layer.Non-porous layer and porous layer can be relative to nail bin and/or the tables of anvil block Face positions in any order.

The example of non-synthetic materials may include but be not limited to albumin, alginates, carbohydrate, casein, cellulose, Chitin, chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, liver Element, hyaluronic acid, keratin, protein, serum and starch.Cellulose may include hydroxyethyl cellulose, oxycellulose, oxidation Regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose and combinations thereof.Collagen can wrap Include bovine pericardium.Carbohydrate may include polysaccharide, such as lyophilized polysaccharide.Protein may include glycoprotein, proteoglycans or it Combination.

The example of synthetic material may include but be not limited to poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine Piperazine), polyester, polyethylene glycol, PEO, PEO-polypropylene oxide copolymers, copolymerization oxirane, polyoxygenated Alkene, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxy Heterocycle hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- grass Sour alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, poe, polyphosphazene and their group Close.It conventional method can be used synthetically to prepare above-mentioned non-synthetic materials, such as synthesize hyaluronic acid.

Hydrogel can be made up of one or more hydrogel precursors.Precursor may include monomer and/or macromonomer.Water-setting Glue precursor may include electrophilic body functional group and/or nucleophile electrophilic body functional group.In general, electrophilic body can be with nucleophilic precursor reactant To form chemical bond.Term " functional group " used herein refer to the electrophilic group for being capable of reacting with each other to form chemical bond or Nucleophilic group.It is sub- that the example of electrophilic functional group may include but be not limited to n-hydroxysuccinimide (" NHS "), sulfosuccinic acyl Amine, carbonyl dimidazoles, sulfonic acid chloride, aryl halide, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, it is all Such as succinimidyl succinate and/or succinimidyl propionate, isocyanide ester, thiocyanates, carbodiimides, benzo three Azoles carbonic ester, epoxide, aldehyde, maleimide, imino-ester, combinations thereof etc..Electrophilic functional group may include amber Amber imide ester.The example of nucleophilic functional group may include but be not limited to-NH₂、-SH、-OH、-PH₂With-CO-NH-NH₂。

Hydrogel can be formed by single precursor or multiple precursors.Hydrogel can be formed by the first precursor and the second precursor.The One hydrogel precursor and the second hydrogel precursor can be in situ in contact or form hydrogel in vivo.Hydrogel precursor typically may be used Refer to polymer, functional group, macromolecular, small molecule and/or reaction can be participated in form the crosslinking agent of hydrogel.Precursor may include Such as homogeneous solution, the uneven or solution that is separated in appropriate solvent, such as water or buffer solution.The pH of buffer solution can be E.g., from about 8 to about 12, such as about 8.2 to about 9.The example of buffer solution may include but be not limited to borate buffer solution.Precursor can be In emulsion.According to the present invention, the first precursor can form hydrogel with the second precursors reaction.First precursor can be before contact second Spontaneously it is crosslinked during body.According to the present invention, first group of electrophilic functional group on the first precursor can be with second group on the second precursor Nucleophilic functional group is reacted.(for example, when related to pH, temperature and/or solvent when during precursor is blended in the environment for allowing reaction When), functional group can be reacted with each other to form covalent bond.At least some and more than one others precursors reaction in precursor When, precursor can turn into crosslinking.

Tissue thickness compensation part may include at least one monomer, and the monomer is selected from 3- sulfopropyl acrylic acid sylvite (" KSPA "), PAA (" NaA "), N- (three (hydroxymethyl) methyl) acrylamides (" triacryl ") and 2- acryloyls Amine -2- methyl isophthalic acids-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, and the copolymer includes two or more Selected from KSPA, NaA, triacryl, AMPS monomer.Tissue thickness compensation part may include from KSPA, NaA, three propylene The homopolymer of acyl group, AMPS.Tissue thickness compensation part may include the hydrophilically modified monomer that can be copolymerized with it.Hydrophilically modified list Body may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

Tissue thickness compensation part may include crosslinking agent.Crosslinking agent may include low molecule amount two or polyvinyl crosslinking agents, such as Glycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethyl allene Acid esters, pi-allyl (methyl) acrylate, C₂-C₈- alkylidene diacrylate or dimethylacrylate, divinyl ether, diethyl Alkene sulfone, two and trivinylbenzene, trimethylolpropane trimethacrylate or trimethyl acrylic ester, tetramethylol methane tetraacrylate Or tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or dimethyl allene Acid amides, ethylene bisacrylamide or ethene DMAA, triallyl phthalate or diallyl phthalate third Ester.Crosslinking agent may include N, N'- methylene-bisacrylamide (" MBAA ").

Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility light At least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer, optionally include amine function Macromonomer, succinimide ester function macromonomer, optionally include amine and/or Mercaptofunctional macromonomer, ring Epoxide function macromonomer, the mixing for optionally including amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agent Carbodiimides, anion polysaccharide and the polyvalent cation of thing, Geniposide (Genipin) and water dissolvable.

Tissue thickness compensation part may include undersaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.Tissue Thickness compensation part may include methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2- hydroxyethyl first Base acrylate, 2- hydroxy-ethyl acrylates, 2- (dimethyl aminoethyl) methacrylate, NVP, first Base acrylamide and/or N, N- DMAA are poly- (methacrylic acid).

Tissue thickness compensation part may include reinforcing material.Reinforcing material may include above-described non-synthetic materials and synthesis At least one of material.Reinforcing material may include collagen, gelatin, fibrin, fibrinogen, elastin laminin, angle egg In vain, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose Element, chitin, chitosan, alginates, poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), poly- It is ester, polyethylene glycol, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly- It is (caprolactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, pla-pcl, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene Diol ester, polyoxy acid ester, poe, polyphosphazene and combinations thereof.

Tissue thickness compensation part may include the layer for including reinforcing material.The porous layer of tissue thickness compensation part and/or non-porous Layer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer may not include reinforcing material.Enhancement layer can Including the internal layer among the first non-porous layer and the second non-porous layer.Enhancement layer may include the outer layer of tissue thickness compensation part.Enhancement layer It may include the outer surface of tissue thickness compensation part.

Reinforcing material may include mesh sheet, monofilament, multifilament weave fabric, fiber, pad, felt, particle and/or pulvis.Reinforcing material It can be coupled in the layer of tissue thickness compensation part.Reinforcing material can be coupled at least one of non-porous layer and porous layer.Can Using routine techniques (such as be knitted, weave, tatting and/be knitted or to form the mesh sheet including reinforcing material.

According to the present invention, multiple reinforcement materials can be oriented to random direction and/or common direction.Common direction can exemplified by It is one of such as parallel with staple line and vertical with staple line.For example, monofilament and/or multifilament weave fabric can with random direction and/or altogether Equidirectional orientation.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include The multiple reinforcing fibers being orientated in non-porous layer with random direction.Tissue thickness compensation part may include in non-porous layer with common direction Multiple reinforcing fibers of orientation.

Fiber can form non-woven material, for example, pad and felt.Fiber can have any appropriate length, such as from 0.1mm To 100mm and 0.4mm to 50mm.Reinforcing material can be ground into powder.Powder can have the grain for example from 10 microns to 1 centimetre Degree.Powder can be coupled in tissue thickness compensation part.

Tissue thickness compensation part can be formed in situ.Hydrogel can be formed in situ.Tissue thickness compensation part can by covalently from Son and/or hydrophobic bond are formed in situ.(non-covalent) crosslinking of physics can be mutual by complexing, hydrogen bonding, desolvation, Van der Waals Effect, ionic bonding and combinations thereof cause.(covalent) crosslinking of chemistry can pass through any one of following number of mechanisms To realize：Radical polymerization, polycondensation, anion or cationic polymerization, step growth polymerization, the reaction of electrophilic material-nucleophile, And combinations thereof.

Optionally, being formed in situ for tissue thickness compensation part may include to make two or more precursors reactions, the precursor quilt It is physically separated from until situ contact and/or environmental condition is reacted so as to react with each other to form hydrogel.Original position can The polymer of polymerization can be prepared by precursor, and the precursor can be reacted to form polymer in operative site.Tissue thickness compensation part It can be formed by the cross-linking reaction of precursor in the original location.Precursor may include that the formation in situ tissue thickness compensation part can be triggered Polymerisation initiator.Tissue thickness compensation part may include before being activated when forming the application of cross-linked hydrogel Body.Being formed in situ for tissue thickness compensation part may include to excite at least one precursor to form chemical bond, so as to form tissue thickness Spend compensating part.Optionally, activation can by operative site physical condition, biotic factor and/or electrochemical conditions change come reality Existing, the condition, which changes, includes but is not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or magnetic thorn Swash, and other physiological and environmental variances.Precursor can contact body exterior and introduce operative site.

Tissue thickness compensation part may include the one or more packaging parts or list that can store at least one component wherein Member.Packaging part can store hydrogel precursor wherein.For example, packaging part can store two kinds of components wherein.Packaging part energy It is enough to store the first hydrogel precursor and the second hydrogel precursor wherein.First packaging part can store the first hydrogel wherein Precursor and the second packaging part can store the second hydrogel precursor wherein.As described above, packaging part can be alignd with nail leg or At least substantially alignment so as to the puncture packaging part when nail leg contacts packaging part and/or otherwise ruptures packaging part.When During deployment nail, the packaging part can be compressed, conquassation, is collapsed and/or is otherwise ruptured.After packaging part rupture, it is stored In component can flow out packaging part.Store component therein and can contact other components, the layer of tissue thickness compensation part and/or group Knit.Other components may be from identical or different packaging part, provides in the layer of tissue thickness compensation part and/or is cured by clinic Life is used for operative site.As above-described result, the component being stored in packaging part can provide tissue thickness compensation part Extension and/or swelling.

Tissue thickness compensation part may include the layer containing packaging part.Packaging part may include the space associated with layer, pit, Dome, pipe and combinations thereof.Packaging part may include the space in layer.Layer may include that mutual two layers can be invested, its Middle packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, at least a portion of packaging part It can be positioned in the dome upwardly extended from layer.Packaging part may include the pit formed in layer.The Part I of packaging part It may include dome, and the Part II of packaging part may include pit.Packaging part may include the pipe being embedded in layer.Pipe may include this Non-synthetic materials and/or synthetic material described in text, such as PLA.Tissue thickness compensation part may include the foam of biological absorbable, Such as ORC, the foam of the biological absorbable includes the PLA pipes being embedded, and the pipe can encapsulate such as hydrogel.Encapsulation Part may include mutual unconnected separate unit.One or more of packaging part can be via the one or more for extending through layer Path, conduit, and/or passage and be in fluid communication with each other.

The release rate of component from packaging part can be controlled by as described below：Such as tissue thickness compensation part thickness, The part of tissue thickness compensation part, the size of component, the hydrophily of component, and/or the physics and/or change in component Learn interaction, the part, and/or surgical instruments of tissue thickness compensation part.Layer may include one or more light filling bars or weak Change part (such as local perforations), such as one or more of thin section or weakening part can be advantageous to cut layer and make packaging part Rupture.Local perforations can not extend fully through layer, and in some cases, perforation may extend entirely through layer.

Optionally, anvil block may include tissue thickness compensation part, and the tissue thickness compensation part is included with least one micro- The encapsulating component of ball particle.Tissue thickness compensation part may include packaging part, and the packaging part includes the first encapsulating component and second Encapsulating component.Tissue thickness compensation part may include packaging part, and the packaging part includes the first microsphere particle and the second microsphere particle.

Tissue thickness compensation part may be adapted to be used together with surgical instruments.As described above, tissue thickness compensation part can be with nail Storehouse and/or anvil block are associated.Tissue thickness compensation part may be configured to be adapted for engagement with any shape, the size of nail bin and/or anvil block And/or dimension.As described herein, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.In sewing process Before and during sewing process, tissue thickness compensation part can keep tissue thickness compensation part and nail bin and/or anvil The tactile any mechanical and/or chemical mode of seated connection is attached to nail bin and/or anvil block.Nail pierce through tissue thickness compensation part with Afterwards, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.When nail bin and/or anvil block move away from tissue thickness When spending compensating part, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.

Referring now to Figure 14, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible tissue Thickness compensation part 10020.Referring now to Figure 16-Figure 18, support section 10010 may include platform surface 10011 and be limited to branch Multiple nail cavities 10012 in support part point 10010.The size of each nail cavity 10012 can for example be set to and can be removable wherein Followed closely except ground stores, such as follow closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and staple drivers 10040 when being in its non-firing position, and each staple drivers can support one or more nails 10030 in nail cavity 10012.Example Such as, referring first to Figure 22 and Figure 23, each staple drivers 10040 may include for example one or more supports or groove 10041, the branch Frame or groove support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 16, nail bin 10000 may also include nail percussion sliding part 10050；The nail percussion sliding part can move to nail from the proximal extremity 10001 of nail bin The distal end 10002 in storehouse, so as to successively by staple drivers 10040 and nail 10030 from its non-firing position to be positioned in nail The anvil block on the opposite of storehouse 10000 lifts.Referring first to Figure 16 and Figure 18, each nail 10030 may include base portion 10031 and from base portion One or more legs 10032 of 10031 extensions, wherein each nail can be at least one of for example substantially U-shaped and basic V-shaped. Nail 10030 is enabled to when nail 10030 is in its non-firing position, and the top of nail leg 10032 is relative to support section 10010 Platform surface 10011 be recessed.Nail 10030 is enabled to when nail 10030 is in its non-firing position, the top of nail leg 10032 End flushes relative to the platform surface 10011 of support section 10010.Nail 10030 is enabled to when nail 10030 does not fire in it During position, the top of nail leg 10032 or at least certain part of nail leg 10032 extend to the platform surface of support section 10010 10011 tops.In this case, when nail 10030 is in its non-firing position, nail leg 10032 may extend into simultaneously quilt It is embedded into tissue thickness compensation part 10020.For example, nail leg 10032 can for example extend to the top of platform surface 10011 about 0.075".Nail leg 10032 can for example extend between about 0.025 " and about 0.125 " of the top of platform surface 10011 away from From.Further described above, tissue thickness compensation part 10020 may include such as about 0.08 " and about 0.125 " it Between uncompressed thickness.

In use, as further described above and can for example be transported referring first to Figure 31, anvil block such as anvil block 10060 Move the closing position relative with nail bin 10000.As described in more detail below, anvil block 10060 will can be organized against tissue thickness Compensating part 10020 positions and for example presses to tissue thickness compensation part 10020 platform surface 10011 of support section 10010. Once anvil block 10060 is appropriately positioned, then nail 10030 can be disposed, it is same as shown in figure 31.Optionally, as described above, nail is hit Hair sliding part 10050 can move from the distal end 10002 of proximal extremity 10001 of nail bin 10000, as shown in figure 32.Work as cunning When moving part 10050 is pushed into, sliding part 10050 can contact staple drivers 10040 and in nail cavity 10012 by staple drivers 10040 are lifted up.Sliding part 10050 and staple drivers 10040 can each include one or more slopes or inclined-plane, this Or multiple slopes or inclined-plane can cooperate so that staple drivers 10040 move upwards from its non-firing position.For example, with reference to Figure 19- Figure 23, each staple drivers 10040 may include at least one inclined-plane 10042, and sliding part 10050 may include one or more Inclined-plane 10052, it is enabled to when sliding part 10050 is pushed into nail bin towards distal side, and inclined-plane 10052 is on inclined-plane 10042 Lower slider.When staple drivers 10040 are lifted up in its respective nail cavity 10012, staple drivers 10040 will can be followed closely 10030 are lifted up so that nail 10030 can be exposed by the opening in nail platform 10011 from its nail cavity 10012.In example During property percussion sequence, referring first to Figure 25-Figure 27, sliding part 10050 contact stud 10030a first and can start to follow closely 10030a is lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start that 10030b will be followed closely, 10030c, 10030d, 10030e and 10030f and any other follow-up nail are lifted in order.As shown in figure 27, sliding part 10050 can drive up nail 10030 so that and the leg 10032 of the nail contacted with relative anvil block is deformed into desired shape, and And it is shot up from support section 10010.In all cases, the part as percussion sequence, sliding part 10030 can simultaneously by The motion upwards of multiple nails.Percussion sequence shown in reference picture 27, nail 10030a and 10030b have moved to its complete firing position And it is shot up from support section 10010, during nail 10030c and 10030d is in by percussion and by least in part It is contained in support section 10010, and follows closely 10030e and 10030f and be still within its non-firing position.

As described above and referring to Figure 33, when nail 10030 is in its non-firing position, following closely 10030 nail leg 10032 can prolong Reach the top of platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 27, nail 10030e and 10030f is illustrated at its non-firing position, and its nail leg 10032 extends to the top of platform surface 10011 and extended to In tissue thickness compensation part 10020.When nail 10030 is in its non-firing position, the top of nail leg 10032 or nail leg 10032 Any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.Such as Figure 27 institutes Show, when nail 10030 moves to its firing position from its non-firing position, the end of nail leg convex can wear tissue contacting surface 10032.The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.Tissue Thickness compensation part 10020 may include multiple holes, and the multiple hole can receive nail leg 10032 and allow nail leg 10032 relative Slided in tissue thickness compensation part 10020.Support section 10010 may also include the multiple guiding extended from platform surface 10011 Device 10013.Guider 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011 so that nail leg 10032 can be at least Partly supported by guider 10013.Guider 10013 can be positioned in the proximal extremity and/or distal end of nail cavity opening Place.According to the present invention, the first guider 10013 can be positioned in the first end of each nail cavity opening, and the second guider 10013 can be positioned in the second end of each nail cavity opening so that the sustainable nail 10030 of each first guider 10013 First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guider 10013.Referring to Figure 33, each lead It may include that groove or slit, such as groove 10016, such as nail leg 10032 can be slidably received in the groove to device 10013 In 10016.Optionally, each guider 10013 may include to extend and may extend into tissue thickness's benefit from platform surface 10011 Repay anti-skid stud, projection, and/or the spike in part 10020.As described in more detail below, anti-skid stud, projection, and/or spike can subtract Relative motion between cell thickness compensation part 10020 and support section 10010.The top of nail leg 10032 can be positioned in It can not extended on the top surface of guider 10013 in guider 10013 and when following closely 10030 and being in its non-firing position Side.For example, guider 10013 can limit guiding height, and this can not be extended to when following closely 10030 and being in its non-firing position Above guiding height.

According to the present invention, tissue thickness compensation part (such as tissue thickness compensation part 10020) for example can be by single material piece Form.Tissue thickness compensation part may include continuous sheet, and the continuous sheet can cover the whole top of support section 10010 Platform surface 10011, or alternatively, covering is less than whole platform surface 10011.Material piece can cover supporting part Nail cavity opening in points 10010, but alternatively is that material piece may include can to align with nail cavity opening or at least The opening of section aligned.According to the present invention, tissue thickness compensation part can be made up of for example multiple material layers.Referring now to Figure 15, Tissue thickness compensation part may include compressible core and the wrappage around compressible core.Wrappage 10022 can be by compressible core Releasably hold support section 10010.For example, support section 10010 may include for example from the one or more of its extension Protuberance, such as protuberance 10014 (Figure 18), the protuberance can be received in one or more holes and/or slit, such as limited In hole 10024 in wrappage 10022.Protuberance 10014 and hole 10024 enable to protuberance 10014 can be by wrappage 10022 remain to support section 10010.The end of protuberance 10014 for example can be handled to deform, to expand by rivet hot weldering The end of protuberance 10014, and therefore limit the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 may include one or more perforation 10025, and it can be advantageous to discharge wrappage 10022 from support section 10010, such as Shown in Figure 15.Referring now to Figure 24, tissue thickness compensation part may include wrappage 10222, and the wrappage includes multiple holes 10223, its mesopore 10223 can align with the nail cavity opening in support section 10010 or at least partly align.Tissue thickness compensates The core of part may also include the hole alignd with the hole 10223 in wrappage 10222 or at least partly alignd.Alternatively select Select, the core of tissue thickness compensation part may include continuous main body and may extend into below hole 10223 so that continuous main body covering Nail cavity opening in platform surface 10011.

Optionally, as described above, tissue thickness compensation part may include to be used to compressible core releasably holding support The wrappage of part 10010.For example, with reference to Figure 16, nail bin may also include retainer fixture 10026, and the retainer fixture can Suppress wrappage and compressible core prematurely separates with support section 10010.Optionally, each retainer fixture 10026 can wrap The hole 10028 of the protuberance 10014 extended from support section 10010 can be received by including so that retainer fixture 10026 can be protected Hold support section 10010.Retainer fixture 10026 can each include at least one flat of bottom 10027, and the flat of bottom can Extend to below support section 10010 and in the inner support of support section 10010 and keep staple drivers 10040.As described above, Tissue thickness compensation part can be removably attachable to support section 10010 by nail 10030.More particularly, as also described above, When following closely 10030 and be in its non-firing position, follow closely 10030 leg and may extend into tissue thickness compensation part 10020, and therefore general Tissue thickness compensation part 10020 releasably holds support section 10010.The leg of nail 10030 can its corresponding nail cavity 10012 side wall contact, wherein, due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part 10020 can be maintained at appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue is thick Degree compensating part 10020 can be trapped in nail 10030 and is kept against the tissue T of suture.Beaten when anvil block is subsequently moved into When open position is to discharge tissue T, support section 10010 is movable away from the tissue thickness compensation part 10020 for having been secured to tissue. It can be used adhesive that tissue thickness compensation part 10020 is removedly remained into support section 10010.Usable two parts glue Mixture, wherein, the Part I of adhesive can be placed on platform surface 10011, and the Part II of adhesive can quilt It is placed into tissue thickness compensation part 10020 so that when tissue thickness compensation part 10020, which is close to platform surface 10011, places, Part I can contact Part II to enable adhesive and tissue thickness compensation part 10020 is separably bonded into supporting part Divide 10010.Optionally, it can be used any other suitable method that tissue thickness compensation part is separably remained to the branch of nail bin Support part point.

Further described above, sliding part 10050 proximally can be advanced to distal end in end 10001 10002 are accommodated in all nails 10030 in nail bin 10000 with complete deployment.Referring now to Figure 56-Figure 60, sliding part 10050 It can be pushed away in the longitudinal cavity 10016 in support section 10010 by the knife bar 10052 of firing member or surgical stapling device towards distal side Enter.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, such as staple cartridge channel 10070 It is interior, and firing member 10052 can be advanced to and be contacted with sliding part 10050, as shown in figure 56.When sliding part 10050 is by hitting Hair component 10052 towards distal side promotes when, sliding part 10050 can contact the staple drivers or driver 10040 of recent side, and general Nail 10030 is fired or projected from warehouse 10010, as described above.As shown in figure 56, firing member 10052 may also include cutting blade 10053, when nail 10030 is fired, the cutting blade can be pushed into by the cutter slit in support section 10010 towards distal side.According to The present invention, corresponding cutter slit can extend across the anvil block for being positioned in the opposite of nail bin 10000 so that cutting blade 10053 can be in anvil Extend and cut tissue and the tissue thickness compensation part being positioned in therebetween between seat and support section 10010.In various situations Under, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the distal side of nail bin 10000 End 10002, as shown in figure 58.Now, firing member 10052 can proximally bounce back.Sliding part 10050 can be with firing member 10052 proximally bounce back, but referring now to Figure 59, when firing member 10052 bounces back, sliding part 10050 can be left on nail In the distal end 10002 in storehouse 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue is thick Degree compensating part 10020 can separate with support section 10010, and exhaust the remaining non-implanted portion of nail bin 10000, including Support section 10010, it can be removed from staple cartridge channel 10070.

When exhausted nail bin 10000 from staple cartridge channel be removed after, further described above, new nail bin 10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin leads to Road 10070, firing member 10052, and/or nail bin 10000 may include cooperative structures, and the cooperative structures can be in new non-percussion nail Storehouse 10000 prevents firing member 10052 to be pushed into again or then towards distal side when being not located in staple cartridge channel 10070. More particularly, referring again to Figure 56, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and when slip When part 10050 is in its nearside non-firing position, the support nose 10055 of firing member 10052 can be positioned in sliding part On support lugn 10056 on 10050 and/or on so that firing member 10052 is maintained at position upward enough, with Prevent from falling into the lock crossbeam being limited in staple cartridge channel from the lock or crossbeam 10054 of the extension of firing member 10052.Due to lock 10054 when will not fall into lock crossbeam, and in such cases, when firing member 10052 is pushed into, lock 10054 can not abut lock The distal side side wall 10057 of groove.When firing member 10052 promotes sliding part 10050 towards distal side, firing member 10052 can Its upward firing position is supported on due to leaning against the support nose 10055 on support lugn 10056.Work as firing member 10052 relative to sliding part 10050 when bouncing back, and as described above and as shown in figure 59, is being slided when support nose 10055 does not rely on When on the support lugn 10056 of part 10050, firing member 10052 can fall from its upward position.For example, surgical staples may include Firing member 10052 can be biased to the spring 10058 and/or any other suitable biasing element of its down position.One Denier firing member 10052 has been fully retracted, and as shown in figure 60, firing member 10052 can not again pass through the nail bin 10000 used up It is pushed into towards distal side.More particularly, when the sliding part 10050 for being now in operation order has been left on the remote of nail bin 10000 When at side end 10002, firing member 10052 can not be maintained at its upper position by sliding part 10050.Therefore, as described above, If firing member 10052 is re-advanced in the case of no replacement nail bin, lock beams 10054 will contact lock crossbeam Side wall 10057, this will prevent firing member 10052 to be advanced to again towards distal side in nail bin 10000.In other words, once with Most nail bin 10000 is replaced by new nail bin, and for new nail bin by with proximally-oriented sliding part 10050, this is proximally-oriented Sliding part firing member 10052 can be maintained to its upward position, and firing member 10052 is pushed away again towards distal side Enter.

As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing position Between move, so as to which nail 10030 is projected from support section 10010.It has been shot up from support section 10010 in nail 10030 After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that staple drivers can be prevented The 10040 one or more holding feature structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 can project staple drivers 10040 from the support section 10010 with nail 10030.For example, staple drivers 10040 It can be made up of for example bioabsorbable and/or biocompatible materials, such as PEI (Ultem).Staple drivers can It is attached to nail 10030.For example, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding so that driving Device is integrally formed with nail.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE that September in 2006 is submitted on the 29th OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent applications No.11/541,123 is incorporated by reference in its entirety herein.

As described above, surgery suturing appliance may include that the staple cartridge channel of nail bin can be received, be rotationally coupled to nail bin The anvil block of passage and the firing member including blade, the firing member can move relative to anvil block and staple cartridge channel.Using In, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can remove from staple cartridge channel And replaced by new nail bin.For example, the staple cartridge channel of surgery suturing appliance, anvil block, and/or firing member can be with replacing nail bin one Rise and be reused.Alternatively, nail bin may include a part for disposable loading unit component, and this disposably adds Carrier unit component for example may include staple cartridge channel, anvil block, and/or firing member, and these can be used as and replace disposable loading unit A part for component is replaced with nail bin.Some disposable loading unit components are disclosed in what is submitted within 2 15th, 2008 Entitled " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT " U.S. Patent application No.12/031, in 817, the complete disclosure of the patent application is by reference simultaneously Enter herein.

Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded, and it includes as described herein At least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two layers or more layer Or piece.Tissue thickness compensation part can be used conventional method obtain, such as mixing, blending, combination, spraying, wicking, solvent evaporation, Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..During extrusion, opening can include at least one opening The form of mould is that the extrudate exposed assigns shape.During calendering, opening may include the roll gap between two rollers.Conventional molding Method may include but be not limited to be blow molded, be molded, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blow blowing, calendering, Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraper Coating, roller coat and casting), and combinations thereof.During injection, opening may include nozzle and/or passage/runner and/or mould Cavity and feature structure.During compression moulding, composition can be positioned in cavity body of mould, be heated to suitable temperature, and by relative Compressed and shaped under high pressure.During casting, composition can include liquid or slurries, and it, which injects or otherwise provided, arrives mould The inside of tool or object, above and/or surrounding, with the feature structure of copy mold or object.After casting, composition can be done It is dry, cool down and/or be cured to form solid.

According to the present invention, manufacture includes at least one preservation and/or is absorbed in the tissue thickness compensation part of medicine therein Method offer tissue thickness compensation part can be provided, and tissue thickness compensation part and medicament contact is retained medicine In tissue thickness compensation part.Manufacture comprising antiseptic materials microstructure thickness compensation part method may include provide hydrogel, Dried hydrogel, in silver nitrate aqueous solution swollen hydrogel, contact hydrogel and sodium chloride solution, there is antibacterial to be formed The tissue thickness compensation part of characteristic.Tissue thickness compensation part may include the silver being dispersed therein.

Referring now to Figure 116, tissue thickness compensation part (for example, tissue thickness compensation part 22020) can for example be attached to outer The anvil block (for example, anvil block 22060) of section's suture instruments.Tissue thickness compensation part 22020 may include to be limited to the He of the first film 22026 Cavity 22024 between second film 22027, wherein at least part of the first film 22026 is attached to the second film 22027.For example, the One film 22026 can be attached to the second film 22027 along such as transverse joint 22028a and transverse joint 22028b.First film 22026 can be along the peripheral attachment of sealing to the second film 22027, hermetically to encapsulate cavity 22024.First film 22026 and Two films 22027 can such as transversely seam 22028a, 22028b and/or any other seam of junctional membrane 22026 and film 22027 To carry out thermal weld.Referring again to Figure 116, anvil block 22060 may include multiple nail shapes pits 22062, the multiple nail shaping Pit 22062 can each receive the leg of nail and make its deformation, wherein the second film 22027 may include to may extend into forming pit Protuberance 22022 in 22062.The size and construction of protuberance 22022, which can be set to, makes it be snugly fit inside forming pit In 22062 and tissue thickness compensation part 22020 can be remained to anvil block 22060.As illustrated, anvil block 22060 may include Such as six row forming pits 22062, wherein tissue thickness compensation part 22020 can be similarly included aligns with forming pit 22062 Six row protuberances 22022.Can be used is included more or less than other of six row forming pits 22062 and/or protuberance 22022 Embodiment.It can be used one or more adhesives that tissue thickness compensation part 22020 is remained into anvil block 20060.

As described above, tissue thickness compensation part 22020 may include to be defined in cavity 22024 therein.Cavity 22024 can edge The Longitudinal extending of anvil block 22060.Referring again to Figure 116, tissue thickness compensation part 22020 may include to be positioned in cavity 22024 Compressible material.Referring now to Figure 117, nail (such as following closely 22030) can be projected for example from nail bin, to cause nail 22030 connecing Penetrate tissue T before touching anvil block 22060 and then penetrate tissue thickness compensation part 22020.When the leg of nail 22030 passes through anvil block 22060 when being deformed, and leg can downwardly turn over, to penetrate tissue thickness compensation part 22020 again.Under any circumstance, once Nail 22030 has penetrated tissue thickness compensation part 22020, and being contained in one or more fluids in cavity 22024 just for example can be from Tissue thickness compensation part 22020 flows out or is exuded in tissue T.Cavity 22024 may include the one kind being for example accommodated therein or Various powders, the powder can escape chamber in tissue thickness compensation part 22020 once followed closely 22030 and ruptured at least in part Body 22024.According to the present invention, the material 22025 being positioned in cavity 22024 can be when nail 22030 be deformed into its percussion configuration Compressed or be squeezed in nail 22030, for example can be extruded with the fluid for be stored in material 22025 from material 22025.Again Secondary to capture tissue thickness compensation part (for example, compensating part 22029) referring to Figure 117, nail 22030, the compensating part is for example It is removably attached to the nail bin of the opposite side against tissue T.

Further described above, material 22025 may include the fibrin ferment of such as freeze-drying, the blood of freeze-drying Fibrin, and/or the non-woven oxidized regenerated cellulose of fine fibre.Material 22025 may include the powder chip of compression.Annular seal space Body 22024 may include internal gas, and the pressure of the internal gas is less than the pressure of the air around tissue thickness compensation part 22020 Power.In this case, the pressure difference between the gas and air in internal cavity 22024 can cause film 22027 and the quilt of film 22028 Inwardly towing.After internal cavity 22024 is by the rupture of nail 22030, as described above, vacuum in internal cavity 22024 can be with Ambient atmosphere obtains balance and material 22025 can escape internal cavity 22024, also as described above.In such cases, group Knitting thickness compensation part 22020 can extend to tissue T of the capture in nail 20030 and apply compression stress.In material 22025 by vacuum In the case of being encapsulated in tissue thickness compensation part 22020, material 22025 can expand after internally cavity 22024 is pierced Exhibition.Film 22026,22027 can be made up of bioabsorbable property material, and can just dissolved when being placed in patient. For example, each film 22026,22027 can be made up of layer or lamilate, the layer or lamilate have for example close between about 0.25 Thickness between ear and about 0.50 mil.Under any circumstance, further described above, when nail 22030 is followed closely from it When storehouse fires, including can be cut element crosscutting for the tissue thickness compensation part 22020 of material 22025.

Referring again to Figure 116, the cavity 22024 and material 22025 of tissue thickness compensation part 22020 can be positioned in nail into Below four inner rows of shape pit 22062, and seam 22028a, 22028b can be positioned in the outside of forming pit 22062 Row is following.In this case, the nail in outside nail row can not grafting material 22025, and therefore they can not catch wherein Obtain material 22025.On the contrary, such nail can capture film 22026 and film 22027 only along seam 22028a, 22028b.As another A kind of outer selection, referring now to Figure 118 and Figure 119, tissue thickness compensation part 22120 can according to it is similar manner as above including The multiple materials of first film 22126, the second film 22127 and capture between the first film 22126 and the second film 22127 22125a-d.For example, referring primarily to Figure 118, the first material 22125a can with the outer skidding of the nail 22030 in nail bin 22000 and The outer skidding alignment of nail cavity 22062 in anvil block 22060, the second material 22125b and the 3rd material 22125c can each with nail 22030 and nail cavity 22062 two inner rows alignment, and the 4th material 22126d can with nail 22030 and nail cavity 22062 it is another One outer skidding alignment.In this case, referring now to Figure 119, following closely can all be arranged in 22030 makes it can be at it At least one of middle capture material 22125a-22125d.As shown in Figure 118 and Figure 119, further described above, Nail 22030 can between non-firing position and firing position by the staple drivers 22040 that are positioned in nail bin 22000 come upwards Lifting.

Referring again to Figure 118 and Figure 119, layer 22126 and layer 22127 can limit the one of wherein settable material 22125a-d Individual or multiple seal cavities.Layer 22126 and layer 22127 can be peripherally for example using any suitable method (for example, thermal welds And/or laser welding) be sealed, the periphery may include transverse joint 22128a and transverse joint 22128b.Material Each of 22125a-22125d is enclosed in independent cavity, and alternatively, material 22125a- In 22125d both or more person be enclosed in same cavity.Material 22125a-22125d can be made up of identical material, And alternatively, one or more of material 22125a-22125d can be made up of different materials.Material One or more of 22125a-22125d can be made up of such as odium stearate and/or LAE.Material 22125a-22125d can be wrapped Include lubricant.In such cases, when nail leg penetrates the material 22125a-22125d of tissue thickness compensation part 22120, can make The leg of nail 22030 is exposed to lubricant.After leg passes through tissue thickness compensation part 22120, leg can contact anvil block 22060, its Middle lubricant can reduce the coefficient of friction and frictional force between nail leg and anvil block 22060.In such cases, percussion nail can be reduced Power needed for 22030.Due to tissue thickness compensation part 22120 abut anvil block 22060 positioning, follow closely 22030 nail leg can from Open tissue thickness compensation part 22120 and directly contact anvil block 22060 afterwards, thus reduce before nail leg contacts anvil block 22060 The possibility of lubricant can be wiped from nail leg.Similarly, the nail leg for following closely 22030 can be exposed to tissue thickness compensation part 22120 Direct contact anvil block 22060 after interior one or more medicines, thus reducing before nail leg reenters tissue T can be from Nail leg wipes the possibility of medicine.In some cases, when nail leg deforms downwards, nail leg can reenter tissue thickness's compensation Part 22120, to cause nail leg to be exposed to medicine again for example before tissue T is reentered.It is optionally, similar to the above, Second film 22127 may include the multiple protruding portion 22122 that can be for example closely received in nail cavity 22062, so as to for example by group Knit thickness compensation part 22120 and remain to anvil block 22060.

Referring now to Figure 120 and Figure 121, the end effector of surgery suturing appliance may include tissue thickness compensation part (example Such as, compensating part 22220), what institute's tissue thickness compensation part for example can align including the nail shapes pit 22062 with anvil block 22060 Multiple cavities 22222.Compensating part 22220 can be made up of first layer or bottom 22226 and the second layer or top layer 22227, wherein the One layer 22226 and/or the second layer 22227 may include multiple bossings of limited cavity 22222 or local bubble.Such as figure Shown in 120, compensating part 22220 could attach to anvil block 22060, to cause the nail shapes pit of cavity 22222 and anvil block 22060 22062 alignment are at least substantially alignd.Optionally, each cavity 22222 may include the one or more medicines being accommodated therein Thing, for example, oxidized regenerated cellulose, calcium, and/or alginates.During use, each cavity 22222 can be for example by from nail The nail 22030 that storehouse 22000 is projected is in sealing, does not pierce through state before piercing through.Referring now to Figure 121, nail 22030 leg Through after tissue T, each nail leg is pierceable and penetrates first layer 22226 and enters cavity 22222, and wherein nail leg then may be used Through the one or more medicines being accommodated therein before piercing through and penetrating the second layer 22227.It is similar to the above, nail 22030 Leg can then contact anvil block 22060.

Cavity 22222 can keep being stored in one or more medicines therein before rupture and be in drying regime or at least Essentially dry state.After cavity 22222 has ruptured, fluid (for example, blood) can enter cavity 22222 and with one Kind or multi-medicament mixing.The mixture of fluid and medicine can cause medicine to be expanded in cavity 22222, wherein for example medicine can Including for example, at least a kind of hydrogel.Medicine may include for example, at least a kind of hemostasis agent material.First layer 22226 and/or second Layer 22227 can be made up of flexible material, and the flexible material is stretchable to adapt to the expansion of medicine.Layer 22226,22227 can be by Such as CAP/GLY materials are formed.Under any circumstance, the expansion of medicine for example in nail 22030 and/or can be positioned to capture Tissue around nail 22030 applies compression stress.In all cases, the expansion of medicine can cause cavity 22222 to rupture.For example, First group of cavity 22222 can include the first medicine wherein, and second group of cavity 22222 can include the second medicine wherein.Example Such as, the first medicine can expand the first amount and/or be expanded with first rate, and the second medicine can expand the second amount and/or with Second speed expands, for example, wherein the first amount may differ from the second amount and/or first rate may differ from the second speed. Further described above, one or more cavitys 22222 may include to be stored in one or more medicines in each cavity Thing, wherein medicine may include such as the first medicine and the second medicine.Cavity 22222 can keep the first medicine and before rupture Two medicines are in drying regime or at least substantially dry state.As described above, after cavity 22222 has ruptured, blood Such as can enter in cavity 22222 and be mixed with the first medicine and the second medicine, wherein the first medicine and the second medicine can shapes Into the gel of expansion.

Referring now to Figure 122-124, tissue thickness compensation part (for example, compensating part 22320) may include can respectively with nail into The multiple first cavity 22322a and multiple second cavity 22322b of shape pit 22062a and nail shapes pit 22062b alignment.It is main The independent ladder table that can be limited to referring to Figure 123, nail shapes pit 22062a and nail shapes pit 22062b on anvil block 22060 In face.More particularly, for example, forming pit 22062a can be limited in the first surface 22069a of anvil block 22060, and into Shape pit 22062b can be limited in second surface 22069b, and wherein first surface 22069a can be positioned so that deviation or higher than the First cavity 22322a of two surface 22069b tissue thickness compensation parts 22320 can be more than the second cavity 22322b, wherein for example First cavity 22322a can be higher than the second cavity 22322b and extend.Due to described above, the first cavity 22322a can prolong upwards Reach in the first nail shapes pit 22062a, while the second cavity 22322 can extend up to the second nail shapes pit 22062b In.Optionally, each first cavity 22322a for example can include bigger medication amount than the second cavity 22322b.As in addition One kind selection, the first cavity 22322a and the second cavity 22322b can be wherein comprising identical or at least substantially identical medicines Amount, even if cavity 22322a and cavity 22322b can be of different sizes.

Further described above, the first cavity 22322a can be disposed in particular row, and the second cavity 22322b, which can be disposed in, not to go together.Tissue thickness compensation part may include the cavity to be alignd with each forming pit, and conduct Another option, referring to Figure 130, tissue thickness compensation part (for example, compensating part 22420) for example may include with forming pit Only some alignment cavitys.Referring again to Figure 123, compensating part 22320 could attach to anvil block 22060.Cavity 22322a and/or Cavity 22322b is configurable to make it be snugly fit inside nail shapes pit 22062a and/or nail shapes pit 22062b respectively It is interior.Compensating part 22320 can be assembled into anvil block 22060, to cause the second layer 22327 of compensating part 22320 to be oriented to abut The second surface 22069b of anvil block 22060.Alternatively, can quilt referring now to Figure 125 and 126, compensating part 22320 Be positioned adjacent to anvil block 22060 so that proper anvil block 22060 towards nail bin 22000 move with by tissue T compression therebetween when, mend Anvil block 22060 can be abutted by repaying part 22320.Referring now to Figure 127, once nail 22030 fires from nail bin 22000 and passes through anvil Seat 22060 is deformed, and compensating part 22320 can abut tissue T by the capture of nail 22030 and anvil block 22060 is with regard to removable remote From compensating part 22320.In some cases, anvil block can not be passed through referring now to Figure 128, nail one or more of 22030 22030 are correctly deformed.In such cases, referring now to Figure 129, when nail is fired, overlay on do not fire or not into Cavity in the tissue thickness compensation part for nailing on face of shape can be pierced.For example, tissue thickness compensation part can be by that biological can inhale The property received material is formed, and the bioabsorbable property material can dissolve and then release is contained in the medicine not pierced through in cavity.

Further described above, the first cavity 22322a of tissue thickness compensation part 22320 and/or the second cavity 22322b may include for example to be sealed in gas therein, for example, air, carbon dioxide, and/or nitrogen.Cavity 22322a and/or Cavity 22322b may include bubble, and the bubble can be quick-fried when following closely 22030 percussions through cavity 22322a and/or cavity 22322b Split, gas therein is contained in release.This explosion can be the surgery for rupturing cavity 22322a and cavity 22322b Doctor provides sound feedback.However, in some cases, some nails 22030 can not fire, as described above, and and its Associated cavity 22322a and cavity 22322b can not burst.In all cases, surgeon can be to the tissue of suture Any bubble not burst or cavity 22322a and cavity 22322b are scanned, and determines the need for taking any correction to arrange Apply.

As described above, referring now to Figure 131, surgery suturing appliance may include firing member, for example, firing member 22080, The firing member 22080 may include cutting element or cutting edge 22081, and the cutting element or cutting edge 22081 can hit Hair component 22080 is advanced through storehouse 22000 to be advanced through tissue T and one or more tissue thickness when disposing nail 22030 from it Spend compensating part.Referring primarily to Figure 133, compensating part (for example, compensating part 22520) could attach to the anvil block of surgery suturing appliance 22060, wherein anvil block 22060 may include that size and construction are set to that at least one of knife for receiving cutting element 22081 is narrow Groove 22061.Similarly, nail bin 22000 may include that size and construction can also be set at least one of reception cutting element 22081 The cutter slit 22011 divided.Referring again to Figure 131, compensating part 22520 may include for example along the line of cut 22521 of compensating part 22520 One or more cavitys of positioning, for example, cavity 22522, wherein cavity 22522 can be narrow with the knife that is limited in anvil block 22060 Groove 22061 aligns.When cutting element 22081, which is distally advanced, follows closely 22030 through nail bin 22000 to dispose, cutting element 22081 can cut into the cavity 22522 of tissue T and compensating part 22520.It is similar to the above, referring primarily to Figure 132, each cavity 22522 can limit the cavity 22524 of sealing, and the cavity 22524 of the sealing can include one or more medicines wherein 22525.One or more of cavity 22522 can include fluid, and the fluid can be cut component in cavity 22522 22081 discharge when cutting at least in part.In all cases, cutting element 22081 can continuously cut cavity 22522, and And it therefore can continuously discharge the medicine being contained therein.

Referring primarily to Figure 133, compensating part 22520 may include laterally projecting portion or the wing 22529 to be extended sideways along it.It is prominent Portion 22529 is fixed to anvil faces 22069a and/or anvil faces 22069b using for example one or more adhesives.It is prominent The size and construction in portion 22522 can be set in the cutter slit 22061 for being snugly fit inside anvil block 22060, for example to dash forward Anvil block 22060 can be remained to by compensating part 22520 by going out portion 22522.The size and construction in laterally projecting portion 22529, which can be set to, to be made It is extended to or overlayed on nail shapes pit 22062b and/or nail shapes pit 22062a.Alternatively, join now See Figure 134 and Figure 135, compensating part 22620 may include laterally projecting portion 22629, and the laterally projecting portion 22629 does not extend into simultaneously Or overlay on the nail shapes pit 22062a and 22062b and/or any other nail shapes pit of such as anvil block 22060.For example, Compensating part 22620 at large can be obtained in the nail 22030 projected from nail bin 22030.Under any circumstance, referring again to Figure 131, Cutting element 22081 can compensating part 22520 by nail 22030 be fixed to tissue T when crosscutting compensating part 22520.In such situation Under, compensating part 22520 can be separated with anvil block 22060 and kept together with tissue T.Referring again to shown in Figure 134 and Figure 135 Compensating part 22620, compensating part 22,620 22030 can not be fixed to anvil block 22060 by nail, and can be in cutting element 22081 Compensating part is remained attached into anvil block 22060 after crosscutting compensating part 22620.

Referring now to Figure 136 and Figure 137, the end effector of surgery suturing appliance may include tissue thickness compensation part, example Such as compensating part 22720, the compensating part 22720 could attach to or can be attached to anvil block, such as anvil block 22760 etc..With Similar to the above, anvil block 22760 may include multiple nail shapes pits 22762 and longitudinal knife slot 22761, the longitudinal knife slot 22761 can receive cutting element wherein when cutting element is advanced through end effector.Compensating part 22720 may include can It is attached to one another to limit the first film layer 22726 of cavity 22724 and the second film layer 22727.For example, the first film layer 22726 can edge The neighboring 22728 of sealing is attached to the second film layer 22727, wherein the neighboring 22728 sealed can such as receiving cavity 22724 At least one of medicine 22725.As shown in Figure 137, cavity 22724 and medicine 22725 can prolong below whole nail cavities 22762 Stretch, and the periphery 22728 sealed can be positioned laterally relative to outermost nail cavity 22762.Compensating part 22720 may also include example Such as longitudinal rib 22721, the longitudinal rib 22721 can be extended up in cutter slit 22761.For example, the size of rib 22721 and Construction, which can be set to, to be snugly fit inside in cutter slit 22761, so as to which compensating part 22720 is fixed into anvil block 22760.Rib 22721 can make that compensating part 22720 is alignd with anvil block 22760 or center is aligned.Similarly, referring to Figure 138, tissue thickness's compensation Part 22820 may include holding rib 22821, and the holding rib 22821 can be for example positioned in cutter slit 22761, to mend Repay part 22820 and be fixed to anvil block 22760.Referring again to Figure 137, in all cases, when cutting element is advanced through cutter slit When 22761, cutting element crosscutting rib 22721 and can be such that compensating part 22720 is discharged from anvil block 22760.For example, this cutting structure Part is shown as a part for firing member 22080 in Figure 138.

Referring again to Figure 138, tissue thickness compensation part 22820 may include first layer 22826 and the second layer 22827, described First layer 22826 and the second layer 22827 can be constructed and arranged to limit multiple first package 22824a and multiple second packages 22824b.Each in first package 22824a can include the first medicine, and each in the second package 22824b The second medicine can be included, wherein the second medicine may differ from the first medicine.First package 22824a and the second package 22824b Alternate configurations can be arranged to.For example, the first package 22824a and the second package 22824b can be extended transversely with across tissue thickness Compensating part 22820 is spent, to cause such as the second package 22824b to be positioned at two the first package 22824a centres and the first envelope Bag 22824a is positioned among two the second package 22824b.When cutting element 22080 travels across compensating part 22820, such as Shown in Figure 138, cutting element 22080 can crosscutting first package 22824a, be the second package 22824b afterwards, be the first envelope afterwards 22824a is wrapped, is second package 22824b etc. afterwards.Correspondingly, in such cases, cutting element 22080 can be released continuously The first medicine being for example contained in the first package 22824a and the second medicine being contained in the second package 22824b are put, it is described First package 22824a and the second package 22824b is in alternate configurations.In the first package 22824a and the second package 22824b Be oriented to it is adjacent to each other in the case of, when the first medicine and the second medicine are from its corresponding first package 22824a and the second envelope When wrapping 22824b releases, the first medicine can mix with the second medicine.For example, cutting element passes through the propulsion of compensating part 22820 It may be such that the first medicine mixes with the second medicine.

Further described above, the first medicine may include the first powder, and the second medicine may include the second powder. First medicine and/or the second medicine can be made up of the agent material that for example stops blooding, oxidized regenerated cellulose, alginates, and/or calcium.The One medicine and/or the second medicine may include fluid.One or more of first package 22824a and/or the second package 22824b One or more of may include lubricant, the lubricant, which can reduce, promotes firing member 22080 to pass through compensating part 22820 And/or the power needed for tissue T.First film layer 22826 and/or the second film layer 22827 can by such as bioabsorbable material (such as PDS) form.First film layer 22826 and the second film layer 22827 can be attached to one another, to cause the first package 22824a being fired Component 22080 seals off before cutting with the second package 22824b.First package 22824a and/or the second package 22825b can With certain rupture strength, to be resistant to certain fracture pressure.More particularly, when anvil block (for example, anvil block 22760) court When back to the bin motion compensation part 22820 of the positioning of anvil block 22760, package 22824a, package 22824b can be positioned so that tightly By the tissue being arranged among package 22824a, package 22824b and nail bin, wherein anvil block 22760 can be pushed away then downwardly toward nail bin Pressure clamps, so as to the tissue of compression set therebetween.In such cases, package 22824a, package 22824b can be through being pressurized Compression pressure.In some cases, it is desirable to package 22824a and/or package 22824b keeps complete, until they are cut component 22080 incisions and/or the nail by being fired from nail bin pierce through.In some other cases, package 22824a and/or package it is expected 22824b being applied to its compression clamp load because rupturing.

As described above, the first package 22824a and the second package 22842b can be extended transversely with across compensating part 22820.Example Such as, the first package 22824a can extend along axis of pitch 22823a, and the second package 22824b can be along axis of pitch 22823b extends.First axle 22823a and/or second axis 22823b can perpendicular to or be at least substantially orthogonal to compensating part 22820 longitudinal axis 22083.For example, longitudinal axis 22083 can limit the cutting path of firing member 22080.First axle 22823a and/or second axis 22823b can be not orthogonal to longitudinal axis 22083 and can incline relative to longitudinal axis 22083 Tiltedly.Optionally, as described above, the first package 22824a and the second package 22824b can be arranged to alternate configurations.As in addition One kind selection, can be used the first package 22824a and the second package 22824b any other suitable configuration.For example, it is arranged in Package sequence in tissue thickness compensation part may include the first package 22824a, the second package 22824b, the second package 22824b, With the first package 22824a.Tissue thickness compensation part may also include multiple 3rd packages, and the 3rd package includes being different from the 3rd medicine of one medicine and the second medicine.For example, the first package, the second package and the 3rd package can be arranged to alternately structure Type.For example, the package sequence being arranged in tissue thickness compensation part may include such as the first package, be afterwards the second package, it After be the 3rd package.

Referring again to Figure 138, the first package 22824a and/or the second package 22824b of tissue thickness compensation part 22820 Can limit such as U-shaped or at least substantially cross section of U-shaped.Referring now to Figure 139, the envelope of tissue thickness compensation part 22920 Bag 22924 can limit for example circular or at least substantially circular cross section.Referring now to Figure 140, tissue thickness compensation part 23020 package 23024 can limit for example ovate and/or oval cross section.Referring again to Figure 138, the first cavity 22824a and the second cavity 22824b may include to be limited to symmetrical in parallel or at least substantially parallel row or at least Almost symmetrical configuration.Alternatively, referring now to Figure 141, tissue thickness compensation part is (for example, compensating part 23120) may include to be limited to asymmetric cavity 23122 therein, the asymmetric cavity 23122 can have for example irregular And/or non-repetitive pattern.For example, each in cavity 23122 can be wherein comprising one or more different medicines.

Referring now to Figure 142, tissue thickness compensation part (for example, tissue thickness compensation part 23220) may include housing 23226, the housing 23226 limits cavity 23224 therein and the material 23225 being positioned in cavity 23224.Housing 23226 can be made up of such as absorbable polymer, PDS, PGA, PLLA, Cap Gly, and/or PCL, and material 23225 can be by example Such as styptic, oxidized regenerated cellulose, Hercules, fibrin, and/or fibrin ferment composition, the material 23225 can be adopted With any suitable form, such as powder, fiber, and/or gel.Housing 23226 can be manufactured using expressing technique.Such In the case of, housing 23226 may include constant along its length or at least substantially constant cross section, and the housing 23226 can Produced in the case where seam need not be welded.For example, cavity 23224 can be limited by the side wall extended around its whole periphery Fixed, the side wall, which does not have, is defined in opening therein.Housing 23226 can by be defined in opening therein mesh sheet and/ Or straw shape material is formed.Cutting openings can be carried out for example, by laser cutting parameter and/or clicking technique in housing 23226.

As a part for manufacture material 23225, referring now to Figure 145-147, strands line can utilize fiber and/or fiber Material (for example, oxidized regenerated cellulose) is formed.Can will be shorter shown in the longer fibers 23325 shown in Figure 145 and Figure 146 Fiber 23425 mixes in the way of shown in Figure 147, to form the strands line of material 23225.Strands line can be in tension force Lower progress drawing and/or it is settable under tension, to stretch the fiber being contained therein along the longitudinal direction.Referring now to figure 148, the strands line of material 23225 can be shaken up by grasper 23290, and the grasper 23290 can firmly grasp and distortion material 23225 are expected to increase the volume of strands line.For example, when strands line just moves relative to such as grasper 23290, grasper 23290 can shake up material 23225.Referring again to Figure 148, cutting element can be for example utilized in the strands line of material 23225 23291 prepare small otch and/or micro-incision.It is similar to the above, when strands line just moves relative to cutting element 23291, The cleavable material 23225 of cutting element 23291.The strands line of material 23225 can be shaken up before above-mentioned otch is prepared, and be made For another option, the strands line of material 23225 can be cut into before it is shaken up.

Once the strands line of material 23225 is suitably prepared, so that it may which material 23225 is positioned in housing 23225. Referring now to Figure 149, two or more housings 23226 can be formed together as a part for above-mentioned expressing technique, wherein shell Body 23226 can be connected together using the part as pipe 23227.The strands line of material 23225 can be positioned on or be drawn into limit Due in the cavity 23224 in pipe 23227.The strands line of material 23225 can be positioned in the first openend of cavity 23224 23221 is nearby and/or internal, wherein grasper 23292 can be inserted by the second openend 23222 of cavity 23224.Then may be used Push grasper 23292 and pass through cavity 23224, until the jaw 23292a of grasper 23292 passes through the first openend 23222 simultaneously And/or person is positioned relative to the first openend 23222, to cause grasper jaw 23292a to be manipulated to promptly material 23225 strands line.Grasper may include such as hook component, and the hook component can firmly grasp the strands line of material 23225.It is in office In the case of what, once grasper 23292 has fully firmly grasped the strands line of material 23225, grasper 23292 can recall cavity In 23224, so as to which the strands line of material 23225 is pulled in cavity 23224.Grasper 23292 can be led in strands line Before moving in pipe 23227, period, and/or later distortion material 23225 strands line.

Once the strands line of material 23225 has been properly positioned in pipe 23227, grasper 23292 can be grasped then The vertical strands line with releasable material 23225.Can be before strands line be drawn across the second openend 23222 of pipe 23227 Strands line is discharged, and alternatively, it can be drawn across discharging yarn after the second openend 23222 in strands line Strand, as shown in Figure 150.In some cases, strands line can be drawn through to the second openend 23222, so that proper release During strands line, strands line can be shunk or be sprung back in pipe 23227 by the second openend 23222.In all cases, can be in neighbour The opening position cutting strands line of nearly first openend 23221, to cause strands line to shrink or return by the first openend 23222 It is bound in pipe 23227, it is similar to the above.In all cases, further described above, grasper 23292 can be to material The strands line of material 23225 applies tension force, so that proper grasper 23292 discharges strands line and/or when strands line is cut, yarn Tension force in strand can be released, so as to allow strands linear shrinkage.

Referring now to Figure 151, once the strands line of material 23225 has been sufficiently positioned in pipe 23227, so that it may will manage 23227 and material 23225 cut into multiple sections, wherein each section can be prepared to such as tissue thickness compensation part 23220. Extending through the cavity 23224 of the covering 23226 of each such section may include positioned at the openend of its opposing end portions.Example Such as, can be closed and/or one of sealed opening end or two for example, by rivet hot weldering, thermal weld, and/or laser welding process Person.Referring to Figure 152, the section of the part including covering 23226 and material therein 23225 can be positioned in mould, The openend of covering 23226 can be closed and/or be sealed to the mould.More particularly, mould can be for example including pedestal 23294 and moveable part 23296, wherein section can be positioned in the cavity 23295 being defined in pedestal 23294.Once It is positioned, moveable part 23296 can move down, with to section applying power.Optionally, can via pedestal 23294 and/or Moveable part 23296 heats section, can deform covering 23226 wherein being applied to the heat of section and/or power.More Say, moveable part 23296 can limit pit 23297, and the pit 23297 can be with to covering into profile body 23226 some parts (such as its openend) apply clamping force, to close, flatten, and/or constriction tissue thickness compensation part 23220 these parts.For example, pit 23297 can form the blind end 23228 of tissue thickness compensation part 23220 and press The flat part of tissue thickness compensation part 23220 being positioned among blind end 23228.It is suitable in tissue thickness compensation part 23220 After ground is formed, moveable part 23296 can be moved to open position and tissue thickness compensation part can be removed from mould 23220.Then tissue thickness compensation part 23220 can be positioned in cooling container, wherein compensating part 23220 can be allowed to be cooled to Room temperature and/or any other suitable temperature.

Alternatively, further described above, can be positioned in material 23225 in pipe 23227 The pipe was positioned in hot-forming die later.After pipe 23227 and the material 23225 being positioned in are formed, then Pipe 23227 and material 23225 can be divided into for example multiple tissue thickness compensation parts 23220.It is thick referring again to Figure 142, tissue Degree compensating part 23220 may include the horizontal wing or fixture 23229 that can be for example attached to anvil block 22060.For example, when in mold When dividing formation tissue thickness compensation part 23220 between 23294 and mould part 23296, it can be formed in covering 23226 laterally The wing 23229, as described above.Referring now to Figure 143, tissue thickness compensation part 23320 may include the horizontal stroke extended from covering 23326 Guide vane 23329.Referring now to Figure 144, tissue thickness compensation part 23420 can be for example including connecing with one or more transversal flexibilities The covering 23426 in conjunction portion 23428, one or more of transversal flexibility junction surfaces 23428 can allow covering 23426 to work as Bend and flatten when compression pressure is subjected in above-mentioned hot-forming die.Optionally, due to described above, tissue thickness compensation part 23220 may not include transverse joint.In such cases, anvil block can for example be extended to referring again to Figure 142, material 23225 22060 transverse edge.

As described above, strands line can be drawn through to pipe and be subsequently cut into certain length to form one or more groups Knit thickness compensation part.Further described above, strands line can be pulled or is pushed through using rigid material strand Pipe.The rigid strand of polymeric material (such as PCL) can be for example heated to above its glass transition temperature and be drawn into The shape of deformation.For example, rigid strand may include undeformed spiral shape, the undeformed spiral shape is being drawn into it May include during deformed shape such as straight line or at least substantially shape of straight line.Then, rigid strand can be cool below Glass transition temperature, while restraint rigidity strand is so that rigid strand can keep its deformed shape.Once rigid strand is in In its fiber deformed, so that it may for example form strands line around rigid strand.ORC strands line can for example wind, assemble, and/or It is folded on rigid strand.Alternatively, for example, rigid strand can be inserted into ORC fibers.Rigid strand can Including that can roll up and/or be immersed in the intrastitial tacky surfaces of ORC.Under any circumstance, then can be fine by rigid strand and ORC Dimension is inserted into pipe, similar to the above, and is again heated to the glass transition temperature more than rigid strand.In such situation Under, rigid strand can be unconfined or at least substantially unconfined, and can allow to return or at least substantially return to Its initial undeformed shape.For example, rigid strand can shrink when returning to its original shape and ORC fibers is retracted to pipe It is interior.When rigid pipe shrinks, the center of pipe can be clamped so that rigid strand and ORC fibers to be maintained to the center of pipe.With phase above Seemingly, the end of salable pipe, to encapsulate rigid strand and ORC fibers therein.

Referring now to Figure 24 4, tissue thickness compensation part 33320 may include shell 33326, be positioned in shell 33326 Compressible core and the blind end 33328 that compressible core can be contained in shell 33326.Further described above, Shell 33326 can be made by continuous expressing technique and may include continuous shape of cross section along its length.Referring now to figure 245-247, tissue thickness compensation part 33420 may include shell 33426, the cavity being limited in shell 33,426 33424 and determine Core 33425 of the position in cavity 33424.For example, shell 33426 may include the film main body formed by continuous extruded shape, and Core 33425 may include fiber drug core, such as ORC.Shell 33426 may include one or more flexible legs 33423, one Or multiple flexible legs 33423 can extend in the cutter slit 22063 being defined in anvil block 22060 and compensate tissue thickness Part 33420 releasably holds anvil block 22060.Figure 24 8-250 are now participated in, tissue thickness compensation part 33520 may include outer Shell 33526, the cavity 33524 being limited in shell 33526 and the core 33425 being positioned in cavity 33524.For example, shell 33526 may include the film main body that is formed by continuous extruded shape, and core 33425 may include fiber drug core, such as ORC.Outside Shell 33526 may include one or more holding members 33528, and one or more of holding members 33528 can surround anvil block 22060 outer surface extends and tissue thickness compensation part 33520 can be releasably held into anvil block 22060.It is for example, main Referring to Figure 25 0, gap that shell 33526 may include moveable part 33527 and be limited between moveable part 33527 33523, wherein after tissue thickness compensation part 33520 separates with anvil block 22060, moveable part 33527 can flick with The core 33425 that exposure is accommodated therein.Referring now to Figure 25 1-252, tissue thickness compensation part 33620 may include shell 33626, The cavity 33424 being limited in shell 33626 and the core 33425 being positioned in cavity 33424.For example, shell 33626 can wrap The film main body formed by continuous extruded shape is included, and core 33425 may include fiber drug core, such as ORC.Shell 33626 can Including light filling bar 33623, the light filling bar 33623 can align with the cutter slit 22063 being limited in anvil block 22060, with cause through The cutting element of tissue thickness compensation part 33620 may pass through light filling bar 33623 and reduce the institute of transecting patient tissue thickness compensation part 33620 The power or energy needed.Referring now to Figure 25 3-254, tissue thickness compensation part 33720 may include shell 33726, be limited to shell Cavity 33424 in 33726 and the core 33425 being positioned in cavity 33424.For example, shell 33726 may include by continuously squeezing Go out the film main body of shape formation, and core 33425 may include fiber drug core, such as ORC.Shell 33726 may include one or Multiple holding members 33723, the holding member 33723 can wrap the outer surface of anvil block 22060 and can be by tissue thicknesses Compensating part 33720 releasably holds anvil block 22060.Referring now to Figure 25 5-256, tissue thickness compensation part 33820 can wrap Include shell 33826, the cavity being limited in shell 33,826 33424 and the core 33425 being positioned in cavity 33424.It is for example, outer Shell 33826 may include the film main body formed by continuous extruded shape, and core 33425 may include fiber drug core, such as ORC. For example, shell 33826 may include the cavity 33424 and substantially flat tissue contacting surface 33829 of substantial rectangular, compare Under, the cavity 33424 and tissue contacting surface of arc are shown in Figure 25 4.Referring now to Figure 25 7-258, tissue thickness is mended Repaying part 33920 may include shell 33926, the multiple cavities being limited in shell 33,926 33924 and is positioned at each cavity Core 33925 in 33924.For example, shell 33926 may include the film main body formed by continuous extruded shape, and core 33925 can Each include fiber drug core, such as ORC.Core 33925 can be made up of different materials.Shell 33926 may include one or more Individual holding member 33923, the holding member 33923 can extend in the cutter slit 22063 of anvil block 22060.

Referring now to Figure 153, tissue thickness compensation part can be formed using folding process., can be by material according to the present invention 23525 (for example, oxidized regenerated celluloses) are placed on emulsion sheet 23526, and the emulsion sheet 23526 can be folded and then It is sealed so that encapsulating material 23525.For example, emulsion sheet 23526 can be made up of such as cytoskeleton related protein matter glycine. Using series-operation, wherein emulsion sheet 23526 can be under hopper 23592 through the hopper 23592 can be by material 23525 are assigned on emulsion sheet 23526.For example, before material 23525 is placed on emulsion sheet 23526, can be in roller Emulsion sheet 23526 is flattened between 23591 and anvil block 23590.Material 23525 can be placed on to a side of emulsion sheet 23526 Or in half portion, wherein the another side of emulsion sheet 23526 or half portion can be folded or be turned on material 23525.In material It is foldable or be folded over piece at least in part before, during and/or after 23525 have been placed on emulsion sheet 23526 23526.Anvil block 23590 may include such as cam face 23594, and the cam face 23594, which can be lifted for example, to be vertically moved The edge or side of emulsion sheet 23526 and subsequent doubling emulsion sheet 23526.Cam face 23594 may include three-D cam or Druum cam, the three-D cam or druum cam are in emulsion sheet 23526 by stepping up and turning over during cam face 23594 Turn a part for emulsion sheet 23526.

After emulsion sheet 23526 has been folded on material 23525, the emulsion sheet 23526 of folding and it is positioned in Material 23525 may pass through mould 23593, the emulsion sheet 23526 and material that the mould 23593 is compressible and/or compacting folds 23525 are expected to form pipe 23527.Folding can be sealed using any appropriate process of such as thermal weld and/or laser welding etc The edge of folded emulsion sheet 23526.Pipe 23527 also for example can have been passed through one or more before sealing in the side wall of pipe 23527 Individual roller 23595 flattens.Pipe 23527 can also be flattened after the side wall of pipe 23527 is sealed by one or more rollers. Under any circumstance, pipe 23527 can be divided into part to produce single tissue thickness compensation part.Using such as thermal weld And/or any appropriate process of laser welding etc comes the end of seal tissue thickness compensation part, but alternatively select Select, one or two end of tissue thickness compensation part is positively retained at open configuration.

Referring now to Figure 154, compensating part could attach to anvil block, for example, anvil block 22060, wherein compensating part can be wherein Store at least one medicine.Compensating part 23620 may include central main part 23626 and can be attached to anvil block 22060 Horizontal attachment part 23628.Compensating part 23620, which may also include, to be limited in the tissue contacting surface 23625 of compensating part 23620 The array of capillary channel 23627, wherein capillary channel 23627 can store one or more medicines wherein.For example, medicine Thing may include fluid, and the fluid can be maintained at because of fluid tension between the side wall of capillary channel 23627.In various feelings Under condition, the coming medicament administration to compensating part 23620 of anvil block 22060 can be attached in compensating part 23620, and in certain situation Under, can for example compensating part be attached to anvil block 22060 later by medicament administration to compensating part 23620.Under any circumstance, Compensating part 23620, which can contact, is positioned at anvil block 22060 and back to the tissue between the nail bin of anvil block 22060, wherein being stored in Medicine in capillary channel 23627 can flow to tissue.In all cases, medicine can be flowed in capillary channel 23627.

Referring again to the compensating part 23620 shown in Figure 154, the serial capillary channel 23627 can be constructed and cloth Intersecting hachure pattern is set to, wherein the passage 23627 of the first quantity can extend along a first direction and the passage of the second quantity 23627 can extend along second direction.The passage 23627 of first quantity can intersect and flow with the passage 23627 of the second quantity Body connects.Referring now to Figure 155, compensating part 23920 may include main body 23926, and the main body 23926 connects including being defined in tissue Touch the array of the capillary channel 23927 in surface 23925.Passage 23927 can limit along linear path, while passage 23927 can limit along nonlinear path.For example, the passage 23927 of the first quantity can extend along axis 23923, and the The passage 23927 of two quantity can extend along axis 23924, and its axis 23923 can be along the direction different from axis 23924 Extension.Axis 23923 can perpendicular to or be at least substantially orthogonal to axis 23924, wherein passage 23627 can limit therebetween Island 23922.For example, the top surface of island 23922 can limit the tissue contacting surface 23925 of compensating part 23920.Mend Repaying part 23920 may include that longitudinal axis 23921 and passage 23627 can be along horizontal or oblique relative to longitudinal axis 23921 Direction extension.Referring again to Figure 154, compensating part 23720 may include main body 23726 and be defined in multiple in main body 23726 Capillary channel 23727.Compensating part 23720 may also include the vertical passage that can be in fluid communication with capillary channel 23727 23721.Optionally, one or more medicines can be stored in vertical passage 23721, wherein medicine can be for example in passage Flowed between 23721 and capillary channel 23727.Passage 23721 can be limited to extend up to and is defined in anvil block 22060 Longitudinal projection in longitudinal knife slot 22061.

As described above, referring again to Figure 154, the capillary channel array being defined in compensating part may include intersecting hachure figure Case.However, alternatively, capillary channel array may include any suitable shape or configuration.For example, with reference to figure Compensating part 23820 shown in 154, the passage 23827 being defined in the main body 23826 of compensating part 23820 may include it is for example parallel, Tendency passage, the parallel, tendency passage are assembled towards centre gangway 23821 and/or sent out away from centre gangway 23821 Dissipate.Referring now to Figure 158, the end effector of surgery suturing appliance may include nail bin 24000, and the nail bin 24000 includes group Knit thickness compensation part 24010, wherein tissue thickness compensation part 24010 can include wherein and/or thereon at least one medicine, For example, medicine 24001.Referring now to Figure 159, the compensating part 24020 that can will be attached to anvil block 24060 is for example moved to closure position Put, so as to which compensating part 24020 to be positioned to contact with tissue thickness compensation part 24010.In such cases, can be by medicine 24001 are for example transferred to compensating part 24020 from tissue thickness compensation part 24010.Referring now to Figure 160, compensating part 24020 can wrap The tissue contacting surface 24025 that can be contacted with tissue thickness compensation part 24010 is included, wherein medicine 24001 can flow to and be defined in group Knit in the capillary channel 24027 in contact surface 24025.Referring now to Figure 157, compensating part 24020 can thereon and/or Including at least one medicine of such as medicine 24002 etc, at least one medicine can be transferred to from compensating part 24020 Tissue thickness compensation part 24010.

Referring now to Figure 24 0 and Figure 24 1, tissue thickness compensation part 33020 may include to be defined in multiple logical in its surface Road and/or well are recessed.Tissue thickness compensation part 33020 may include along the longitudinal axis limited through tissue thickness compensation part 33020 The vertical passage 33026 of line extension.For example, the end of vertical passage 33026 can flow with the periphery of tissue thickness compensation part 33020 Body connects.Tissue thickness compensation part 33020 may also include multiple wells recessed 33022 and recessed with well 33022 and vertical passage 33026 The multiple slanted channels 33024 being in fluid communication.Tissue thickness compensation part 33020 may also include can recessed with well 33022 and tissue it is thick Spend multiple entrance-exit passageways 33027 of the peripheral fluid connection of compensating part 33020.Optionally, due to described above, fluid Can before tissue thickness compensation part has been implanted to patient tissue, period, and/or flow into or out tissue thickness afterwards Compensating part 33020.Passage 33024,33026 and being defined in the tissue contacting surface 33025 of tissue thickness compensation part 33020 33027 and the pattern of well recessed 33022 can limit gripping, the gripping can contact tissue and limit tissue thickness The slip spent between compensating part 33020 and tissue.Referring now to Figure 24 0A and Figure 24 1A, tissue thickness compensation part 33120 can wrap Include the multiple circular channels being defined in its surface.Tissue thickness compensation part 33120 may include concentric circular paths 33127, institute State the opening that concentric circular paths 33127 include being defined in the periphery of tissue thickness compensation part 33120.It is similar to the above, stream Body can flow into or out tissue thickness compensation part 33120 by passage 33127.Tissue thickness compensation part 33120 may include together Heart circular channel 33122, the concentric circular paths 33122 may not include the periphery for being defined in tissue thickness compensation part 33120 In opening.Referring now to Figure 24 2 and Figure 24 3, tissue thickness compensation part 33220 may include multiple ridges 33227 from its extension, The ridge 33227 can grasp the tissue positioned against tissue thickness compensation part 33220.For example, ridge 33227 can be it is straight or Ridge 33227 may include crooked outline.Although above-mentioned ridge and passage can be used for tissue thickness compensation part, such ridge and passage can It is used together with any suitable bioabsorbable and/or biocompatibility layer.

According to the present invention, compensating part can be made up of multiple layers.For example, compensating part may include first layer and be attached to first layer The second layer.First layer may include tissue contacting surface and the multiple capillary channels being defined in tissue contacting surface.First Layer may also include the capillary channel being defined in towards the second layer and in the side of tissue contacting surface.The second layer can wrap Include and be defined in capillary channel therein.Well is recessed to be limited between the first layer of compensating part and the second layer.Can for example it formed Capillary channel is formed at benefit during the moulding technology of layer and/or using any suitable method during rivet hot Welding Repay in the layer of part.For example, the layer of compensating part can be attached to one another together using rivet hot Welding.For example, layer can be by following Material form, the material become when being applied in heat it is deformable, for example, CAP/GLY (36/64).Under any circumstance, The capillary channel being defined in the tissue contacting surface of compensating part can limit grip surface therebetween, and the grip surface can change The kind grasping and control that can be applied to the tissue being positioned between the anvil block of surgery suturing appliance and nail bin.In other words, limit It can reduce the area of the accessible tissue of compensating part in the capillary channel of the tissue contacting surface of compensating part.In such cases, For given power, the relatively small area of contact between compensating part and tissue can cause higher contact.In various feelings Under condition, higher contact can reduce the slip between compensating part and tissue.

Optionally, one or more medicines can be positioned at be defined in first layer and the second layer and/or between capillary In tube passage and/or space.Forming multiple layers of compensating part may include one group of therapeutic agent layer or therapeutic agent.For example, first layer can It is made up of the first medicine and the second layer can be made up of the second medicine, wherein the first medicine may differ from the second medicine.For example, limit The 3rd medicine can be stored due to the capillary channel in first layer, and be defined in the capillary channel in the second layer to store Four medicines, wherein the first medicine, the second medicine, the 3rd medicine and/or the 4th medicine may be, for example, different.First medicine, Two medicines, the 3rd medicine and/or the 4th medicine may be, for example, different.Referring now to Figure 161, compensating part 24120 may include more Individual layer, for example, layer 24121-24125.First layer 24121 and/or layer 5 24125 may include can the sandwiched second layer 24122, Three layer 24123 and/or the 4th layer 24124 of flat material piece.Optionally, one or more of layer 24121-24125 may include It is defined in one or more of passages 24127.Passage 24127 can extend to the other end from one end of compensating part 24120, and And passage 24127 can extend to opposite side from the side of compensating part 24120.Passage 24127 can be in any conjunction of compensating part 24120 Extend between suitable side and/or end along any suitable direction.Referring now to Figure 164 and Figure 165, compensating part 24820 It may include two or more internal layers 24827 that can for example limit interconnection 24822, the interconnection 24822 is from compensation The side of part 24820 extends to opposite side.Referring again to Figure 161, the passage being defined in one in layer 24121-24125 24127 can align with the passage being defined in the layer of positioning adjacent thereto.It is defined in logical in one in layer 24121-24125 Road 24127 can towards or opening towards the flat surfaces on the layer of positioning adjacent thereto.Referring again to Figure 161, layer 24121- One or more of 24125 may include to be defined at least one well recessed 24129 therein.Well recessed 24129 can be with being defined in layer One or more of passage 24127 be in fluid communication.Similar to the above, well recessed 24129 may include to be open towards or towards adjacent The opening of layer, wherein adjacent layer can cover opening.

Further described above, passage 24127 and/or well recessed 24129 can be wherein comprising one or more Medicine.Passage 24127 may include the one or more openends that can allow medicine flow pass 24127.Similarly, passage 24127 one or more that may include to can allow for fluid (for example, blood) to flow in passage 24127 are open.In such situation Under, fluid can be flowed in compensating part 24120, absorbed the drug and/or layer 24121-24125 at least a portion and then flowed Go out compensating part 24120.Referring again to Figure 164 and Figure 165, compensating part 24820 may include the hole being for example defined in outer layer 24826 24828.Referring again to Figure 161, layer 24121-24125 can be made up of any suitable material, for example, bioabsorbable polymerization Thing, PLA, and/or PGA.Can be all made up of identical material in layer 24121-24125.Alternatively, layer One or more of 24121-24125 can be made up of different materials.Optionally, layer 24121-24125 one or more It may include the through hole 24128 through extension, the through hole 24128 for example can allow for the fluid of such as blood etc to flow to passage Between two or more in 24127, in well recessed 24126, and/or in layer 24121-21135.Using such as thermal weld And/or one or more of layer 24121-24125 is connected to each other by laser welding process.In such cases, The fluid-soluble solution layer 24121-24125 flowed in compensating part 24120 welding portion, and allow layer 24121-24125 points From and/or peel off.Layer one or more of 24121-24125 can be made up of following material, and the material is to be faster than and/or slowly In the speed dissolving for the material for forming other layer of 24121-24125.For example, the internal layer 24122-24124 of compensating part 24120 can be by Such as formed with being faster than the material of the speed for the material for being formed outer layer 24121 and 24125 dissolving.In such cases, compensation is worked as When the inside of part 24120 is dissolved, global shape that compensating part 24120 can be consistent or at least substantially consistent. The outermost layer of compensating part can be made up of the material that the speed for the material for being for example faster than the innermost layer for being formed compensating part dissolves.Example Such as, layer may include the material piece with the thickness between about 1 mil and about 4 mils.

Referring now to Figure 162 and Figure 163, the compensating part of such as compensating part 24220 etc may include that anvil block can be attached to The supporting layer 24226 of (for example, anvil block 22060) and/or nail bin.Compensating part 24220, which may also include, is attached to supporting layer 24226 Support 24222, its medium-height trestle 24222 may include multiple shelf layers 24227.Support may include for example dimensional structured matrix.Appoint Selection of land, each in shelf layer 24227 can be made up of multiple fibers.Referring now to Figure 166, each shelf layer 24227 can be by Fibrous braid is formed, the fibrous braid include more than the first individual fibers 24228 that extend in a first direction and along second or More than second individual fibers 24229 of different directions extension.Each fibrous braid may include multiple pits or cavity 24223, wherein Layer 24227, fiber 24228,24229 and cavity 24223 can limit the matrix for contributing to tissue and cell ingrowth.It is fine Dimension 24228,24229 and/or any other suitable fiber can be made up of bioabsorbable material.Fiber can be by for example stopping blooding (it can be each other for agent, binding activity agent (for example, with those of bioactivity and/or pharmacological activity), and/or supporting member Weave in) form.Under any circumstance, the material of fiber may be selected to cause required biological respinse, for example, cell moves Move on in support 24222, ECM secretes, and/or the propagation of structural support cell.

Further described above, supporting layer 24226 can be in structural support support 24222.Can for example using Support 24222 is attached to supporting layer 24226 by one or more bioabsorbable adhesives.Similarly, using such as one Supporting layer 24226 is attached to anvil block or nail bin by kind or various biocompatible adhesive.It can come in any suitable manner Arrangement or the layer 24227 for stacking support 24222.Each layer 24227 may include the pattern of fiber, and its middle level 24227 can be arranged To cause the pattern of layer 24227 to be in alignment with each other in support 24222.Referring to Figure 167, layer 24227 can be stacked on each other On so that the fiber 24228 in first layer 24227 aligns with the fiber 24228 in the second layer 24227.Equally, can be by layer 24227 stack on top of each other so that the fiber 24229 in first layer 24227 and the fiber 24229 in the second layer 24227 are right Together.Referring now to Figure 168, support 24422 may include multiple shelf layers 24427, wherein the fiber in each shelf layer 24427 24429 are orientated along equidirectional, for example, longitudinal direction.Referring now to Figure 170, each shelf layer 24227 may include fibre The pattern of dimension, its middle level 24227 can be disposed in support 24322 with so that the pattern of layer 24227 does not line up each other.Can be by layer 24227 stack on top of each other so that fiber 24228 in first layer 24227 along transverse to or it is oblique in the second layer The direction extension of fiber 24228 in 24227.Equally, layer 24227 can be stacked on top of each other so that in first layer 24227 Fiber 24229 along transverse to or the oblique fiber 24229 in the second layer 24227 direction extend.Referring now to figure 171, support 24522 may include for example multiple shelf layers 24427, and the multiple shelf layer 24427 is oriented such that each Fiber 24229 in rack-layer 24427 is orientated along different directions.

Further described above, the first support layer 24227 of support 24222 can be for example made up of the first material, And the second support layer 24227 of support 24222 can be made up of second or different materials.For example, the first material may include the first medicine Thing, and the second material may include second or different pharmaceutical.Further described above, for example, first of support 24222 Rack-layer 24227 for example may include to be absorbed into its intrastitial first medicine, and the second support layer 24227 of support 24222 can Including be absorbed into its intrastitial second or different pharmaceutical.For example, the first material may include the first medicine, and the second material can Including second or different pharmaceutical.Support may include any suitable number of layer with any suitable fibers density, the fiber It is made up of any suitable number of material.

Tissue thickness compensation part can be arranged on surgical device (for example, surgery cuts and stitching devices) using retainer In.Retainer may include grip surface and allow surgeon, nurse, technical staff or other staff to compensate tissue thickness One or more of part aligns with the feature (for example, anvil block and/or nail bin) of surgical instruments.Retainer may include to pass through engagement The nail bin of surgical instruments is come the feature for one or more tissue thickness compensation parts of aliging.Retainer may include by engaging surgery device The anvil block of tool is come the feature for one or more tissue thickness compensation parts of aliging.Nail bin for surgical instruments can include with retainer Together, and retainer is made to engage the tissue thickness's compensation that nail bin can be arranged in surgical instruments and can alignd with surgical instruments One or more of part.After tissue thickness compensation part has been alignd and is attached to surgical instruments, retainer and group can be made Thickness compensation part separation is knitted, and is then removed from surgical instruments.

Figure 61-67 is shown for example is attached to anvil block 19040 and general available for by the first tissue thickness compensation part 19002 Minor microstructure thickness compensation part 19004 is attached to the embodiment of the retainer 19000 of the nail bin 19050 of surgical stapling device.It can carry For the retainer group including retainer 19000, the first tissue thickness compensation part 19002 and minor microstructure thickness compensation part 19004 Part 19060.In general, during use, device assembly 19060 can will be kept to be inserted into anvil block 19040 and nail bin can be supported Between 19050 passage.Then, anvil block 19040 can be closed.By closing anvil block 19040, anvil block 19040 can be pushed down on Onto the first tissue thickness compensation part 19002, to cause the first tissue thickness compensation part 19002 to could attach to anvil block 19040.Close Anvil block 19040 is closed to push down on retainer 19000 and nail bin 19050 is arranged in the passage of surgical instruments.When beating again When opening anvil block 19040, the first tissue thickness compensation part 19002 can separate with retainer 19000, and ought be then from surgical device When removing retainer 19000, retainer 19000 can separate with minor microstructure thickness compensation part 19004.Surgical device is then ready for It is ready, with being attached to the first tissue thickness compensation part 19002 of anvil block 19040 and being attached to the minor microstructure of nail bin 19050 Thickness compensation part 19004 is used together.

Referring to Figure 61, retainer 19000 may include grasping piece 19014, and the grasping piece 19014 is available for preparing surgical instruments Personnel (for example, surgeon, nurse or technical staff) grasp retainer 19000.Retainer 19000 may include to determine thereon The first surface 19001 of position the first tissue thickness compensation part 19002 and minor microstructure thickness compensation part 19004 can be positioned thereon Relative second surface 19003.Optionally, one or more adhesives can be administered to the table of first surface 19001 and/or second Face 19003, for being attached the first tissue thickness compensation part 19002 and minor microstructure thickness compensation part 19004 to it.Retainer 19000 may also include the fixture of the nail bin 19050 of for example engageable surgical device.Referring to Figure 64, retainer 19000 may include energy Enough engage the distally fixture 19108 of the groove 19056 at the distal end of nail bin 19050, and/or nail bin 19050 can be engaged On ridge or edge 19054 nearside fixture 19106.

Referring to Figure 61, the first tissue thickness compensation part 19002 may include towards retainer surface 19006 and towards anvil block table Face 19010.Retainer 19000 can will be attached to for example, by adhesive and/or engagement features towards retainer surface 19006 First surface 19001.At least one adhesive can included thereon towards anvil faces 19010, described adhesive can be by One tissue thickness compensation part 19002 is attached to the anvil block 19040 of surgical device.For example, adhesive may include to may be affixed to anvil block The activatable adhesive of 19040 nail profiled surface 19044 (Figure 63).

Referring to Figure 61 and Figure 63-66, the first tissue thickness compensation part may include engagement anvil block towards anvil faces 19010 The engagement features 19020 of similar engagement features 19042 on 19040.Therefore, the first confining force can be by the first tissue thickness compensation Part 19002 remains to retainer 19000, and the first tissue thickness compensation part 19002 can be remained to anvil block by the second confining force 19040.Second confining force can be more than the first confining force, so that during the proper removal retainer 19000 from end effector, first group Anvil block 19040 can be remained attached to and can be separated with retainer 19000 by knitting thickness compensation part 19002.

Referring again to Figure 61, minor microstructure thickness compensation part 19004 may include towards retainer surface 19008 and towards nail Storehouse surface 19012.It will can be attached to by one or more adhesives and/or engagement features towards retainer surface 19006 The first surface 19001 of retainer 19000.Adhesive can included thereon towards nail bin surface 19012, described adhesive can incite somebody to action Minor microstructure thickness compensation part 19004 is attached to the nail bin 19050 of surgical device.For example, with reference to Figure 64, adhesive can be by second Tissue thickness compensation part 19004 is attached to the nail platform 19052 of nail bin 19050.Engagement is may also include towards nail bin surface 19012 The engagement features of cooperation engagement features on nail bin 19050.Therefore, the first confining force can be by minor microstructure thickness compensation part 19004 remain to retainer 19000, and minor microstructure thickness compensation part 19004 can be remained to nail bin by the second confining force 19050.Second confining force can be more than the first confining force, so that during the proper removal retainer 19000 from end effector, second group Nail bin 19050 can be remained attached to and can be separated with retainer 19000 by knitting thickness compensation part 19004.

As shown in Figure 64, device assembly 19060 can will be kept to be attached to nail bin 19050 in the way of shown in arrow A.As above It is described, the groove 19056 in 19018 engageable nail bin of distally fixture on retainer 19000, and the nearside folder on retainer Have the edge or ridge 19054 on 19016 engageable nail bins 19050.Now, retainer 19000 is attached to nail bin 19050, such as schemes Shown in 65, and minor microstructure thickness compensation part 19004 could attach to nail bin 19050.As shown in Figure 66, the anvil block of surgical device 19040 may be such that the surface 19044 (for example, nail profiled surface and/or tissue contacting surface) of anvil block along the closure in arrow B directions Contacted with the first tissue thickness compensation part 19002.As described above, the anvil block 19040 of contact the first tissue thickness compensation part 19002 It may be such that the first tissue thickness compensation part 19002 is attached to anvil block 19040.

, can be by first group after holding device assembly 19060 has been attached to nail bin 19050 and anvil block 19040 has closed Knit thickness compensation part 19002 and be attached to anvil block 19040, and minor microstructure thickness compensation part 19004 can be attached to nail bin 19050.As described above, the confining force that the first tissue thickness compensation part 19002 is remained to retainer 19000 is smaller than first Tissue thickness compensation part 19002 remains to the confining force of anvil block 19040.Therefore, when reopening anvil block 19040, first group Knitting thickness compensation part 19002 can separate with retainer 19000 and can be kept together with anvil block 19040, as shown in Figure 67.Separately Outside as described above, the confining force that minor microstructure thickness compensation part 19004 is remained to retainer 19000 is smaller than the first tissue Thickness compensation part 19004 remains to the confining force of nail bin 19050.Therefore, moved when along the direction of arrow C and D shown in Figure 67 During except retainer 19000, retainer 19000 can separate with minor microstructure thickness compensation part 19004.Surgical stapling shown in Figure 67 Device includes being attached to the first tissue thickness compensation part 19002 of anvil block 19040 and is attached to the minor microstructure thickness of nail bin 19050 Compensating part 19004, and be ready for ready available.

Figure 39 0-396 show just with the first tissue thickness compensation part 19002 and minor microstructure thickness compensation part 19,004 1 Act the retainer 19000 used.Retainer 19000 can also be mended with the first tissue thickness compensation part 19002 and minor microstructure thickness Only one repaid in part 19004 is used together.For example, the first tissue thickness compensation part 19002 can be saved.

Figure 68-70 shows the embodiment of the retainer 19100 for the engagement features 19108 that may include on surface 19101.Such as Shown in Figure 69 and Figure 70, the engagement features 19108 on retainer 19100 engage the association in the first tissue thickness compensation part 19102 Make engagement features 19109.

Figure 71 and Figure 72, which is shown, may include the anvil block 19230 that tissue thickness compensation part 19210 can be alignd and is attached to Surface 19202 retainer 19200 embodiment.Retainer 19200 may include the alignment bolt extended from surface 19202 19204.Retainer 19200 shown in Figure 71 and Figure 72 includes four alignment bolts 19204, but can provide more or less alignment Bolt 19204.Referring to Figure 72, tissue thickness compensation part 19210 may include main body 19212, and the main body 19212 includes hole 19216, the hole 19216 can be positioned so that the position for the alignment bolt 19204 for making it correspond to extend from retainer 19200. Each hole 19216 in tissue thickness compensation part 19210 coordinates on alignment bolt 19204, and due to hole 19216 and bolt Tight fit between 19204, tissue thickness compensation part 19210 can be alignd with retainer 19200.Optionally, each hole 19216 can be slightly less than its corresponding bolt 19204 so that each hole 19216 extends when being placed on its bolt 19204.This expansion Hole 19216 can be maintained on bolt 19204 by exhibition.Each hole 19216 can include adhesive wherein, with the He of bolt 19204 Releasable bonding is produced between tissue thickness compensation part 19210.

Tissue thickness compensation part 19220 may include from the extension of the main body 19212 of tissue thickness compensation part 19220 can be by The inserted sheet 19220 that slit 19234 in anvil block 19230 receives.Slit 19234 in anvil block 19230 can for example be positioned at nail into In shape surface 19232.Similar to the above after retainer 19200 has been attached to nail bin, anvil block 19230 can abut retainer Tissue thickness compensation part 19210 on 19200 is closed.When anvil block 19230 closes, referring to Figure 72, tissue thickness's compensation The engageable slit 19234 of inserted sheet 19220 on part 19210, so as to which tissue thickness compensation part 19210 is attached into anvil block 19230. Referring primarily to Figure 71, each inserted sheet 19220 may include inserted sheet 19220 being directed to tapered in the slit 19234 of anvil block 19230 Part 19222.Tapered portion 19222 may include inclined wall and can have cross-sectional area incremental along its length.Each inserted sheet 19220 body portion 19226 can have the cross-sectional area of the maximum cross-section area less than tapered portion 19222.Tapered portion 19222 may include locking surface 19224, wherein when inserted sheet 19220 enters slit 19234, locking surface 19224 can be snapped into On the antelabium 19235 of slit 19234.Therefore, inserted sheet 19220 can be maintained in slit 19234 by locking surface 19224, so as to Tissue thickness compensation part 19210 is remained into anvil block 19230.It is defined in tissue thickness compensation part 19210 and extends in slotting Slit 19228 between piece 19220 can allow inserted sheet 19220 inwardly to bend and coordinate in slit 19234.Just utilize slit 19234 inserted sheets 19220 kept can limit the first confining force that tissue thickness compensation part 19210 is remained to anvil block 19230, and And the hole 19216 in the tissue thickness compensation part 19210 being just maintained on bolt 19204 can limit the second confining force.First protects Holding force can be more than the second confining force so that when removing retainer 19200 from end effector, the first tissue thickness compensation part 19210 can remain attached to anvil block 19230 and can be separated with retainer 19200.

The main body 19212 of tissue thickness compensation part 19210 in Figure 71 and Figure 72 can also limit slit 19214 in it. Slit 19214 can align along the longitudinal axis of tissue thickness compensation part 19210.For example, slit 19214 can be arranged in longitudinal direction On axis so that when tissue thickness compensation part 19210 is attached into anvil block 19230, the cutting of slit 19214 and surgical device The longitudinal path alignment of knife.Slit 19214 can reduce cutter and cut through energy value needed for tissue thickness compensation part 19210.

Figure 73-83 shows the embodiment of the retainer 19300 including fixture 19310, and the fixture 19310 can be by group Thickness compensation part 19340 is knitted to be maintained on the first surface 19302 of retainer 19300.When anvil block 19360 closes at retainer It is similar to the above when on 19300, anvil block 19360 can push outwardly on movable clamp 19310, and thus make retainer 19300 Depart from from tissue thickness compensation part 19340.When reopening anvil block 19360, anvil block 19360 abuts tissue thickness compensation part 19340 are extruded and move away from retainer 19300, so that tissue thickness compensation part 19340 could attach to anvil block 19360。

Retainer 19300 may include nail bin installs fixture 19312 and 19314, the He of nail bin installs fixture 19312 19314 can be similar to above in relation to those described in Figure 61-70.In addition to first surface 19302 described above, keep Device 19300 may also include the second surface 19304 that can carry minor microstructure thickness compensation part.Second surface 19304 may include Alignment structures, for example, boss ridge 19308.Slit in the engageable such as minor microstructure thickness compensation part of boss ridge 19308 and/ Or the slit in nail bin 19370.

Referring to Figure 75-77, during use, retainer 19300 can be attached to by nail by fixture 19314 and 19312 Storehouse 19370.The first tissue thickness compensation part 19340 can be positioned on the first surface 19302 at retainer 19300, and can Keep fixing by fixture 19310.Referring primarily to Figure 81-83, each fixture includes the first surface that can abut retainer 19300 The flat pieces 19313 of 19302 clamping the first tissue thickness compensation parts 19340.Each fixture 19310 may include inward-facing taper Or curved surface 19311.When direction of the anvil block 19360 along arrow E is moved, referring to Figure 82, the edge of anvil block 19360 The inward-facing curved surface 19311 of 19366 accessible fixtures 19310.The direction that arrow E is continued on when anvil block 19360 is moved When dynamic, the interference between the edge 19366 of anvil block 19360 and the curved surface 19311 of fixture 19310 can be along arrow F side To fixture 19310 is pushed outwardly on, as shown in Figure 82.When direction of the fixture 19310 along arrow F is moved, the first tissue thickness Compensating part 19340 discharges from the flat pieces 19313 of fixture 19310.

When anvil block 19360 continues on arrow E direction movement, it also contacts and is attached to tissue thickness compensation part 19340.For example, when direction of the anvil block 19360 along arrow E is moved, the engagement features in tissue thickness compensation part 19340 Passage 19364 in (for example, boss ridge 19344) engagement anvil block 19360.Boss ridge 19344 can have with passage 19364 It is full of cooperation, to cause tissue thickness compensation part 19340 to be attached to anvil block 19360.Tissue thickness compensation part 19340 may include to adhere to To the adhesive on the surface of anvil block 19360.Boss ridge 19344 may include the adhesive for being attached to the surface of passage 19364.Together Sample, the surface of the main body 19342 of tissue thickness compensation part 19340 may include the bonding on the surface 19362 for being attached to anvil block 19360 Agent.After tissue thickness compensation part 19340 is attached to anvil block 19360, when anvil block 19360 along arrow G direction by moving It is dynamic and when returning to its open position, as shown in Figure 83, tissue thickness compensation part 19340 can be lifted from retainer 19300 and It can be kept together with anvil block 19360.

Figure 84 shows the sectional side view of the embodiment of retainer 19400.The first tissue thickness compensation part 19410 positions On the first side 19402 of retainer 19400, and minor microstructure thickness compensation part 19420 is positioned within the of device 19400 On two sides 19404.Retainer 19400 is limited through one or more holes 19406 of extension.By extend through hole 19406 Connector 19430 simultaneously passes through hole to connect the first tissue thickness compensation part 19410 and minor microstructure thickness compensation part 19420.The One tissue thickness compensation part 19410, minor microstructure thickness compensation part 19420 and connector 19430 all can be by homogenous materials Formed.For example, can be by the first tissue thickness compensation part 19410, minor microstructure thickness compensation part 19420 and connector 19430 Overmolding is on retainer 19400.Alternatively, connector 19430 is formed as in tissue thickness compensation part One of (for example, the first tissue thickness compensation part 19410) part.Connector 19430 may pass through hole 19406, and then Remaining tissue thickness compensation part is attached to, for example, minor microstructure thickness compensation part 19420.Can be for example by using adhesive Or the interference fit between the receiving port (not shown) in the end and minor microstructure thickness compensation part 19420 for passing through connector come Connector 19430 is attached to minor microstructure thickness compensation part 19420.Connector 19430 can be separate part, the independent portion Part is placed in hole 19406 and can be by, for example, the end of adhesive or connector 19430 and the first tissue thickness The interference fit between receiving port in compensating part 19410 and minor microstructure thickness compensation part 19420 is attached to the first tissue Thickness compensation part 19410 and minor microstructure thickness compensation part 19410.

After retainer 19400 has been placed on nail bin 19450, for example, can by the anvil block 19440 of surgical device along Arrow H direction is moved to closing position.When anvil block 19440 closes, the surface of the first tissue thickness compensation part 19410 The first tissue thickness compensation part 19410 can be attached to anvil block 19440 by adhesive and/or engagement features on 19414.Equally, Adhesive and/or engagement features on the surface 19424 of minor microstructure thickness compensation part 19420 can be by minor microstructure thickness compensations Part 19420 is attached to nail bin 19450.Closed in anvil block 19440 and the first tissue thickness compensation part 19410 and minor microstructure are thick Degree compensating part 19420 is attached respectively to after anvil block 19440 and nail bin 19450, can be pulled and be protected along arrow I direction (Figure 88) Holder 19400 between the first tissue thickness compensation part 19410 and minor microstructure thickness compensation part 19420 to remove retainer 19400 and it is broken connector 19430.As shown in Figure 89, it has been removed in the fracture of connector 19430 and retainer 19400 Afterwards, anvil block 19440 can be reopened, the first tissue thickness compensation part 19410 will be attached to anvil block 19440 and minor microstructure Thickness compensation part 19420 will be attached to nail bin 19450.

According to the present invention, the portions of proximal 19407 in each hole 19406 in retainer 19400 may include cutting edge.Work as edge When arrow I (Figure 88) direction drawing retainer, traction force is transmitted by the portions of proximal 19407 in hole 19406 so that connection Part is broken.The power of transmission is concentrated on each connector relatively by the cutting edge at the portions of proximal 19407 in each hole 19406 On small region.Therefore, connector will relatively easily be broken and less traction force can be needed to be mended from the first tissue thickness Repay removal retainer 19400 between part 19410 and minor microstructure thickness compensation part 19420.

As described above, device assembly is kept to may include to be positioned at the first tissue thickness compensation part and minor microstructure thickness compensation part Between retainer, wherein when two tissue thickness compensation parts have been inserted and are attached to the end effector of surgical instruments, Retainer can be from being pulled and can be removed from end effector between tissue thickness compensation part.Retainer can provide first group Knit the barrier between thickness compensation part and minor microstructure thickness compensation part.Once from the first tissue thickness compensation part and minor microstructure Remove retainer between thickness compensation part, among the first tissue thickness compensation part and/or on material just for example can be with second Among tissue thickness compensation part and/or on material react.One or two in tissue thickness compensation part may include Can by substance encapsulation tissue thickness compensation part film.Film can be attached to retainer, wherein when from tissue thickness compensation part it Between when pulling retainer, as described above, retainer can pull film away from tissue thickness compensation part with the thing that is accommodated therein of exposure Matter.Now, the material in each tissue thickness compensation part can interact with each other.

Figure 90-100 shows the embodiment of the retainer of the anvil block of engagement surgical device (for example, surgical stapling device).Protect The first tissue thickness compensation part can be alignd and minor microstructure thickness compensation part is alignd with nail bin by holder with anvil block.Close anvil Seat causes the first tissue thickness compensation part to be attached to anvil block, and causes minor microstructure thickness compensation part to be attached to nail bin.Keep Device can also carry nail bin, and wherein tissue thickness compensation part is optionally located between retainer and nail bin.Closure anvil block causes to follow closely Storehouse is attached to the passage of surgical stapling device and causes the first tissue thickness compensation part to be attached to anvil block.

Figure 90-93 shows the embodiment of retainer 19500.Retainer 19500 includes being available for surgeon, nurse, skill Art personnel or other staff manipulate the grasping piece 19502 of retainer 19500.Grasping piece 19502, which may include to provide, preferably grabs Hold the texturizing surfaces on surface, such as bossing 19503.Retainer 19500 may include that tissue thickness's compensation can be installed thereon The surface 19504 of part.Surface 19504 may include one or more protuberances 19506, wherein 19506 engageable tissue of protuberance Groove in thickness compensation part and relative to retainer 19500 surface 19504 come tissue thickness compensation part of aliging.Tissue is thick Groove in degree compensating part can be slightly less than protuberance 19506 so that when being engaged with groove, protuberance 19506 can be thick by tissue Degree compensating part remains to surface 19504.Protuberance 19506 may pass through the hole in tissue thickness compensation part and engagement slot (example Such as, the cutting cutter slit 19558 in the anvil block 19550 shown in Figure 95) so that tissue thickness compensation part and retainer 19500 Align and the additional alignment of retainer 19500 and anvil block 19550 is provided.Tissue thickness compensation part 19540 may include as above institute The adhesive on surface 19542 stated and/or engagement features by tissue thickness compensation part for being attached to anvil block 19550.

As shown in Figure 94 a, nail bin 19530 can be attached to retainer 19500.Can be by extending from retainer 19500 Nail bin 19530 is attached to retainer 19500 by fixture 19510 and 19512.Fixture 19512 on retainer 19500 is engageable Slit 19534 in nail bin 19530.The fixture 19510 of retainer 19500 can surround the bottom 19532 of nail bin 19532.According to The present invention, minor microstructure thickness compensation part can be attached to nail bin 19530.Minor microstructure thickness compensation part can be attached to nail bin 19530 nail platform 19536.

, can be by including retainer 19500, tissue thickness compensation part 19540 and nail bin 19530 as shown in Figure 95 and Figure 96 Direction of the device assembly 19590 along arrow L is kept to slide on the anvil block 19550 of surgical device (for example, surgical stapling device).Protect Guiding inserted sheet 19508 in holder 19500 can surround the edge 19552 of anvil block 19550, and determine relative to anvil block 19550 Position keeps device assembly 19590., can as shown in Figure 97 and Figure 98 after keeping device assembly 19590 to be joined on anvil block 19550 Anvil block is closed along arrow M direction.Nail bin 19530 can be positioned at the passage of surgical device by the closure of anvil block 19550 In 19560.The fixture 19510 that the closure of anvil block 19550 can cause to extend from retainer 19500 engages the ridge of passage 19560 19562, so as to which nail bin 19530 is firmly positioned in passage 19560.When reopening anvil block along arrow N direction When 19550, referring now to Figure 99 and Figure 100, tissue thickness compensation part 19540 can remain attached to anvil block 19550 and with guarantor Holder 19500 separates.Then retainer 19500 can be removed along arrow O (Figure 99 and Figure 100) direction from surgical instruments, from And leave the nail bin 19530 in the passage 19560 of surgical device and be attached to the tissue thickness compensation part of anvil block 19550 19540。

Figure 101 and Figure 102 respectively illustrates two alternative embodiments of tissue thickness compensation part 19570 and 19580 Example.Figure 101 is attached to the sectional view of the tissue thickness compensation part 19570 of retainer 19501, wherein tissue thickness compensation part 19570 may include projection 19574, and the projection 19574 can contact the edge 19552 of anvil block 19550 and partially around anvil The outer surface 19556 of seat 19550.Projection can grasp anvil block 19550 and/or be attached to anvil block using one or more adhesives 19550.In order to discharge tissue thickness compensation part from anvil block 19550 after relative patient tissue implantation compensating part 19570 19570, projection 19574 can outwards be bent from anvil block 19550, so as to allow tissue thickness compensation part 19570 to be pulled away from anvil Seat 19550.Figure 102 is attached to the sectional view of the tissue thickness compensation part 19580 of the retainer 19501 shown in Figure 101.Tissue Thickness compensation part 19580 includes bearing sleeve 19584, and the bearing sleeve 19584 can surround anvil block 19550 so that tissue thickness compensation part 19580 align with anvil block 19550 and/or tissue thickness compensation part 19580 are maintained on anvil block 19550.Bearing sleeve 19584 Tissue thickness compensation part 19580 can be maintained on anvil block 19550.In order that bearing sleeve 19584 separates with anvil block 19550, tissue Thickness compensation part 19580 can be for example torn to leave bearing sleeve 19584 at perforation 19586.Therefore, bearing sleeve 19584 is positively retained at On anvil block 19550, and the remainder of tissue thickness compensation part 19580 can keep being sewn onto patient tissue.

Tissue thickness compensation part (for example, tissue thickness compensation part 19570) may include interior section, the interior section bag Include the biocompatible substance being positioned in.Biocompatible substance may include such as antiinflammatory, coagulating agent, and/or antibiosis Element.According to the present invention, the main body of such as chip etc can be inserted into the interior section in tissue thickness compensation part.For example, Chip can be inserted into by the openend of tissue thickness compensation part and be defined in cavity therein.Chip can pass through interference fit It is maintained in the cavity of tissue thickness compensation part.Step for chip to be assembled into tissue thickness compensation part may include to heat Tissue thickness compensation part is so that the first step of tissue thickness compensation part expansion.When tissue thickness compensation part is expanded, it is defined in Cavity therein is also expansible.When tissue thickness compensation part is in expansion state, according to second step, can insert wafers into In cavity.Then, when tissue thickness compensation part cools down, according to third step, cavity is collapsible on chip and by chip The appropriate location being maintained in cavity.

Figure 103-115 shows the embodiment of the retainer including separate insertion tool.Insertion instrument can be used for component It is inserted into the surgical instruments of such as surgical stapling device etc.Insertion instrument can also be by the nail bin of holding device assembly and one or more Individual tissue thickness compensation part is expressed to the appropriate location in surgical instruments.Referring to Figure 103 and Figure 104, retainer 19600 may include First plate 19620 and the second plate 19622.First plate 19620 and the second plate 19622 can be attached by hinge 19612.Hinge First plate 19620 can be positioned at an angle relative to the second plate 19622 by 19612, and may also allow for the phase of the first plate 19620 Rotated for the second plate 19622 around hinge 19612.

First plate 19620 may include exterior surface 19604 and inner surface 19606.Equally, the second plate 19622 may include Exterior surface 19610 and inner surface 19608.The inner surface 19606 of first plate 19620 may include cam projection 19614.Phase As, the inner surface 19608 of the second plate 19622 may include cam projection 19616.Referring to Figure 110-115, the first plate it is outside Surface 19604 may include the tissue thickness compensation part being positioned on.The exterior surface 19601 of second plate 19622 may also comprise The tissue thickness compensation part being positioned on.Adhesive, engagement features, and/or other suitable attachment components can for example be utilized Tissue thickness compensation part is attached to outer surface 19604 and 19610.Retainer 19600 may include to extend from the second plate 19622 The fixture 19618 that can engage nail bin 19690, as shown in Figure 110 and Figure 112-115.

Referring now to Figure 105-109, insertion instrument 19630 may include first end 19632 and second end 19634.The One end 19632 can be sufficiently large, so that for example surgeon, nurse and/or technical staff firmly grasp.Second end 19634 Cavity 19640 is limited, wherein cavity may include the cam 19648 being positioned in.First side of cam 19648 may include first Protuberance 19642, the first lower concave part 19646 of the second protuberance 19644 and positioning between the two.Second side of cam 19648 It may include the 3rd protuberance 19643, the second lower concave part 19647 of the 4th protuberance 19645 and positioning between the two.It is for example, prominent Going out portion and lower concave part can be arranged in a mirror-image fashion.In other words, can be by the first protuberance 19642 with face cam 19648 The second side on the mode of the 3rd protuberance 19643 be arranged on the first side of cam 19648.Equally, second can be protruded Portion 19644 is arranged in the first of cam 19648 in a manner of the 4th protuberance 19645 on the second side of face cam 19648 On side.In addition, can be by the first lower concave part 19464 in a manner of the second lower concave part 19647 on the second side of face cam 19648 It is arranged on the first side of cam 19648.

During use, the second end 19634 of insertion instrument 19630 can be placed on to the first plate of retainer 19600 19620 and second between plate 19622 so that the cam projection 19614 for example on the first plate 19620 engages with lower concave part 19646 And the cam projection 19616 on the second plate 19622 is engaged with lower concave part 19647.As shown in Figure 112 and Figure 113, it can incite somebody to action Include the plug-in package of retainer 19600, insertion instrument 19630, one or more tissue thickness compensation parts and nail bin 19690 19700 are inserted into surgical instruments.Surgical instruments (for example, surgical stapling device) may include anvil block 19720 and can receive nail bin 19690 passage 19740.Direction (Figure 113) of the plug-in package 19700 along arrow P can be inserted into surgical instruments to incite somebody to action Nail bin 19690 is locked in passage 19740.In this position, cam 19614 and 19616 can respectively with lower concave part 19646 and 19647 alignment.

After nail bin 19690 is locked in passage 19740, as shown in Figure 114, insertion instrument 19600 can be relative to outer The direction that section's apparatus continues on arrow Q moves.Further moving for direction of the insertion instrument 19600 along arrow Q can make First protuberance 19642 aligns with the first cam projection 19614, and makes the 3rd protuberance 19634 and the second cam projection 19616 alignment.This alignment can cause retainer plate 19620 and 19622 around direction (figure of the hinge 19612 along arrow R 114) rotated in a manner of away from each other.In such cases, retainer plate 19620 and tissue thickness compensation part 19670 are removable To anvil block 19720, and retainer plate 19622 can be shifted to and contact anvil block 19720.Optionally, can be by group due to described above Thickness compensation part 19670 is knitted to be placed on anvil block 19720., can after tissue thickness compensation part 19670 is attached to anvil block 19720 Direction (shown in Figure 115) retraction or mobile insertion instrument 19630 along arrow S.Direction of the insertion instrument 19630 along arrow S Movement cam projection 19614 and 19616 can be caused to be separated respectively with the first protuberance 19642 and the 3rd protuberance 19643, and And it is changed into aliging again with the first lower concave part 19646 and the second lower concave part 19647 respectively.Second protuberance 19642 and the 4th is prominent Cam projection 19614 and 19616 can be abutted respectively by going out portion 19645, and can prevent insertion instrument 19630 and retainer 19600 It is kept completely separate.In the case where cam projection 19614 and 19616 is alignd again with lower concave part 19646 and 19647, the first plate 19620 can surround hinge 19612 rotates towards the second plate 19622 and away from anvil block 19720 at least in part.Guarantor can also be made Holder 19600 is separated with passage 19740, and is removed then along arrow S direction, and anvil block is for example attached to so as to leave 19720 tissue thickness compensation part 19670.

As described herein, device assembly is kept to can be used for one or more tissue thickness compensation parts being installed to surgical stapling device In the end effector of tool.Keep device assembly that the layer in addition to tissue thickness compensation part can be installed in surgical instruments.Layer can Including such as absorbable material and/or biocompatible materials.

Referring to Figure 172, end effector 12 being capable of receive end actuator insert 25002.End effector 12 can wrap Include lower jaw 25070 and the anvil block 25060 that can be pivoted relative to lower jaw 25070.End effector insert 25002 can Nail bin 25000 including anvil block insert 25004 can be pivotally connected to.End effector 12 being capable of receive end actuator Insert 25002 so that nail bin 25000 coordinates in the staple cartridge channel 25072 of such as lower jaw 25070 and so that anvil block is inserted Enter part 25004 and contact such as anvil block 25060.Lower jaw 25070 may include nail bin 25000 can be fixed into staple cartridge channel 25072 multiple fixing components 25074.Anvil block insert 25004 may include to engage at least one guarantor in anvil block 25060 Hold at least one holding projection of groove.Anvil block insert 25004 can pivot phase in anvil block 25060 towards lower jaw 25070 Ground is answered to be pivoted towards nail bin 25000, as described in more detail.

Referring also to Figure 172, end effector insert 25002 may also include retainer 25010.Retainer 25010 can jail Admittedly engage at least one of nail bin 25000 and anvil block insert 25004.Retainer 25010 may include to clamp, engages, Buckle, at least one stationary fixture 25012 for clamping, and/or catching on nail bin 25000.As shown in Figure 172, retainer 25010 can Including for example positioned at two stationary fixtures 25012 of its each longitudinal direction side.For example followed closely for example, stationary fixture 25012 can be clipped in In the part in storehouse 25000.According to the present invention, tissue thickness compensation part can be performed by retainer 25010 relative to end Device insert 25002 keeps fixing.For example, tissue thickness compensation part can be positioned within device 25010 and nail bin 25000 it Between.

Optionally, when end effector insert 25002 is just inserted into end effector 12 by operator, retainer 25010 can provide solid or substantially solid element so that operator firmly grasps.In addition, retainer 25010 can be prevented by example Such as the premature deformations for the tissue thickness compensation part that retainer 25010 limits.It can cut and/or fasten using end effector 12 Retainer 25010 is removed from end effector 12 before tissue.Alternatively, retainer 25010 can keep fixed Position is in end effector 12.For example, when cavity 25002 (Figure 20 7) percussion of the nail from nail bin 25000, can be by cutting member The crosscutting retainer 25010 of part 25052 (Figure 20 7).Retainer 25010 may include polymer composition, for example, bioabsorbable Biocompatible elastomeric polymer.Retainer 25010 may also include bioabsorbable polymer, for example, lyophilized polysaccharide, sugar Protide, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Retainer 25010 may include At least one therapeutic agent, such as pharmaceutically active agents or medicine.

Referring to Figure 173, end effector 26012 may include anvil block 26060 and lower jaw 26070.According to the present invention, can incite somebody to action Tissue compensating part 26020 is releasably secured to anvil block 26060, lower jaw 26070, and/or anvil block 26060 and lower jaw Both 26070.For example, first tissue compensating member 26020 can be releasably secured to the nail bin 26000 in lower jaw 26070, And minor microstructure compensating part 26022 can be releasably secured to anvil block 26060.First tissue compensating member 26020 and second Tissue compensating part 26022 can be deformable and/or elastic, be similarly at least one tissue thickness's compensation as described herein Part.For example, first tissue compensating member 26020 and minor microstructure compensating part 26022 may include polymer composition, such as can biology The biocompatible elastomeric polymer of absorption.First tissue compensating member 26020 and minor microstructure compensating part 26022 may also include Bioabsorbable polymer, for example, lyophilized polysaccharide, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxygen Change regenerated cellulose (ORC).First tissue compensating member 26020 and minor microstructure compensating part 26022 may include at least one treatment Agent, such as pharmaceutically active agents or medicine.

Tissue compensating part 26020,26022 may include firmly or substantially firm protective cap 26024,26026.Example Such as, the first protective cap 26024 can be positioned at the distal end of first tissue compensating member 26020, and the second protective cap 26026 It can be positioned at the distal end of minor microstructure compensating part 26022.Protective cap 26024,26026 can prevent or limit tissue compensation The premature deformations of part 26020,26022.For example, when Tissue compensating part 26020,26022 for example moves through trochar and/or enclosed When being operated around patient tissue, protective cap 26024,26026 can protective tissue compensating part 26020,26022.Similarly, referring to Figure 174, end effector 12 may include the first tissue compensation for the nail bin 25000 being releasably secured in lower jaw 25070 Part 25020 and the minor microstructure compensating part 25022 for being releasably secured to anvil block 25060.According to the present invention, will can protect Cap 25026 is positioned at the distal end of minor microstructure compensating part 25022.Protective cap 25026 can be positioned adjacent to tissue benefit Repay deformable/elastic part of part 25022.Protective cap 25026 can on Tissue compensating part 25022 and/or around extend, make Obtain distal end and the center section of the protective tissue compensating part 25022 of protective cap 25026.

Referring to Figure 175-202, sleeve pipe 27010 can engage the anvil block 25060 of the end effector 12 of such as surgical instruments. Sleeve pipe 27010 may include furcation 27040 (Figure 176-179), nose 27080 (Figure 186-189) and (figure of compensating part 27120 180-182).Sleeve pipe 27010 can translate distal end of the trigger shaft 25052 (Figure 196) close to side terminal part actuator 12 When discharge compensating part 27020.Compensating part 27020 can be deformable and/or elastic, be similarly to as described herein at least one Individual tissue thickness compensation part.For example, compensating part 27020 may include polymer composition, such as bioabsorbable bio-compatible Property elastomer polymer.Compensating part 27020 may also include bioabsorbable polymer, for example, lyophilized polysaccharide, glycoprotein, Elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensating part 27020 may include at least one Therapeutic agent, such as pharmaceutically active agents or medicine.Referring primarily to Figure 175, furcation 27040 can be positioned to the outer of anvil block 25060 On surface 25061 and/or around.The nose 27080 of sleeve pipe 27010 can be positioned at anvil block 25060 distal portion office and/ Or surrounding.Compensating part 27020 can be positioned on the inner surface of anvil block 25060 and/or surrounding.

Referring also to Figure 175, furcation 27040 may include at least one fork 27042a.Optionally, as shown in Figure 50 5-508, Furcation 27040 may include the forks of the first fork 27042a and second 27042b.For example, fork 27042a, 27042b can be it is symmetrical or Person's substantial symmetry.First fork 27042a can be symmetrical relative to the second fork 27042b.First fork 27042a and/or second Fork 27042b can narrow at its distal end.For example, each fork 27042a, 27042b may include narrow end 27048.Mainly Referring to Figure 178, furcation 27040 may be, for example, into profile.Referring again to Figure 175, the profile of furcation 27040 can for example Match somebody with somebody or substantially match anvil block 25060 outer surface 25061 profile.Referring primarily to Figure 178 and Figure 179, furcation 27040 It may also include at least one fastener 27044a from the first fork 27042a extensions.First fastener 27044a can be positioned on furcation 27040 the first side, and the second fastener 27044b can be positioned on the second side of furcation 27040.Fastener 27044a, 27044b Can for example it be positioned at or near the proximal extremity of furcation 27040.Fastener 27044a, 27044b can be for example along the first forks The forks of 27042a and/or second 27042b is positioned at or near the distal end of furcation 27040.Fastener 27044a, 27044b It can extend along the long length of furcation 27040 and/or the short length of furcation 27040.For example, multiple fasteners 27044a, 27044b can be positioned along each longitudinal direction side of furcation.Referring primarily to Figure 179, the first fastener 27044a can It may include the second fastener extension 27046b including the first fastener extension 27046a and/or the second fastener 27044b.For example, the One fastener extension 27046a can protrude from fastener 27044a at least a portion, and the second fastener extension 27046b can be from Fastener 27044b at least a portion protrudes.In addition, the first fastener extension 27046a and the second fastener extension 27046b are each From the gap 27128 (Figure 181) that can be engaged in compensating part 27020, as described in more detail.

Referring now to Figure 20 1, the compensating part 27020 for sleeve pipe 27010 may include longitudinal projection 27024 and positioned at compensation The edge 27026 of each longitudinal direction side of part 27020.Compensating part 27020 can be positioned adjacent to the inner surface of adjacent anvil block 25060 25063.In addition, when sleeve pipe 27010 is positioned on anvil block 25060, longitudinal projection 27024 can substantial alignment anvil block In longitudinal slit 25062 in 25060 and/or the longitudinal slit 25062 being positioned in anvil block 25060.Compensating part 27020 Edge 27026 can wrap anvil block 25060 at least in part towards outer surface 25061.Referring primarily to Figure 180-181, for covering The compensating part 27120 of pipe 27110 may include main body 27122, and the main body 27122 has the longitudinal direction extended along its at least a portion Projection 27124.For example, longitudinal projection 27124 can limit the longitudinal path of the center line along main body 27122.Determine when by sleeve pipe 27110 When on anvil block 25060, longitudinal projection 27124 can be received by the longitudinal slit 25062 (Figure 20 1) in anvil block 25060 for position.Mainly Referring to Figure 182, longitudinal projection 27124 may include lobe.For example, the cross section of longitudinal projection 27124 can be formed arc and/ Or partial circle.Alternatively, longitudinal projection 27124 may include angular and/or stair-stepping protuberance.Compensation Part 27120 may also include edge, the edge 27126 can be it is for example straight, bending, reeded, corrugated, and/or Zigzag.Edge 27126 may include gap 27128, and the gap 27128 can be positioned at anvil in the sleeve pipe 27110 of assembling Fastener extension 27046a, 27046b (Figure 179) are received when on seat 25060.Fastener extension 27046a, 27046b can be fitted through Gap 27128 is crossed to engage anvil block 25060 so that fastener extension 27046a, 27046b for example contribute to consolidate sleeve pipe 27110 Surely anvil block 25060 is arrived.

Referring primarily to Figure 183-185, the compensating part 27220 for sleeve pipe 27210 may include main body 27222, the main body 27222 include longitudinal projection 27224 along the extension of its at least a portion.Optionally, it is similar to the above, determine when by sleeve pipe 27210 When on anvil block 25060, longitudinal projection 27224 can be received by the longitudinal slit 25062 (Figure 20 2) in anvil block 25060 for position.Mainly Referring to Figure 185, longitudinal projection 27224 may include angular protuberance so that prominent 70224 cross section forms substantial rectangular Shape.Compensating part 27220 may also include edge 27226, and the edge 27226 can be for example straight, bending, fluted , it is corrugated, and/or zigzag.Edge 27226 may include gap 27228, and the gap 27228 can be in assembling Fastener extension 27046a, 27046b (Figure 179) are received when sleeve pipe 27210 is positioned on anvil block 25060.Fastener extension 27046a, 27046b can fit through gap 27228 and engage anvil block 25060 so that fastener extension 27046a, 27046b Such as help sleeve pipe 27210 being fixed to anvil block 25060.Compensating part 27220 may also include the main body for traversing compensating part 27220 27222 multiple ribs 27229.When sleeve pipe 27210 is positioned at into anvil block 25060 and/or when compensating part 27220 contacts tissue When, rib 27229 can support the main body 27222 of compensating part 27220.

Referring to Figure 38 6-390, the nose 27080 of sleeve pipe 27010 may include the ridge 27082 that aligns, and the alignment ridge 27082 can With longitudinal slit 25062 (Figure 20 1) substantial alignment in anvil block 25060.When alignment ridge 27082 and longitudinal slit 25062 are right For Qi Shihe when sleeve pipe 27010 is positioned on anvil block 25060, nose 27082 can be at least partially around the bifurcated of sleeve pipe 27010 The distal part in portion 27040.For example, when sleeve pipe 27010 is positioned on anvil block 25060,27042a, 27042b are each pitched Narrow end 27048 can be positioned in nose 27080.As described in more detail, when by furcation 27042 and nose During 27080 engagement, nose 27080 can be such that fork 27042a, 27042b is bent in a manner of closer and/or be downward.In addition, As shown in Figure 190, when the narrow end 27048 of furcation 27040 is positioned in nose 27080, on furcation 27040 The edge 27026 of the engageable such as compensating part 27020 of fastener 27044a, 27044b., can be by compensating part due to this engagement 27010 are fixed to anvil block 25060.

, can be by compensating part when nose 27080 engages with the furcation 27040 of sleeve pipe 27010 referring to Figure 191-195 27020 are fixed to anvil block 25060.When trigger shaft 25050 translates along a part for the longitudinal slit 25062 in anvil block 25060 When, nose 27080 can keep engaging with furcation 27040.Referring now to Figure 195-200, when the cutting member on trigger shaft 25050 Any other desired part (for example, keeping flange 25054) of part 25052 and/or trigger shaft 25050 is close to anvil block 25060 During distal end, trigger shaft 25050 can be such that nose 27080 is separated with furcation 27040.Trigger shaft 25050 can for example contact nose Portion 27080 and nose 27080 is pushed away into anvil block 25060 so that the furcation 27040 of nose 27080 and sleeve pipe 27010 divides From.Referring now to Figure 20 2, when nose 27080 separates with furcation 27040, the first fork 27042a and the second fork 27042b energy Enough flexures are away from anvil block 25060.For example, when furcation 27070 engages with nose 27080, fork 27042a, 27042b can directions Anvil block 25060 is bent in a manner of closer and/or be downward and can be maintained at this position by nose 27080 Put.It can be maintained at by nose 27080 by 27042a, 27042b is pitched under spring-load so that fork 27042a, 27042b are in nose 27080, once separating with fork 27042a, 27042b, attempt to spring back to neutral configuration.Alternatively, pitch 27042a, 27042b can be fully deformed so that fork 27042a, 27042b is once separated in nose 27080, so that it may logical Cross trigger shaft 25050 outwards deformation or extension.When fork 27042a, 27042b move away from anvil block 25060, along each fork Fastener 27044a, 27044b of 27042a, 27042b longitudinal direction side can depart from compensating part 27020, and this can allow from anvil block 25060 Discharge compensating part 27020.

Referring to Figure 20 3-209, the end effector 12 of surgical instruments for example being capable of receive end actuator insert 28010.End effector insert 28010 may include compensating part main body 28012 and at least one fixture 28014a, 28014b. End effector insert 28010 may include nearside fixture 28014b for example at the proximal extremity of compensating part main body 28012 and Distally fixture 28014a at the distal end of compensating part main body 28012., can be by distally fixture 28014a referring primarily to Figure 20 6 The anvil block 25060 of end effector 12 is fixed at or near the distal end of anvil block 25060.For example, distally fixture 28014a can be with the substantial alignment of longitudinal slit 25062 of anvil block 25060 and/or can partly be positioned at anvil block 25060 In longitudinal slit 25062., can be by lower jaws of the nearside fixture 28014b fixed to end effector 12 referring primarily to Figure 20 7 Nail bin 25000 (Figure 20 8) in 25070.Nearside fixture 28014b can be fixed at or near the proximal extremity of nail bin 25000 To nail bin 25000.For example, proximal extremity fixture 28014b can be with the substantial alignment of longitudinal slit 25004 in nail bin 25000 simultaneously And/or person can be positioned in the longitudinal slit 25004 in nail bin 25000.

Referring now to Figure 20 8 and 209, the end that end effector insert 28010 can be inserted into surgical instruments performs In device 12.Optionally, at least a portion of end effector insert 28010 is (for example, compensating part main body 28012, distally fixture 28014a, and/or nearside fixture 28014b) may be, for example, deformable and/or elastic.When by end effector insert 28010 when being inserted into end effector 12, distal side and/or nearside fixture 28014a, 28014b is flexible or flexure.Work as fixture When 28014a, 28014b are for example bent, fixture 28014a, 28014b for example can attempt to return its initial undeformed configuration and Corresponding screen resilience or restoring force can be produced.Optionally, when end effector insert 28010 is positioned at into end effector 12 When interior, end effector insert 28010 can apply spring-load to end effector 12.End effector insert 28010 Can be solid or substantially solid so that operator is just inserting end effector insert 28010 and nail bin 25000 Insert 28010 can be firmly grasped when in end effector 12.

End effector insert 28010 can be in the cutting of end effector 12 and/or coming from end for tightening operation Actuator 12 removes.Alternatively, end effector insert 28010 can be during cutting and/or firing operation Remain positioned in end effector 12.For example, when nail fires from the nail cavity 25002 (Figure 20 7) in its nail bin 25000, can Pass through the crosscut end actuator insert 28010 of cutting element 25052.End effector insert 28010 may include tissue thickness Compensating material is spent, is similarly at least one in tissue thickness compensation part as described herein.For example, end effector insert 28010 may include polymer composition, such as bioabsorbable biocompatible elastomeric polymer.End effector inserts Part 28010 may also include bioabsorbable polymer, for example, lyophilized polysaccharide, glycoprotein, elastin laminin, proteoglycans, bright Glue, collagen and/or oxidized regenerated cellulose (ORC).End effector insert 28010 may include at least one therapeutic agent, example Such as pharmaceutically active agents or medicine.

Referring to Figure 21 0-215, tissue thickness compensation part 29020 can be positioned in the end effector 12 of surgical instruments. Tissue thickness compensation part 29020 can be substantially similar at least one in tissue thickness compensation part as described herein.For example, group It can be fully deformed and elastic to knit thickness compensation part 29020 so that the deformation of tissue thickness compensation part 29020 produces resilience Power or restoring force.Referring primarily to Figure 21 1, tissue thickness compensation part 29020 can be attracted to the anvil of end effector 12 by electrostatic charge Seat 25060 so that tissue thickness compensation part 29020 is fixed to anvil block 25060 by electrostatic charge.Electrostatic charge can be neutralized so that anvil block 25060 release tissue thickness compensation parts 29020.Additionally or alternatively, referring now to Figure 21 2, can pass through Tissue thickness compensation part 29020 is fixed to anvil block 25060 by least one suction element 29022.For example, tissue thickness compensates Tissue thickness compensation part 29020 can be releasably secured to anvil block by multiple micro-suction elements 29022 on the surface of part 29020 25060.Additionally or alternatively, can be by tissue thickness compensation part referring to Figure 21 3, hook-loop securing member 29024 29020 are fixed to anvil block 25060.For example, the surface of tissue thickness compensation part 29020 may include multiple hook fastener 29024a, And the surface of anvil block 25060 may include for example multiple ring fastener 29024b.The engageable ring fasteners of hook fastener 29024a 29024b so that tissue thickness compensation part 29020 is releasably secured to anvil block 25060.

Additionally or alternatively, referring now to Figure 21 4, tissue thickness can be mended by band 29026 Repay part 29020 and be fixed to anvil block 25060.Band 29026 may include elastomer polymer and/or can surround the system of anvil block 25060 Knot knots.When removing band 29026 from anvil block 25060, tissue thickness compensation part 29020 can be discharged from anvil block 25060.In order to Be advantageous to the removal of band 29026, it for example can be stretched and/or be cut.According to the present invention, multiple bands 29026 will can be organized Thickness compensation part 29020 is fixed to anvil block 25060.Alternatively or additionally, referring now to Figure 21 5, can lead to The bearing sleeve 29028 being positioned at the distal end of tissue thickness compensation part 29020 is crossed to fix tissue thickness compensation part 29020 To anvil block 25060.Bearing sleeve 29028 can receive the distal end of such as anvil block 25060 wherein.Tissue thickness compensation part Alignment edge 29029 on 29020 can align and/or can be positioned on the longitudinal slit 25062 in anvil block 25060 anvil block In longitudinal slit 25062 in 25060.For example, when by tissue thickness compensation part 29020 be positioned on anvil block 25060 and/or from When anvil block 25060 removes, alignment edge 29029 can slide in longitudinal slit 25062.

Referring to Figure 21 6-218, tissue thickness compensation part 30020 can be positioned to the anvil of the end effector 12 of surgical instruments On seat 25060.Tissue thickness compensation part 30020 may include main body 30022 and pit 30024.For example, can be by compensating part material 30026 are maintained between main body 30022 and pit 30024.Compensating part material 30026 may include bioabsorbable polymer, Such as lyophilized polysaccharide, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Remove Outside this or alternatively, compensating part material 30026 may include at least one therapeutic agent, for example, pharmaceutically active agents or Medicine.Tissue thickness compensation part 30020 can be deformable and/or elastic, be similarly at least one group as described herein Knit thickness compensation part.For example, tissue thickness compensation part, which can wrap 30020, includes polymer composition, such as bioabsorbable biology Biocompatible elastomer polymer.Tissue thickness compensation part 30020 may also include bioabsorbable polymer, for example, lyophilized more Sugar, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).

Referring primarily to Figure 21 7, the main body 30022 of tissue thickness compensation part 30020 may include alignment element 30028, described Alignment element 30028 can receive narrow in the longitudinal direction of anvil block 25060 when tissue thickness compensation part 30020 is fixed to anvil block 25060 In groove 25062.Main body 30022 may include stepped thickness so that the geometry of main body 30022 substantially corresponds to anvil block 25060 geometry.In addition, main body 30022 may include longitudinal flange 30029.For example, longitudinal flange 30029 can such as edge The extension of side longitudinally in each of the main body 30022 of tissue thickness compensation part 30020.Longitudinal flange 30029 can wrap at least in part Around anvil block 25060 so that tissue thickness compensation part 30020 is fixed into anvil block 25060.In addition, for example, longitudinal flange 30029 can be It is sufficiently resilient so that the deflection of longitudinal flange 30029 is to adapt to and/or engage anvil block 25060.When flange 30029 engages anvil During seat 25060, longitudinal flange 30029 can apply clamping force to anvil block 25060.Pit 30024 may include indenture 30025.As general When tissue thickness compensation part 30020 is fixed to anvil block 25060, it can for example make indenture 30025 and the longitudinal slit in anvil block 25060 25062 substantial alignments.Tissue thickness compensation part 30020 can be relatively thin at indenture 30025 so that translation cutting element 25052 (Figure 20 7) cuts off tissue thickness compensation part 30020 in relatively thin opening position.

Referring now to Figure 21 9 and Figure 22 0, tissue thickness compensation part 30120 may include main body 30122, the main body 30122 Compensating material 30026 can be kept wherein.Tissue thickness compensation part 30120 may include alignment element 30128, indenture 30125, And/or longitudinal flange 30129.Tissue thickness compensation part 30120, which may also include, to be moved between the open position and the closed position Breech lock 30124.When breech lock 30124 is in the close position, as shown in Figure 21 9, compensating material 30026 can be encapsulated in tissue In the main body 30122 of thickness compensation part 30120, and when breech lock 30124 is in an open position, as shown in Figure 22 0, material is compensated Material 30026 can escape from main body 30122.Similar at least one in tissue thickness compensation part as described herein, tissue thickness Compensating part 30120 can be deformable and/or elastic.For example, tissue thickness compensation part 30120 may include combination of polymers Thing, such as bioabsorbable biocompatible elastomeric polymer.Tissue thickness compensation part 30120 may also include can biology suction The polymer of receipts, for example, lyophilized polysaccharide, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxidation regeneration are fine Dimension is plain (ORC).Due to the elasticity of tissue thickness compensation part 30120, at least a portion of main body 30122 can be bent so as to be fastened with a bolt or latch Lock 30124 moves between the open and the closed positions.When removing anvil block from surgical site, tissue thickness compensation part 30120 main body 30122 can remain attached to anvil block.For example, main body 30122 can be torn can wherein capture master to leave Any nail of body 30122.

Referring to Figure 22 1, tissue thickness compensation part 30220 may include main body 30222 and pit 30224.For example, it will can compensate Part material 30026 is maintained between main body 30222 and pit 30224.Tissue thickness compensation part 30220 may include alignment element, Indenture and/or longitudinal flange 30229.In addition, at least one longitudinal flange 30229 may include groove or slit 30228, the ditch Groove or slit 30228 can receive the inserted sheet 30225 from the extension of pit 30224 of tissue thickness compensation part 30220.In this feelings Under condition, groove 30228 can be connected main body 30222 and pit 30224 with the engagement of inserted sheet 30225.In addition, in this case, Tissue thickness compensation part 30220 can be encapsulated and/or be maintained to compensating material 30026 by the connection of groove 30028 and inserted sheet 30025 It is interior.Referring now to Figure 22 2a, the pit 30324 of tissue thickness compensation part 30320 may include the anchor log 30325 from its extension. In addition, tissue thickness compensation part 30320 may include the main body 30322 with opening 30328.Anchor log 30325 can be from pit 30324 extend to engage the opening 30328 in main body 30322.In this configuration, pit 30324 and main body 30222 can be encapsulated Compensating material 30026 between the two.Tissue thickness compensation part 30320 may also include one or more flanges 30229, one Or multiple flanges 30229 may be mounted to anvil block so as to which main body 30322 is remained into anvil block.

Referring now to Figure 22 3, tissue thickness compensation part 30420 may include main body 30422 and pit 30424.It will can compensate Material 30026 is maintained between the main body 30422 of tissue thickness compensation part 30420 and pit 30424.Main body 30422 may include Aperture 30428, and pit 30424 may include anchor log 30425.For example, anchor log 30425 from pit 30424 and can be worn The aperture 30428 for crossing main body 30422 extends.For example, when tissue thickness compensation part 30420 is fixed into anvil block 25060, grappling The engageable anvil block 25060 of part 30425.Anchor log 30525 can be sufficiently deformable and elastic so that anchor log 30425 exists Bent when engaging anvil block 25060.In addition, the anchor log 30425 of flexure can apply clamping force with by tissue thickness to anvil block 25060 Compensating part 30420 is fixed or aided in be fixed to anvil block 25060.Alternatively, anchor log can not extend fully through Aperture in compensating part main body.Referring to Figure 22 4, the anchor log 30525 on the pit 30524 of tissue thickness compensation part 30520 can Engage the aperture 30528 in the main body 30522 of tissue thickness compensation part 30520.The engageable aperture 30528 of anchor log 30525 with Pit 30524 is fixed to main body 30522.For example, aperture 30528 may include the neck down portions for extending to pod.Anchor log 30525 may include built-in edge, and the built-in edge may pass through neck down portions and engaging socket is so that anchor log 20525 to be fixed In aperture 30528.For example, tissue thickness compensation part 30520 may also include alignment element, indenture and/or longitudinal flange 30529。

Referring to Figure 22 5-227, tissue thickness compensation part 31020 can engage the end effector 31012 of surgical instruments Anvil block 31060.Tissue thickness compensation part 31020 may include outer membrane 31022, the compensation of inner membrance 31024 and positioning between the two Material 31026.Tissue thickness compensation part 31020 can be deformable and/or elastic, and it is thick to be similarly to tissue as described herein Spend at least one in compensating part.For example, compensating material 31026 may include polymer composition, such as bioabsorbable life Thing biocompatible elastomer polymer.Tissue thickness compensation part 31020 may also include bioabsorbable polymer, for example, lyophilized Polysaccharide, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Tissue thickness is mended Repaying part 31020 may include at least one therapeutic agent, such as pharmaceutically active agents or medicine.The compensation of tissue thickness compensation part 31020 Material 31206 may include therapeutic agent.

For example, inner membrance 31024 can be positioned adjacent to the nail shapes pit 31066 in anvil block 31060.Referring primarily to figure 225, inner membrance 31024 may include stepped geometry so that the geometry of inner membrance 31024 corresponds essentially to anvil block 31060 geometry.Inner membrance 31024 may also include alignment ridge 31028, it is described alignment ridge 31028 can for example with anvil block 31060 In the substantial alignment of longitudinal slit 31062 and/or parallel.As described in more detail, inner membrance 31024 may include from inner membrance The inward flange 31025 that 31024 side longitudinally in each extends and terminated in fastener 31027.Outer membrane 31022 may include for example to lead Body 31021 and at least one outward flange 31023.Optionally, for example, outward flange 31023 can be from the side longitudinally in each of main body 31021 Extension.Outward flange 31023 can be fixed to inward flange 31025 so that compensating material 31026 is maintained at outer membrane 31022 and inner membrance Between 31024.

Referring primarily to Figure 22 7, anvil block 31060 may include outer surface 31061 and at least a portion along outer surface 31061 At least one groove 31064.According to the present invention, the fastener 31027 on inner membrance 31024a inward flange 31025 can be positioned at In groove 31064.Referring to Figure 22 6, for example, tissue thickness compensation part 31020 can enter line slip around anvil block 31060.Anvil block Groove 31064 on 31060 may extend into the distal end of anvil block 31060.In such cases, tissue thickness compensation part 31020 fastener 31027 can be in the groove 31064 and along the running lengthwise of tissue thickness compensation part 31020.

Referring now to Figure 22 8 and Figure 22 9, tissue thickness compensation part 31120 may include compensating material 31026 and at least one Connector 31124.Each connector 31124 can extend around compensating material 31026 and can terminate at button in its opposing end portions In part 31127.Fastener 31127 can be positioned in the groove 31064 of anvil block 31060 so that tissue thickness compensation part 31120 is tight It is affixed to anvil block 31060.Groove 31164 on anvil block 31060 may extend into the distal end of anvil block 31060.In such cases, The fastener 31127 of connector 31124 is slid into groove 31064.Alternatively, connector 31224 can be bullet Property so that they can be bent around anvil block 31060 and buckle.During use, connector 31224 can be by compensating material 31026 are held in position in, until compensating material 31026 separates with anvil block 31060.In some cases, connector 31224 can remain attached to anvil block 31060 and can be removed together with anvil block from surgical site.In some other cases, even Fitting 31224 can be separated with anvil block 31060 and can be implanted together with compensating material 31026.

With reference to figure 230- Figure 23 6, tissue thickness compensation part 32020 may include that main part 32022, at least one longitudinal direction are convex Edge 32024 and at least one pit 32026.Tissue thickness compensation part 31020 can be deformable and/or elastic, and this is similar It is at least one in tissue thickness compensation part as described herein.For example, compensating material 31026 may include polymer composition, Such as bioabsorbable biocompatible elastomeric polymer.Tissue thickness compensation part 31020 may also include bioabsorbable Polymer, for example, lyophilized polysaccharide, glycoprotein, elastin laminin, proteoglycans, gelatin, collagen and/or oxidation regeneration fiber Plain (ORC).Longitudinal flange 32024 can extend along the side longitudinally in each of main part 32022.Referring primarily to Figure 23 3, tissue thickness The longitudinal flange 32024 of compensating part 32020 can engage anvil block 25060.For example, tissue thickness compensation part 32020 is slid into On anvil block 25060 and longitudinal flange 32024, and a part for anvil block 25060 can be wrapped at least in part.In such situation Under, for example, tissue thickness compensation part 32020 can be fixed to anvil block 25060 by flange 32024.Optionally, mended when by tissue thickness When repaying part 32020 and being fixed to anvil block, the main part 32022 of tissue thickness compensation part 32020 can with the surface of anvil block 25060 Nail shapes pit 25066 is overlapping.

Further described above, multiple pits 32026 can laterally traverse main part 32022.Referring primarily to Figure 23 4, multiple pits 32026 may include at least one therapeutic agent, such as pharmaceutically active agents or medicine.It is multiple according to the present invention First pit 32026a may include the first therapeutic agent or its combination, and multiple second pit 32026b may include second therapeutic agent Or its combination.First pit 32026a and the second pit 32026b for example can be alternately carried out positioning along main part 32022. In addition, when discharging the first therapeutic agent from the first pit 32026a and discharging second therapeutic agent from the second pit 32026b, the One therapeutic agent and second therapeutic agent can react with each other.Referring to Figure 23 6, for example, when the cutting element on trigger shaft 25050 25052 along the longitudinal slit 25062 in anvil block 25060 translate when, therapeutic agent that pit 32026 releasably remains at.

Referring now to Figure 23 7, the end effector of surgery suturing appliance may include anvil block 32560 and be mended with tissue thickness Repay the nail bin 32500 of part 32520.Similar to the above, nail bin 32500 may include to be at least partially contained in multiple nails therein 32530, the multiple nail 32530 can be projected from nail bin to capture tissue thickness compensation part 32520 wherein.In addition with phase above Seemingly, nail 32530 can penetrate tissue thickness compensation part 32520 and contact the nail shapes pit being defined in anvil block 32560 32562.Referring now to Figure 23 9, anvil block 32560 may also include the layer 32570 being attached with it, and the layer 32570 will can be organized Thickness compensation part 32580 remains to anvil block 32560.For example, layer 32570 may include charged layer, the charged layer can keep and/ Or produce electrostatic charge and attract tissue thickness compensation part 32580.More particularly, Van der Waals molecular force (no matter actively Activate or Passively activated) for example tissue thickness compensation part 32580 can be remained to layer 32570.Charged layer 32570 can be with surgery The shank of suture instruments is electrically connected, and the shank may include control piece, and the control piece can be such that charged layer 32570 is selected with power supply Couple to selecting property and therefore allow optionally to produce electrostatic charge in charged layer 32570.For example, charged layer 32570 can wrap Include the conductive electrode being for example embedded in polymer.Under any circumstance, electrostatic layer 32570 can attract tissue thickness compensation part The particle of oppositely charged in 32580, and tissue thickness compensation part 32580 is remained into anvil block.Referring now to Figure 23 8, Charged layer 32570 may include the grid or grid for the conductor 32571 being electrically connected each other.For example, conductor can be positioned and be arranged to So that they surround the nail shapes pit 32562 being defined in anvil block 32560.In such cases, nail 32530 can be from nail bin 32500 project, and can then be deformed by anvil block 32560, and will not capture conductor 32571 wherein.In all cases, Charged layer 32570 can be made to be disconnected with power supply, to cause layer after nail 32530 engages with tissue thickness compensation part 32580 Electrostatic charge in 32570 can dissipate.In some other cases, just it can come to make charged layer 32570 by what is fired in nail 32530 Disconnected with power supply.Under any circumstance, when electrostatic charge dissipates, anvil block 32560 can be reopened and layer 32570 can be moved Away from tissue thickness compensation part 32580.Electrostatic charge can need can be before the separation of tissue thickness compensation part 32580 in layer 32570 Dissipate completely, and alternatively, layer 32570 can be before the electrostatic charge in layer 32570 dissipates completely from tissue Thickness compensation part 32580 separates.Due to described above, tissue thickness can be compensated in the case of without using chemical adhesive Part 32580 is attached to anvil block 32560.

Further described above, layer 32570 can also provide feedback capability for the shank of surgery suturing appliance.Example Such as, layer 32570 can be clamping pressure pressure-sensitive and that its application of face can be detected for example, by anvil block 32560.

Further described above, tissue thickness compensation part can be made up of biocompatible materials.Biocompatibility Material (for example, foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer, and/or combinations thereof, so as to provide required characteristic for material.Biocompatible foam may include surface-active Agent.Surfactant can be administered to the surface of material and/or be dispersed in material.Without wishing to be bound by any specific theory, apply The surface tension of fluid of contact material can be reduced by using the surfactant of biocompatible materials.For example, surfactant The surface tension of the water of contact material can be reduced, to promote water penetration in material.Water may act as catalyst.Surfactant can Increase the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant, and/or non-ionic surface active Agent.It is fine that surfactant example includes but is not limited to polyacrylic acid, methalose, methylcellulose, ethyl cellulose, propyl group Tie up element, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl base ether, polyoxyethylene lauryl ether, polyoxethylene octylphenyl Ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitol monolaurate, polyoxyethylene stearyl Base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethylene oxy) ethanol, poloxamer and combinations thereof.Table Face activating agent may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant may include non-phospholipid surfactants.Phosphatide Surfactant can provide antibacterial stability characteristic (quality), and/or other materials can be dispersed in biocompatible materials.

Tissue thickness compensation part may include at least one medicine.Tissue thickness compensation part may include natural material as described herein One or more in material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, poly- Lactic acid, polydioxanone, polyhydroxy-alkanoates, Poliglecaprone and combinations thereof.Tissue thickness compensation part can wrap Include the film containing at least one medicine.Tissue thickness compensation part may include the biodegradable film containing at least one medicine.Medicine Thing may include liquid, gel, and/or powder.Medicine may include anticarcinogen, for example, cis-platinum, mitomycin, and/or adriamycin.

Tissue thickness compensation part can include biodegradation material, to provide at least one medicine when biodegradation material is degraded The controlled elution or release of thing.When the agent of Biodegradable material contact activation (for example, activator fluid), biodegradable material Expect degradable, decomposable asymmetric choice net or loss structure integrality.Activator fluid may include such as saline solution or any other electrolyte Solution.Biodegradable material can be by routine techniques (including but not limited to spray, impregnate, and/or brush) come contact activation Agent fluid.In use, for example, surgeon can will include the end effector of the tissue thickness compensation part containing at least one medicine And/or nail bin is impregnated into activator fluid (including salting liquid, for example, sodium chloride, calcium chloride, and/or potassium chloride).Work as tissue When thickness compensation part is degraded, tissue thickness compensation part releasable medicaments.Medicine can from the elution or release of tissue thickness compensation part By quickly initially eluting or rate of release and slower lasting elution or rate of release characterize.

According to the present invention, tissue thickness compensation part can be for example made up of biocompatible materials, the biocompatibility material Material may include oxidant.Oxidant can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but not It is limited to hydrogen peroxide, urea peroxide, calper calcium peroxide and peromag and SODIUM PERCARBONATE.Oxidant may include that peroxy aoxidizes Agent and hypochlorous acid base oxidant, for example, hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidant It may include alkali metal chlorite, hypochlorite and perborate, for example, chloritization sodium, sodium hypochlorite and sodium perborate.Oxidation Agent may include vanadate.Oxidant may include ascorbic acid.Oxidant may include active oxygen product.According to the present invention, tissue Support may include the biocompatible materials containing oxidant.

Biocompatible materials may include liquid, gel, and/or powder.Oxidant may include such as particulate and/or nanometer Particle.For example, oxidant can be ground into particulate and/or nano particle.Can be by making oxidant be suspended in polymer solution Oxidant is incorporated into biocompatible materials.Oxidant can be incorporated into biocompatibility in lyophilization process In material.After lyophilized, oxidant could attach to the cell-wall of biocompatible materials, with contact when with tissue phase Interaction.Oxidant not can be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatibility In foam, to provide long-term biological effects by the slow release of oxygen.Percarbonate dry powder can be embedded in and be knitted with non- Make in the polymer fiber of structure, to provide long-term biological effects by the slow release of oxygen.Biocompatible materials can Including oxidant and medicine, for example, fortimicin and ascorbic acid.

Biocompatible materials may include the oxidant of quick release and/or the oxidant of slower sustained release.Oxidant Can be by quickly initially eluting or rate of release and slower lasting elution or releasing from the elution or release of biocompatible materials Speed is put to characterize.When oxidant contacts body fluid (for example, water), oxidant can produce oxygen.The example of body fluid may include but Be not limited to blood, blood plasma, peritoneal fluid, celiolymph, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, And/or bile.Without wishing to be bound by any specific theory, oxidant can reduce cell death, enhancing organizational vitality and/or Keep the mechanical strength of tissue-tissue that can be damaged during cutting and/or suture.

Biocompatible materials may include at least one particulate and/or nano particle.Biocompatible materials may include this The one or more in natural material, non-synthetic materials and synthetic material described in text.Biocompatible materials may include have The particle of the average diameter of about 10nm to about 100nm and/or about 10 μm to about 100 μm (such as 45-50nm and/or 45-50 μm). Biocompatible materials may include biocompatible foam, and the biocompatible foam includes being embedded at least one micro- Grain and/or nano particle.Particulate and/or nano particle not can be chemically bonded to biocompatible materials.Particulate and/or nanometer Particle can provide the controlled release of medicine.Particulate and/or nano particle may include at least one medicine.Particulate and/or nanometer Grain may include such as styptic, antimicrobial, and/or oxidant.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes the styptic containing oxidized regenerated cellulose, anti-micro- containing fortimicin and/or gentamicin Biological agent, and/or the oxidant containing percarbant.Particulate and/or nano particle can provide the medicine of such as at most three days by Controlled release is put.

Particulate and/or nano particle can be embedded into biocompatible materials during manufacturing process.For example, bio-compatible Property polymer (for example, PGA/PCL) can contact solvent (for example, dioxane) to form mixture.Biocompatibility gathers Compound can be ground to form particle.The dry particle for containing or not contain ORC particles can contact mixture to form suspension Liquid.Suspension can be freezed to form biocompatible foam, the biocompatible foam includes PGA/PCL, the PGA/PCL With dry particle and/or the ORC particles being embedded.

Tissue thickness compensation part disclosed herein or layer can be made up of such as absorbable polymer.Tissue thickness compensation part It can be made up of for example following material：Foam, film, fiber weaving thing, fiber non-woven thing PGA, PGA/PCL (poly- (glycolic -co- Caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- trimethylene Carbonic ester)), the absorbable polyurethane of PDS, PEPBO or other, polyester, makrolon, poe, polyanhydride, polyesteramide, And/or polyoxy acid ester.According to the present invention, tissue thickness compensation part by such as PGA/PLA (poly- (glycolic -co- lactic acid)) and/ Or PDS/PLA (poly- (p- dioxanone -co- lactic acid)) is formed.According to the present invention, tissue thickness compensation part can be by for example having Machine material is formed.Tissue thickness compensation part can be by such as carboxymethyl cellulose, mosanom, cross-linked-hyaluronic acid, and/or oxidation again Raw cellulose is formed.According to the present invention, tissue thickness compensation part may include such as 3-7 Xiao A hardness (30-50 Shore OO hardness) In the range of hardometer, wherein maximum rigidity is 15 Xiao A hardness (65 Shore OO hardness).Tissue thickness compensation part is born in 3lbf 40% compression can occur under lotus, 60% compression can occur under 6lbf loads, and/or can be sent out under 20lbf loads Raw 80% compression.One or more gases (for example, air, nitrogen, carbon dioxide, and/or oxygen) can be blasted tissue thickness In degree compensating part and/or it may be housed in tissue thickness compensation part.Tissue thickness compensation part can include particle, institute wherein State particle can account for the material hardness that forms tissue thickness compensation part about 50% to more than 75%.

According to the present invention, tissue thickness compensation part may include for example hyaluronic acid, nutrient, fibrin, fibrin ferment, Rich in hematoblastic blood plasma, SASP (- 5ASA+ sulfapryidines azo bond))-pro-drug-colon is thin Bacterium (azo reductase), aminosalicylic acid (have be used for delay release different pro-drug structures 5ASA), (- the pH of 5ASA+ acrylic resins-S coatings>7 (coating dissolvings)),(coating of 5ASA+ ethyl celluloses-when Between/pH dependent sustained releases),(- the pH of 5ASA+ acrylic resins-L coatings>6), Olsalazine (5ASA+5ASA- Colon bacteria (azo reductase)), Balsalazide (5ASA+4 amino benzoyl-B- alanine)-colon bacteria (azo reduce Enzyme)), granular aminosalicylic acid, Lialda (sustained release and SR preparations of aminosalicylic acid), HMPL-004 (can forbid TNF-α, interleukin- 1 β and core-k B activation herbal mixture), CCX282-B (interference T lymphocytes transport in intestinal mucosa orally becoming Change cytokine receptor antagonist), rifaximin (broad-spectrum antibiotic of nonabsorable), infliximab, murine Chymieric (targets the monoclonal antibody of TNF-α, the TNF-α is approved for reducing sign/symptom, keeping in taking The clinical remission of adult/child patient of equivalent/severe amount phenobarbital and to it is insufficient reaction conventional therapy Crohn Sick fistulization), adalimumab, human IgG1 (anti-TNF-alpha monoclonal antibodies-be approved for reduce Crohn disease sign/symptom And available for reduction and the holding moderate with insufficient reaction conventional therapy/severe activity Crohn diseases or English is not tolerated The clinical remission of the adult patients of husband's profit former times monoclonal antibody), Certolizumab pegoll, the anti-TNF FAB ' of peopleization (be linked to The monoclonal antibody fragment of polyethylene glycol-be approved sign/symptom for reducing Crohn diseases and can be used for reducing and keeping The reaction of the adult patients of moderate/severe disease with insufficient reaction conventional therapy), natalizumab, the first non-TNF-α Inhibitor (being approved the biologic artifact for Crohn diseases), the monoclonal IgG4 antibody of peopleization (target α -4 integrins - By FDA check and approve for induce and keep with exist inflammatory signs moderate/severe disease and it is insufficient reaction or can not Be resistant to clinical response and the alleviation of the patient of conventional Crohn treatment and TNF-α inhibitor), may be together with infliximab The concomitant immunity modulator of administration), imuran -6-MP (purine synthetic inhibitor-pro-drug), methotrexate (MTX) (knot Close dihydrofolate reduction (DHFR) enzyme, it participates in tetrahydrofolic acid Lipase absobed, suppresses all purine synthetics), allopurinol and Imuran treatment, PPI, suppress to protect healing H2, C-Diff-Flagyl of line, vancomycin (at excrement transposition for acid Reason；Probioticses；Flora breeds again in normal chamber), and/or rifaximin (treatment (the significantly liver property of bacterial overgrowth Encephalopathic)；Do not absorbed by intestines and stomach and do not act on bacterium in tube chamber).

As described herein, tissue thickness compensation part can for example compensate the change of tissue thickness, the tissue be trapped in from In the nail that nail bin projects and/or it is accommodated in staple line.In other words, some nails in staple line can capture the thicker of tissue Point, and other nails in staple line can capture the thinner part of tissue.In such cases, tissue thickness compensation part can be in nail Existing different height or thickness, and tissue of the capture in nail can be applied compressive force to, it is thick but regardless of the tissue captured It is or thin.According to the present invention, tissue thickness compensation part can compensate for the change of tissue hardness.For example, some nails in staple line can be caught The high compression part of tissue is obtained, and other nails in staple line can capture the relatively low compression section of tissue.In such cases, group Knitting thickness compensation part for example can capture with compared with less height is presented in the nail of little compressible or the tissue of higher hardness Degree, and accordingly, larger height is presented in the nail captured with higher compression ratio or compared with the tissue of soft. In any case, tissue thickness compensation part is for example regardless of whether the change of compensation tissue thickness and/or tissue hardness change can claim For such as " Tissue compensating part " and/or " compensating part ".

Device disclosed in this invention can be designed as being handled after being intended for single use, or can be designed as them can It is used for multiple times.However, in either case, described device can be repaired, to be reused after use at least once. Again any combination that may include following steps is recovered：Dismantle the device and then cleaning or replace some parts and subsequent group Dress.Particularly, described device can be dismantled, and it is any number of optionally can to replace or remove in any combination the device Specific component or part.After cleaning and/or replacement specific part, the device can be re-assemblied so as to subsequent at restoration facilities Use, or re-assemblied before it will carry out surgical operation by surgical team.Those skilled in the art will be appreciated that, fill The reparation put can utilize it is a variety of be used to dismantling, the technology for cleaning/replace and re-assembly.The uses of these technologies and gained Prosthetic device is within the scope of the present invention.

Preferably, invention as described herein will be handled before surgery.First, new or used dress is obtained Put, and device is cleaned when necessary.Then device is carried out disinfection.In a kind of disinfection technology, the device is placed in In the container for closing and sealing, such as in plastics or TYVEK bag.Then the spoke of the container can be penetrated by being placed in container and device Penetrate area, such as γ radiation, x- rays or high energy electron.The bacterium on device and in container is killed in radiation.Then after sterilizing Device be stored in disinfecting container.Apparatus is kept sterile by the sealing container, until opening the container in Medical Devices.

By reference in full or any patent, the patent that are partly incorporated herein disclose or other open materials only exist The material being incorporated in existing definition of the present invention, statement or the afoul scope of other open materials with not being incorporated to this Text.Thus, under necessary degree, the disclosure that herein explicitly illustrates will substitute be herein incorporated by reference it is any Afoul material.If according to state be herein incorporated by reference but with it is as described herein it is existing definition, statement or other disclosures Afoul any material of material or part thereof, only do not produce conflict between the material and existing open material being incorporated to It is incorporated herein under degree.

Although being described the present invention as exemplary design, it is also possible in spirit and scope of the present disclosure It is interior that the present invention will be further modified.Therefore present patent application be intended to using its general principles any modification, Purposes or adaptive version.In addition, present patent application is intended to come from known in art of the present invention or is used to have practical framework The interior pattern away from the disclosure.

Claims

1. a kind of compensating part, it can be attached to the anvil block of fastening instrument, wherein the anvil block include can be with the fastener The fastener cartridge jaw of tool profiled surface positioned opposite, and wherein described compensating part includes：

Pipe, the pipe is made up of two or more as the housing that a part for expressing technique is formed together, wherein described Pipe includes hole, side wall, first end and the second end in the restriction hole, wherein the side wall entirely close to the anvil block into Arrange shape surface and the fastener cartridge jaw；

Strands line, the strands line are configured to be pulled through the hole so that the strands line can be in the benefit It is cut during repaying the manufacture of part with together with the pipe；With

Attachment part, the attachment part can be attached to the anvil block.

2. compensating part according to claim 1, wherein the strands line is made up of oxidized regenerated cellulose.

3. compensating part according to claim 1, wherein the pipe is made up of polymeric material.

4. compensating part according to claim 1, it is configured to engage the anvil block wherein the attachment portion includes The first side the first flank and be configured to engage the anvil block the second side the second flank.

5. a kind of compensating part, it can be attached to the anvil block of fastening instrument, wherein the anvil block includes profiled surface, and wherein The compensating part includes：

Pipe, the pipe is made up of two or more as the housing that a part for expressing technique is formed together, wherein described Pipe includes hole, first end and second end, wherein the first end and the second end have been sealed and closed；

Attachment part, the attachment part are configured to be attached to the anvil block.

6. a kind of compensating part, it can be attached to the anvil block of fastening instrument, wherein the anvil block includes profiled surface, and wherein The compensating part includes：

Pipe, the pipe is made up of two or more as the housing that a part for expressing technique is formed together, wherein described Pipe includes hole, first end and second end；

Attachment part, the attachment part are configured to be attached to the anvil block,

Wherein described pipe includes flexure joints.