CN104349800B

CN104349800B - Tissue thickness compensation part including controlled release and expansion

Info

Publication number: CN104349800B
Application number: CN201380028028.XA
Authority: CN
Inventors: C·O·巴克斯特三世; F·E·谢尔顿四世; C·J·沙伊布; C·W·威登豪斯; W·B·韦森伯格二世; J·L·斯塔门; M·H·兰西克; S·A·马奇勒; G·W·奈特; M·S·克罗珀; S·P·康伦; J·S·斯韦兹
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2012-03-28
Filing date: 2013-03-27
Publication date: 2017-11-10
Anticipated expiration: 2033-03-27
Also published as: RU2014143262A; RU2637167C2; JP2015513957A; JP6320989B2; CN104349800A; MX2014011670A

Abstract

The invention discloses a kind of tissue thickness compensation part, it can generally include first layer and the second layer, the first layer includes being sealed around the first biocompatible materials in impermeable material, the second layer includes the second biocompatible materials with least one packaging part, wherein first biocompatible materials expands when being contacted with fluid.The tissue thickness compensation part can include styptic, antiinflammatory, antibiotic, antimicrobial, antiadhesives, anti-coagulants, medicine, and/or pharmaceutically active agents.The packaging part can include Biodegradable material with vivo and/or ira situ degradation.The tissue thickness compensation part can include hydrogel.The reaction product may include the composition of fluid swollen.Also describe product and preparation and the method using the tissue thickness compensation part including the tissue thickness compensation part.

Description

Tissue thickness compensation part including controlled release and expansion

The cross reference of related application

The patent application of this non-transitory is entitled according to submitting 35U.S.C. § 120 29 days April in 2011 “Tissue Thickness Compensator For A Surgical Stapler Comprising An Adjustable The part continuation application of Anvil " U.S. Patent Application Serial Number 13/097,891, according to the U.S. Patent application Entitled " the Selectively Orientable Implantable that 35U.S.C. § 120 Septembers in 2010 are submitted on the 30th The part continuation application of Fastener Cartridge " U.S. Patent Application Serial Number 12/894,377, above-mentioned patent application Complete disclosure be hereby incorporated by reference.

Background technology

The present invention relates to surgical instruments, and in various embodiments, the present invention relates to be designed to cut and stitch The charge-coupled surgery cuts knitted and suture instruments and its nail bin.

The content of the invention

It is the incomplete row of claimed or possible claimed invention embodiment below Table.

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

First layer, the first layer include being sealed around the first biocompatible materials in impermeable material； With

The second layer, the second layer include the second biocompatible materials with least one packaging part；

Wherein the first biocompatible materials expands when being contacted with fluid.

2. according to the tissue thickness compensation part of embodiment 1, including the third layer with the 3rd biocompatible materials, wherein The first layer is among the second layer and third layer.

3. according to the tissue thickness compensation part of embodiment 2, wherein each of the first layer and second layer include group Knit contact surface.

4. according to embodiment 2 or the tissue thickness compensation part of embodiment 3, wherein first biocompatible materials, Two biocompatible materialses and the 3rd biocompatible materials are independently selected from albumin, alginates, carbohydrate, junket egg In vain, cellulose, chitin, chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibrin Original, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, poly- (lactic acid), poly- (glycolic), poly- (hydroxybutyric acid Ester), poly- (phosphine piperazine), polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide, makrolon, polymethylacrylic acid hydroxyl Ethyl ester, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, Polypropylene, glycerine, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly- (iminocarbonic ester), poly- The combination of oxa- ester, poe, polyphosphazene or above-mentioned substance.

5. according to the tissue thickness compensation part of any one of previous embodiment, wherein the first biocompatible materials bag Include dried hydrogel.

6. according to the tissue thickness compensation part of embodiment 5, wherein the hydrogel includes being selected from following compound：Alkylene Base oxide, polysaccharide, ester, aliphatic (acid) ester, ortho esters, phosphate, carbonic ester, polyurethanes, ether, acid amides, phenolic resin or The combination of above-mentioned substance.

7. according to the tissue thickness compensation part of any one of previous embodiment, wherein first biocompatible materials is The composition of water-swellable.

8. according to the tissue thickness compensation part of any one of previous embodiment, wherein the fluid include water, saline solution, Or body fluid.

9. according to the tissue thickness compensation part of any one of previous embodiment, wherein when the impermeable material ruptures, First biocompatible materials contacts the fluid.

10. according to the tissue thickness compensation part of any one of previous embodiment, wherein impermeable material include poly- (lactic acid), Poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide, poly- Carbonic ester, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxa hexamethylene Ketone), polyacrylic acid, poly- acetic acid esters, polypropylene, glycerine, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, polyamides Amine, poly- (iminocarbonic ester), polyoxaesters, poe, polyphosphazene, or the combination of above-mentioned substance.

11. according to the tissue thickness compensation part according to any one of previous embodiment, wherein at least one packaging part Including the packed component of at least one, the packed component includes styptic, antiinflammatory, antibiotic, antimicrobial, anti-adhesion Agent, the combination of anti-coagulants, medicine, pharmaceutically active agents or above-mentioned substance.

12. according to the tissue thickness compensation part according to embodiment 11, wherein at least one packed component includes resisting Microorganism agent, the antimicrobial include triclosan, chlorhexidine or its salt, silver or its salt, ammonium or its salt, copper or its salt, iron Or the combination of its salt, zinc or its salt or above-mentioned substance.

13. according to the tissue thickness compensation part of any one of previous embodiment, wherein at least one packaging part includes Pipe, the pipe include polyglycolic acid, PLA, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone, pla-pcl, Or the combination of above-mentioned substance.

14. according to the tissue thickness compensation part of any one of previous embodiment, wherein at least one packaging part is in body Interior degraded.

15. a kind of product, the product is selected from the anvil block of robotic suturing device and the nail bin for robotic suturing device, the product bag Include the tissue thickness compensation part of embodiment 1.

16. a kind of tissue thickness compensation part, it includes：

Internal layer, the internal layer include being impregnated with styptic, antiinflammatory, antibiotic, antimicrobial, antiadhesives, anti-freezing The hydrogel of at least one of agent, medicine and pharmaceutically active agents；With

Outer layer, the outer layer include the impermeable material for sealing around the internal layer；

Wherein described hydrogel expands when being contacted with least one of water, saline solution and body fluid.

17. according to the tissue thickness compensation part of embodiment 16, wherein when impermeable material ruptures, the Hydrogel contact Water, saline solution or body fluid, and wherein when the impermeable material ruptures, styptic, antiinflammatory, antibiotic, anti-micro- life At least one of agent, antiadhesives, anti-coagulants, medicine and pharmaceutically active agents are released.

18. a kind of internal layer by including biocompatible materials and the impermeable material including sealing around the internal layer The outer layer method for preparing tissue thickness compensation part, this method includes：

With in styptic, antiinflammatory, antibiotic, antimicrobial, antiadhesives, anti-coagulants, medicine and pharmaceutically active agents At least one dipping internal layer；

Wherein biocompatible materials expands when contacting at least one of water, saline solution and body fluid.

19. the method for embodiment 18, in addition to：

Rupture the impermeable material；And

Contact at least one of the biocompatible materials and water, saline solution and body fluid, so that the tissue Thickness compensation part expands.

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 some 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 in the close position of the end effector shown in Fig. 2；

Fig. 4 is that the end effector shown in 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 that the end effector shown in Fig. 2 to Fig. 4 is another local horizontal when knife bar is partly advanced through wherein Side cross-sectional view；

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

Fig. 7 A are the schematic diagram 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 that nail is driven against anvil block；

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

Figure 11 is the profile of Figure 10 nail bin；

Figure 12 is the front view for the nail bin and sliding part for making nail be moved towards anvil block that can traverse Figure 10；

Figure 13 is the schematic diagram for the staple drivers that can be lifted by Figure 12 sliding part towards anvil block；

Figure 14 is that nail bin includes and surgery suturing appliance 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 being 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 move in Figure 14 nail bin, with from cartridge deployment Nail；

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 nails, and by Figure 19 slip Part 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 nail bin includes rigid support portion and compressible tissue thickness compensation 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 drawing of anvil block in the close position, and nail bin includes rigid support portion and can pressed The tissue thickness compensation part of contracting, show that never firing position moves to firing position to nail during First ray；

Figure 32 is Figure 31 anvil block and another profile of nail bin, is shown after percussion sequence is completed in opening The anvil block of position；

Figure 33 is the local detail drawing of Figure 31 nail bin, shows 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 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 nail bin includes rigid support portion and compressible Tissue thickness compensation part, show the nail in non-firing position 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 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, shows to be positioned between anvil block and nail bin have difference The tissue of thickness；

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 the schematic diagram for showing the tissue thickness compensation part being positioned in the intersecting tissue regions of multiple staple lines；

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 part sectioned view of the end effector of surgery suturing appliance, is shown in retraction, non-firing position Trigger shaft and nail percussion sliding part；

Figure 57 is another part sectioned view of Figure 56 end effector, is shown in the local percussion for promoting position Bar and nail percussion sliding part；

Figure 58 is the profile of Figure 56 end effector, is shown in being fully advanced or the trigger shaft of firing position；

Figure 59 is the profile of Figure 56 end effector, show after being fired in advanced position trigger shaft with 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 tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 62 is the detail drawing of the non-woven material of Figure 61 tissue thickness compensation part；

Figure 63 is the tissue thickness compensation part for showing Figure 61 against organizing to be implanted and from end effector release Front view；

Figure 64 is the detail drawing according to the non-woven material of the tissue thickness compensation part of at least one embodiment；

Figure 65 is according at least one schematic diagram for implementing to be illustrated the cluster of randomly-oriented crimped fibre；

Figure 66 is according at least one schematic diagram for implementing to be illustrated the cluster of randomly-oriented crimped fibre；

Figure 67 is according at least one schematic diagram for implementing to be illustrated the construction of crimped fibre；

Figure 68 is according at least one schematic diagram for implementing to be illustrated the construction of crimped fibre；

Figure 69 is according at least one schematic diagram for implementing to be illustrated the construction of crimped fibre；

Figure 70 is the section plan of the coiled fiber in the tissue thickness compensation part according at least one embodiment；

Figure 70 A are the section plans of Figure 70 coiled fiber；

Figure 70 B are the cross-sectional details figures of Figure 70 tissue thickness compensation part；

Figure 71 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 72 is the schematic diagram of the deformation for the tissue thickness compensation part for showing Figure 71；

Figure 73 be according to the schematic diagram of the weaving suture loading of the tissue thickness compensation part of at least one embodiment, it illustrates Weaving suture loading in loading configuration；

Figure 74 is the schematic diagram of Figure 73 weaving suture loading, and it illustrates the weaving suture loading in release configuration；

Figure 75 is the flat of the tissue thickness compensation part of the weaving suture loading in the end effector of surgical instruments with Figure 73 Face figure；

Figure 76 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 77 is the partial plan layout of Figure 76 tissue thickness compensation part；

Figure 78 be Figure 61 end effector and tissue thickness compensation part fastener cartridge assembly exploded view；

Figure 79 is the partial sectional view of Figure 78 fastener cartridge assembly, and it illustrates do not fire, partly fire and fire Fastener；

Figure 80 is the front view of Figure 78 fastener cartridge assembly, and it illustrates driver to fire fastener from fastener cartridge group The nail cavity of part enters tissue thickness compensation part；

Figure 81 is the detail drawing of Figure 80 fastener cartridge assembly；

Figure 82 is the front view of the tissue of Figure 61 tissue thickness compensation part and capture in percussion fastener；

Figure 83 is the front view of the tissue of Figure 61 tissue thickness compensation part and capture in percussion fastener；

Figure 84 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 85 is the schematic diagram of the deformation of the deformable tube for the tissue thickness compensation part for showing Figure 84；

Figure 86 is the detail drawing of the deformable tube of Figure 84 tissue thickness compensation part；

Figure 87 is according at least one schematic diagram for implementing to exemplify the deformation of the deformable tube of tissue thickness compensation part；

Figure 88 is according to the front view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part includes Against the tubular element of tissue implantation；

Figure 89 is according to the front view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part includes Against the tubular element of tissue implantation；

Figure 90 is the fragmentary, perspective view according to the deformable tube including tubulose lattice of at least one embodiment；

Figure 91 is the front view of the tubulose strand of Figure 90 deformable tube.

Figure 92 is the front view of Figure 90 deformable tube；

Figure 93 is the front view according to multiple tubulose strands of the deformable tube for Figure 90 of various embodiments；

Figure 94 is the front view against Figure 90 of tissue implantation tubulose lattice；

Figure 95 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 96 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 97 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 98 is the front view of Figure 97 deformable tube；

Figure 99 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 100 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 101 is the fragmentary, perspective view according to the deformable tube of at least one embodiment；

Figure 102 is according to the perspective view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part is determined Position is in the end effector of surgical instruments；

Figure 103 is the front view of the tubular element of Figure 102 tissue thickness compensation part；

Figure 104 is Figure 102 tissue thickness compensation part and the positive view of end effector, and it illustrates in not clamping The end effector of configuration；

Figure 105 is Figure 102 tissue thickness compensation part and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 106 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 107 is Figure 106 tissue thickness compensation part and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 108 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Positive view；

Figure 109 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 110 is Figure 109 tissue thickness compensation part and the positive view of end effector, it illustrates in clamping and The end effector of percussion configuration；

Figure 111 is according to the perspective view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part is determined Position is in the end effector of surgical instruments；

Figure 112 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 113 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 114 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 115 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment It is positioned in the end effector of surgical instruments；

Figure 116 is the tissue thickness compensation according to the partial plan layout of the tissue thickness compensation part of at least one embodiment Part is positioned in the end effector of surgical instruments；

Figure 117 is the tissue thickness compensation according to the partial plan layout of the tissue thickness compensation part of at least one embodiment Part is positioned in the end effector of surgical instruments；

Figure 118 is Figure 116 tissue thickness compensation part and the local positive view of end effector, and it illustrates in not The end effector of clamping configuration；

Figure 119 is Figure 116 tissue thickness compensation part and the local positive view of end effector, and it illustrates in folder The end effector of tight configuration；

Figure 120 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 121 is Figure 120 tissue thickness compensation part and the front view of end effector；

Figure 122 is Figure 120 tissue thickness compensation part and the perspective view of end effector, and it illustrates towards clamping configuration The anvil block of the end effector of motion；

Figure 123 is Figure 120 tissue thickness compensation part and the front view of end effector, and it illustrates in clamping configuration End effector；

Figure 124 is the positive view of the tubular element of the tissue thickness compensation part of Figure 120 in not deformed configuration；

Figure 125 is the positive view of the tubular element of the tissue thickness compensation part of Figure 120 in deformed configuration；

Figure 126 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 127 is Figure 126 tissue thickness compensation part and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 128 is Figure 126 tissue thickness compensation part and the positive view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；

Figure 129 is according to the perspective view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part is determined Position is in the end effector of surgical instruments；

Figure 130 is the tissue thickness compensation part according to the positive view of the tissue thickness compensation part of at least one embodiment Anvil block fixed to surgical end effectors；

Figure 131 is Figure 130 tissue thickness compensation part and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 132 is Figure 130 tissue thickness compensation part and the positive view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；

Figure 133 is Figure 132 tissue thickness compensation part and the detail drawing of end effector；

Figure 134 is compensated according to the tissue thickness being clamped in the end effector of surgical instruments of at least one embodiment The positive view of part, it illustrates dispose to follow closely by nail percussion sliding part；

Figure 135 is Figure 134 tissue thickness compensation part and the positive view of end effector, and it illustrates in clamping structure The end effector of type；

Figure 136 is Figure 134 tissue thickness compensation part and the positive view of end effector, and it illustrates in percussion structure The end effector of type；

Figure 137 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 138 is the perspective view of the tubular element of Figure 137 tissue thickness compensation part；

Figure 139 is the perspective view of the tubular element for the Figure 138 being cut off between first end and second end；

Figure 140 is the perspective view of Figure 137 tissue thickness compensation part, and it illustrates the cutting of cut-out tissue thickness compensation part Element and the nail for engaging tissue thickness compensation part；

Figure 141 is the perspective according to the framework of the tissue thickness compensation part that Figure 137 can be made of at least one embodiment Figure；

Figure 142 is the positive view of Figure 141 framework, and it illustrates the Figure 137 solidified in the frame tissue thickness benefit Repay part；

Figure 143 is to be removed from Figure 142 framework and be prepared for the group trimmed by least one cutting device Knit the positive view of thickness compensation part；

The tissue that Figure 144 is Figure 143 after at least one cutting device is trimmed to tissue thickness compensation part is thick Spend the positive view of compensating part；

Figure 145 is the positive view of the tissue thickness compensation part formed in Figure 142 framework, and it illustrates with various The cut-off tube of cross-sectional geometry；

Figure 146 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective view；

Figure 147 is the detail drawing according to Figure 146 of at least one embodiment tissue thickness compensation part；

Figure 148 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 149 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 150 A are Figure 146 tissue thickness compensation part and the positive view of end effector, and it illustrates in not pressing from both sides The end effector of tight configuration；

Figure 150 B are Figure 146 tissue thickness compensation part and the positive view of end effector, and it illustrates in clamping The end effector of configuration；

Figure 150 C are Figure 146 tissue thickness compensation part and the positive view of end effector, and it illustrates in clamping With the end effector of percussion configuration；

Figure 150 D are the positive views of the Figure 146 of capture in percussion nail tissue thickness compensation part；

Figure 150 E are the positive views of the Figure 146 of capture in percussion nail tissue thickness compensation part, and it illustrates tissue The further expansion of thickness compensation part；

Figure 151 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective cut-away schematic view；

Figure 152 is the partial elevation view of the Figure 151 of capture in percussion nail tissue thickness compensation part；

Figure 153 is the front view of the deformable tube of Figure 151 tissue thickness compensation part；

Figure 154 is the front view according to the deformable tube of at least one embodiment；

Figure 155 is the perspective cut-away schematic view of Figure 151 tissue thickness compensation part；

Figure 156 is the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Perspective cut-away schematic view；

Figure 157 is the perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 158 is the local positive view of Figure 157 tissue thickness compensation part, and it illustrates with tissue and thick with tissue Spend the fastener of compensating part engagement；

Figure 159 is the perspective cut-away schematic view according to the tissue thickness compensation part of at least one embodiment；

Figure 160 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 161 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 162 is according to the front view of the tissue thickness compensation part of at least one embodiment, and the tissue thickness compensation part is determined Position is in the rounded ends actuator of surgical instruments；

Figure 163 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 164 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 165 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 166 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 167 is the front view according to the tissue thickness compensation part of at least one embodiment；

Figure 168 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 169 is the tissue thickness compensation according to the fragmentary, perspective view of the tissue thickness compensation part of at least one embodiment Part is positioned in the end effector of surgical instruments；

Figure 170 is the tissue thickness compensation according to the fragmentary, perspective view of the tissue thickness compensation part of at least one embodiment Part has the fastener being positioned in its hole；

Figure 171 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, and it illustrates the tissue in not deformed configuration Thickness compensation part；

Figure 172 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, and it illustrates the group in part deformed configuration Knit thickness compensation part；

Figure 173 is the fragmentary, perspective view of Figure 169 tissue thickness compensation part, thick it illustrates the tissue in deformed configuration Spend compensating part；

Figure 174 is the perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 175 is the perspective according to the end effector of the suture instruments for including anvil block and nail bin of at least one embodiment Figure；

Figure 176 is the sectional view of Figure 175 end effector, and it illustrates be positioned in nail bin to be in non-cock Nail and including the tissue thickness compensation part in the sealing container for not piercing through state, wherein for illustrative purposes, container It is illustrated as its part to be removed；

Figure 177 is the sectional view of Figure 175 end effector, and it illustrates Figure 176 at least part cock Nail and at least part pierce through state container；

Figure 178 is the perspective according to the end effector of the suture instruments for including anvil block and nail bin of at least one embodiment Figure；

Figure 179 is the sectional view of Figure 178 end effector, and it illustrates be positioned in nail bin to be in non-cock Nail and be positioned in the tissue thickness compensation part of nail bin in the sealing container of state is not pierced through, wherein for explanation Purpose, container are illustrated as its part and are removed；

Figure 180 is the sectional view of Figure 178 end effector, and it illustrates Figure 179 at least part cock Nail and nail bin at least partly pierce through state container；

Figure 181 is the suture according to the sealing container for including anvil block and being attached to anvil block of at least one alternative embodiment The perspective view of the end effector of apparatus, wherein for illustrative purposes, container is illustrated as its part and is removed；

Figure 182 is the sectional view of Figure 181 end effector, it illustrates at least in part from nail bin percussion nail and It is attached to the container at least partly puncture state of anvil block；

Figure 183 is attached to the sectional view of the container of the anvil block of Figure 181 shown in swelling state；

Figure 184 is attached to the detail drawing of the container of the anvil block of Figure 183 shown in swelling state；

Figure 185 is shown in the container upwardly extended transverse to the side of staple line；

Figure 186 is shown in the multiple containers upwardly extended transverse to the side of staple line；

Figure 187 is the sectional view according to the nail bin of various embodiments；

Figure 188 is the partial sectional view for the Figure 187 being under implantation condition；

Figure 189 A are the fragmentary, perspective view of tissue thickness compensation part before inflation；

Figure 189 B are fragmentary, perspective view of Figure 189 tissue thickness compensation part during expansion；

Figure 190 is the partial perspective according to the tissue thickness compensation part comprising fluid swollen composition of various embodiments Figure；

Figure 191 is the sectional view for being oriented to the tissue adjacent with tissue thickness compensation part according to various embodiments；

Figure 192 is the partial sectional view of Figure 191 after nail bin is fired；

Figure 193 is the schematic diagram for the tissue thickness compensation part for showing Figure 191 with organizing adjacent implantation；

Figure 194 is the fragmentary, perspective view according to the tissue thickness compensation part of various embodiments；

Figure 195 is the perspective view of the jaw for the tissue thickness compensation part that can receive Figure 194；

Figure 196 is the partial sectional view of nail bin, and it illustrates the nail from cartridge deployment；

Figure 197 is located at Top tissue thickness compensation part and bottom tissue thickness in the actuator of disposable loading unit Spend the perspective view of compensating part；

Figure 198 A are the section views according to Figure 197 manufactured in a mold of various embodiments Lower tissue thickness compensation part Figure；

Figure 198 B are the sectional views according to the three-layer weave thickness compensation part manufactured in a mold of various embodiments；

Figure 199 is according to the sectional view of the anvil block of various embodiments, and the anvil block includes the tissue thickness comprising reinforcing material Compensating part；

Figure 200 be according to the sectional view of the tissue of various embodiments, the tissue be positioned at Top tissue thickness compensation part with Among Lower tissue thickness compensation part；

Figure 20 1 is Figure 200 sectional view, and it illustrates the nail from cartridge deployment；

Figure 20 2 is the sectional view of Figure 200 after nail bin is fired；

Figure 20 3A show the pin according to various embodiments, and the pin can deliver a fluid to the tissue thickness for being attached to nail bin Spend compensating part；

Figure 20 3B are the sectional views for the nail bin for including tissue thickness compensation part, and the tissue thickness compensation part can receive figure 203A pin；

The method that Figure 20 4 shows the manufacture tissue thickness compensation part according to various embodiments；

Figure 20 5 is the schematic diagram and method of the thickness compensation part expanded according to the formation of various embodiments；

Figure 20 6 shows the micella comprising hydrogel precursor；And

Figure 20 7 is according to the schematic diagram of the surgical instruments of various embodiments, and the surgical instruments includes tissue thickness compensation part And the fluid of tissue thickness compensation part can be delivered to；

Figure 20 8 is the tissue thickness compensation according to the fragmentary, perspective view of the tissue thickness compensation part of at least one embodiment Part is fixed to the anvil block of the end effector of surgical instruments.

Figure 20 9 is the perspective view of the tubular element of Figure 20 8 tissue thickness compensation part.

Figure 21 0 is the perspective view of Figure 20 9 tubular element, and it illustrates be cut to two halves and make in each half hydrophilic Property substance fluids contact tubular element.

Figure 21 1 is the perspective view of the half of Figure 21 0 cut-out tubular element, and it illustrates the expansion of cut-out tubular element.

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

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

Entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " United States Patent (USP) Shen Please sequence number 12/894,327 (attorney END6736USNP/100060)；

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

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

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

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " U.S. State's patent application serial number 12/894,312 (attorney END6842USNP/100527)；

It is entitled that " the SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " U.S. is special Sharp patent application serial numbers 12/894,377 (attorney END6843USNP/100528)；

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

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

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

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT the PRESENT " (agent of U.S. Patent Application Serial Number 12/894,350 File number END6855USNP/100540)；

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

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

Entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " United States Patent (USP) Patent application serial numbers 12/894,345 (attorney END6858USNP/100543)；

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

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

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

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " U.S. Patent application sequence Row number 12/894,361 (attorney END6862USNP/100548)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION the MATRIX " (attorney of U.S. Patent Application Serial Number 12/894,367 END6863USNP/100549)；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " U.S. State's patent application serial number 12/894,388 (attorney END6864USNP/100550)；

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

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

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " United States Patent (USP) Patent application serial numbers 13/097,936 (attorney END6736USCIP1/100060CIP1)；

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

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION the THEREOF " (attorney of U.S. Patent Application Serial Number 13/097,856 END6841USCIP1/100526CIP1)；

It is entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent Application Serial Number 13/097,928 (attorney END6842USCIP1/100527CIP1)；

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

Entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " U.S. State's patent application serial number 13/097,948 (attorney END6847USCIP1/100532CIP1)；

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

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

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

It is entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent Application Serial Number 13/097,917 (attorney END6856USCIP1/100541CIP1)；

Entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " United States Patent (USP) Shen Please sequence number 13/097,873 (attorney END6857USCIP1/100542CIP1)；

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

It is entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/097,924 (attorney END6859USCIP1/100544CIP1)；

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

Entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " U.S. Patent application sequence Row number 13/242,066 (attorney END6841USCIP3/100526CIP3)；

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

Entitled " the STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " U.S. Patent application serial number 13/241,912 (attorney END7019USNP/110375)；

Entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " U.S. Patent application Sequence number 13/241,922 (attorney END7013USNP/110377)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION the MOTIONS " (attorney of U.S. Patent Application Serial Number 13/241,637 END6888USNP3/110378)；And

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

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 patent application is incorporated herein by reference：

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

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

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " United States Patent (USP) Patent application serial numbers _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP3/100528CIP3)；

It is entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP4/100528CIP4)；

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

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

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " U.S. State's patent application serial number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP9/100528CIP9)；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END6843USCIP10/100528CP10)；

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

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

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7100USNP/110601)；

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

It is entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7107USNP/110603)；

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

It is entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7103USNP/110605)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " United States Patent (USP) Shen Please sequence number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney END7104USNP/110606)；

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

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

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.The ordinary skill people of this area Member is it should be appreciated that it is unrestricted exemplary embodiment to specifically describe herein and be illustrated in the apparatus and method in accompanying drawing. The feature that one exemplary embodiment is illustrated or described, it can be combined with the feature of other embodiment.It is such Modifications and variations are included within the scope of the invention.

It can use disclosed herein or claimed for manufacturing, being formed or producing in other manners system Any of method of product or product manufactures, formed or produced in other manners the complete of considered product or product Portion or part, and using the manufacture of such method, formation or the portion for producing considered product or product in other manners In the case of point, can the remainder of article of manufacture or product in any way, including by using disclosed herein and be authorized The protection of sharp claim is used to manufacture, formed or any one in the other method of article of manufacture or product in other manners Person, and can be combined in any way the various pieces so produced.Similarly, it is disclosed herein or claimed Any product or product can individualism, or combined and deposited with so disclosed any other product compatible or product Or as the presence of its integral part.Therefore, can by with reference to shown in a kind of product, product or method or described special characteristic, The all or part of unrestrictedly group with the feature or characteristic of other one or more biocompatible articles, product or method of structure or characteristic Close.Such modifications and variations are included within the scope of the invention.

With reference to certain figures or otherwise, specific embodiment or some systems in invention disclosed herein In the case that product, product or method may include some structures, characteristic or feature, reader should be appreciated that this represents those structures, spy Property or feature structure can be embodied in considered product, product or method with any compatible combination.Specifically, it is multiple optional Such disclosure of structure, characteristic or feature should be understood in addition disclose in combination all that structure, characteristic or Feature, but except the situation as the structure disclosed in alternate forms each other, characteristic or feature.In this class formation, characteristic or spy In the case that sign is used as disclosed in alternate forms each other, this should be understood to disclose those alternate forms as mutual Replace.

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 be apparent from, various method and apparatus disclosed herein can be used for many surgical procedures and application (including with opening The application that formula surgical procedures are combined) in.With continued reference to present embodiment, reader will be further understood that, this paper institutes Disclosed various apparatuses can in any way in insertion body, such as by natural cavity, by the otch that is formed in tissue or Puncturing hole etc..The working portion or end effector portion of apparatus can be plugged directly into patient's body or can be by leading to work Road enters device and inserted, and the end effector and slender axles of surgical instruments 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 To the various forms of surgery suturing appliance 10 and the end effector 12 of size.In Fig. 1-Fig. 1 E, such as end effector 12 Including elongated passageway 14, the elongated passageway forms the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implantable " nail bin 30 and also movably support as end effector 12 upper jaw 15 anvil block 20.

Elongated passageway 14 can be by being made such as 300＆400 series, 17-4＆17-7 stainless steels, titanium, and can be formed with interval Side wall 16.Anvil block 20 as 300＆400 series 17-4＆17-7 stainless steels, titanium under it can be process, and can be shaped with nail Surface, the nail shaped lower face are generally indicated as 22 and are formed with multiple nail shapes pits 23.Referring to Figure 1B -1E. In addition, anvil block 20 have from anvil block 20 to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 is from slide assemblies 24 each horizontal lateral process, to receive in respective slots or opening 18 in the side wall 16 of elongated passageway 14, so as to be advantageous to By anvil block pin 26 movably or be attached pivotally to the respective slots or opening 18.

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 hemostatic material (such as oxidized regenerated cellulose (" ORC ") or bioabsorbable foam) structure Into wherein being supported by the unfashioned peg 32 of multirow.For anti-non-magnetic shim it is impacted and prevent hemostatic material introduce and position It is activated during process, 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 (are gathered in oneself by PGA (polyglycolic acid, being sold with trade mark Vicryl), PCL Ester), PLA or PLLA (PLA), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, being sold with trade mark Monocryl) Or other biodegradable films that PGA, PCL, PLA, PDS compound are formed, the film are only just permeable in rupture. The body 31 of nail bin 30 is sized to removedly be supported in elongated passageway 14 as depicted so that when anvil block 20 It is driven to and is formed with nail bin 30 when contacting, each of which nail 32 aligns with corresponding nail shapes pit 23.

In use, once end effector 12 positions adjacent to target tissue, end effector 12 is just manipulated to target group Knit capture or be clamped between the upper surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 in the following way into Shape：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated passageway 14, so as to follow closely profiled surface 22 and more specifically make Nail shapes pit 23 therein substantially simultaneously contacts the top surface 36 of nail bin 30.As anvil block 20 is continuously moved in nail bin 30, The leg 34 of nail 32 contact in anvil block 20 corresponding to nail shapes pit 23, nail shapes pit 23 for bending 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 schedule to last its shaping The final forming height " FF " hoped.

Above-mentioned nail forming process is generally described in Figure 1B -1E.For example, Figure 1B shows end effector 12, wherein target group " T " is knitted to be located between anvil block 20 and the top surface 36 of implantable nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, wherein anvil Seat 20 is closed up to target tissue " T ", and target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Fig. 1 D Initial nail shaping is shown, wherein anvil block 20 has started to compress nail bin 30 so that follow closely 32 leg 34 and begin through in anvil block 20 Nail shapes pit 23 and shape.Fig. 1 E show through target tissue " T " and in final shaped state nail 32, for clarity Remove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, with Warehouse 31 and nail 32 is set to remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13,15 During common clamping, end effector 12 makes all nails while shaped.Remaining " by conquassation " bulk material 31 is used as styptic And staple line reinforcing agent (other film compositions 38 of PGA, PDS or any of above) (ORC).Further, since nail 32 during shaping not Warehouse 31 must be left, therefore follows closely 32 possibilities for being changed into deformity during shaping and is minimized.As used herein, term " implantation Formula " refers to that in addition to nail the warehouse material of support nail also would be held in patient's body and finally can be absorbed by patient body.This Class implanted nail bin is different from previous nail bin structure, and the previous nail bin construction is still intactly fixed afterwards by percussion at it Position is 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 elongation 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 by through passage or opening size it is related.Therefore, one End effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it operationally can be at least about through diameter 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 of the end effector 12 for the closure for being attached to outer shaft 40 It is identical 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 can be with it His length provides, or can have joint in Slender axles assembly or can otherwise be advantageous to end effector 12 relative to The other parts of axle or shank assembly carry out joint motions, and following article will be discussed in.Slender axles assembly 40 includes ridge structure Part 50, the ridge component extend to end effector 12 from shank assembly 100.The nearside end of the elongated passageway 14 of end effector 12 With gudgeon 17 is kept from a pair of its projection, this is sized to receive in the distal side of ridge component 50 to holding gudgeon at end In corresponding gudgeon opening or support 52 provided in end, so that end effector 12 can removedly couple slender axles Component 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 made of and be designed to right hand housing member 102 and the left hand housing member (not shown) being combined together.It can lead to Cross the snap in features structure, bolt and the pod that mold or formed in other manners wherein, and/or by adhesive, screw etc. And 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 rotationally supported within groove 106, and the groove is from from housing member 102, each of 104 to inner process Fit ribs 108 formed.This structure is advantageous to ridge component 50 and is attached to shank assembly 100, while enables the phase of ridge component 50 Rotated for shank assembly 100 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 a distal lip 64, and the nearside is convex Edge and distal lip limit rotated trench 65, and the rotated trench can rotatably connect the leading edge portion 101 of shank assembly 100 It is received in therebetween.This structure enables axle bush 60 to be rotated relative to shank assembly 100 around longitudinal axis A-A.Ridge component 50 By ridge pin 66 non-rotatably pin joint to axle bush 60.In addition, turn knob 70 is attached to axle bush 60.For example, rotation Button 70 has hollow mounting flange portion 72, and the hollow mounting flange portion is sized to connect a part for axle bush 60 It is received in wherein.Knob 70 can by such as glass or carbon filled nylon, makrolon,Etc. being made, and also by ridge pin 66 are attached to axle bush 60.In addition, the reservation flange 74 to inner process is formed in mounting flange portion 72 and can extend to It is formed in the radial groove 68 in axle bush 60.Therefore, surgeon can be by firmly grasping turn knob 70 and making its relative Rotated in shank assembly 100, and ridge component 50 (and being attached to the end effector 12 of ridge component 50) is surrounded longitudinal axis A-A Rotated 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, longitudinal slit is provided through firing tube 110, so that ridge pin 66 can be worn Cross longitudinal slit to 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 movement on 50.Referring to Fig. 1.Such a moved to along distal direction of firing tube 110 carries out firing phase interaction with anvil block 20 Axial movement is referred to herein as " percussion motion ".As can be seen in Figure 1, firing trigger 130 passes through pivot pin 132 movably or are pivotally coupled to shank assembly 100.It is remote that firing trigger 130 is biased using torsionspring 135 The pistol grip portion 107 of shank assembly 100 and reach " opening " or original position not activated.As can be seen in Figure 1, hit Hair trigger 130 has top 134, and the top is movingly attached (pin joint) and arrives percussion chain link 136, and the percussion chain link is movable Support lining ring 120 is arrived in ground attachment (pin joint).Therefore, firing trigger 130 is from original position (Fig. 1) towards adjacent shank component 100 The motion of firing trigger 130 of end position of pistol-grip portion 107 percussion yoke 114 and firing tube 110 will be made to exist Moved in distal direction " DD ".The motion of pistol grip portion 107 of the firing trigger 130 away from shank assembly 100 (is being reversed Under the biasing of spring 135) percussion yoke 114 and firing tube 110 will 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 alternate forms, 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 removedly connected to ridge component 50 will be explained now.By that elongated will lead to Start connection process in the trunnion mounting 52 in holding gudgeon 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 gudgeon 17 is maintained at into its respective support In 52.Such position of the first percussion adapter 140 above gudgeon 17 is referred to here 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 In place.

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 gudgeon 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140 In trunnion mounting 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 the coupled position.When firing trigger 130 is activated first, retaining pin 162 is distad transported Dynamic, 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 In latch well 164 in housing member.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and for surgeon provide end effector 12 be " locked " in ridge component 50 touch Feel instruction.As long as in addition, retaining pin 162 intentionally is not biased out into latch well 164, surgeon just will not unintentionally activate and hit Trigger 130 is sent out to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection position The firing trigger 130 put, 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 the breech lock 138 when firing release button and being in the first position latching and engage percussion yoke 114.Such as exist It can be seen that in Fig. 1, late spring 139 is used to trigger system locking press button 137 being biased to the first position latching.In various situations Under, breech lock 138 is used to engage percussion yoke 114 at following point：At this point, the position pair of the percussion yoke 114 in ridge component 50 Ying Yu wherein the first percussion adapters 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that As the first percussion adapter 140 is vertically to promoting in clamping slideway 28, anvil block 20 will move along path so that nail shaping table Face 22 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 further be moved in ridge component 50 towards distal side 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 is prevented before surgeon is ready to start to follow closely forming process Inadvertently shape nail 32.In such embodiment, surgeon must be before firing trigger 130 can be further actuated Trigger system locking press button 137 is depressed to start to follow closely forming process.

Surgical instruments 10 can be used only as tissue apposition device as needed.However, the present invention may also comprise tissue cutting 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 in other manners from the projection of knife bar 180.Cutter component 172 can be by for example with more than 38HRC's (RHC) 420 or 440 stainless steels of hardness are made, and can have the tissue cutting edge 176 being formed in its distal end 174, and energy The slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are enough slidably extended through, end is clamped in cut through Tissue in portion's actuator 12.Knife bar 180 extends through ridge component 50 and with the nearside with Cutter conveyer transmission handing-over End section, 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 activated in other manners.Root According to the present invention, first cutter tooth wheel 192 is also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes the first cutter tooth Wheel 192 pivots.Percussion return spring 202 is attached between first cutter tooth wheel 192 and shank housing 100, knife is promoted and triggered Device 200 is 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 structure enable 4th cutter tooth wheel 198 along distal direction " DD " or Proximal direction " PD " axially trigger shaft 180, while make trigger shaft 180 relative to 4th cutter tooth wheel 198 around longitudinal axis A-A Rotation.Therefore, surgeon can be by pulling knife actuating trigger 200 to make to hit towards the pistol grip 107 of shank assembly 100 Hair bar 180 axially promotes and most all morning distal side promotes 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 211 are pivotally supported in the pistol grip portion 107 of shank assembly 100.Cutter securing rod 211 With activated end 212, when firing trigger 130 is in complete firing position, activated end 212 can be by firing trigger 130 Engagement.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, the holding suspension hook can be engaged in a manner of suspension hook Latch bar 216 on first cutting gear 192.Cutter securing rod 211 is biased to by " locking " position using Lock spring 218 Put.In " locking " position, suspension hook 214 is kept to keep engaging with latch bar 216, so as to prevent knife actuating trigger 200 Actuating, 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 bias of torsionspring 135, so that anvil block 20 can Open position is biased downwards into the bias of spring 21.When in open position, surgeon can withdraw from end effector 12 and leave implantable nail bin 30 and nail 32.What end effector passed through passage, service aisle etc. and was inserted into wherein should In, surgeon will make anvil block 20 be back to closing position by activating firing trigger 130, so that end effector 12 It can be withdrawn by by the passage or service aisle.However, if surgeon wants to cut target tissue after percussion nail, Then surgeon activates cutter traveling trigger 200 in the above described manner, and end effector is reached through target tissue with trigger shaft 172 End.Then, the releasable cutter traveling trigger 200 of surgeon, so that percussion return spring 202 can make percussion transmission dress Put and knife bar 172 is back to starting (does not activate) position.Once knife bar 172 is back to original position, surgeon can open End effector jaw 13,15, implanted storehouse 30 is released to patient's body and then withdraws from end execution from patient's body Device 12.Therefore, such surgical instruments is advantageous to using can be small and what is be inserted into by relatively small service aisle and passage Implanted nail bin, while provide following selection for surgeon：The percussion nail or if necessary in hitting in the case where not cutting tissue Tissue is also cut after hair nail.

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.These retouching in greater detail below State.

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.Want to obtain more nail shapings, surgeon only needs further to compress firing trigger so that anvil Seat is further driven to be contacted with being formed with nail.As used herein, term " shaping contact " refers to follow closely profiled surface or nail Forming 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 follow closely Degree that leg is folded and finally refer to the forming height of nail referred to above.Those skilled in the art will enter one Step understands that, because when applying percussion motion 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 can Corresponding elongated slot 250 in anvil block 20 " is slidably traversed, and lower cross member 175 ' is oriented to traverse end effector Elongated slot 252 in 12 " elongated passageway 14 ".It is also equipped with departing from slit (not shown) in anvil block 20 " so that work as knife bar 172 ' when being driven to the end position in end effector 12 ", and upper cross member 173 ' passes through corresponding slit and fallen, with Make anvil block 20 " that open position can be moved to, so as to depart from the tissue for suturing and cutting.Anvil block 20 " can in addition with Above-mentioned anvil block 20 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 Unclosing structure (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, shelves knife bar 172 " towards distal side move when, upper cross member 173 ' and lower cross member 175 ' while pull anvil Seat 20 " and elongated passageway 14 ", desired nail is realized to reach when knife bar 172 " promotes through end effector 12 " towards distal side Shaping.Referring to Fig. 5.Therefore, in this embodiment, nail shaping is cut while occurred with tissue, but nail in itself can be in knife bar 172 " sequentially shape when being driven towards distal side.

The various surgery nail bins of the present invention and unique and new feature 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 on each side of elongated slot, it is described elongated Slit is centrally arranged in nail bin, for receiving the tissue cutting element through the elongated slot.In a kind of arrangement side In formula, such as nail into a line can be substantially parallel to the nail in adjacent staple line but deviate with it.As other another Preferred form of this, one or more staple line can be essentially nonlinear.That is, the base portion of at least one nail in staple line can edge Substantially the axis crosscutting with the base portion of other nails in same staple line extends.For example, the staple line on every side of elongated slot There can be 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 on 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 through tissue and contact stud shaping anvil block.Once disposing nail from staple cartridge body, then staple cartridge body can be removed from operative site.Nail It is implantable at least a portion of storehouse or nail bin to have nail.For example, following article is more fully described, nail bin may include warehouse, when When anvil block moves to closing position from open position, the warehouse can be compressed by anvil block, crushes and/or collapse.When warehouse compressed, Conquassation and/or when collapsing, the nail in warehouse can be deformed by anvil block.Alternatively, for supporting nail bin Jaw 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 When, nail is deformable.In some cases, nail can not project from nail bin, and in other cases, nail can be with a part for warehouse It is shot up together 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 positioned in addition 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 at not pressing Contracting condition.In this uncompressed condition, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 can be from beating Open position is to tissue T is contacted, and as shown in Figure 6B, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 can be by group The tissue contacting surface 1019 for knitting T against staple cartridge body 1010 positions, but referring again to Fig. 6 B, and staple cartridge body 1010 now can be by Few (if any) compression stress or pressure, and follow closely 1020 be positively retained at unshaped or do not fire under the conditions of.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 (all by buttress material and/or plastic material Such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) form, and the second layer 1012 can be by bioabsorbable bubble Foam material and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are formed.Optionally, first layer 1011, second Nail 1020 can be maintained in staple cartridge body 1010 by layer 1012, third layer 1013 and the 4th layer one or more of 1014, 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-resilient material Material is formed, and the nail leg 1021 for following closely 1020 can be held in place by by the material relative to each other.In addition, it is located at third layer The second layer 1012 and the 4th layer of 1014 motion that can stablize or reduce nail 1020 in 1013 opposite sides, even if the second layer 1012 and the 4th layer 1014 can include compressible foam or elastomeric material.The screw top end 1023 of nail leg 1021 can be at least in part In embedded first layer 1011.For example, first layer 1011 and third layer 1013 can be collaboratively and firmly by nail legs 1021 It is held in place by.First layer 1011 and third layer 1013 can be respectively by such as bioabsorbable material (such as with trade name Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly (hydroxy alkanoate) of Vicryl sales 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 be respectively by extremely Few a kind of hemostatic material or styptic are formed.

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 about twice, about three times, about four times, about five times of first layer 1011 and/or About ten times.In other words, for given power, the compression degree of the second layer 1012 can be about twice of first layer 1011, about three times, About four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can first layer 1011 approximately twice as with Between about ten times.The second layer 1012 may include the amount for being defined in multiple air gaps therein, the wherein air gap in the second layer 1012 And/or size can be controlled to provide the expectation compressibility of the second layer 1012.It is similar to the above, although third layer 1013 can be It is compressible, but the 4th layer 1014 can substantially have more compressibility than third layer 1013.For example, the 4th layer 1014 can Compressibility can be about twice, about three times, about four times, about five times, and/or about ten times of third layer 1013.In other words, for given Power, the 4th layer 1014 of compression degree can be about twice, about three times, about four times, about five times of third layer 1013, and/or about Ten times.4th layer 1014 of compressibility can be between third layer 1013 be approximately twice as about ten times.4th layer 1014 can Including being defined in multiple air gaps therein, wherein the amount and/or size of air gap in the 4th layer 1014 can be controlled to provide 4th layer 1014 of expectation compressibility.In various scenarios, can (that is, layer be directed to the power of given size and pressed by compression ratio The distance of contracting) express the compressibility of warehouse or warehouse layer.For example, compared with the layer compared with little compressible, there is high pressure The layer of shrinkage will compress bigger distance for applying to the compression stress of the given size of this layer.For so, the second layer 1012 There is higher compression ratio than first layer 1011；Similarly, there is higher compression than third layer 1013 for the 4th layer 1014 Rate.The second layer 1012 and the 4th layer 1014 can be made up of and can have identical compression ratio identical material.The second layer 1012 It can be made up of with the 4th layer 1014 the material with different compression ratios.Similarly, first layer 1011 and third layer 1013 can include Identical material simultaneously can have identical compression ratio.First layer 1011 and third layer 1013 can be by the materials with different compression ratios Form.

When anvil block 1040 moves 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 the quilt of nail bin 1000 Nail bin 1000 is supported when being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to anvil block 1040 pressure applied, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More particularly, warehouse 1010 Compression and the first layer for moving downward the puncture of top 1023 warehouse 1010 that can make nail leg 1021 of tissue contacting surface 1019 1011st, pierce through tissue T and enter in the forming pit 1042 in anvil block 1040.When warehouse 1010 is further pressed by anvil block 1040 During contracting, the accessible wall for limiting forming pit 1042 in top 1023, and therefore leg 1021 can be deformed inward or crimp, such as such as Shown in Fig. 6 C.As nail leg 1021 deforms, equally as shown in Figure 6 C, the base portion 1022 for following closely 1020 can contact nail bin supporting member 1030 or supported by nail bin supporting member 1030.Optionally, as described in greater detail below, nail bin supporting member 1030 may include multiple Supporting construction, such as nail support trenches, slit or groove 1032, such as the multiple supporting construction can be when nail 1020 be deformed Support nail 1020 or at least base portion 1022 of nail 1020.Equally as shown in Figure 6 C, the cavity 1015 in the 4th layer 1014 can be due to It is applied to the compression stress of staple cartridge body 1010 and collapses.In addition to chamber 1015, staple cartridge body 1010 may also include one or more skies Gap (such as space 1016), such as can be located in one or more of spaces or no-fix has the part of nail, described one Individual or multiple spaces can allow for warehouse 1010 to collapse.Cavity 1015 and/or space 1016 can collapse so that limit cavity And/or the wall of wall deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 is positioned at cavity and/or space The layer of lower section.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer 1014 are substantially applied by anvil block 1040 The compression pressure compression added.It may also be noted that first layer 1011 and third layer 1013 are also compressed.Closed when anvil block 1040 moves to it When closing position, anvil block 1040 can continue further pressure by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Contracting warehouse 1010.As warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed to it to be fully formed shape, such as Shown in Fig. 6 D.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 group T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least a portion is knitted to capture in deformable leg Between 1021 and base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 substantially by The compression pressure that anvil block 1040 is applied further compresses.In relatively Fig. 6 C and Fig. 6 D it may also be noted that arriving, the He of first layer 1011 Third layer 1013 has also been further compressed.After nail 1020 is fully shaped completely or at least, anvil block 1040 can be remote Tissue T and be lifted, and nail bin supporting member 1030 can it is remote and/or depart from nail bin 1000 move.As shown in Figure 6 D, as with Upper described result, warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be along staple line branch Support tissue.In some cases, the styptic and/or any other suitable medicine 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, be bonded simultaneously Agent or tissue adhesive can elapse over time provides intensity for tissue.The warehouse 1010 being implanted into can (oxidation be again by such as ORC Raw cellulose), extracellular protein (such as collagen), the polyglycolic acid (PGA) sold with trade name Vicryl, PLA (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone sold with trade name Monocryl The material of 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound is formed. In some situations, warehouse 1010 may include the antibiosis and/or anti-biotic material that can 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 one or more holding knots Structure, one or more holding structures can engage nail bin supporting member 1030, and therefore releasably hold nail bin 1000 To nail bin supporting member 1030.For example, it can be incited somebody to action by least one adhesive (such as, fibrin and/or protein hydrogel) Nail bin 1000 adheres to nail bin supporting member 1030.In use, at least one situation, especially in laparoscopic type and/or In endoscopic procedure, such as the second jaw is moveable to the closing position relative with the first jaw so that the first jaw and Two jaws can be inserted into operative site by trochar.For example, trochar can limit about 5mm hole or intubation, the first pincers Mouth and the second jaw can be inserted into by it.Second jaw is moveable to the part in an open position between closing position Closing position, the partial closed position can allow the first jaw and the second jaw to be inserted into through trochar, without making nail bin Nail 1020 accommodated in body 1010 deforms.For example, when the second jaw is in the centre position of its part closure, anvil block 1040 Compression stress can not be applied to staple cartridge body 1010, and when the second jaw is in the centre position of its part closure, anvil block 1040 can Compress staple cartridge body 1010.Although the compressible nail bin body 1010 when anvil block 1040 is in this centre position, but anvil block 1040 can incompletely compress staple cartridge body 1010, so as to 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 positioned without making nail against the tissue contacting surface 1119 of nail bin 1100 using anvil block 1140 Storehouse 1100 is deformed, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so as to be supported with nail bin The distance 1101a of surface 1131, and tissue contacting surface 1119 can be positioned so that with nail bin support surface 1131 at a distance of away from From 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 tissue contacting surface 1119 of nail bin 1100, and the first layer 1111 and the second layer 1112 of nail bin support member 1110. 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 cover 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.As 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 In shape, 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 has been fully formed or has at least been shaped to Desired Height.In this position, the tissue contacting surface of anvil block 1140 1141 can be with the distance 1101d of storehouse stayed surface 1131, wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Equally as illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially collapse, and follow closely 1120 can completely or at least base The second layer 1112 collapsed in sheet surrounds.In various scenarios, anvil block 1140 can be moved then away from nail bin 1100.Once anvil Seat 1140 departs from from nail bin 1100, then warehouse 1110 for example, at least can partly reexpand in various positions (that is, adjacent nail Position between 1120) in.The warehouse 1110 of conquassation may not reexpand resiliently.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.Although follow closely 1120 quilts It is schematically shown as including two nail legs 1121, but can also be used may include a nail leg or alternatively include more than two The various nails of individual nail leg (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded into warehouse In 1110 second layer 1112 so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into warehouse 1110 In nail cavity 1115 so that the top 1123 of nail leg 1121 is advanced into cavity 1115 base portion 1122.Inserted on top 1123 After entering cavity 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be rested upon Enough depths into 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 multiple nails in warehouse 1210 1220.Optionally, each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 from its extension.For example, 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 1212 Lower surface 1218 position depth.In figs. 8 and 9, internal layer 1212 does not include the part that can receive nail 1220 Nail cavity, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 Can be by compressible material (such as bioabsorbable foam that can allow for warehouse 1210 to be collapsed when applying compressive load to it And/or oxidized regenerated cellulose (ORC)) form.Internal layer 1212 can be by for example comprising PLA (PLA) and/or polyglycolic acid (PGA) freeze dried foam is formed.ORC can it is commercially available with trade name Surgicel and may include loose Woven fabric (as Surgical sponge is the same), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can be by wherein including and/or applying above The material for being covered with medicine (fibrin ferment and/or fibrin that are such as freeze-dried) is formed, and the medicine for example can be by patient's body Interior fluid water activation and/or activation.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, compressible warehouse 4110 for example by foamed material and can be at least partially situated 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 waterproof wrappage or film 4111 of device clamper 4160.

In use, for example, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to closure towards nail bin 4100 Position.When anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.When anvil block closes in it When 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 and At least in part deform nail 4120.In any case in both cases, nail bin 4100 may also include one or more sledges 4170, one or more of sledges can be longitudinally propelling in the interior edge of nail bin 4100 so that sledge 4170 can then engage staple drivers 4162 and make staple drivers 4162 and nail 4120 towards anvil block move.Sliding part 4170 can be in cartridge tray 4180 and staple drivers 4162 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 Complete forming process and nail 4120 is deformed into height or at least desired height that it is fully formed.Do not make in the closure of anvil block In the case of the deformation of nail 4120, nail 4120 moves upwards towards anvil block can start and complete forming process and be deformed into nail 4120 Its height being fully formed or at least desired height.Sliding part 4170 can be advanced to nail bin from the proximal extremity of nail bin 4100 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 Nail 4120 in the proximal extremity in storehouse 4100 is fully formed.Referring to Figure 12, sliding part 4170 can each include at least one angulation Degree or inclined surface 4711, it can slide below staple drivers 4162 and lift staple drivers as shown in figure 13 4162。

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 various scenarios, storehouse dish 4180 can jointing nail in a position-stable manner Warehouse channel 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 from can The warehouse 4110 of compression is dismantled.Referring again to Figure 10, storehouse dish 4180 may include relative side wall 4181, and warehouse 4110 can be removable Except 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 Disk 4180 releasedly departs from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from operation When position removes, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.Driving Device 4162 can project and stay in operative site from driver clamper 4160.For example, driver 4162 can be by that biological can inhale Material (polyglycolic acid (PGA), PLA (PLA or PLLA), the poly- dioxa hexamethylene such as sold with trade name Vicryl of receipts Ketone (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 the case of other 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 may be allowed 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 shrinks.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) alternate forms.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, the replacement in addition to nail or as nail, storehouse may include the fastener of any suitable type.For example, this fastener can Including pivotable arm, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin can Including multiple first fastener portions, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, Second fastener portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin to complete The forming process of nail.Sliding part or driver can be promoted in anvil block, to move downwardly to one or more formed parts Engaged with relative nail bin and nail or the fastener being positioned in nail bin.

As described herein, nail bin may include to be stored in four nails row therein.Four nails row can be configured to two Inner side nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in cutting element or knife in nail bin On first side of slit；Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit. Nail bin may not include cutting element slit wherein；However, the replacement as nail bin slit, this nail bin may include can be by cutting element The specified portions of cutting.Similarly, inner side nail row can be arranged in nail bin so that its with cutting element slit wherein equidistantly or extremely It is few to be substantially equally spaced.Similarly, each outside staple can be arranged in nail bin so that it is with cutting element slit wherein etc. It is equally spaced away from ground or at least substantially.According to the present invention, nail bin, which may include to be stored in nail bin, is more or less than four Individual nail row.Nail bin may include six nail rows.Gone for example, nail bin can include three nails on the first side of cutting element slit wherein, and And include three nails on the second side of cutting element slit wherein and go.Nail bin may include odd number nail row.For example, nail bin can cut Include two staples on first side of component slit, and include three staples on the second side of cutting element slit wherein.Staple It may include that there is identical or at least substantially identical unshaped staple height nail.Alternatively, it is one or more Nail row may include the nail with the unshaped staple height different from other nails.For example, the nail on the first side of cutting element slit wherein There can be the first unshaped height, and the nail on the second side of cutting element slit wherein can have the second unshaped height, and this Two unshapeds are highly different from the first height.

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 Disclosed in having in the United States Patent (USP) 7,380,696 that on June 3rd, 2008 announces, the complete disclosure of the patent is by reference It is incorporated herein.For the illustrative multi-stroke handle of surgical stapling and cutting off apparatus in CO-PENDING and jointly owned title For " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION Carried out in INDICATOR AND RETRACTION MECHANISM " U.S. Patent Application Serial Number 10/374,026 more detailed Thin description, the disclosure of the patent application are incorporated by reference in its entirety accordingly.Meeting the other application of the present invention can tie Single firing schedule is closed, such as in CO-PENDING and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent Application Serial Numbers 10/441, Described in 632, 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 capturing by out of, cartridge deployment nail The thickness of tissue compensates.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include rigid Part I (such as Support section 10010) and compressible Part II (such as tissue thickness compensation part 10020).Referring first to Figure 16, support Part 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 In 10012.For example, each nail 10030 may include base portion 10031 and the one or more legs extended from base portion 10031 10032.Before nail 10030 is by deployment, also as described in more detail below, the base portion 10031 for following closely 10030 can be by being positioned at support Staple drivers support in part 10010, while, nail cavity can be at least partly accommodated in by following closely 10030 leg 10032 In 10012.Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thickness Compensating part 10020, the top surface of tissue thickness compensation part 10020 is penetrated, penetrate tissue T, and contact and be positioned in nail bin The anvil block on 10000 opposites.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness's benefit A part for part 10020 and a part for the tissue T in each nail 10030 are repaid, and applies compressive force to tissue.To upper Text is described further, 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 is cut Region 10039 is stayed to be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention area The size in domain 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 journey of leg deformation Degree.

In the past, surgeon usually needed the suitable nail for having appropriate staple height for the organizational choice to be sutured.Example Such as, surgeon may be selected high nail and be used together and select low nail to be used together with thin tissue with thick tissue.But Under certain situation, the tissue being just sewn does not have consistent thickness, and therefore, some nails can not realize desired percussion configuration. For example, Figure 48 is shown for the high nail in thin tissue.Referring now to Figure 49, when tissue thickness compensation part, (such as tissue is thick Spend compensating 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 particularly, 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 less part of nail retention region 10039.For example, it is trapped in the feelings in nail 10030 in thicker tissue T Under condition, 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 stress is still applied to the tissue T of surrounding.In all cases, to upper Text is described further, and 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 the larger nail retention region 10039 in such nail.Due to the resilience of tissue thickness compensation part 10020 Power, referring now to Figure 46, even if being limited at this nail retention region 10039 become in staple 10030 can be extended, positioning Still enough compression pressures can be applied to tissue T having become the tissue thickness compensation part 10020 in staple 10030.Each In the case of kind, the tissue thickness compensation part 10020 among adjacent nail 10030 can have been become appropriate around staple 10030 The nail 10030 of shaping biases against tissue T, and therefore is applied to for example to surround and/or be trapped in by compression pressure and has deformed Tissue in nail 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the different group Knit density for example can be produced 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 why 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 pressure can be applied to tissue by tissue thickness compensation part.Referring now to Figure 50-Figure 55, formed nail 10030 is predefined height H.Reference picture 50, tissue thickness compensation part is not used by, and group Knit T and occupy 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 being deformed into can be determined by the distance between the platform surface 10011 of support section 10010 and relative anvil block.It is flat The distance between tissue contacting surface of platform surface 10011 and anvil block may be, for example, about 0.097 ".Height H can also be by being limited to The depth of forming pit in anvil block determines.Forming pit can for example have the depth from tissue contacting surface measurement.Optionally, As described in more detail below, nail bin 10000 may also include staple drivers, and the staple drivers can lift nail 10030 towards anvil block, and And nail is lifted or " excessively driving " is to the top of platform surface 10011.In this case, 10030 forming height H is followed closely may be used also Determined by following closely 10030 distances being overdriven.For example, nail 10030 can be overdriven such as about .028 ", and can 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 may include such as about 0.0089 " diameter. Staple line may include the diameter for example between about 0.0069 " and about 0.0119 ".For example, the forming height H of nail 10030 0.189 is may be about ", and staple line diameter may be about 0.0089 ", so as to for example produce about 0.171 " nail retention it is high Degree.

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.The compensating part of tissue thickness may include to be greater than to be 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 in the height.In some cases, tissue T It may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention region Interior about 0.25mm compression height, so as to obtain adding up to such as about 2.0mm nail retention region height.In some feelings Under condition, 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 height Degree.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness is mended Repaying 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's 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, for example big so as to obtain adding up to About 2.0mm nail retention region height.In some cases, tissue T may include the about 0.75mm's 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 obtain Add up to such as about 2.0mm nail retention region height.In some cases, tissue T may include in nail retention region About 1.50mm compression height, and tissue thickness compensation part may include that the compression of the about 0.50mm in nail retention region is high Degree, so as to obtain adding up to such as about 2.0mm nail retention region height.In some cases, tissue T may include to cut in nail The compression height of the about 0.25mm in region is stayed, 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 this is highly more than twice of the firing height of nail.Tissue thickness Compensating part may include compression height, and this is highly about the 85% to about 150% of such as forming nail height.Optionally, as above Described, tissue thickness compensation part can be compressed between uncompressed thickness and compressed thickness.The pressure of tissue thickness compensation part Contracting thickness may be, for example, about the 10% of its uncompressed thickness, about the 20% of its uncompressed thickness, its uncompressed thickness it is big About 30%, its uncompressed thickness about 40%, about the 50% of its uncompressed thickness, its uncompressed thickness about 60%, About the 70% of its uncompressed thickness, about the 90% of about the 80% of its uncompressed thickness, and/or its uncompressed thickness.Group Knit thickness compensation part uncompressed thickness 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 be between about the 60% to about 99% of its uncompressed thickness. The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation part Than at most 100 times of its compressed thickness thickness.Compressible Part II can be elastic or at least partly elastic, and can Tissue T is biased against the deformation leg of nail.For example, compressible Part II can be elastic swollen between tissue T and the base portion of nail It is swollen, to promote tissue T against the leg of nail.It is discussed in detail as discussed further below, tissue thickness compensation part can be positioned in group Among the nail leg for knitting T and deformation.In all cases, due to described above, tissue thickness compensation part can eliminate nail retention area Any gap in domain.

Tissue thickness compensation part can include the material for being characterised by one or more of following characteristic：For example, biofacies Capacitive, bioresorbable, bioresorbability, biodurable, biological degradability, compressibility, fluid absorbability, swelling It is property, self-expanding, bioactivity, Drug, pharmaceutical activity, anti-adhesion, hemostatic, antibiosis disposition, antibiotic property, antiviral Property, trophism, adhesiveness, permeability, hydrophily and/or hydrophobicity.According to the present invention, including the surgical instruments of anvil block and nail bin It may include the tissue thickness compensation part associated with anvil block and/or nail bin, it includes styptic (such as fibrin and blood coagulation Enzyme), at least one of antibiotic (such as doxycpl) and medicine (such as matrix metalloproteinase (MMPs)).

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 (that is, in one direction in whole depth of foam 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 expands 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 expands in the presence of body fluid, organizationally to further provide for compressing.Such layer can be water Gel, the hydrogel can be synthesize and/or natural source material, and for example can be that biology is durable and/or biodegradable 's.Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include to come self-carbon water compound microgel and/ Or nanogel.The usable fibrous nonwoven material that additional flexibility, rigidity, and/or intensity can be provided or fiber mesh class Type element strengthens tissue thickness compensation part.According to the present invention, tissue thickness compensation part has porous form, the porous form table Reveal gradient-structure, such as aperture on a surface and larger hole on the other surface.Such form for It is even more ideal for tissue growth or hemostasis behavior.In addition, gradient can also be combined with the bio-absorbable section of change.It is short-term to inhale It can be preferable to receive section, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue more preferably be cured in the case of ne-leakage The problem of conjunction.

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 foam elastic Property body and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include the polytetrafluoroethylene (PTFE) of expansion (ePTFE), can be commercially available from W.L.Gore＆Associates, Inc. with brand name GORE-TEX soft tissue slices；And altogether Polyesteretherurethane foam, it is commercially available from Polyganics with trade name NASOPORE.

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 of gauge about 70%, and by weight about 30% PCL.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, biocompatible elastomers copolymer.It is suitable raw Thing is absorbable, the elastomer copolymer of bio-compatible includes but is not limited to 6-caprolactone and the copolymer of glycolide (ε-oneself in The mol ratio of ester and glycolide is preferably about 30:70 to about 70:30, it is therefore preferable to 35:65 to about 65:35, and 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)；Trimethylene carbonate and lactide (including L- lactides, D- lactides, their blend or lactic acid copolymer) (mol ratio of trimethylene carbonate and lactide is preferably from about 30 to elastomer copolymer:70 to about 70:30)；And they Blend.Elastomer copolymer can be the copolymer of glycolide and 6-caprolactone.Alternatively, elastomer copolymer For lactide and the copolymer of 6-caprolactone.

Be published on November nineteen ninety-five 21 it is entitled " ELASTOMERIC MEDICAL DEVICE " United States Patent (USP) 5, 468,253 and it is published in entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS " on December 4th, 2001 United States Patent (USP) 6,325,810 disclosure be each incorporated by reference in its entirety accordingly 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.When polymer composition is desorbed/absorbed, pharmaceutically active agents can be released.Pharmaceutically active agents can be released to fluid such as Flow through on polymer composition or through in the blood of polymer composition.The example of pharmaceutically active agents may include but be not limited to Styptic and medicine, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Anti-inflammatory drug, such as double chlorine are fragrant Acid, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or preparation, such as triclosan, Ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol；And anticancer, such as cis-platinum, mitomycin, Ah mould Element.

Polymer composition may include hemostatic material.Tissue thickness compensation part can include hemostatic material, and it includes poly- (breast Acid), poly- (glycolic), poly- (butyric ester), poly- (caprolactone), poly- (dioxanone), polyoxyalkylene, copolymerization (ether- Ester), collagen, gelatin, fibrin ferment, fibrin, fibrinogen, FN, elastin laminin, albumin, hemoglobin, Ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, HES, hydroxyethyl cellulose, cellulose, oxycellulose, Hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, malt Magma essence, alginate, clotting factor, methacrylate, polyurethane, acrylate, platelet agonist, vessel retraction Agent, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, ferric sulfate, ferric subsulfate, iron chloride, zinc, Zinc chloride, aluminium chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucosan and they Combination.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 it polymerize 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 by volume about 93% to by volume about 95% Percent porosity.Polymer composition may include to be more than 85% porosity by volume.Polymer composition can have example Such as about 5 microns to about 2000 microns of hole size.Polymer composition can have for example between about 10 microns to about Hole size between 100 microns.For example, polymer composition can for example include PGA and PCL copolymer.Polymer composition There can be the hole size for example between about 100 microns to about 1000 microns.For example, polymer composition can be wrapped for example Include PLLA and PCL copolymer.

According to some aspects, the hardness of polymer composition can represent that the Shore hardness can be defined as with Shore hardness 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 be for example according to ASTMD2240-00 according to any suitable scale such as A classes And/or OO classes scales determines hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16A's Shore A Hardness value, the Shore A Hardness value is for example in about 45OO to about 65OO Shore OO scopes.For example, combination of polymers Thing may include such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part can have Shore A Hardness value less than 15A.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 10A. The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 5A.Polymeric material can have for example big 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 70 weight % PLLA polymer composition and 30 weight % PCL polymer composition；Institute Stating polymer composition has such as 90% porosity, 100 microns to 1000 microns of hole size and 4A to 16A by volume Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include that 65 weight % PGA's is poly- Polymer composition and 35 weight % PCL polymer composition；The polymer composition have for example by volume from The Shore A Hardness value and 45OO of 93% to 95% porosity, 10 microns to 100 microns of hole size and 4A to 16A arrive 65OO shore OO hardness value.

Tissue thickness compensation part may include the material of expansion.As described above, tissue thickness compensation part can be included in it is uncompressed Or the compression material expanded during deployment.Tissue thickness compensation part may include the self-expanding material being formed in situ.Tissue thickness compensates Part may include at least one precursor, the precursor can be chosen so as to in other one or more precursors, water and/or body fluid extremely Spontaneously it is crosslinked during few one contact inflatable to be formed referring to Figure 20 5, other accessible one or more precursors of the first precursor And/or swellability tissue thickness compensation part.Tissue thickness compensation part may include the composition of such as fluid swollen, such as The composition of water-swellable.Tissue thickness compensation part may include the gel for including water.

Referring to Figure 189 A and Figure 189 B, for example, tissue thickness compensation part 70000 may include at least one hydrogel precursor 70010, the hydrogel precursor 70010 is chosen so as to form hydrogel in the original location and/or in vivo, so that tissue thickness compensation part 70000 expansions.Figure 189 A show the tissue thickness compensation part 70000 including packaging part, and the packaging part includes before inflation First hydrogel precursor 70010A and the second hydrogel precursor 70010B.As shown in Figure 189 A, the first hydrogel precursor 70010A Can be physically separated from one another in identical packaging part with the second hydrogel precursor 70010B.First packaging part may include first Hydrogel precursor 70010A, and the second packaging part may include the second hydrogel precursor 70010B.Figure 189 B, which are shown, works as water-setting The expansion of thickness Tissue compensating part 70000 when glue is formed in the original location and/or in vivo.As shown in Figure 189 B, packaging part is rupturable, and And first hydrogel precursor 70010A can contact the second hydrogel precursor 70010B to form hydrogel 70020.Hydrogel can wrap Include expandable material.It is up to 72 hours for example, hydrogel is inflatable.

Tissue thickness compensation part may include biodegradable foam, the biodegradable foam have comprising it is embedded its In dried hydrogel particle or granule packaging part.It is not intended to be limited to any particular theory, the packaging part in foam can Formed by contacting the aqueous solution of hydrogel precursor and the organic solution of biocompatible materials, so as to form foam.Such as Shown in Figure 20 6, aqueous solution and organic solution can form micella.Aqueous solution and organic solution can be dried to encapsulate in foam Dried hydrogel particle or granule.For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form glue The dispersion of beam.The organic solution of the accessible dioxane comprising poly- (glycolic) and polycaprolactone of aqueous solution.Water Property solution and organic solution can be lyophilized and have the biology for disperseing dried hydrogel particle therein or granule can so as to be formed The foam of degraded.It is not intended to be limited to any particular theory, it is believed that micelle forma-tion has the drying water being dispersed in foaming structure The packaging part of gel particle or granule.The packaging part is rupturable, and dried hydrogel particle or granule can contact fluid (such as body fluid) simultaneously expands.

For example, tissue thickness compensation part may expand when contacting activator (such as fluid).Referring to Figure 190, for example, tissue Thickness compensation part 70050 may include swellable material, such as hydrogel, and the swellable material is for example in contact fluid 70055 Expanded when (such as body fluid, saline solution, water and/or activator).The example of body fluid may include but be not limited to blood, blood plasma, abdomen Film liquid, celiolymph, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, bile, and/or gas (such as CO₂).Tissue thickness compensation part 70050 may expand when tissue thickness compensation part 70050 absorbs fluid.And for example, tissue thickness is mended Repaying part 70050 may include non-cross-linked hydrogels, and the non-cross-linked hydrogels expand when contact includes the activator 70 055 of crosslinking agent To form cross-linked hydrogel.Tissue thickness compensation part may expand when contacting activator.Tissue thickness compensation part can be opened from contact Begin expansion or swelling be up to 72 hours, such as from 24 hours to 72 hours, up to 24 hours, it is up to 48 hours and small up to 72 When, so as to which for example, tissue provides the pressure continuously increased and/or compression.As shown in Figure 190, tissue is contacted in fluid 70055 After thickness compensation part 70050, the original depth of tissue thickness compensation part 70050 is smaller than expanded thickness.

Referring to Figure 187 and Figure 188 a, nail bin 70100 may include tissue thickness compensation part 70105 and each include nail leg 70112 multiple nails 70110.As shown in Figure 187, tissue thickness compensation part 70105 can have the firing height for being less than nail 70110 Original depth or compression height.Tissue thickness compensation part 70100 can with fluid 70102 (such as body fluid, saline solution And/or activator) contact when it is in situ and/or expand in vivo, so as to which the leg 70112 for example against nail 70110 promotes tissue T. As shown in Figure 188, tissue thickness compensation part 70100 can expand and/or be swelled when contacting fluid 70102.Tissue thickness compensates Part 70105 can compensate for the thickness of the tissue T of capture in each nail 70110.As shown in Figure 188, tissue thickness compensation part 70105 Can have the expanded thickness or uncompressed height of the firing height for being less than nail 70110.

Optionally, as described above, tissue thickness compensation part may include original depth and expanded thickness.Tissue thickness compensation part Original depth can be for example, its expanded thickness about 0.001%, about the 0.01% of its expanded thickness, its expanded thickness About 0.1%, about the 1% of its expanded thickness, about the 10% of its expanded thickness, its expanded thickness about 20%, its About the 30% of expanded thickness, about the 40% of its expanded thickness, about the 50% of its expanded thickness, its expanded thickness about 60%th, about the 70% of its expanded thickness, about the 90% of about the 80% of its expanded thickness, and/or its expanded thickness.Tissue The expanded thickness of thickness compensation part than e.g., from about 2 times of its original depth thickness, 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.Group The original depth for knitting thickness compensation part may be up to the 1% of its expanded thickness, be up to the 5% of its expanded thickness, be up to its expansion thickness The 10% of degree and the 50% of up to its expanded thickness.The expanded thickness of tissue thickness compensation part is than its original depth thickness at least 50%th, 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, as above-described result, tissue thickness compensation part can eliminate nail retention area Any gap in domain.

As described above, tissue thickness compensation part may 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.Water Gel may include noncrosslinking hydrogel, the hydrogel of crosslinking and combinations thereof.Hydrogel may include chemical cross-linking agent, thing Manage crosslinking agent, hydrophobic patch and/or the undissolved fragment of water.Hydrogel can be crosslinked by polymerisation, small molecule and/or polymerization Thing-crosslinked polymer is chemically crosslinked.Hydrogel can be mutual by ionic interaction, hydrophobic interaction, Hydrogenbond Effect, stereocomplex and/or supramolecular chemistry are physically crosslinked.Due to crosslinking agent, hydrophobic patch and/or undissolved of water Section, hydrogel can be substantially undissolved, but due to absorbing and/or keeping fluid, hydrogel is inflatable and/or is swelled.Before Body 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 including hydrogel may include at least one of above-mentioned non-synthetic materials and synthetic material. Hydrogel may include to synthesize hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.Multiple layers can wrap 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, tissue thickness compensates 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 that first is porous Non-porous layer among layer and the second porous layer.Non-porous layer and porous layer can be relative to the surfaces of nail bin and/or anvil block by any Positioned in sequence.

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 and Combinations thereof.

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 with the second precursor Spontaneously it is crosslinked during contact.According to the present invention, first group of electrophilic functional group on the first precursor can be with second on the second precursor Group nucleophilic functional group reaction.(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-bisacrylamides (" 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 reinforcing materials can be orientated with random direction and/or common direction.Common direction can be for example One kind parallel to staple line and in staple line.For example, monofilament and/or multifilament weave fabric can be with random directions and/or common Direction is orientated.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include multiple The multiple reinforcing fibers being orientated in non-porous layer with random direction.Tissue thickness compensation part may include it is multiple in non-porous layer with altogether Multiple reinforcing fibers of equidirectional orientation.

Referring to Figure 199, anvil block 70300 may include tissue thickness compensation part 70305, and the tissue thickness compensation part 70305 is wrapped Include the first non-porous layer 70307 and the second non-porous layer 70309 for hermetically encapsulating enhancement layer 70310.Enhancement layer 70310 may include water Gel, the hydrogel includes the ORC particles or fiber being embedded, and non-porous layer may include ORC.As shown in Figure 199, tissue Thickness compensation part 70305 can conform to the profile of anvil block 70300.The internal layer of tissue thickness compensation part 70305 can conform to anvil The inner surface of seat 70300, it includes forming pit 70301.

Fiber can form non-woven material, such as 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.Chemistry it is (covalent) be crosslinked can be realized by any one in multiple mechanism, The mechanism includes：Raolical polymerizable, polycondensation reaction, anion or cationic polymerization, step-growth polymerization reaction, Electrophile-nucleophile reacts and combinations thereof.

Optionally, being formed in situ for tissue thickness compensation part may include to make two or more precursors reactions, the precursor It is physically separated from until situ contact and/or environmental condition is reacted, so as to reacts with each other to form hydrogel.It is in situ Polymerizable polymer can be prepared by precursor, and the precursor can be reacted to form polymer in operative site.Tissue thickness compensates Part can be formed by the cross-linking reaction of precursor in the original location.Precursor may include that the shape in situ tissue thickness compensation part can be triggered Into 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 includes that the one or more packaging parts or unit of wherein at least one component can be stored.Envelope Piece installing can store hydrogel precursor therein.Packaging part can store two kinds of components for example therein.Packaging part can store First hydrogel precursor and the second hydrogel precursor therein.First packaging part can store the first hydrogel precursor therein, And the second packaging part can store the second hydrogel precursor therein.As described above, packaging part can align or at least with nail leg Substantial alignment is so as to the puncture packaging part when nail leg contacts packaging part and/or ruptures packaging part in other manners.Work as portion During administration's nail, the packaging part can be compressed, conquassation, is collapsed and/or is ruptured in other manners.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, is provided in the layer of tissue thickness compensation part and/or passes through clinic Doctor is provided to operative site.As above-described result, the component being stored in packaging part can provide tissue thickness's compensation The expansion and/or swelling of part.

Tissue thickness compensation part may include the layer for including packaging part.Packaging part may include the space associated with layer, pit, Dome, pipe and combinations thereof.The packaging part may include the space in layer.Layer may include that mutual two can be attached to Layer, wherein packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, packaging part is at least A part can be positioned in the dome upwardly extended from layer.Packaging part may include the pit formed in layer.The of packaging part A part may include dome, and the Part II of packaging part may include pit.Packaging part may include the pipe being embedded in layer.Guan Ke Including non-synthetic materials as described herein and/or synthetic material, such as PLA.Tissue thickness compensation part may include bioabsorbable Foam, such as ORC, the bioabsorbable foam includes the PLA pipes being embedded, and the pipe can encapsulate such as water-setting Glue.Packaging part may include mutual unconnected separate unit.One or more of packaging part can be via extending through the one of layer Individual or multiple path, conduit, and/or passages 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 light filling bars or weakening part can be advantageous to incised layer and make packaging part Rupture.Local perforations can not extend completely through layer, and in some cases, perforation may extend entirely through layer.

Referring to Figure 194 and Figure 195, tissue thickness compensation part 70150 may include the outer layer 70152A for including packaging part 70154 With internal layer 70152B.Packaging part can include the first packed component and the second packed component.Packaging part can independently include the One of one packed component and the second packed component.First packed component can separate with the second packed component.Outside Layer 70152A may include tissue contacting surface.Internal layer 70152B may include Device contacts surface.Device contacts surface 70152B can To be releasably attached to anvil block 70156.Outer layer 70152A could attach to internal layer 70152B with outer layer 70152A and internal layer Space is limited between 70152B.As shown in Figure 194, each packaging part 70154 may include the device contacts table in internal layer 70152B Dome on face.The dome may include local perforations to promote incised layer by the rupture of nail leg and packaging part.Such as Figure 195 institutes Show, anvil block 70156 may include multiple formation pit rows 70158, and the wherein dome of packaging part 70154 can be with forming pit 70158 Alignment.Tissue contacting surface may include do not have vaulted flat surfaces.Tissue contacting surface may include one or more packaging parts, Such as from the packaging part 70154 of its extension.

Optionally, anvil block may include tissue thickness compensation part, and the tissue thickness compensation part includes containing with least one The packed component of microsphere particle.Tissue thickness compensation part may include to be packaged component comprising the first packed component and second Packaging part.Tissue thickness compensation part may include the packaging part comprising the first microsphere particle and the second microsphere particle.

Referring to Figure 196, robotic suturing device may include anvil block 70180 and nail bin (being shown in other accompanying drawings).The nail 70190 of nail bin It can be deformed when anvil block 70180 moves into closing position by anvil block 70180 and/or by the way that 70190 will be followed closely to closure anvil block The Staple drivers system 70192 of 70180 movements deforms.The leg 70194 of nail can contact anvil block 70180 so that at least portion of nail 70190 Divide ground deformation.Anvil block 70180 may include tissue thickness compensation part 70182, and it includes outer layer 70183A, internal layer 70183B.Tissue Thickness compensation part 70182 may include the first packed component and the second packed component.Packaging part 210185 can align or at least Substantial alignment so that when nail leg 70194 passes through tissue T and outer layer 70183A and promoted, the pierceable encapsulation of nail leg 70194 Part 70185 and/or in other manners rupture packaging part 70185.As shown in Figure 196, nail 70190C is in percussion position completely Put, during nail 70190B is in just by percussion, and follows closely 70190A and be in its non-firing position.Follow closely 70190C and 70190B Leg moved through the internal layer 70183B of tissue T, outer layer 70183A and tissue thickness compensation part 70182, and contacted It is positioned at the anvil block 70180 on nail bin opposite.After packaging part 70185 ruptures, packed component can flow out and the example that is in contact with each other Such as body fluid and/or tissue T.Packed component can be reacted to form reaction product (such as hydrogel), with for example in tissue T and nail Base portion between expansion and against nail leg promote tissue T.In all cases, due to described above, tissue thickness's compensation Part can eliminate any gap in nail retention region.

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 to Figure 191-Figure 193, any robotic suturing device 70118 may include anvil block 70120 and including firing member 70124, The nail bin 70122 of multiple nails 70128, blade 70129 and tissue thickness compensation part 70130.Tissue thickness compensation part 70130 can wrap Containing the packed component of at least one.When tissue thickness compensation part is compressed, sutured and/or cut, packed component can break scattered. Referring to Figure 192, for example, nail 70128 can be deployed between non-firing position and firing position so that nail leg moves through tissue thickness Compensating part 70130 is spent, the lower surface and top surface of tissue thickness compensation part 70130 is penetrated, penetrates tissue T, and contact It is positioned in the anvil block 70120 on the opposite of nail bin 70118.Packed component can interreaction, it is and embedded and be dispersed in tissue thickness Lyophilic powder in compensating part reacts and/or with humoral response so that tissue thickness compensation part 70130 expands or is swelled.Work as leg During against deflection, the leg each followed closely can be captured in a part and each nail 70128 for tissue thickness compensation part 70130 A part for tissue T and to tissue T apply compression stress.As shown in Figure 192 and Figure 193, tissue thickness compensation part 70130 can mend Repay the thickness of the tissue T of capture in each nail 70128.

Referring to Figure 197, surgical instruments 70200 may include anvil block 70205 and nail bin 70215, and the anvil block 70205 includes upper Portion's tissue thickness compensation part 70210, the nail bin 70215 include the bottom tissue thickness with outer layer 70220 and internal layer 70225 Compensating part.Top tissue thickness compensation part 70210 can be positioned on the first side of destination organization, and bottom tissue thickness compensates Part can be positioned on the second side of tissue.Top tissue thickness compensation part 70210 may include ORC, the compensation of bottom tissue thickness The outer layer of part may include the hydrogel with the ORC particles being embedded, and the internal layer of Lower tissue thickness compensation part can wrap Include such as ORC.

Referring to Figure 200-Figure 20 2, surgical instruments 70400 may include nail bin 70405 and anvil block 70410.Nail bin 70405 can wrap Tissue thickness compensation part 70415 is included, it includes bioabsorbable foam.Bioabsorbable foam may include packaging part, its Include packed component 70420.Bioabsorbable foam may include ORC, and packed component can include such as medicine.Anvil The tissue thickness compensation part 70415 of seat 70410 may include internal layer 70425 and outer layer 70430.Internal layer 70425 may include can biology The foam of absorption, and outer layer 70430 may include the hydrogel that for example optionally includes reinforcing material.In exemplary percussion sequence Period, referring first to Figure 20 1, sliding part 70435 contact stud 70440A first and can start nail being lifted up.Work as sliding part 70435 towards farther side be further promoted when, sliding part 70435 can start will nail 70440B-D and any other follow-up nail with Sequential order is lifted.Sliding part 70435 can drive up nail 70440 so that the leg of nail contacts relative anvil block 70410 and deformed Into required shape.Percussion sequence shown in reference picture 201, nail 70440A- nails 70440C have been moved to hitting completely for they Position is sent out, during nail 70440D is in just by percussion, and 70420E is followed closely and is still within its non-firing position.Hit exemplary During sending out sequence, being packaged component 70470 can be dissipated by nail leg and broken.Packed component 70420 may be from the envelope around nail leg Piece installing is to contact tissue T.In all cases, extra medicine can be extruded encapsulation by the extra compression of tissue thickness compensation part Part.The medicine can treat tissue immediately and can reduce tissue bleeding.

In all cases, surgeon or other clinicians fluid can be delivered in tissue thickness compensation part with Manufacture is included therein the tissue thickness compensation part of storage and/or at least one medicine absorbed.According to the present invention, nail bin and/ Or anvil block may include that the port for leading to tissue thickness compensation part entrance can be provided.Referring to Figure 20 3, nail bin 70500 may include example Such as in the port 70505 of its distal end.Port 70505 can receive pin 70510, the perforated needle in all 3A as shown in Figure 20. Pin 70510 can be inserted into tissue thickness compensation part 70515 by clinician by port 70505, so as to deliver a fluid to Tissue thickness compensation part 70515.Fluid may include such as medicine and hydrogel precursor.As described above, work as tissue thickness compensation part When rupture and/or compression, fluid can be discharged into tissue from tissue thickness compensation part.For example, when tissue thickness compensation part 70515 is entered When row is biodegradable, medicine can discharge from tissue thickness compensation part 70515.

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 surface, should One or more slopes or inclined surface can cooperate so that staple drivers 10040 move upwards from its non-firing position.For example, ginseng See Figure 19-Figure 23, each staple drivers 10040 may include at least one inclined surface 10042, and sliding part 10050 can wrap One or more inclined surfaces 10052 are included, it is enabled to when sliding part 10050 is pushed into nail bin towards distal side, is tilted Surface 10052 is in the lower slider of inclined surface 10042.When staple drivers 10040 are lifted up in its respective nail cavity 10012 When, nail 10030 can be lifted up by staple drivers 10040 so that nail 10030 can by the opening in nail platform 10011 from its Expose in nail cavity 10012.During exemplary percussion sequence, referring first to Figure 25-Figure 27, sliding part 10050 can contact first Follow closely 10030a and start nail 10030a being lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start in order to lift nail 10030b, 10030c, 10030d, 10030e and 10030f and any other follow-up nail Rise.As shown in figure 27, sliding part 10050 can drive up nail 10030 so that the leg of the nail contacted with relative anvil block 10032 are deformed into desired shape, and are shot up from support section 10010.In all cases, one as percussion sequence Part, sliding part 10030 can be simultaneously by the motions upwards of multiple nails.Percussion sequence shown in reference picture 27, nail 10030a and 10030b has moved to its complete firing position and is shot up from support section 10010, and nail 10030c and 10030d is in quilt During percussion and it is at least partly accommodated in support section 10010, and follows closely 10030e and 10030f still locates In 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 27,10030e is followed closely Its non-firing position is illustrated at 10030f, and its nail leg 10032 extends to the top of platform surface 10011 and extended Into 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 Shown in 27, when nail 10030 moves to its firing position from its non-firing position, the top 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 Part 10013.Guiding piece 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 guiding piece 10013.Guiding piece 10013 can be positioned in the proximal extremity and/or distal end of nail cavity opening Place.According to the present invention, the first guiding piece 10013 can be positioned in the first end of each nail cavity opening, and the second guiding piece 10013 can be positioned in the second end of each nail cavity opening so that the sustainable nail 10030 of each first guiding piece 10013 First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guiding piece 10013.Referring to Figure 33, Mei Geyin Guiding element 10013 may include that groove or slit, such as groove 10016, such as nail leg 10032 can be slidably received in the groove In 10016.Optionally, each guiding piece 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 guiding piece 10013 in guiding piece 10013 and when following closely 10030 and being in its non-firing position Side.For example, guiding piece 10013 can limit steering level, and this can not be extended to when following closely 10030 and being in its non-firing position Above steering level.

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 multilayer material.It is thick referring now to Figure 15, tissue Degree compensating part may include compressible core and the wrappage around compressible core.Wrappage 10022 can be releasable by compressible core Ground remains to support section 10010.For example, support section 10010 may include the one or more protuberances for example extended from it, Such as protuberance 10014 (Figure 18), the protuberance can be received in one or more holes and/or slit, be such as limited to bag Wrap up in the hole 10024 in thing 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 deformed by heating processing, to expand protuberance 10014 end, and therefore limit the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 It may include one or more perforation 10025, it can be advantageous to discharge wrappage 10022 from support section 10010, such as Figure 15 institutes Show.Referring now to Figure 24, tissue thickness compensation part may include wrappage 10222, and the wrappage includes multiple holes 10223, wherein Hole 10223 can align with the nail cavity opening in support section 10010 or at least partly align.The core of tissue thickness compensation part may be used also Including the hole alignd with the hole 10223 in wrappage 10222 or at least partly alignd.Alternatively, tissue thickness The core of compensating part may include continuous main body and may extend into below hole 10223 so that continuous main body covering platform surface Nail cavity opening in 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 bound 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 edge 10053, when nail 10030 is fired, the cutting edge can be pushed into by the cutter slit in support section 10010 towards distal side.Root 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 edge 10053 can Extend and cut tissue and the tissue thickness compensation part positioned therebetween between anvil block and support section 10010.In various feelings Under condition, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the remote of nail bin 10000 Side 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 structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 Staple drivers 10040 can be projected from the support section 10010 with nail 10030.For example, staple drivers 10040 can be by Such as bioabsorbable and/or biocompatible materials is formed, such as PEI (Ultem).Staple drivers attach To nail 10030.For example, staple drivers can be molded into it is each nail 10030 base portion on and/or surrounding so that driver with Nail is integrally formed.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE OR that September in 2006 is submitted on the 29th CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent Application Serial Numbers 11/541,123 are 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 In INSTRUMENT " U.S. Patent Application Serial Number 12/031,817, the complete disclosure of the patent application is with the side of reference Formula is incorporated 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 provided in other manners, arrives The inside of mould 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, manufacturing the method for tissue thickness compensation part can generally include：Tissue thickness compensation part combination is provided Thing, liquified composition is so that its is flowable, and the composition of melting, semi-molten or mecystasis is formed as having and it is expected thickness The layer and/or film of degree.Referring to Figure 198 A, tissue thickness compensation part can be made up of following steps：Water is dissolved in aqueous solution Gel precursors, disperse biocompatible particles and/or fiber wherein, there is provided the wherein mould with biocompatible particles, Solution is provided in mould, makes activator and solution contact, and curing solution to form tissue thickness compensation part, the tissue Thickness compensation part includes the outer layer comprising biocompatible particles and includes the internal layer for the biocompatible particles being embedded.Such as Shown in 198 figure A, biocompatible layer 70250 can be provided in the bottom of mould 70260, can will then be provided with biology The aqueous solution of the hydrogel precursor 70255 of biocompatible particle 70257 is provided to mould 70260, and can be consolidated aqueous solution Change to form tissue thickness compensation part, the tissue thickness compensation part, which has, includes the first of biocompatible materials (such as ORC) Layer, and include the second layer for the hydrogel for being provided with biocompatible fibres (such as ORC fibers).Tissue thickness compensates Part may include foam, and the foam is including the outer layer containing biocompatible particles and containing the biocompatible particles being embedded Internal layer.Tissue thickness compensation part can be manufactured by following steps：Mosanom is dissolved in water, disperses ORC particles wherein, there is provided Wherein there is the mould of ORC particles, solution is poured into mould, spraying or injection calcium chloride are to contact solution, so as to trigger alginic acid The crosslinking of sodium, to form tissue thickness compensation part, it includes the outer layer comprising ORC and comprising being embedded in it freeze-drying hydrogel In hydrogel and ORC particles internal layer.

Referring to Figure 198 B, the method for manufacture three-layer weave thickness compensation part can generally include：It is molten in the first aqueous solution The first hydrogel precursor is solved, biocompatible particles and/or fiber are disperseed in the first aqueous solution, there is provided wherein there is biology The mould 70260 of the first layer 70250 of biocompatible particle, the first aqueous solution is provided in mould, makes activator and first Aqueous solution contacts, and the first aqueous solution of solidification dissolves the second hydrogel to form the second layer 70255 in the second aqueous solution Precursor, the second aqueous solution is provided in mould, solidify the second aqueous solution to form third layer 70265.Three-layer weave is thick Degree compensating part can manufacture by the following method：Mosanom is dissolved in water to form the first aqueous solution, in the first aqueous solution In disperse ORC particles, there is provided the mould of the first layer wherein with ORC particles, the first aqueous solution is poured into mould, sprayed Or injection calcium chloride, to contact the first aqueous solution, so as to trigger the crosslinking of mosanom, the first aqueous solution of freeze-drying is with shape Into the second layer for including the hydrogel with the ORC particles being embedded, it is water-based molten to form second that mosanom is dissolved in water Liquid, the second aqueous solution is poured into mould, spraying or injection calcium chloride are to contact the second aqueous solution, so as to trigger mosanom Crosslinking, the second aqueous solution of freeze-drying is to form the third layer including hydrogel.

According to the present invention, manufacture includes at least one tissue thickness compensation part for storing and/or being absorbed in 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.Method of the manufacture comprising antiseptic materials microstructure thickness compensation part may include offer hydrogel, Dried hydrogel, the swollen hydrogel in silver nitrate aqueous solution, hydrogel and sodium chloride solution are contacted, resisted so as to be formed to have The tissue thickness compensation part of bacterium characteristic.Tissue thickness compensation part may include the silver being dispersed therein.

Referring to Figure 20 4, manufacturing the method for tissue thickness compensation part may include coetrusion and/or Method for bonding.For example, tissue Thickness compensation part 70550 may include lamilate, and the lamilate includes first layer 70555 and includes water in a sealing manner The second layer 70560 of the internal layer 70565 of gel.Hydrogel may include such as dry film, dry foam, powder and/or granule.Water-setting Glue may include super-absorbent material, such as polyvinylpyrrolidone, carboxymethyl cellulose, polysulfide propyl acrylate.It can pass through By the raw material of first layer and the second layer respectively from hopper feed in extruder, first layer and the second layer are then provided sequentially to make Make first layer and/or the second layer.The raw material of internal layer 70565 can be added extruder hopper.Raw material can be in elevated temperature Under dispersion mixing and compound in an extruder.As raw material in opening leave mould 70570, internal layer 70565 can be deposited into On the surface of first layer 70555.Tissue thickness compensation part may include foam, film, powder and/or particle.First layer 70555 and It can position face-to-face for two layer 70560.The second layer 70560 can be alignd face-to-face by roller 70575 with first layer 70555.First Layer 70555 may be affixed to the second layer 70560, and wherein first layer 70555 and the second layer 70560 can Physical entrapment internal layer 70565.Layer Can for example optical pressure, conventional hot calendering bonding technique and/or by using adhesive bond together, with formed tissue thickness benefit Repay part 70550.As shown in Figure 78, first layer 70555 and the second layer 70560 can rolling by, for example, grooved roller 70580 Process processed is bonded together.Optionally, can be by the way that the first layer of outer layer or barrier can be collectively forming as above-described result 70555 and the second layer 70560 accommodate and/or seal internal layer 70565.Outer layer can prevent or reduce the contact wetting of internal layer 70565, directly Ruptured to outer layer.

Referring to Figure 61, the end effector 12 (Fig. 1) of surgical instruments 10 can receive fastener cartridge assembly, such as nail bin 20000.As shown in Figure 61, nail bin 20000 can coordinate in the staple cartridge channel 20072 of the jaw 20070 of end effector 12. Alternatively, nail bin 20000 can be integral with end effector 12 so that nail bin 20000 and end effector 12 are formed as individual unit construction.Nail bin 20000 may include such as the first main part, such as rigid support portion 20010.Nail Storehouse 20000 may also include such as the second main part, such as compressible portion or tissue thickness compensation part 20020.As in addition One kind selection, tissue thickness compensation part 20020 may not include the integral part of nail bin 20000, but can be relative to end effector 12 otherwise position.For example, tissue thickness compensation part 20020 can be fixed to end effector 12 anvil block 20060 or Can otherwise it be maintained in end effector 12.Referring to Figure 78, nail bin may also include retainer fixture 20126, and it can Suppress tissue thickness compensation part 20020 prematurely to separate from support section 20010.Reader will be appreciated that, tissue as described herein Thickness compensation part can be arranged in a variety of end effectors or be engaged in other manners with a variety of end effectors, and these Within the scope of the invention.

Similar to tissue thickness compensation part as described herein, referring now to Figure 78, tissue thickness compensation part 20020 can be from outer Section's end effector 12 discharges or departed from it.For example, the rigid support portion 20010 of nail bin 20000 can keep holding with end The fastener cartridge passage 20072 of row device jaw 20070 engages, and tissue thickness compensation part 20020 is from rigid support portion 20010 Middle disengaging.20030 (Figure 78-Figure 83) will followed closely after the nail cavity 20012 in rigid support portion 2010 is disposed, tissue thickness is mended Repaying part 20020 can discharge from end effector 12.Nail 20030 can fire from nail cavity 20012 so that the engagement tissue of nail 20030 is thick Spend compensating part 20020.In addition, referring generally to Figure 63, Figure 82 and Figure 83, nail 20030 can capture tissue thickness compensation part 20020 Tissue T of the part together with suture.Tissue thickness compensation part 20020 can be deformable, and capture in percussion nail 20030 The part of tissue thickness compensation part 20020 can be compressed.Similar to tissue thickness compensation part as described herein, tissue thickness is mended Repay the tissue T being trapped in each nail 20030 that part 20020 can compensate for different-thickness, compressibility and/or density.In addition, also such as Described herein, tissue thickness compensation part 20020 can compensate for becoming gap caused by staple 20030.

Tissue thickness compensation part 20020 can be compressed between uncompressed height and compression height.Referring to Figure 78, tissue thickness Compensating part 20020 can have top surface 20021 and lower surface 20022.The height of tissue thickness compensation part can be top The distance between surface 20021 and lower surface 20022.Minimum force or do not apply when applying to tissue thickness compensation part 20020 During power, i.e., when tissue thickness compensation part 20020 is not compressed, the uncompressed height of tissue thickness compensation part 20020 can be with It is the distance between top surface 20021 and lower surface 20022.Such as when to the applying power of tissue thickness compensation part 20020, it is all Such as when percussion nail 20030 captures a part for tissue thickness compensation part 20020, the compression of tissue thickness compensation part 20020 is high Degree can be the distance between top surface 20021 and lower surface 20022.Tissue thickness compensation part 20020 can have distal side End 20025 and proximal extremity 20026.As shown in Figure 78, the uncompressed height of tissue thickness compensation part 20020 can be thick in tissue It is homogeneous between the distal end 20025 and proximal extremity 20026 of degree compensating part 20020.Alternatively, do not press Contracting height can change between distal end 20025 and proximal extremity 20026.For example, the top of tissue thickness compensation part 20020 Surface 20021 and/or lower surface 20022 can angulation and/or stageds relative to other parts so that uncompressed height is near Change between side end 20026 and distal end 20025.The uncompressed height of tissue thickness compensation part 20020 may be, for example, about 0.08 inch.Alternatively, the uncompressed height of tissue thickness compensation part 20020 can be for example at about 0.025 inch Change between about 0.10 inch.

Such as it is described in greater detail herein, tissue thickness compensation part 20020 can be in its proximal extremity 20026 and distal end Different compression heights is compressed between 20025.Alternatively, tissue thickness compensation part 20020 can be whole at its Equably compressed under length.The compression height of tissue thickness compensation part 20020 may depend on the geometry of such as end effector 12 Shape, the characteristic of tissue thickness compensation part 20020, the tissue T of engagement and/or nail 20030.Tissue thickness compensation part 20020 Compression height can be relevant with the tissue space in end effector 12.Optionally, for example, when anvil block 20060 presss from both sides towards nail bin 20000 When tight, tissue space can be limited at the top platform surface 20011 (Figure 78) of nail bin 20000 and the tissue of anvil block 20060 connects Between tactile surface 20061 (Figure 61).Tissue space may be, for example, about 0.025 inch or be about 0.100 inch.Tissue space can example Such as it is about 0.750 millimeter or is about 3.500 millimeters.The compression height of tissue thickness compensation part 20020 can for example be equal to or substantially It is upper to be equal to tissue space.When tissue T is positioned in the tissue space of end effector 12, the compression of tissue thickness compensation part is high Degree can be reduced, to adapt to tissue T.Such as when tissue space is about 0.750 millimeter, the compression height of tissue thickness compensation part It can be about 0.500 millimeter.For example, when tissue space is about 3.500 millimeters, the compression height of tissue thickness compensation part 20020 It can be about 2.5mm.In addition, tissue thickness compensation part 20020 may include minimal compressed height.For example, tissue thickness compensation part 20020 minimal compressed height can be about 0.250 millimeter.Be limited to nail bin platform surface and anvil block tissue contacting surface it Between tissue space can for example be equal to or at least substantially equal to uncompressed height of tissue thickness compensation part.

Referring primarily to Figure 62, tissue thickness compensation part 20020 may include the fibrous nonwoven material for including fiber 20082 20080.Tissue thickness compensation part 20020 may include the material of felt or similar felt.Fiber 20082 in non-woven material 20080 It can be tightened together by any method as known in the art, including but not limited to needle point method, heat bonding, water entanglement, ultrasound Bond pattern, chemical adhesion and meltblowing adhesive.In addition, the layer of non-woven material 20080 can by machinery, plus thermally or chemically Tighten together to form tissue thickness compensation part 20020.Such as it is described in greater detail herein, the non-woven material 20080 of fiber Can be compressible, it can make tissue thickness compensation part 20020 compressible.Tissue thickness compensation part 20020 may also comprise not Compression section.For example, tissue thickness compensation part 20020 may include compressible non-woven material 20080 and uncompressed part.

Referring still primarily to Figure 62, non-woven material 20080 may include multiple fibers 20082.In non-woven material 20080 At least some fibers 20082 can be crimped fibre 20086.Crimped fibre 20086 can be for example in non-woven material 20080 It is curling, distorting, coiling, bending, deformation, spiral, circular and/or arch.As in further detail herein Description, crimped fibre 20086 can be formed by any suitable shape so that the deformation of crimped fibre 20086 produces load on spring Power or restoring force.Crimped fibre 20086 can form coiling or the substantially shape of coiled type by thermoforming.Crimped fibre 20086 can be formed by non-crimped fiber 20084.For example, non-crimped fiber 20084 can be wrapped in around heated mandrel to be formed The substantially shape of coiled type.

Tissue thickness compensation part 20020 may include homogeneous, absorbable polymer matrix.Uniform absorbable polymerization Thing matrix may include such as foam, gel and/or film.In addition, multiple fibers 20082 be dispersed among entirely uniforming it is absorbable In polymeric matrix.At least some fibers 20082 in homogeneous, absorbable polymer matrix can be such as crimped fibre 20086.As described in more detail, the homogeneous, absorbable polymer matrix of tissue thickness compensation part 2002 can be can Compression.

Referring to Figure 65 and Figure 66, crimped fibre 20086 can random dispersion at least one of whole non-woven material 20080 In point.For example, crimped fibre 20086 can random dispersion in whole non-woven material 20080 so that non-woven material 20080 A part include more crimped fibres 20086 than the other parts of non-woven material 20080.In addition, crimped fibre 20086 can It is gathered in such as fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e in non-woven material 20080.Volume The shape of bent fiber 20086 can cause the entanglement of fiber 20086 during the manufacture of non-woven material 20080；Crimped fibre 20086 entanglement can then cause fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e formation.Except this it Outside or alternatively, crimped fibre 20086 can in whole non-woven material 20080 random orientation.For example, with reference to Figure 62, the first crimped fibre 20086a can be orientated in the first direction, and the second crimped fibre 20086b can be orientated in a second direction, and And the 3rd crimped fibre 20086c can be orientated along third direction.

Crimped fibre 20086 can systematically be distributed and/or be arranged at least a portion of whole non-woven material 20080. For example, referring now to Figure 67, crimped fibre 20186 can be positioned in construction 20185, plurality of crimped fibre 20186a edges First direction is arranged, and other multiple crimped fibre 20186b are arranged in a second direction.Crimped fibre 20186 can with overlapping, So that they mutually tangle or interconnected.Crimped fibre 20186 systemic can be arranged so that crimped fibre 20186a is substantially parallel In another crimped fibre 20186a.Another crimped fibre 20186b can extend substantially transversely to some crimped fibres 20186a. Optionally, crimped fibre 20186a substantially can align with first axle Y, and crimped fibre 20186b can be substantially with second Axis X is alignd.For example, first axle Y can be perpendicular or substantially perpendicular to second axis X.

Referring primarily to Figure 68, the cocoa of crimped fibre 20286 is arranged to construction 20285.Each crimped fibre 20286 can wrap Include the longitudinal axis being limited between the first end 20287 of crimped fibre 20286 and second end 20289.Crimped fibre 20286 can systematically be distributed in non-woven material 20080 so that the first end 20287 of a crimped fibre 20286 positions In the position of the second end 20289 adjacent to another crimped fibre 20286.Alternatively, referring now to figure 69, fibrous structure 20385 may include the first crimped fibre 20386a being for example orientated in the first direction, be orientated in a second direction Second crimped fibre 20386b, and the 3rd crimped fibre 20386c being orientated along third direction.According to the present invention, crimped fibre 20286 single pattern or construction can repeat in whole non-woven material 20080.Crimped fibre can be in whole non-woven material Arranged in 20080 with different pattern.As other alternate forms, non-woven material 20080 may include that at least one curling is fine Tie up pattern, and the crimped fibre of multiple random orientations and/or random distribution.

Referring again to Figure 62, multiple fibers 20082 in non-woven material 20080 may include at least some non-crimped fibers 20084.Non-crimped fiber 20084 and crimped fibre 20086 in non-woven material 20080 can be tangled or interconnected.Crimped fibre 20086 and the ratio of non-crimped fiber 20084 may be, for example, about 25:1.Alternatively, crimped fibre 20086 with it is non- The ratio of crimped fibre 20084 may be, for example, about 1:25.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 ratio may be, for example, about 1:1.As described in more detail, when non-woven material 20080 has deformed, non-woven material The quantity of crimped fibre 20086 can influence restoring force caused by non-woven material 20080 in the per unit volume of material 20080.Such as Equally it is more fully described herein, restoring force caused by non-woven material 20080 may also depend upon such as non-woven material 20080 Material, shape, size, position and/or the orientation of middle crimped fibre 20086 and non-crimped fiber 20084.

The fiber 20082 of non-woven material 20080 can include polymer composition.The polymer composition of fiber 20082 Polymer, absorbable polymer or the combinations thereof of nonabsorable can be included.Absorbable polymer may include can biology Absorb, biocompatible elastomeric polymer.In addition, the polymer composition of fiber 20082 may include synthetic polymer, non- Synthetic polymer or combinations thereof.The example of synthetic polymer includes but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, fiber 20082 may include 90/ 10 poly- (glycolide-L- lactides) copolymers, for example, the copolymer can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. are commercially available.The example of non-synthetic polymer includes but is not limited to lyophilized polysaccharides, glycoprotein, elastic egg In vain, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Optionally, mended similar to tissue thickness as described herein Repay the polymer composition in part, the polymer composition amount of may include of fiber 20082 is different (such as by weight percentage) Absorbable polymer, polymer, synthetic polymer and/or the non-synthetic polymer of nonabsorable.

The crimped fibre 20086 of non-woven material 20080 may include first polymer composition, and non-woven material 20080 non-crimped fiber 20084 may include different polymer compositions.For example, crimped fibre 20086 may include that synthesis is poly- Compound, such as 90/10 poly- (glycolide-L- lactides), and non-crimped fiber 20084 may include non-synthetic polymer, such as oxygen Change regenerated cellulose.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 may include that identical polymerize Compositions.

As described herein, crimped fibre 20086 and non-crimped fiber 20084 can be for example, by needle point method, heat bonding, water Tangle, ultrasound pattern bonds, chemical adhesion and meltblowing adhesive tighten together.Including synthetic fibers such as " VICRYL (polyglactic 910) " crimped fibre 20086, and the non-crimped fiber 20084 including oxidized regenerated cellulose can lead to Cross acupuncture and form non-woven material 20080 together.Non-woven material 20080 may include for example, about 5% to 50% (by weight Meter) curling " VICRYL (polyglactic 910) " fiber 20086, and be the non-volume of about 5% to 50% (by weight) Bent oxidized regenerated cellulose (ORC) fiber 20084.Such as when non-woven material 20080 contacts tissue T, non-crimping ORC fibers 20084 can react rapidly to form gel block with the blood plasma in tissue.The formation of gel ORC block can be instantaneous or almost instantaneous Ground contacts with tissue.In addition, after gel ORC block formation, " VICRYL (polyglactic 910) " fiber of curling 20086 can still be distributed in whole non-woven material 20080.For example, crimped fibre 20086 can be suspended in gel ORC block. Because gel ORC block is bioabsorbable, curling " VICRYL (polyglactic910) " fiber 20086 can be in adjacent tissue Apply screen resilience, as described in more detail.In addition, tissue can start in " VICRYL (polyglactic 910) " fiber And/or healed around forming nail 30030, also as described in more detail.

Referring primarily to Figure 78-Figure 81, the support section 20010 of nail bin 20000 may include warehouse 20017, top platform table Face 20011 and multiple nail cavities 20012.Each nail cavity 20012 can limit the opening in platform surface 20011.Nail 20030 can be by can It is positioned in nail cavity 20012 with removing.According to the present invention, single nail 20030 is arranged in each nail cavity 20012.Referring primarily to Figure 82 and Figure 83, and nail as described herein is similar to, each nail 20030 may include with the end of first end 20035 and second The base portion 20031 at end 20036.Nail leg 20032 can extend from the first end 20035 of base portion 20031, and another nail leg 20032 can extend from the second end 20036 of base portion 20031.Referring again to Figure 78-Figure 81, before deployment nail 20030, often The base portion 20031 of individual nail 20030 can be supported by staple drivers 20040, and the staple drivers are positioned at the rigid support of nail bin 20000 In part 20010.In addition, before deployment nail 20030, the leg 20032 of each nail 20030 can be at least partially contained within nail cavity In 20012.

Nail 20030 can be deployed between initial position and firing position.For example, referring primarily to Figure 81, nail 20030 can be located In initial position (nail 20030e, 20030f), part percussion or centre position (nail 20030c, 20030d) or firing position (nail 20030a、20030b).Driver 20040 can drive the nail between initial position and firing position.For example, each nail 20030 base portion 20031 can be supported by driver 20040.Follow closely the leg 20032 of (such as nail 20030e, 20030f in Figure 80) It can be positioned in nail cavity 20012.When firing member or nail percussion sliding part 20050 are from the proximal extremity 20001 of nail bin 20000 When distal end 20002 translates, the inclined surface 20051 on sliding part 20050 can contact the nauropemeter on driver 20040 Face 20042, with deployment be positioned at nail 20030 on contact driver 20040.Nail 20030 can be deployed in initial position Between firing position so that leg 20032 moves across the non-woven material 20080 of tissue thickness compensation part 20020, penetrates group The top surface 20021 of thickness compensation part 20020 is knitted, penetrates tissue T, and contact is positioned at nail cavity in end effector 12 The anvil block 20060 (Figure 61) on 20000 opposites.Nail leg 20032 can be directed to anvil block 20060 and deform, the leg of each nail 20030 20032 can capture a part for a part for non-woven material 20080 and tissue T.

In percussion configuration (Figure 82 and Figure 83), each nail 20030 can follow closely the tissue in 20030 to tissue T and capture Thickness compensation part 20020 applies compression stress.Referring primarily to Figure 80 and Figure 81, the leg 20032 of each nail 20030 can be towards nail 20030 base portion 20031 deforms downwards, to form nail retention region 20039.Nail retention region 20039 can be tissue T and tissue The region that thickness compensation part 20020 can be captured by percussion nail 20030.In all cases, nail retention region 20039 can limit Strained leg 20032 inner surface and follow closely 20030 base portion 20031 inner surface between.The retention area of nail 20030 20039 size may depend on a number of factors, such as the journey of the diameter of the length of leg, leg, the width of base portion and/or leg deformation Degree.

Optionally, when non-woven material 20080 is trapped in nail retention region 20039, the quilt of non-woven material 20080 Capture portion can be compressed.The compression height for the non-woven material 20080 being trapped in nail retention region 20039 can be according to identical Tissue T in nail retention region 20039 and change in nail bin 20000.For example, in the case where tissue T is relatively thin, nail retention area Domain 20039 can have the space for more giving non-woven material 20080, and therefore, the degree that non-woven material 20080 is compressed can Can unlike when tissue T is thicker its will as compression it is big.Such as in the case where tissue T is thicker, non-woven material 20080 can That is compressed is more, to adapt to thicker tissue T.For example, with reference to Figure 82, non-woven material 20080 for example can be cut in the first nail Stay and the first height is compressed in the 20039a of region, the second height is compressed in the second nail retention region 20039b, in the 3rd nail Third height is compressed in the 20039c of retention area, the 4th is compressed in the 4th nail retention region 20039d highly, and The 5th height is compressed in 5th nail retention region 20039e.Similarly, as shown in Figure 83, non-woven material 20080 can be The first height is compressed in one nail retention region 20039a, the second height is compressed in the second nail retention region 20039b, Third height is compressed in 3rd nail retention region 20039c, and it is high in the 4th nail retention region 20039d to be compressed to the 4th Degree.Alternatively, the compression height of non-woven material 20080 can be in whole nail bin 20010 to be homogeneous.

Optionally, non-woven material 20080 can be moved to compressed configuration by the power applied from initial uncompressed configuration.This Outside, non-woven material 20080 can be flexible so that screen resilience or restoring force can be produced when non-woven material 20080 is compressed. During deformation, the non-woven material 20080 can attempt to the resilience from the configuration for compressing or deforming.When non-woven material 20080 attempts During resilience, it can apply screen resilience or restoring force in the tissue being also trapped in nail retention region 30039, such as more detailed herein Carefully describe.When the power of application is then removed, restoring force can make non-woven material resilience from the configuration of compression.It is non-woven Material 20080 is resiliently to initial uncompressed configuration or resilient to the configuration for being substantially similar to initial uncompressed configuration.It is non- The deformation of weaving material 20080 can be elastic.The deformation of non-woven material can be partial elastic and partially plastic.

When a part for non-woven material 20080 is compressed in nail retention region 20039, non-woven compensating part The crimped fibre 20086 in the part in 20039 can also compress or deform in other manners.Crimped fibre 20086 Deflection can be corresponding with the decrement of the captured part of non-woven material 20080.For example, with reference to Figure 63, non-woven material 20080 nails 20030 that can be disposed capture.The nail 20030 that non-woven material 20080 is disposed compresses more, and curling is fine The average deformation of dimension 20086 can be bigger.In addition, the nail that non-woven material 20080 is disposed compresses fewer, crimped fibre 20086 average deformation can be smaller.Similarly, referring to Figure 82 and Figure 83, non-woven material 20080 is compressed more wherein Nail retention region 20039d in, the crimped fibre 20086 in nail retention region 20039d generally can deform more.In addition, In nail retention region 20039a, non-woven material 20080 is compressed fewer, the crimped fibre in nail retention region 20039a 20086 generally can deform fewer.

Ability of the non-woven material 20080 from the configuration resilience of deformation, i.e. the screen resilience of non-woven material 20080, can use Certainly in the screen resilience of crimped fibre 20086 in non-woven material 20080.Crimped fibre 20086 can deform with resiliencely.Curling The deformation of fiber 20086 can be partial elastic and partially plastic.Optionally, the compression of each crimped fibre 20086 can make by The crimped fibre 20086 of compression produces screen resilience or restoring force.For example, when fiber 20086 is attempted from resilience in its compressed configuration When, the crimped fibre 20086 compressed can produce restoring force.Fiber 20086 can attempt to return to its initial uncompressed structure Type or the configuration for being substantially similar to its configuration.Crimped fibre 20086 can attempt to part and return to its initial configuration.Optionally, The only a part of crimped fibre 20086 can be flexible in non-woven material 20080.When crimped fibre 20086 includes linear bullet Property material when, the restoring force of the crimped fibre 20086 compressed may depend on the quantity that for example crimped fibre 20086 is compressed and The device of spring stiffness coefficient of crimped fibre 20086.The device of spring stiffness coefficient of crimped fibre 20086 can be fine at least dependent on such as curling Orientation, material, shape and/or the size of dimension 20086.

Crimped fibre 20086 in non-woven material 20080 may include homogeneous device of spring stiffness coefficient.Alternatively Select, the device of spring stiffness coefficient of the crimped fibre 20086 in non-woven material 20080 can be change.When with big spring When the crimped fibre 20086 of stiffness factor is greatly compressed, crimped fibre 20086 can produce big restoring force.When with same When the crimped fibre 20086 of the big device of spring stiffness coefficient of sample is compressed less, crimped fibre 20086 can produce smaller recovery Power.The summation of restoring force can be produced in tissue thickness as caused by the crimped fibre 20086 of the compression in non-woven material 20080 Merging restoring force on the whole non-woven material 20080 of compensating part 20020.Non-woven material 20080 can be trapped in tool Have to apply in the tissue T in the percussion nail 20030 of the non-woven material 20080 of compression and merge restoring force.

In addition, the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 can influence non-woven material 20080 device of spring stiffness coefficient.For example, the negligible amounts of the crimped fibre 20086 when per unit volume non-woven material 20080 When, the screen resilience in non-woven material 20080 can be relatively low；For example, when the crimped fibre of per unit volume non-woven material 20080 When 20086 quantity is more, the screen resilience in non-woven material 20080 can be higher；For example, work as per unit volume non-woven material 20080 crimped fibre 20086 it is more when, the screen resilience in non-woven material 20080 can be higher.Work as non-woven material When 20080 screen resilience is relatively low, such as when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is relatively low When, the merging restoring force being applied to by tissue thickness compensation part 20020 in captured tissue T also can be smaller.When non-woven material Material 20080 screen resilience it is higher when, such as when per unit volume non-woven material 20080 crimped fibre 20086 quantity compared with Gao Shi, the sum of the restoring forces being applied to by tissue thickness compensation part 20020 in captured tissue T also can be higher.

Referring primarily to Figure 64, the non-woven material 20080 ' of tissue thickness compensation part 20020 ' may include therapeutic agent 20088, Such as medicine and/or pharmaceutically active agents.The therapeutic agent 20088 of the releasable therapeutically effective amount of non-woven material 20080 '.For example, work as When non-woven material 20080 ' is absorbed, therapeutic agent 20088 can be released.Therapeutic agent 20088 can be released to flow through it is non-woven Fluid on material 20080 ' or through non-woven material 20080 ', such as blood.The example of therapeutic agent 20088 can include but It is not limited to styptic and medicine, such as fibrin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Anti-inflammatory drug, it is all Such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or preparation, Such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, and/or chloramphenicol；And/or anticancer, such as Cis-platinum, mitomycin and/or adriamycin.Therapeutic agent 20088 can include biological agent, such as stem cell.Non-woven material 20080 ' fiber 20082 can include therapeutic agent 20088.Alternatively, therapeutic agent 20088 may be added to that non-woven Material 20080 ' is incorporated into tissue thickness compensation part 20020 ' in other manners.

Referring primarily to Figure 70-Figure 70 B, the tissue thickness compensation part 20520 for end effector 12 (Figure 61) may include Multiple springs or coiled fiber 20586.Similar with crimped fibre 20086 as described herein, coiled fiber 20586 is in tissue thickness In compensating part 20520 can be (such as) curling, distortion, coiling, bending, deformation, it is spiral, circular and/ Or arch.Coiled fiber 20586 can be wrapped in around mandrel to form coiling or the substantially shape of coiled type.Coiled fiber 20586 can in whole tissue thickness compensation part 20520 random orientation and/or random distribution.Alternatively, coil Fiber 20586 can systematicness arrangement and/or heterogeneity distribution in whole tissue thickness compensation part 20520.For example, with reference to figure 70, coiled fiber 20586 may include the longitudinal axis between the first end 20587 of coiled fiber 20586 and second end 20589 Line.The longitudinal axis of coiled fiber 20520 in tissue thickness compensation part 20520 can be parallel or substantially parallel.Each coiling The first end 20587 of fiber 20520 can position and often along the first longitudinal side 20523 of tissue thickness compensation part 20520 The second end 20589 of individual coiled fiber 20586 can position along the second longitudinal side 20524 of tissue thickness compensation part 20520. In such construct, coiled fiber 20586 can laterally traverse tissue thickness compensation part.Alternatively, coiling is fine Dimension 20586 can longitudinally or diagonally traverse tissue thickness compensation part 20520.

Optionally, similar with crimped fibre 20086 as described herein, coiled fiber 20586 can include polymer composition. Crimped fibre 20586 can be at least partially elasticity so that the deformation of crimped fibre 20586 produces restoring force.Coiled fiber 20586 polymer composition can include such as polycaprolactone (PCL) so that coiled fiber 20586 is in chlorophyll solvent Insoluble.Referring to Figure 70 A, spring or coiled fiber 20520 are positively retained in compensating material 20580.Compensating material 20580 can Coiled fiber 20586 is maintained at loading position so that coiled fiber 20586 applies load on spring to compensating material 20580 and existed Apply load on spring in compensating material 20580.Coiled fiber 20586 can be maintained at neutral position by compensating material 20580, at this In the case of coiled fiber 20586 will not apply load on spring to compensating material 20580 or apply spring in the compensating material 20580 Load.Compensating material 20580 can be bioabsorbable, and in some cases, can include foam, such as polyglycolic acid (PGA) foam.In addition, compensating material 20580 can be solvable in such as chlorophyll solvent.Tissue thickness compensation part may include Such as the coiled fiber 20586 containing polycaprolactone (PCL) and the compensating material 20580 containing polyglycolic acid (PGA) foam, make It is insoluble in chlorophyll solvent to obtain coiled fiber 20520, and compensating material 20580 is solvable in chlorophyll solvent 's.Compensating material 20580 can be at least partially elasticity so that the compression of compensating material 20580 produces restoring force.In addition, Referring to Figure 70 B, the compensating material 20580 of tissue thickness compensation part 20520 can include therapeutic agent 20588, such as stem cell.Work as benefit Repay the therapeutic agent 20588 of 20580 releasable therapeutically effective amount of compensating material when material 20580 is absorbed.

Similar with tissue thickness compensation part 20020 as described herein, tissue thickness compensation part 20520 can be compressible 's.For example, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, the engageable tissue of nail 20030 is thick Spend a part for compensating part 20520.According to the present invention, nail 20030 can capture the part and phase of tissue thickness compensation part 20520 Adjacent tissue T.Nail 20030 can apply captured part from compression stress to tissue thickness compensation part 20520 and tissue T so that tissue Thickness compensation part 20520 is compressed to compression height from uncompressed height.The compression of tissue thickness compensation part 20520 can cause it In coiled fiber 20586 corresponding deformation.As described in more detail, the deformation of each coiled fiber 20586 can produce Raw restoring force, the restoring force may depend on the screen resilience of coiled fiber, for example, the deflection of coiled fiber 20586 and/or coiling The device of spring stiffness coefficient of fiber 20586.The device of spring stiffness coefficient of coiled fiber 20586 can be at least dependent on such as coiled fiber 20586 orientation, material, shape and/or size.The deformation of coiled fiber 20586 can be whole in tissue thickness compensation part 20520 Restoring force is produced in individual tissue thickness compensation part 20520.Tissue thickness compensation part 20520 can be to being caught in percussion nail 20030 Obtain tissue T and apply the sum of the restoring forces as caused by the coiled fiber 20586 and/or elastic compensating material 20586 that deform.

Referring primarily to Figure 71 and Figure 72, the tissue thickness compensation part 20620 for end effector 12 may include multiple bullets Spring coil 20686.Similar with crimped fibre 20086 as described herein and coiled fiber 20586, spring coil 20686 is being organized In thickness compensation part 20620 can be (such as) curling, distortion, coiling, bending, deformation, it is spiral, circular And/or arch.Optionally, similar with fiber and coil as described herein, spring coil 20686 can include combination of polymers Thing.In addition, spring coil 20686 can be at least partially elasticity so that the deformation of spring coil 20686 produces restoring force. Spring coil 20686 may include first end 20687, second end 20689 and longitudinal axis between the two.Referring to Figure 71, bullet The first end 20686 of spring coil 20686 can be positioned at or near the proximal extremity 20626 of tissue thickness compensation part, and The second end 20689 of identical springs coil 20686 can be positioned at the distal end 20625 of tissue thickness compensation part 20620 Near or so that for example spring coil 20686 longitudinally traverses tissue thickness compensation part 20620.Alternatively, disk Tissue thickness compensation part 20620 can laterally or be diagonally traversed around fiber 20686.

Tissue thickness compensation part 20620 may include outer membrane 20680, and the outer membrane 20680 is at least partly around at least one Spring coil 20686.Referring to Figure 71, outer membrane 20680 can surround multiple spring coils in tissue thickness compensation part 20620 20686 periphery extension.Alternatively, the bullet that outer membrane 20680 can be in fully enclosed tissue thickness compensation part 20620 Spring coil 20686 or at least one spring coil 20686.Spring coil 20686 can be maintained at end effector by outer membrane 20680 In 12.Spring coil 20686 can be maintained at loading position by outer membrane 20680 so that spring coil 20686 produces load on spring simultaneously And external membrane 20680 applies screen resilience.Alternatively, spring coil 20686 can be maintained at neutral by outer membrane 20680 Position.Tissue thickness compensation part 20620 can also include packing material 20624.Packing material 20624 can be kept by outer membrane 20680 In the spring coil 20686 and/or around.Packing material 20624 can include therapeutic agent 20688, be controlled similar to as described herein Treat agent.In addition, packing material 20624 can support the spring coil 20686 in tissue thickness compensation part 20620.Packing material 20624 can be compressible and be at least partially elasticity so that packing material 20624 helps to be mended by tissue thickness Screen resilience or restoring force caused by part 20620 are repaid, as described in more detail.

Similar with tissue thickness compensation part as described herein, tissue thickness compensation part 20620 can be compressible.Work as nail When 20030 (Figure 78-Figure 81) are deployed to firing position from initial position, 20030 engageable tissue thickness compensation parts 20620 are followed closely A part.Optionally, each nail 20030 can capture a part for tissue thickness compensation part 20620 together with adjacent tissue T.Nail 20030 can apply captured part from compression stress to tissue thickness compensation part 20620 and captured tissue T so that tissue thickness Compensating part 20620 is compressed between uncompressed height and compression height.The compression of tissue thickness compensation part 20620 can cause to protect Hold the corresponding deformation (Figure 72) of spring coil 20686 wherein.As described in more detail, each spring coil 20686 Deformation can produce restoring force, the restoring force depends on the screen resilience of spring coil 20686, for example, spring coil 20686 The device of spring stiffness coefficient of deflection and/or spring coil 20686.The device of spring stiffness coefficient of spring coil 20686 can at least depend on In such as material of spring coil 20686, shape and/or size.In addition, time according to packing material 20624 and outer membrane 20680 Elastic force, the compression of packing material 20624 and/or outer membrane 20680 can also produce restoring force.At least by tissue thickness compensation part The summation of restoring force caused by deformed spring coil 20686, packing material 20624 and/or outer membrane 20680 in 20620 can be Restoring force is produced in whole tissue thickness compensation part 20620.Tissue thickness compensation part 20620 can be to the quilt in percussion nail 20030 Capture tissue T and apply the sum of the restoring forces as caused by deformed spring coil 20686.

Optionally, referring primarily to Figure 73-Figure 75, the tissue thickness compensation part 20720 for end effector 12 may include Multiple spring coils 20786.Similar with coiled fiber as described herein and spring, spring coil 20786 compensates in tissue thickness In part 20720 can be (such as) curling, distortion, coiling, bending, deformation, it is spiral, circular and/or bow Shape.Spring coil 20786 can be at least partially elasticity so that the deformation of spring coil 20786 produces restoring force.This Outside, spring coil 20786 may include first end 20787, second end 20789 and longitudinal axis between the two.Referring primarily to Figure 75, the first end 20787 of spring coil 20786 can be positioned at the proximal extremity 20726 of tissue thickness compensation part 20720 Near or, and the second end 20789 of spring coil 20786 can be positioned on the distal end of tissue thickness compensation part 20720 At or near 20725 so that spring coil 20786 longitudinally traverses tissue thickness compensation part 20720.Spring coil 20786 can Along two parallel row Longitudinal extendings in tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be positioned on end and hold In row device 12 so that sliding part 20050 (Figure 61) or cutting element 20052 can be along between the spring coils 20786 of parallel row Slit 20015 translate.Alternatively, spring coil 20786 can laterally or diagonally traverse tissue thickness's benefit Repay part 20720.

Referring again to Figure 75, spring coil 20786 can keep or be embedded in compensating material 20780.Compensating material 20780 can To be bioabsorbable, and in some cases, foam, such as polyglycolic acid (PGA) foam can be included.Compensating material 20780 can be flexible so that the deformation of compensating material 20780 produces screen resilience.Compensating material 20780 is molten in such as chlorophyll Can be solvable in agent.For example, tissue thickness compensation part can be for example including the spring coil 20786 containing polycaprolactone (PCL) With the compensating material 20780 containing polyglycolic acid (PGA) foam so that spring coil 20786 is in chlorophyll solvent can not Molten, and compensating material 20780 is solvable in chlorophyll solvent.Compensating material 20780 can be at least partially elasticity, So that the deformation of compensating material 20780 produces load on spring or restoring force.

Tissue thickness compensation part 20720 may include plait 20790, and it can be between the spring coil 20786 of parallel row Extension.For example, with reference to Figure 75, the first plait 20790 can diagonally traverse the spring coil 20786 of two parallel rows, and Second plait 20790 can also diagonally traverse the spring coil 20786 of two parallel rows.First and second plaits 20790 It can intersect.Plait 20790 can repeatedly intersect along the length of tissue thickness compensation part 20720.Plait 20790 can be by spring Coil 20786 is maintained in loading configuration so that spring coil 20786 is maintained at the base in tissue thickness compensation part 20720 This flat position.Spring coil 20786 can be directly attached to by traversing the plait 20790 of tissue thickness compensation part 20720.As Another option, plait 20790 can be connected to spring coil 20786 via support member 20792, the edge of support member 20792 The longitudinal axis for spring coil 20786 extends through each spring coil 20786.

As described in more detail, nail bin 20000 may include slit 20015, and it can be received including cutting element 20052 translational slidiing part 20050 (Figure 61).When sliding part 20050 translates along slit 20015, sliding part 20050 can incite somebody to action Nail 20030 is projected from the securing member chamber 20012 in nail bin 20000, and cutting element 20052 can simultaneously or almost simultaneously be cut Disconnected tissue T.Referring again to Figure 75, when cutting element 20052 translates, it also can be cut off in tissue thickness compensation part 20720 Parallel row spring coil 20786 between the plait 20790 that intersects.When plait 20790 is cut off, each spring coil 20786 can be released from its loading configuration so that what each spring coil 20786 loaded from tissue thickness compensation part 20720 Substantially flat position is recovered to expanding position.Optionally, when spring coil 20786 expands, around the benefit of spring coil 20786 Material 20780 is repaid also to may expand.

Optionally, when 20030 (Figure 78-Figure 81) of nail are deployed to firing position from initial position, nail 20030 is engageable A part for tissue thickness compensation part 20720, and tissue thickness compensation part 20720 can expand or attempt swollen in nail 20030 It is swollen, and compression stress can be applied to tissue T.Optionally, at least one nail 20030 can capture tissue thickness compensation part 20720 A part is together with adjacent tissue T.Nail 20030 can be to the captured part and captured tissue T of tissue thickness compensation part 20720 Apply compression stress so that tissue thickness compensation part 20720 is compressed between uncompressed height and compression height.Tissue thickness is mended Repay the corresponding deformation of compensating material 20780 that the compression of part 20720 can cause spring coil 20786 and remain at.Such as this Text is more fully described, and the deformation of each spring coil 20786 can produce restoring force, and the restoring force may depend on spring coil Screen resilience, for example, the device of spring stiffness coefficient of the deflection of spring coil 20786 and/or spring coil 20786.Spring coil 20786 device of spring stiffness coefficient can be at least dependent on such as orientation of spring coil 20786, material, shape and/or size.By Restoring force caused by least deformed spring coil 20786 and/or compensating material 30380 in tissue thickness compensation part 20720 Summation can produce restoring force in whole tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be to the tissue that is captured T and percussion nail 20030 apply the sum of the restoring forces as caused by the deformed spring coil 20786 in tissue thickness compensation part 20720.

Optionally, referring primarily to Figure 76 and Figure 77, the tissue thickness compensation part 20820 for surgical end-effector 12 can Including spring coil 20886.Similar with fiber and coil as described herein, spring coil 20886 is in tissue thickness compensation part Can be in 20820 (such as) crimp, distorting, coiling, bending, deformation, spiral, circular and/or arch 's.Spring coil 20886 can include polymer composition and can be at least partially elasticity so that spring coil 20886 Deformation produce screen resilience.In addition, spring coil 20886 may include first end 20887 and second end 20889.Referring to figure 76, first end 20887 can be positioned at or near the proximal extremity 20826 of tissue thickness compensation part 20820, and the second end End 20889 can be positioned at or near the distal end 20825 of tissue thickness compensation part 20820.Spring coil 20886 can be from group The proximal extremity 20825 for knitting thickness compensation part 20820 winds or is folded into distal end 20826.

Referring again to Figure 76, spring coil 20886 can keep or be embedded in compensating material 20880.Compensating material 20880 can To be bioabsorbable, and in some cases, foam, such as polyglycolic acid (PGA) foam can be included.Compensating material 20880 in such as chlorophyll solvent can be solvable.Tissue thickness compensation part can be for example including containing polycaprolactone (PCL) Spring coil 20886 and the compensating material 20880 containing polyglycolic acid (PGA) foam so that spring coil 20886 is in chlorophyll It is insoluble in solvent, and compensating material 20880 is solvable in chlorophyll solvent.Compensating material 20880 can at least portion Divide flexible so that the deformation of compensating material 20880 produces load on spring or restoring force.

It is similar with tissue thickness compensation part as described herein, for example, tissue thickness compensation part 20820 can be compressible 's.The compensating material that the compression of tissue thickness compensation part 20820 can cause to keep or be embedded in tissue thickness compensation part 20820 At least a portion deformation of spring coil 20886 in 20880.As described in more detail, the deformation of spring coil 20886 Restoring force can be produced, the restoring force may depend on such as screen resilience of spring coil 20886, the deflection of spring coil 20886 And/or the device of spring stiffness coefficient of spring coil 20886.Produced by deformed spring coil 20886 and/or deformation-compensated material 20880 The summation of raw restoring force can produce restoring force in whole tissue thickness compensation part 20820.Tissue thickness compensation part 20820 can Sum of the restoring forces are applied to the captured tissue T in percussion nail 20030.

Referring now to Figure 84, surgical end-effector 12 may include to have the tissue of at least one tubular element 30080 thick Spend compensating part 30020.Tissue thickness compensation part 30020 is positively retained in surgical end-effector 12.As retouched in further detail herein State, the fastener that can be disposed in end effector 12 so that fastener moves to firing position and makes tissue thickness compensation part At least a portion deformation of tubular element 30080 in 30020.Reader will be appreciated that, including at least one as described herein The tissue thickness compensation part of tubular element can be arranged on a variety of surgical end-effectors in or in other manners with a variety of surgeries End effector engages, and these are within the scope of the invention.

Optionally, can be relative to the anvil block 30060 of end effector 12 referring also to Figure 84, tissue thickness compensation part 30020 Positioning.Alternatively, tissue thickness compensation part 30020 can be relative to the fastener cartridge assembly of end effector 12 (such as nail bin 30000) positions.Nail bin 30000 can coordinate the warehouse channel 30072 in the jaw 30070 of end effector 12 In.For example, tissue thickness compensation part 30020 can be releasably secured to nail bin 30000.Tissue thickness compensation part 30020 Tubular element 30080 can position adjacent to the top platform surface 30011 of the rigid support portion 30010 of nail bin 30000.Tubulose Element 30080 can be by adhesive or by wrappage (similar with least one of wrappage as described herein) (for example, figure 16) it is fixed to top platform surface 30011.Tissue thickness compensation part 30020 can be whole into one with the component including nail bin 30000 Body so that nail bin 30000 and tissue thickness compensation part 30020 are formed as individual unit construction.For example, nail bin 30000 may include Such as first main part, such as rigid support portion 30010, and the second main part, such as tissue thickness compensation part 30020。

Referring to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 may include elongated portion 30082, the elongated portion 30082 has extends through at least one tube chamber 30084 therein at least in part.Referring primarily to figure 86, the elongated portion 30082 of tubular element 30080 may include to weave or weave strand 30090, as described in more detail. Alternatively, elongated portion 30082 may include solid construction, such as polymer extrudate, rather than weaving strand 30090.The elongated portion 30082 of tubular element 30080 may include thickness.The thickness of elongated portion 30082 can be whole long at it It is in degree and a diameter of substantially uniform around its；In other cases, the thickness can change.Elongated portion 30082 can To be elongated so that for example the length of elongated portion 30082 is more than the diameter of elongated portion 30082.Elongated portion may include example Length and about 0.10 inch to about 0.15 inch of diameter such as about 1.20 inches to about 2.60 inches.Tubular element 20080 length can be such as about 1.40 inches, and the diameter of tubular element 20080 can be such as about 0.125 inch. In addition, elongated portion 30082 can limit for example substantially circular or oval shape of cross section.Alternatively, Shape of cross section may include polygonal shape, such as triangle, hexagon and/or octagon.Referring again to Figure 84, tubular element 30080 may include the first distal end 30083 and the second proximal extremity 30085.The shape of cross section of elongated portion 30082 can be Narrow at first end 30083 and/or second end 30085, wherein at least one end 30083 of tubular element 30080, 30085 can close and/or seal.Alternatively, tube chamber 30084 can continue across the distal side of tubular element 30080 End 30083,30085 so that end 30083,30085 is open.

Tubular element 30080 may include the single central lumen for extending through elongated portion 30084 at least in part 30084.Tube chamber 30084 can extend across the whole length of elongated portion 30084.As other alternate forms, tubular element 30080 may include to extend through multiple tube chambers 30084 therein.The tube chamber 30084 for extending through tubular element 30080 can be circle Shape, semicircle, wedge shape and/or combinations thereof.According to the present invention, tubular element 30080 may also include support web, and it can For example modified " T " or X-shaped shape are formed in tube chamber 30084.Size, tube chamber and/or support in tubular element 30080 is fine Dimension net can limit the shape of cross section of tubular element 30080.The shape of cross section of tubular element 30080 can in its whole length To be consistent, or alternatively, the shape of cross section of tubular element 30080 can change along its length.Such as this Text is more fully described, and the shape of cross section of tubular element 30080 can influence compressibility and the resilience of tubular element 30080 Power.

Tubular element 30080 may include perpendicular diameter and horizontal diameter；Its size can be according to the pipe in end effector 12 The construction of the very best part 30080, the size (tissue space for including end effector 12) of end effector 12 and nail retention region 30039 expection geometry selects.For example, the perpendicular diameter of tubular element 30080 can have with the desired height of forming nail Close.In such cases, the perpendicular diameter of tubular element 30080 may be selected so that when tubular element 30080 is trapped in shaping When in nail 30030, perpendicular diameter can reduce about 5% to about 20%.For example, perpendicular diameter is about 0.100 inch of pipe The very best part 30080 can be used for being expected the nail that forming height is about 0.080 inch to about 0.095 inch.Therefore, when tubulose member When part 30080 is trapped in forming nail 30030, even if not capturing any tissue T wherein, tubular element 30080 it is vertical Diameter can also reduce about 5% to about 20%.When tissue T is trapped in forming nail 30030, tubular element 30080 Compression even can be bigger.Perpendicular diameter can be homogeneous in the whole length of tubular element 30080, or alternatively select Select, perpendicular diameter can vary along its length.

When tubular element 30080 is in not deformed or resilient configuration, the horizontal diameter of tubular element 30080 can be more than, Equal to or less than the perpendicular diameter of tubular element 30080.For example, with reference to Figure 85, horizontal diameter is big than perpendicular diameter for example big About three times.For example, horizontal diameter may be about 0.400 inch and perpendicular diameter may be about 0.125 inch.As other one Kind selection, referring now to Figure 87, when tubular element 31080 is in not deformed or resilient configuration, the level of tubular element 31080 Diameter can be equal or substantially equal to the perpendicular diameter of tubular element 31080.For example, horizontal diameter may be about 0.125 inch And perpendicular diameter is alternatively about 0.125 inch.Tubular element 30080 may include about 0.125 inch of perpendicular diameter, big About 0.400 inch of horizontal diameter and about 1.400 inches of length.As described in more detail, when power A is put on into pipe During the very best part 30080 and/or 31080, tubular element is deformable so that cross-sectional geometry (including horizontal and vertical diameter) Alterable.

Referring again to Figure 84-Figure 86, the tubular element 30080 in tissue thickness compensation part 30020 can be deformable.It is whole Individual tubular element 30080 can be deformable.For example, tubular element 30080 can be from the proximal extremity of elongated portion 30082 30083 to distal end 30085 and around its whole girth can be deformable.Alternatively, tubular element 30080 only a part can be deformable.For example, the only intermediate length and/or tubular element 30080 of elongated portion 30082 The only a part of girth can be deformable.

When compression stress to be put on to the contact point on the elongated portion 30082 of tubular element 30080, contact point can be inclined Move, this can change the cross sectional dimensions of tubular element 30080.For example, referring again to Figure 85, tubular element 30080 may include carefully Top apex 30086 and bottom apex 30088 on long part 30082.In the initial undeformed configuration, tubular element 30080 It may include the undeformed vertical diameter between undeformed cross-sectional dimension, including top apex 30086 and bottom apex 30088. When compression stress A is put on into top apex 30086, tubular element 30080 is moveable to deformed configuration.In deformed configuration, The cross sectional dimensions of pipe 30080 can change.For example, pipe 30086 may include between top apex 30086 and bottom apex 30088 Deformation perpendicular diameter, the deformation perpendicular diameter is smaller than undeformed vertical diameter.Referring to Figure 87, for example, working as tubular element 30080 when never deformed configuration moves to deformed configuration, and the horizontal diameter of deformation tube 30080 can be lengthened out.Deformation tube 30080 Deformed cross-sectional dimension can be at least dependent on exerted forces A position, angle orientation and/or size.As described in more detail, The deformation of tubular element 30080 can produce screen resilience or restoring force, and it may depend on the screen resilience of tubular element 30080.

Referring also to Figure 85, tubular element 30080 can produce screen resilience or restoring force when compressed.In such cases, As described herein, when power A to be put on to the contact point on the elongated portion 30082 of tubular element 30080, tubular element 30080 can move to deformed configuration from initial undeformed configuration.When removing applied power A, deformation tube 30080 can be from deformation Configuration resilience.Deformation tube 30080 resiliently to initial undeformed configuration or it is resilient to initial undeformed configuration substantially class As configuration.Tubular element 30080 is related to the screen resilience of tubular element 30080 from the ability of deformed configuration resilience.

Referring again to Figure 85, tubular element 30080 can apply screen resilience or restoring force.When for example by following closely 30030 (Figure 88 And Figure 89) when applying applied power A to tubular element 30080, restoring force can be produced by tubular element 30080, such as herein more Describe in detail.The power A applied can change the cross sectional dimensions of tubular element 30080.In addition, in linear elastic material, The restoring force of each crushed element of tubular element 30080 may depend on the deformation size and tubular element of tubular element 30080 The device of spring stiffness coefficient of 30080 part.The device of spring stiffness coefficient of tubular element 30080 can be at least dependent on such as tubulose member Orientation, material, cross-sectional geometry and/or the size of part 30080.Tubular element in tissue thickness compensation part 30020 30080 may include homogeneous device of spring stiffness coefficient.Alternatively, device of spring stiffness coefficient can be along tubular element 30080 length and/or the diameter change around tubular element 30080.When the tubular element with the first device of spring stiffness coefficient When 30080 part is greatly compressed, tubular element 30080 can produce larger restoring force.When with identical first spring When a part for the tubular element 30080 of stiffness factor is compressed less, tubular element 30080 can produce smaller restoring force.

Referring again to Figure 84, the tubular element 30080 in tissue thickness compensation part 30020 can include polymer composition. The elongated portion 30082 of tubular element 30080 can include the polymer composition.In addition, the polymer composition can include extremely Small part elastomeric material so that the deformation of tubular element 30080 produces restoring force.The polymer composition, which can include, for example can not Polymer, absorbable polymer or the combinations thereof of absorption.The example of synthetic polymer includes but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, it can inhale The polymer of receipts may include bioabsorbable biocompatible elastomeric polymer.In addition, the polymer of tubular element 30080 Composition may include synthetic polymer, non-synthetic polymer or combinations thereof.Optionally, similar to described elsewhere herein Polymer composition, the polymer composition amount of may include of tubular element 30080 different (such as by weight percentage) can The polymer of absorption, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.

Referring to Figure 84 and Figure 85, tubular element 30080 can for example include therapeutic agent 30098, such as pharmaceutically active agents or medicine Thing.Therapeutic agent 30098 is positively retained in the tube chamber 30084 of tubular element 30080.Elongated portion 30082 can be encapsulated or part is sealed Fill therapeutic agent 30098.Additionally or alternatively, the polymer composition of elongated portion 30082 can be included and controlled Treat agent 30098.The therapeutic agent 30098 of 30080 releasable therapeutically effective amount of tubular element.It can be absorbed in tubular element 30080 When discharge therapeutic agent 30098.For example, therapeutic agent 30098 is releasably to flowing through on tubular element 30080 or through tubular element 30080 fluid, such as blood.Tubular element is pierced through as other alternate forms, such as when following closely 30030 (Figure 88 and Figure 89) 30080 and/or when in nail percussion sliding part 30050 cutting element 30052 (Figure 84) cutting tubular element 30080 a part When, releasable therapeutic agent 30098.The example of therapeutic agent 30098 may include but be not limited to styptic and medicine, such as, fibrin Albumen, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, Sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ammonia benzyl Penicillin, gentamicin, polymyxin B and/or chloramphenicol；Anticancer, such as cis-platinum, mitomycin and/or adriamycin；With/ Or biological agent, such as stem cell.

It can be disposed, be made from nail bin 30000 referring again to Figure 84, Figure 88 and Figure 89, such as fastener (such as following closely 30030) 30030 engagement tissue thickness compensation parts 30020 must be followed closely and to the applying power A of tubular element 32080 therein.As described herein, Tubular element 30080 can be caused to deform the applying power A of tubular element 30080.It is similar with end effector 12 as described herein, nail The rigid support portion 30010 in storehouse 30000 may include warehouse 30017, platform surface 30011 and multiple nail cavities therein 30012.Each nail cavity 30012, which can limit the opening in platform surface 30011 and follow closely 30030, can be removably positioned in nail In chamber 30012 (Figure 104).Referring primarily to Figure 88 and Figure 89, each nail 30030 may include base portion 30031 and from base portion 30031 Two nail legs 30032 of extension.Before deployment nail 30030, the base portion 30031 of each nail 30030 can be by being positioned at nail bin Staple drivers 30040 (Figure 104) support in 30000 rigid support portion 30010.In addition before deployment nail 30030, often The leg 30032 of individual nail 30030 can be at least partially contained within nail cavity 30012 (Figure 104).

Optionally, as described in more detail, nail 30030 can be deployed between initial position and firing position.Example Such as, the engageable driver 30040 (Figure 104) of nail percussion sliding part 30050 is so that at least one follow closely 30030 in initial position with hitting Hair moves between position.Referring primarily to Figure 88, nail 30030 is moveable to firing position, wherein the leg 30032 of nail 30030 engages The tubular element 32080 of tissue thickness compensation part 32020, penetrate tissue T and contact and the nail in surgical end-effector 12 The anvil block 30060 (Figure 104) that storehouse 30000 is relative and positions.Nail shapes pit 30062 in anvil block 30060 can make nail leg 30032 Bending so that the tissue T in a part and nail retention region 30039 for tubular element 32080 is captured by percussion nail 30030 A part.As described in more detail, when nail 30030 moves between initial position and firing position, at least one nail Leg 30032 can pierce the tubular element 32080 of tissue thickness compensation part 32020.Alternatively, nail leg 30032 can Around the peripolesis of tubular element 32080 so that nail leg 30032 avoids piercing through tubular element 32080.With it is as described herein tight Firmware is similar, and the leg 30032 of each nail 30030 can be cut towards the deformation downwards of base portion 30031 of nail 30030 with forming nail between the two Stay region 30039.Nail retention region 30039 can be that a wherein part for tissue T and tissue thickness compensation part 32020 can be by firing The region of the capture of nail 30030.In firing position, each nail 30030 to tissue T and can be trapped in the nail of nail 30030 and cut The tissue thickness compensation part 32020 in region 30039 is stayed to apply compression stress.

Referring also to Figure 88, when tubular element 32080 is trapped in nail retention region 30039, tubular element 32080 Captured part is deformable, as described herein.In addition, tubular element 32080 can retain according to the identical nail is for example trapped in Thickness, compressibility and/or the density of tissue T in region 30039 and be deformed into the difference in different nail retention regions 30039 Deformed configuration.Tubular element 32080 in tissue thickness compensation part 32080 can extend longitudinally through continuous nail retention region 30039.In such construct, tubular element 32080 can be deformed into each nail retention region along a line percussion nail 30030 Different deformation configurations in 30039.Referring now to Figure 89, tubular element 33080 in tissue thickness compensation part 33020 can be along A line percussion nail 30030 is laterally arranged in nail retention region 30039.Tubular element 33080 can be protected by soft shell 33210 Hold.In such construct, tubular element 33080 and soft shell 33210 can be deformed in each nail retention region 30039 not Same deformed configuration.For example, in the case where tissue T is relatively thin, tubular element 33080 is lessly and thicker in tissue T compressible In the case of, tubular element 33080 is morely to adapt to compared with thick tissue T compressible.Alternatively, tubular element 33080 deformation size can be homogeneous in the whole length of tissue thickness compensation part 33020 and/or width range.

Referring to Figure 90-Figure 92, the tubular element 34080 in tissue thickness compensation part 34020 may include multiple strands 34090.Referring primarily to Figure 90, strand 34090 can be woven or be woven into the tubulose lattice 34092 to form tubular element 34080 It is interior.The tubulose lattice 34092 formed by strand 34090 can be substantially hollow.The strand 34090 of tubular element 34080 can For solid strand, tubulose strand and/or other another suitable shapes.For example, with reference to Figure 91, tubulose lattice 34092 it is single Strand 34090 can be pipe.Referring to Figure 93, strand 34090 may include to extend through at least one tube chamber 34094 therein.Tube chamber 34094 number, geometry, and/or dimension can determine that the shape of cross section of strand 34090.For example, strand 34090 may include Circular tube chamber, semicircle tube chamber, wedge-shaped lumen and/or combinations thereof.According to the present invention, strand 34090 may also include support Web 34096, it can form for example modified " T " or X-shaped shape.At least the diameter of strand 34090, extend through it is therein Tube chamber and support web can characterize the shape of cross section of strand 34090.As described in more detail, each strand 34090 Shape of cross section can influence as caused by strand 34090 screen resilience or restoring force and as caused by tubular element 34080 it is right Answer screen resilience or restoring force.

Referring to Figure 94, the tubulose lattice 34092 of strand 34090 can be deformable.Tubulose lattice 34092 can be produced or had Help the deformability and/or screen resilience of tubular element 34080.For example, the strand 34090 of tubulose lattice 34092 can be woven in Together so that strand 34090 can be slided and/or bent relative to each other.When to the elongated portion of tubular element 34080 During 34082 applying power, strand 34090 therein slidably and/or bending so that tubulose lattice 34092 moves to deformed configuration. For example, referring also to Figure 94,30030 compressible tubulose lattices 34092 of nail and the tissue T being trapped in nail retention region 34039, This can cause the strand 34090 of tubulose lattice 34092 to slide and/or bend relative to each other.When tubulose lattice 34092 is compressed During to deformed configuration, the top apex 34086 of tubulose lattice 34092 can transport towards the bottom apex 34088 of tubulose lattice 34092 It is dynamic, to adapt to the captured tissue T in nail retention region 30039.In all cases, it is trapped in percussion nail 30030 Tubulose lattice 34092 will attempt to regain its not deformed configuration and restoring force can be applied to captured tissue T.This Outside, it is positioned at the part for the tubulose lattice 34092 (that is, not captured in percussion nail 30030) between nail retention region 30039 also It can be deformed due to the deformation of the adjacent part of the tubulose lattice 34092 in nail retention region 30039.In tubulose lattice 34092 In the case of deformation, tubulose lattice 34092 can attempt to from deformed configuration resilience or partly resilience.Optionally, tubulose lattice 34092 part resiliently only can partly resilience and/or guarantor to the other parts of its initial configuration and tubulose lattice 34092 Hold complete compression.

Similar with the description of this paper tubular element, each strand 34090 can also be deformable.In addition, strand 34090 Deformation can produce restoring force, the restoring force depend on each strand 34090 screen resilience.Referring primarily to Figure 91 and Figure 92, pipe Each strand 34090 of shape lattice 34092 can be tubulose.Alternatively, each strand of tubulose lattice 34092 34090 can be solid.As other alternate forms, tubulose lattice 30092 may include at least one tubulose strand 34090, extremely A few solid strand 34090, at least one " X " or "T"-shaped shape strand 34090 and/or combinations thereof.

Strand 34090 in tubular element 34080 can include polymer composition.The polymer composition of strand 34090 Polymer, absorbable polymer or the combinations thereof of nonabsorable can be included.The example of synthetic polymer includes but unlimited In polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymerization Thing.For example, absorbable polymer may include bioabsorbable biocompatible elastomeric polymer.In addition, strand 34090 Polymer composition may include synthetic polymer, non-synthetic polymer and/or combinations thereof.Optionally, similar to herein Described polymer composition elsewhere, the polymer composition amount of may include of strand 34090 are different (such as by weight percentage Meter) absorbable polymer, polymer, synthetic polymer and/or the non-synthetic polymer of nonabsorable.

Strand 34090 in tubular element 34080 can also include such as therapeutic agent 34098 (Figure 91), such as pharmaceutical activity Agent or medicine.The therapeutic agent 34098 of 34090 releasable therapeutically effective amount of strand.It can be discharged when tubulose strand 34090 is absorbed Therapeutic agent 34098.For example, therapeutic agent 30098 is releasable to the fluid flowed through on strand 34090 or through strand 34090, it is all Such as blood.As other alternate forms, such as when nail 30030 pierces through strand 34090 and/or when nail percussion sliding part 30050 On cutting element 30052 (Figure 84) cutting tubulose lattice 34092 a part when, releasable therapeutic agent 34098.Therapeutic agent 34098 example may include but be not limited to styptic and medicine, such as fibrin, fibrin ferment and/or oxidation regeneration fiber Plain (ORC)；Anti-inflammatory drug, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and Antimicrobial agents or preparation, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B and/or chlorine are mould Element；Anticancer, such as cis-platinum, mitomycin and/or adriamycin；And/or biological agent, such as stem cell.

Referring to Figure 95 and Figure 96, tubular element 35080 may include multiple layers 35100 of strand 35090.Tubular element 35080 may include multiple layers 35100 of tubulose lattice 35092.Referring to Figure 95, tubular element 35080 may include such as strand 35090 first layer 35100a and second layer 35100b.Referring now to Figure 96, the tubular element of tissue thickness compensation part 35120 35180 may include the third layer 35100c of such as strand 35090.In addition, the different layers 35100 in tubular element 35180 can wrap Containing different materials.Each layer 35100a, 35100b, 35100c can be it is bioabsorbable, wherein each layer 35100a, 35100b, 35100c can include different polymer compositions.For example, first layer 35100a may include that first polymer combines Thing；Second layer 35100b may include second polymer composition；And third layer 35100c may include third polymerization compositions. In such cases, layer 35100a, 35100b, 35100c of tubular element 35180 can be by different rates by bio-absorbable.Example Such as, first layer 35100a can quickly absorb, and second layer 35100b is than first layer 35100a more slow trappings, and third layer 35100c is than first layer 35100a and/or second layer 35100b more slow trappings.Alternatively, first layer 35100a Can slow-absorbing, second layer 35100b faster absorbs than first layer 35100a, and third layer 35100c is than first layer 35100a and/or second layer 35100b faster absorb.

Similar with strand 34090 as described herein, the strand 35090 in tubular element 35180 can include medicine 35098. Referring again to Figure 95, in order to control the elution of medicine 35098 or release, the first layer of the strand 35090 comprising medicine 35098a 35100a can be by first rate by bio-absorbable, and the second layer 35100b of the strand 35090 comprising medicine 30098b can be pressed Second speed is by bio-absorbable.For example, first layer 35100a can be quickly absorbed to allow medicine 35098a rapid initial releases, and And second layer 35100b can allow medicine 30098b controlled releases compared with slow trapping.In first layer 30100a strand 35090 Medicine 35098a may differ from the medicine 35098b in second layer 35100b strand 35090.For example, in first layer 35100a The strand 35090 that strand 35090 can be included in oxidized regenerated cellulose (ORC) and second layer 35100b can include solution, should Solution includes hyaluronic acid.In such cases, the releasable oxidized regenerated cellulose of first layer 35100a initial absorption is to help Help control bleeding, and second layer 35100b subsequent absorption releasably the solution comprising hyaluronic acid to help to suppress tissue attached .Alternatively, layer 35100a, 35100b can include identical medicine 35098a, 35098b.For example, referring again to Strand 35090 in Figure 96, layer 35100a, 35100b and 35100c can include anticancer, such as cis-platinum.In addition, first layer 35100a can be quickly absorbed to allow cis-platinum rapid initial release, and second layer 35100b can allow cis-platinum by controlled release compared with slow trapping Put, and third layer 35100c can most slow trapping to allow the controlled release more extended of cis-platinum.

Referring to Figure 97 and Figure 98, tissue thickness compensation part 36020 can include overmold material 36024.Overmolding material Material 36024 can be formed at the outside of tubular element 36080, the inner side of tubular element 36080 or the inner side and outer side of tubular element 36080 Both.Referring to Figure 97, overmold material 36024 can be coextruded in the inner side and outer side of tubular element 36080 simultaneously, and tubulose Element 36080 may include the tubulose lattice 36092 of strand 36090.It is similar with polymer composition as described herein, overmolding Material 36024 may include such as polyglycolic acid (PGA), poly- (lactic acid) (PLA) and/or any other is suitable bioabsorbable Biocompatible elastomeric polymer.In addition, overmold material 36024 can be non-porous so that overmold material 36024 The impermeable layer of fluid formed in tubular element 36080.Overmold material 36024 can limit the tube chamber passed through 36084。

As discussed further above, the strand 36090 in tubular element 36080 and/tubulose lattice 36092 can include treatment Agent 36098.Referring also to Figure 97 and Figure 98, non-porous overmold material 36024 internally can include medicine in tube chamber 36084a 36098.Alternatively or additionally, non-porous overmold material 36024 can wrap in intermediary canal 36084b Drug containing 36098, the intermediary canal 36084b of the tubulose lattice 36092 such as comprising the strand 36090 containing medicine.With it is above-mentioned Similar, tubular element 36080 can position (Figure 84) relative to the cutting element 30052 in nail cavity 30012 and nail bin 30000. The deployment of nail 30030 and/or the translation of cutting element 30052 can pierce through or rupture non-porous overmold material 36024, make The medicine 36098 that be accommodated at least one tube chamber 36084 of tubular element 30080 can be discharged from tube chamber 30084 by obtaining.Referring to Figure 99, tubular element 37080 may include non-porous film 37110.Non-porous film 37110 can be at least partly around tubulose lattice 37092 Or the first layer 37100a and second layer 37100b of tubulose lattice 30092 are to provide and overmold material as described herein The impermeable covering of 36024 similar fluids.

As described herein, tubular element can include bioabsorbable material, therapeutic agent, multiple strands, tubulose lattice, pipe At least one of layer, overmold material, non-porous film or its combination of shape lattice.For example, with reference to Figure 100, tubular element 38080 can include overmold material 38024 and through tubular element 38080 central lumen 38084 and position more personal shares Line 38090.Strand 38090 can include therapeutic agent 38098.Alternatively, for example, with reference to Figure 101, tubular element 39080 can include such as overmold material 39024 and the treatment being positioned in the central lumen 39084 of tubular element 39080 Agent 39098.Optionally, at least one of tubular element 39080 and overmold material 39024 can include fluid treatment agent 39098。

Mainly referring again to Figure 84, tubular element 30080 can relative to the rigid support portion 30010 of nail bin 30000 and Positioning.Tubular element 30080 can the neighbouring longitudinal register of rigid support portion 30010.Tubular element 30080 can be arranged essentially parallel to Or alignd with the longitudinal slit in rigid support portion 30010 or cavity 30015.Tubular element 30080 can be with longitudinal slit 30015 alignment a so that part for tubular element 30080 is a part of overlapping with longitudinal slit 30015.In such cases, Cutting element 30052 in nail percussion sliding part 30050 can be cut off when cutting edge 30052 translates along longitudinal slit 30015 A part for tubular element 30080.Alternatively, tubular element 30080 can be longitudinal positioning of longitudinal slit 30015 The first side or the second side on.As other alternate forms, tubular element 30080 can prop up relative to the rigidity of nail bin 30000 Support part is divided 30010 and positioned so that tubular element 30080 laterally or diagonally traverses rigid support portion 30010 at least A part.

See, for example, Figure 102, tissue thickness compensation part 40020 may include multiple tubular elements 40080.Tubular element 40080 can include for example different length, shape of cross section and/or material.In addition, tubular element 40080 can be relative to nail bin 30000 rigid support portion 40010 and position so that the tubulose axis of tubular element 40080 is parallel to each other.Tubular element 40080 tubulose axis can be longitudinally-aligned so that the first tubular element 40080 is positioned in another tubular element 40080. Alternatively, parallel tubular elements 40080 can longitudinally traverse such as nail bin 30000.As other alternative shape Formula, parallel tubular elements 40080 can laterally or diagonally traverse nail bin 30000.Alternatively, non-parallel tubulose Element 40080 can be angled with respect to each other orientation so that its tubulose axis intersects each other and/or not parallel.

Referring to Figure 102-Figure 105, tissue thickness compensation part 40020 can have two tubular elements 40080；First tubulose member Part 40080a can be longitudinally positioned on the first side of the longitudinal slit 30015 in rigid support portion 30010, and the second tubulose Element 40080b can be longitudinally positioned on the second side of longitudinal slit 30015.Each tubular element 40080 may include strand 40090 tubulose lattice 40092.Nail bin 30000 may include six row nail cavity 30012 altogether, wherein for example three row nail chamber 30012 is fixed Position is on every side of longitudinal slit 30015.In such cases, it may not be necessary to translate in nail percussion sliding part 30050 Cutting edge 30052 cuts off a part for tubular element 40080.

Similarly, may include to be longitudinally arranged in nail bin referring now to Figure 106-Figure 107, tissue thickness compensation part 41020 Two tubular elements 41080a, 41080b in 30000.Similar to the above, the nail 30030 in three row nail chamber 30012 can Engage a tubular element 41080a and another engageable tubulose of nail 30030 in different three row nail chambers 30012 Element 41080b.Referring also to Figure 106-Figure 107, the nail 30030 disposed can across the cross section of tubular element 40080 not Tubular element 40080 is engaged with opening position.As described herein, the screen resilience applied by tubular element 41080 is elastic and corresponding extensive Multiple power may depend on shape of cross section of tubular element 41080 etc..It is positioned at positioned at the curved portions office of tubular element 41080 Or nail 30030 in neighbouring nail retention region 30039 is than being positioned in the nail retention region 30039 near non-arch section Nail 30030 be subjected to bigger restoring force.Similarly, the nail retention region being positioned in the non-arch section of tubular element 41080 Nail 30030 in 30039 can be subjected to than 30030 bodies of nail by being positioned at or near the arch section of tubular element 30080 The smaller restoring force of the restoring force tested.In other words, due to the nail 30030 along such part may capture it is large number of Elastomeric material, the arch section of tubular element 41080 have more big spring stiffness than the non-arch section of tubular element 41080 Coefficient.Optionally, therefore, referring primarily to Figure 107, restoring force can be in tubular element as caused by tissue thickness compensation part 41020 Nail 30030a and 30030c in 30080a is bigger and smaller near nail 30030b nearby.Correspondingly, mended by tissue thickness Repaying restoring force caused by part 41020 can be near the nail 30030d and 30030f in tubular element 30080b than following closely near 30030e It is bigger.

Referring again to Figure 102-Figure 105, the cross section geometric form for including the strand 40090 of tubulose lattice 40092 may be selected Shape, to provide the required screen resilience elasticity applied by tubulose lattice 40092 and corresponding restoring force.For example, referring again to figure 103, the strand 40090a being positioned in the arch section of tubular element 40080 may include X-shaped cross-section, and be positioned at tubulose Strand 40090b in the non-arch section of element 40080 may include tubular cross-section.Including different cross-sectional geometries Strand 40090a can be weaved with 40090b together with to form tubulose lattice 40092.Alternatively, strand 40090a Such as adhesive can use to be attached to each other with 40090b.Referring to Figure 104 and Figure 105, the strand 40090 in tubular element 40080 Different cross-sectional geometries can optimize the restoring force that is subjected in the nail retention region 30039 of nail bin 30000.Can Select specific cross-sectional geometry so that the resilience constant in the nail retention region 30039 of nail bin substantially balance or It is equal.

Referring to Figure 108, tubular element 41080a, 41080b of tissue thickness compensation part 41120 can pass through adjacent part 41126 tighten together.Although translate cutting element 30052 can between tubular element 41080a and 41080b by, Cutting element 30052 may be needed to cut off at least a portion of adjacent part 41126.Adjacent part 41126 can include soft material Material, such as foam or gel, it is easily translated cutting element 30052 and cut off.Adjacent part 41026 can compensate tissue thickness Part 41120 is releasably secured to surgical end-effector 12.Adjacent part 41126 can be fixed to rigid support portion 30010 Top platform surface 30011 so that it is adjacent after tubular element 41080a, 41080b is discharged from surgical end-effector 12 Part 41126 is remained in surgical end-effector 12.

Referring to Figure 109-Figure 110, tissue thickness compensation part 42020 may include multiple tubular elements 42080 so that for example manage The quantity of the very best part 42080 is identical with the line number of the nail cavity 30012 in nail bin 30000.Nail bin 30000 may include six row nail cavities 30012 and tissue thickness compensation part 42020 may include six tubular elements 42080.Each tubular element 42080 can be with a line The substantial alignment of nail cavity 30012.When nail 30030 is projected from a line nail cavity 30012, each nail 30030 from the row can Pierce through identical tubular element 42080 (Figure 110).The deformation of one pipe 42080 can have minimum to the deformation of adjacent tubes 42080 Influence or do not influence.Therefore, tubular element 42080 can apply in the nail retention region 30039 across the width of nail bin 30030 Substantially discrete and customization screen resilience.Identical tubular element 35080 is engaged in the nail 30030 fired from multirow nail cavity 30012 In the case of (Figure 107), the deformation of tubular element 35080 less can customize.For example, tubular element 35080 is in the first row Deformation in nail retention region 30039 can influence the change in nail retention region 30039 of the tubular element 35080 in another row Shape.Translation cutting edge 30052 can avoid cutting off tubular element 42080.Alternatively, referring to Figure 111, tissue thickness Compensating part 43020 may include the tubular element 43080 of more than six, such as seven tubular elements 44080.In addition, tubular element 43080 can symmetrically or non-symmetrically be arranged in end effector 12.When the longitudinal direction of odd number tubular element 43080 and it is arranged symmetrically When in end effector 12, translation cutting element 30052 can cut off the intervalve champion being covered on vertical passage 30015 Part.

Referring to Figure 112, tissue thickness compensation part 44020 may include central tubular element 44080b, its at least in part with Longitudinal slit 30015 in the rigid support portion 33010 of nail bin 30000 is alignd.Tissue thickness compensation part 44020 may also include At least one peripheral tubular element 44080a, 44080c on the side of longitudinal slit 30015.For example, tissue thickness compensates Part 44020 may include three tubular elements 44080：First peripheral tubular element 44080a can be longitudinal positioning of nail bin 30000 On first side of longitudinal slit 30015, central tubular element 44080b can be positioned substantially at the top of longitudinal slit 30015 and/ Or alignd with longitudinal slit 30015, and the second peripheral tubular element 44080c can be longitudinal positioning of the of longitudinal slit 30015 On two sides.Central tubular element 44080b may include that relative to perpendicular diameter be the horizontal diameter that substantially extends.Central tubular Element 44080b and/or any other tubular element can be overlapping with multirow nail cavity 30012.Referring also to Figure 112, for example, central tube The very best part 44080b can and each peripheral tubular element 44080a, 44080c overlapping with four of nail cavity 30012 nail rows can be with Single row of nail cavity 30012 is overlapping.Alternatively, central tubular element 44080b can for example with less than four row nail cavities 30012 is overlapping, for example, two row nail cavities 30012.In addition, peripheral tubular element 44080a, 44080c can be with more than a line nail cavity 30012 is overlapping, such as two row nail cavities 30012.Referring now to Figure 113, the central tubular element of tissue thickness compensation part 44120 44180b can include therapeutic agent 44198 in central tubular element 44180b tube chamber 44184.Optionally, central tubular element 44180b and/or at least one peripheral tubular element 44080a, 44080c can include therapeutic agent 44198 and/or any other conjunction Suitable therapeutic agent.

Referring to Figure 114, tissue thickness compensation part 44220 may include shell 44224, the shell can with it is as described herein overlapping Injected plastics material 32024 is similar.Multiple tubular elements 44080 are held in place by shell 44224 in end effector 12.Shell 44224 can be coextruded with tubular element 44080.Tubular element 44080 may include the tubulose lattice 44092 of strand 44090.It is similar In described polymer composition elsewhere herein, shell 44224 can be for example comprising polyglycolic acid (PGA), poly- (lactic acid) (PLA) And/or any other suitable bioabsorbable biocompatible elastomeric polymer.In addition, shell 44224 can be non-porous So that shell 44224 for example forms the impermeable layer of fluid in tissue thickness compensation part 44220.Such as this paper further Discuss, the strand 44090 in tubular element 44080 and/or tubulose lattice 44092 can include therapeutic agent 44098.Non-porous shell 44224 can include therapeutic agent 44098 in tissue thickness compensation part.As described herein, tubular element 44080 can be relative to nail cavity 30012 and cutting element 30052 be positioned in nail bin 30000.The deployment of nail 30030 and/or the translation of cutting element 30052 Non-porous shell 44224 can be pierced through or make its rupture so that the therapeutic agent 44198 wherein included can be from tissue thickness compensation part Discharged in 44020.

Referring to Figure 115, tissue thickness compensation part 44320 may include central tubular element 44380b, the central tubular element Including tubulose lattice 44392.Tubulose lattice 44392 can have nonwoven part or a gap 44381, the nonwoven part or Gap is substantially alignd with the longitudinal slit 30015 of rigid support portion 30010.In this case, tubular element 44380b The woven portion of tubulose lattice 44092 is not overlapping with longitudinal slit 30015.Therefore, cutting in nail percussion sliding part 30052 is translated Cut the overlapping of the woven portion that element 30052 can be translated along longitudinal slit 30015 without cutting off tubulose lattice 44392.It is although adjacent The nail 30030c and 30030d that gap 44381 in nearly tubular element 44380b positions can receive from the structure of tubulose lattice 44392 Less support, but other feature structure can be that these nails 30030 provide support and/or in its nail retention region 30039 Other restoring force is provided.For example, as described in more detail, tubular element, supporting part, spring and/or pillar in addition Material can for example be positioned at least one of the inside and outside tubular element 44380b near gap 44381 place.

Referring now to Figure 116-Figure 119, tissue thickness compensation part 45020 may include laterally to traverse the more of nail bin 30000 Individual tubular element 45080.Tubular element 45080 can be positioned so that perpendicular to nail cavity 30012 row and/or nail bin 30000 it is firm The longitudinal axis of property support section 30010.Referring to Figure 116, the longitudinal direction that tubular element 45080 can be traversed in nail bin 30000 is narrow Groove 30015 so that the cutting element 30052 in nail percussion sliding part 30050 can be narrow along longitudinal direction in nail percussion sliding part 30050 Tubular element 45080 is cut off when groove 30015 translates.Alternatively, referring now to Figure 117, tissue thickness compensation part 46020 may include two groups of tubular elements laterally traversed 46080.First group of tubular element 46080a laterally traversed can determine On the first side of longitudinal slit 30015, second group of tubular element 46080b laterally traversed can be positioned on longitudinal slit for position On 30015 the second side.In such construct, cutting element 30052 can pass through between two groups of tubular elements 46080, and A part for tubular element 46080 is not cut off.Alternatively, when at least one other tubular element 46080 not Traverse longitudinal slit 30015 and be not cut element 30052 cut off when, cutting element 30052 can cut off traverse longitudinal direction it is narrow At least one tubular element 46080 of groove 30015.

When tubular element 45080 laterally traverses nail bin 30000, referring to Figure 118 and Figure 119, nail 30030 is engageable every At least one tubular element 45080 in individual nail retention region 30039.In such construct, each tubular element 45080 can edge The length of nail bin 30000 provides discrete restoring force.For example, referring primarily to Figure 119, with organizing the tissue thickness at thinner place to mend Repay the tubular element 45080 that the distal end of part 45020 is positioned about to compare, organize the tissue thickness compensation part at thicker place The tubular element 45080 that 45020 proximal extremity is positioned about can greatly be compressed.Therefore, with can be by thick closer to tissue Restoring force caused by the tubular element 46080 of the distal end positioning of degree compensating part 45020 is compared, and is compensated closer to tissue thickness The tubular element 45080 of the proximal extremity positioning of part 45020 can provide bigger restoring force.In addition, referring also to Figure 119, one Deformation of the deformation of pipe 45080 for adjacent tubes 45080 can have minimum influence or not influence.Therefore, tubular element 45080 can apply substantially discrete and customization screen resilience in the nail retention region 30039 of the length along nail bin 30030. In the case that the multiple nails 30030 fired from single row of nail cavity 30012 engage identical tubular element 35080, tubular element 35080 Deformation less can customize.For example, the deformation of the tubular element 35080 in a nail retention region 30039 can influence the tubulose Deformation of the element 35080 in another nail retention region 30039.

As other alternate forms, referring to Figure 120-Figure 125, the tubular element 47080 of tissue thickness compensation part 47020 Nail bin 30000 can diagonally be traversed.Tubular element 47080 can traverse the longitudinal slit 30015 in nail bin 30000 so that nail The cutting element 30052 fired on sliding part 30050 can be when nail percussion sliding part 30052 translates along longitudinal slit 30015 Cut off the tubular element 47080 diagonally traversed.Alternatively, tissue thickness compensation part 47020 may include two groups The tubular element 47080 diagonally traversed.First group of tubular element 47080 diagonally traversed can be positioned on longitudinal slit On 30015 the first side, second group of tubular element 47080 diagonally traversed can be positioned on the second side of longitudinal slit 30015 On.In such construct, cutting element 30052 can pass through between two groups of tubular elements 47080, and can not cut off any Tubular element 47080.

Referring still to Figure 120-Figure 123, the tubular element 47080 diagonally traversed can be positioned in nail bin 30000, make Gap is obtained to be limited between tubular element 47080.When such as by being captured in the nail retention region 30039 of forming nail 30030 Tissue T to adjacent tubular elements 47080 apply compression stress when, the gap between adjacent tubular elements can be tubular element 47080 horizontal expansion provides space.Tubular element 47080 can be connected by material membrane or material piece 47024 across gap.Material Tablet can be positioned in the platform surface 30011 of rigid support portion 30010 and/or the tissue contact side of tubular element 47080 At least one on.

Referring to Figure 124 and Figure 125, at least one tubular element 47080 diagonally traversed can be fixed relative to nail cavity 30012 Position is in nail bin 30000 so that tubular element 47080 is positioned at the leg 30032 for the nail 30030 disposed from multirow nail cavity 30012 Between.When nail 30030 moves to firing position from initial position, as described in more detail, nail leg 30032 can keep fixed Position is around tubular element 47080.In addition, for example, nail can deform so that nail leg 30032 surrounds the week of tubular element 47080 Wrap up on side.In such construct, nail 30030 can move to percussion or shaping position, without piercing through tubular element 47080.Nail Leg 30032 can prevent from inadvertently discharging the therapeutic agent 47098 remained at around the motion of tubular element 47080.Each pipe The very best part 47080 may depend on nail cavity 30012 relative to the selected angle orientation of the longitudinal slit 30015 of nail bin 30000 and exist Position in nail bin 30000.For example, tubular element 47080 can be relative to the longitudinal slit 30015 of nail bin 30000 into about 40 Five (45) degree angle positioning.Alternatively, tubular element 47080 can be for example relative to the longitudinal slit of nail bin 30000 The degree angle positioning of 30015 into 15 (15) to 75 (75).

Similar to the description of the disclosure in the whole text, multiple tubular elements in tissue thickness compensation part can be for example, by bonding Agent, wrappage, band, overmold material, compensating material and/or any other suitable connection adhesive or structure connect Connect.Referring to Figure 126-Figure 128, soft shell 48024 can surround or encapsulate the tubular element in tissue thickness compensation part 48020 48080.Soft shell 48024 can limit the tubular element 48080 in end effector 12, and can make each tubular element 48080 are held in place, such as longitudinally-aligned with a line nail cavity 30012.For example, tissue thickness compensation part 48020 may include six Tubular element 48080.Soft shell 48024 can be sufficiently deformable and flexible, to limit the tubulose wherein wrapped up member Part 48020, while allow the deformation and resilience of tubular element 48080.In addition, soft shell 48024 can stretch tight tightly around tubulose Element 48080, and can be deformed in tubular element 48080 and/or keep during resilience engaging with tightening for tubular element.

Referring to Figure 127, before deployment nail 30030, anvil block 30060 can be pivoted or rotated downwards, to compress anvil block 30060 Tissue thickness compensation part 48020 and tissue T between nail bin 30000.The compression of tissue thickness compensation part 48020 may include soft Property the shell 48024 and wherein corresponding compression of tubular element 48020.When tubular element 48020 deforms, soft shell 48024 Can similarly it deform.Tubular element 48020 can equably compress on the whole width of nail bin 30000, and soft shell 48024 can undergo the similar homogeneous compaction on whole tubular element 48080.Referring to Figure 128, when anvil block 30060 is from nail When being opened after the deployment of storehouse 30000 nail 30030, tubular element 48080 can from compressed configuration resilience or partly resilience (figure 127).According to the present invention, tubular element 48080 can be with resilience so that tubular element 48080 returns to its initial not deformed structure Type.Tubular element 48080 can partly resilience so that tubular element 48080 partly returns to its initial undeformed configuration. For example, the deformation of tubular element 48080 can be partial elastic and partially plastic.It is flexible outer when 48080 resilience of tubular element Shell 48024 can keep tightening with each tubular element 48080 and engage.Tubular element 48080 and soft shell 48024 can be with resiliences To such degree, the degree makes tubular element 48080 and tissue T fills nail retention region 30039, while tubular element Apply appropriate restoring force in 48080 tissue T wherein.Referring to Figure 129, in other cases, including six are maintained at soft The tissue thickness compensation part 48120 of tubular element 48180 in property shell 48124 can for example be positioned in end effector 12 On anvil block 30060.

Referring to Figure 130-Figure 133, tissue thickness compensation part 49020 may include tubular element 49080, and the tubular element is along anvil The longitudinal axis longitudinal register of seat 30060.Tissue thickness compensation part 49020 can be consolidated by compressible compensating material 49024 Surely the anvil block 30060 of end effector 12 is arrived.In addition, compressible compensating material 49024 can surround or encapsulate tubular element 49080.Similar to description herein, tubular element 49080 may include at least one therapeutic agent 49098, and the therapeutic agent can pass through In the following manner discharges：The various components of absorptive tissue thickness compensation part 49020, the nail 30030 by being fired by nail bin 30000 And/or cutting element 30052 pierces through tubular element 49080.

Referring to Figure 131, nail bin 30000 may include the nail 30030 being positioned in nail cavity 30012, wherein in deployment nail 30030 Before, the tissue thickness compensation part 49020 of anvil block 30060 and attachment thereon, which can be pivoted and compressed towards nail bin 30000, catches Obtain tissue T between the two.The tubular element 49080 of tissue thickness compensation part 49020 can be by pivotal anvil 30060 along nail bin 30000 length equably deforms (Figure 131).Referring to Figure 132 and Figure 133, nail percussion sliding part 30050 can be along nail bin 30000 In longitudinal slit 30015 translate and engage each driver 30040 of the lower section of nail 30030 being positioned in nail cavity 30010, The driver 30040 wherein each engaged can fire or project nail 30030 from nail cavity 30012.When anvil block 30060 discharges tissue During pressure on T and tissue thickness compensation part 49020, tissue thickness compensation part 49020 (including tubular element 49080 and can press The compensating material 49024 of contracting) resilient configuration (Figure 132 and figure can be recoiled to from compressed configuration (Figure 131) resilience or partly 133).Resiliently to such degree, the degree makes tissue thick for tubular element 49080 and compressible compensating material 49024 Compensating part 49020 and tissue T filling nail retention region 30039 are spent, while restoring force is applied to by tissue thickness compensation part 49020 In captured tissue T.

Referring to Figure 124-Figure 126, two tissue thickness compensation parts 50020a, 50020b can be positioned in the end of surgical instruments In portion's actuator 12.For example, the first tissue thickness compensation part 50020a can be attached to the nail bin 30000 in lower jaw 30070, And minor microstructure thickness compensation part 50020b can be attached to anvil block 30060.The first tissue thickness compensation part 50020a can be wrapped Multiple tubular elements 50080 are included, the plurality of tubular element is longitudinally arranged and is maintained in the first compensating material 50024a.Extremely A few tubular element 50080 can include therapeutic agent 50098, similar to therapeutic agent as described herein.First compensating material 50024a can be deformable or substantially rigid.In addition, the first compensating material 50024a can make tubular element 50080 relative to Nail channel 30000 is held in place.For example, the first compensating material 50024a can make each tubular element 50080 keep following closely with a line Chamber 30012 is longitudinally-aligned.Minor microstructure thickness compensation part 50020b can include the first compensating material 50024a, the second compensating material 50024b and/or the 3rd compensating material 50024c.Second compensating material 50024b and the 3rd compensating material 50024c can be variable It is shape or substantially rigid.

Anvil block 30060 can pivot and apply compressive force to tissue thickness compensation part 50020a, 50020b and anvil block Tissue T between 30060 and nail bin 30000.In some cases, the first tissue thickness compensation part 50020a and minor microstructure are thick It is not compressible to spend compensating part 50020b.Alternatively, the first tissue thickness compensation part 50020a and/or At least one component in two tissue thickness compensation part 50020b can be compressible.Referring now to Figure 135 and Figure 136, work as nail 30030 from nail bin 30000 when being fired, and each nail 30030, which can pierce through, is maintained at the first tissue thickness compensation part 50020a In tubular element 50080.As shown in Figure 135, the therapeutic agent 50098 being maintained in tubular element 50080 can be in the thorn of nail 30030 Discharged when wearing tubular element 50080.In release, therapeutic agent 50098 can coat nail leg 30032 and around percussion nail 30030 Tissue T.When nail 30030 is fired from nail bin 30000, nail 30030 also can pierce minor microstructure thickness compensation part 50020b。

Referring to Figure 137-Figure 140, tissue thickness compensation part 51020 may include laterally to traverse tissue thickness compensation part 51020 at least one tubular element 51080.For example, with reference to Figure 137, tissue thickness compensation part 51020 can be relative to nail bin 30000 positioning so that the first end 51083 of the tubular element 51080 laterally traversed can be positioned in the of nail bin 30000 Near one longitudinal direction side, and the second end 51085 of the tubular element 51080 laterally traversed can be positioned in nail bin 30000 Second longitudinal side near.For example, tubular element 51080 may include capsule shape.As shown in Figure 138, tubular element 51080 It can be perforated between first end 51083 and second end 51085, and in some cases, tubular element 51080 can be Perforated at or near the center 51087 of tubular element 51080.For example, tubular element 51080 can include polymer composition, Such as bioabsorbable biocompatible elastomeric polymer.In addition, referring again to Figure 137, tissue thickness compensation part 51020 It may include multiple tubular elements 51080 laterally traversed.For example, 13 tubular elements 51080 can be laterally arranged in In tissue thickness compensation part 51020.

Referring again to Figure 137, tissue thickness compensation part 51020 may also include at least partly around tubular element 51080 Compensating material 51024.Compensating material 51024 can include bioabsorbable polymer, such as lyophilized polysaccharide, glycoprotein, Elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensating material 51024 can make tubular element 51080 are held in place in tissue thickness compensation part 51020.In addition, compensating material 51024 can be fixed to nail bin 30000 The top platform surface 30011 of rigid support portion 30010 so that compensating material 51020 is firmly positioned in end effector In 12.Compensating material 51024 can include at least one medicine 51098.

Referring still to Figure 137, the tubular element 51080 of lateral register can position relative to translation cutting element 30052, make Tubular element 51080 can be cut off by obtaining cutting element 30052.Cut off at or near the perforation that cutting element 30052 can be wherein Tubular element 51080.When tubular element 51080 is cut to two halves, the cut-off part of tubular element 51080 can be swelled or Expansion, as shown in Figure 139.For example, tubular element 51080 can include hydroaropic substance 51099, the hydroaropic substance can be in tubulose Discharge and/or expose when element 51080 is cut off.In addition, when hydroaropic substance 51099 contacts the body fluid in tissue T, it is hydrophilic Property material 51099 can attract the fluid, and this can cause tubular element 51080 to be swelled or expand.When tubular element 51080 is swollen When swollen, the tubular element 51080 of swelling can be offset or is adapted to around the compensating material 51024 of tubular element 51080. For example, when compensating material 51024 includes gelatin, the gelatin can be offset to adapt to the tubular element 51080 of swelling.Now Referring to Figure 140, the expansion of tubular element 51080 and the skew of compensating material 51024 can cause tissue thickness compensation part 51020 Corresponding expansion.

Other tissue thickness compensation parts discussed in the whole text similar to the disclosure, tissue thickness compensation part 51020 can pass through The force deformation applied or compression.In addition, tissue thickness compensation part 51020 can be fully flexible so that it is passing through Screen resilience is produced during the force deformation of application, and can then resilience or partly resilience when removing applied power.Optionally, When tissue thickness compensation part 51020 is captured in nail retention region 30039, nail 30030 can make tissue thickness compensation part 51020 deformations.For example, nail 30030 can make the tubular element of the tissue thickness compensation part 51020 of capture in percussion nail 30030 51080 and/or compensating material 51024 deform.Optionally, the non-capture portion of tissue thickness compensation part 51020 can also be cut because of nail Stay the deformation in region 30039 and deform.In deformation, tissue thickness compensation part 51020 can attempt to the resilience from deformed configuration. Optionally, such resilience can occur before the hydrophilic swellable of tubular element 51080, the hydrophily of tubular element 51080 it is swollen While swollen, and/or after the hydrophilic swellable of tubular element 51080.When tissue thickness compensation part 51020 attempts resilience, It can apply restoring force in the tissue in being also trapped in nail retention region 30039, as described in more detail.

Optionally, in tissue thickness compensation part 51020 in tubular element 51080 and/or compensating material 51024 at least one Person can include therapeutic agent 51098.When the tubular element 51080 comprising therapeutic agent 51098 is cut off, included in tubular element Therapeutic agent 51098 in 51080 can be released.In addition, when compensating material 51024 includes therapeutic agent 51098, therapeutic agent 51098 can discharge when bioabsorbable compensating material 51024 is absorbed.Tissue thickness compensation part 51020 can provide treatment The rapid initial release of agent 51098, it is the controlled release of therapeutic agent 51098 afterwards.For example, when the pipe for including therapeutic agent 51098 When the very best part 51080 is cut off, tissue thickness compensation part 51020 can be provided from tubular element 51080 to tissue T along line of cut The rapid initial release of therapeutic agent 51098.In addition, when the bioabsorbable quilt of compensating material 51024 for including therapeutic agent 51098 During absorption, tissue thickness compensation part 51020 can provide the controlled release of the extension of therapeutic agent 51098.Flowed into therapeutic agent 51098 Before compensating material 51024, when at least some in therapeutic agent 51098 can keep shorter one section in tubular element 51080 Between.Alternatively, at least some in therapeutic agent 51098 are positively retained in tubular element 51080 until tubulose member Part 51080 is absorbed.The therapeutic agent 51098 and compensating material 51024 discharged from tubular element 51080 can be identical. Alternatively, such as tubular element 51080 and compensating material 51024 can include different therapeutic agents or different control Treat agent combination.

Referring still to Figure 140, end effector 12 can almost simultaneously or fast successive cut tissue T and percussion nail 30030 enter in the tissue T of cut-out.In this case, nail 30030 can have been turned off adjacent tissue T's in cutting element 30052 It is deployed in immediately in tissue T after tubular element 51080.In other words, nail 30030 can be in the swelling of tubular element 51080 And tissue thickness compensation part 51020 is engaged after the expansion of tissue thickness compensation part 51020 immediately, or simultaneously carry out. After nail 30030 is entered in tissue T by percussion, tissue thickness compensation part 51020 can continue to increase or expand.Followed closely in deployment When 30030, nail 30030 can pierce through tubular element 51080.In this case, cut-off tubular element is remained at Therapeutic agent 51098 in 51080 can discharge from tubular element 51080, and can cover percussion nail 30030 in some cases Leg 30031.

Referring to Figure 141, tissue thickness compensation part 51020 can be manufactured for example by molding technology.According to the present invention, framework or Mould 51120 may include first longitudinal side 51122 and second longitudinal side 51124.Side 51124 may include one or more longitudinally in each Individual recess 51130, one or more of recesses can each receive the first end 50183 or the of tubular element 51080 Two ends 50185.The first end 50183 of tubular element 51080 can be positioned in the first recess in first longitudinal side 51122 In 51130a, and the second end 50183 of tubular element 51080 can be positioned in second longitudinal side 51124 it is second recessed In mouth 51130b so that tubular element 51080 laterally traverses framework 51120.Recess 51180 may include semi-circular grooves, should Semi-circular grooves can be bonded the first end 50183 or second end 50185 of wherein tubular element 51080 securely.First Recess 51130a can be positioned so that directly on the second recess 51130b opposite, and tubular element 51080 can be positioned so that it is vertical Directly in or be at least substantially orthogonal to the longitudinal axis of framework 51120.Alternatively, the first recess 51130a can be from Second recess 51130b is offset so that tubular element 51080 is angularly positioned relative to the longitudinal axis of framework 51120.As Other alternate forms, at least one tubular element 51080 can be longitudinal positioning of in framework 51120 so that tubular element exists Extend between the cross side 51126,51128 of framework 51120.In addition, for example, at least one tubular element can be positioned angularly Between two recesses on the cross side 51126,51128 of framework, and/or recess and longitudinal direction side on cross side 51126 In the framework between recess on 51124.Framework 51120 may include support lugn 51136, and the support lugn is sustainable to be positioned at Tubular element 51080 in framework 51120.

For example, framework 51120 may include recess 51130 to accommodate 12 tubular elements 51080.Framework recess 51130 It can be filled by tubular element 51080, and alternatively, and not all recess 51130 can be filled.Optionally, At least one tubular element 51080 can be positioned in framework 51120.At least half recess 51130 can receive tubular element 51080.Once tubular element 51080 is positioned in framework 51120, compensating material 51024 can be added to framework 51120.When being added to framework 51120, compensating material 51024 can be fluid.For example, compensating material 51024 can be inclined Note in framework 51120 and can be flowed around tubular element 51080 therein is positioned at.Referring to Figure 142, the compensation material of flowing Material 51024 can surround the tubular element 51080 supported by the recess 51130 in framework 51120 and flow.In compensating material 51024 Solidification, or after at least curing sufficiently, can be by comprising compensating material 51024 and tubular element 51080 referring now to Figure 143 Tissue thickness compensation part 51020 removes from framework 51120.Tissue thickness compensation part 51020 can be trimmed.For example, can Unnecessary compensating material 51024 is removed from tissue thickness compensation part 51020 so that the longitudinal direction side of compensating material is substantially Flat.In addition, referring to Figure 144, the first end 50183 and second end 50185 of tubular element 51080 can be crushed on one Rise, or make its closure with sealed tubular element 51080.Institute can be made before tubular element 51080 is placed in framework 51120 State closed end.Alternatively, trimming process can crosscut end 51083,51085 and hot stack process can be used for Sealing and/or the end 51083,51085 of closure tubular element 51080.

Referring again to Figure 141, rigid pins 51127 can be positioned in each tubular element 51080.For example, rigid pins 51127 can extend across the longitudinal direction tube chamber of tubular element 51080.Rigid pins 51127 can extend over each tubular element 51080 so that rigid pins 51127 can be positioned in the recess 51130 in framework 51120.For example, with rigid pins In 51127 embodiment, when compensating material 51204 is poured into framework 51120 and when the compensating material 51024 of flowing is enclosed When being flowed around tubular element 51080, rigid pins 51127 can support tubular element 51080.Once compensating material 51024 solidifies, firmly Change and/or lyophilized, or cure sufficiently, harden and/or freeze, you can by tissue thickness compensation part 51020 from framework 51120 Remove, and rigid pins 51127 can be removed from the longitudinal direction tube chamber of tubular element 51080.Then such as medicine can be used to fill out Fill tubular element 51080., can be to for example including the end of tubular element 51080 after tubular element 51080 is filled with medicine 51083rd, 51085 tissue thickness compensation part 51020 is trimmed.Tissue thickness compensation part 51020 can be for example punched, and/ Or for example pass through heat and/or pressure seal.

As described herein, tissue thickness compensation part 52020 may include multiple tubular elements 51080.Referring now to Figure 145, Tubular element 51080 may include different material properties, size and geometry.For example, the first tubular element 51080a can be wrapped Containing first thickness and the first material, and the second tubular element 51080b can include second thickness and the second material.Optionally, group Identical material can be included by knitting at least two tubular elements 51080 in thickness compensation part 52020.Alternatively, Each tubular element 51080 in tissue thickness compensation part 5202 can include different materials.Similarly, tissue thickness compensation part At least two tubular elements 51080 in 52020 may include identical geometry.Alternatively, tissue thickness Each tubular element 51080 in compensating part 52020 may include different geometries.

Referring now to Figure 20 8- Figure 21 1, tissue thickness compensation part 51220 may include laterally to traverse tissue thickness compensation part 51220 at least one tubular element 51280.Referring to Figure 20 8, tissue thickness compensation part 51220 can be relative to end effector 12 anvil block 30060 positions.For example, tissue thickness compensation part 51220 can be fixed to the anvil block 30060 of end effector 12 Fixation surface 30061.Referring primarily to Figure 20 9, for example, tubular element 51280 may include capsule shape.For example, tubular element 51280 can include polymer composition, such as bioabsorbable biocompatible elastomeric polymer.

Referring again to Figure 20 8, tissue thickness compensation part 51220 can be also included at least partly around tubular element 51280 Compensating material 51224.For example, compensating material 51224 can include bioabsorbable polymer, such as lyophilized polysaccharide, sugared egg White class, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).It is similar as above, compensating material 51024 can be such that tubular element 51280 is held in place in tissue thickness compensation part 51220.In addition, compensating material 51224 can quilt Fixation surface 30061 fixed to anvil block 30060 so that compensating material 51220 is firmly positioned in end effector 12.Mend At least one medicine can be included by repaying material 51224.

Referring still to Figure 20 8, the tubular element 51280 of lateral register can be relative to the cutting in translational slidiing part 30250 Element 30252 positions so that translatable cutting element 30252 can cut off tubular element 51280.For example, cutting element 30252 can cut off tubular element 51280 at or near each center of tubular element 51280.When tubular element 51280 is cut to During two halves, the cut-off part of tubular element 51280 can be swelled or expand, as shown in Figure 20 8.Referring primarily to Figure 21 0, tubulose Element 51280 can include hydroaropic substance 51099, the hydroaropic substance can be discharged when tubular element 51280 is cut off and/or Exposure.In addition, referring now to Figure 21 1, when hydroaropic substance 51099 contacts the body fluid in tissue T, hydroaropic substance 51099 The fluid can be attracted, this can cause tubular element 51280 to be swelled or expand.When tubular element 51280 expands, around pipe The compensating material 51224 of the very best part 51280 can offset or be adapted to the tubular element 51280 of swelling.For example, when compensation When material 51224 includes gelatin, the gelatin can be offset to adapt to the tubular element 51280 of swelling.Referring again to Figure 20 8, The expansion of tubular element 51280 and the skew of compensating material 51224 can cause the corresponding expansion of tissue thickness compensation part 51220.

Other tissue thickness compensation parts discussed in the whole text similar to the disclosure, tissue thickness compensation part 51220 can pass through The force deformation applied or compression.In addition, tissue thickness compensation part 51220 can be fully flexible so that it is passing through Screen resilience is produced during the force deformation of application, and can then resilience or partly resilience when removing applied power.Optionally, When tissue thickness compensation part 51220 is trapped in nail retention region 30039 (Figure 88), nail 30030 can mend tissue thickness Part 51220 is repaid to deform.For example, nail 30030 can make the tubulose of the tissue thickness compensation part 51220 of capture in percussion nail 30030 Element 51280 and/or compensating material 51224 deform.Optionally, the non-capture portion of tissue thickness compensation part 51220 also can be because Deformation in nail retention region 30039 and deform.In deformation, tissue thickness compensation part 51220 can attempt to from deformed configuration Resilience.Optionally, such resilience can occur before the hydrophilic swellable of tubular element 51280, tubular element 51280 it is hydrophilic Property expansion while, and/or after the hydrophilic swellable of tubular element 51280.When tissue thickness compensation part 51220 attempts resilience When, it can apply restoring force in the tissue in being also trapped in nail retention region 30039, as described in more detail.

Referring to Figure 146-Figure 149, tissue thickness compensation part 52020 may include laterally to traverse tissue thickness compensation part One or more tubular elements 52080 of 52020 (being similar at least one tissue thickness compensation part as described herein).Tissue is thick Degree compensating part 52020 may include multiple tubular elements 52080 laterally traversed.Tissue thickness compensation part 52020 may also include One or more material pieces 52024, the material piece keep or retained at least one tubulose member in tissue thickness compensation part 52020 Part 52080.One or more material pieces 52024 can be positioned in the above and or below of tubular element 52080, and can jail Admittedly keep each tubular element 52080 in tissue thickness compensation part 52020.Referring primarily to Figure 146, tissue thickness compensation part It may include the first material piece 52024a and the second material piece 52024b.Tubular element 52080 can be positioned in the first material piece Between 52024a and the second material piece 52024b.In addition, nail bin can be fixed to referring still to Figure 146, material piece 52024b The top platform surface 30011 of 30000 rigid support portion so that tissue thickness compensation part 52020 is firmly positioned in end In portion's actuator 12.Alternatively, one or more material pieces 52024 can be fixed to anvil block 30060 or with it His mode is maintained in end effector 12.

Referring primarily to Figure 147, tissue thickness compensation part 52020 can be porous and/or permeable.For example, material piece 52024 may include multiple holes 52026.Hole 52026 can be substantially circular.Hole 52036 can be visible in material piece 52024 's.Alternatively, hole 52036 can be microcosmic.Referring still to Figure 147, tubular element 52080 may also comprise multiple Hole 52026.Referring to Figure 148, tissue thickness compensation part 52120 may include material piece 52124, and the material piece includes multiple non-circular Hole 52126.For example, hole 52126 may include rhombus and/or fluting shape.Alternatively, referring to Figure 149, tissue Thickness compensation part 52220 may include tubular element 52280, and the tubular element includes permeable tubulose lattice 52292.For example, Material piece 52224 can include bioabsorbable biocompatible elastomeric polymer and can include medicine.

At least one tubular element 52080 can be swelled or expand, as shown in Figure 150 A- Figure 150 D.For example, with reference to figure 150A, tubular element 52080 can be positioned in the first material piece 52024a and the second material in tissue thickness compensation part 52020 Among piece 52024b.When tissue thickness compensation part 52020 contacts tissue T, as shown in Figure 150 B, tissue thickness compensation part 52020 can expand.For example, tubular element 52080 can be included within tissue T and/or on fluid when expand Hydroaropic substance 52099.In addition, material piece 52024 and tubular element 52080 can be permeable, as described herein so that Fluid penetrable tissue thickness compensation part 52020 from tissue T is hydrophilic in fluid contact tubular element 52080 so as to allow Property material 52099.When tubular element 52080 expands, the material piece 52024 around tubular element 52080 can offset or adjust It is whole with adapt to swelling tubular element 52080.The various tissue thickness compensation parts discussed in the whole text similar to the disclosure, expansion Tissue thickness compensation part 52020 can pass through (compression stress such as applied by the percussion nail) deformation of applied power or compression, such as Shown in Figure 150 C.In addition, tissue thickness compensation part 52020 can be fully flexible so that it is passing through applied power change Screen resilience is produced during shape, and can the then resilience when removing applied power.It is thick referring now to Figure 150 D and Figure 150 E, tissue Degree compensating part 52020 can recoil to different configurations in different nail retention regions 30039, suitably to adapt to captured group Knit T.

Referring to Figure 151-Figure 156, tissue thickness compensation part 53020 may include multiple vertically oriented tubular elements 53080. Optionally, each tubular element 53080 may include tubulose axis, and the tubulose axis is substantially perpendicular to the rigidity of nail bin 30000 The top platform surface 30011 of support section 30010.In addition, the first end of each tubular element 53080 can for example neighbouring top Portion's platform surface 30011 positions.Tubular element 53080 may be, for example, deformable and can include elastomer polymer.Optionally Ground, as shown in Figure 152, tubular element 53080 can be compressed when the tissue T being sewn is captured in nail retention region 30039. Tubular element 53080 can include elastomeric material so that when tubular element 53080 is attempted from deformed configuration resilience, tubular element 53080 deformation produces restoring force.The deformation of tubular element 53080 can be at least partly elastic and at least part plasticity.Pipe The very best part 53080 can serve as spring under the power applied, and can not fasten.Referring to Figure 153, tubular element 53080 Can be substantially cylinder-shaped.Referring to Figure 154, tubular element 53180 may include buckling region 53112.When to tubular element 53180 When applying compression stress, it can fasten or deform at buckling region 53112.Tubular element 53180 can flexibly and/or modeling Deform to property, be then designed to fasten suddenly at buckling region 53112 under the tightening force being pre-selected.

Referring primarily to Figure 155, the first tubular element 53080 can be positioned at the first end of nail cavity 30012, and separately One tubular element 53080 can be positioned at the second end of nail cavity 30012.As shown in Figure 153, tubular element 53080 can Including extending through tube chamber 53084 therein.Referring again to Figure 152, when nail 30030 moves to firing position from initial position When, each nail leg 30032 can pass through the tube chamber 53084 of each tubular element 53080.Alternatively, main ginseng See Figure 156, vertically oriented tubular element 54080 can be disposed in tissue thickness compensation part 54020 so that tubular element 54080 adjacent to each other or contacts.In other words, tubular element 54080 can be clustered or concentrate in together.Tubular element 54080 Can systematically it be disposed in tissue thickness compensation part 54020；However, in other cases, tubular element 54080 can by with Machine is arranged.

Referring again to Figure 151, Figure 155 and Figure 156, tissue thickness compensation part 53020 may also comprise material piece 53024, should Material piece makes tubular element 53080 keep or be retained in tissue thickness compensation part 53020.Material piece 53024 can be positioned in The above and or below of tubular element 53080, and each tubulose in tissue thickness compensation part 53020 can be firmly held Element 53080.Tissue thickness compensation part 53020 may include the first and second material pieces 53024.Tubular element 53080 can be determined Position is between the first and second material pieces 53024.In addition, material piece 53024 can be fixed to the rigid support portion of nail bin 30000 The top platform surface 30011 divided so that tissue thickness compensation part 53020 is firmly positioned in end effector 12.As Another option, material piece 53024 can be fixed to anvil block 30060 or be maintained at end effector 12 in other manners In.Material piece 53024 can be sufficiently deformable so that spring 55080 of the material piece 53024 in tissue thickness compensation part becomes Deformed during shape.

Referring to Figure 157 and Figure 158, tissue thickness compensation part 55020 may include at least one spring 55080, the spring It is fully flexible so that it can produce screen resilience in deformation.Referring primarily to Figure 157, tissue thickness compensation part 55020 It may include multiple springs 55080, such as three row springs 55080.Spring 55080 can systematically and/or be randomly arranged in group Knit in thickness compensation part 55020.For example, spring 55080 can include elastomer polymer.The shape of spring 55080 can allow it Deformation.Spring 55080 can be deformed into deformed configuration from initial configuration.For example, when a part of quilt of tissue thickness compensation part 55020 When capture is in nail retention region 30039, within nail retention region 30039 and/or the spring 55080 of surrounding can deform.Example Such as, spring 55080 can be fastened or collapsed under the compression stress applied for percussion nail 30030, and spring 55080 can produce it is extensive Multiple power, the restoring force depend on the device of spring stiffness coefficient of distortion spring 55080 and/or the deflection of spring 55080.Spring 55080 can serve as sponge under the compression stress applied by percussion nail 30030.In addition, spring 55080 can include compensating material, such as The disclosure is more fully described in the whole text.

Tissue thickness compensation part 55020 can also include one or more material pieces 55024, and the material piece is kept or reservation group Knit at least one spring 55080 in thickness compensation part 55020.Material piece 55024 can be positioned in the top of spring 55080 And/or lower section, and the spring 55080 in tissue thickness compensation part 55020 can be firmly held.Tissue thickness compensation part 55020 may include the first material piece 55024a and the second material piece 55024b.Tubular element 52080 can be positioned in the first material Between piece 55024a and the second material piece 55024b.Referring primarily to Figure 158, tissue thickness compensation part 55020 may also include the 3rd Material piece 55024c, the 3rd material piece position adjacent to the first material piece 55024a or the second material piece 55024b.Optionally, extremely A few material piece 55024 can be fixed to the top platform surface 30011 of the rigid support portion of nail bin 30000 so that group Thickness compensation part 55020 is knitted to be firmly positioned in end effector 12.Alternatively, at least one material piece 55024 can be fixed to anvil block 30060 or be maintained in other manners in end effector 12.

Referring now to Figure 158, when following closely 30030 and being fired from nail bin 30000 (Figure 156), nail 30030 can engage group Knit thickness compensation part 55020.Percussion nail 30030 can follow closely the part capture of tissue T and tissue thickness compensation part 55020 In retention area 30039.Spring 55080 can be deformable so that tissue thickness compensation part 55020 is by percussion nail 30030 Compressed during capture.Spring 55080 can be positioned between the percussion nail 30030 in tissue thickness compensation part 55020.As in addition One kind selection, at least one spring 55080 can be captured in nail retention region 30039.

Referring to Figure 159, tissue thickness compensation part 60020 may include at least two compensation layers 60022.Tissue thickness compensation part 60020 may include multiple compensation layers 60022, and the plurality of compensation layer can stack in top of each other, be positioned side by side, or their group Close.As described in more detail, the compensation layer 60022 of tissue thickness compensation part 60020 may include for example different geometric forms Shape and/or material property.In addition, as described in more detail, pit and/or passage may be present in the adjacent compensation layer stacked Between 60022.For example, tissue thickness compensation part 62020 may include six compensation layer 62022a, 62022b, 62022c, 62022d, 62022e, 62022f, six compensation layers can be stacked (Figure 174) top of each other is adjacent.

Referring to Figure 160, Figure 161 and Figure 163-Figure 168, tissue thickness compensation part may include the first compensation layer 60122a and Two compensation layer 60122b.First compensation layer 60122a can be stacked the second compensation layer 60122b top is adjacent.It is adjacent to stack Compensation layer 60122 can be separated by Separation or pit 60132.Referring primarily to Figure 160, tissue thickness compensation part 60120 also may be used Including at least one cantilever beam or support being positioned between the first compensation layer 60122a and the second compensation layer 60122b 60124.Support member 60124 can position the first compensation layer 60122a relative to the second compensation layer 60122b so that compensation layer 60122 are separated by Separation 60132.As described in more detail, support member 60124 and/or compensation layer 60122a, 60122b deformation can for example reduce Separation 60132.

The support beam of tissue thickness compensation part may include multiple geometries and size.For example, support beam can be simple I Ellbeam, single-bend support beam 60124 (Figure 160) placed in the middle, eccentric single-bend support beam 60224 (Figure 161), elliptical support beam 60324 (Figure 163), multi-bend support beam 60424 (Figure 164), and/or symmetrical double cantilever support beams 60524 (Figure 165).In addition, Referring now to Figure 160, Figure 166 and Figure 167, for example, support beam 60624 can be thinner than at least one compensation layer 60122 (Figure 166), Support beam 60724 can be thicker than at least one compensation layer 60122 (Figure 167), and/or support beam 60124 can be and at least one benefit Repay the substantially the same thickness of layer 60122 (Figure 160).Material, geometry and/or the size of support beam 60124 for example can shadows Ring the deformability and screen resilience elasticity of tissue thickness compensation part 60120.

Referring still to Figure 160, for example, the compensation layer 60122 of tissue thickness compensation part 60120 and support beam 60124 can wrap Containing different materials, such as structured material, biomaterial and/or electric material.For example, at least one compensation layer 60122 can Include polymer composition.Polymer composition can include the material of at least partly elasticity so that compensation layer 60122 and/or branch The deformation of support beam 60124 can produce screen resilience.The polymer composition of compensation layer 60122 can include nonabsorable polymer, Absorbable polymer or combinations thereof.For example, absorbable polymer may include bioabsorbable biocompatibility bullet Elastomer polymer.In addition, the polymer composition of compensation layer 60122 may include synthetic polymer, non-synthetic polymer or they Combination.The example of synthetic polymer include but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), Polydioxanone (PDO) and their copolymer.The example of non-synthetic polymer includes but is not limited to polysaccharide, glycoprotein Class, elastin laminin, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Optionally, similar to institute elsewhere herein The polymer composition stated, the polymer composition of compensation layer 60122 can include amount different (such as by weight percentage) Absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or non-synthetic polymer.Optionally, tissue thickness is mended Different polymer compositions can be included by repaying each compensation layer 60022 in part 60120, or alternatively, at least Two compensation layers 60122 can include identical polymer composition.

Referring again to Figure 159, for example, at least one compensation layer 60022 can include therapeutic agent 60098, such as medicine or medicine Thing activating agent.The therapeutic agent 60098 of 60022 releasable therapeutically effective amount of compensation layer.Therapeutic agent 60098 can be in compensation layer 60022 Discharged when being absorbed.The example of therapeutic agent 60098 may include but be not limited to styptic and medicine, such as, fibrin, blood coagulation Enzyme and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/ Or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, celebrating Big mycin, polymyxin B, and/or chloramphenicol；And/or anticancer, such as cis-platinum, mitomycin and/or adriamycin.For example, control Biological agent, such as stem cell can be included by treating agent 60098.Optionally, each compensation layer in tissue thickness compensation part 60020 60022 can include different therapeutic agents 60098, or alternatively, at least two compensation layers 60022 can include identical Therapeutic agent 60098.For example, the compensation layer 60022 comprising therapeutic agent 60098 (such as biological agent) can for example be wrapped in two Between structured compensation layer 60022, described two structured compensation layers include polymer composition, such as polyglycolic acid (PGA) Foam.According to the present invention, compensation layer 60022 can also include such as conductive material, such as copper.

Referring again to Figure 174, the compensation layer 62022 in tissue thickness compensation part 62020 can have different geometries. When layer 62022 is adjacently located in tissue thickness compensation part 62020, compensation layer 62022 can be formed between layer 62022 to A few three dimensional catheter 62032.For example, when the second compensation layer 62022b for including passage is positioned in the substantially flat 3rd During compensation layer 62022c top, the 3rd compensation layer 62022c passage and flat surfaces can limit three dimensional catheter between the two 62032a.Similarly, for example, when the 5th compensation layer 62022e for including passage is positioned in the 4th compensation including respective channel During layer 62022d lower section, the passage can form what is limited by the passage in neighbouring compensation layer 62022d, 62022e stacked Three dimensional catheter 62032b.When fluid flows through tissue thickness compensation part 62020, conduit 62032 can guide therapeutic agent and/or body Liquid.

Referring to Figure 170, tissue thickness compensation part 61020 may include compensation layer 61022, such as layer 60122a and 21022b, The layer can receive the nail 30030 of the deployment from nail bin 20000 (Figure 169).When nail 30030 moves to percussion from initial position During position, the geometry of at least one compensation layer 61022 can guide nail leg 30032 to firing position.Optionally, at least one Individual compensation layer 61022 may include to extend through hole 61030 therein, and its mesopore 61030 can be arranged in nail 30030 from nail bin The nail leg 30032 for having disposed nail 30030 is received when being fired in 20000 (Figure 169), as described in more detail.As another Outer a kind of selection, referring again to Figure 174, for example, nail leg 30032 can pierce through at least one compensation layer, such as compensation layer 62022f, and can be received in by hole 62030 at least one compensation layer, such as compensation layer 62022a.

Referring primarily to Figure 170, tissue thickness compensation part 60120 may include on one of compensation layer 61022a, 61022b At least one support tabs 61026.Support tabs 61026 can projection enter and be limited to Separation between adjacent compensation layer 61032, the gap 61032 between such as the first compensation layer 61020a and the second compensation layer 61020b.Support tabs 61026 can be from First compensation layer 61022a longitudinal lateral process.In addition, support tabs 61026 can be along the length extension of longitudinal direction side or only along one Part extends.Optionally, at least one support tabs 61026 can be from compensation layer 61022a, 61022b two longitudinal lateral processes. In addition, compensation layer 61022a, 61022b of adjacent positioned may include corresponding support tabs 60126 so that from the first compensation layer 60122a extension support tabs 60126 can at least in part with extending from the second compensation layer 60122b support tabs 60126 Alignment.Referring again to Figure 168, tissue thickness compensation part 60820 may include between adjacent compensation layer 60122a, 60122b Restrictor plate 60828.For example, restrictor plate 60828, which can be positioned on, is defined in the first compensation layer 60122a and the second compensation layer In gap 60132 between 60122b.As described in more detail, support tabs 61026 and/or restrictor plate 60828 can Control support member 60124 and/or compensation layer 60122a, 60122b deformation and/or deflection.

As described herein, the compensation layer 60022 of tissue thickness compensation part 60020 can include different materials, geometry And/or size.Such tissue thickness compensation part 60020 can be assembled by a variety of manufacturing technologies.It is thick referring primarily to Figure 159, tissue Degree compensating part 60022 can be manufactured by lithographic printing, stereolithography (SLA) or silk-screen printing technique.For example, cubic light is scribed Tissue thickness compensation part 60020 can be formed by making technique, wherein each compensation layer 60022 includes different material and/or geometric form Feature structure.For example, the ultraviolet light in stereo lithography machine can draw the geometry of the first compensation layer 60022 so that include First compensation layer 60022 of one material, geometry and/or size is solidified by ultraviolet light.Ultraviolet light can then draw second The geometry of compensation layer 60022 so that the second compensation layer 60022 comprising the second material, geometry and/or size passes through Ultraviolet light solidifies.According to the present invention, stereo lithography machine can draw compensation layer 60022 on top of each other, draw compensation side by side Layer 60022 draws compensation layer 60022 with combinations thereof.In addition, compensation layer 60022 can be plotted as so that pit 60132 It is present between adjacent compensation layer 60022.Because stereo lithography machine can be formed with the very thin of unique geometry Layer, therefore the tissue thickness compensation part 60020 manufactured by stereolithography processes may include extremely complex 3 dimensional coil geometry.

Referring to Figure 169, tissue thickness compensation part 60920 can be positioned in the end effector 12 of surgical instruments 10 (Fig. 1). Tissue thickness compensation part 60920 can position relative to the nail bin 20000 of end effector 12.For example, tissue thickness compensation part 60920 can be releasably secured to nail bin 20000.At least one compensation layer 60922 of tissue thickness compensation part 60920 can be adjacent Top platform surface 20011 (Figure 79) positioning of nearly nail bin 20000.For example, the second compensation layer 60922b can by adhesive or Top platform surface 20011 is fixed to by wrappage (similar with least one of wrappage as described herein) (Figure 16). Tissue thickness compensation part 60920 can be integral with nail bin 20000 so that nail bin 20000 and the shape of tissue thickness compensation part 60920 As individual unit construction.For example, nail bin 20000 may include the first main part, such as (figure of rigid support portion 20010 79), and the second main part, such as tissue thickness compensation part 60920.

Referring still to Figure 169, tissue thickness compensation part 60920 may include the compensation of the first compensating part part 60920a and second Part part 60920b.First compensating part part 60920a can be positioned in the first longitudinal side of nail bin 20000, and the second compensation Part part 60920b can be positioned in the second longitudinal side of nail bin 20000.Optionally, when tissue thickness compensation part 60920 is relative When nail bin 20000 positions, the longitudinal slit 20015 (Figure 78) in rigid support portion 20010 (Figure 78) can be in the first compensation Extend between part part 60920a and the second compensating part part 60920b.For example, when in nail percussion sliding part 20050 (Figure 78) When cutting element 20052 translates across end effector 12, cutting element 20052 may pass through the first compensating part part 60920a and Longitudinal slit 20015 between second compensating part part 60920b, the part without cutting off tissue thickness compensation part 60920. Alternatively, cutting element 20052 can cut off a part for tissue thickness compensation part 60920.

Referring now to Figure 162, tissue thickness compensation part 63020 can fit in the end effector of circular surgical apparatus In 12 '.Tissue thickness compensation part 62030 may include the first compensation layer 63022a of circle and the second circular compensation layer 63022b.Second compensation layer 63022b can be positioned on the circular top platform surface 20011 ' of circular nail bin 20000 ', wherein Second compensation layer 63022b may include the geometry of the geometry corresponding to platform surface 20011 '.For example, platform surface 20011 ' may include stepped portion, and the second compensation layer 63022b may include corresponding stepped portion.Tissue thickness compensation part It may also include, for example, at least one support member 63024 and/or support tabs that extend around tissue thickness compensation part 63020 63026。

Referring again to Figure 170, percussion nail 30030 can engage tissue thickness compensation part 60920.As the disclosure is described in the whole text As, percussion nail 30030 can capture the part and tissue T of tissue thickness compensation part 60920, and apply compressive force to Tissue thickness compensation part 60920.In addition, referring primarily to Figure 171-Figure 173, tissue thickness compensation part 60920 can be deformable. Optionally, as described herein, the first compensation layer 60920a can be separated by Separation 60932 and the second compensation layer 60920b. Referring to Figure 171, before compression organization thickness compensation part 60920, gap 60932 may include the first distance.When for example by hitting When compression stress A is applied to tissue thickness compensation part 60920 and tissue T by 30030 (Figure 170) of hair nail, support member 60924 can become Shape.Referring now to Figure 172, single bent support beam 60924 can be bent under compression stress A so that the first compensation layer 60920a and Separation 60932 between two compensation layer 60920b is reduced to second distance.Referring primarily to Figure 173, the first compensation layer 60922a and the second compensation layer 60922b can also be deformed under compression stress A.Support tabs 60926 can control compensation layer 60920 Deformation.For example, support tabs 60926 can prevent from mending by supporting its longitudinal direction side when compensation layer 60920 is in contact with each other Repay the overbending of layer 60920.Support tabs 60926 can also be bent under compression stress A or archwise.Or conduct in addition Another option, it is more detailed herein when compensation layer 60920 and/or the contact restrictor plate 60128 of support tabs 60926 The restrictor plate 60128 (Figure 168) carefully described can limit the deformation of compensation layer 60920.

In addition, being similar to various tissue thickness compensation parts as described herein, tissue thickness compensation part 60920 can be in deformation Produce screen resilience or restoring force.Restoring force can depend, at least partially, on tissue thickness caused by the tissue thickness compensation part of deformation Orientation, size, material and/or the geometry of compensating part 60920, and the tissue thickness's compensation deformed by the power applied The amount of part 60920.In addition, at least a portion of tissue thickness compensation part 60920 can be flexible so that tissue thickness compensation part 60920 produce load on spring or restoring force when being deformed by percussion nail 30030.Support member 60924 may include elastomeric material and/ Or at least one compensation layer 60922 may include elastomeric material so that tissue thickness compensation part 60920 is flexible.

Referring now to Figure 175, the end effector of surgery suturing appliance may include the first jaw and the second jaw, wherein the At least one of one jaw and the second jaw can be moved relative to each other.For example, end effector, which can have, includes nail bin First jaw of passage 19070 and the second jaw including anvil block 19060, wherein anvil block 19060 can towards and/or away from nail bin Passage 19070 pivots.Staple cartridge channel 19070 can receive nail bin 19000, lead to for example, it can be removably retained in nail bin In road 19070.Nail bin 19000 may include warehouse 19010 and tissue thickness compensation part 19020, wherein tissue thickness compensation part 19020 can be removably attached to warehouse 19010.Referring now to Figure 176, warehouse 19010 may include multiple Hes of nail cavity 19012 The nail 19030 being positioned in each nail cavity 19012.In addition, nail 19030 can be by the staple drivers that are positioned in warehouse 19010 19040 supports, wherein sliding part and/or firing member can for example be advanced through nail bin 19000 to be lifted up nail cavity 19012 Interior staple drivers 19040, as shown in Figure 177, and nail 19030 is projected from nail cavity 19012.

Referring primarily to Figure 175 and Figure 176, tissue thickness compensation part 19020 may include elastic component 19022 and encapsulation elasticity The container 19024 of component 19022.Container 19024 can be sealed and can limit the cavity comprising internal gas, the inside gas Body has the pressure different from ambient atmosphere pressure.The pressure of internal gas can be more than the pressure of ambient atmosphere, and be used as another A kind of outer selection, the pressure of internal gas can be less than the pressure of ambient atmosphere.Container 19024 includes big less than surrounding wherein In the embodiment of the strong pressure of air pressure, the side wall of container 19024 can be with wrapped vacuum.In this case, the vacuum can be with Container 19024 is caused to deform, collapse and/or graduation, wherein the elastic component 19022 being positioned in container 19024 can be elastic It is compressed in container 19024.When extracting vacuum on container 19024, elastic component 19022 can be deflected down or deformed simultaneously And it can be held in place under compression or vacuum sealing state by the side wall of container 19024.

Elastic component 19022 and container 19024 are made up of biocompatible materials.Optionally, for example, elastic component 19022 and/or container 19024 can be made up of bioabsorbable material (such as PLLA, PGA and/or PCL).Elastic component 19022 can be made up of elastomeric material.Elastic component 19022 may also comprise structural resiliency.For example, elastic component 19022 can be The form of hollow tube.

Further described above, tissue thickness compensation part 19020 can against or neighbouring warehouse 19010 platform Surface 19011 positions.Referring now to Figure 177, when nail 19030 is fired at least in part, appearance can be pierced through by following closely 19030 leg Device 19024 makes its rupture.Container 19024 may include core 19026, and the core can be positioned on warehouse 19010 The top of cutting slit 19016 so that when cutting element 19080 be advanced into cutting be positioned at nail bin 19000 and anvil block 19060 it Between tissue T when, the core 19026 of the also cleavable container 19024 of cutting element 19080, so as to pierce through container 19024 or Make its rupture.In either case, once container 19024 has ruptured, then the internal gas in container 19024 can with around The air of tissue thickness compensation part 19020 obtains balance, and allows the elastic expansion of elastic component 19022, to reacquire or The configuration of its not deformed and/or non-graduation is reacquired at least in part.In this case, elastic component 19022 can be by partially Put the tissue T that power is applied in the nail 19020 for being trapped in deformation.More particularly, by being limited in anvil block 19060 After the profiled surface deformation of pit 19062, the leg for following closely 19030 can be by tissue T and at least a portion of elastic component 19022 Capture is in nail 19030 so that when container 19024 ruptures, tissue thickness compensation part 19020, which can compensate, is trapped in nail The thickness of tissue T in 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, the nail 19030 is trapped in Interior elastic component 19022 can be expanded to fill the gap in nail 19030, and enough compression stresses are applied into tissue T. Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the elastic component 19022 being trapped in the nail 19030 can Keep compression to think that the relatively thick tissue in nail 19030 concedes space, and equally, enough compression stresses are applied to tissue T.

When container 19024 is pierced, as described above, elastic component 19022 can attempt to expansion to be elastically returned to it Initial configuration.In some cases, a part of of the elastic component 19022 being trapped in nail 19030 possibly can not return To its initial not deformed shape.In this case, elastic component 19022 may include spring, and the spring can apply compression stress To the tissue T being trapped in nail 19030.According to the present invention, elastic component 19022 can simulate Hookean spring, wherein by bullet Property component 19022 apply compression stress with amount or apart from Linear proportional, its elastic member 19022 be maintained at nail 19030 in Deflection.Alternatively, elastic component 19022 can simulate nonlinear spring, wherein being applied by elastic component 19022 Compression stress not with amount or apart from Linear proportional, its elastic member 19022 be maintained at nail 19030 intrinsic deflections.

Referring primarily to Figure 178 and Figure 179, nail bin 19200 may include tissue thickness compensation part 19220, and the tissue thickness is mended The container 19222 of one or more sealings can be included wherein by repaying part.Each in container 19222 can be sealed and can wrapped Containing internal gas.The pressure of internal gas in sealing container 19222 can exceed atmospheric pressure, and in sealing container 19222 The pressure of internal gas can be strong with subatmospheric.The pressure subatmospheric of internal gas in container 19222 is strong In the case of, container 19222 can be described as including vacuum.Optionally, for example, one or more containers 19222 can be wrapped or Included in oversheath, case, wrappage and/or film 19224, wherein tissue thickness compensation part 19220 can be positioned in warehouse 19010 top of platform surface 19011.For example, each container 19222 can be by with circular or at least substantially circular cross section The pipe of (for example, with closed end and openend) is made.Vacuum can be extracted on the openend of pipe, and it is sufficient when reaching in pipe During enough vacuum, openend can be closed and seal.For example, pipe can be made up of such as polymeric material, the openend of its middle pipe It can be heated to close and seal the openend.Under any circumstance, the vacuum in each container 19222 can inwardly pull pipe Side wall and make tubular elastic deform and/or graduation.Container 19222 is shown as in Figure 179 at least part graduation State.

When nail 19030 is in its non-firing position, as shown in Figure 179, tissue thickness can be positioned in by following closely 19030 top Spend the lower section of compensating part 19220.For example, nail 19030 can be positioned in its respective nail cavity 19012 so that nail 19030 not with appearance Device 19222 contacts, until the non-firing position shown in nail 19030 from Figure 179 moves to its firing position shown in Figure 180.Group Knitting the wrappage 19224 of thickness compensation part 19220 can prematurely not pierced through with protective container 19220 by nail 19030.Referring now to Figure 180, when nail 19030 is fired at least in part, container 19222 can be pierced through or make its rupture by following closely 19030 leg.At this In the case of kind, internal gas in container 19222 can obtain balance with the air around container 19222, and elastic expansion with Reacquire or reacquire at least in part the configuration of its undeformed and/or non-graduation.In this case, it is pierced Container 19222 bias force can be applied to tissue in the nail 19030 for being trapped in deformation.More particularly, limit is being passed through After the profiled surface deformation for the pit 19062 being scheduled in anvil block 19060, the leg for following closely 19030 can be by tissue T and container 19222 at least a portion capture is in nail 19030 so that when container 19222 ruptures, container 19222, which can compensate, is caught Obtain the thickness of the tissue T in nail 19030.For example, when the tissue T being trapped in nail 19030 is relatively thin, the nail is trapped in Container 19222 in 19030 can be expanded to fill the gap in nail 19030, while enough compression stresses are applied to Tissue T.Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the container 19222 that is trapped in the nail 19030 Compression can be kept to think that the relatively thick tissue in nail 19030 concedes space, while enough compression stresses are applied into tissue T.

When container 19222 is pierced, as described above, container 19222 can attempt to expansion it is initial to be elastically returned to its Configuration.The part being trapped in nail 19030 of container 19222 possibly can not return to its initial not deformed shape.At this In the case of kind, container 19222 may include spring, and the spring can apply compressive force to the tissue T being trapped in nail 19030. According to the present invention, container 19222 can simulate Hookean spring, wherein by the compression stress that container 19222 applies and amount or range line Property it is proportional, wherein container 19222 be maintained at nail 19030 intrinsic deflections.Alternatively, container 19222 can simulate Nonlinear spring, wherein the compression stress applied by container 19222 is not protected with amount or apart from Linear proportional, wherein container 19222 Hold and following closely 19030 intrinsic deflections.Container 19222 at which under its sealed configuration when can be hollow and empty.As other one Kind selects, each limited cavity in container 19222, and may also include at least one medicine wherein included.For example, Container 19222 can include at least one medicine, and at least one medicine can be released and/or bio-absorbable.

The container 19222 of tissue thickness compensation part 19220 can be arranged in any suitable manner.As shown in Figure 178, limit The nail cavity 19012 being scheduled in warehouse 19010, and the nail 19030 being positioned in nail cavity 19012 can be arranged in line.As illustrated, example Such as, nail cavity 19012 can be arranged to the row of six vertical linears；However, any suitably-arranged side using nail cavity 19012 Formula.Also as shown in Figure 178, tissue thickness compensation part 19220 may include six containers 19222, wherein each in container 19222 It is individual to be alignd with a line nail cavity 19012, or the side of being positioned on.Each in nail 19030 in a line nail cavity 19012 can Pierce through identical container 19222.In some cases, some followed closely in 19030 nail leg can not pierce through the appearance being positioned on Device 19222；However, in the case where container 19222 limits continuous inner chamber, for example, can be filled by least one in nail 19030 Ground is divided to pierce through cavity, to allow the atmospheric pressure around the pressure of inner chamber gas and container 19222 to obtain balance.Referring now to Figure 185, tissue thickness compensation part for example may include container, such as container 19222 ', and it can be transverse to the direction of staple line 19030 Extension.For example, container 19222 ' can be across multiple nail row extensions.Referring now to Figure 186, tissue thickness compensation part 19220 " can wrap Include multiple containers 19222 ", its along perpendicular to or be at least substantially orthogonal to staple line 19030 direction extension.For example, container Some of 19222 " can be pierced through by nail 19030, and other can not be pierced through by nail 19030.For example, container 19222 " can be horizontal Crosscutting container 19222 " and its rupture can be made across or through cutting path extension, wherein cutting element.

Optionally, as described above, for example, tissue thickness compensation part such as tissue thickness compensation part 19220 can for example wrap Include multiple sealing containers, such as container 19222.As also described above, each of sealing container 19222 may include independent inside Gas.Container 19222 can have different internal pressures.For example, the first container 19222 may include the inside with first pressure Vacuum, and second container 19222 may include the inner vacuum with the second different pressures.For example, the deformation of container 19222 or Graduation amount may depend on the vacuum pressure of the internal gas wherein included.For example, with the phase of container 19222 with smaller vacuum Than the amount that the container 19222 with relatively large vacuum can deform or graduation is bigger.The cavity of container can be segmented into two or more Multiple independent seal cavities, wherein each independent seal cavity may include independent internal gas.For example, one in nail row A little nails can for example can be arranged as piercing through the first cavity limited in a reservoir, while follow closely other nails in row can and cloth It is set to the second cavity for piercing through and limiting in a reservoir.In this case, the nail in going wherein especially is being followed closely from the one of nail row End is sequentially fired in the embodiment of the other end, as described above, one of cavity can be kept when another cavity ruptures It is complete and its internal gas can be maintained.For example, the first cavity can have internal gas, it has the first vacuum pressure, and Second cavity can have internal gas, and it has the second different vacuum pressures.According to the present invention, complete cavity is kept to maintain Its internal pressure, until container is by bio-absorbable, so as to form timing pressure release.

It is for example attachable referring now to Figure 181 and Figure 182, tissue thickness compensation part such as tissue thickness compensation part 19120 To anvil block 19160.Similar as above, tissue thickness compensation part 19120 may include container 19124 and be positioned at multiple bullets therein Property component 19122.Also similar as above, container 19124 can limit the cavity comprising internal gas, and the internal gas, which has, to be less than Or the pressure more than the atmospheric pressure around tissue thickness compensation part 19120.Internal gas in container 19124 includes vacuum In the case of, container 19124 and be positioned at elastic component 19122 therein can be by the vacuum and container in container 19124 The pressure difference between atmospheric pressure outside 19124 and deform, collapse and/or graduation.In use, anvil block 19160 can be transported Closing position is moved, wherein anvil block positions relative to nail bin 19100, and the tissue engagement surface wherein on container 19124 19121 can engage the tissue T being positioned among tissue thickness compensation part 19120 and nail bin 19100.In use, structure is fired Part 19080 can be promoted with percussion nail 19030 towards distal side, as described above, while cutting tissue T.Tissue thickness compensation part 19120 may also include center section 19126, and the center section can align with the cutting slit being limited in anvil block 19160, wherein When firing member 19080 is advanced through tissue thickness compensation part 19120 towards distal side, firing member 19080 can pierce through container 19124 or make its rupture.In addition, similar as above, firing member 19080 can be lifted up staple drivers 19040 and hit Hair nail 19030 so that nail 19030 can contact anvil block 19160 and be deformed to its deformed configuration, as shown in Figure 183.Work as nail 19030 when being fired, and nail 19030 can pierce through tissue T and then pierce through container 19124 or make its rupture so that be positioned at container Elastic component 19122 in 19124 can expand at least in part, as described above.

Further described above, tissue thickness compensation part can be made up of biocompatible materials.Biocompatibility Material (such as foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer and/or combinations thereof, with characteristic needed for being provided for material.Biocompatible foam may include surfactant.Table Face activating agent can be applied to material surface and/or be dispersed in material.Any particular theory is not intended to be limited to, is applied to The surfactant of biocompatible materials can reduce the surface tension of the fluid of contact material.For example, surfactant can To reduce the surface tension of the water of contact material, to accelerate water to penetrate into material.Water can serve as catalyst.Surfactant can be with Improve the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant and/or non-ionic surface active Agent.The example of surfactant includes but is not limited to polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethyl Cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl 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 and pool Lip river Sha Mu, and combinations thereof.Surfactant may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant can wrap Include non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or other materials is dispersed in into bio-compatible In property material.Tissue thickness compensation part can include at least one medicine.Tissue thickness compensation part can include as described herein natural One or more of material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include bio-compatible sex vesicle Foam, the biocompatible foam include gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, PLA, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone and combinations thereof.Tissue thickness compensation part can wrap Film is included, the film includes at least one medicine.Tissue thickness compensation part may include Biodegradable films, and the Biodegradable films include At least one medicine.Medicine may include liquid, gel and/or powder.Medicine may include anticancer, such as 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 of thing.When biodegradation material contacts activator such as activating solution, biodegradation material can degrade, Ke Yifen Solution, or lose structural intergrity.For example, activating solution may include saline solution or any other electrolyte solution.Biodegradable material Material can contact activating solution by routine techniques, and the technology includes but is not limited to spraying, dipping and/or brushing.In use, For example, surgeon can will include the end effector and/or nail bin of tissue thickness compensation part (it includes at least one medicine) Immerse in activating solution, the activating solution includes salting liquid, such as sodium chloride, calcium chloride, and/or potassium chloride.Tissue thickness compensates Part can discharge medicine when tissue thickness compensation part is degraded.Medicine can be quickly from the feature of the elution of tissue thickness compensation part Initial eluting rate and at a slow speed persistently eluting rate.

According to the present invention, tissue thickness compensation part can be for example made up of the biocompatible materials that can include oxidant.Oxygen Agent can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but be not limited to hydrogen peroxide, peroxide Change urea, calper calcium peroxide and peromag, and SODIUM PERCARBONATE.Oxidant may include peroxy oxidant and the oxidation of hypohalogenous acids alkali Agent, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidant may include alkali metal chlorine Hydrochlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and sodium perborate.Oxidant may include vanadate.Oxygen Agent may include ascorbic acid.Oxidant may include active oxygen generator.According to the present invention, organization bracket can include bio-compatible Property material, the biocompatible materials include oxidant.

Biocompatible materials may include liquid, gel and/or powder.For example, oxidant may include particulate and/or nanometer Particle.For example, oxidant can be ground into particulate and/or nano particle.Can be by the way that oxidant be suspended in a polymer solution And oxidant is set to be attached in biocompatible materials.Oxidant can be attached to biocompatible materials during lyophilized technique In.After lyophilized, oxidant could attach to the cell membrane of biocompatible materials, with contact and tissue interaction.Oxygen Agent can not be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, with logical Too slow On The Drug Release oxygen provides long-term biological effects.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structure It is interior, to provide long-term biological effects by slowly discharging oxygen.Biocompatible materials may include oxidant and medicine, such as strength Mycin and ascorbic acid.

Biocompatible materials may include quick release oxidant and/or at a slow speed sustained release oxidant.Oxidant is from life The feature of the elution of thing compatibility material can be quick initial eluting rate and continue eluting rate at a slow speed.When oxidant contacts body fluid When (such as water), oxidant can generate oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, myelencephalon Liquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content and/or bile.It is not intended to be limited to any specific Theory, oxidant can reduce cell death, strengthen organizational vitality and/or maintain to be broken in cutting and/or sewing process The mechanical strength of bad tissue to tissue.Biocompatible materials may include at least one particulate and/or nano particle.Biofacies Capacitive material may include one or more of natural material, non-synthetic materials and synthetic material as described herein.Bio-compatible Property material may include that average diameter is about 10nm to about 100nm and/or about 10 μm to about 100 μm, such as 45-50nm and/or 45- 50 μm of particle.Biocompatible materials may include biocompatible foam, and the biocompatible foam includes being embedded At least one particulate and/or nano particle.Particulate and/or nano particle can not be chemically bonded to biocompatible materials.It is micro- Grain and/or nano particle can provide the controlled release of medicine.Particulate and/or nano particle can include at least one medicine.Example Such as, particulate and/or nano particle can include styptic, antimicrobial and/or oxidant.Tissue thickness compensation part may include to give birth to Thing biocompatible foam, the biocompatible foam include styptic (it includes oxidized regenerated cellulose), antimicrobial (its Including fortimicin and/or gentamicin) and/or oxidant (it includes percarbant).For example, particulate and/or nanometer Grain can provide the controlled release of the medicine of up to three days.

Particulate and/or nano particle can be embedded in biocompatible materials in the fabrication process.For example, biocompatibility Polymer (such as PGA/PCL) can contact solvent (such as dioxane) to form mixture.Biofacies can be ground Capacitive polymer is to form particle.It can be contacted with or without the dry particl of ORC particles with mixture to form supensoid agent.Should Supensoid agent can be lyophilized to form biocompatible foam, and the biocompatible foam is included with the dry particl being embedded And/or the PGA/PCL of ORC particles.

For example, tissue thickness compensation part disclosed herein or layer can be made up of absorbable polymer.For example, tissue is thick Spending compensating part can be constituted by the following substances：Foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly- (ethanol Sour -co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- three Carbonate)), it is PDS, PEPBO or other absorbable polyurethane, polyester, makrolon, poe, condensing model, poly- Esteramides, and/or polyoxy acid ester.According to the present invention, tissue thickness compensation part can be by such as PGA/PLA (poly- (glycolic -co-s Lactic acid)) and/or PDS/PLA (poly- (to dioxanone -co- lactic acid)) compositions.According to the present invention, tissue thickness compensation part It can be made up of such as organic material.For example, tissue thickness compensation part can by carboxymethyl cellulose, mosanom, cross-linked-hyaluronic acid, And/or oxidized regenerated cellulose is formed.According to the present invention, tissue thickness compensation part may include that scope is 3-7 Shore A (Xiao 30-50 Family name OO) hardometer, wherein maximum rigidity is such as 15 Shore As (65 Shore OO).Tissue thickness compensation part can be for example in 3 ft lbfs 40% compression is subjected under load, 60% compression is subjected under the load of 6 ft lbfs, and/or 80% is subjected under the load of 20 ft lbfs Compression.One or more gases (such as air, nitrogen, carbon dioxide and/or oxygen) can for example blast and/or included in group Knit in thickness compensation part.Tissue thickness compensation part can be wherein comprising the globule for forming tissue thickness compensation part, the globule bag Include the material stiffness between about 50% and about 75%.

According to the present invention, tissue thickness compensation part can include such as hyaluronic acid, nutritional ingredient, fibrin, blood coagulation Enzyme, rich in hematoblastic blood plasma, salicylazosulfapyridine (- 5ASA+ sulfadiazine diazo bonds)-pro-drug- Colon bacteria (azo reductase), aminosalicylic acid (have for sustained release different pro-drugs configure 5ASA),(5ASA+ Utech-S coatings-pH>7 (coating dissolvings)),(5ASA+ ethylcellulose coats-be based on Time/pH slow release),(5ASA+ Utech-L coatings-pH>6), Olsalazine (5ASA+5ASA-colon Bacterium (azo reductase)), Balsalazide (5ASA+4 aminobenzoyl-B- alanine)-colon bacteria (azo reductase)), make Grain mesalazine, Lialda (mesalazine delay and controlled-release formulation), (herbal mixture, HMPL-004 (can press down HMPL-004 The herbal mixture of the activation of TNF-α processed, Interleukin -1β and core-κ B), (interference T lymphocytes enter intestines to CCX282-B The oral chemokine receptor antagonist of mucous membrane), it is rifaximin (non-absorbability broad-spectrum antibiotic), infliximab, small (directly against the monoclonal antibody of TNF-α, it is approved for mitigating suffer from hyporeactive to conventional therapy mouse chimeric antibody Sign/symptom of the adult/pediatric patient of moderate/severe tube chamber and fistula type Crohn disease and maintain clinical remission), A Damu (monoclonal antibody of anti-tnf-alpha, it is approved for the sign/symptom for mitigating Crohn disease, Yi Jiyong for monoclonal antibody, people's total IgG 1 In induction and maintain to conventional therapy underaction, or moderate/severe activity is suffered from as do not tolerate infliximab The clinical remission of the adult patient of Crohn disease), match trastuzumab, the anti-TNF FAB ' of humanization (be connected to the list of polyethylene glycol Monoclonal antibody fragment, it is approved for the sign/symptom for mitigating Crohn disease, and for inducing and maintaining to conventional therapy The reaction of hyporeactive adult patients with moderate/severe disease), natalizumab, the first non-TNF-α inhibitor (batch The mutatis mutandis biologic artifact in Crohn disease), Humanized monoclonal IgG4 antibody (directly against α -4 integrins, obtain FDA Ratify to be used for induce and maintain confirmation to have inflammation and to the treatment of conventional Crow grace and TNF-α inhibitor underaction or can not be resistant to The clinical response of the patient with moderate/severe disease of the treatment of conventional Crow grace and TNF-α inhibitor and alleviation), may give Surely there are the concomitant immunity conditioning agent, imuran 6-MP (purine synthetic inhibitor-pro-drug), first of infliximab Aminopterin (with reference to dihyrofolate reductase (DHFR) enzyme, it participates in the synthesis of tetrahydrofolic acid, suppresses the synthesis of all purine), not Purine alcohol and the treatment of sulphur purine, PPI, for acid suppression to protect the H2 of healing line, clostridium difficile (C-Diff)-flagyl, ten thousand (excrement transposition is handled ancient mycin；Probiotics；Intracavitary normal flora is educated again), and/or rifaximin (bacterial overgrowth processing (especially hepatic encephalopathy)；Do not absorb in the gastrointestinal tract and intracavitary bacterium is worked).

As described herein, for example, tissue thickness compensation part can compensate be trapped in it is being projected from nail bin and/or comprising The change of the thickness of the tissue in nail 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 this case, tissue thickness compensation part can be in nail Different height or thickness is presented, and apply compressive force to the tissue being trapped in nail regardless of whether captured tissue be it is thick or It is 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 capture The highly compressible portion of tissue, and other nails in staple line can capture the compressibility smaller ones of tissue.In this feelings Under condition, for example, smaller height can be presented in tissue thickness compensation part in nail (it has captured the tissue with relatively low compressibility) Degree or higher hardness, and correspondingly, larger height can be presented in nail (it has captured the tissue with higher compressibility) Spend or compared with soft.Under any circumstance, for example, no matter tissue thickness compensation part whether compensate tissue thickness change and/or The change of tissue hardness, it is referred to alternatively 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.Repair It may include any combination of following steps again：Dismounting described device and then cleaning are replaced particular elements and then filled again Match somebody with somebody.Particularly, described device can be disassembled, and optionally can replace or take out in any combination the Arbitrary Digit of described device Purpose particular elements or part.Cleaning and/or replace particular elements after, described device can at restoration facilities or Ressembled before surgical operation will be carried out by operating team then to use.Those skilled in the art will be understood that, fill The reparation put can utilize it is a variety of be used to dismantling, the technology for cleaning/replace and ressemble.The uses of these technologies and gained It is repaired device within the scope of the present invention.

Preferably, invention as described herein will be handled before surgery.First, new or used device is obtained Tool, and apparatus is cleaned when necessary.Then apparatus is carried out disinfection.In a kind of disinfection technology, the apparatus is put In the container for closing and sealing, such as in plastics or TYVEK bag.Then the container can be penetrated by being placed in container and apparatus Radiation field in, such as γ radiation, x- rays or high energy electron.The bacterium on apparatus and in container is killed in radiation.Then will Apparatus after sterilization is stored in sterile chamber.Apparatus is kept sterile by the sealing container, should until being opened in medical facilities Untill container.

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.It is any be stated to be herein incorporated by reference but with existing definition as described herein, statement or other are public Open afoul any material of material or part thereof only will not produce punching between the material and existing open material being incorporated to It is incorporated herein under prominent 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 product, the product is selected from the anvil block of robotic suturing device and the nail bin for robotic suturing device, and the product includes group Thickness compensation part is knitted, the tissue thickness compensation part includes：

First layer, the first layer include being sealed around the first biocompatible materials in impermeable material；With

Wherein described first biocompatible materials expands when being contacted with fluid.

2. tissue thickness compensation part according to claim 1, including the third layer with the 3rd biocompatible materials, its Described in first layer be located among the second layer and third layer.

3. tissue thickness compensation part according to claim 2, wherein each of the first layer and second layer include Tissue contacting surface.

4. according to the tissue thickness compensation part described in claim 2 or claim 3, wherein the first biocompatibility material Material, the second biocompatible materials and the 3rd biocompatible materials independently selected from alginates, carbohydrate, chitin, Chitosan, blood, heparin, hyaluronic acid, protein, serum, poly- (lactic acid), poly- (glycolic), poly- (hydroxybutyric acid Ester), poly- (phosphine piperazine), polyethylene glycol, polyalkylene oxides, polyacrylamide, makrolon, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, poly- third Alkene, glycerine, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, polyamide, poly- (iminocarbonic ester), polyoxy are miscellaneous The combination of ester, poe, polyphosphazene or above-mentioned substance.

5. tissue thickness compensation part according to claim 4, wherein carbohydrate include cellulose, glucan and shallow lake Powder.

6. according to the tissue thickness compensation part described in claim 2 or claim 3, wherein the first biocompatibility material Material, the second biocompatible materials and the 3rd biocompatible materials are polyester.

7. tissue thickness compensation part according to claim 4, wherein protein include albumin, casein, collagen, elasticity Albumen, fibrin, fibrinogen, gelatin and keratin.

8. according to the tissue thickness compensation part any one of claim 1-3, wherein first biocompatible materials Including dried hydrogel.

9. tissue thickness compensation part according to claim 8, wherein the hydrogel includes being selected from following compound：It is sub- The combination of trialkylphosphine oxide, polysaccharide, ester, ether, acid amides, phenolic resin or above-mentioned substance.

10. tissue thickness compensation part according to claim 9, wherein ester include aliphatic (acid) ester, ortho esters, phosphate, carbonic acid Ester and polyurethanes.

11. according to the tissue thickness compensation part any one of claim 1-3, wherein first biocompatible materials It is the composition of water-swellable.

12. according to the tissue thickness compensation part any one of claim 1-3, wherein the fluid is water-soluble including water, salt Liquid or body fluid.

13. according to the tissue thickness compensation part any one of claim 1-3, wherein when the impermeable material ruptures When, first biocompatible materials contacts the fluid.

14. according to the tissue thickness compensation part any one of claim 1-3, wherein the impermeable material includes gathering (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyethylene glycol, polyalkylene oxides, polyacrylamide, Makrolon, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxane Hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, glycerine, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, poly- The combination of acid amides, poly- (iminocarbonic ester), polyoxaesters, poe, polyphosphazene or above-mentioned substance.

15. according to the tissue thickness compensation part any one of claim 1-3, wherein the impermeable material includes gathering Ester.

16. according to the tissue thickness compensation part any one of claim 1-3, wherein at least one packaging part includes The packed component of at least one, the packed component include styptic, antiinflammatory, antibiotic, antimicrobial, anti-adhesion Agent, the combination of anti-coagulants, pharmaceutically active agents or above-mentioned substance.

17. according to the tissue thickness compensation part any one of claim 1-3, wherein at least one packaging part includes The packed component of at least one, the packed component include medicine.

18. tissue thickness compensation part according to claim 16, wherein at least one packed component is including anti-micro- Biological agent, the antimicrobial include triclosan, chlorhexidine or its salt, silver or its salt, ammonium or its salt, copper or its salt, iron or The combination of its salt, zinc or its salt or above-mentioned substance.

19. according to the tissue thickness compensation part any one of claim 1-3, wherein at least one packaging part includes Pipe, the pipe include polyglycolic acid, PLA, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone, polycaprolactone, Or the combination of above-mentioned substance.

20. according to the tissue thickness compensation part any one of claim 1-3, wherein at least one packaging part is in body Interior degraded.