CN106456162A - Implantable layers and methods for altering one or more properties of implantable layers for use with fastening instruments - Google Patents

Abstract

A method is disclosed for changing the spring rate of an implantable layer for use with a surgical instrument which includes the steps of obtaining an implantable layer having a first spring rate, wherein the implantable layer is at least partially comprised of a material having a glass transition temperature and a melting temperature, heating the implantable layer to a temperature higher than the glass transition temperature and lower than the melting temperature, deforming the implantable layer to change the first spring rate to a second spring rate, wherein the second spring rate is different than the first spring rate, allowing the implantable layer to cool below the glass transition temperature, and releasing the implantable layer.

Description

Implantable layer and for changing the implantable layer being used together with fastening instrument one The method of individual or multiple characteristic

Background technology

The present invention relates to surgical instrumenties, and in various arrangements, it is related to the surgery being designed to suture and cut tissue Suture and cutting device and its nail bin.

Brief description

By combining accompanying drawing following explanation, the features and advantages of the present invention and the realization with reference to embodiment of the present invention The mode of these feature and advantage will become more apparent, and is better understood invention itself, wherein：

Fig. 1 is to have the surgical stapling of handle portions and the front, left perspective view of cutting off apparatus；

Fig. 2 is surgical stapling and the two-piece type knife of cutting off apparatus and the perspective view of trigger shaft (" e-beam ") of Fig. 1；

Fig. 3 is the perspective view of the wedge-shaped slides of nail bin of nail administration assembly；

Fig. 4 is the longitudinal sectional drawing of nail bin and anvil block in the close position, and this nail bin includes rigid support portion and can Compression organization thickness compensation part, shows that nail never firing position during First ray moves to firing position；

Fig. 5 is the anvil block of Fig. 4 and another profile of nail bin, show complete in an open position after percussion sequence Anvil block；

Fig. 6 is the decomposition diagram of tissue thickness compensation part and nail bin groupware；

Fig. 7 is the partial sectional view of the nail bin groupware of Fig. 6, illustrates in the nail cavity be positioned at staple cartridge body and is partially submerged into tissue The nail not fired in thickness compensation part；

Fig. 8 is the partial sectional view of the nail bin groupware of Fig. 6, illustrates to project and against anvil block shaping from the nail cavity of staple cartridge body The nail of percussion, and the tissue thickness compensation part and capture tissue in the nail retention region of nail formed thereby is shown further；

Fig. 9 is the fragmentary, perspective view of the end effector of reuse surgical fasteners tool, and some of them part removes and illustrates, and Other parts are illustrated in cross-section；Additionally, the cutting element of end effector is shown in part propulsion position；

Figure 10 is the part section end-view of the end effector of Fig. 9, there is shown with patient tissue capture in end execution Between the anvil block of device and tissue thickness compensation part；Additionally, the nail being removedly stored in the warehouse of end effector is illustrated as The cutting element being in non-firing position and end effector is shown in and does not advance position near tissue thickness compensation part Put；

Figure 11 is the part section end-view of the end effector of Fig. 9, there is shown with nail and is in firing position and cuts Component is in part propulsion position, and wherein patient tissue is by crosscutting at least in part；

Figure 12 is the part section end-view of the end effector of Fig. 9, there is shown with nail and is in firing position and cuts Component is in propulsion position, and the wherein cut component of at least a portion of tissue thickness compensation part is crosscutting；

Figure 13 is the perspective view of the fastener cartridge including tissue thickness compensation part；

Figure 14 is the sectional view of the tissue thickness compensation part of Figure 13, illustrates the proximal end with respect to tissue thickness compensation part The cutting element of positioning；

Figure 15 is the exploded view of tissue thickness compensation part assembly；

Figure 16 is the perspective view of tissue thickness compensation part component layer；

Figure 17 is the sectional view of the tissue thickness compensation part assembly of Figure 15；

Figure 18 is tissue thickness compensation part assembly and the profile perspective for assembling its mould of assembling；

Figure 19 is the perspective view of the tissue thickness compensation part assembly of assembling of Figure 18；

Figure 20 is tissue thickness compensation part assembly and the perspective view for assembling its mould；

Figure 21 is tissue thickness compensation part assembly and the perspective view for assembling its mould；

Figure 22 is the profile perspective of the mould for assembling it of the tissue thickness compensation part assembly of Figure 21 and Figure 21；

Figure 23 is the perspective view of the end effector including tissue thickness compensation part；

Figure 24 is the end effector of Figure 23 and the modification structure of tissue thickness compensation part and modification tissue thickness compensation part The perspective view of part；

Figure 25 is the perspective view of the end effector of the tissue thickness compensation part of modification of inclusion Figure 24 of Figure 23；

Figure 26 is the profile perspective of tissue thickness compensation part；

Figure 27 is the profile perspective of the mould of the tissue thickness compensation part for changing Figure 26；

Figure 28 is the profile perspective of the tissue thickness compensation part after the mould modification by Figure 27 of Figure 26；

Figure 29 is the profile perspective of tissue thickness compensation part；

Figure 30 is the profile perspective of the mould of the tissue thickness compensation part for changing Figure 29；

Figure 31 is the profile perspective of the tissue thickness compensation part after the mould modification by Figure 30 of Figure 29；

Figure 32 is the profile perspective of tissue thickness compensation part；

Figure 33 is the profile perspective of the mould of the tissue thickness compensation part for changing Figure 32；

Figure 34 is the profile perspective of the tissue thickness compensation part after the mould modification by Figure 33 of Figure 32；

Figure 35 is the profile perspective of the tissue thickness compensation part including the first height；

Figure 36 is the saturating with the section of the tissue thickness compensation part being the second height by the first Level Change in modification of Figure 35 View；

Figure 37 is the sectional view of the mould of the tissue thickness compensation part for changing Figure 35；

Figure 38 is the profile perspective of tissue thickness compensation part；

Figure 39 is the profile perspective of the tissue thickness compensation part after modification of Figure 38；

Figure 40 is the curve chart of the impact of the flexible ratio illustrating compression stress to tissue thickness compensation part；

Figure 41 is the profile perspective of tissue thickness compensation part；

Figure 42 is the profile perspective of the space creator of the tissue thickness compensation part for changing Figure 41；

Figure 43 is the profile perspective of the tissue thickness compensation part after the space creator modification by Figure 42 of Figure 41；

The securing member being used together with the surgical instrumenties including firing member of at least one embodiment according to Figure 44 The broken section front view in storehouse, wherein partly removes and illustrates；

Figure 45 is broken section front view, illustrates that the tissue thickness of the fastener cartridge of Figure 44 just removing from fastener cartridge is mended The firing member repaid part and be shown in Figure 44 of lock-out state；

Figure 46 is the fragmentary, perspective view of the tissue thickness compensation part of Figure 45；

The fragmentary, perspective view of the tissue thickness compensation part of at least one embodiment according to Figure 47；

Figure 48 is supported including the fastener cartridge of the tissue thickness compensation part with Figure 47, sliding part and by sliding part The broken section front view of the end effector of the surgical instrumenties of firing member, wherein partly removes and illustrates；

Figure 49 is the broken section front view of the end effector of Figure 48, illustrates to be in the percussion structure of part firing position Part；

Figure 50 is the broken section front view of the end effector of Figure 48, illustrates that the tissue thickness removing from fastener cartridge is mended Firing member in repaying part and being in the lock state；

According to Figure 51, the fragmentary, perspective view of the fastener cartridge of at least one embodiment, wherein partly removes and illustrates；

Figure 52 is the perspective view of the sliding part of fastener cartridge of Figure 51；

Figure 53 is the fragmentary, perspective view of the fastener cartridge of Figure 51；

The front view of the sliding part of at least one embodiment according to Figure 54；

The perspective view of the sliding part being shown in unlocked configurations of at least one embodiment according to Figure 55；

Figure 56 is the perspective view of the sliding part being shown in locked configuration of Figure 55；

Figure 57 is the broken section front view of the sliding part being positioned in fastener cartridge of Figure 55, illustrates to be in its non-locking The tissue thickness of the sliding part of configuration, the firing member being supported by sliding part, and the fastener cartridge being engaged with sliding part is compensated Part；

Figure 58 is the broken section front view of the tissue thickness compensation part just removing from the fastener cartridge of Figure 57 of Figure 57, should The sliding part of Figure 55 is placed in its locked configuration and the firing member of Figure 57 is placed in lock-out state by fastener cartridge；

The local of the sliding part being positioned at the proximal end of fastener cartridge of at least one embodiment according to Figure 59 Sectional front view, wherein partly removes and illustrates；

Figure 60 is the broken section front view of the sliding part being shown at the distal end of fastener cartridge of Figure 59；

Figure 61 is the perspective view of the sliding part according at least one embodiment；

Figure 62 is the diagram of the nail illustrating the multiple barbs of inclusion according at least one embodiment, and wherein nail is illustrated as locating In unshaped configuration and deformed configuration；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 63, wherein nail is located in In the nail cavity of non-firing position；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 64；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 65；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 66；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 67；

The front view of the nail of the multiple barbs of inclusion of at least one embodiment according to Figure 68, wherein nail is located in In the nail cavity of non-firing position；

Figure 69 is the nail of Figure 68 and the plane graph of nail cavity；

The fragmentary, perspective view of the nail leg with barb of at least one embodiment according to Figure 70；

Figure 71 is the fragmentary, perspective view of the nail leg with barb of nail of Figure 68；

Figure 71 A is the sectional plain-view drawing of the nail leg with barb of Figure 71；

The fragmentary, perspective view of the nail leg with barb of at least one embodiment according to Figure 72；And

The fragmentary, perspective view of the nail leg with barb of at least one embodiment according to Figure 73.

Specific embodiment

Present applicant also has the U.S. Patent application of following identification, and these U.S. Patent applications are each to quote Mode is each integrally incorporated herein：

The U.S. of entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " Patent application serial number 12/894,311 (now for U.S. Patent Publication 2012/0080496)；

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 (now for U.S. Patent Publication 2012/0080482)；

The United States Patent (USP) Shen of entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " Please serial number 12/894,327 (now for U.S. Patent Publication 2012/0080499)；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND The U.S. Patent Application Serial Number of DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " 12/894,351 (now for U.S. Patent Publication 2012/0080502)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM The U.S. Patent Application Serial Number 12/894,338 (now for U.S. Patent Publication 2012/0080481) of ARRANGEMENT "；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " U.S. Patent Application Serial Number 12/894,369 (now for U.S. Patent Publication 2012/0080344)；

The U.S. of entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " State's patent application serial number 12/894,312 (now for U.S. Patent Publication 2012/0080479)；

The U.S. of entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " is special Sharp patent application serial numbers 12/894,377 (now for United States Patent (USP) 8,393,514)；

Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL The U.S. Patent Application Serial Number 12/894,339 (now for U.S. Patent Publication 2012/0080500) of ARRANGEMENT "；

Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING The U.S. Patent Application Serial Number 12/894,360 (now for U.S. Patent Publication 2012/0080484) of SYSTEM "；

Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE The U.S. Patent Application Serial Number 12/894,322 of CARTRIDGE ARRANGEMENTS " is (now for U.S. Patent Publication 2012/ 0080501)；

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES " U.S. Patent Application Serial Number 12/894,350 (now for U.S. Patent Publication 2012/0080478)；

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE The U.S. Patent Application Serial Number 12/894,383 (now for U.S. Patent Publication 2012/0080345) of LAYERS "；

The U.S. Patent Application Serial Number 12/894,389 of entitled " COMPRESSIBLE FASTENER CARTRIDGE " (now for U.S. Patent Publication 2012/0080335)；

The United States Patent (USP) of entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " Patent application serial numbers 12/894,345 (now for U.S. Patent Publication 2012/0080483)；

The U.S. Patent Application Serial Number 12/894,306 of entitled " COLLAPSIBLE FASTENER CARTRIDGE " (now for U.S. Patent Publication 2012/0080332)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION The U.S. Patent Application Serial Number 12/894,318 (now for U.S. Patent Publication 2012/0080480) of MATRIX ELEMENTS "；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT The U.S. Patent Application Serial Number 12/894,330 (now for U.S. Patent Publication 2012/0080503) of MATRIX "；

The U.S. Patent application sequence of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " Row number 12/894,361 (now for United States Patent (USP) 8,529,600)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM The U.S. Patent Application Serial Number 12/894,367 of COMPRISING A RETENTION MATRIX " is (now for U.S. Patent Publication 2012/0080485)；

The U.S. of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " State's patent application serial number 12/894,388 (now for United States Patent (USP) 8,474,677)；

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " U.S. Patent Application Serial Number 12/894,376 (now for U.S. Patent Publication 2012/0080486)；

Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING The U.S. Patent Application Serial Number 13/097,865 (now for U.S. Patent Publication 2012/0080488) of POCKETS "；

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " Patent application serial numbers 13/097,936 (now for U.S. Patent Publication 2012/0080339)；

Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE The U.S. Patent Application Serial Number 13/097,954 (now for U.S. Patent Publication 2012/0080340) of PORTION "；

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A The U.S. Patent Application Serial Number 13/097,856 of COMPRESSIBLE PORTION THEREOF " is (now for U.S. Patent Publication 2012/0080336)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent Application Serial Number 13/097,928 (now for U.S. Patent Publication 2012/0080490)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING The U.S. Patent Application Serial Number 13/097,891 of AN ADJUSTABLE ANVIL " is (now for U.S. Patent Publication 2012/ 0080489)；

The U.S. of entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " State's patent application serial number 13/097,948 (now for U.S. Patent Publication 2012/0083836)；

The U.S. Patent Application Serial Number 13/ of entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY " 097,907 (now for U.S. Patent Publication 2012/0080338)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING The U.S. Patent Application Serial Number 13/097,861 of DIFFERENT PROPERTIES " is (now for U.S. Patent Publication 2012/ 0080337)；

The U.S. Patent Application Serial Number 13/097 of entitled " STAPLE CARTRIDGE LOADING ASSEMBLY ", 869 (now for U.S. Patent Publication 2012/0160721)；

Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent Application Serial Number 13/097,917 (now for U.S. Patent Publication 2012/0083834)；

The United States Patent (USP) Shen of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " Please serial number 13/097,873 (now for U.S. Patent Publication 2012/0083833)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT The U.S. Patent Application Serial Number 13/097,938 (now for U.S. Patent Publication 2012/0080491) of COMPONENTS "；

Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/097,924 (now for U.S. Patent Publication 2012/0083835)；

The U.S. Patent Application Serial Number 13/ of entitled " SURGICAL STAPLER WITH FLOATING ANVIL " 242,029 (now for U.S. Patent Publication 2012/0080493)；

The U.S. Patent application sequence of entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " Row number 13/242,066 (now for U.S. Patent Publication 2012/0080498)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " Number 13/242,086 (now for U.S. Patent Publication 2013/0075450)；

The U.S. of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " Patent application serial number 13/241,912 (now for U.S. Patent Publication 2013/0075448)；

The U.S. Patent application of entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " Serial number 13/241,922 (now for U.S. Patent Publication 2013/0075449)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING The U.S. Patent Application Serial Number 13/241,637 of MULTIPLE ACTUATION MOTIONS " is (now for U.S. Patent Publication 2012/0074201)；

Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END The U.S. Patent Application Serial Number 13/241,629 (now for U.S. Patent Publication 2012/0074200) of EFFECTOR "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF The U.S. Patent Application Serial Number 13/433,096 (now for U.S. Patent Publication 2012/0241496) of CAPSULES "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " U.S. Patent Application Serial Number 13/433,103 (now for U.S. Patent Publication 2012/0241498)；

The U.S. Patent Application Serial Number of entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " 13/433,098 (now for U.S. Patent Publication 2012/0241491)；

The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " Patent application serial numbers 13/433,102 (now for U.S. Patent Publication 2012/0241497)；

Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/433,114 (now for U.S. Patent Publication 2012/0241499)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE The U.S. Patent Application Serial Number 13/433,136 (now for U.S. Patent Publication 2012/0241492) of MEDICAMENT "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND The U.S. Patent Application Serial Number 13/433,141 (now for U.S. Patent Publication 2012/0241493) of EXPANSION "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A The U.S. Patent Application Serial Number 13/433,144 (now for U.S. Patent Publication 2012/0241500) of RESILIENT LOAD "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A The U.S. Patent Application Serial Number 13/433,148 (now for U.S. Patent Publication 2012/0241501) of RESILIENT LOAD "；

The U.S. of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " State's patent application serial number 13/433,155 (now for U.S. Patent Publication 2012/0241502)；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS The U.S. Patent Application Serial Number 13/433,163 of FOR SURGICAL STAPLERS " is (now for U.S. Patent Publication 2012/ 0248169)；

The U.S. Patent Application Serial Number 13/433,167 of entitled " TISSUE THICKNESS COMPENSATORS " (now for U.S. Patent Publication 2012/0241503)；

The U.S. Patent Application Serial Number 13/ of entitled " LAYERED TISSUE THICKNESS COMPENSATOR " 433,175 (now for U.S. Patent Publication 2012/0253298)；

Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " U.S. Patent Application Serial Number 13/433,179 (now for U.S. Patent Publication 2012/0241505)；

The U.S. Patent Application Serial Number 13/763,028 of entitled " ADHESIVE FILM LAMINATE " is (now for the U.S. Patent disclosure 2013/0146643)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A The U.S. Patent Application Serial Number 13/433,115 of LOW PRESSURE ENVIRONMENT " is (now for U.S. Patent Publication 2013/ 0256372)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF The U.S. Patent Application Serial Number 13/433,118 (now for U.S. Patent Publication 2013/0256365) of MATERIALS "；

Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent Application Serial Number 13/433,135 (now for U.S. Patent Publication 2013/0256382)；

Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent Application Serial Number 13/433,140 (now for U.S. Patent Publication 2013/0256368)；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF The U.S. Patent Application Serial Number 13/433,129 (now for U.S. Patent Publication 2013/0256367) of MEDICAMENTS "；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED The U.S. Patent Application Serial Number 11/216,562 (now for United States Patent (USP) 7,669,746) of STAPLE HEIGHTS "；

Entitled " SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING The U.S. Patent Application Serial Number 11/714,049 of POCKETS OF VARYING DEPTHS " is (now for U.S. Patent Publication 2007/0194082)；

Entitled " SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING The U.S. Patent Application Serial Number 11/711,979 (now for United States Patent (USP) 8,317,070) of DIFFERENT LENGTHS "；

Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT The U.S. Patent Application Serial Number 11/711,975 (now for U.S. Patent Publication 2007/0194079) of HEIGHT "；

Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES " U.S. Patent Application Serial Number 11/711,977 (now for United States Patent (USP) 7, 673,781)；

Entitled " SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS " U.S. Patent Application Serial Number 11/712,315 (now for United States Patent (USP) 7, 500,979)；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED The U.S. Patent Application Serial Number 12/038,939 (now for United States Patent (USP) 7,934,630) of STAPLE HEIGHTS "；

Entitled " SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING The U.S. Patent Application Serial Number 13/020,263 of DIFFERENT LENGTHS " is (now for U.S. Patent Publication 2011/ 0147434)；

Entitled " ROBOTICALLY-CONTROLLEDSURGICAL STAPLING DEVICES THAT PRODUCE The U.S. Patent Application Serial Number 13/118,278 of FORMED STAPLES HAVING DIFFERENT LENGTHS " is (now for U.S. State's patent disclosure 2011/0290851)；

The U.S. of entitled " ROBOTICALLY-CONTROLLEDCABLE-BASED SURGICAL END EFFECTORS " State's patent application serial number 13/369,629 (now for U.S. Patent Publication 2012/0138660)；

Entitled " SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT The U.S. Patent Application Serial Number 12/695,359 (now for United States Patent (USP) 8,464,923) of FORMED HEIGHTS "；

Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED The U.S. Patent Application Serial Number 13/072,923 (now for United States Patent (USP) 8,567,656) of STAPLE HEIGHTS "；

The U.S. Patent application sequence of entitled " LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR " Row number 13/766,325 (now for U.S. Patent Publication 2013/0256380)；

The U.S. of entitled " ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR " State's patent application serial number 13/763,078 (now for U.S. Patent Publication 2013/0256383)；

The U.S. Patent application of entitled " LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS " Serial number 13/763,094 (now for U.S. Patent Publication 2013/0256377)；

The U.S. of entitled " END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER " Patent application serial number 13/763,106 (now for U.S. Patent Publication 2013/0256378)；

The United States Patent (USP) Shen of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " Please serial number 13/433,147 (now for U.S. Patent Publication 2013/0256369)；

The U.S. of entitled " SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES " State's patent application serial number 13/763,112 (now for U.S. Patent Publication 2013/0256379)；

Entitled " ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A The U.S. Patent Application Serial Number 13/763,035 of FASTENER CARTRIDGE " is (now for U.S. Patent Publication 2013/ 0214030)；

Entitled " RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE The U.S. Patent Application Serial Number 13/763,042 (now for U.S. Patent Publication 2013/0221063) of HAVING THE SAME "；

Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS The U.S. Patent Application Serial Number 13/763,048 (now for U.S. Patent Publication 2013/0221064) of COMPENSATOR "；

Entitled " FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A The U.S. Patent Application Serial Number 13/763,054 of TISSUE THICKNESS COMPENSATOR "；

Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE The U.S. Patent Application Serial Number 13/763,065 of THICKNESS COMPENSATOR " is (now for U.S. Patent Publication 2013/ 0221065)；

The U.S. Patent application of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER " Serial number 13/763,021；

The U.S. of entitled " ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR " State's patent application serial number 13/763,078 (now for U.S. Patent Publication 2013/0256383)；

The United States Patent (USP) Shen of entitled " LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES " Please serial number 13/763,095 (now for U.S. Patent Publication 2013/0161374)；

The U.S. of entitled " IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES " Patent application serial number 13/463,147 (now for U.S. Patent Publication 2013/0292398)；

Entitled " MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING The U.S. Patent Application Serial Number 13/763,192 (now for U.S. Patent Publication 2013/0146642) of DEVICES "；

Entitled " RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING The U.S. Patent Application Serial Number 13/763,161 (now for U.S. Patent Publication 2013/0153641) of THE SAME "；

Entitled " ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END The U.S. Patent Application Serial Number 13/763,177 (now for U.S. Patent Publication 2013/0146641) of EFFECTOR "；

The United States Patent (USP) of entitled " STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION " Patent application serial numbers 13/763,037；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH The U.S. Patent Application Serial Number 13/433,126 (now for U.S. Patent Publication 2013/0256366) of FEATURES "；

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS The U.S. Patent Application Serial Number of COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " 13/433,132 (now for U.S. Patent Publication 2013/0256373).

Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR The U.S. Patent Application Serial Number 13/851,703 of INCLUDING OPENINGS THEREIN "；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH " U.S. Patent Application Serial Number 13/851,676；

The U.S. Patent Application Serial Number 13/851,693 of entitled " FASTENER CARTRIDGE ASSEMBLIES "； And

Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR The U.S. Patent Application Serial Number 13/851,684 of AND A GAP SETTING ELEMENT ".

Present applicant also has a following patent application, and described patent application and the application submit to and entirely on the same day Literary composition is each herein incorporated by reference：

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7439USNP)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7440USNP)；

The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING A BARBED STAPLE " Number _ _ _ _ _ _ _ _ _ _ (attorney END7441USNP)；

Entitled " IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS The U.S. Patent Application Serial Number of FOR USE WITH SURGICAL FASTENING INSTRUMENTS " _ _ _ _ _ _ _ _ _ _ (generation Reason people file number END7349USNP/130323)；

Entitled " IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE The United States Patent (USP) Shen of IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT " Please serial number _ _ _ _ _ _ _ _ _ _ (attorney END7347USNP/130325)；

The U.S. Patent Application Serial Number of entitled " IMPLANTABLE LAYER ASSEMBLIES " _ _ _ _ _ _ _ _ _ _ (generation Reason people file number END7346USNP/130326)；

The U.S. Patent application of entitled " IMPLANTABLE LAYERS COMPRISING A PRESSED REGION " Serial number _ _ _ _ _ _ _ _ _ _ (attorney END7345USNP/130327)；And

The United States Patent (USP) of entitled " FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT " Patent application serial numbers _ _ _ _ _ _ _ _ _ _ (attorney END7350USNP/130328).

Some exemplary will now be described, to understand the knot of apparatus as disclosed herein and method on the whole The principle of structure, function, manufacture and use.One or more examples of these embodiments are shown in the drawings.This area general Logical technical staff will be understood that, herein specifically describing and be illustrated in the apparatus and method in accompanying drawing is nonrestrictive example Property embodiment, and the scope of multiple embodiments of the present invention is limited only by the appended claims.In conjunction with an exemplary reality The scheme of applying illustrates or the feature that describes can be combined with the feature of other embodiments.Such modification and modification are intended to be included in In the scope of the present invention.

Term " inclusion " (and any form including, such as " include (comprises) " and " include (comprising) "), " there is " (and any form having, such as " have (has) " and " having (having) "), " bag Contain " (and any form comprising, such as " comprise (includes) " and " comprising (including) " and " containing " (and contain Any form having, such as " containing (contains) " and " containing (containing) ") it is open link-verb.Therefore, " bag Include ", " having ", "comprising" or " containing " Surgery Systemss of one or more elements, device or equipment has these or many Individual element, but it is not limited to that only there are these one or more elements.Equally, " include ", " having ", "comprising" or " containing " one Or the element of the system, device or equipment of multiple feature has these one or more features, but be not limited to only to have these one Individual or multiple features.

The clinician that term " nearside " and " distally " are herein defined as the handle portions with respect to manipulation of surgical apparatus comes Use.Term " nearside " refers to the part near clinician, and term " distally " refers to the portion away from clinician Point.It is also understood that for the sake of succinct and clear, accompanying drawing can be combined herein and uses such as " vertical ", " level ", "up" and "down" Etc spatial terminology.However, surgical instrumenties use in many orientations and position, and these terms and non-limiting and/ Or absolutization.

There is provided various exemplary means and method to execute laparoscopic type and minimally invasive surgical procedures.However, this area Those of ordinary skill will readily appreciate that, various method and apparatus disclosed herein can be used for many surgical operations and application In, including for example combining with open surgery.With continued reference to this specific embodiment, person skilled in the art Member will be further understood that, various apparatuses disclosed herein can insert in vivo by any way, such as passes through natural cavity, passes through It is formed at otch or puncturing hole in tissue etc..The working portion of apparatus or end effector portion can be plugged directly into patient's body Interior or can be inserted by having the entrance device of service aisle, the end effector of surgical instrumenties and slender axles can be by described works Make passage and advance.

Go to accompanying drawing, wherein similar numbering indicates similar component in all of the figs, Fig. 1 illustrates to be suitable to and tissue thickness is mended Repay exemplary surgical suture and the cutting off apparatus 8010 that part assembly is used together, described in greater detail below.Surgical stapling May include anvil block 8014 with cutting off apparatus 8010, this anvil block can be around it to the pivotal attachment of elongate staple channel 8016 by repeatedly Open and close.Nail administration assembly 8012 may include anvil block 8014 and passage 8016, and wherein assembly 8012 can proximally be attached to Form the slender axles 8018 of tool portion 8022.When nail administration assembly 8012 closes or at least substantially closing, enforcement division Divide 8022 can assume sufficiently small cross section, this cross section is suitable to pass through the trocar to insert nail administration assembly 8012.Various In the case of, assembly 8012 can be manipulated by the shank 8020 connecting to axle 8018.Shank 8020 may include user control such as knob 8030, this knob makes slender axles 8018 and nail administration assembly 8012 around the longitudinal axis rotation of axle 8018.Closure trigger 8026 can pivot in pistol grip 8036 front to close nail administration assembly 8012.For example, when closure trigger 8026 is pressed from both sides When tight, closure release button 8038 can outwards be present on shank 8020 so that release button 8038 can be depressed is closed with unclamping Close trigger 8026 and open nail administration assembly 8012.The firing trigger 8034 that can pivot in closure trigger 8026 front can Make that nail administration assembly 8012 is cut off simultaneously and suture is clamped at tissue therein.In all cases, can be using percussion triggering Device 8034 to adopt multiple firing schedules to reduce the size of the power that every stroke needs are applied by surgical handss.In some realities Apply in scheme, shank 8020 may include one or more rotatable indicator wheel, such as may indicate that the rotatable finger of percussion process Show device wheel 8041.If necessary, manually percussion trip lever 8042 can allow trigger system firing before traveling completes completely Retraction, and additionally, in the case that trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon Or other clinicians make trigger system bounce back.With regard to surgical stapling and cutting off apparatus 8010 be suitable to be used together with the disclosure Other surgical staplings and cutting off apparatus additional detail for example on March 27th, 2013 submit to entitled " FASTENER The U.S. Patent application 13/851 of CARTRIDGE ASSEMBLY ", is described in 693, the complete disclosure of this patent with Way of reference is expressly incorporated herein.Additionally, the surgical stapling of energising and cutting off apparatus also can be used together with the disclosure.See, for example, The U.S. Patent Application Publication of entitled " the POWERED SURGICAL STAPLING DEVICE " of August in 2008 submission on the 8th 2009/0090763A1, the complete disclosure of this patent is herein incorporated by reference.

In conjunction with Fig. 2 and Fig. 3, firing assembly (such as firing assembly 9090) can be together with surgical stapling and cutting off apparatus 8010 Using the wedge-shaped slides 9126 advancing including multiple wedge 9204, described wedge is configured to apply nail from nail It is deployed in tissue between anvil block 8014 and elongate staple channel 8016 for the capture with assembly 8012.Additionally, in percussion assembly The e-beam 9102 of 9090 extremity office can be conducive to individually closing and firing, and during firing by anvil block 8014 with Elongate staple channel 8016 is spaced apart.E-beam 9102 may include a pair of top pin 9110, can follow the part of wedge-shaped slides 9126 9218 a pair of intermediate pin 9112, and base pins or leg 9114, and sharp cutting edge 9116, this cutting edge can be constructed Cut-out captured tissue when one-tenth can advance towards distally firing assembly 9090.Additionally, hold cutting edge 9116 each hang down Straight end proximally project be integrally formed top guide part 9118 and intermating guides 9120 can limit tissue assembly further Region 9122, thus contribute to guiding to sharp cutting edge 9116 before cut-out tissue.Intermating guides 9120 are also Can be used for engaging and firing nail administration assembly by the staged central member 9124 of adjacent wedge-shaped slides 9126 (Fig. 2) 8012, described wedge-shaped slides are passed through nail administration assembly 8012 impact nail and are shaped.

In all cases, nail bin may include for mending in the thickness of the tissue in the nail of cartridge deployment to capture The device repaid.Referring to Fig. 4, nail bin (such as nail bin 10000) for example can be used together simultaneously with surgical stapling and cutting off apparatus 8010 And may include rigid Part I (such as support section 10010) and compressible Part II (such as tissue thickness's benefit Repay part 10020).Support section 10010 may include warehouse and multiple nail cavity 10012.Nail 10030 for example can removedly position In each nail cavity 10012.Referring primarily to Fig. 4 and Fig. 5, each nail 10030 may include base portion 10031 and from base portion 10031 The one or more lower limbs 10032 extending.Before nail 10030 is deployed, the base portion 10031 of nail 10030 can be by being positioned at support Staple drivers in part 10010 support, and the lower limb 10032 of nail 10030 simultaneously can be at least partially recessed into nail cavity 10012 Interior.In all cases, nail 10030 can be deployed between non-firing position and firing position so that lower limb 10032 moves across Tissue thickness compensation part 10020, penetrate the top surface of tissue thickness compensation part 10020, penetrate tissue T, and contacting and follow closely The anvil block of storehouse 10000 relative localization.When lower limb 10032 is against deflection, the lower limb 10032 of each nail 10030 can capture tissue A part for tissue T in a part for thickness compensation part 10020 and each nail 10030, and apply compressive force to group Knit.To being described further above, the lower limb 10032 of each nail 10030 can be made to deform downwardly toward the base portion 10031 of nail, with shape Become nail retention region, in this nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In various situations Under, nail retention region can be limited between inner surface and the inner surface of base portion 10031 of strained lower limb 10032.Nail retention The size in region may depend on a number of factors, the length of such as lower limb, the journey of the diameter of lower limb, the width of base portion and/or leg deformation Degree.

In use, to being described further above and referring primarily to Fig. 4, surgical stapling and cutting off apparatus 8010 Anvil block such as anvil block 8014 can by press closure trigger 8026 and move in the make position relative with nail bin 10000 with Propulsion e-beam 9102.Tissue can be positioned by anvil block 8014 against tissue thickness compensation part 10020, and in all cases, example As tissue thickness compensation part 10020 is compressed against support section 10010.Once anvil block 8014 suitably positions, then can dispose Nail 10030, also shown in FIG. 4.In all cases, as described above, in many aspects similar to sliding part 9126 (referring to figure 3) nail percussion sliding part 10050 can be moved towards distal end 10002 from the proximal end of nail bin 10000, as shown in Figure 5.When When percussion assembly 9090 is pushed into, sliding part 10050 can contact staple drivers 10040 and is lifted up following closely in nail cavity 10012 Driver 10040.In at least one example, sliding part 10050 and staple drivers 10040 can each include one or more tiltedly Slope or inclined surface, one or more of slopes or inclined surface can cooperate so that staple drivers 10040 not hitting from them Send out position to move upwards.When staple drivers 10040 are moving upward in the nail cavity 10012 of each of which, staple drivers 10040 Can be lifted up following closely 10030 so that nail 10030 can occur from its nail cavity 10012.In all cases, as percussion sequence A part, sliding part 10050 can make some nails move upwards simultaneously.

As mentioned above and referring to Fig. 5, when following closely the non-firing position that 10030 are in them, the nail leg 10032 of nail 10030 May extend into and in compensating part 10020, exceed support section 10010.In all cases, when nail 10030 is in not firing of they During position, any other part of the tip of nail leg 10032 or nail leg 10032 may not project through tissue thickness compensation part 10020 top tissue contacting surface 10021.In some cases, the tip of nail leg 10032 may include and can cut and penetrate The sharp tip of tissue thickness compensation part 10020.

In all cases it may be preferred to prevent and/or limit the frictional force between tissue thickness compensation part and nail. Referring now to Fig. 6 to Fig. 8, the tissue thickness compensation part 20220 for being used together with nail bin groupware 20200 may include at least portion Extend through multiple mesopores 20224 of tissue thickness compensation part 20220 with dividing.In all cases, nail bin groupware 20200 can The tissue thickness compensation part 20220 releasedly fix including staple cartridge body 20210 and with respect to staple cartridge body 20210.Warehouse 20210 May include such as storehouse platform 20211 and be defined through storehouse platform 20211 and enter the nail cavity in the main body of staple cartridge body 20210 20212.Nail 20230 for example can be removably positioned in nail cavity 20212.Tissue thickness compensation part 20220 may include tissue Contact surface 20221 (Fig. 7) and platform contact surface 20222 (Fig. 6).Contact with platform surface 20222 can releasedly against The platform 20211 of such as warehouse 20210 positions, and tissue contacting surface 20221 can be fixed against tissue T for example to be stapled Position.Mesopore 20224 can extend across contact with platform surface 20222 and enters in tissue thickness compensation part 20220 and can Hole, slit, gap, the path of bore hole, opening and/or removing is included for example in tissue thickness compensation part 20220.

Referring primarily to Fig. 7 and Fig. 8, follow closely 20230 and can be positioned in the nail cavity 20212 of warehouse 20210.Each nail 20230 can Including base portion 20231 and a pair of nail leg 20232, for example, described nail leg can extend from base portion 20231.Each nail leg 20232 can be from The relative both ends of base portion 20231 extend.Referring primarily to Fig. 7, in the mesopore 20224 in tissue thickness compensation part 20220 One or more openings that may include in contact with platform surface 20222.The opening of mesopore 20224 can be positioned at nail cavity Corresponding nail leg 20232 in 20212 is aligned.For example, when tissue thickness compensation part 20220 is fixing with respect to warehouse 20210, single Individual nail leg 20232 can be aligned with the opening of single mesopore 20224.In some cases, nail leg 20232 may extend into each So that at least a portion of nail 20230 embeds in such as tissue thickness compensation part 20220 in lyriform pore 20224.For example, main ginseng See Fig. 7, nail 20230 may include the first nail leg 20232a and the second nail leg 20232b.Additionally, tissue thickness compensation part 20220 can Including the first mesopore 20224a being for example aligned with the first nail leg 20232a, and second being aligned with the second nail leg 20232b Mesopore 20224b.Before deployment nail 20230, for example, the first nail leg 20232a can extend partially across the first mesopore 20224a, and the second nail leg 20232b can extend partially across the second mesopore 20224b.Tissue thickness compensation part 20220 can Including the modification space hole 20224 not for example being aligned with nail leg 20232.In some cases, nail bin groupware 20200 may include example As the additional nail 20230 that is not aligned with mesopore 20224 and/or nail leg 20232.

Nail 20230 never percussion configuration (Fig. 7) can move to percussion configuration (Fig. 8).Each nail 20230 can not fire structure Along nail axial-movement when moving between type and percussion configuration.When being in non-percussion configuration, nail leg 20232 can be from nail cavity 20212 Extend and enter in such as tissue thickness compensation part 20220.For example, when nail 20230 is in non-percussion configuration, nail leg 20232 Can be partially submerged in tissue thickness compensation part 20220.Additionally, for example, when nail is in non-percussion configuration, nail leg 20232 is extremely A few part can be aligned with the mesopore 20224 of tissue thickness compensation part 20220 and/or be positioned at tissue thickness compensation part Gap in the hole.In other cases, when being in non-percussion configuration, nail leg 20232 can be entirely positioned at nail cavity 20212 Interior, and can be aligned with the mesopore 20224 being for example positioned above storehouse platform 20211 (Fig. 6).

During firing schedule, nail 20230 never percussion configuration (Fig. 7) can move to percussion configuration (Fig. 8), as this paper institute State.Staple drivers 20240 can be positioned in each nail cavity 20212.Staple drivers 20240 in each nail cavity 20212 can court Storehouse platform 20211 (Fig. 6) promotes, and for example, nail 20230 is driven in tissue T and drives (Fig. 8) towards anvil block 20260, should Anvil block can be in many aspects similar to other anvil blocks as herein described, such as anvil block 8014 (Fig. 1).In each nail 20230 never When percussion configuration moves to percussion configuration, the movable mesopore through in tissue thickness compensation part 20220 of nail leg 20232 20224.Mesopore 20224 can have the predetermined trajectories in tissue thickness compensation part 20220.For example, mesopore 20224 can along hang down Straight in and/or be substantially perpendicular to tissue contacting surface 20221 (Fig. 7) and/or the platform of tissue thickness compensation part 20220 The axis of contact surface 20222 (Fig. 6) extends.In other cases, mesopore 20224 can be mended along with respect to such as tissue thickness Repay the tissue contacting surface 20221 of part 20220 and/or contact with platform surface 20222 is extended with the axis that oblique angle is orientated.Some In the case of, one group of mesopore 20224 can be parallel.In some cases, for example, the institute in tissue thickness compensation part 20220 There is mesopore 20224 can be parallel.Mesopore 20224 may include the path of part bending and/or the path of partial linear.Between Entitled " the FASTENER CARTRIDGE that other characteristics of lyriform pore 20224 and feature were submitted on March 27th, 2013 The U.S. Patent application 13/851 of ASSEMBLY ", is more fully described in 693, and the complete disclosure of this patent is with the side of quoting Formula is expressly incorporated herein.For tissue thickness compensation part is revised as existing including the methods and techniques of mesopore such as mesopore 20224 Hereinafter it is more fully described.

Referring now to Fig. 9 to Figure 12, in many aspects similar to the end effector of the surgical instrumenties of surgical instrumenties 8010 22090 for example may include first jaw with fastener cartridge assembly 22000 and second jaw with anvil block 10060.First Jaw may include staple cartridge channel 10070, and this staple cartridge channel is configured to removedly receive storehouse assembly 22000.Alternative Ground, staple cartridge channel 10070 and storehouse assembly 22000 may include integral unit.In all cases, anvil block 10060 can be in open position Put motion and make position (Fig. 9 to Figure 12) between.In the open position of anvil block 10060, for example, anvil block 10060 can position On the first side of the tissue T (Figure 10 to Figure 12) of patient, and storehouse assembly 22000 can be positioned on the second of tissue T or relative On side.When anvil block 10060 moves in its make position, anvil block 10060 can be against storehouse assembly 22000 compression organization T.Alternative Ground, the first jaw including storehouse assembly 22000 can move with respect to anvil block 10060.In many aspects similar to percussion assembly The firing member 10052 of 9090 (Fig. 3) can be from the proximal end 22001 of storehouse assembly 22000 towards the distal end of storehouse assembly 22000 22002 towards distally propulsion so that in firing member 10052, proximally end 22001 pushes away towards the distal end 22002 of storehouse assembly 22000 Project securing member when entering, be such as removedly stored in the nail 22030 in the warehouse 22010 of storehouse assembly 22000.

To being described further above, nail 22030 can be supported by staple drivers 10040, and this staple drivers is movably fixed In nail cavity 22012 in being limited to warehouse 22010 for the position.Additionally, firing member 10052 is configured in firing member 10052 proximally end 22001 towards distal end 22002 move when in warehouse 22010 towards distally advance nail percussion sliding part 10050.In such cases, nail percussion sliding part 10050 is configured to lift staple drivers towards anvil block 10060 10040 and the nail 22030 that is supported on.Substantially, to being described further above, staple drivers 10040 can make nail 22030 never firing positions (Figure 10) move to firing position (Figure 11 and Figure 12), wherein the accessible anvil block 10060 of nail 22030 And deform between not deformed configuration (Figure 10) and deformed configuration (Figure 11 and Figure 12).Anvil block 10060 may include forming pit 10062, this forming pit is configured to receive nail 22030 and make nail deform.Nail 22030 can with for example follow closely 10030 And/or any other nail disclosed herein is same or similar, and therefore, nail 22030 is not herein more fully described. However, readers will note that, nail 22030 for example includes any suitable shape in its not deformed configuration and/or its deformed configuration Shape and/or suitably sized, such as width and/or height.For example, in some cases, do not fire position when nail 22030 is in it When putting, nail 22030 may include the height not extended on the platform surface 22011 of warehouse 22010, and in other cases, When nail 22030 is in its non-firing position, the lower limbs that nail 22030 may include wherein nail 22030 prolong upwards from platform surface 22011 The height stretched is so that the lower limb of nail 22030 is at least partially embedded in the tissue thickness compensation part 22010 of storehouse assembly 22000.

With continued reference to the embodiment shown in Fig. 9 to Figure 12, to being described further above, storehouse assembly 22000 can Including warehouse 22010 and tissue thickness compensation part 22020.In all cases, warehouse 22010 can for example be similar in many aspects In support section 10010, therefore, for simplicity, the many in such aspect does not herein repeat.Additionally, tissue is thick Degree compensating part 22020 can be for example in many aspects similar to tissue thickness compensation part 10020.To being described further above, Firing member 10052 may include cut portion 10053, and this cut portion is configured in firing member 10052 towards remote The crosscutting tissue being positioned between anvil block 10060 and tissue thickness compensation part 22020 during the propulsion of side.Therefore, in all cases, Firing member 10052 be configured to simultaneously percussion nail 22030 to suture tissue T and to cut tissue T.In some situations Under, percussion process can cause cutting process at least in part.In other words, cutting process can delayed percussion process.In such feelings Under condition, a part for tissue T can be sewn, and then cuts.

As shown in Fig. 9 to Figure 12, warehouse 22010 may include storehouse cutter slit 22015, and this storehouse cutter slit is configured to Receive a part for firing member 10052 towards distally when firing member 10052 advances.To being described further above, anvil Seat 10060 may include anvil block cutter slit 10065, and this anvil block cutter slit is configured in firing member 10052 towards distally A part for firing member 10052 is received during propulsion.In all cases, tissue thickness compensation part 22020 may include tissue thickness Degree compensating part cutter slit 22025, this tissue thickness compensation part cutter slit can be with anvil block cutter slit 10065 and storehouse cutter slit 22015 Be aligned is so that firing member 10052 can pass through storehouse cutter slit 22015, anvil block cutter slit 10065 and tissue thickness compensation part simultaneously Cutter slit 22025.In all cases, anvil block cutter slit 10065 can be prolonged above tissue thickness compensation part cutter slit 22025 Stretch so that the cut portion 10053 of firing member 10052 can pass through storehouse cutter slit 22015, anvil block cutter slit 10065 and simultaneously Tissue thickness compensation part cutter slit 22025.Tissue thickness compensation part cutter slit 22025 can limit the tissue of cut portion 10053 Thickness compensation part cutter track footpath, wherein tissue thickness compensation part cutter track footpath can be parallel to anvil block cutter track footpath and storehouse cutter track footpaths.Various In the case of, tissue thickness compensation part cutter track footpath can be longitudinal direction, and in some cases, tissue thickness compensation part cutter track footpath can be Bending.To being described further above, the fastener cartridge of the end effector of bending and bending is public in U.S. Patent application Have disclosed in cloth 2008/0169329.Entitled " the CURVED END EFFECTOR FOR A that on January 11st, 2007 submits to The U.S. Patent Application Serial Number 11/652,164 of SURGICAL STAPLING DEVICE " is (now for U.S. Patent Application Publication 2008/0169329) during complete disclosure is hereby incorporated by reference.In such cases, tissue thickness compensates Part can be bending.In at least one such embodiment, tissue thickness compensation part can be bending, to mate fastener cartridge Warehouse curvature.For tissue thickness compensation part being revised as the methods and techniques including cutter slit such as cutter slit 22025 Hereinafter it is described.

To being described further above, referring primarily to Fig. 9, tissue thickness compensation part cutter slit 22025 can be in the first seam Close and extend between part 22021a and the second sutured portion 22021b, this first sutured portion can be sutured by first group of nail 22030, This second sutured portion can be by second group of nail 22030 suture.Cutter slit 22025 can by the first sutured portion 22021a releasedly It is connected to the second sutured portion 22021b.In use, as shown in figure 9, cut portion 10053 can be advanced through knife towards distally narrow Groove 22025 is separated with the second sutured portion 22021b with crosscutting cutter slit 22025 and by the first sutured portion 22021a.At certain In the case of a little, cutter slit 22025 may include multiple adapters or bridgeware 22026, its can cut part 10053 crosscutting it Front connection the first sutured portion 22021a and the second sutured portion 22021b.In all cases, at least compensate in tissue thickness When part 22020 is in uncompressed state, adapter 22026 can have and the first sutured portion 22021a and/or the second suturing part Divide 22021b identical thickness.In at least one under such circumstances, adapter 22026, the first sutured portion 22021a and/or Second sutured portion 22021b by for example flat or at least substantially flat material piece entirety and can form.Each In the case of planting other, the first sutured portion 22021a may include first thickness, and it is thick that the second sutured portion 22021b may include second Degree, and adapter 22026 may include the 3rd thickness, wherein one of first thickness, second thickness and the 3rd thickness or many Person may differ from other thickness.

Cutter slit 22025 may also include and is for example defined in hole therein, such as hole 22024.For example, hole 22024 can be thin Long and can be along cutter slit 22025 longitudinal extension.In the case of various other, the hole in cutter slit 22025 may include any Suitable arrangement.In some cases, hole 22024 may include the perforation being positioned in the middle of adapter 22026, and it can be utilized for example Laser cutting operation is forming.In some cases, hole 22024 can be cut to tissue thickness compensation part from material piece 22020 so that hole 22024 and adapter 22026 are for example arranged in the way of being alternately arranged.In other cases, tissue thickness Compensating part 22020 may be molded pore-forming 22024 and has been formed on wherein.In all cases, one or more of hole 22024 can be wrapped Include such as through hole.In all cases, one or more of hole 22024 may include such as mesopore.In some cases, hole One or more of 22024 may not include through hole, and can have the reduce thickness of such as cutter slit 22025 on the contrary.For Tissue thickness compensation part is revised as hereinafter being described including the methods and techniques in hole such as hole 22024.

To being described further above, refer again to Fig. 9 to Figure 11, when anvil block 10060 is in an open position, patient Tissue can be positioned in the anvil block 10060 of end effector 22090 and storehouse assembly 22000 tissue thickness compensation part 22020 it Between.When anvil block 10060 moves in make position, the lower surface of anvil block 10060 or tissue contacting surface 10063 can contact Tissue T and the platform surface 22011 promotion tissue T towards warehouse 22010.Tissue T can contact tissue thickness compensation part 22020 Top surface or tissue contacting surface 22021, wherein when anvil block 10060 moves in its make position, anvil block 10060 can support Press tissue T by tissue thickness compensation part 22020, and to being described further above, against the platform table of warehouse 22010 Face 22011 compression organization thickness compensation part 22020.In all cases, tissue thickness compensation part 22020 may include lower surface 22029, this lower surface can abutment platforms surface 22011.In some cases, in tissue thickness compensation part 22020 against storehouse Before body 22010 is compressed, gap may be present between lower surface 22029 and platform surface 22011.In such cases, Tissue thickness compensation part 22020 can translate towards warehouse before against warehouse 22010 by compression first.Work as tissue thickness compensation part 22020 against warehouse 22010 compressed when, in all cases, the first sutured portion of tissue thickness compensation part 22020 22021a and/or the second sutured portion 22021b can transverse movements.For example, the first sutured portion 22021a and/or the second suture Part 22021b can move laterally away from storehouse cutter slit 22015.In all cases, adapter 22026 is configured to Suppress the such transverse movement between the first sutured portion 22021a and the second sutured portion 22021b.In all cases, main Will be referring to Figure 11, adapter 22026 is configured to stretching to allow the first sutured portion when anvil block 10060 closes Some relative lateral motion between 22021a and the second sutured portion 22021b.Situation about being switched on again in anvil block 10060 Under, adapter 22026 is configured to return resiliently to, or at least substantially returns to its non-stretched configuration, and makees For result, the first sutured portion 22021a and the second sutured portion 22021b are laterally drawn towards its initial position shown in Figure 10 Return.Additionally, when anvil block 10060 moves in its make position, the compressible tissue T of anvil block 10060.In such cases, group Knit T can flow at least in part in hole 22024.

When checking Figure 10 to Figure 12, readers will recognize that, the cutter slit 22025 of tissue thickness compensation part 22020 is along it Longitudinal length includes the material fewer than the first sutured portion 22021a and/or the second sutured portion 22021b.In other words, pass through The longitudinal cross-section of the first sutured portion 22021a and/or the second sutured portion 22021b is by the material of crosscutting first amount, and wears Cross the longitudinal cross-section of cutter slit 22025 by the material of the second few for the crosscutting material than the first amount amount.

Once anvil block 10060 is properly positioned, to being described further above, firing member 10052 can be towards remote Side advances with percussion nail, as shown in figure 11, and cuts tissue T and adapter 22026, as shown in figure 12.Additionally, tissue thickness Compensating part cutting-in force, tissue cutting-in force, tissue thickness compensation part resistance and/or tissue resistance can make cutting of firing member 10052 Cut part 10053 to be passivated.Blunt knife may not be for example according to preferred mode transecting patient tissue T and/or tissue thickness compensation part 22020.Referring primarily to Figure 12, cut portion 10053 may include the such as first blade area 10053a, the second blade area 10053b And/or the 3rd blade area 10053c, the wherein first blade area 10053a is vertically oriented on above the second blade area 10053b, and Wherein second blade area 10053b is vertically oriented on above the such as the 3rd blade area 10053c.Cut portion 10053 may include appoints What suitable number and/or the blade area of position, have wherein selected the blade area shown in Figure 12 for purposes of discussion.To above It is described further, the first blade area 10053a is configured to transecting patient tissue T, and the second blade area 10053b can quilt It is constructed to be permeable to transecting patient tissue thickness compensation part 22020.As a result, the first blade area 10053a can stand above-mentioned tissue incision Power and/or tissue resistance.Such power can be with first rate abrasion or passivation the first blade area 10053a.Second blade area 10053b Above-mentioned tissue thickness compensation part cutting-in force and/or tissue thickness compensation part resistance can be stood.Such power can the second speed abrasion Or passivation the second blade area 10053b.In all cases, the second speed may differ from first rate.

Turning now to Figure 13 and Figure 14, fastener cartridge 22400 may include tissue thickness compensation part 22420, this tissue thickness Compensating part may include the first sutured portion 22421a being connected by cutter slit 22425 and the second sutured portion 22421b.Cutter slit 22425 may include angled longitudinally connected device 22426.Angled longitudinally connected device 22426 can be near in cutter slit 22425 Extend between the distal end 22402 of side end 22401 and cutter slit 22425.In some cases, angled longitudinally connected Device 22426 may extend away the whole length of cutter slit 22425, and in other cases, angled longitudinally connected device 22426 can prolong Stretch the length less than cutter slit 22425.Angled longitudinally connected device 22426 can be at the top of tissue thickness compensation part 22420 Extend between the lower surface 22429 of surface 22428 and tissue thickness compensation part 22420.In some cases, angled vertical May extend away the whole distance between top surface 22428 and lower surface 22429 to adapter 22426, and in other cases, Angled longitudinally connected device 22426 may extend away and is less than the distance between top surface 22428 and lower surface 22429.Each In the case of kind, the proximal end of longitudinally connected device 22426 can extend from the top surface 22428 of tissue thickness compensation part, and indulges Can extend from lower surface 22429 to the distal end of adapter 22426.Alternatively, the distal end of longitudinally connected device 22426 Can extend from the top surface 22428 of tissue thickness compensation part, and the proximal end of longitudinally connected device 22426 can be from lower surface 22429 extensions.In all cases, longitudinally connected device 22426 may include thin bridgeware (that is, less than tissue thickness compensation part 22420 whole thickness) a series of or thin bridgeware, the first sutured portion 22421a for example can engage by this bridgeware Two sutured portion 22421b, this first sutured portion can be by first group of nail 22030 suture, and this second sutured portion can be by second group Nail 22030 suture.These bridgewares that are thin, being at an angle of and/or longitudinally connected device 22426 can be on the second blade area 10053b Distribution abrasion, rather than concentrated on a point.In all cases, as a result, for example, occur in the second blade area Abrasion on 10053b can be equal or nearly equal to the abrasion at the first blade area 10053a.

Referring now to Figure 15 to Figure 17, example organization thickness compensation part assembly 1000 may include ground floor 1002 and can be attached It is connected to the second layer 1004 of ground floor 1002.Tissue thickness compensation part assembly 1000 can use surgical instrumenties, such as surgical instrumenties 8010 (Fig. 1) are using.In addition, tissue thickness compensation part assembly 1000 can be with the storehouse assembly 22000 of end effector 22090 Tissue thickness compensation part 22020 similar mode using and alternative tissue thickness compensation part 22020 (Fig. 9).For example, The second layer 1004 of tissue thickness compensation part assembly 1000 may include can be fixed with the first sutured portion 22021a similar mode Part I 1006 on the platform surface 22011 on the first side of storehouse cutter slit 22015 for the position, and can be with the second suture Part 22021b similar mode is positioned at the platform surface on second side relative with the first side of storehouse cutter slit 22015 Part II 1008 (Fig. 9 to Figure 11) on 22011.In all cases, the Part I 1006 and second of the second layer 1004 Part 1008 can be spaced apart and can betwixt include gap 1010, and this gap may include the cutting for firing member 10052 The cutter track footpath of part 10053 and can when tissue thickness compensation part assembly 1000 is assembled with storehouse end effector 22090 at least Partly extend above storehouse cutter slit 22015.In some cases, ground floor 1002 is configured to couple first Divide 1006 and Part II 1008 and extension above gap 1010 at least in part, for example as shown in figure 17.

In use, tissue T can be trapped between anvil block 10060 and the tissue contacting surface 1012 of ground floor 1002. When firing member 10052 is pushed into, first group nail 20030 can be deployed with suture Part I 1006 and second group nail can It is deployed to suture Part II 1008.First group of nail and second group of nail are configured to penetrate the second layer 1004 respectively First contact with platform surface 1007 and the second contact with platform surface 1009, then penetrate the tissue contacting surface 1012 of ground floor, Then penetrate captured tissue T to contact the pit 10062 of anvil block 10060.Additionally, the propulsion of firing member 10052 can cause Cut portion 10053 is made to be advanced through the gap 1010 of tissue thickness compensation part assembly 1000 towards distally.Cut portion 10053 can Crosscutting ground floor 1002, simultaneously advances through gap 1010, thus by the Part I 1006 of the second layer 1004 and Part II 1008 separate.

Refer again to Figure 17, the ground floor 1002 of tissue thickness compensation part assembly 1000 may include the first height H1, second The Part I 1006 of layer 1004 may include the second height H2, and the Part II 1008 of the second layer 1004 may include three-hypers Degree H3.In some cases, as shown in figure 17, the second height H2 can be identical or substantially the same with third height H3.? In the case of other, the second height H2 may differ from third height H3.In some cases, the first height H1 is smaller than the second height H2 and/or third height H3, as shown in figure 17.It is close that the ground floor 1002 of tissue thickness compensation part assembly 1000 may include first Degree, the Part I 1006 of the second layer 1004 may include the second density, and the Part II 1008 of the second layer 1004 may include Triple density.In some cases, as shown in figure 17, the second density can be identical or substantially the same with triple density.? In the case of other, the second density may differ from triple density and/or the first density different from ground floor 1002.First Points 1006 can be identical or at least substantially identical with the material of Part II 1008 composition.In other cases, first Points 1006 and the material composition of Part II 1008 can material group different from each other and/or may differ from ground floor 1002 Become.

As described above, reuse cut portion 10053 and being passivated and cut cutting tissue T and tissue thickness compensation part material Cut part 10053.In order to slow down passivating process it may be necessary to reduce the tissue thickness compensation part cut by cut portion 10053 Material.Additional benefit can be to advance the power needed for firing member 10052 to reduce during firing schedule towards distally.In order to reduce The passivation of cut portion 10053, ground floor 1002 can include such as thin film at least in part.In such cases, the first height H1 can be significantly less than the second height H2 and third height H3, as shown in figure 17.In some cases, ground floor 1002 can have and wear Cross and therein evenly or substantially go up uniform height, as shown in figure 17.In other cases, the gap bridges portion of ground floor 1002 Divide 1014 can extend above gap 1010 at least in part and thin than the remainder of ground floor 1002.Cut portion 10053 the gap bridges part 1014 of crosscutting ground floor 1002 can simultaneously advance Part I 1006 He through the second layer 1004 Gap 1010 between Part II 1008, this can reduce the resistance that cut portion 10053 stood and/or slow down cutting The passivation of part 10053.Under any circumstance, ground floor 1002 is configured to maintain and the second layer before being crosscut The connection of 1004 Part I 1006 and Part II 1008 engages, and is pushed in cut portion 10053 with crosscutting the The resistance reducing when one layer 1002 assumes cut portion 10053.

In order to reduce the passivation of cut portion 10053 further and/or reduce the resistance that cut portion 10053 is stood Power, gap bridges part 1014 may include the perforated section 1016 along the cutter track footpath being limited by gap 1010, as shown in figure 16.Perforation Section 1016 may include multiple perforation 1018, and described perforation can be cut before ground floor 1002 is for example assembled into the second layer 1004 In ground floor 1002.When cut portion 10053 is advanced through the cutter track footpath being limited by gap 1010, perforation 1018 can reduce Interaction between cut portion 10053 and ground floor 1002, this can slow down cut portion 10053 passivation and/or Reduce the resistance that cut portion 10053 is stood.

In all cases, as described in greater detail below, tissue thickness compensation part assembly 1000 can be by one or more Biocompatible materialses are constituted.In some cases, ground floor 1002 can be by such as biocompatibility backing material and/or plasticity Material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) is constituted, and the second layer 1004 can be by for example can giving birth to The foamed materialss that thing absorbs and/or compressible hemostatic material (such as, oxidized regenerated cellulose (ORC)) are constituted.In some situations Under, ground floor 1002 can be the thin film comprising for example bioabsorbable material, and described bioabsorbable material is such as with business The polyglycolic acid (PGA) of name of an article Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate Acid esters (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL) and/or PGA, PLA, The complex of PDS, PHA, PGCL and/or PCL.In some cases, the Part I 1006 of the second layer 1004 and/or second Divide 1008 can be made up of the freeze dried foam for example comprising polylactic acid (PLA) and/or polyglycolic acid (PGA).In some cases, Two layer 1004 of Part I 1006 and/or Part II 1008 can be made up of biocompatible foam, this bio-compatible sex vesicle Foam may include the open celled foam of porous and/or the closed-cell foam of porous.

Refer again to Figure 15 and Figure 17, ground floor 1002 may be at least partially disposed on the second layer 1004 so that working as group When knitting thickness compensation part assembly 1000 and being assembled with end effector 22090 (Fig. 9), the second layer 1004 can be positioned on ground floor 1002 And platform surface 22011 (Fig. 9) between.In other cases, ground floor 1002 can be positioned on Part I 1006 and second So that when tissue thickness compensation part assembly 1000 is assembled with end effector 22090 (Fig. 9) under point 1008 (not shown), the Can be positioned on for one layer 1002 between the second layer 1004 and platform surface 22011 (Fig. 9).Under any circumstance, ground floor 1002 can It is attached to the first contact surface 1020 of Part I 1006 and second contact surface of Part II 1008 of the second layer 1004 1022.Ground floor 1002 can be attached to the second layer 1004 by being related to the thermal pressing process of applying heat and/or pressure, as follows It is more fully described in literary composition.In other cases, ground floor 1002 can be such as fine by such as biocompatible adhesive material Fibrillarin and/or protein hydrogel are attached to the second layer 1004.The disclosure contemplates for ground floor 1002 is attached to second The other modes of layer 1004.

Referring now to Figure 21 and Figure 22, ground floor 1002 can be at least partially embedded the Part I 1006 of the second layer 1004 And/or in Part II 1008.In such cases, tissue thickness compensation part assembly 1000 can be prepared using mould 1024, For example as shown in figure 21.In all cases, polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) will can be comprised Organic solution pour in mould 1024.Ground floor 1002 can be immersed in organic solution.As shown in figure 22, die cover 1028 Centre frame 1026 and center sill 1027 ground floor 1002 can be clipped in organic to guarantee that ground floor 1002 keeps immersing between the two In solution, then this organic solution can carry out lyophilizing using such as conventional lyophilizing technique and/or any other suitable technology.Complete After becoming freeze-drying process and/or any other suitable process, die cover 1028 can be removed and tissue thickness compensation part group Part 1000 can reclaim from mould 1028.

As shown in figure 21, the ground floor 1002 of tissue thickness compensation part 1000 can be partially positioned at the of the second layer 1004 In a part 1006 and Part II 1008.In some cases, ground floor 1002 can be partially positioned at Part I 1006 With one of Part II 1008 top that is interior and being attached to the other of Part I 1006 and Part II 1008 Surface or lower surface.

In some cases, when covering 1028 and mould 1024 is in closed configuration, center sill 1027 and frame 1026 can be extremely Partially along parallel to or be arranged essentially parallel to the first contact with platform surface 1007 and/or the second contact with platform surface 1009 Axis extends, as shown in figure 22.In such cases, ground floor 1002 can embed Part I 1006 and/or Part II In 1008 so that ground floor 1002 with parallel with the first contact with platform surface 1007 and/or the second contact with platform surface 1009 or Substantially parallel relation positions or substantially positions.In other cases although not shown, but when lid 1028 and mould 1024 When being in closed configuration, center sill 1027 and frame 1026 can at least in part along with the first contact with platform surface 1007 and/or the The axis of two contact with platform surface 1008 bevel extends.In such cases, ground floor 1002 can embed Part I 1006 And/or so that ground floor 1002 is with respect to the first contact with platform surface 1007 and/or the second contact with platform in Part II 1008 Surface 1009 positions with oblique angle positioning or substantially.The disclosure is susceptible to for ground floor 1002 is partially embedded into Part I 1006 and/or Part II 1008 in other technologies.

Referring now to Figure 18 and Figure 19, show in many aspects similar to tissue thickness compensation part assembly 1000 and tissue The tissue thickness compensation part assembly 1033 of thickness compensation part 20020.Tissue thickness compensation part assembly 1033 may include and can be spaced apart And the Part I 1006 being separably linked together by multiple bridge members or adapter 1030 and Part II 1008, Described bridge member or adapter can extend in the gap 1010 between Part I 1006 and Part II 1008.In addition, group Knit some or all the be partially embedded into Part I 1006 and second in the adapter 1030 of thickness compensation part assembly 1033 In part 1008, as shown in figure 19.Additionally, some or all in adapter 1030 may include being positioned in Part I 1006 First end, the second end being positioned in Part II 1008, and gap bridges part 1032 between the two.Gap bridge Socket part divides 1032 can extend, as shown in figure 19 in the gap 1010 between Part I 1006 and Part II 1008.Adapter 1030 can open along the length separation in gap 1010 so that Part I 1006 is detachably coupled to Part II 1008.

In some cases, adapter 1030 can be evenly distributed along the axis extending along gap 1010, as Figure 19 institute Show.In other cases although not shown, but adapter 1030 unevenly can divide along the axis extending along gap 1010 Cloth.Cut portion 10053 is configured in cut portion 10053 between Part I 1006 and Part II 1008 It is advanced through the gap bridges part 1032 of crosscutting adapter 1030 during the cutter track footpath being limited by gap 1010.In adapter 1030 In the case of being unevenly distributed along the axis extending along Part I 1006 and Part II, in the case of at least one, Adapter 1030 at the distal segment in gap 1010 than at the proximal section in gap 1010 with bigger frequency and/or Person closer to each other come to arrange so that cut portion 10053 along limited by gap 1010 cutter track footpath propulsion when can stand increase Plus resistance.In other cases, adapter 1030 saves than the distally in gap 1010 at the proximal section in gap 1010 Section sentence bigger frequency and/or closer to each other arranging, for example make cut portion 10053 along by gap 1010 The resistance reducing can be stood during the cutter track footpath propulsion limiting.

In some cases, adapter 1030 can parallel to or be arranged essentially parallel to the first contact with platform part 1007 And/or second contact with platform part 1009 single plane in extend or substantially extend, as shown in figure 19.In other situations Lower although not shown, but adapter 1030 can along can parallel to each other or be substantially parallel to each other and/or parallel to or basic On extend or substantially prolong parallel to multiple planes of the first contact with platform part 1007 and/or the second contact with platform part 1009 Stretch.

To being described further above, some or all in the gap bridges part 1032 of adapter 1030 are than it The remainder of corresponding connectors 1030 thin to make cut portion when cut portion 10053 is pushed into crosscutting adapter 1030 Under 10053 resistances being presented on reduction, maintain the Part I 1006 of the second layer 1004 and the connection of Part II 1008 simultaneously Engage.For example, some or all in adapter 1030 may include dog-bone shapes, and this dog-bone shapes has and terminates in the second layer Thicker end portion in 1004 Part I 1006 and Part II 1008 and the relatively thin core betwixt extending.Some In the case of, adapter 1030 can each one section of stitching thread of freedom be constituted, and this stitching thread can be made up of bioabsorbable material, described Bioabsorbable material such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly- two Oxygen six cyclic ketones (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25 (PGCL) sold with trade name Monocryl, poly- oneself Lactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL.

Refer again to Figure 18, tissue thickness compensation part assembly 1033 can be prepared using mould 1034.Can will comprise to be polymerized The organic solution of thing (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) pours in mould 1034.Can be by adapter In 1030 immersion organic solutions.As shown in figure 18, one or more of adapter 1030 can each freedom prolong from die cover 1038 The one or more beams 1039 stretched are clipped in the one or more special slit 1040 on centre frame 1036 and are adapted to It is enough in and engage to guarantee adapter 1030 with slit 1040 cooperation when die cover 1038 is in closed configuration with mould 1034 Remain immersed in organic solution.The size of slit 1040 can be configured to receive or receive bridging part at least in part 1032, when die cover 1038 is in closed configuration with mould 1034, this bridging part can be fixed by beam 1039.Adapter 1030 From gap bridges part 1032 extend end freely can float organic solution.Alternatively, the end of adapter 1030 The side of such as mould 1034 can be fixed to.In some cases, adapter 1030 can between the side of mould 1034 Stretch in organic solution.In other cases, adapter 1030 can be loosely retained between the side of mould 1034 so that example As extended through organic solution in a non-linear manner.

To being described further above, in all cases, then organic solution can using conventional lyophilizing technique and/or Any other suitable technology carrys out lyophilizing.After completing freeze-drying process, die cover 1036 can be removed and tissue thickness is mended Repay part assembly 1033 to reclaim from mould 1034.As shown in figure 19, gained tissue thickness compensation part assembly 1033 is included partly It is positioned at the adapter 1030 in Part I 1006 and Part II 1008.The disclosure is susceptible to for by adapter 1030 The other technologies embedding in Part I 1006 and/or Part II 1008 with dividing.It will be appreciate that, adapter 1030 can pass through Change the height of centre frame 1038 and/or slit 1040 depth and closer to or further from contact with platform surface 1007 and 1009 Positioning.

Referring now to Figure 20, illustrate to compensate similar to tissue thickness compensation part assembly 1033, tissue thickness in many aspects The tissue thickness compensation part assembly 1042 of part assembly 1000 and/or tissue thickness compensation part 20020.Tissue thickness compensation part assembly 1042 may include and can be spaced apart and can by the continuous flexible component 1044 that can be formed by multiple bridge members or adapter 1046 The Part I 1006 being discretely linked together and Part II 1008, described bridge member or adapter can be across Part I Gap 1010 between 1006 and Part II 1008 extends.Continuous flexible component 1044 may include first end 1048, second End 1050, and the flexible portion 1052 extending between first end 1048 and the second end 1050.Flexible portion 1052 It is configured to for example extend through Part I 1006 and Part II 1008 several times to be formed with zigzag pattern Adapter 1046, as shown in figure 20.Flexible portion 1052 can pass through the distal segment 1054 of Part I 1006 in the first direction With the distal segment 1056 of Part II 1008 to form the first gap bridges part 1046a across gap 1010.Flexible portion 1052 Part II that then can circulate and be passed through distal segment 1056 nearside along the second direction contrary with first direction 1008 and be passed through the Part I 1006 of distal segment 1054 nearside, thus being formed at the first gap bridges part 1046a Second gap bridges part 1046b of nearside.Modification space bridging part 1046c and 1046d for example can in the same manner across Gap 1010 is formed, as shown in figure 20.

In some cases, continuous flexible component 1044 may include stitching thread and can be made up of suture material, described Suture material is such as with the polyglycolic acid (PGA) of trade name Vicryl sale, polylactic acid (PLA or PLLA), poly- dioxane Ketone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25 (PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL complex.In some cases, tissue thickness compensation part group Part 1042 for example can be assembled by what lyophilizing manufactured later in Part I 1006 and Part II 1008.In some cases, Pin (not shown) could attach to the first end 1048 of continuous flexible component 1044 and for example can pass through the with zigzag pattern A part 1006 and Part II 1008 so that Part I 1006 to be connected to Part II 1008, as mentioned above.Continuous flexible The first end 1048 of component 1044 and/or the second end 1050 can be by such as first end 1048 and/or the second ends Fasten one or more knots at 1050 and be fixed to the side wall of Part I 1006 and/or Part II 1008.Knot can be against The side wall of a part 1006 and/or Part II 1008 is to prevent flexible portion 1052 with respect to Part I 1006 and/or the Two parts 1008 are untied.In other cases, the Part I 1006 of tissue thickness compensation part assembly 1042 and Part II 1008 can form around continuous flexible component 1044.In such cases, as shown in figure 20, continuous flexible component 1044 can be such as It is arranged in mould 1062 with zigzag pattern, wherein slit 1064 is limited in side wall 1066 and during slit 1068 is limited to In heart frame 1070.The organic solution comprising polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) can be poured into In mould 1062, until continuous flexible component 1044 is immersed in organic solution.Die cover 1072 can be used for guaranteeing continuous flexible Component 1044 remains immersed in organic solution, this organic solution and then use conventional lyophilizing technique and/or any other is suitable Technology carry out lyophilizing.For example make first end 1048 pass through opening 1053 and make the second end 1050 pass through opening 1055 it Afterwards, the first end 1048 of continuous flexible component 1044 and the second end 1050 can be by first end 1048 and the second ends Fasten one or more knots at 1050 and be separately fixed at the opening 1053 and 1055 of mould 1062.Knot can be against mould 1062 Side wall to prevent continuous flexible component 1044 from untiing with respect to mould 1066.Remove it in tissue thickness compensation part from mould Afterwards, in all cases, the part (such as part 1048,1050 and/or 1052) of continuous flexible component 1044 and then can be cut Cut and remove from tissue thickness compensation part.The disclosure is susceptible to other skills for assembling tissue thickness compensation part assembly 1042 Art.

In some cases, when excessive power or pressure are applied to tissue thickness compensation part assembly (such as tissue thickness Compensating part assembly 1042) when, it can damage.For example, when tissue thickness compensation part assembly 1042 is loaded into nail bin (such as nail bin 10000), when above, can pressure is applied on tissue thickness compensation part assembly (such as tissue thickness compensation part assembly 1042).Group Knit thickness compensation part assembly 1042 and can be equipped with pressure or power sensitive components, this pressure or power sensitive components can provide to user Whether the pressure that tissue thickness compensation part assembly is stood exceedes the warning feedback of threshold value.For example, pressure or power sensitive membrane can be attached It is connected to tissue thickness compensation part assembly 1042 and be configured in the pressure standing to exceed threshold value change color.? In some cases, pressure or power sensitive membrane may be disposed at Part I 1006 and/or Part II 1008 top and can lead to Cross such as binding agent to be attached to thereon.Pressure or power sensitive membrane can be biocompatible with permission tissue thickness compensation part group Part 1042 is by pressure or power sensitive membrane implantation within a patient.

Referring now to Figure 23 to Figure 25, show surgical end-effector 1100.End effector 1100 is in many aspects Similar to disclosed various end effector, such as end effector 22090 (Fig. 9) elsewhere herein.As shown in figure 23, end Executor 1100 may include the such as nail bin groupware 1102 similar to nail bin groupware 20200 (Fig. 6) in many aspects.In addition, end Portion executor 1100 may include for example in many aspects similar to other tissue thickness compensation parts that presents is disclosed elsewhere (such as tissue thickness compensation part 22020 (Fig. 9), tissue thickness compensation part 20220 (Fig. 6) and/or tissue thickness compensation part 10020 (Fig. 4)) tissue thickness compensation part 1104.

To being described further above, end effector 1100 may include tissue thickness compensation part 1104, wherein organizes Thickness compensation part 1104 can be prepared using conventional lyophilizing technique and/or any other suitable technology.In at least one example In, tissue thickness compensation part 1104 can be dissolved in by making polymer (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) In organic solvent and so that solution lyophilizing is prepared.Tissue thickness compensation part 1104 can be made up of biocompatible foam, this life Thing biocompatible foam may include the open celled foam of such as porous and/or the closed-cell foam of porous.

To being described further above, tissue thickness compensation part 1104 can be changed or modified for surgical operation In.For example, after completing freeze-drying process, tissue thickness compensation part 1104 can contact thick to change tissue with modification component 1106 Degree compensating part 1104 is in particular surgeries.In some cases, modification can be by 1104 groups of tissue thickness compensation part Carry out equipped with after end effector 1100, as shown in Figure 23 to Figure 35.For example, as shown in figure 23, tissue thickness compensation part 1104 can releasedly be assembled into storehouse assembly 1102 and change when being assembled with storehouse assembly 1102.In other cases, repair Change and can carry out before tissue thickness compensation part 1104 is assembled with end effector 1100.In at least one example, in system During making, modification can be carried out as single step.In another example, modification can be carried out in surgery intra-operative.

As described in greater detail below, modification process can relate to change the surface of tissue thickness compensation part 1104 or multiple table Face.In some cases, modification process can relate to change one or more parts of tissue thickness compensation part 1104.One or many Individual part can be changed during single modification.Alternatively, some individually can be changed during each comfortable continuous modification. In some cases, modification process may include thermal pressing process, and this thermal pressing process can be used for changing tissue thickness compensation part 1104 at least one of shape, size, size and/or porosity.Additionally, modification process may include in tissue thickness The mode in the one or more partly interior formation space of compensating part 1104.

Refer again to Figure 23 to Figure 25, in some cases, the part 1107 (Figure 23) of tissue thickness compensation part 1104 can Changed by thermal pressing process, this thermal pressing process may include and for part 1107 to be transformed into glassy state, by part 1107 with repair Change component 1106 to engage, pressure is applied to thereon when part 1107 is in glassy state, and make part 1107 be cooled to glass Under glass state, modification component 1106 is still engaged with part 1107 simultaneously.Modification component 1106 can be used for maintaining in part 1107 Pressure persistently be enough to form the time period that gained changes part 1108 (Figure 25).It should be noted that material turning to glassy state Change can into increase to glass transition temperature in response to the temperature of material and from relatively hard state to relative melt or flexible shape The reversible transition of state.The glass transition temperature of material can be specified temp, or is certain temperature model in some cases Enclose.Tissue thickness compensation part modification process as herein described is come in the following manner using this phenomenon：In tissue thickness compensation part It is in modification tissue thickness compensation part during glass flexibility state, then make tissue thickness compensation part be cooled to glass when maintaining modification Below glass transition temperature.

To being described further above, refer again to Figure 23 to Figure 25, the part 1107 of tissue thickness compensation part 1004 Glassy state can be transformed in the following manner：It is heated to the glass transition temperature more than or equal to material to major general's part 1107 Degree but is below the temperature of its melt temperature, and part 1107 is made up of described material.For example, tissue thickness compensation part 1104 can be by Polyglycolic acid (PGA) is constituted, and in such cases, part 1107 can be transformed into glassy state in the following manner：By part 1107 are heated to the temperature but being below its melt temperature more than or equal to the glass transition temperature of polyglycolic acid (PGA).? In the case of various, the glass transition temperature of polyglycolic acid (PGA) can be in the range of such as 35-40 DEG C, and its melting is warm Degree can be in the range of such as 225-230 DEG C.In at least one example, the part 1107 of tissue thickness compensation part 1104 can quilt It is heated to more than or equal to 35 DEG C but be less than 225 DEG C of temperature, so that part 1107 is transformed into glassy state.In another example In, part 1107 can be transformed into glassy state in the following manner：Part 1107 is heated to and is greater than or is equal to 40 DEG C but low In 200 DEG C of temperature.

To being described further above, then modification component 1106 can be used for pressing when part 1107 is in glassy state Power is applied in part 1107.Part 1107 can be made to exit glass by for example part 1107 being cool below 35 DEG C of temperature Glass state.Pressure can be maintained enough to allowing tissue thickness compensation part 1104 to keep or keeping at least in part by modification component 1106 The time period of the modification applying.

In certain embodiments, pressure can for example maintain about 30 seconds to about 8 hours during the time being in glassy state Time period and/or the time period for example maintaining about 30 seconds to about 8 hours after exiting glassy state.In at least one example In, pressure can maintain about 10 minutes during the time being in glassy state and maintain about 10 points after exiting glassy state Clock.The disclosure is susceptible to the other times section for maintaining pressure.

In some cases, modification component 1106 can be used for pressure is applied to before part 1107 is transformed into glassy state In part 1107.In some cases, modification component 1106 can be when part 1107 be heated to reach glassy state, in part 1107 when being in glassy state, and/or when part 1107 changes or is cooled to the temperature of below glassy state to part 1107 Apply pressure.In some cases, for example when the temperature of part 1107 is gradually increased so that part 1107 towards glassy transition, The pressure being applied to part 1107 can gradually increase towards threshold value.In some cases, when part 1107 exits glassy state, in portion Before dividing 1107 to exit glassy state, and/or after part 1107 exits glassy state, the pressure being applied to part 1107 can It is removed, gradually removes, or reduce at least in part.

In some cases, modification component 1106 can also be 1107 turns of the part for making tissue thickness compensation part 1104 Become the thermal source of glassy state.For example, modification component 1106 may include cylindrical distal part 1110, as shown in figure 24, this cylinder Shape distal part may include heating coil (not shown).User can make heating coil energising and by tissue thickness compensation part 1104 part 1107 is engaged with modification component 1106 so that part 1107 to be heated to the material group more than or equal to part 1107 The temperature of the glass transition temperature of compound.Once reaching temperature required, bearing part 1107 pressing component, such as Figure 24 can be changed Shown.Alternatively, modification component 1106 reach temperature required before, can bearing part 1107 pressing modification component.As above institute State, pressure can be maintained enough to allow tissue thickness compensation part 1104 to keep or keep at least in part to be applied by modification component 1106 Plus modification time period.In addition, the heating coil of modification component 1106 can be closed so that the temperature of part 1107 is cooled to Less than glass transition temperature.Then modification component can be removed.In some cases, the pressure being applied by modification component 1106 Can be initiated before part 1107 enters glassy state and be maintained in whole glassy state.In some cases, in portion When dividing 1107 to be in glassy state, can be removed by the pressure that modification component 1106 applies.

As shown in Figure 23 to Figure 25, modification component 1106 is configured to change the portion of tissue thickness compensation part 1104 Divide 1107 shape, size, size, density, flexible ratio and/or porosity.For example, modification part 1108 may include to have and subtracts The substantially concave top surface 1114 of low height H1, and the remainder of tissue thickness compensation part 1104 can keep including big In reduce height H1 elemental height H substantially flat top surface, as shown in figure 25.As described above, modification component 1106 may include cylindrical distal part 1110.In such cases, the curvature of gained concave surface 1114 can partly depend on The cylindrical distally of the modification component 1106 contacting with the part 1107 of tissue thickness compensation part 1104 during repairing corrects one's mistakes journey The curvature of part 1110.Additionally, modification part 1108 can have relatively low new porosity compared with unmodified part 1107, this can Corrected one's mistakes by repairing at least in part and led to by the compression stress that modification component 1106 is applied to part 1107 during journey, as mentioned above. In other words, repairing is corrected one's mistakes and is applied to the pressure of part 1107 during journey and can produce material redistribution, and wherein repairing is corrected one's mistakes journey The cross section before passing through to change part 1108 can have the density of material bigger than the similar cross-section by part 1107.This Outward, modification part 1108 can have the flexible ratios different from the remainder of tissue thickness compensation part 1104, and this can be partly Corrected one's mistakes the change of the density realized by modification part 1108 during journey and porosity and led to by repairing, following article is retouched in more detail State.In the case of at least one, the flexible ratio of modification part 1108 is smaller than or the elasticity ratio more than unmodified part 1107 Rate.

Referring now to Figure 26 to Figure 34, tissue thickness compensation part can be assembled with end effector such as end effector It is modified before 22090 (Fig. 9).In some cases, as shown in Figure 27, Figure 30 and Figure 33, mould may be used in hot pressing Process changes tissue thickness compensation part, as mentioned above.For example, as shown in Figure 26 to Figure 28, tissue thickness compensation part 1120 can quilt It is revised as including longitudinal slit 1122.Tissue thickness compensation part 1120 can be in many aspects similar to its hetero-organization described in other places Thickness compensation part, such as tissue thickness compensation part 22020 (Fig. 9).For example, such as compensating part 22020, compensating part 1120 can be with end Portion executor 22090 is used together.Additionally, longitudinal slit 1122 can be in many aspects similar to cutter slit 22025.For example, such as With cutter slit 22025, the tissue thickness compensation part cutter track footpath being used for cut portion 10053 can be limited to the first seam by slit 1122 Close between part 1124a and the second sutured portion 1124b.Additionally, the first sutured portion 1124a and the second sutured portion 1124b The first sutured portion 22021a (Fig. 9) and second suture of tissue thickness compensation part 22020 can be analogous respectively in many aspects Part 22021b (Fig. 9).In addition, slit 1122 is configured to be releasably attached the first sutured portion 1124a and Two sutured portion 1124b are so that when being used together with end effector 22090, cut portion 10053 can be worn towards distally propulsion Cross slit 1122 to separate with crosscutting slit 1122 and by the first sutured portion 1124a and the second sutured portion 1124b.

Refer again to Figure 26 to Figure 28, tissue thickness compensation part 1120 can using traditional freeze drying technology and/or any other Suitable technology is preparing.In addition, tissue thickness compensation part 1120 can be modified or varied forms slit 1122 to pass through. Similar to tissue thickness compensation part 1104, tissue thickness compensation part 1120 can be at least in part by having glass transition temperature Material constitutes and can be changed by material is transformed into glassy state.In one example, tissue thickness compensation part 1120 can It is heated to the glass transition temperature of the material compositions more than or equal to tissue thickness compensation part 1120 in baking oven (not shown) Spend but the temperature less than its melt temperature.As shown in figure 27, the mould 1126 including center sill 1128 can be used for by with lower section Formula forms slit 1122：When tissue thickness compensation part 1120 is in glassy state, center sill 1128 is inserted tissue thickness compensation part In 1120.When center sill 1128 remains inserted in tissue thickness compensation part 1120, tissue thickness compensation part 1120 then can be made It is cool below the temperature of glass transition temperature.In some cases, it is in its glassy state in tissue thickness compensation part 1120 When, center sill 1128 can remove from tissue thickness compensation part 1120.

In some cases, cooling medium can be used for being actively cooled tissue thickness compensation part 1120.In some cases, Fan can be used for when tissue thickness compensation part 1120 is in mould 1126 and/or in tissue thickness compensation part 1120 Generate air stream above tissue thickness compensation part 1120 after mould removes.In some cases, process of refrigerastion can be used for Remove from mould when tissue thickness compensation part 1120 is in mould 1126 and/or in tissue thickness compensation part 1120 Cools tissue thickness compensation part 1120 afterwards.Center sill 1128 can be after tissue thickness compensation part 1120 changes and exits glassy state It is removed.Center sill 1128 can remain inserted into and persistently be enough in tissue thickness compensation part 1120 allow tissue thickness compensation part 1120 Keep or at least substantially keep the time period in the space occupied by center sill 1128.In some examples, center sill 1128 can During the time being in glassy state, for example remain inserted into the time period of about 30 seconds to about 8 hours and/or for example exiting The time period of about 30 seconds to about 8 hours is remained inserted into after glassy state.In at least one example, center sill 1128 can be in Remain inserted into about 10 minutes during the time of glassy state and remain inserted into about 10 minutes after exiting glassy state.This public affairs Open it is contemplated that being used for center sill 1128 maintains the other times section in tissue thickness compensation part 1120.

To being described further above, as shown in figure 28, repairing is corrected one's mistakes the pressure being applied by center sill 1128 during journey Increased density of material can be produced at the part 1130 of tissue thickness compensation part 1120.Part 1130 can connect the first suturing part Divide 1124a and the second sutured portion 1124b, thus providing additional stability for slit 1122.In some cases, mould 1126 May include edge modifier, such as edge modifier 1132a and 1132b, it can repairing modification tissue thickness during journey of correcting one's mistakes be mended Repay part 1120 to produce edge 1134a and 1134b of modification respectively, as shown in figure 28.

Refer again to Figure 26 to Figure 28 it may be necessary to remove the material of significant quantity to be formed from tissue thickness compensation part 1120 Slit 1122.In such cases, center sill 1128 can be heated to the material compositions more than tissue thickness compensation part 1120 Melt temperature temperature.After the center sill 1128 by heating is inserted in tissue thickness compensation part 1120, center sill 1128 Melting passes through tissue thickness compensation part 1120, thus forming the sky for slit 1122 in tissue thickness compensation part 1120 Between, as shown in figure 28.In certain circumstances, it may be necessary to be gradually increased by center sill 1128 against tissue thickness compensation part 1120 The pressure applying is to be gradually inserted center sill 1128 in tissue thickness compensation part 1120.

In certain circumstances, it may be necessary to increase the density of material on one or more surfaces of tissue thickness compensation part.As Shown in Figure 29 to Figure 31, tissue thickness compensation part 1140 can be modified or varied so that the surface of tissue thickness compensation part 1140 1142 may include the density of material higher than the remainder of tissue thickness compensation part 1140, in some cases, this higher material Material density can be realized after freeze drying.Tissue thickness compensation part 1140 can be thick similar to its hetero-organization described in other places in many aspects Degree compensating part, such as tissue thickness compensation part 22020 (Fig. 9) and/or tissue thickness compensation part 1120 (Figure 26).Surface modifier 1144 may be used in the surface 1142 that thermal pressing process changes tissue thickness compensation part 1140, and described thermal pressing process is in many Aspect similar to the thermal pressing process for changing tissue thickness compensation part 1104 and/or tissue thickness compensation part 1120, as above Described.For example, tissue thickness compensation part 1140 can be made up of the material including glass transition temperature at least in part and can It is modified after being transformed into glassy state.

As described above, tissue thickness compensation part (such as tissue thickness compensation part 1140) can be transformed into glassy state, wherein should Tissue thickness compensation part is heated to the glass transition temperature of the material compositions more than or equal to tissue thickness compensation part 1140 Spend but the temperature less than its melt temperature.When tissue thickness compensation part 1140 is in glassy state, can press against surface 1142 Surface modifier 1144.The pressure-compressible surface 1142 being applied by surface modifier 1144, thus increase the material on surface 1142 Material density.The increase of density of material can be kept by surface 1142 in the following manner：Surface 1142 is made to be cool below vitrification The temperature of transition temperature.

In some cases, glassy state for example can be in by the pressure that surface modifier 1144 applies against surface 1142 Time during maintain the time period of about 30 seconds to about 8 hours and/or after exiting glassy state, for example maintain about 30 seconds To the time period of about 8 hours.In at least one example, pressure can maintain about 10 minutes during the time being in glassy state And maintain about 10 minutes after exiting glassy state.The disclosure is susceptible to for maintaining by surface modifier 1144 against table The other times section of the pressure that face 1142 applies.

In some cases, fan can be used for when tissue thickness compensation part 1140 is contacted with modifying agent 1144 and/or Person generates air in tissue thickness compensation part 1140 after modifying agent 1144 removes above tissue thickness compensation part 1140 Stream.In some cases, process of refrigerastion can be used for when tissue thickness compensation part 1140 is contacted with modifying agent 1144 and/or In tissue thickness compensation part 1140 after modifying agent 1144 removes cools tissue thickness compensation part 1140.Mend in tissue thickness Repay part 1140 change exit glassy state after, in all cases, surface modifier 1144 can be with tissue thickness compensation part 1140 It is disengaged.In some cases, surface modifier 1144 may include heating element heater, and this heating element heater can be used for surface 1142 Temperature increase to the temperature of the glass transition temperature of material compositions more than or equal to tissue thickness compensation part 1140, such as Upper described.

Refer again to Figure 30, surface modifier 1144 may include flat or at least substantially flat contact surface 1146 For contacting such as surface 1142.In other cases, contact surface 1146 can have various textures, such as can repairing correct one's mistakes The projection in the surface 1142 of tissue thickness compensation part 1140 is extended to during journey.In some cases, surface modifier 1144 Can be used for pressure is applied to the table of tissue thickness compensation part 1140 before tissue thickness compensation part 1140 is converted to glassy state On face 1142.In some cases, surface modifier 1144 can be heated to reach glassy state in tissue thickness compensation part 1140 When, when tissue thickness compensation part 1140 is in glassy state, and/or changes in tissue thickness compensation part 1140 or be cooled to Apply pressure to surface 1142 during temperature below glassy state.In some cases, for example in tissue thickness compensation part 1140 When temperature is gradually increased so that tissue thickness compensation part 1140 towards glassy transition, surface is applied to by surface modifier 1144 1142 pressure can gradually increase towards threshold value.In some cases, when tissue thickness compensation part 1140 exits glassy state, in group Knit before thickness compensation part 1140 exits glassy state, and/or after tissue thickness compensation part 1140 exits glassy state, apply The pressure being added to surface 1142 can be removed, gradually remove or reduce at least in part.

In some cases, tissue thickness compensation part 1140 can be modified or varied is including epidermis or dense outer layer.? In some cases, gained epidermis or dense outer layer may include texture, such as may extend into the surface of tissue thickness compensation part 1140 Projection in 1142.In some cases, the contact surface 1146 of surface modifier 1144 can be heated to more than or equal to group Knit the temperature of the melt temperature of the material compositions of thickness compensation part 1140.Surface modifier 1144 and/or tissue thickness compensate Part 1140 movable so that the heated contact surface of the surface 1142 of tissue thickness compensation part 1140 and surface modifier 1144 1146 contacts, so that surface 1142 melts or at least substantially melts.Surface modifier 1144 and tissue thickness compensation part 1140 then separable with allow modification surface 1142 be cooled to below its melt temperature, this can be by epidermis or dense outer layer shape Become in tissue thickness compensation part 1140.

In some cases, the contact surface 1146 of surface modifier 1144 can be added before being contacted with surface 1142 Heat.In other cases, the contact surface 1146 of surface modifier 1144 can be heated after being contacted with surface 1142.

In some cases, the contact surface 1146 of surface modifier 1144 can keep and tissue thickness compensation part 1140 Surface 1142 contact is enough to make surface 1142 flow into the time period in required geometry.Such time period can be at e.g., from about 30 seconds To in the range of about 8 hours, the disclosure is contemplated that other times section.Such time period can enough to local influence and/or Melt the material of tissue thickness compensation part 1140 and enable its flow in new geometry.As described herein, such new geometry Shape can be specified by the instrument for manufacturing tissue thickness compensation part 1140.

In some cases, tissue can be made before separate surface modifier 1144 with tissue thickness compensation part 1140 thick The surface 1142 of degree compensating part 1140 cools down or is actively cooled the temperature of the melt temperature less than tissue thickness compensation part 1140 Degree.In other cases, tissue thickness can be made after separate surface modifier 1144 with tissue thickness compensation part 1140 to mend The surface 1142 repaying part 1140 cools down or is actively cooled the temperature of the melt temperature less than tissue thickness compensation part 1140.

To being described further above, the surface 1142 of modification may include density, and for example this density ratio tissue thickness is mended Repay the remainder of part 1140 density about 10%, than tissue thickness compensation part 1140 remainder density about 20%th, the ratio density about 30% of the remainder of tissue thickness compensation part 1140, than the residue of tissue thickness compensation part 1140 Partial density about 40%, than tissue thickness compensation part 1140 remainder density about 50%, than tissue thickness mend Repay the remainder of part 1140 density about 60%, than tissue thickness compensation part 1140 remainder density about 70%th, than density about 80%, the residue than tissue thickness compensation part 1140 of the remainder of tissue thickness compensation part 1140 Partial density about 90% and/or the density about 100% of the remainder than tissue thickness compensation part 1140.? In the case of various, surface 1142 may include density, and such as this density is more than the close of the remainder of tissue thickness compensation part 1140 Degree, and the twice of the density of remainder less than tissue thickness compensation part 1140.In all cases, the surface of modification 1142 may include density, and such as this density is more than the twice of the density of remainder of tissue thickness compensation part 1140.

Referring now to Figure 32 to Figure 34, tissue thickness compensation part 1150 can be modified to including can extend through at least in part Cross multiple holes 1152 of tissue thickness compensation part 1150.Tissue thickness compensation part 1150 can be in many aspects similar to described herein Other tissue thickness compensation parts, such as tissue thickness compensation part 20220 (Fig. 6).Such as compensating part 20220, compensating part 1150 Can be used together with storehouse assembly 20200 (Fig. 6), and hole 1152 can be in many aspects similar to extending through group at least in part Knit the mesopore 20224 of thickness compensation part 20220.For example, such as hole 20224, when tissue thickness compensation part 1150 is assembled with storehouse During assembly 20200, hole 1152 can be aligned so that nail leg 20232 can in nail leg 20232 never with corresponding nail leg 20232 (Fig. 7) Percussion configuration moves to the mesopore 1152 moving across in tissue thickness compensation part 1150 during percussion configuration, such as more detailed above Ground description.

To being described further above, refer again to Figure 32 to Figure 34, tissue thickness compensation part 1150 can be using tradition Freeze drying technology and/or any other suitable technology are preparing.In some cases, there is the polymer of glass transition temperature (such as polylactic acid (PLA) and/or polyglycolic acid (PGA)) is dissolvable in water to form solution in organic solvent, and this solution can be frozen Do to produce tissue thickness compensation part 1150.Additionally, tissue thickness compensation part 1150 can be after freeze drying using thermal pressing process Modification, described thermal pressing process is in many aspects similar to for changing tissue thickness compensation part 1104, tissue thickness compensation part 1120 and/or the thermal pressing process of tissue thickness compensation part 1140, as mentioned above.For example, once tissue thickness compensation part 1150 It is transformed into glassy state, tissue thickness compensation part 1150 can be modified to including hole 1152.

As described above, tissue thickness compensation part (such as tissue thickness compensation part 1150) can be by baking oven (not shown) It is heated to the glass transition temperature of material compositions more than or equal to tissue thickness compensation part 1150 but melt temperature less than it Degree temperature and be transformed into glassy state.Mould 1154 (such as pin 1156) including multiple posts, dowel, pin and/or projection can use In forming hole 1152 in the following manner：When tissue thickness compensation part 1150 is in glassy state, pin 1156 is inserted tissue thickness In compensating part 1150.When pin 1156 remains inserted in tissue thickness compensation part 1150, tissue thickness compensation part then can be made 1150 temperature being cool below glass transition temperature.In some cases, it is in glass in tissue thickness compensation part 1150 During state, pin 1156 can remove from tissue thickness compensation part 1150.In some cases, fan can be used in tissue thickness compensation part 1150 is when engaging with pin 1156 and/or thick in tissue after tissue thickness compensation part 1150 is disengaged with pin 1156 Degree compensating part 1150 top generates air stream.In some cases, process of refrigerastion can be used for tissue thickness compensation part 1150 with Pin 1156 engage when and/or after tissue thickness compensation part 1150 is disengaged with pin 1156 cools tissue thickness mend Repay part 1150.In all cases, pin 1156 can be removed after tissue thickness compensation part 1150 changes and exits glassy state.Pin 1156 can remain inserted in tissue thickness compensation part 1150 and to be persistently enough to allow tissue thickness compensation part 1150 to keep or at least base Keep in basis limiting the time period in the space in hole 1152 being occupied by pin 1156.

In some examples, pin 1156 can for example remain inserted into during the time being in glassy state about 30 seconds little to about 8 When time period and/or the time period for example remaining inserted into about 30 seconds to about 8 hours after exiting glassy state.At least In one example, pin 1156 can remain inserted into during the time being in glassy state about 10 minutes and exit glassy state it After remain inserted into about 10 minutes.The disclosure be susceptible to for maintain pin 1156 insert tissue thickness compensation part 1150 in other Time period.

In some cases, before tissue thickness compensation part 1150 changes and exits glassy state, pin 1156 can be thick from tissue Degree compensating part 1150 removes.In other cases, pin 1156 can elapse over time and gradually remove.For example, mend in tissue thickness Repay part 1150 change exit glassy state before, pin 1156 partly can remove from tissue thickness compensation part 1150.In tissue thickness After glassy state is exited in compensating part 1150 transformation, then pin 1156 can remove from tissue thickness compensation part 1150 completely.Reader will Understand, the depth that pin 1156 inserts in tissue thickness compensation part 1150 is bigger, and can be formed in tissue thickness compensation part 1150 is right Answer the depth in hole 1152 bigger.

Refer again to Figure 32 to Figure 34, in some cases, pin 1156 can be heated to be mended more than or equal to tissue thickness Repay the temperature of the melt temperature of the material compositions of part 1150.In addition, pin 1156 can be inserted in tissue thickness compensation part 1150 To form hole by melting or melt through the reception region of pin 1156 of tissue thickness compensation part 1150 at least in part 1152.In all cases, pin 1156 can be heated before inserting in tissue thickness compensation part 1150.In all cases, Pin 1156 can be heated after inserting in tissue thickness compensation part 1150.In all cases, pin 1156 can be with pin 1156 It is inserted in tissue thickness compensation part 1150 and be gradually heated up.

In some cases, pin 1156 can remain positioned in and persistently be enough in tissue thickness compensation part 1150 allow tissue thick Time period in the geometry needed for melted material inflow of degree compensating part 1150.Such time period can be at e.g., from about 30 seconds to about In the range of 8 hours, the disclosure is contemplated that other times section.Such time period can be enough to local influence and/or melting The material of tissue thickness compensation part 1150 and enabling its flow in new geometry.As described herein, such new geometry Can be specified by the instrument for manufacturing tissue thickness compensation part 1150.

In some cases, tissue thickness compensation part can be made before pin 1156 is separated with tissue thickness compensation part 1150 1150 coolings or the temperature being actively cooled the melt temperature less than tissue thickness compensation part 1150.In other cases, may be used Tissue thickness compensation part 1150 is made to cool down or be actively cooled after separate pin 1156 with tissue thickness compensation part 1150 Temperature less than the melt temperature of tissue thickness compensation part 1150.

Refer again to Figure 32 to Figure 34, pin 1156 can be arranged to the row of the length longitudinal extension along mould 1154, should Row may correspond to the staple in nail bin (such as nail bin groupware 20200 (Fig. 6)).For example, as shown in figure 33, pin 1156 can be arranged Become six rows, it is configured to form six rounds 1152, this six round is configured to receive six nails 20230 (Fig. 7).In some cases, as shown in figure 33, the row of pin 1156 can be arranged to two groups, and described two groups are spaced apart and by structure Cause to receive in two parts 1158 and 1160 of tissue thickness compensation part 1150, thus being formed by 1162 points of mid portion From two groups of holes 1152.When tissue thickness compensation part 1150 is assembled with nail bin groupware 20200, mid portion 1162 can at least portion It is positioned above storehouse cutter slit 22015 (Fig. 6) with dividing.In use, firing member 10052 (Figure 10) can advance towards distally to push away Dynamic nail leg 20232 (Fig. 8) pass through part 1158 and 1160 in hole 1152 and advance cut portion 10053 (Figure 10) with crosscutting Mid portion 1162 and separate section 1158 and 1160.

Refer again to Figure 32 to Figure 34, hole 1152 be configured in tissue thickness compensation part 1150 extend and Terminate at the certain depth in tissue thickness compensation part 1150.Hole 1152 may include uniform depth, as shown in figure 34.At it In the case of him, hole 1152 may include different depth (not shown).For example, the first round 1152 may include the first depth, and the Two rounds 1152 may include the second depth different from the first depth, and the 3rd round 1152 may include different from the first depth and 3rd depth of the second depth.The depth in hole 1152 can determine at least partially through the height of corresponding pin 1156.For example, wrap The first pricking with needle 1156 including the first height and the second pricking with needle 1156 including the second height more than the first height can be formed including First round 1152 of the first depth and the second round 1152 including the second depth more than the first depth.

Refer again to Figure 32 to Figure 34, pin 1156 is configured to for the path being used for hole 1152 to be limited to tissue thickness In degree compensating part 1150.In some cases, pin 1156 can along perpendicular to and/or be substantially perpendicular to the mould of mould 1154 The axis on tool surface 1164 extends, as shown in figure 33.Pin 1156 is inserted and in tissue thickness compensation part 1150, maintains mould simultaneously Parallel relation between the surface 1166 of surface 1164 and tissue thickness compensation part 1150 may result in and compensates with respect to tissue thickness The surface 1166 of part 1150 limits the path for the vertical of hole 1152 and/or perpendicular, as shown in figure 34.In other feelings Under condition, pin 1156 can be extended from die surface 1164 with oblique angle (not shown) and/or pin 1156 is to tissue thickness compensation part Insertion path in 1150 can be at an angle of so that pin 1156 can limit use with respect to the surface 1166 of tissue thickness compensation part 1150 Non-perpendicular path in hole 1152.In some cases, one group of pin 1156 can parallel to each other and/or substantially be put down each other OK, as shown in figure 33, thus leading to one group of hole 1152 parallel to each other and/or be substantially parallel to each other, as shown in figure 24. In other cases although not shown, but one group of nonparallel pin can extend from die surface 1164 and can be in insertion tissue Nonparallel hole is produced when in thickness compensation part 1150.In some cases, pin 1156 is configured in tissue thickness Form hole, this tissue thickness compensation part may include the path of part bending and/or the path of partial linear in compensating part 1150.Example As the path that pin 1156 can partly bend extends from die surface 1164 and can be inserted into tissue thickness compensation part 1150 Hole is formed in tissue thickness compensation part 1150 with the path being bent using corresponding part.

Refer again to Figure 32 to Figure 34, some or all in pin 1156 may include blunt distal end 1168, such as Figure 33 Shown.In other cases, some or all in pin 1156 may include sharp keen distal end (not shown).In pin 1156 Some or all may include cylindrical or at least substantially cylindrical shape, for example, as shown in figure 33.The disclosure it is also contemplated that To other shapes.In all cases, one or more of pin 1156 extending from die surface 1164 may not be inserted Enter the whole thickness through tissue thickness compensation part 1150.In some cases, from the pin 1156 that die surface 1164 extends One or more whole thickness may being inserted into through tissue thickness compensation part 1150 to be formed, to extend through tissue thick The opening of whole thickness of degree compensating part 1150 and/or hole.In some cases, from the pin 1156 that die surface 1164 extends One or more the first sides being insertable through tissue thickness compensation part 1150 and pass through such as tissue thickness compensation part 1150 can be relative with the first side the second side leave.In some cases, one or more of pin 1156 may include and is more than The length of the whole thickness of tissue thickness compensation part 1150 is to be conducive to for one or more pins 1156 being inserted through tissue thickness The whole thickness of compensating part 1150.

Referring now to Figure 35 to Figure 37, it may be necessary to reset the size of tissue thickness compensation part.For example, tissue thickness One or more sizes of compensating part can be adjusted to that size corresponding to nail bin to be assembled with nail in tissue thickness compensation part There is provided to nail bin during storehouse and preferably coordinate.In some cases, tissue thickness compensation part 1170 can be passed through it highly from such as figure The first height H1 shown in 35 changes into the second height H2 as shown in figure 36 to reset size.Tissue thickness compensation part 1170 can be in many aspects similar to other tissue thickness compensation parts as herein described, such as tissue thickness compensation part 22020 (figure 9), tissue thickness compensation part 1140 (Figure 29) and/or tissue thickness compensation part 1150 (Figure 32).For example, such as compensating part 22020, compensating part 1170 can be used together with end effector 22090 (Fig. 9).

In all cases, refer again to Figure 35 to Figure 37, tissue thickness compensation part 1170 can be using traditional freeze drying technology And/or any other suitable technology is preparing.In some cases, tissue thickness compensation part 1170 can use such as hot pressing Process and mould 1172 resetting size, as shown in figure 37.Mould 1172 may include and is configured to receive tissue thickness Spend the receptor 1174 of compensating part 1170 and the adjustment means 1176 in receptor 1174 can be inserted partially into.When tissue is thick When degree compensating part 1170 is transformed into glassy state, tissue thickness compensation part 1170 can be reset size.In an embodiment In, tissue thickness compensation part 1170 can be heated to the material more than or equal to tissue thickness compensation part 1170 in baking oven (not shown) The glass transition temperature of feed composition but less than its melt temperature temperature.In another embodiment, receptor 1174 And/or adjustment means 1176 may include the heating element heater for tissue thickness compensation part 1170 is converted to glassy state.Adjust structure Part 1176 and then can be inserted in receptor 1174 apart from H3, for example as shown in figure 37, thus compression organization thickness compensation part 1170 and it is highly reduced to the second height H2 from the first height H1.In some cases, can be in tissue thickness compensation part Before 1170 entrance glassy states or just when tissue thickness compensation part 1170 enters glassy state, adjustment means 1176 are inserted In receptor 1174.Adjustment means 1176 can keep against tissue thickness compensation part 1170 with compression organization thickness compensation part 1170 Persistently be enough to the time period allowing tissue thickness compensation part 1170 to keep or at least substantially keeping the second height H2, as Figure 36 institute Show.When being under the compression of adjustment means 1176, tissue thickness compensation part 1170 then can be made to be cool below The temperature of glass transition temperature.After tissue thickness compensation part 1170 changes and exits glassy state, adjustment means 1176 can be returned Contracting.In some cases, before tissue thickness compensation part 1170 exits glassy state, adjustment means 1176 can bounce back.Some In the case of, above-mentioned resizing process can be used for changing another size of tissue thickness compensation part 1170, such as tissue thickness The length of compensating part 1170 or width.In some cases, these sizes are changed simultaneously or can change in order.

In some examples, the compression from adjustment means 1176 can be tieed up for example during the time being in glassy state Hold time period of about 30 seconds to about 8 hours and/or for example maintain after exiting glassy state about 30 seconds to about 8 hours when Between section.In at least one example, the compression from adjustment means 1176 can maintain during the time being in glassy state About 10 minutes and maintain about 10 minutes after exiting glassy state.The disclosure is contemplated that for maintaining by adjustment means The time period of 1176 compressions applying against tissue thickness compensation part 1170.

In some cases, adjustment means 1176 can be used for inciting somebody to action before tissue thickness compensation part 1170 is converted to glassy state Pressure is applied in tissue thickness compensation part 1170.In some cases, adjustment means 1176 can be in tissue thickness compensation part 1170 when being heated to reach glassy state, when tissue thickness compensation part 1170 is in glassy state, and/or in tissue thickness Compensating part 1170 changes or is cooled to during the temperature of below glassy state to tissue thickness compensation part 1170 applying pressure.In some feelings Under condition, such as, when the temperature of tissue thickness compensation part 1170 is gradually towards glassy transition, it is applied to tissue thickness compensation part 1170 pressure can gradually increase towards threshold value.In some cases, when tissue thickness compensation part 1170 exits glassy state, in group Knit before thickness compensation part 1170 exits glassy state, and/or after tissue thickness compensation part 1170 exits glassy state, apply The pressure being added to tissue thickness compensation part 1170 can be removed, gradually remove or reduce at least in part.

It will be appreciate that, for the different moulds (such as mould 1144,1154 and/or 1172) during above-mentioned modification it is Illustrative examples.Other Design of Dies and configuration can also be used for manipulating tissue thickness compensation part in many ways.Additionally, manipulation group The power involved by thickness compensation part of knitting does not need only compression stress.For example, pulling force can also be used for with those described above Mode similar mode modification tissue thickness compensation part, the shape resetting tissue thickness compensation part and/or size.For example, Also stretch tissue thickness compensation part 1170 can be carried out using pulling force and it is highly reduced to the second height from the first height H1 (Figure 35) Degree H2 (Figure 36), for example, using the modification process similar to above-mentioned modification process in many aspects.In some cases, pulling force Combination with compression stress can be used for repairing and corrects one's mistakes manipulating tissue thickness compensation part during journey.

Refer again to Figure 35 to Figure 37 it may be necessary to the porosity of modification tissue thickness compensation part is to make in surgical operation With.Tissue thickness compensation part may include the open celled foam of such as porous and/or the closed-cell foam of porous.Traditional freeze drying technology can be right The porosity of tissue thickness compensation part provides certain control, but such control it is not easily possible to repeat and may need can not Additional the fine-tuning being obtained by traditional freeze drying technology.As shown in FIG. 35 to 37, for example above-mentioned modification process can be used The height of tissue thickness compensation part 1170 is made to be changed into the second height H2 (Figure 36) from the first height H1 (Figure 35).In addition, also can make Change the porosity of tissue thickness compensation part 1170 with identical and/or similar modification process.For example, tissue thickness compensation part 1170 repairing can correct one's mistakes and have the first porosity (Figure 35) before journey, and have the second porosity after completing modification process (Figure 36), as mentioned above.The change of porosity can be at least partially attributed to during above-mentioned modification process by adjustment means 1176 compression stresses being applied to tissue thickness compensation part 1170 and/or energy.

To being described further above, tissue thickness compensation part 1170 may include multiple holes 1180.For example, as upper State the result of modification process, some or all in hole 1180 can change in terms of position, size and/or shape.Example As, one or more of hole 1180 repairing can be corrected one's mistakes and include spherical or made of substantially spherical shape, as modification before journey The result of process, this shape can be changed to ellipse or generally elliptical shape.In at least one example, hole One or more of 1180 repairing can correct one's mistakes and include first size before journey and the result as modification process includes difference The second size in first size.In some cases, as described in greater detail below, it is thick that porosity change can be confined to tissue One or more regions of degree compensating part 1170 or area.

Additionally, in some cases, the change of the porosity of tissue thickness compensation part 1170 can be mended along with tissue thickness Repay the change of the density of part 1170.In other words, when adjustment means 1176 advance against tissue thickness compensation part 1170, compression Power can reduce the space occupied by tissue thickness compensation part 1170, thus leading to material and/or hole redistribution, this can cause The increase of the density of tissue thickness compensation part 1170 and/or the reduction of its porosity.In some cases, following article is in more detail Description, density changes one or more regions or the area that can be confined to tissue thickness compensation part 1170.

To being described further above, the porosity of tissue thickness compensation part 1170 and/or the change of density can cause The change of the flexible ratio of tissue thickness compensation part 1170.When tissue thickness compensation part against by follow closely such as nail 20230 (Fig. 8) catch During the tissue deployment obtaining, the flexible ratio of tissue thickness compensation part can affect it and compensate the ability of tissue thickness, such as more detailed above Carefully describe.Additionally, the flexible ratio of tissue thickness compensation part also can affect it capturing against by nail tissue thickness compensation part Tissue apply stressed ability.In other words, the change of the flexible ratio of tissue thickness compensation part can change by tissue thickness Compensating part is against the tissue pressure applied being captured by nail.Due to histological types certain pressure can be made more positive Response, so the precise controlling to the flexible ratio of tissue thickness compensation part can be favourable.

As shown in FIG. 35 to 37, tissue thickness compensation part 1170 may include the first flexible ratio (Figure 35), this first bullet Sex rate using above-mentioned modification process change or can be revised as the second flexible ratio (Figure 36) different from the first flexible ratio.Example As described above, when tissue thickness compensation part 1170 is in glassy state, adjustment means 1176 can be against tissue thickness compensation part 1170 propulsions.As response, tissue thickness compensation part 1170 can be compressed, and this leads to the elasticity ratio of tissue thickness compensation part 1170 The change of rate.Adjustment means 1176 are positively retained in propulsion position and persistently be enough to allow tissue thickness compensation part 1170 to keep or extremely It is kept substantially the time period of the change of flexible ratio less.In addition, tissue thickness compensation part 1170 can be made to be cooled to its material group Below the glass transition temperature of compound, maintain the pressure being applied by adjustment means 1176 against tissue thickness compensation part 1170 simultaneously Power.

In some cases, adjustment means 1176 can compensate against tissue thickness for example during the time being in glassy state Part 1170 maintain propulsion position in last about 30 seconds to about 8 hours time period and/or for example exit glassy state it Last the time period of about 30 seconds to about 8 hours afterwards.In at least one example, adjustment means 1176 for example can be in glassy state Time during maintain in propulsion position against tissue thickness compensation part 1170 and continue about 10 minutes and exiting glass Continue about 10 minutes after state.The disclosure is contemplated that for tieing up adjustment means 1176 against tissue thickness compensation part 1170 Hold the other times section in propulsion position.

In some cases, adjustment means 1176 can be used for inciting somebody to action before tissue thickness compensation part 1170 is converted to glassy state Pressure is applied in tissue thickness compensation part 1170, to change the flexible ratio of tissue thickness compensation part 1170.In some situations Under, adjustment means 1176 can be when tissue thickness compensation part 1170 be heated to reach glassy state, in tissue thickness compensation part 1170 when being in glassy state, and/or when tissue thickness compensation part 1170 changes or is cooled to the temperature of below glassy state Apply pressure to tissue thickness compensation part 1170.In some cases, for example tissue thickness compensation part 1170 temperature gradually Increase so that when tissue thickness compensation part 1170 is towards glassy transition, the pressure being applied to tissue thickness compensation part 1170 can be gradually Increase towards threshold value.In some cases, when tissue thickness compensation part 1170 exits glassy state, in tissue thickness compensation part 1170 Before exiting glassy state, and/or after tissue thickness compensation part 1170 exits glassy state, it is applied to tissue thickness and compensates The pressure of part 1170 can be removed, gradually remove or reduce at least in part.

Refer again to Figure 35 to Figure 40, tissue thickness compensation part 1170 can using traditional freeze drying technology and/or any other Suitable technology to be manufactured with natural flexible ratio.As described above, the flexible ratio of tissue thickness compensation part 1170 can affect It applies stressed ability against by the tissue that nail tissue thickness compensation part 1170 captures.Above-mentioned modification process can be used for adjusting The natural elasticity ratio of tissue thickness compensation part 1170 is to adjust it against the group being captured by nail tissue thickness compensation part 1170 Knit and apply stressed ability.In some cases, the natural elasticity ratio of tissue thickness compensation part 1170 can be from point A (Figure 40) The first flexible ratio increase to the second flexible ratio, this second flexible ratio includes and up to point B (Figure 40) place is Big flexible ratio.In some cases, such increase of the flexible ratio of tissue thickness compensation part 1170 can be in the following manner Realize：When tissue thickness compensation part 1170 is in glassy state, applied to tissue thickness compensation part 1170 using adjustment means 1176 Compressive forces, as explained during above-mentioned modification.As shown in figure 40, point B represents the maximum of tissue thickness compensation part 1170 Elastic rate.Therefore, by adjustment means 1176 point B be applied to tissue thickness compensation part 1170 exceed threshold compression appoint What additional compression may result in the reduction of the flexible ratio of tissue thickness compensation part 1170 being modified.For example, as shown in figure 40, exist Flexible ratio at point C is less than the flexible ratio at point B, even if being applied to tissue thickness by adjustment means 1176 in point C The compression stress of compensating part 1170 is more than the compression stress applying at point B.

As described above, one or more processes can be used for impact being combined with such as fastener cartridge and/or reuse surgical fasteners tool The flexible ratio of material using and/or any other characteristic.The flexible ratio of material and/or any other characteristic can be whole Change during modification.In some cases, such change is probably gradual, and in other cases, this change is probably Unexpected.In all cases, one or more of step of modification process may result in the flexible ratio of material to increase, and one Individual or multiple steps may result in the reduction of the flexible ratio of material.Finally, repairing correct one's mistakes journey start before initial elasticity ratio And the follow-up flexible ratio after modification process between when more completing, the net change of flexible ratio can be measured.Various In the case of, after material has been heated and has then cooled down, material can have the flexible ratio of change.

In certain circumstances, it may be necessary to one or more of above-mentioned modification process is applied to tissue thickness compensate Part.For example, the first modification process can be used for changing the porosity of tissue thickness compensation part, such as compensates above in relation to tissue thickness Described in part 1170.The second modification process after first modification process can be used for changing the surface of tissue thickness compensation part, as above Literary composition is with respect to described in tissue thickness compensation part 1140.Additionally, the 3rd modification process can be used for being revised as tissue thickness compensation part Longitudinal slit including the longitudinal slit 1122 similar to tissue thickness compensation part 1120.During another the 4th modification, Tissue thickness compensation part can be modified to the hole including the hole 1152 similar to tissue thickness compensation part 1150.It will be appreciate that, Some in above-mentioned modification can combination or packet during single modification.For example, mould is designed to including mould 1154 Pin 1156 and mould 1126 center sill 1128.The disclosure is contemplated that other change arrangement.

Referring now to Figure 38 and Figure 39, can use one or more of above-mentioned modification process that tissue thickness compensation part is all It is part including having different flexible ratios, porosity and/or density as tissue thickness compensation part 1190 is altered or modified.? In some cases, using one or more of above-mentioned modification process, tissue thickness compensation part 1190 can be revised as including gradient (that is, the size of fine pore is gradually increased into macropore across the thickness of tissue thickness compensation part 1190 to pore morphology in one direction Gap).Such form is even more ideal for tissue growth or hemostasis behavior.In addition, gradient also can be with the bio-absorbable of change Section is combined.Short-term absorption profile may be more suitable for realizing hemostasis, and Long-term absorption section can be realized preferably organizing more Close and non-leakage.

Refer again to Figure 38 and Figure 39, tissue thickness compensation part 1190 can have the residue with tissue thickness compensation part 1196 Partly different one or more region geometry shapes.For example, as shown in figure 38, tissue thickness compensation part 1190 may include one Or multiple jut, such as jut 1196.In addition, tissue thickness compensation part 1190 may include through inclusion one or many Uniform or at least substantially uniform first flexible ratio of the tissue thickness compensation part 1190 of individual region geometry shape, first Porosity and/or the first density, as shown in figure 38.In some cases, one or more of above-mentioned modification process can be used Tissue thickness compensation part 1190 is altered or modified, one or more region geometry shapes are altered or modified and/or draw The local playing the such as first flexible ratio, the first porosity and/or the first density changes.The tissue thickness compensation part 1190 of modification May include the region of one or more modifications, the region of described modification has the region changed with other and/or tissue is thick Spend the respectively different elasticity ratio of the first flexible ratio of remainder, the first porosity and/or first density of compensating part 1190 Rate, porosity and/or density.In some cases, the region of the one or more modification of gained may correspond to one or more areas Domain geometry.For example, as shown in figure 39, tissue thickness compensation part 1190 can be changed or modified and be and jut 1196 water Flat or at least substantially level, and form for example flat or at least substantially flat surface 1198.The tissue thickness of modification Compensating part 1190 may include the Part I 1192 with the first flexible ratio, the first porosity and/or the first density and tool Have be different from the second flexible ratio of the first flexible ratio, the first porosity and/or the first density, the second porosity and/ Or second density Part II 1194.Part II 1194 may correspond to jut 1196, and may result in and jut Point 1196 levels or at least substantially level, to form for example flat or at least substantially flat surface 1198.In some sides Face, before the modification of tissue thickness compensation part 1190, the geometry of jut 1196 reflects, mates or is similar in tissue Thickness compensation part 1190 be modified after Part II 1194 geometry.

Refer again to Figure 37 to Figure 39, can be changed using mould 1172 similar to the mode of tissue thickness compensation part 1170 Become or modification tissue thickness compensation part 1190.For example, tissue thickness compensation part 1190 can be heated in receptor 1174 and be more than Or be equal to the glass transition temperature of material compositions of tissue thickness compensation part 1190 but be less than the temperature of its melt temperature.? In some cases, when tissue thickness compensation part 1190 is in glassy state, adjustment means 1176 can divide 1196 to push away by abutment projection Enter, thus compressing jut 1196 and rearranging its geometry to form Part II 1194, as shown in figure 39.Right It is described further above, the compression that adjustment means 1176 are configured to be maintained against jut 1196 is held Continuous enough to allow tissue thickness compensation part 1190 to keep or the modification that at least substantially keeps being applied by adjustment means 1176 when Between section.When being under the compression of adjustment means 1176, tissue thickness compensation part 1190 can be made to cool down or can actively Be cool below the temperature of its glass transition temperature.After tissue thickness compensation part 1190 changes and exits glassy state, adjust Section component 1190 can bounce back.Tissue thickness compensation part 1190 can keep or at least substantially keep Part II 1194, such as Figure 39 Shown.In some cases, adjustment means 1176 can be when tissue thickness compensation part 1190 be heated to reach glassy state, in group When knitting thickness compensation part 1190 and being in glassy state, and/or change in tissue thickness compensation part 1190 or be cooled to glassy state Pressure is applied on jut 1196 during following temperature.In some cases, for example in tissue thickness compensation part 1190 Temperature when being gradually increased so that tissue thickness compensation part 1190 towards glassy transition, be applied to tissue thickness compensation part 1190 The pressure of jut 1196 can gradually increase towards threshold value.In some cases, exit glass in tissue thickness compensation part 1190 During state, before tissue thickness compensation part 1190 exits glassy state, and/or exit glass in tissue thickness compensation part 1190 After state, the pressure being applied to the jut 1196 of tissue thickness compensation part 1190 can be removed, gradually remove or at least portion Ground is divided to reduce.

Referring now to Figure 41 to Figure 43, group can be prepared using traditional freeze drying technology and/or any other suitable technology Knit thickness compensation part, such as tissue thickness compensation part 1200.In addition, tissue thickness compensation part 1200 can be modified or varied with In such as surgical operation.Tissue thickness compensation part 1200 can be in many aspects similar to other tissue thickness compensation parts, such as Tissue thickness compensation part 22020 (Fig. 9) and/or tissue thickness compensation part 1120 (Figure 26).For example, such as tissue thickness compensation part 22020, tissue thickness compensation part 1200 can be used together with end effector 22090.Additionally, as shown in Figure 41 to Figure 43, group Knit thickness compensation part 1200 and can be modified to including longitudinal slit 1202, this longitudinal slit, such as cutter slit 22025, can will be used for The tissue thickness compensation part cutter track footpath of cut portion 10053 is limited to the first sutured portion 1204a and the second sutured portion 1204b Between.Additionally, the first sutured portion 1204a and the second sutured portion 1204b can compensate similar to tissue thickness in many aspects First sutured portion 22021a (Fig. 9) of part 22020 and the second sutured portion 22021b (Fig. 9).In addition, slit 1202 can be by structure Cause to be releasably attached the first sutured portion 1204a and the second sutured portion 1204b so that with end effector 22090 when being used together, and cut portion 10053 can be advanced through slit 1202 with crosscutting slit 1202 and by first towards distally Sutured portion 1204a and the second sutured portion 1204b separate.

Refer again to Figure 41 to Figure 43, tissue thickness compensation part 1200 can be assembled with end effector such as end execution It is modified before device 22090 (Fig. 9).Alternatively, tissue thickness compensation part 1200 can be after it be assembled with end effector It is modified.As described above, tissue thickness compensation part 1200 can be come using traditional freeze drying technology and/or any other suitable technology Preparation.Space creator 1206 can be used for changing tissue thickness compensation part 1200 in thermal pressing process, as Figure 41 to Figure 43 institute Show.For example, space creator 1206 can be heated to the molten of the material compositions more than or equal to tissue thickness compensation part 1200 Melt the temperature of temperature.Then space creator 1206 can be aligned with tissue thickness compensation part 1200 and insert tissue thickness and compensate In part, to form longitudinal slit 1202.Space creator 1206 melting passes through tissue thickness compensation part 1200 with for longitudinal direction Slit 1202 creates space.Space creator 1206 can return after reaching the desired depth in tissue thickness compensation part 1200 Contracting.In some cases, thermal pressing process can be mended through tissue thickness by reinserting the space creator 1206 of heating Repay part 1200 to repeat to widen the space creating for longitudinal slit 1202.

Refer again to Figure 41 to Figure 43, space creator 1206 may include hot wire.For example, space creator 1206 can Including thin, tension the metal wire being made up of such as nichrome or rustless steel, or it is pre-formed as the thicker of required form Line.Hot wire can be temperature required by being resistively heated to.Tissue thickness is passed through to mend in the hot wire of space creator 1206 Repay part 1200 material when, from the heat of hot wire can just make before contact material evaporate.In some cases, heat Tinsel can have cylindrical or substantially cylindrical shape, as shown in figure 42.The depth of longitudinal slit 1202 can be partly Pass through the insertion depth of tissue thickness compensation part 1200 depending on space creator 1206, and the width of longitudinal slit 1202 can It is partly dependent on the diameter of the hot wire of space creator 1206.

In some cases, space creator 1206 can be inserted partially into the whole thickness through tissue thickness compensation part. In some cases, space creator 1206 can be inserted completely through the whole thickness of tissue thickness compensation part 1200 and prolonged with being formed Extend through opening, hole and/or the slit of the whole thickness of tissue thickness compensation part 1200.In some cases, space creator 1206 the first sides being insertable through tissue thickness compensation part 1200 and pass through such as tissue thickness compensation part 1200 can be with The second relative side of first side is left.

Disclosed herein is many techniques, described technology utilization thermal energy is changing tissue thickness compensation part.Such technique can Referred to as felt technique.In some cases, felt technique is possible with applying compression stress to tissue thickness compensation part and/or draws Power.In other cases, felt technique can not apply compression stress and/or pulling force using to tissue thickness compensation part.At any one In the case of, felt technique disclosed herein can also be used for for example changing and appropriately implant layer and/or backing material.

In all cases, tissue thickness compensation part assembly can comprise polymer composition.Polymer composition may include One or more synthetic polymer and/or one or more non-synthetic polymer.Synthetic polymer may include the absorbable of synthesis Polymer and/or the non-absorbable polymer of synthesis.In all cases, polymer composition can comprise such as biocompatibility Foam.Biocompatible foam may include the open celled foam of such as porous and/or the closed-cell foam of porous.Biocompatible foam Can have a uniform pore morphology, or can have gradient pore morphology (that is, a direction across foam thickness, orifice size by Cumulative plus become macropore).In all cases, polymer composition may include porous support, porous matrix, gel-type vehicle, water Gel-type vehicle, solution matrix, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and can biology drop One or more of polymer of solution and combinations thereof.For example, tissue thickness compensation part assembly may include by thread The foam of matrix enhancement, or may include the foam with additional hydrogel layer, this additional hydrogel layer exists in body fluid Lower stretching, extension, organizationally to further provide for compressing.In all cases, tissue thickness compensation part assembly also can by material and/ Or the coating in the second layer or third layer is constituted, this coating stretches in the presence of body fluid, organizationally to further provide for compressing. Such layer can be hydrogel, this hydrogel can for synthesis and/or natural source material, and for example can for biological durable and/ Or it is biodegradable.In some cases, can use and for example be provided that the fiber of additional flexibility, rigidity and/or intensity is non- Weaving material or fiber mesh type element are strengthening tissue thickness compensation part assembly.In all cases, tissue thickness compensates Part assembly has porous form, and this porous form shows gradient-structure, for example, is aperture on a surface, and another It is larger hole on surface.Such form is even more ideal for tissue growth or hemostasis behavior.In addition, gradient also can be with change The bio-absorbable section changed is combined.Short-term absorption profile may be more suitable for realizing hemostasis；And Long-term absorption section can be realized Preferably organization healing again will not seepage.

The example of non-synthetic polymer includes but is not limited to lyophilized polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, bright Glue, collagen and oxidized regenerated cellulose (ORC).The example including but not limited to poly- (lactic acid) of the absorbable polymer of synthesis (PLA), PLLA (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), PTMC (TMC), poly- Ethylene glycol terephthalate (PET), the copolymer (PGCL) of polyhydroxy-alkanoates (PHA), Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone, second The copolymer of lactide and trimethylene carbonate, poly- (decanedioic acid glyceride) (PGS), PPDO, poly- (ortho esters), Condensing model, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, tyrosine-based polyimide carbonate, tyrosine-based polycarbonate, Poly- (D, L- lactide-carbamate), poly- (B- hydroxybutyric acid), poly- (E- caprolactone), Polyethylene Glycol (PEG), poly- [two (carboxylics Phenoxyl) phosphonitrile], poly- (aminoacid), intend poly- (aminoacid), absorbable polyurethane, and combinations thereof.In various situations Under, this polymer composition can comprise the PLLA of about 50% to about 90% for example based on the weight of polymer composition, and The PCL of about 50% to about 10% based on the weight of polymer composition.In at least one embodiment, this polymer group Compound can comprise such as by weight about 70% PLLA, and by weight about 30% PCL.In all cases, should Polymer composition can comprise the PGA of about 55% to about 85% for example based on the weight of polymer composition, and by polymerization The PCL of the weight meter 15% to 45% of compositions.In at least one embodiment, this polymer composition can comprise for example By weight about 65% PGA, and by weight about 35% PCL.In all cases, this polymer composition can wrap PGA containing about 90% to about 95% for example based on the weight of polymer composition, and based on the weight of polymer composition The PLA of about 5% to about 10%.

In all cases, the absorbable polymer of synthesis may include bioabsorbable biocompatible elastomers copolymerization Thing.Suitably bioabsorbable, biocompatibility elastomer copolymer includes but is not limited to 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester (6-caprolactone is preferably about 30 with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester to copolymer:70 to about 70:30 it is therefore preferable to 35:65 to about 65: 35, and it is more preferably 45:55 to 35:65)；6-caprolactone and lactide (include L- lactide, D- lactide, they Blend or lactic acid copolymer) elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and it is more preferably 45:55 to 30:70)；To dioxanone (1,4- dioxane -2- ketone) and the third friendship Elastomer copolymer (the mol ratio to dioxanone and lactide of ester (including L- lactide, D- lactide and lactic acid) It is preferably about 40:60 to about 60:40)；6-caprolactone and to the elastomer copolymer of dioxanone (6-caprolactone with right The mol ratio of dioxanone is preferably about 30:70 to about 70:30)；To dioxanone and trimethylene carbonate Elastomer copolymer (30 are preferably from about to the mol ratio of dioxanone and trimethylene carbonate:70 to about 70:30)； (trimethylene carbonate is preferably from about the elastomer copolymer of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester 30:70 to about 70:30)；Trimethylene carbonate and lactide (include L- lactide, D- lactide, their blend or breast Acid copolymer) elastomer copolymer (mol ratio of trimethylene carbonate and lactide is preferably from about 30:70 to about 70: 30)；And their blend.In one embodiment, elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone. In another embodiment, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

It is published in the United States Patent (USP) 5 of entitled " the ELASTOMERIC MEDICAL DEVICE " on November nineteen ninety-five 21, 468,253 with entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS's " being published on December calendar year 2001 4 The disclosure of United States Patent (USP) 6,325,810 is each incorporated by reference in its entirety herein accordingly.

In all cases, the absorbable polymer of synthesis can for example include one or more of following material：Permissible Trade name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly- (Acetic acid, hydroxy-, bimol. cyclic ester-L- third hands over Ester) copolymer, can with trade name DEXON from the commercially available PGA of American Cyanamid Co., can be with commodity Title PDS from Ethicon, the commercially available polydioxanone of Inc., can be with trade name MAXON from American Commercially available poly- (glycolide-trimethylene carbonate) statistic copolymer of Cyanamid Co., can be with trade name MONOCRYL is from Ethicon commercially available 75/25 poly- (Acetic acid, hydroxy-, bimol. cyclic ester-E- caprolactone-poliglecaprolactone 25) altogether Polymers.

The example of the non-absorbable polymer of synthesis includes but is not limited to polyurethane foam plastics, polypropylene (PP), poly- second Alkene (PE), Merlon, polyamide, such as nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyether-ether-ketone (PEEK), politef (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones and combinations thereof.The non-absorbable polymer of synthesis may include but do not limit In foam elastomer and porous elastomers, such as silicone, polyisoprene and rubber.In all cases, described synthesized polymer Thing may include can be with brand name GORE-TEX Soft Tissue Patch from W.L.Gore＆Associates, and Inc. is commercially available The expanded PTFE (ePTFE) obtaining, and can be with brand name NASOPORE from the commercially available copolymerization of Polyganics Ether-ether polyurethane foam.

The feature of the polymer composition of tissue thickness compensation part assembly may be in for example porosity percentage ratio, hole size, And/or hardness.In all cases, this polymer composition can have the hole of such as about 30% to about 99% by volume Porosity percentage ratio.In some cases, this polymer composition can have such as by volume about 60% to about 98% Porosity percentage ratio.In all cases, this polymer composition can have such as by volume about 85% to about 97% Porosity percentage ratio.In at least one embodiment, this polymer composition can comprise such as by weight about 70% PLLA and by weight about 30% PCL, and may include for example by volume about 90% porosity.At least one In individual such embodiment, therefore, this polymer composition will comprise by volume about 10% copolymer.At at least one In embodiment, this polymer composition can comprise such as by weight about 65% PGA and by weight about 35% PCL, and can have the porosity percentage ratio of such as about 93% to about 95% by volume.In all cases, it is polymerized Compositions may include the porosity being more than 85% by volume.Polymer composition can have such as about 5 microns to about 2000 microns of hole size.In all cases, polymer composition can have for example micro- to about 100 between about 10 microns Hole size between rice.In at least one such embodiment, this polymer composition can comprise being total to of such as PGA and PCL Polymers.In some cases, polymer composition can have the hole for example between about 100 microns to about 1000 microns Size.In at least one such embodiment, this polymer composition can comprise the copolymer of such as PLLA and PCL.According to Some aspects, the hardness of polymer composition can represent with Shore hardness, this Shore hardness can be defined as (all with durometer As sclerometer) material that the measures resistance to residual indentation.In order to assess the durometer value of given material, according to entitled ASTM program D2240- of " Standard Test Method for Rubber Property-Durometer Hardness " 00 (it is incorporated by reference in its entirety herein), is pressed to material with hardness head pressure feet.Hardness head pressure feet can be pressed into material Material, keeps the sufficiently long time (such as 15 seconds), in this case, subsequently reads reading by suitable scale.According to used Scale type, when pressure head foot completely penetrates through material, reading 0 can be obtained, and when material is not pierced, reading can be obtained 100.This reading is nondimensional.In all cases, can be according to ASTM D2240-00, using any suitable scale such as A Class and/or OO class scale are determining hardness.In all cases, the polymer composition of tissue thickness compensation part assembly can have The Shore A Hardness value of such as about 4A to about 16A, this hardness number is of about 45OO to about 65OO in the range of Shore OO. In at least one such embodiment, this polymer composition can comprise such as PLLA/PCL copolymer or PGA/PCL copolymerization Thing.In all cases, the polymer composition of tissue thickness compensation part assembly can have the Shore A Hardness value less than 15A.? In the case of various, the polymer composition of tissue thickness compensation part assembly can have the Shore A Hardness value less than 10A.Various In the case of, the polymer composition of tissue thickness compensation part assembly can have the Shore A Hardness value less than 5A.In some situations Under, polymeric material can have the Shore OO composition value of such as about 35OO to about 75OO.

In all cases, polymer composition can have at least two in the above-mentioned characteristic identifying.In various feelings Under condition, polymer composition can have at least three kinds in the above-mentioned characteristic identifying.This polymer composition can have for example 85% to 97% porosity, 5 microns to 2000 microns of hole size and the Shore A Hardness value of 4A to 16A by volume, with And the shore OO hardness value of 45OO to 65OO.In at least one embodiment, for example, polymer composition can comprise by polymerization The PLLA of weight meter 70% of compositions and based on the weight of polymer composition 30% PCL, and have by volume 90% porosity, 100 microns to 1000 microns of hole size and the Shore A Hardness value of 4A to 16A and 45OO to 65OO Shore OO hardness value.In at least one embodiment, for example, polymer composition can comprise the weight by polymer composition The PGA of gauge 65% and based on the weight of polymer composition 35% PCL, and there is by volume 93% to 95% hole Degree, 10 microns to 100 microns of hole size and the Shore A Hardness value of 4A to 16A and the Shore OO hardness of 45OO to 65OO Value.

In all cases, polymer composition can comprise pharmaceutically active agents.Polymer composition is releasable to treat effectively The pharmaceutically active agents of amount.In all cases, when polymer composition is desorbed/absorbs, pharmaceutically active agents can be released.? In the case of various, pharmaceutically active agents can be released to fluid and such as flow through above polymer composition or pass through polymer composition Blood in.The example of pharmaceutically active agents may include but be not limited to hemorrhage and medicine, such as fibrin, thrombin and oxygen Change regenerated cellulose (ORC)；Antiinflammatory medicine, such as diclofenac, aspirin, naproxen, sulindac and hydrocortisone； Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamycin, many Acarasiales Plain B, chloromycetin；And anticarcinogen, such as cisplatin, mitomycin, amycin.

Disclosed herein is for the various methods changing tissue thickness compensation part.Such method can be used for change for example with tightly Any suitable layer that firmware storehouse and/or reuse surgical fasteners tool are used together.Such layer can comprise to use any suitable work What skill was formed forms less than absolutely fine and close.For example, such technique may include such as extrusion, injection molding, weaving, lyophilizing, gas Body foaming and/or melt-blown process.Some techniques may produce foam, and other techniques may not produce foam；However, any In the case of, all it is contemplated that be used together all such embodiments with all of the embodiments disclosed herein.

In various embodiments, referring to Figure 44 to Figure 46, the end effector such as end execution of reuse surgical fasteners tool Device 100 is configured to capture, fastening and/or incision tissue.End effector 100 may include fastener cartridge 110, and Comprise additionally in firing member 140, this firing member can be advanced through fastener cartridge 110 will removedly be stored in nail bin Nail in 110 is deployed to capture in the tissue in end effector 100.In all cases, firing member 140 can be proximally Position (Figure 44) is followed closely and transecting patient tissue towards the distal end propulsion of end effector 100 with disposing simultaneously.But exist so Certain situation, wherein may not be needed by firing member 140 towards end effector 100 distal end propulsion.For example, end The fastener cartridge 110 of executor 100 can be can be removed and/or interchangeable, in fastener cartridge 110 delocalization in end In the case of in executor 100, may not be needed propulsion in end effector 100 for firing member 140.In percussion In the case that component 140 is advanced through end effector 100 and is positioned in end effector 100 without fastener cartridge, hit The blade 142 sending out component 140 can cut into tissue in end effector 100 for the capture and need not fastening tissue simultaneously.Similarly, Used in advance in the fastener cartridge being positioned in end effector 100, or extended, and at least some of securing member is In the case of fastener cartridge deployment, may not be needed propulsion in end effector 100 for firing member 140.? Firing member 140 is advanced through the fastener cartridge that end effector 100 extends simultaneously in advance and is positioned in end effector 100 In the case of, the blade 142 of firing member 140 can cut into tissue in end effector for the capture and need not fastening group simultaneously Knit.In various embodiments, end effector 100 may include one or more locking systems, when fastener cartridge is not present in When in end effector 100 and/or when the fastener cartridge being positioned in end effector 100 extends at least in part When, this locking system can prevent firing member 140 from advancing towards distally.Various locking systems are in entitled " SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT " and be published on January 24th, 2006 United States Patent (USP) 6,988,649 in have disclosed.Entitled " SURGICAL STAPLING INSTRUMENT HAVING A The complete disclosure of the United States Patent (USP) 6,988,649 of SPENT CARTRIDGE LOCKOUT " is herein incorporated by reference.

Refer again to Figure 44 to Figure 46, fastener cartridge 110 may include warehouse and tissue thickness compensation part 120, wherein to upper Literary composition is described further, and tissue thickness compensation part 120 can be passed through removedly to be stored in warehouse against by end effector 100 The tissue implantation of interior securing member capture.Tissue thickness compensation part 120 can be positioned on above top surface or the platform of warehouse, its In be removedly stored in nail 180 in the nail cavity being defined in warehouse can by such as firing member (such as sliding part 130 and/ Or firing member 140) project from nail cavity.In certain embodiments, fastener cartridge 110 may also include driver, this driver Be configured to support nail 180 and transmit the motion that sliding part 130 arrives nail 180, so as to make nail 180 in non-firing position and Move between firing position.In all cases, when nail 180 is in its non-firing position, nail 180 can be embedding at least in part Enter in tissue thickness compensation part 120, and in some cases, when nail 180 is in its non-firing position, nail 180 can be by group Knit thickness compensation part 120 to be maintained in the appropriate location above the platform of storehouse.Before nail 180 is deployed in tissue, in tissue In the case that thickness compensation part 120 is with respect to warehouse and/or nail 180 motion, in some cases, tissue thickness compensation part 120 Nail 180 can be made with respect to the motion of its optimum position or away from the motion of its optimum position.Additionally, before nail 180 is deployed, in group Knit thickness compensation part 120 in the case that storehouse 110 removes, storehouse 110 may be not suitable for its initial expected purposes.In view of more than Described, as discussed in more detail below, end effector 100 may include locking piece, and this locking piece is configured in nail Before 180 are deployed, remove from warehouse in tissue thickness compensation part 120 or become situation about departing from from warehouse at least in part Under prevent firing member 140 and/or sliding part 130 towards distally advance to dispose nail 180.

Refer again to Figure 44 to Figure 46, tissue thickness compensation part 120 may include (one) and is configured to by nail 180 capture Main body 121, and the stop pin 122 that (two) extend from main body 121.In all cases, when tissue thickness compensation part 120 not Correct position above warehouse platform removes or substantially when moving in this position, stop pin 122 may include embedded main body 121 In first end 123 and be positioned at the second end 124 in the middle of firing member 140 and sliding part 130.In such position In, the second end 124 of stop pin 122 can be positioned on the shoulder being limited on sliding part 130 or frame 134 and from trigger shaft 140 Towards in the middle of the projection 144 of distal extension.In other words, when stop pin 122 is positioned at sliding part 130 and trigger shaft 140 is middle, Stop pin 122 and sliding part 130 can cooperate so that trigger shaft 140 to be supported on the locking shoulder 112 being defined in fastener cartridge 110 So that when distally percussion force is applied to trigger shaft 140, trigger shaft 140 can advance towards distally and slide in the unlocked position of top Part 130 is with percussion nail 180.When tissue thickness compensation part 120 removes and/or substantially from respect to warehouse from storehouse 110 When desired location departs from, referring primarily to Figure 45, stop pin 122 may no longer be positioned in sliding part 130 and firing member 140 Between, and/or firing member 140 may not be supported in its unlocked position (Figure 44).In such cases, fire Component 140 can become to be positioned in latched position so that the locked shoulder 112 of distally propulsion of firing member 140 prevents.Extremely Under such circumstances, end effector 100 may also include and is for example configured to for firing member 140 to be biased into it few one kind Biasing member in lock-out state, such as spring.In some cases, firing member 140 can be biased into for example by biasing member Contact with sliding part 130, and stop pin 122 betwixt need not be positioned, this stop pin may include the locking bit of firing member 140 Put.

As above-described result, if tissue thickness compensation part 120 prematurely removes from storehouse 110, storehouse 110 is variable Obtain inoperable.In such cases, stop pin 122 may include fuse, before firing member 140 is towards distally propulsion, in group Knit in the case that thickness compensation part 120 is removed, this fuse makes storehouse 110 disable.In all cases, stop pin 122 may include Key, when key is positioned between sliding part 130 and firing member 140, this key maintains storehouse 110 in released state, and Firing member 140 is towards before the propulsion of distally, i.e. before firing member 140 starts its firing schedule, in tissue thickness compensation part 120 allow storehouse 110 to enter lock-out state in the case that storehouse 110 removes.When firing member 140 is in its lock-out state simultaneously And can not towards distally advance when, the blade 142 of firing member 140 can not cut tissue in end effector 100 for the capture.This Outward, in such cases, sliding part 130 can not be advanced with percussion nail 180 by firing member 140 towards distally.Therefore, when tissue is thick Degree compensating part 120 no-fix or when not being appropriately positioned on storehouse 110, tissue thickness compensation part locking piece can prevent capture from existing Tissue in end effector 100 is cut into and sutures.Before tissue thickness compensation part 120 is removed or departs from, in percussion Towards in the case of the propulsion of distally, firing member 140 can complete firing schedule or its percussion row of end effector 100 to component 140 At least a portion of journey.In such cases, sliding part 130 towards distally propulsion so that be limited on sliding part 130 one or Multiple slopes 132 can lift nail 180, and the blade 142 of firing member 140 can cut into tissue thickness compensation part 120 and/or catches Obtain the tissue in end effector 100.In some cases, firing member 140 can contact stop pin 122 and in percussion structure Part 140 makes it be displaced from when advancing towards distally.In such cases, stop pin 122 can be flexibility.In all cases, Stop pin 122 can be made up of for example bioabsorbable material and/or biocompatible materialses.In some cases, fire structure Part 140 can cut stop pin 122 towards distally when firing member 140 advances.Under any circumstance, once firing member 140 Advance at least in part, the purpose of stop pin 122 may become out-of-date.In other words, tissue thickness compensation part locking piece can use Make initial inspection to be present in end effector to verify tissue thickness compensation part, and once having completed initial inspection, just may be used Carry out the firing schedule of end effector.

Refer again to Figure 47 to Figure 50, end effector 200 may include anvil block 260, and comprises additionally in fastener cartridge 210, this fastener cartridge includes warehouse 214 and tissue thickness compensation part 220, and wherein to being described further above, tissue is thick Degree compensating part 220 can be against the tissue of the securing member capture passing through removedly to be stored in warehouse 214 by end effector 200 Implantation.Tissue thickness compensation part 220 can be positioned on above top surface or the platform 211 of warehouse 214, wherein removedly stores The nail in nail cavity in being defined in warehouse 214 can be by such as firing member (such as sliding part 230 and/or firing member 240) Project from nail cavity.In certain embodiments, fastener cartridge 210 may also include driver, and this driver is configured to prop up Nail and transmit sliding part 230 arrive nail motion to make nail move between non-firing position and firing position.Various In the case of, when nail is in its non-firing position, nail can be at least partially embedded in tissue thickness compensation part 220, and at certain In the case of a little, when nail is in its non-firing position, during tissue thickness compensation part 220 can be held in place by by nail.? Before nail is deployed in tissue, in the case that tissue thickness compensation part 220 is with respect to warehouse 214 and/or nail motion, one In the case of a little, tissue thickness compensation part 220 can make nail with respect to the motion of its optimum position or away from the motion of its optimum position.This Outward, before nail is deployed, in the case that tissue thickness compensation part 220 removes from storehouse 210, storehouse 210 may be not suitable for Its initial expected purposes.In view of the above, as discussed in more detail below, end effector 200 may include locking piece, this lock Determine part to be configured to, before nail is deployed, remove from warehouse 214 in tissue thickness compensation part 220 or become at least Partly prevent firing member 240 and/or sliding part 230 from advancing towards distally to dispose nail in the case of warehouse disengaging.

Refer again to Figure 44 to Figure 46, tissue thickness compensation part 220 may include that (one) be configured to be captured by nail Main body 221, and (two) ring of extending from main body 221 or tie-down 222.In all cases, referring primarily to Figure 47, ring 222 May include the end being at least partially embedded in main body 221 and extend between the ends can with sliding part 230 releasedly The mid portion engaging.In some cases, ring 222 may include such as stitching thread or flexible wires.In some cases, ring 222 Can be made up of for example bioabsorbable material and/or biocompatible materialses.Referring primarily to Figure 48, sliding part 230 may include Longitudinal main part 236, the hook 238 extending from main part 236, and it is limited to narrow between main part 236 and hook 238 Groove 237.As shown in figure 48, when tissue thickness compensation part 220 is positioned at storehouse platform 211 top, ring 222 is positioned at slit 237 Interior, and sliding part 230 and firing member 240 be in non-firing position.In addition as shown in figure 48, prolong from firing member 240 The distally projection 244 stretched positions against the support shoulder 234 being limited on sliding part 230 and/or is positioned on, this Firing member 240 is maintained in unlocked position in brace shoulder portion, that is, be maintained in such position, in this position, when percussion fortune Dynamic when being applied to firing member 240, the locking being limited in end effector 200 is takeed on by the distally motion of firing member 240 Portion 212 hinders or at least substantially hinders.Therefore, when firing member 240 is maintained in its unlocked position sliding part 230, Referring to Figure 49, firing member 240 will slide past locking shoulder 212 to advance sliding part 230 towards distally, and percussion is removedly It is stored in the nail in warehouse 214, and with blade 242 incision tissue thickness compensation part and be positioned in end effector 200 Tissue.As shown in figure 49, when sliding part 230 advances towards distally, ring 222 slidably exit be defined in narrow in sliding part 230 Groove 237.

Remove or the correct position substantially above the platform 211 in storehouse 210 from storehouse 210 in tissue thickness compensation part 220 In the case of motion, referring now to Figure 50, tissue thickness compensation part 220 can be by sliding part 230 towards distally tractive so that firing structure Part 240 is no longer supported by sliding part 230.More specifically, the ring 222 being positioned in slit 237 of tissue thickness compensation part 220 can By sliding part 230 from its non-firing position towards distally tractive so that supporting shoulder 234 to be no longer positioned at the remote of firing member 240 Below lateral process 244.In such cases, firing member 240 can be shifted down in latched position, wherein firing member 240 Distally motion can be locked shoulder 212 and hinder.In some cases, may also include can be by firing member for end effector 200 240 are biased into the biasing member in its lock-out state, such as spring.When firing member 240 is in its lock-out state, percussion Component 240 can not move towards distally to advance sliding part 230, will follow closely and fire from warehouse 210, and/or incision capture is at end Tissue in portion executor 200.Although sliding part 230 can push away towards distally when tissue thickness compensation part 220 removes from storehouse 210 Enter, but in all cases, sliding part 230 may will not be sufficiently advanced to dispose nail from storehouse 210.Use when surgical instrumenties When person recognizes that firing member 240 is in the lock state middle, user nail bin 210 can be removed from end effector 200 and It is replaced with such as nail bin 210, wherein tissue thickness compensation part 220 is properly positioned at platform 211 top and sliding part 230 Not yet advance towards distally from its non-firing position.It is contemplated that other embodiments, wherein nail bin can not be from end effectors Remove, in such embodiment, remove from nail bin in tissue thickness compensation part and/or firing member enters lock-out state In in the case of, end effector can be completely replaced.

Turning now to Figure 51 to Figure 53, nail bin 310 may include warehouse 314 and the slip being movably positioned in warehouse 314 Part 330.Similar to above, warehouse 314 may include for example multiple securing member chambers, such as securing member chamber 316, and is for example limited to Longitudinal slit therein, such as cutter slit 318.Sliding part 330 may include the center master being slidably located in cutter slit 318 Body portion 336 and the hook 338 extending from center body portion 336.Referring primarily to Figure 51, the tissue thickness compensation part in storehouse 310 320 may include main part 321 and the fastener 322 extending from main part 321, wherein do not hit when sliding part 330 is in it When sending out or not advancing in position, fastener 322 can be releasably held in and be defined between hook 338 and center body portion 336 Slit 337 in.Similar to above, fastener 322 may include the end 323 being arranged in main body 321 and can be from tissue thickness The main body 321 of compensating part 320 proximally extends, wherein in the situation that for example tissue thickness compensation part 320 removes from warehouse 314 Under, fastener 322 can by sliding part 330 towards distally tractive so that the support shoulder 334 being limited in center body portion 336 not Firing member (such as firing member 240) can be supported again thereon, and make firing member can enter lock-out state.Each In the case of kind, the user of surgical instrumenties can be attempted re-assemblying tissue thickness compensation part 320 or be repositioned at warehouse 314 Platform 311 above；However, because reorientating of tissue thickness compensation part 320 will not reset sliding part 330, so hitting Send out component 340 to will remain in lock-out state.Therefore, such arrangement can prevent storehouse 310 quilt in the case that it is tampered Use.

In all cases, refer again to Figure 51 to Figure 53, from the core 336 of sliding part 330 and/or slit 337 At least a portion of the restriction extending hook 338 betwixt may extend into above platform 311.In some cases, from sliding part 330 and/or at least a portion of restriction hook 338 betwixt of extending of core 336 of slit 337 may extend into cutter slit Above in the of 318.In such embodiment, when tissue thickness compensation part 320 is assembled into warehouse 314, fastener 322 can be easy to slide Move in slit 337.In some cases, fastener 322 can be positioned on platform surface 311 top or fixed against it of warehouse 314 Position.In all cases, referring primarily to Figure 53, warehouse 314 may include and is limited to depressed part therein or pit 319, works as slip When part 330 is in it and does not fire or do not advance in position, hook 338 can be positioned in described depressed part or pit.In such reality Apply in scheme, the top of hook 338 can be positioned in below platform surface 311.In all cases, pit 319 may also include limit It is scheduled on one or more of the distal end of pit 319 inclined surface 313, and extend downwardly from platform surface 311.One In the case of a little, when sliding part 330 advances towards distally, fastener 322 can adjoin inclined surface 313, in such cases, hook 338 Then can separate with fastener 322.In all cases, depressed part 319 is configured to be conducive to compensate in tissue thickness Part 320 is assembled into, during warehouse 314, fastener 322 is assembled into sliding part 330.In various embodiments, slit 337 can be longitudinal Ground extends and may include the distal end of closure and open proximal end, and wherein fastener 322 can be from open proximal end Slide in slit 337.In the case that tissue thickness compensation part 320 does not prematurely remove or departs from from storehouse 314, sliding part 330 can advance so that fastener 322 leaves slit 337 through its distal end and so that is limited on sliding part 330 towards distally Slope 332 can by nail project from nail bin 310.

In all cases, using at least one binding agent, tissue thickness compensation part can be adhered to sliding part.Such In the case of, the attachment of binding agent between tissue thickness compensation part and sliding part can sufficiently strong to allow tissue thickness compensation part in group Knit thickness compensation part in the case that storehouse removes by sliding part towards distally tractive.Make when sliding part is advanced towards distally by firing member For firing schedule a part of when, between tissue thickness compensation part and sliding part binding agent attachment may failure, thus allowing Sliding part slides towards distally with respect to tissue thickness compensation part.In all cases, tissue thickness compensation part can use thermal welding Technique and/or heat forming technology are attached to sliding part.In such cases, the combination between tissue thickness compensation part and sliding part Sufficiently strong sliding part can be led towards distally in the case that tissue thickness compensation part removes from storehouse with permission tissue thickness compensation part Draw.When sliding part by firing member towards distally advance as firing schedule a part of when, tissue thickness compensation part and sliding part Between combination may fail, thus allow sliding part with respect to tissue thickness compensation part towards distally slide.

In some cases, for example, ring, fastener and/or label can be integrally formed with tissue thickness compensation part.In various feelings Under condition, for example, ring, fastener and/or label may include the material with tissue thickness compensation part one.In some cases, can be by Additional layer is attached to tissue thickness compensation part.In all cases, this layer may include the mounting portion engaging with sliding part.

Turning now to Figure 54, similar to above, sliding part 430 may include center body portion 436, and comprises additionally in many Individual slope 432, the nail that described slope is configured to for example removedly be stored in warehouse projects.It is also similarly to Literary composition, main part 436 may include the hook 438 extending from it, wherein slit 437 can be limited to main part 436 and hook 438 it Between.In some cases, slit 437 may include distal end 437a of closure and open proximal end 437d.In various feelings Under condition, slit 437 may also include the Part I 437b extending in a first direction and the Part II extending in a second direction 437c.In some cases, Part I 437b can extend along a longitudinal axis and Part II 437 can be transverse to longitudinal axiss The second axis of line extend.In the case of at least one is such, Part II 437c can be at an angle of with respect to Part I 437b Extend.

Turning now to Figure 55 to Figure 58, sliding part 530 may include Part I 535, and comprises additionally in second Divide 536, this Part II can be with respect to Part I 535 in unlocked position (Figure 55 and Figure 57) and latched position (Figure 56 and Tu 58) move between.Part I 535 may include (one) and is configured to (such as be limited in nail bin 510 in longitudinal slit Cutter slit 518) in the core that slides, and the nail that (two) are configured to removedly be stored in storehouse 510 penetrates The multiple slopes 532 going out.The core of Part I 535 may include and is limited to the first slit 533a therein and the second slit 533b.First slit 533a and the second slit 533b is configured to receive the pin extending respectively from Part II 536 531a and 531b.First pin 531a is configured to slide in the first slit 533a, and the second pin 531b can be by structure Cause to slide in the second slit 533b, to allow Part II 536 to rotate with respect to Part I 535.Various In the case of, the first pin 531a can be closely received in the first slit 533a so that the first slit 533a can constrain the first pin 531a moving along first path, and similarly, the second pin 531b can be closely received in the second slit 533b so that the Two slit 533b can constrain the second pin 531b moving along the second path.Referring primarily to Figure 57, second of sliding part 530 536 are divided to may include the arm being configured to slide in cutter slit 518, wherein arm may include and is limited in its proximal end Support shoulder 534 and be limited to the hook 538 in its distal end.Similar to above, shoulder 534 is supported to be configured to It is in the non-firing position of nearside in sliding part 530 and tissue thickness compensation part 220 is for example in the platform surface in storehouse 510 When positioning above in the of 511 or against it, firing member 240 is supported in such as unlocked position.It is also similarly to above, hook 538 can It is configured to releasably hold the ring 222 of tissue thickness compensation part 220 so that in tissue thickness compensation part 220 from storehouse In the case that body removes and/or is substantially opposite warehouse displacement, ring 222 can be pulled on Part II 536 with by the Two parts 536 are pivoted in its latched position, as shown in figure 58.In such latched position of Part II 536, support shoulder The 534 distally projections 244 that can no longer support firing member 240, and firing member 240 can drop downward in its latched position. As shown in figure 58, the rotation in its latched position for the Part II 536 can make support shoulder 534 towards distally motion and/or Down away from firing member 240.Equally as shown in figure 50, firing member 240 may include the lock extending from its opposite side 541, this lock is configured to the adjacent locking shoulder 212 when firing member 240 is in its latched position.When percussion structure When part 240 is maintained in its unlocked position by sliding part 530, lock 541 can not contact locking shoulder 212 and firing member 240 can be advanced through storehouse 510.

In all cases, as described above, nail drives a part for sliding part to may extend into above the platform surface of warehouse. For example, refer again to Figure 52 and Figure 54, the such as hook 438 of the hook 338 of sliding part 330 (Figure 52) and/or sliding part 430 may extend away To above platform surface.In such cases, hook 338 and/or hook 438 can on the mesa surface just towards distal translation, and Under certain situation, contact against platform surface positioning or be positioned at the tissue thickness compensation part above platform surface.In some feelings Under condition, tissue thickness compensation part can be lifted up away from warehouse and be conducive to mending tissue thickness by hook 338 and/or hook 438 Repay part gradually to discharge from storehouse.For example, hook 338 and/or hook 438 can begin at the proximal end of tissue thickness compensation part and towards group Knit the distal end motion of thickness compensation part, initially to lift the proximal end of tissue thickness compensation part, and then by it Gradually lifted away from storehouse platform until the distal end of tissue thickness compensation part is finally lifted away from warehouse.In other cases, Following article discusses in more detail further, and the part for the contact tissue thickness compensation parts of sliding part is it may be preferred that downwards Deflect and/or otherwise do not disturb tissue thickness compensation part when sliding part advances towards distally.

Turning now to Figure 59 and Figure 60, nail bin 610 may include warehouse 614, releasably holds the tissue thickness of warehouse 614 Degree compensating part 620, and be configured to longitudinally traverse warehouse 614 and project the nail being removedly stored in warehouse Sliding part 630.Sliding part 630 may include to have and limits the main body portion 635 of multiple ramped surfaces thereon, a brace shoulder Portion 634, and the arm 636 extending from main part 635.In all cases, arm 636 can be assembled into main body portion 635.For example, arm 636 may include the first end in for example embedded main body portion 635 and the second end including hook 638 Portion.In all cases, arm 636 may include the cantilever beam extending from main body portion 635.In some cases, arm 636 can It is made up of for example elastic and/or flexible material.Similar to above, slit 637 can be limited between hook 638 and arm 636, and it can It is configured to releasably hold tissue thickness compensation part 620 when sliding part 630 is in the non-firing position of its nearside A part.For example, in the case that tissue thickness compensation part 620 is pulled away from warehouse 614, tissue thickness compensation part 620 can be by Sliding part 630 towards distally tractive away from firing member so that firing member enters in lock-out state.

In all cases, to being described further above, at least a portion (such as hook 638) of arm 636 may extend away To above the platform surface 611 of warehouse 614.In some cases, when sliding part 630 is in its proximal position (Figure 59), Arm 636 can be with the engagement of loops for example extending from tissue thickness compensation part 620, and when sliding part 630 advances towards distally, arm 636 can be disengaged with ring.When sliding part 630 advances towards distally, in some cases, arm 636 can contact tissue thickness and mends Repay the main part 621 of part 620 and bend downwards.In all cases, when sliding part 630 advances towards distally, deflection Arm 636 can slide in the longitudinal knife slot 618 in being defined in warehouse 614.In some cases, referring to Figure 60, longitudinal slit 618 distal end can be limited by nose wall or roof 619, wherein when sliding part 630 reaches the distal end 617 in storehouse 610, arm 636 can be in nose wall 619 slip underneath so that the firing schedule of end effector can complete.In some cases, arm 636 may Do not pass through tissue thickness compensation part 620 to deflect down or deflect substantially downward, wherein when arm 636 reaches longitudinal slit 618 During end, arm 636 can contact nose wall 618 and flexure downwards is so that in its lower slider, as shown in figure 60.In all cases, As a result, flexible arm 636 can allow firing schedule to complete and sliding part 630 is parked at the distal end in storehouse.

Turning now to Figure 61, sliding part such as sliding part 730 for example may include main body portion 735 and moveable arm 736.Similar to above, main body portion 735 may include one or more nail drive slopes 732 and be configured to by Firing member is supported on the support shoulder 734 in unlocked position, as mentioned above.Arm 736 may include first end and the second end, This first end pivotably and/or is rotatably mounted to main body portion 735, and this second end includes being configured to The hook 738 being releasably engaged with tissue thickness compensation part, as mentioned above.When sliding part 730 advances towards distally, hook 738 can separate from tissue thickness compensation part；However, the upper face of hook 738 can keep the bottom table with tissue thickness compensation part Face contacts.In such cases, arm 736 can for example be pivoted downwardly in cutter slit 318, so that below tissue thickness compensation part Slide.More specifically, arm 736 can be pivoted to, from the uppermost position (Figure 61) of rising or projection, the position reducing or being recessed.? In the case of various, sliding part 730 may also include the bullet being for example configured to be biased into arm 736 in its raised position Property biasing member, such as spring 731.When arm 736 has been rotated downwardly to it and has dipped middle, spring 731 can apply to arm 736 Biasing force, this arm is passed in tissue thickness compensation part.In some cases, spring 731 can be positioned in arm 736 and limit In the middle of the frame part 733 on main body portion 735.In all cases, spring 731 may include and for example prolongs from arm 736 The cantilever spring stretched or leaf spring.When arm 736 pushes down on, cantilever spring is configured to along such as frame part 731 Flexure and/or slip.In various embodiments, main body portion 735 may also include such as stop shoulder 739, this stop Shoulder can limit rotating up or advancing of arm 736.Under any circumstance, similar to above, arm 736 is configured to It contacts roof 619 and allows firing schedule to be rotated down when completing.

In all cases, nail may include base portion and the one or more lower limbs extending from base portion.In some cases, follow closely May include and there is the base portion of first end and the second end, the first lower limb extending from first end, and extend from the second end The second lower limb.In some cases, nail can be formed by the continuous lines including the first lower limb, base portion and the second lower limb.The first of continuous lines End may include the tip of the first nail leg, and the second end of continuous lines may include the tip of the second nail leg.One such nail, I.e. nail 800 is shown in such as Figure 62.Nail 800 may include base portion 802, the first nail leg extending from the first end of base portion 802 804, and the second nail leg 804 extending from the second end of base portion 802.First nail leg 804 may include the first tip 806, and And similarly, the second nail leg 804 may include the second tip 806.In all cases, most advanced and sophisticated 806 it is configured to penetrate Tissue, all as shown in the tissue T in such as Figure 62.In some cases, most advanced and sophisticated 806 can be sharp, and can be by for example Mould pressing process is forming.In various embodiments, line can be made up of such as titanium and/or rustless steel.

In various embodiments, can be U-shape or at least base when nail 800 is for example at which in its unshaped configuration U-shape in basis.In such embodiment, the lower limb 804 of nail 800 can be parallel to each other or at least substantially parallel to each other.This Outward, in such embodiment, lower limb 804 can perpendicular to or be at least substantially orthogonal to base portion 802.In some embodiments In, can be V-arrangement shape or at least substantially V-arrangement shape when nail 800 is for example at which in its unshaped configuration.In such reality Apply in scheme, the lower limb 804 of nail 800 is not parallel to each other；On the contrary, lower limb 804 can extend along non-flat line direction.Additionally, such In embodiment, one of lower limb 804 or two are not orthogonal to base portion 802, and wherein one of lower limb 804 or two can be along inclination Extend in the direction of base portion 802.In all cases, lower limb 804 can stretch out with respect to the center of nail or center line or open.? In any case, nail 800 can removedly be stored in nail bin, projects from nail bin to pierce tissue, as shown in Figure 62, then Contact is positioned at the anvil block on the opposite side of tissue.Anvil block is configured to make nail 800 be deformed into any suitable shape, Such as B form configuration, for example equally as shown in Figure 62.The nail configuration of various shapings such as B form configuration can limit tissue retention Region, such as organizes retention region 807, and this tissue retention region is configured to tissue is trapped in nail.

As described above, nail can removedly be stored in the intracavity being defined in warehouse.Warehouse 810 is shown in Figure 63, its May include and be defined in one or more of nail cavities 812.Referring to Figure 63, Figure 68 and Figure 69, each nail cavity 812 may include first End 814 and the second end 814.Such as include in the embodiment of longitudinal end executor in some embodiments, for example, the One end 814 may include the proximal end of nail cavity 812 and the second end 814 may include the distal end of nail cavity 812.Various In the case of, nail can be positioned on so that the first lower limb 804 of nail 800 is positioned in the first end 814 of nail cavity 812 in nail cavity 812, And the second lower limb 804 is positioned in the second end 814.In all cases, nail cavity width can be limited to the end of nail cavity 812 Between 814.The base portion 802 of nail can be limited by base widths, and this base widths is equal or shorter than such as nail cavity width.In some feelings Under condition, nail can have the nail width that can be limited between the tip 806 of nail leg 804.In some embodiments, nail width can wait In nail cavity width.In various embodiments, nail width can be wider than nail cavity width.In such embodiment, lower limb 804 can be with nail The end 814 in chamber 812 contacts and can be when nail is positioned in nail cavity 812 by the inside fexible bias pressure in end 814.When nail is by upwards When being lifted out nail cavity 812, lower limb 804 outwards flexibly can launch when nail cavity 812 occurs at it.For example, nail can be positioned on nail cavity In 812 so that when nail be in its do not fire or non-raised position in when, the tip 806 of nail leg 804 does not extend to warehouse 810 Above top surface or platform.In such position, tip 806 be can be positioned so that and flushed or recessed with the platform 811 of warehouse 810 Fall into below this platform.Alternatively, the tip 806 of lower limb 804 can extend at least partly into above the platform 811 of warehouse 810.? In any case, when nail is lifted up, nail tip end 806 may alternatively appear in platform 811 top and occurs from chamber 812 in lower limb 804 When outwards launch.During the lifting of nail sometimes, lower limb 804 may no longer be contacted with the end 814 of nail cavity 812, and Lower limb 804 can be no longer by the side wall inward bias of nail cavity 812.

In all cases, anvil block may include one or more pits, and this pit is configured in nail 800 from nail bin The tip 806 of nail leg 804 is received during injection.Anvil pits are configured to for example overturn inside for nail leg 804 towards each other Or bending.In other cases, anvil pits are configured to for example nail leg 804 is outwardly away from upset or curved each other Bent.However, in some cases, one or more of nail leg of nail can be missed nail pit and possibly cannot suitably become Shape.In some cases, one or more of nail leg may not contact anvil block and may be at all indeformable.In any one feelings Under condition, tissue may suitably be captured and/or be maintained in its tissue retention region by nail.Additionally, deformity or unshaped Nail may not apply required compression pressure to tissue.In some cases, lopsided or unfashioned nail may not be protected Hold in the tissue and can become to depart from tissue.

Refer again to Figure 62, nail 800 and/or various other nail disclosed herein may include or many extending from it Individual barb.In all cases, barb is configured to engage the tissue in nail and/or around nail for the capture.Some In the case of, barb can help to nail is maintained in tissue, particularly when nail has become deformity or unshaped.Nail 800 may include Barb from one of lower limb 804 or two extensions.For example, each lower limb 804 may include facing out from the center of nail 800 Or multiple barb 808 and/or towards the inward-facing one or more barbs 809 in the center of such as nail 800.In some situations Under, barb 808 can extend away from tissue retention region 807 and/or barb 809 can extend towards tissue retention region 807 or Extend in tissue retention region.As shown in Figure 62, two in the nail leg 804 of nail 800 may include barb 808 and barb 809. In some cases, nail leg 804 may include barb 808, but does not include barb 809.Nail 820 is shown in Figure 63, and it includes barb 808, but do not include barb 809.In some cases, nail leg 804 may include barb 809, but does not include barb 808.Nail 830, 840,850,860 and 870 are shown in Figure 64, Figure 65, Figure 66, Figure 67 and Figure 68, and it includes barb 809, but does not include down Hook 808.In some embodiments, for example, the first lower limb 804 of nail may include barb 808, and the second lower limb 804 followed closely may include Barb 809.

In all cases, when nail is in unshaped configuration, the lower limb 804 of nail and base portion 802 can limit nail plane.Fall Hook 808 can the lower limb 804 in such nail plane stretch out.Similarly, barb 809 can lower limb 804 in such plane inside Extend.In some cases, nail may include the barb with respect to the plane horizontal expansion of such nail.It is contemplated that other embodiment party Case, wherein lower limb 804 and base portion 802 are not located at or are fully located in single plane.In such embodiment, barb can be along any Suitable direction extends.In various embodiments, referring now to Figure 67, nail such as nail 860 for example may include and prolongs from base portion 802 The barb 803 stretched.In all cases, barb 803 can extend inward towards the tissue retention region 807 of nail 860.In some situations Under, barb 803 can be outwardly away from tissue retention region 807 and extend.As shown in Figure 67, barb 803 can be by lower limb 804 and base portion Extend in the nail plane of 802 restrictions.In some cases, barb 803 can be with respect to the plane horizontal expansion of such nail.Various examples Property barb configuration is hereinafter discussed in further detail.

In all cases, nail leg 804 may include the array of the barb 808 extending along its whole length.In certain situation Under, nail leg 804 may include the array along the barb 808 extending less than its whole length.By way of example, referring to Figure 62, nail 800 lower limb 804 each includes the array of the barb 808 along the whole length extension less than lower limb 804.Similarly, referring to Figure 63, nail 820 lower limb 804 each includes the array of the barb 808 along the whole length extension less than lower limb 804.With reference to following closely 800, for example, The array of hook 808 can extend towards the tip 806 of lower limb 804 along each in lower limb 804 from the base portion 802 of nail 800.As shown in Figure 62, The array of barb 808 may not extend to the tip 806 of lower limb 804.In all cases, the array of barb 808 can be along such as lower limb The half of 804 length or only about half of extension；However, any suitable length of barb array can be used.For example, barb 808 array can extend along the length half less than lower limb 804 or more than the half of its length.In some embodiments, barb 808 array can extend towards base portion 802 along each in lower limb 804 from the tip 806 of lower limb 804.In such embodiment, barb 808 array may not extend to base portion 802.In some embodiments, lower limb 804 may include the array of barb 808, and it does not prolong Reach tip 806 or the base portion 802 of lower limb 804.In certain embodiments, lower limb 804 may include the more than one battle array of barb 808 Row.

In all cases, to being described further above, nail leg 804 may include the barb extending along its whole length 809 array.By way of example, referring to Figure 64, the lower limb 804 of nail 830 is each included along falling that the whole length of lower limb 804 extends The array of hook 809.In some cases, nail leg 804 may include the array along the barb 809 extending less than its whole length.With Way of example, referring to Figure 65, the lower limb 804 following closely 840 each includes the barb 809 along the whole length extension less than lower limb 804 Array.Similarly, referring to Figure 68, the lower limb 804 of nail 870 each includes the barb 809 extending along the whole length less than lower limb 804 Array.With reference to nail 840, for example, the array of barb 809 can along each in lower limb 804 from the base portion 802 of nail 840 towards the point of lower limb 804 End 806 extension.As shown in Figure 65, the array of barb 809 may not extend to the tip 806 of lower limb 804.In all cases, The array of hook 809 can be along the such as half of the length of lower limb 804 or only about half of extension；However, any of barb array can be used Suitable length.For example, the array of barb 809 can extend along the length half less than lower limb 804 or more than the half of its length.? In some embodiments, the array of barb 809 can extend towards base portion 802 along each in lower limb 804 from the tip 806 of lower limb 804.? In such embodiment, the array of barb 809 may not extend to base portion 802.In some embodiments, as shown in Figure 66, Lower limb 804 may include the array of barb 809, and it does not extend to the tip 806 of lower limb 804 or base portion 802.In certain embodiments, Lower limb 804 may include the more than one array of barb 809.

Various barb configurations are shown in Figure 70 to Figure 73, but any suitable barb configuration all can use.Referring to Figure 70, follow closely Lower limb 804 may include for example, at least one barb 809.In all cases, barb 809 may include pin.Pin may include can be from First surface 809a and second surface 809b that the periphery 805 of nail leg 804 extends.First surface 809a may include such as nauropemeter Face, convex surface and/or concave surface.Second surface 809b may include for example flat or at least substantially flat surface. In all cases, first surface 809a and second surface 809b can be focused at such as edge 809c.Barb 809 can use appoints What suitable technique is formed.For example, barb 809 can be formed using Sheet Metal Forming Technology.In at least one embodiment, shaping dies For example can be used for impacting the periphery 805 of the line including lower limb 804, to upset or to disturb enough materials to form barb 809.? In the case of various, barb may include for example any suitable tip or burr.In various embodiments, barb 809 can be cone Shape.In all cases, barb 809 may include the base portion adjacent with periphery 805, and this base portion is thicker than the tip of barb 809.

Referring now to Figure 68, Figure 69, Figure 71 and Figure 71 A, nail leg 804 may include for example, at least one barb 879.At least In one embodiment, barb 879 can be around the part extension of the periphery 805 of nail leg 804.In all cases, barb 879 May include can be from the first surface 879a and second surface 879b of periphery 805 extension of nail leg 804.First surface 879a may include Such as inclined surface, convex surface and/or concave surface.Second surface 879b may include for example flat or at least substantially puts down Smooth surface.In all cases, first surface 879a and second surface 879b can be focused at such as edge 879c.Various In the case of, edge 879c can be such as arch.Barb 879 can be formed using any suitable technique.For example, barb 879 can Formed using Sheet Metal Forming Technology.In at least one embodiment, shaping dies for example can be used for impacting the week of the line including lower limb 804 Side 805, to upset or to disturb enough materials to form barb 879.Referring primarily to Figure 71 A, the line including lower limb 804 can be by straight Footpath 801 limits, and barb 879 can be limited by the big diameter of diameter group 801.Correspondingly, the line including lower limb 804 can be limited by radius Determine, and barb 879 can be limited by the radius bigger than line radius.In various embodiments, barb 879 can be taper.? In the case of various, barb 879 may include the base portion adjacent with periphery 805, and this base portion is thicker than the tip of barb 879.

Referring now to Figure 72, nail leg 804 may include for example, at least one barb 889.In at least one embodiment, Hook 889 can extend around the whole periphery 805 of nail leg 804.In all cases, may include can be from the week of nail leg 804 for barb 889 First surface 889a and second surface 889b that side 805 extends.First surface 889a may include such as inclined surface, convex surface And/or concave surface.Second surface 889b may include for example flat or at least substantially flat surface.In various situations Under, first surface 889a and second surface 889b can be focused at such as edge 889c.In all cases, edge 889c can be Such as arch.Barb 889 can be formed using any suitable technique.For example, barb 889 can be formed using Sheet Metal Forming Technology.? In at least one embodiment, shaping dies for example can be used for impacting the periphery 805 of the line including lower limb 804, to upset or dry Disturb enough materials to form barb 889.Line including lower limb 804 can be limited by linear diameter, and barb 889 can be by than linear diameter Big diameter limits.Correspondingly, the line including lower limb 804 can be limited by radius, and barb 889 can be by the radius bigger than line radius Limit.In various embodiments, barb 889 can be taper.In all cases, barb 889 may include and periphery 805 phase Adjacent base portion, this base portion is thicker than the tip of barb 889.

Referring now to Figure 73, nail leg 804 may include for example, at least one barb 899.In all cases, barb 899 can Including pin.Pin may include can be from the first surface 899a and second surface 899b of the periphery extension of nail leg 804.First surface 899a may include such as inclined surface, convex surface and/or concave surface.Second surface 899b may include for example flat or extremely Few substantially flat surface.In all cases, first surface 899a and second surface 899b can be focused at such as edge At 899c.Barb 899 can be formed using any suitable technique.For example, barb 899 can be formed using Sheet Metal Forming Technology.At least In one embodiment, shaping dies for example can be used for impacting the periphery of the line including lower limb 804, to upset or to disturb enough Material is forming barb 899.In various embodiments, the line including nail may include one or more flattened side.At least In one embodiment, line may include for example relative to flattened side 895.In at least one such embodiment, planar side Face 895 is formed as cylindrical wires.In some cases, in addition to flattened side 895, line can keep one or more cylinders Shape surface.In all cases, barb may include for example any suitable tip or burr.In various embodiments, barb 899 can be taper.In all cases, barb 899 may include the base portion adjacent with the periphery of lower limb 804, and this base portion compares barb 899 most advanced and sophisticated thickness.

In all cases, the lower limb of nail can limit nail plane.The base portion of nail may or may not be positioned in nail plane.? In the case of any one, from one or more barbs that lower limb and/or base portion extend can extend in nail plane and/or with respect to Nail plane extends parallel to.In some cases, the one or more barbs extending from lower limb and/or base portion can be outside from nail plane Extend.The one or more barbs extending from lower limb and/or base portion can extend transversely with respect to nail plane.In all cases, Barb can extend circumferentially over upon around nail leg.Such barb can extend in nail plane and stretch out from nail plane.At some In the case of, barb can extend around the whole girth of nail leg.In some cases, barb can extend less than 360 degree around nail leg. The barb extending in nail plane can readily control the tissue in nail plane.The barb stretching out from nail plane can readily control Tissue outside nail plane.Nail and/or nail leg may include the one or more barbs extending in nail plane and from nail plane The one or more barbs stretching out.

Refer again to Figure 62, the barb extending from nail leg 804 is configured to nail leg 804 is maintained in tissue. As described above, in some cases, nail leg 804 can become deformity and/or unshaped by anvil block, and due to extend from it one Individual or multiple barbs, nail leg 804 can still remain in tissue.In all cases, barb is configured to organize It is trapped in the tissue retention region of nail.In some cases, barb is configured to keep tissue against base portion 802. In such cases, barb can apply compression stress or pressure to tissue.Above in conjunction with the embodiment institute shown in Figure 70 to Figure 73 State, barb may include such as inclination, convex and/or concave top surface, such as surface 809a, 879a, 889a and/or 899a. The top surface of barb is configured to be conducive to insert nail leg 804 and barb in tissue and/or is inserted through tissue. Equally above in conjunction with described in the embodiment shown in Figure 70 to Figure 73, barb may include for example flat or at least substantially flat Lower surface, such as surface 809b, 879b, 889b and/or 899b.The lower surface of barb is configured to suppression and will fall Hook and nail leg 804 are from tissue displacement.As above-mentioned result, in some cases, the top surface of barb is configured to Enough puncture is organized, and the lower surface of barb is configured to subjacent tissue.In all cases, the tip of nail leg 804 806 are configured to puncturing hole in the tissue, and the nail leg 804 extending from it and barb are configured to flexibly Deployment aperture is so that tissue can flow around barb when nail leg 804 is pushed through tissue and flow back into the bottom of barb Lower face.

In certain embodiments, the first barb can extend from the first lower limb 804 of nail, and the second barb can be from the of nail Two lower limbs 804 extend.In all cases, the first barb and the second barb can be located at identical or at least substantially between base portion 802 Identical distance.In some cases, the first barb and the second barb can away from base portion 802 identical or at least substantially identical erect Straight Distance positioning.As described above, nail leg 804 may include the array of the barb of the length extension along nail leg 804.In various embodiment party In case, referring primarily to Figure 62, nail may include the first lower limb 804 of first array with barb and second array with barb The second lower limb 804, wherein the first array of barb and the second array of barb be configured to collaboratively be maintained at nail In tissue.In various embodiments, the barb from the first array and the barb from the second array may include and be configured to Can be in a pair of barb engaging tissue at the such as identical vertical distance of base portion 802.In all cases, nail may include and is more than A pair of barb.In some cases, each pair of barb centering can enough be caused in joint group at the different vertical distance of base portion 802 Knit.In such cases, nail can be suitable for using with different tissues thickness.For example, when nail is for suturing thin tissue, fall for a pair Hook or less than all of barb to engageable thin tissue.If following closely the tissue for suturing thickness, however, additional barb to or All of barb is to engageable tissue.In certain embodiments, the barb extending from lower limb 804 can be according to tissue thickness or group The mode knitting the scope of thickness is arranged, described tissue thickness is closed by stapling.For example, refer again to Figure 62, barb 808 and 809 can Optionally position along lower limb 804 so that it is positioned in the tissue capturing in following closely and/or the tissue in nail is adjacent with capture Positioning.In some cases, nail leg 804 by deflection or the part that contacted with anvil block be may not include from falling that it extends Hook.In at least some cases, the array of the barb extending from the inward-facing side of nail leg 804 can be longer than from nail leg 804 The array of the barb that the side facing out extends.In other cases, the barb extending from the inward-facing side of nail leg 804 Array can be shorter than the array of the barb extending from the side facing out of nail leg 804.In still another case, from nail leg 804 As the array of barb that the array of the barb that inward-facing side extends can be extended with the side facing out from nail leg 804 Long.

If as described above, nail leg 804 is lopsided and/or unfashioned unintentionally, from falling that nail leg 804 extends Hook can help to nail is maintained in tissue.It is contemplated, however, that arriving some situations, including in barb disclosed herein One or more nails is inserted in tissue and keeps unfashioned intentionally.Under any circumstance, including disclosed herein The nail of one or more of barb can be used for suturing thick tissue.More particularly, in some cases, in nail bin and anvil block Between thickness and/or compact tissue presence and/or nail in thickness and/or compact tissue presence can anti-non-magnetic shim complete Shape or close.For example, follow closely possible not completely closed one-tenth B form configuration, or nail may be not completely closed.In such situation Under, the barb of not closed nail may suppress or prevent tissue to be drawn out for example to follow closely.Barb along the extension of the length of nail leg Array can allow lower limb to keep in the tissue, but regardless of the thickness of tissue.

It is contemplated that various embodiments, the nail 800 such as with barb for the nail with barb for the wherein at least one is for example removable It is stored in all nail bins 22000 as shown in Figure 10 to Figure 12 of nail bin with removing.It is contemplated that wherein nail bin is only included with barb Some embodiments of nail, are susceptible to other embodiments using the nail with barb and the nail without barb simultaneously.For example, A line nail may include the nail with barb, and the second row nail may include the nail without barb.In some cases, it is stored in nail bin Nail can have identical or substantially the same unshaped height.At least with reference to the nail of U-shape and/or V-arrangement shape, for example, The unshaped height of nail can be defined as the vertical distance between the bottom of base portion followed closely and the tip of nail leg.It is inserted into nail in nail Before in storehouse, when nail is removedly stored in nail bin, and/or before nail is against deflection, can take such Measurement.In some cases, arrange that the nail with barb in the first row can have the first unshaped height in nail bin, and The nail with barb being arranged in nail bin in second row can have the second unshaped height.Band in the 3rd row in nail bin The nail of barb can have the first unshaped height, the second unshaped height or the 3rd unshaped height.The first row, the second row and/ The nail with barb of the third line can be positioned on the phase homonymy of the cutter slit being defined in nail bin or cutter slit opposite side On.In use, the nail with barb being removedly stored in nail bin can be shaped as identical forming height or differing formed Highly.The forming height of nail can be defined as total vertical distance of nail after it is against deflection.At least reference becomes Form the nail of B form, the forming height of nail for example, can be measured between the bottom of the base portion of nail and the topmost portion of nail leg.? Under certain situation, arrange that the nail with barb in the first row may be deformed to the first forming height in nail bin, and in nail bin In the nail with barb that is arranged in second row may be deformed to the second forming height.In the 3rd row in nail bin with barb Nail can have the first forming height, the second forming height or the 3rd forming height.The band of first row, second row and/or the 3rd row The nail of barb can be positioned on the phase homonymy of the cutter slit being defined in nail bin or on the opposite side of nail bin.As it will be appreciate that , the nail being shown in Figure 10 to Figure 12 is reformed into differing formed height.Nail 800 with barb for example can be used for formation to be had not With in the nail bin of the staple of forming height and/or suture instrumentses.It is high that the nail 800 with barb of first row can be deformed into the first shaping Degree, and the nail 800 with barb of second row can be deformed into the second forming height.In all cases, the band barb of the 3rd row Nail 800 can be deformed into the 3rd forming height.In some cases, the nail 800 with barb being deformed into differing heights can start In identical or substantially the same unshaped height.In some cases, it is deformed into the nail 800 with barb of differing formed height Can begin at different unshaped height.Various structures can be used for making nail be configured to differing formed height.For example, support nail is movable Driver can at the different distance with respect to anvil block support nail.In some cases, anvil block may include and has different depth Nail shapes pit.In all cases, staple drivers may include support, this support be configured to support nail base portion and Promote nail up towards the forming pit being defined in anvil block.The forming height of nail can pass through lower surface and the forming pit of support The distance between top surface determining.It is published in entitled " the SURGICAL STAPLING on November 27th, 2012 The United States Patent (USP) 8,317 of DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS ", 070 is incorporated by.In some cases, the platform of nail bin may include stepped surface, as shown in Figure 1.First The nail cavity of row can be defined in the first ladder, and the nail cavity of second row can be defined in the second ladder, the wherein first ladder and Second ladder can offset vertically each other.For example, the first ladder can be vertically positioned above anvil block, or than the second ladder more more Near anvil positioning.In some cases, wall can be positioned between the first ladder and the second ladder.In some cases, nail bin Platform may include the first ladder, be vertically positioned at the second ladder above the first ladder, and be vertically positioned at second The 3rd ladder above ladder.It is contemplated that the platform of various embodiments, wherein nail bin includes any suitable number of ladder And any suitable number of wall between ladder.For example, the nail cavity of first row can be defined in the first ladder, second row Nail cavity can be defined in the second ladder, and/or the nail cavity of the 3rd row can be defined in the 3rd ladder.For example, the first row Nail cavity may include the nail with the first unshaped height, and the nail cavity of second row may include the nail with the second unshaped height, and And/or the nail cavity of person the 3rd row may include the nail with the 3rd unshaped height.It is contemplated that various embodiments, wherein nail bin Including any suitable number of staple with different unshaped height.For example, the nail in first row nail cavity can be deformed into first Forming height, the nail in second row nail cavity can be deformed into the second forming height, and/or the 3rd nail chamber can be deformed into the 3rd Forming height.It is contemplated that various embodiments, wherein nail bin include being deformed into any suitable number of of differing formed height Staple.In addition to there is differing formed staple height or replace there are different staple heights, the end effector of suture instrumentses can have There is different tissues gap.For example, generally referring to Figure 10 and Figure 11, gap can be limited at storehouse platform surface 22011 He of nail bin Between the anvil block tissue compression surface 10063 of anvil block.This gap is configured to receive tissue T.This gap also can be by structure Cause to receive tissue thickness compensation part；However, the nail with barb can or can not be together with tissue thickness compensation part Use, and the discussion providing with respect to the nail with barb is applicable to any one situation.Under any circumstance, reader will manage Solution, anvil block tissue compression surface 10063 is stepped.Anvil block tissue compression surface 10063 includes being vertically positioned at second The Part I of upper.When the anvil block of end effector and nail bin are in closure state, as shown in figure 11, the first gap Distance is limited between exterior section and the storehouse platform surface 22011 on anvil block tissue compression surface 10063, and second is different Clearance distance is limited between interior section and the storehouse platform surface 22011 on anvil block tissue compression surface 10063.First clearance gap From being illustrated as more than the second clearance distance, but the first clearance distance is possible to be shorter than the second clearance distance.With compared with short air gap away from More compressed than the tissue with a distance from larger gap from the tissue being compressed between anvil block and nail bin.For example, the nail with barb 800 barb differently can engage tissue, and this depends on tissue positioned in shorter interstice or larger interstice.More Specifically, the tissue being compressed in shorter interstice can be sought larger group than being compressed in after end effector release at it The tissue knitted in gap launches more again, and the barb of the nail with barb can suppress or resist this again to launch, and this depends on Position in its configuration and/or on barb.In other cases, barb is configured to and/or is positioned to not suppress Or the expansion again of resisted organize.As it will be appreciate that, anvil block tissue compression surface 10063 is stepped, and storehouse put down Platform surface is flat or at least substantially flat, and therefore, be limited to the difference of interstice in end effector with The height of staged anvil faces and change.It is contemplated that other embodiments.For example, anvil block tissue compression surface can be flat Or at least substantially flat, and storehouse platform surface can be stepped.In other cases, anvil block tissue compression surface and Storehouse platform surface can be stepped.Under any circumstance, different gap distance can be limited to anvil block tissue compression surface and Between the platform surface of storehouse.Although two clearance distances are shown in Figure 10 and Figure 11, possibly more than two clearance distances, Such as three clearance distances.With reference to Figure 10 and Figure 11, the forming pit of first longitudinal direction row may be arranged at having of end effector In the Part I of the first tissue clearance distance, and the forming pit of second longitudinal direction row may be arranged at having of end effector In Part II different from the minor microstructure clearance distance of the first tissue clearance distance.In some cases, end effector May include the forming pit of the 3rd longitudinal row, it is arranged in the having different from the first tissue clearance distance and the of end effector In the Part III of the 3rd interstice's distance of two interstice's distances.In some cases, end effector may include Three forming pits longitudinally arranged, it is arranged in having and the first tissue clearance distance or minor microstructure clearance gap of end effector In the Part III with a distance from identical interstice.It will be appreciate that, end effector can have different tissues clearance distance And/or differing formed staple height.End effector can have one, another one, or both have concurrently.In some cases, relatively Short forming nail height can be associated with shorter interstice distance, and larger forming nail height can be with larger interstice apart from phase Association.In other cases, shorter forming nail height can be associated with larger interstice distance, and larger forming nail height can With shorter interstice distance be associated.To being described further above, nail can have U-shape in its unshaped state Configuration.The nail of U-shape may include base portion and two nail legs extending from base portion, and wherein nail leg extends to that along parallel direction This.In addition to being described further above, nail may include V-arrangement shape configurations in its unshaped state.V-arrangement shape configurations can Two nail legs extend including base portion and from base portion, wherein nail leg extends along uneven direction.Various enforcement as herein described Described in the context in linear end effector and/or linear fastener storehouse for the scheme.Such embodiment and its teachings Can be applicable to nonlinear end executor and/or non-linear fastener cartridge, such as circular and/or contoured end effector. For example, the entitled " SURGICAL submitting on 2 28th, 2011 including the various end effectors of nonlinear end executor The U.S. Patent Application Serial Number 13/036,647 of STAPLING INSTRUMENT " is (now for U.S. Patent Application Publication 2011/ 0226837) have disclosed in, this patent is incorporated by accordingly.In addition, the title of September in 2012 submission on the 29th For " STAPLE CARTRIDGE " U.S. Patent Application Serial Number 12/893,461 (now for U.S. Patent Application Publication 2012/ 0074198) it is incorporated by accordingly.Entitled " the END EFFECTORS FOR A submitting to on 2 15th, 2008 SURGICAL CUTTING AND STAPLING INSTRUMENT " U.S. Patent Application Serial Number 12/031,873 (now for United States Patent (USP) 7,980,443) also it is incorporated by accordingly.Entitled " the SURGICAL that on December 7th, 2010 announces The complete disclosure of the United States Patent (USP) 7,845,537 of INSTRUMENT HAVING RECORDING CAPABILITIES " with Way of reference is expressly incorporated herein.Entitled " the SURGICAL STAPLING INSTRUMENTS WITH that on May 27th, 2011 submits to The Application U.S. Serial No 13/118,241 of ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS " is (now for the U.S. Public announcement of a patent application 2012/0298719) complete disclosure be herein incorporated by reference.

Be processed after apparatus as disclosed herein can be designed as being intended for single use, or can be designed as them can be many Secondary use.But either which kind of situation, this device all can be at least using once exercising use through repairing afterwards again.Again repair May include the combination in any in following steps：Dismantle this device and then clean or change specific component and subsequent group again Dress.Specifically, this device can be dismantled, and can optionally replace in any combination or remove any number of particular elements Or part.After cleaning and/or replacing specific component, this device can re-assembly at restoration facilities so that subsequent use, or Person is re-assemblied by surgical team before will carrying out surgical operation.It will be understood by those of skill in the art that device is again Reparation can utilize multiple technology for dismantling, cleaning/change and re-assembly.The purposes of such technology and gained are again Prosthetic device is within the scope of the present invention.

Preferably, invention as herein described will be processed before surgery.First, obtain new or used apparatus, and root It is carried out according to needs.Then apparatus can be sterilized.In a kind of sterilization technology, this apparatus is placed on closure and seals Container in, in such as plastics or TYVEK bag.Then container and apparatus are placed on the radiation field such as γ that can penetrate this container In radiation, x- ray or high energy electron.The antibacterial on apparatus and in container is killed in radiation.Then can be by the apparatus storage after sterilizing In sterile chamber.This sealing container makes apparatus holding aseptic till opening this container in medical facilities.

Any patent, announcement or other open materials being expressly incorporated herein in full or partly with way of reference all only simultaneously The material entering is not expressly incorporated herein with the existing definition described in the disclosure, statement or the afoul scope of other open materials.Cause This, and under necessary degree, the disclosure being expressly recited herein replaces any conflict being herein incorporated by reference Material.Any it is herein incorporated by reference but afoul with existing definition as herein described, statement or other open materials Any material or part thereof, is incorporated to this only between the material being incorporated to and existing open material under the degree not producing conflict Literary composition.

Although the present invention has been described as having exemplary design, can also be right in the spirit and scope of the disclosure The present invention modifies.Therefore the application is intended to any modification using its general principles, purposes or modified version. In addition, the application is intended to belong to known or used this different from the disclosure that is having in practical framework in art of the present invention Class pattern.

Claims (19)

1. a kind of method of the flexible ratio for changing the tissue thickness compensation part being used together with surgical instrumenties, methods described Comprise the following steps：

Obtain and include the tissue thickness compensation part of the first flexible ratio, wherein said tissue thickness compensation part is at least in part by having Glass transition temperature and the material of melt temperature is had to constitute；

Described tissue thickness compensation part is heated to above described glass transition temperature and the temperature less than described melt temperature；

Make the deformation of described tissue thickness compensation part, described first flexible ratio is changed into the second flexible ratio, wherein said the Two flexible ratios are different from described first flexible ratio；

Described tissue thickness compensation part is made to be cool below described glass transition temperature；And

Discharge described tissue thickness compensation part.

2. method according to claim 1, wherein obtains described tissue thickness compensation part and comprises the following steps：

Obtain the biocompatible polymer including glass transition temperature and melt temperature；

Described biocompatible polymer is dissolved in solvent to produce solution；And

Solution described in lyophilizing.

3. method according to claim 1, wherein makes the described step of described tissue thickness compensation part deformation include institute At least a portion stating tissue thickness compensation part is maintained in constrained geometry.

4. method according to claim 1, wherein makes the described step of described tissue thickness compensation part deformation include institute At least a portion stating tissue thickness compensation part is maintained under compression.

5. method according to claim 1, also includes described tissue thickness compensation part is actively cooled less than described The step of the temperature of glass transition temperature.

6. a kind of method for preparing the biocompatible foam being used together with surgical stapling device, methods described includes following Step：

Obtain the biocompatible polymer including glass transition temperature and melt temperature；

Described biocompatible polymer is dissolved in solvent to produce solution；

Solution described in lyophilizing is to produce the biocompatible foam including initial density；

Described biocompatible foam is heated to above described glass transition temperature and the temperature less than described melt temperature；

At least a portion manipulating described biocompatible foam is to change into modification density by described initial density；

Described material is made to be cool below described glass transition temperature；And

Discharge described biocompatible foam.

7. method according to claim 6, wherein manipulates the described at least one of institute of described biocompatible foam State step to include at least one pulling force is applied to described at least a portion of described biocompatible foam.

8. method according to claim 6, wherein manipulates the described at least one of institute of described biocompatible foam State step to include described at least a portion of described biocompatible foam is maintained under compression.

9. method according to claim 6, wherein manipulates the described at least one of institute of described biocompatible foam State step to include described at least a portion of described biocompatible foam is maintained in compression geometry.

10. method according to claim 6, also includes described biocompatible foam is actively cooled less than described The temperature of glass transition temperature.

11. methods according to claim 6, wherein manipulate the described at least one of institute of described biocompatible foam State step to include positioning described biocompatible foam in the receiver and against described in described biocompatible foam At least a portion propulsion adjustment means.

A kind of 12. methods for changing the biocompatible materialses being used together with surgical instrumenties, wherein said bio-compatible Property material have less than absolutely fine and close composition, and wherein said biocompatible materialses have initial porosity, institute The method of stating comprises the following steps：

Obtain described biocompatible materialses；

A part for described biocompatible materialses is transformed into glassy state from non-glass state；

Exert a force to described part so that described initial porosity is changed into modification porosity；

Described part is made to return to described non-glass state；And

Remove described power.

13. methods according to claim 12, wherein obtain described biocompatible materialses and comprise the following steps：

Obtain the biocompatible polymer including glass transition temperature and melt temperature；

Described biocompatible polymer is dissolved in solvent to produce solution；And

Solution described in lyophilizing.

14. methods according to claim 13, wherein said power includes at least one compression stress.

15. methods according to claim 13, wherein said power includes at least one pulling force.

16. methods according to claim 13, also include described biocompatible materialses are actively cooled less than institute State the temperature of glass transition temperature.

17. methods according to claim 12, wherein said part includes multiple holes, and wherein by described initial hole The described step that degree changes into described modification porosity is designed to reduce the plurality of hole.

18. methods according to claim 17, each hole in wherein said multiple holes includes thering is described initial hole First volume of degree and second volume with described modification porosity, and wherein said second volume is different from described the One volume.

19. methods according to claim 18, wherein said second volume is less than described first volume.