CN106999183A - Surgical staples and driver for nail bin are arranged - Google Patents

Surgical staples and driver for nail bin are arranged Download PDF

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Publication number
CN106999183A
CN106999183A CN201580064655.8A CN201580064655A CN106999183A CN 106999183 A CN106999183 A CN 106999183A CN 201580064655 A CN201580064655 A CN 201580064655A CN 106999183 A CN106999183 A CN 106999183A
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CN
China
Prior art keywords
nail
leg
cavity
driver
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CN201580064655.8A
Other languages
Chinese (zh)
Other versions
CN106999183B (en
Inventor
J·L·哈里斯
J·R·摩根
M·S·齐纳
F·E·谢尔顿四世
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Angiotech Pharmaceuticals Inc
Original Assignee
Angiotech Pharmaceuticals Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US14/498,105 external-priority patent/US9801628B2/en
Application filed by Angiotech Pharmaceuticals Inc filed Critical Angiotech Pharmaceuticals Inc
Publication of CN106999183A publication Critical patent/CN106999183A/en
Application granted granted Critical
Publication of CN106999183B publication Critical patent/CN106999183B/en
Active legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A61B17/1222—Packages or dispensers therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00898—Material properties expandable upon contact with fluid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00942—Material properties hydrophilic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B2017/0688—Packages or dispensers for surgical staplers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07228—Arrangement of the staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder

Abstract

The invention discloses a kind of end effector and a kind of nail bin.The nail bin includes the array of nail, and wherein at least one nail is angularly orientated relative to the longitudinal axis of the nail bin.The angled nail provides longitudinal flexible for the suture tissue.In addition, the nail bin and/or the end effector are configured to provide the compression of variable pitch to tissue.For example, can before quilting, during and/or after optimizing tissue compression.

Description

Surgical staples and driver for nail bin are arranged
Technical background
The present invention relates to suture instruments, and in various embodiments, it is related to a kind of for preparing one or more nails The surgery suturing appliance of row.
Suture instruments may include the elongated nip component of a pair of collaborative works, suffer from wherein each jaw member may be adapted to insertion In person's body and relative to be stapled and/or incision tissue positioning.In various embodiments, one of jaw member can be propped up Support wherein accommodates the nail bins of at least two staples being laterally spaced apart, and another jaw member is sustainable has and nail bin In staple alignment nail shapes pit anvil block.In general, suture instruments may also include push rod and blade, the push rod and Blade can be slided with by the cam face on push rod and/or in the wedge-shaped slides that push rod is pushed relative to jaw member Cam face will be followed closely and projected successively from nail bin.In at least one embodiment, cam face is configured to start By storehouse carrying and the multiple staple drivers associated with nail, lean against on anvil block and be held between jaw member to push nail Tissue in formed lateral spacing deformation staple.In at least one embodiment, blade can follow cam face and along Route cutting tissue between staple.The example of such suture instruments is in entitled " SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING Have disclosed in INSTRUMENTS FOR DEPLOYING THE SAME " United States Patent (USP) 7,794,475, the whole of the patent Disclosure is herein incorporated by reference.
The current each aspect of correlation technique in the field of the invention only for the purpose of illustration discussed above, without should It is considered as the negative to right.
Brief description of the drawings
The various features of the embodiment described herein are described in detail in the dependent claims.However, closing Drawings described below can be combined according to following in the various embodiments of the tissue of operation and the various embodiments of method and its advantage Illustrate to be understood：
Fig. 1 is the perspective view of the reuse surgical fasteners tool according at least one embodiment；
Fig. 2 is the exploded view of the end effector of Fig. 1 reuse surgical fasteners tool；
Fig. 3 is the top plan view of the fastener cartridge of Fig. 2 end effector；
Fig. 4 is the bottom plan view of the anvil block of Fig. 2 end effector；
Fig. 5 is the fragmentary bottom plan view of the anvil block according at least one embodiment；
Fig. 6 is the fragmentary bottom plan view of the anvil block according at least one embodiment；
Fig. 7 is the decomposition diagram of the end effector including nail bin of the various embodiments according to the disclosure, the nail Storehouse includes nail, the one group of staple drivers more than first being angularly orientated, and one group of staple drivers more than second；
Fig. 8 be Fig. 7 one more than first in staple drivers more than staple drivers perspective view；
Fig. 8 A are the plans of Fig. 8 staple drivers more than first；
Fig. 8 B are the perspective view of Fig. 8 staple drivers more than first, and further show Fig. 7 for being supported by many staple drivers Nail；
Fig. 8 C be Fig. 7 one more than second in staple drivers more than staple drivers perspective view；
Fig. 8 D are the plans of Fig. 8 C staple drivers more than second；
Fig. 9 is the perspective view of Fig. 8 C staple drivers more than second, and further shows Fig. 7 for being supported by many staple drivers Nail；
Figure 10 is the plan of the nail bin of the various embodiments according to the disclosure；
Figure 11 is the plan according to many staple drivers of the various embodiments of the disclosure and the arrangement of driving wedge；
Figure 12 is the plan according to many staple drivers of the various embodiments of the disclosure and the arrangement of driving wedge；
Figure 13 is the plan according to many staple drivers of the various embodiments of the disclosure and the arrangement of driving wedge；
Figure 14 is the plan according to single staple drivers of the various embodiments of the disclosure and the arrangement of driving wedge；
Figure 15 is the front view of Figure 14 driving wedge；
Figure 16 is the plan according to the nail of the various embodiments of the disclosure and the arrangement of driving wedge；
Figure 17 be according at least one embodiment be shown in do not formed or non-percussion configuration nail perspective view；
Figure 18 is the front view of Figure 17 nail；
Figure 19 is the front view of the nail of Figure 17 in formation or percussion configuration；
Figure 20 be according at least one embodiment be shown in do not formed or non-percussion configuration include it is inflatable The front view of the nail of coating；
Figure 21 is the fragmentary bottom plan view of the nail for the Figure 20 being deployed in patient tissue；
Figure 22 is the fragmentary bottom plan view of the nail for the Figure 20 being deployed in patient tissue, shows the painting in swelling state Layer；
Figure 23 shows the tissue sutured by staple line according at least one embodiment；
Figure 24 shows the tissue sutured by staple line according at least one embodiment；
Figure 25 shows the tissue sutured by staple line according at least one embodiment；
Figure 26 is the front view of the driving wedge and nail of the various embodiments according to the disclosure；
Figure 27 is Figure 26 driving wedge and the perspective view of nail；
Figure 28 is Figure 26 driving wedge and the plan of nail；
Figure 29 is the perspective view of circular stapling device；
Figure 29 A are a part for the sewing-end of circular stapling device and the perspective view of fastener cartridge assembly；
Figure 30 is part and the perspective view of another fastener cartridge assembly of the sewing-end of circular stapling device；
Figure 31 is part and the perspective view of another fastener cartridge assembly of the sewing-end of circular stapling device；
Figure 32 shows the tissue sutured by staple line according at least one embodiment, wherein in the nail in staple line at least Some nails are overlapping；
Figure 33 is configured for being capable of the partial plan layout of the nail bin of the staple line of deployment diagram 32；
Figure 34 is configured for that the partial plan layout of the anvil block of the nail deformation from Figure 33 nail bin injection can be made；
Figure 35 is the partial plan layout for being configured to dispose the nail bin of staple line according at least one embodiment；
Figure 36 is configured for that the partial plan layout of the anvil block of the nail deformation from Figure 35 nail bin injection can be made；
Figure 37 is held according to the end without driver nail bin with sliding part that includes of the various embodiments of the disclosure The decomposition diagram of row device；
Figure 38 is the perspective view of Figure 37 sliding part；
Figure 38 A are Figure 37 sliding part and the partial plan layout of nail, and it shows the deployment process of nail；
Figure 38 B are Figure 37 sliding part and the front view of nail, and it shows the deployment process of nail；
Figure 39 is the saturating of the sliding part without driver nail bin being shown in Figure 37 of the various embodiments according to the disclosure View；
Figure 39 A are to be at an angle of nail and Figure 39 sliding part without driver according to the having for various embodiments of the disclosure The partial plan layout of nail bin；
Figure 39 B be Figure 39 of the various embodiments according to the disclosure sliding part and Figure 20 nail fragmentary, perspective view；
Figure 40 is the fragmentary, perspective view of the sliding part and nail according to the various embodiments of the disclosure；
Figure 41 is the plan of the array of the nail of the various embodiments according to the disclosure；
Figure 42 is the plan according to the nail of the various embodiments of the disclosure and the array of driving wedge；
Figure 43 is the part of the nail bin of the arrangement wherein with angled nail cavity of the various embodiments according to the disclosure Perspective view；
Figure 44 is the partial plan layout of Figure 43 nail bin；
Figure 45 is the perspective section partial view of Figure 43 nail bin, and it shows to be positioned at nail and driver in nail bin；
Figure 46 is the part of the nail bin of the arrangement wherein with angled nail cavity of the various embodiments according to the disclosure Perspective view；
Figure 47 is the partial plan layout of Figure 46 nail bin；
Figure 48 is the partial perspective profile of Figure 46 nail bin；
Figure 49 is the part of the nail bin of the arrangement wherein with angled nail cavity of the various embodiments according to the disclosure Perspective view；
Figure 50 is the partial plan layout of Figure 49 nail bin；
Figure 51 is the partial perspective profile of Figure 49 nail bin, and it shows to be positioned at nail and many staple drivers in nail bin；
Figure 52 shows the previous nail pattern in implanting tissue；
Figure 52 A show the nail pattern by Fig. 3 cartridge deployment；
Figure 52 B show the nail pattern of Figure 52 A in extended configuration；
Figure 53 is the partial plan layout of the nail bin according at least one embodiment, and the nail bin includes warehouse and is positioned at storehouse Implantable auxiliary material on body；
Figure 54 is the partial plan layout of the implantable auxiliary material according at least one embodiment；
Figure 55 is the partial plan layout of the nail bin according at least one embodiment, and the nail bin includes warehouse and is positioned at storehouse Implantable auxiliary material on body；
Figure 56 is the partial plan layout of the implantable auxiliary material according at least one embodiment；
Figure 57 is the partial plan layout of the implantable auxiliary material according at least one embodiment；
Figure 58 is a part for surgery suturing appliance and the decomposition diagram of end effector；
Figure 59 is the perspective view of the surgery nail bin with supporting member, and supporter can be removed the supporting member from storehouse wherein Position in be supported on the platform of nail bin；
Figure 60 is Figure 59 surgery nail bin and the top view of supporting member；
Figure 61 be Figure 59 and Figure 60 surgery nail bin and supporting member a part perspective view；
Figure 62 be Figure 59-Figure 61 surgery nail bin and supporting member another part top view；
Figure 63 be Figure 59-Figure 62 surgery nail bin and supporting member proximal end perspective view；
Figure 64 be Figure 59-Figure 63 surgery nail bin and supporting member proximal end another perspective view, wherein keeping convex Piece is folded for insertion into the longitudinal slit in storehouse；
Figure 65 be Figure 59-Figure 64 surgery nail bin and supporting member proximal end another perspective view, wherein keeping convex Remained in piece insertion longitudinal slit and by nail sliding part；
Figure 66 is the decomposition assembled view of another surgery nail bin and another supporting member；
Figure 67 is the upward view of Figure 66 supporting member；
Figure 68 is the zoomed-in view of a part for Figure 67 supporting member, wherein position of the following nail cavity in nail bin with It is shown in phantom；
Figure 69 is the zoomed-in view of a part for another supporting member, wherein position of the following nail cavity in nail bin with It is shown in phantom；
Figure 70 is the top view of a part for another supporting member, wherein position of the following nail cavity in nail bin is with void Line is shown；
Figure 71 is the top view of a part for another supporting member；
Figure 72 is the sectional view of the supporting member of Figure 71 along Figure 71 line 72-72 interceptions；
Figure 73 is the perspective view of another surgery nail bin；
Figure 74 is the top view of Figure 73 surgery nail bin；
Figure 75 is the enlarged perspective of a part for Figure 73 and Figure 74 surgery nail bin；
Figure 76 is the top view of another surgery nail bin；
Figure 77 is the side front view of a part for surgical stapling device, wherein tissue " T " is clamped in Figure 76 surgery nail bin Between the anvil block of device；
Figure 78 is the zoomed-in view of a part for Figure 76 and Figure 77 surgery nail bin, and one part is illustrated in cross-section；
Figure 79 is the part section front view of nail bin according to the various embodiments of the disclosure and anvil block；And
Figure 80 is the part section front view of nail bin according to the various embodiments of the disclosure and anvil block.
In all some views, corresponding reference symbol indicates corresponding part.Exemplifications set out herein is with a kind of shape Formula shows various embodiments of the present invention, and such example is not necessarily to be construed as limiting the model of the present invention in any way Enclose.
Embodiment
Present applicant possesses the following patent application submitted on the same day with the application, the respective full text of these patent applications It is herein incorporated by reference：
Entitled " CIRCULAR FASTENER CARTRIDGES FOR APPLYING RADIALLY EXPANDABLE FASTENER LINES " attorney is END7503USNP/140283 U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _；
Entitled " SURGICAL STAPLE AND DRIVER ARRANGEMENTS FOR STAPLE CARTRIDGES " Attorney for END7504USNP/140284 U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _；
Entitled " SURGICAL STAPLING BUTTRESSES AND ADJUNCT MATERIALS " attorney The U.S. Patent Application Serial Number that reel number is END7506USNP/140286 _ _ _ _ _ _ _ _ _ _；
Entitled " FASTENER CARTRIDGE FOR CREATING A FLEXIBLE STAPLE LINE " agency The U.S. Patent Application Serial Number that people's file number is END7507USNP/140287 _ _ _ _ _ _ _ _ _ _；With
It is entitled that " METHOD FOR CREATING A FLEXIBLE STAPLE LINE " attorney is END7508USNP/140288 U.S. Patent Application Serial Number.
Present applicant possesses the following patent application submitted on June 30th, 2014, and these patent applications are each complete Text is herein incorporated by reference：
Entitled " FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENT CONFIGURATIONS " U.S. Patent Application Serial Number 14/318,996；
Entitled " FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDING FASTENER CONTROL FEATURES " U.S. Patent Application Serial Number 14/319,006；
Entitled " END EFFECTOR COMPRISING AN ANVIL INCLUDING PROJECTIONS EXTENDING THEREFROM " U.S. Patent Application Serial Number 14/319,014；
Entitled " SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS " U.S. Patent Application Serial Number 14/318,991；
Entitled " SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS " U.S. Patent Application Serial Number 14/319,004；
Entitled " FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS " United States Patent (USP) Patent application serial numbers 14/319,008；
Entitled " FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGING MEMBERS " U.S. Patent Application Serial Number 14/318,997；
It is entitled that " the FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES " U.S. is special Sharp patent application serial numbers 14/319,002；
Entitled " FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS " U.S. Patent Application Serial Number 14/319,013；With
It is entitled that " the FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO " U.S. is special Sharp patent application serial numbers 14/319,016.
Many specific details are set forth herein, so that reader is to the embodiment party described in specification and shown in accompanying drawing Overall structure, function, manufacture and the purposes of case have thorough understanding.However, it will be apparent to those skilled in the art that, can not have Implement the embodiment in the case of these specific details.In other cases, well known operation, part are not elaborated And element, in order to avoid make the embodiment illustrated in specification smudgy.One of ordinary skill in the art will be understood that, this paper institutes It is non-limiting example to state with shown embodiment, so that it can be appreciated that, specific structural and functional details disclosed herein Can be representative and exemplary.Without departing from the scope of the claims can to these embodiments carry out modification and Change.
Term " including (comprise) " (and including any form, such as " including (comprises) " and " including (comprising) "), " have (have) " (and any form having, such as " have (has) " and " have (having) "), " include (include) " (and comprising any form, such as " include (includes) " and " include " and " contain (contain) " (and any form contained such as " contains (contains) " and " contained (including) (containing) ") it is open link-verb.Therefore, " comprising ", " having ", "comprising" or " containing " one or more elements Surgery system, device or equipment have these one or more elements, but be not limited to only have these one or more members Part.Equally, the element tool of the system of " comprising ", " having ", "comprising" or " containing " one or more features, device or equipment There are these one or more features, but be not limited to that only there are these one or more features.
Term " nearside " and " distal side " are herein defined as coming relative to the clinician of the handle portions of manipulation of surgical apparatus Use.Term " nearside " refers to the part near clinician, and term " distal side " refers to the portion away from clinician Point.It is also understood that for the sake of succinct and be clear, herein can with reference to accompanying drawing using spatial terminology such as " vertical ", " level ", "up" and "down".However, surgical instruments can it is many orientation and position use, and these terms and it is non-limiting and/or Absolutization.
Reuse surgical fasteners tool 100 is shown in Figure 1.Reuse surgical fasteners tool 100 is configured to dispose inflatable staple line.Respectively Plant inflatable staple line has disclosed and reuse surgical fasteners tool 100 to dispose appointing in these inflatable staple lines herein One inflatable staple line.In addition, the surgical instruments in addition to reuse surgical fasteners tool 100 can dispose it is disclosed herein can be swollen Any one inflatable staple line in swollen staple line.
Reuse surgical fasteners tool 100 includes shank 110, axle 120 and end effector 200.Shank 110 includes pistol grip 140th, it is configured to operate the closure trigger 150 of closed-system, is configured to operate the percussion of trigger system to touch Send out device 160 and be configured to operation articulation system to make end effector 200 carry out relative to axle 120 The articulation actuator 170 of joint motions.Entitled " the SURGICAL INSTRUMENT that on December 7th, 2010 announces The disclosure of HAVING RECORDING CAPABILITIES " United States Patent (USP) 7,845,537 is incorporated by reference in its entirety Herein.It is contemplated that other embodiment party including being configured to operate closed-system and the single trigger of trigger system Case.It is contemplated that various embodiments, the end effector of its surgical instrument can not carry out joint motions.In August, 2013 Entitled " the FIRING MEMBER RETRACTION DEVICES FOR POWERED SURGICAL submitted for 23rd The disclosure of INSTRUMENTS " U.S. Patent Application Serial Number 13/974,166 is incorporated by reference in its entirety.
Closure trigger 150 can rotate to activate closed-system towards pistol grip 140.Referring first to Fig. 2, closed system System includes closed tube 122, when closure trigger 150 is moved towards pistol grip 140, and the closed tube is promoted towards distal side.Close The first jaw that pipe 122 is closed with the anvil block 220 including end effector 200 is engaged.In the case of at least one, anvil block 220 is wrapped One or more protuberances 228 from its extension are included, the protuberance, which is positioned in, is limited to one or more of second jaw In elongated slot 212.Protuberance 228 and elongated slot 212 are structured and are arranged to enable anvil block 220 relative to second The static or fixed warehouse channel 210 of jaw rotates between the open and the closed positions.In various alternative embodiments In, warehouse channel can rotate relative to static or fixed anvil block 220.No matter whether the warehouse channel or anvil block of end effector are consolidated Fixed, end effector all can be articulating or not articulating relative to axle.
Referring again to Fig. 2, anvil block 220 includes lug 226, and the lug connects with the slit 124 being limited in closed tube 122 Close.When closed tube 122 is moved distally by closure trigger 150, the engageable lug 226 of side wall of slit 124 and make storehouse Passage 210 rotates towards anvil block 220.When closed tube 122 is proximally moved, another engageable lug of side wall of slit 124 226 and anvil block 220 is set to be rotated away from warehouse channel 210.In some cases, bias spring can be positioned in anvil block 220 and storehouse In the middle of passage 210, the bias spring is configured to anvil block 220 being biased away from warehouse channel 210.
Referring again to Fig. 2, firing trigger 160 can rotate to activate trigger system towards pistol grip 140.Percussion system System is included in the firing member of extension in axle 120.Trigger system also include sliding part 250, the sliding part operationally with percussion Component is engaged.When firing trigger 160 rotates towards pistol grip 140, firing trigger 160 is by firing member and slip Part 250 is in end effector 200 towards distal side driving.End effector 200 also includes the nail bin being positioned in warehouse channel 210 230.Nail bin 230 is interchangeable, and therefore can be removed from warehouse channel 210；However, it is contemplated that other embodiments, its Middle nail bin 230 is not easy to replace and/or remove from warehouse channel 210.
Nail bin 230 includes multiple nail cavities 270.Each nail cavity 270 is configured to removedly store nail wherein, but It is possible that some nail cavities 270 may not accommodate the nail being stored therein in.Nail bin 230 also includes being movably positioned in wherein Multiple staple drivers 240.Each driver 240 is configured to three nails of support and/or terminals simultaneously or concurrently by three Nail is lifted out their corresponding nail cavities 270.Although each driver 240 of the embodiment shown in Fig. 1-Fig. 4 disposes three simultaneously Individual nail, but other embodiments are contemplated that, wherein driver can be disposed less than three nails or more than three nail simultaneously.Sliding part 250 include one or more ramped surfaces 252, and the ramped surfaces are configured in the lower slider of driver 240 and will driven Dynamic device 240 is lifted upwardly toward the platform surface 233 of nail bin 230.Sliding part 250 can be from the court of proximal end 231 of nail bin 230 Distad end 232 moves to lift driver 240 successively.When driver 240 is lifted by sliding part 250 towards platform, drive Dynamic device 240 will be followed closely and lifted towards anvil block 220.When sliding part 250 is distally advanced, nail be located against anvil block 220 drive and by Driver 240 is projected from nail cavity 270.Nail bin 230 may also include the support plate 260 being attached to thereon, and the support plate surrounds nail bin 230 bottom extends and driver 240, nail and/or sliding part 250 is maintained in storehouse 230.
Sliding part 250 and/or by the stick member that sliding part 250 is promoted towards distal side be configured to engagement include anvil 220 the first jaw of seat and/or the second jaw including nail bin 230 and anvil block 220 and nail bin 230 is fixed relative to each other Position.In the case of at least one, sliding part 250 includes at least one first protuberance 256 from its extension, first protuberance It is configured to engage anvil block 220, and at least one second protuberance 258, second protuberance is configured to connect Close warehouse channel 210.Anvil block 220 and nail bin 230 can be positioned relative to each other by protuberance 256 and 258.In sliding part 250 towards remote When side is promoted, protuberance 256 and 258 can position anvil block 220 and set tissue space between anvil block 220 and platform 233.
End effector 200 may also include cutting element, and the cutting element is configured to incision and is trapped in nail bin Tissue between 230 and anvil block 220.Referring again to Fig. 2, sliding part 250 includes knife 254；Any suitably cut however, can be used Cut component.When sliding part 250 is promoted towards distal side and followed closely with being disposed from nail cavity 270, knife 254 is moved distally with transecting patient tissue. In some alternative embodiments, the firing member that sliding part 250 is promoted towards distal side be may include into cutting element.Storehouse 230 includes It is configured to receive the longitudinal slit 234 of knife 254 at least in part.Anvil block 220 also includes being configured at least portion Ground is divided to receive the longitudinal slit of knife 254；However, it is contemplated that in such embodiment, wherein storehouse 230 and anvil block 220 Only one includes the slit for being configured to receive cutting element.
Than that described above, referring primarily to Fig. 1, the shank 110 of surgical instruments 100 includes articulation actuator 170, works as cause When dynamic, the articulation actuator can make end effector 200 carry out joint motions around actuated articulation joints 180.Work as actuating When device 170 is promoted in the first direction, end effector 200 can be rotated in a first direction, and work as actuator 170 in a second direction During promotion, end effector 200 can rotate along second or opposite direction.Referring now to Fig. 2, end effector 200 includes peace It is attached to the joint motions jam plate 182 of its proximal end.In the embodiment shown in the drawing, jam plate 182 is installed to storehouse by pin 184 and led to Road 210, the pin extends through the perforate 214 being limited in warehouse channel 210 and jam plate 182.Axle 120 may also include can be first The lock moved between bonding station and second or disengaging configuration, locks in first bonding station and is engaged with jam plate 182, this Two or lock is disengaged with jam plate during disengaging configuration.When lock is in its bonding station, end effector 200 can be maintained at by lock Appropriate location.When lock is in its disengaging configuration, end effector 200 can rotate around actuated articulation joints 180.2014 6 Entitled " the ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMS that the moon is submitted on the 25th The disclosure of FOR SURGICAL INSTRUMENTS " U.S. Patent Application Serial Number 14/314,788 is in full with the side of reference Formula is incorporated to.Entitled " the SURGICAL STAPLING INSTRUMENT WITH AN submitted on 2 26th, 2013 The disclosure of ARTICULATABLE END EFFECTOR " U.S. Patent Application Serial Number 2013/0168435 is in full to draw It is incorporated to mode.
Turning now to Fig. 3 and Fig. 4, the nail cavity 270 of nail bin 200 can be positioned and be arranged so as to be stored in the nail in nail cavity It is used as the part deployment of extending staple line.Nail cavity 270 is disposed in nail cavity array.Nail cavity array includes removedly storing The first row nail cavity 270a of first nail.First row nail cavity 270a is along the first longitudinal direction axis adjacent with longitudinal slit 234 272a extends.Nail cavity array includes the second row nail cavity 270b for removedly storing the second nail.Second row nail cavity 270b along The second longitudinal direction axis 272b extension adjacent with first row nail cavity 270a.Nail cavity array includes removedly storing the 3rd nail 3rd nail chamber 270c.3rd nail chamber 270c extends along second row nail cavity 270b.
Referring again to Fig. 3 and Fig. 4, first longitudinal direction axis 272a is parallel to or at least substantially parallel to second longitudinal direction axis 272b；However, other arrangements are possible, wherein first longitudinal direction axis 272a is not parallel to second longitudinal direction axis 272b.Second Longitudinal axis 272b is parallel to or at least substantially parallel to the 3rd longitudinal axis 272c；However, other arrangements are possible, its Middle second longitudinal direction axis 272b is not parallel to the 3rd longitudinal axis 272c.First longitudinal direction axis 272a parallel to or at least substantially Parallel to the 3rd longitudinal axis 272c；However, other arrangements are possible, wherein first longitudinal direction axis 272a is not parallel to the 3rd Longitudinal axis 272c.
Referring again to Fig. 3 and Fig. 4, nail bin 230 includes the Part I of nail cavity array and the Part II of the chamber array, should The Part I of nail cavity array includes first row 270a, the second row 270b and the 3rd on the first side of longitudinal slit 234 270c is arranged, the Part II of the chamber array includes first row 270a, the second row 270b on the second side of longitudinal slit 234 With the 3rd row 270c.First chamber array portion is mirror image of the second chamber array portion relative to cannelure；However, it is possible to use its It is arranged.
Nail bin 230 is configured to the nail array shown in deployment diagram 52A.Nail bin 230 is configured to along One longitudinal axis 282a disposes the first nail 280a, along second longitudinal direction axis 282b the second nail 280b of deployment, and along 3rd longitudinal axis 282c disposes the 3rd nail 280c.In all cases, nail bin 230 is configured to the first nail 280a, the second nail 280b and the 3rd nail 280c are deployed on the first side of longitudinal cut 284, and by the first nail 280a, the second nail 280b and the 3rd nail 280c are deployed on the second side of longitudinal cut 284.First nail 280a can be determined Position into adjacent with longitudinal cut 284, and the 3rd nail 280c can be positioned so that it is farthest from longitudinal cut 284.Each second row Nail 280b can be positioned in the middle of the first nail 280a and the 3rd nail 280c.
Than that described above, the first nail 280a is removedly stored in the first nail cavity 270a, and the second nail 280b is removedly It is stored in the second nail cavity 270b, and the 3rd nail 280c is removedly stored in the 3rd nail cavity 270c.Nail cavity 270a-270c It is constructed and arranged to the arrangement deployment nail 280a-280c shown in Figure 52 A.First nail 280a relative to longitudinal axis 282a with First angle 274a is orientated.Second nail 280b is orientated relative to longitudinal axis 282b with second angle 274b.3rd nail 280c phases It is orientated for longitudinal axis 282c with third angle 274c.First angle 274a is different from second angle 274b；However, other In embodiment, first angle 274a and second angle 274b can be identical.Third angle 274c is different from second angle 274b；However, in other embodiments, third angle 274c and second angle 274b can be identical.First angle 274a It is identical with third angle 274c；However, in other embodiments, first angle 274a and third angle 274c can be difference 's.
Than that described above, first angle 274a can be measured relative to first longitudinal direction axis 282a, and second angle 274b can phase Measured for second longitudinal direction axis 282b, and third angle 274c can be measured relative to the 3rd longitudinal axis 282c.When first When longitudinal axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis 282c parallel to each other, first angle 274a, Two angle 274b and/or third angle 274c can be vertical relative to first longitudinal direction axis 282a, second longitudinal direction axis 282b and the 3rd Measured to any one of axis 282c.When first longitudinal direction axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis When 282c is parallel to longitudinal slit 234, first angle 274a, second angle 274b and/or third angle 274c can be relative to vertical Measured to slit 234.Correspondingly, as first longitudinal direction axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis 282c During parallel to tissue cross 284, first angle 274a, second angle 274b and/or third angle 274c can be horizontal relative to tissue Cut 284 measurements.
First nail 280a, the second nail 280b and the 3rd nail 280c can be positioned and be arranged so that them and provide lateral overlap Staple line.More particularly, referring again to Figure 52 A, the second nail 280b longitudinal direction row side of the longitudinal direction row relative to the first nail 280a To positioning so that the gap between the second nail 280b and the first nail 280a is alignd, and similarly, the 3rd nail 280c longitudinal direction row Longitudinal direction row's lateral register relative to the second nail 280b so that align in the gap between the 3rd nail 280c and the second nail 280b.This Sample arrangement can limit blood from tissue T to cross section 284 flowing.
In the embodiment shown in the drawing, each first nail 280a includes the distal side leg relative to the adjacent second nail 280b Distal side leg 283a distally located 283b, and it is located at the proximal leg 285a of nearside relative to distal side leg 283b in addition. Similarly, each 3rd nail 280c includes the distal side leg distally located relative to the adjacent second nail 280b distal side leg 283b 283c, and it is located at the proximal leg 285c of nearside relative to distal side leg 283b in addition.With the above-mentioned first nail 280a and the 3rd Following closely the second adjacent nail 280b of 280c includes the near leg of the nails of proximal leg 285a and the 3rd 280c relative to the first nail 280a Portion 285c is located at the proximal leg 285b of nearside.This is only an exemplary, and any suitable cloth can be used Put.
Than that described above, the first nail 280a crosses over first longitudinal direction axis 282a.First nail 280a distal side leg 283a quilts On the side for being positioned at first longitudinal direction axis 282a, and proximal leg 285a is positioned in the another of first longitudinal direction axis 282a On side.In other words, the first nail 280a leg is biased relative to first longitudinal direction axis 282a.It is contemplated that alternative implementation Scheme, wherein the first nail 280a aligns or collinearly with first longitudinal direction axis 282a.
Second nail 280b crosses over second longitudinal direction axis 282b.Second nail 280b distal side leg 283b is positioned in second and indulged To on axis 282b side, and proximal leg 285b is positioned on second longitudinal direction axis 282b opposite side.In other words Say, the second nail 280b leg is biased relative to second longitudinal direction axis 282b.It is contemplated that alternative embodiment, wherein the Two nail 280b align or collinearly with second longitudinal direction axis 282b.
3rd nail 280c crosses over the 3rd longitudinal axis 282c.3rd nail 280c distal side leg 283c is positioned in the 3rd and indulged To on axis 282c side, and proximal leg 285c is positioned on the 3rd longitudinal axis 282c opposite side.In other words Say, the 3rd nail 280c leg is biased relative to the 3rd longitudinal axis 282c.It is contemplated that alternative embodiment, wherein the Three nail 280c align or collinearly with the 3rd longitudinal axis 282c.
In certain embodiments, the first nail 280a may include what is alignd with the adjacent second nail 280b distal side leg 283b Proximal leg 285a.Similarly, the 3rd nail 280c may include the nearside alignd with the adjacent second nail 280b distal side leg 283b Leg 285c.In various embodiments, the first nail 280a may include proximal leg 285a, and the proximal leg is relative to adjacent the Two nail 280b distal side leg 283b is positioned in distal side.Similarly, the 3rd nail 280c may include proximal leg 285c, the near leg Portion is positioned relative to the adjacent second nail 280b distal side leg 283b in distal side.
Second nail 280b row is defined by the first nail 280a row and the 3rd nail 280c row.Second nail 280b is on side Defined by the first nail 280a and defined on another side by the 3rd nail 280c.More particularly, the first nail 280a is relative to the Two nail 280b proximal leg 285b is positioned laterally inward, and similarly, the 3rd nail 280c is remote relative to the second nail 280b's Side leg 283b is laterally outwardly positioned.Therefore, the first nail 280a can provide border, and the 3rd on the second nail 280b side Nail 280b can provide border on the second nail 280b opposite side.
Tradition nail array is shown in Figure 52.The nail array include be positioned on the first side of the otch 384 in tissue T along First longitudinal direction axis 382a positioning the first nail 380a, along second longitudinal direction axis 382b position the second nail 380b, with And the 3rd nail 380c positioned along the 3rd longitudinal axis 382c.Nail 380a aligns or at least base with first longitudinal direction axis 382a Alignd in sheet；Nail 380b aligns with second longitudinal direction axis 382b or at least substantially alignd；And follow closely 380c and the 3rd longitudinal axis Line 382c aligns or at least substantially alignd.In other words, first 380a is followed closely not relative to first longitudinal direction axis 382a with certain Angular orientation, the second nail 380b is not orientated at a certain angle relative to second longitudinal direction axis 382b, and the 3rd follows closely 380c not phases It is orientated at a certain angle for the 3rd longitudinal axis 382c.The nail array also includes second or the opposite side for being positioned at otch 384 On along first longitudinal direction axis 382a position the first nail 380a, along second longitudinal direction axis 382b position the second nail 380b and the 3rd nail 380c positioned along the 3rd longitudinal axis 382c.
When being applied to longitudinal pulling force in the tissue T sutured as the nail array shown in Figure 52, organize extending longitudinally.This Outside, in all cases, when tissue is by extending longitudinally, nail 380a, 380b and 380c can longitudinal translations.It is such to be arranged in perhaps Can be suitable in the case of many；However, nail 380a, 380b and 380c can limit the stretching, extension and/or movement of tissue.In certain situation Under, it is much lower than still unstitched adjacent tissue flexibility by following closely the tissue of 380a, 380b and 380c suture.In other words, Including following closely the suddenly change that 380a, 380b and 380c nail array may cause the material property of tissue.In at least one situation Under, big strain gradient can be produced due to nail array in tissue, and this can then produce big stress gradient in tissue.
When nail 380a-380c is projected from nail bin, the leg of nail can pierce tissue T.Therefore, nail leg portion is produced in the tissue Hole.Various types of tissues are elastic, and can be around nail leg extension when nail leg portion passes through tissue.In various situations Under, the elasticity of tissue can enable tissue towards nail leg extension and return resiliently to reduce or eliminate tissue and nail leg portion it Between the gap that exists.Such elasticity can also enable tissue be stretched when applying stretching force to tissue；However, such elasticity It can be suppressed by some nail patterns.In the case of at least one, the nail pattern being shown in Figure 52 can suppress the extending longitudinally of tissue.When When extending longitudinally power is applied into the tissue by Figure 52 nail pattern suture, tissue can start to be pulled away from from nail leg portion and at it Between produce gap.In some cases, particularly in bariatrician excision application, such gap can cause from gastric tissue Bleeding increases.In some cases, particularly in pneumonectomy application, air leakage can cause lung tissue.
The nail array being shown in Figure 52 A is more more flexible than the nail array being shown in Figure 52.Referring now to Figure 52 B, when will be vertical When being applied to pulling force in tissue T, nail 280a, 280b and 280c can (first) tissue by extending longitudinally when longitudinal translation simultaneously And/or person (second) rotates when tissue is by extending longitudinally.The submissive nail array being shown in Figure 52 can such as follow the usual practice along staple line The longitudinal direction such as limited by staple line produces significant extensibility.This Longitudinal extending can reduce suture tissue T and/or suture The stress and/or strain gradient in tissue T around tissue T.In addition, when extending longitudinally power is applied into tissue, Figure 52 A Shown in submissive nail array can reduce or eliminate the gap between nail leg portion and tissue T, and therefore reduce nail leg portion and tissue Between bleeding and/or air leakage.
Longitudinal translation for following closely 280a, 280b and 280c, the first nail 280a can be moved along first longitudinal direction axis 282a, Second nail 280b can be moved along second longitudinal direction axis 282b, and the 3rd nail 280c can be moved along the 3rd longitudinal axis 282c It is dynamic.When the first nail 280a is moved along first longitudinal direction axis 282a, the first nail 280a can be on first longitudinal direction axis 282a upper berths Open.In other words, when longitudinal force is applied into tissue along and/or parallel to first longitudinal direction axis 282a, the first nail The distance between 280a or clearance distance can increase.Similarly, when the second nail 280b is moved along second longitudinal direction axis 282b, Second nail 280b can be spread out on second longitudinal direction axis 282b.When by longitudinal force along and/or parallel to second longitudinal direction axis When 282b is applied to tissue, the distance between second nail 280b or clearance distance can increase.In addition, similarly, when the 3rd nail 280c along the 3rd longitudinal axis 282c move when, the 3rd nail 280c can be spread out on the 3rd longitudinal axis 282c.It is longitudinal when inciting somebody to action Power is along and/or parallel to the 3rd longitudinal axis 282c when being applied to tissue, the distance between the 3rd nail 280c or clearance gap From can increase.
As described above, when tissue T is extended, nail 280a, 280b and/or 280c can be moved with tissue T.Work as tissue T When longitudinally being pulled, than that described above, first longitudinal direction axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis 282c can be remained parallel to each other.In some cases, such as it is applied to for example when by cross force (that is, transverse to the power of longitudinal force) When in tissue T, first longitudinal direction axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis 282c orientation can become It is not parallel.In some cases, when by tissue T longitudinally pull when, first longitudinal direction axis 282a, second longitudinal direction axis 282b and/ Or the 3rd longitudinal axis 282c be movable to it is closer to each other.When extending longitudinally power is applied in tissue T, such movement It can be the result of the cross-direction shrinkage occurred in tissue T.In some cases, such as when cross force is applied in such as tissue T When, first longitudinal direction axis 282a, second longitudinal direction axis 282b and/or the 3rd longitudinal axis 282c can be moved away from each other.
For the in rotary moving of nail 280a, 280b and 280c, when longitudinal pulling force is applied in tissue T, the first nail 280a can rotate relative to first longitudinal direction axis 282a.When longitudinal pulling force is applied in tissue T, each first nail 280a can Rotated between initial first angle 274a and another first angle 274a.In the case of at least one, each first nail 280a can be rotated between initial orientation and another orientation, and in the initial orientation, the first nail 280a is extended in transverse direction First longitudinal direction axis 282a, this another orientation with first longitudinal direction axis 282a closer to aliging.In some cases, will longitudinal direction Pulling force, which is applied to tissue T, can cause the first nail 280a to rotate to the orientation with first longitudinal direction axis 282a collinearly.In various situations Under, each first nail 280a can be around the axis rotation for extending through first longitudinal direction axis 282a.
As described above, when longitudinal pulling force is applied in tissue T, the first nail 280a can in initial first angle 274a and Rotated between another first angle 274a.In various embodiments, initial or un-extended first angle 274a can be between Between e.g., from about 5 degree and about 85 degree.In certain embodiments, initial or un-extended first angle 274a can be between e.g., from about Between 30 degree and about 60 degree.In at least one embodiment, initial or un-extended first angle 274a can be e.g., from about 45 Degree.In at least one embodiment, initial or un-extended first angle 274a can for e.g., from about 10 degree, about 20 degree, about 30 Degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the first angle 274a of stretching, extension can be between e.g., from about 5 degree and about 85 degree.In some situations Under, the first angle 274a of stretching, extension can be between e.g., from about 30 degree and about 60 degree.In the case of at least one, the first of stretching, extension Angle 274a can be e.g., from about 45 degree.In the case of at least one, the first angle 274a of stretching, extension can for e.g., from about 10 degree, about 20 Degree, about 30 degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the difference between un-extended first angle 274a and the first angle 274a of stretching, extension can be between Between e.g., from about 1 degree and about 45 degree.In some cases, un-extended first angle 274a and stretch first angle 274a it Between difference can be e.g., from about 1 degree, about 2 degree, about 3 degree, about 4 degree, and/or about 5 degree.In some cases, un-extended first Difference between angle 274a and the first angle 274a of stretching, extension can be e.g., from about 5 degree, about 10 degree, about 15 degree, about 20 degree, and/ Or about 25 degree.
Than that described above, when longitudinal pulling force is applied in tissue T, the second nail 280b can be relative to second longitudinal direction axis 282b rotates.When longitudinal pulling force is applied in tissue T, each second nail 280b can be in initial second angle 274b and another Rotated between individual second angle 274b.In the case of at least one, each second nail 280b can take in initial orientation with another Rotated between, in the initial orientation, the second nail 280b extends to second longitudinal direction axis 282b in transverse direction, this another Orientation is alignd closer to second longitudinal direction axis 282b.In some cases, can be caused by longitudinal pulling force being applied into tissue T Two nail 280b rotate to the orientation with second longitudinal direction axis 282b collinearly.In all cases, each second nail 280b can be surrounded With second longitudinal direction axis 282b align and/or extend through second longitudinal direction axis 282b axis rotate.
As described above, when longitudinal pulling force is applied in tissue T, the second nail 280b can in initial second angle 274b and Rotated between another second angle 274b.In various embodiments, initial or un-extended second angle 274a can be between Between e.g., from about 5 degree and about 85 degree.In certain embodiments, initial or un-extended second angle 274b can be between e.g., from about Between 30 degree and about 60 degree.In at least one embodiment, initial or un-extended second angle 274b can be e.g., from about 45 Degree.In at least one embodiment, initial or un-extended second angle 274b can for e.g., from about 10 degree, about 20 degree, about 30 Degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the second angle 274b of stretching, extension can be between e.g., from about 5 degree and about 85 degree.In some situations Under, the second angle 274b of stretching, extension can be between e.g., from about 30 degree and about 60 degree.In the case of at least one, the second of stretching, extension Angle 274b can be e.g., from about 45 degree.In the case of at least one, the second angle 274b of stretching, extension can for e.g., from about 10 degree, about 20 Degree, about 30 degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the difference between un-extended second angle 274b and the second angle 274b of stretching, extension can be between Between e.g., from about 1 degree and about 45 degree.In some cases, un-extended second angle 274b and stretch second angle 274b it Between difference can be e.g., from about 1 degree, about 2 degree, about 3 degree, about 4 degree, and/or about 5 degree.In some cases, un-extended second Difference between angle 274b and the second angle 274b of stretching, extension can be e.g., from about 5 degree, about 10 degree, about 15 degree, about 20 degree, and/ Or about 25 degree.
Than that described above, when longitudinal pulling force is applied in tissue T, the 3rd nail 280c can be relative to the 3rd longitudinal axis 282c rotates.When longitudinal pulling force is applied in tissue T, each 3rd nail 280c can be in initial third angle 274c and another Rotated between individual third angle 274c.In the case of at least one, each 3rd nail 280c can take in initial orientation with another Rotated between, in the initial orientation, the 3rd nail 280c extends to the 3rd longitudinal axis 282c in transverse direction, this another Orientation is closer to align with the 3rd longitudinal axis 282c.In some cases, the 3rd can be caused by longitudinal pulling force being applied into tissue T Nail 280c rotates to the orientation with the 3rd longitudinal axis 282c collinearly.In all cases, it is each 3rd nail 280c can surround with 3rd longitudinal axis 282c alignment and/or the axis rotation for extending through the 3rd longitudinal axis 282c.
As described above, when longitudinal pulling force is applied in tissue T, the 3rd nail 280c can in initial third angle 274c and Rotated between another third angle 274c.In various embodiments, initial or un-extended third angle 274c can be between Between e.g., from about 5 degree and about 85 degree.In certain embodiments, initial or un-extended third angle 274c can be between e.g., from about Between 30 degree and about 60 degree.In at least one embodiment, initial or un-extended third angle 274c can be e.g., from about 45 Degree.In at least one embodiment, initial or un-extended third angle 274c can for e.g., from about 10 degree, about 20 degree, about 30 Degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the third angle 274c of stretching, extension can be between e.g., from about 5 degree and about 85 degree.In some situations Under, the third angle 274c of stretching, extension can be between e.g., from about 30 degree and about 60 degree.In the case of at least one, the 3rd of stretching, extension the Angle 274c can be e.g., from about 45 degree.In the case of at least one, the third angle 274c of stretching, extension can for e.g., from about 10 degree, about 20 Degree, about 30 degree, about 40 degree, about 50 degree, about 60 degree, about 70 degree, and/or about 80 degree.
In all cases, the difference between un-extended third angle 274c and the third angle 274c of stretching, extension can be between Between e.g., from about 1 degree and about 45 degree.In some cases, un-extended third angle 274c and stretch third angle 274c it Between difference can be e.g., from about 1 degree, about 2 degree, about 3 degree, about 4 degree, and/or about 5 degree.In some cases, the un-extended 3rd Difference between angle 274c and the third angle 274c of stretching, extension can be e.g., from about 5 degree, about 10 degree, about 15 degree, about 20 degree, and/ Or about 25 degree.
In all cases, the first nail rotatable first amounts of 280a in the first nail, and second in the second nail Follow closely rotatable second amounts different from the first amount of 280b.First amount is smaller than or more than the second amount.In all cases, first row The first nail rotatable first amounts of 280a in nail, and the 3rd follow closely 280c rotatable different from the first amount the in the 3rd nail Three amounts.First amount is smaller than or more than the 3rd amount.In all cases, the 3rd nail 280c the rotatable 3rd in the 3rd nail Amount, and the second nail rotatable second amount different from the 3rd amount of 280b in the second nail.3rd amount is smaller than or more than Two amounts.
In at least one application, for most interior staple, the i.e. staple near otch, it would be desirable to than other nails Row is with less flexible or not extending.For outermost staple, the i.e. staple farthest from otch, it would be desirable to than other staples It is more flexible or extending.When the angle between the first nail axis and first longitudinal direction axis is less than the second nail axis and second longitudinal direction During angle between axis, the first nail must be directed towards the rotation of second longitudinal direction axis than the second nail, and there is less direction first to indulge The space rotated to axis, and therefore tissue is more hardened than the second nail.Similarly, when the second nail axis and second longitudinal direction When angle between axis is less than the angle between the 3rd nail axis and the 3rd longitudinal axis, the second nail must court than the 3rd nail Rotated to the 3rd longitudinal axis with less space rotated towards second longitudinal direction axis, and therefore make tissue than the 3rd nail More harden.
Than that described above, the nail pattern disclosed in Figure 52 A includes six longitudinal staples.It is contemplated that other embodiment party Case, for example, it includes less than six staples, such as four staples, or more than six staples, such as eight staples.
First nail 280a, the second nail 280 and the 3rd nail 280c may include any suitable configuration, such as V-arrangement configuration or U-shaped Configuration.Nail including V-arrangement configuration may include base portion, the first leg extended from the first end of base portion and from base portion the Second leg of two ends extension, wherein the first leg and the second leg extend along direction is not substantially parallel with each other.Including U-shaped configuration Nail may include base portion, the first leg extended from the first end of base portion and extend from the second end of base portion second Leg, wherein the first leg and the second leg extend along direction parallel to each other.
For the nail pattern for example disclosed in Figure 52 A, each first nail 280a includes nearside nail leg portion 285a and distal side is followed closely Leg 283a.The nail bin for the nail pattern being configured to disclosed in deployment diagram 52A may include proximal end and distal end.Closely Side nail leg portion 285a than distal side nail leg portion 283a closer to nail bin proximal end, and similarly, distal side nail leg portion 283a Distal ends of the comparable nearside nail leg portion 285a closer to nail bin.Each first nail 280a base portion can limit the first base shaft Line.Nearside nail leg portion 285a and distal side nail leg portion 283a can extend from the first base portion axis.First nail 280a can be positioned and cloth It is set to and causes the first base portion axis towards longitudinally cutting line 284 and extend towards the distal end of nail bin.
For the nail pattern for example disclosed in Figure 52 A, each second nail 280b includes nearside nail leg portion 285b and distal side is followed closely Leg 283b.As described above, the nail bin for the nail pattern being configured to disclosed in deployment diagram 52A may include proximal end and remote Side end.Nearside nail leg portion 285b than distal side nail leg portion 283b closer to nail bin proximal end, and similarly, distal side nail Leg 283b than nearside nail leg portion 285b closer to nail bin distal end.Each second nail 280b base portion can limit second Base portion axis.Nearside nail leg portion 285b and distal side nail leg portion 283b can extend from the second base portion axis.Second nail 280b can be determined Position and be arranged so that the second base portion axis towards longitudinally cutting line 284 and towards nail bin proximal end extend.
For the nail pattern for example disclosed in Figure 52 A, each 3rd nail 280c includes nearside nail leg portion 285c and distal side is followed closely Leg 283c.As described above, the nail bin for the nail pattern being configured to disclosed in deployment diagram 52A may include proximal end and remote Side end.Nearside nail leg portion 285c than distal side nail leg portion 283c closer to nail bin proximal end, and similarly, distal side nail Leg 283c than nearside nail leg portion 285c closer to nail bin distal end.Each 3rd nail 280c base portion can limit the 3rd Base portion axis.Nearside nail leg portion 285c and distal side nail leg portion 283c can extend from the 3rd base portion axis.3rd nail 280c can be determined Position and be arranged so that the 3rd base portion axis towards longitudinally cutting line 284 and towards nail bin distal end extend.
For the nail pattern for example disclosed in Figure 52 A, the first nail 280a can align with the 3rd nail 280c.First nail 280a's Nearside nail leg portion 285a can align with the 3rd nail 280c nearside nail leg portion 285c.As nearside nail leg portion 285a and nearside nail leg portion When 285c aligns, nearside nail leg portion 285a and proximal leg 285c can be along the axis locations perpendicular to line of cut 284.First nail 280a distal side nail leg portion 283a can align with the 3rd nail 280c distal side nail leg portion 283c.When distal side nail leg portion 283a and distal side When nail leg portion 283c aligns, distal side nail leg portion 283a and distal side nail leg portion 283c can determine along the axis perpendicular to line of cut 284 Position.In such cases, seal tissue in the case that the 3rd nail 280c can follow closely 280a deformations first.Similarly, the first nail 280a can keep together tissue in the case of the 3rd nail 280c deformations.In other embodiments, the first nail 280a can Do not alignd with the 3rd nail 280c.
Than that described above, when following closely pattern in unstretched condition, the first nail 280a can align with the 3rd nail 280c.Work as nail When pattern is by extending longitudinally, first nail 280a and/or the 3rd nail 280c it is translatable and/or rotation.In all cases, tissue is worked as During by extending longitudinally, the first nail 280a can keep aliging with the 3rd nail 280c.In other cases, the first nail 280a can not be with the Three nail 280c keep alignment.
Again for the nail pattern disclosed in Figure 52 A, the second nail 280b distal side nail leg portion 283b can be with the first nail 280a Nearside nail leg portion 285a and/or the 3rd nail 280c proximal leg 285c alignment.Second nail 280b distal side nail leg portion 283b, The first nail 280a nails of nearside nail leg portion 285a and/or the 3rd 280c nearside nail leg portion 285c can be along perpendicular to line of cut 284 axis location.Second nail 280b nearside nail leg portion 285b can be with the first nail 280a distal side nail leg portion 283a and/or the Three nail 280c distal side nail leg portion 283c alignment.Second nail 280b nearside nail leg portion 285b, the first nail 280a distal side nail leg The nails of portion 283a and/or the 3rd 280c distal side nail leg portion 283c can be along the axis location perpendicular to line of cut 284.
Than that described above, when following closely pattern in unstretched condition, the second nail 280b nail leg portion can be with the first nail 280a And/or the 3rd nail 280c nail leg portion alignment.When following closely pattern by extending longitudinally, the first nail 280a, the second nail 280b and/or the Three nail 280c are translatable and/or rotate.In all cases, when tissue is by extending longitudinally, the second nail 280b leg can not Keep aliging with the first nail 280a and/or the 3rd nail 280c leg.In other cases, when tissue is by extending longitudinally, the Two nail 280b leg can keep aliging with the first nail 280a and/or the 3rd nail 280c leg.
In various embodiments, nail pattern may be arranged so that the nail in a longitudinal staple is longitudinally followed closely with another Nail in row is overlapping.For example, the second nail 280b distal side nail leg portion 283b can follow closely 280a nearside nail leg portion relative to first The nails of 285a and/or the 3rd 280c proximal leg 285c is positioned at distal side.For example, the second nail 280b nearside nail leg portion 285b can It is positioned in the first nail 280a nails of distal side nail leg portion 283a and/or the 3rd 280c distal side nail leg portion 283c nearsides.Second nail 280b nearside nail leg portion 285b, the first nail 280a nails of distal side nail leg portion 283a and/or the 3rd 280c distal side nail leg portion 283c can be along the axis location perpendicular to line of cut 284.
As described above, when following closely pattern in unstretched condition, the second nail 280b can be with the first nail 280a and/or the 3rd nail 280c is overlapping.When follow closely pattern by extending longitudinally when, first nail 280a, second nail 280b and/or the 3rd nail 280c it is translatable and/or Rotation.In all cases, when tissue is by extending longitudinally, the second nail 280b can be with the first nail 280a and/or the 3rd nail 280c Keep overlapping.In some cases, when tissue is by extending longitudinally, the second nail 280b can no longer with the first nail 280a and/or the Three nail 280c are overlapping.
Nail pattern shown in Figure 52 A is shown in unstretched condition.When the tissue sutured as the nail pattern shown in Figure 52 A During by extending longitudinally, nail can be vertically moved with tissue and/or rotated in tissue, as shown in Figure 52 B.Such movement It is shown in Figure 24.
Surgical instruments 100 is configured to use during laparoscopic type surgical operation.End effector 200 and axle 120 size and be dimensioned so as to through trochar or be intubated it is inserted into the patient.Trochar may include inner passage, and this is interior Portion's passage includes internal diameter.In some cases, internal diameter can be such as about 5mm or about 12mm.End effector 200 be along Straight line applies the linear end actuator of nail.It is contemplated that other surgical instruments, it applies along the line that at least part is bent Nail, entitled " the SURGICAL STAPLING DEVICE HAVING SUPPORTS FOR that such as 2014 on Septembers are announced for 9 Those disclosed in A FLEXIBLE DRIVE MECHANISM " United States Patent (USP) 8,827,133.September is announced on the 9th within 2014 Entitled " SURGICAL STAPLING DEVICE HAVING SUPPORTS FOR A FLEXIBLE DRIVE The complete disclosure of MECHANISM " United States Patent (USP) 8,827,133 is incorporated by reference in its entirety.Such surgical instruments energy Enough apply the inflatable staple line of bending using principle disclosed herein.Although surgical instruments 100 can be in laparoscopic type surgery Used during operation, but surgical instruments 100 can be also used during open surgery, in open surgery China and foreign countries Section's apparatus 100 is inserted through the big otch in patient's body.In addition, inflatable staple line disclosed herein can be by open surgical Stitching unstrument applies, entitled " the SURGICAL STAPLING INSTRUMENT " U.S. submitted on October 21st, 1 Those disclosed in patent application publication 2014/0042205.Entitled " the SURGICAL that on October 21st, 2013 submits The disclosure of STAPLING INSTRUMENT " U.S. Patent Application Publication 2014/0042205 is incorporated by reference simultaneously Enter herein.
Turning now to Fig. 4, anvil block 220 includes the array for being defined in forming pit 290a, 290b and 290c therein, its point It is not configured to deform nail 280a, 280b and 280c.First forming pit 290a is fixed along first longitudinal direction axis 292a Position, second longitudinal direction pit 290b is positioned along second longitudinal direction axis 292b, and the 3rd forming pit 290c is longitudinal along the 3rd Axis 292c is positioned.Longitudinal axis 292a, 292b are parallel with 292c and in the proximal end 221 and distal end of anvil block 220 Extend between 222.Anvil block 220 also includes being defined in longitudinal slit 224 therein, and the longitudinal slit is configured to reception and hit Send out at least a portion of component.In the case of at least one, firing member is included in what is extended between anvil block 220 and nail bin 230 Cut portion.What anvil block 220 was included on the side of longitudinal slit 224 one ranked first forming pit 290a, one ranked second shaping Pit 290b and one ranked third forming pit 290c, and to ranked first shaping recessed by another on the opposite side of longitudinal slit 224 Hole 290a, another it ranked second forming pit 290b and another ranked third forming pit 290c.As it will be appreciate that, forming pit 290a, 290b and 290c align and corresponding with nail cavity 270a, 270b and 270c for being each defined in nail bin 230.
Forming pit 290a, 290b and 290c are configured to make nail 280a, 280b and 280c be deformed into such as B shapes structure Type.In all cases, forming pit 290a, 290b and 290c is configured to make staple and/or V-arrangement nail be deformed into example Such as such B shapes configuration.Each forming pit 290a, 290b and 290c include the near of the proximal leg for being configured to reception nail Side end and the distal end for being configured to receive the distal side leg of nail.That is, any suitable anvil block is available In the nail projected from nail bin is formed as into any suitable shape.Each forming pit 290a, 290b and 290c may include at it The groove extended between proximal end and distal end.Groove may include side wall, and the side wall is configured to make in plane Nail leg portion is removed from the plane when nail deforms and prevents or be at least limited in the deformation of nail leg portion.
Turning now to Fig. 5, anvil block 320 includes the array for being defined in forming pit 390a, 390b and 390c therein.It is similar In described above, multiple first forming pit 390a are arranged along first longitudinal direction axis, multiple second forming pit 390b along Second longitudinal direction axis is arranged, and multiple 3rd forming pit 390c are arranged along the 3rd longitudinal axis.Each forming pit 390a, 390b and 390c include nearside forming pit end and distal side forming pit end.For example, each first forming pit 390a includes being configured to receive the proximal end 393a of the proximal leg of the first nail and is configured to reception the The distal end 395a, each second forming pit 390b of the distal side leg of one nail receive the second nail including being configured to The proximal end 393b of the proximal leg and distal end 395b for being configured to receive the distal side leg of the second nail, and Each forming pit 390c includes being configured to receive the proximal end 393c of the proximal leg of the 3rd nail and is constructed Into the distal end 395c for the distal side leg that can receive the 3rd nail.
Proximal end 393a, 393b and 393c and distal end 395a, 395b and 395c may include any suitable structure Type.Referring again to Fig. 5, proximal end 393a, 393b and 393c and distal end 395a, 395b and 395c each include amplification Cup.Amplify the groove 397 of cup than restriction therebetween wide.In some cases, amplification cup and the groove extended therebetween may include Such as hourglass shape.When the leg of nail enters such forming pit, leg can enter amplification cup, and in the deformation of nail leg portion When, nail leg portion can be directed in groove 397 by amplification cup.The side wall that each amplification cup may include to bend and/or be at an angle of, the side Wall is configured to guide nail leg portion towards groove 397.In some cases, amplification cup can adjust unjustified nail leg portion Orientation.
Nail shapes pit 390a, 390b are nested with 390c.For example, the second forming pit 390b distal side amplification cup 395b is positioned in the middle of amplification cup 393c, 395c of the 3rd adjacent nail shapes pit 390c, and in addition, the second forming pit 390b nearside amplification cup 393b is positioned in the middle of amplification cup 393a, 395a of the first adjacent forming pit 390a.In addition, example Such as, the first forming pit 390a nearside amplification cup 393a be positioned at the second adjacent forming pit 390b amplification cup 393b, In the middle of 395b.In addition, for example, the 3rd forming pit 390c distal side amplification cup 395c is positioned at the second adjacent forming pit In the middle of 390b amplification cup 393b, 395b.The amplification forming cup of each nail cavity can limit rectangle perimeter, and whole forming pit can quilt It is positioned in the rectangle perimeter.As the result of above-mentioned nested arrangement, the rectangle perimeter of a nail forming cavity can with another into The rectangle perimeter of shape chamber is overlapping.For example, the second forming cavity 390b rectangle perimeter can be with the first forming cavity 390a rectangle perimeter And/or the 3rd forming cavity 390c rectangle perimeter it is overlapping.
Turning now to Fig. 6, anvil block 420 includes the array for being defined in forming pit 490a, 490b and 490c therein.It is similar In described above, multiple first forming pit 490a are arranged along first longitudinal direction axis, multiple second forming pit 490b along Second longitudinal direction axis is arranged, and multiple 3rd forming pit 490c are arranged along the 3rd longitudinal axis.Each forming pit 490a, 490b and 490c include nearside forming pit end and distal side forming pit end.For example, each first forming pit 490a includes being configured to receive the proximal end 493a of the proximal leg of the first nail and is configured to reception the The distal end 495a, each second forming pit 490b of the distal side leg of one nail receive the second nail including being configured to The proximal end 493b of the proximal leg and distal end 495b for being configured to receive the distal side leg of the second nail, and Each forming pit 490c includes being configured to receive the proximal end 493c of the proximal leg of the 3rd nail and is constructed Into the distal end 495c for the distal side leg that can receive the 3rd nail.
Proximal end 493a, 493b and 493c and distal end 495a, 495b and 495c may include any suitable structure Type.Referring again to Fig. 6, proximal end 493a, 493b and 493c and distal end 495a, 495b and 495c each include amplification Cup.Amplify the groove 497 of cup than restriction therebetween wide.In some cases, amplification cup and the groove extended therebetween may include Such as hourglass shape.When the leg of nail enters such forming pit, leg can enter amplification cup, and in the deformation of nail leg portion When, nail leg portion can be directed in groove 497 by amplification cup.The side wall that each amplification cup may include to bend and/or be at an angle of, the side Wall is configured to guide nail leg portion towards groove 497.In some cases, amplification cup can adjust unjustified nail leg portion Orientation.
Nail shapes pit 490a, 490b are nested with 490c.For example, the second forming pit 490b distal side amplification cup 495b is positioned in the middle of amplification cup 493c, 495c of the 3rd adjacent nail shapes pit 490c, and in addition, the second forming pit 490b nearside amplification cup 493b is positioned in the middle of amplification cup 493a, 495a of the first adjacent forming pit 490a.In addition, example Such as, the first forming pit 490a nearside amplification cup 493a be positioned at adjacent second forming pit 490b amplification cup 493b, In the middle of 495b.In addition, for example, the 3rd forming pit 490c distal side amplification cup 495c is positioned at adjacent second forming pit 490b Amplification cup 493b, 495b in the middle of.The amplification forming cup of each nail cavity can limit rectangle perimeter, and whole forming pit can be positioned In the rectangle perimeter.As the result of above-mentioned nested arrangement, the rectangle perimeter of a nail forming cavity can be with another forming cavity Rectangle perimeter it is overlapping.For example, the second forming cavity 490b rectangle perimeter can with the first forming cavity 490a rectangle perimeter and/or 3rd forming cavity 490c rectangle perimeter is overlapping.
Referring again to Figure 52 A, nail 280a, 280b and 280c be not overlapping.It is contemplated that other embodiments, wherein nail figure At least some nails in nail in case are overlapping.Turning now to Figure 32, the nail pattern disclosed in it includes first row and longitudinally followed closely 580a and second row longitudinally follow closely 580b.As it will be appreciate that, in the nail 580a in first row some nail and second row in Follow closely 580b overlapping.In the case of at least one, the second nail 580b base portion extends below the first nail 580a base portion.Such In the case of, the second nail 580b distal side leg 585b is positioned on the side of the first nail 580a base portion, and the second nail 580b proximal leg 583b is positioned on the opposite side of the first nail 580a base portion.Similarly, in the case of at least one, First nail 580a base portion extends below the second nail 580b base portion.In such cases, the first nail 580a distal side leg 585a is positioned on the side of the second nail 580b base portion, and the first nail 580a proximal leg 583a is positioned in second On the opposite side for the base portion for following closely 580b.As above-mentioned result, the first nail 580a and the second nail 580b interweave.
Referring again to Figure 32, nail pattern includes the first nail 580a and second being positioned on the side of longitudinal tissue's otch Nail 580b, and the first nail 580a and the second nail 580b being positioned on the opposite side of longitudinal tissue's otch.First nail 580a is towards distal side and towards longitudinal tissue's notch orientation, and the second nail 580b is proximally and towards longitudinal tissue's notch orientation.
Referring again to Figure 32, the first nail 580a is along first longitudinal direction axis location, and the second nail 580b is along Two longitudinal axis are positioned.Due to first nail 580a and second nail 580b between it is overlapping, in some cases, first longitudinal direction axis Can be adjacent with second longitudinal direction axis.In some cases, overlapping between the first nail and the second nail makes in these staples Angled nail can have identical centreline space every, the centreline space every available traditional nail pattern (example being longitudinally arranged Such as all nail patterns as shown in figure 50) realize.In some cases, overlapping between the first nail and the second nail makes these Angled nail in staple can have than the centreline space that can be realized with traditional nail pattern being longitudinally arranged every near center Line interval.In at least one embodiment, first longitudinal direction axis can be with second longitudinal direction axis collinear.
The nail pattern being shown in Figure 32 includes repeat patterns.Repeat patterns include two first nail 580a, are followed by two Second nail 580b, is followed by two first nail 580a, is followed by two second nail 580b, by that analogy.The repeat patterns are along closely Side-distal direction Longitudinal extending.First nail 580a has the breach by following closely 580b fillings wherein, and similarly, second Nail 580b has the breach by following closely 580a fillings wherein.Repeat patterns are present on the side of longitudinal cut, and repeat Pattern is present on the opposite side of longitudinal cut.These repeat patterns are mutual mirror images.It is contemplated that other repeat patterns.
Be configured to removedly store and deployment diagram 32 disclosed in the nail bin 530 of nail pattern be shown in Figure 33 In.Nail bin 530 includes being used for removedly storage first and follows closely 580a first row nail cavity 570a and for removedly storing Second nail 580b second row nail cavity 570b.At least some interconnection in first nail cavity 570a and the second nail cavity 570b are with removable Ground stores overlapping the first nail 580a and the second nail 580b.First row nail cavity 570a can arrange along first longitudinal direction axis, and One, which ranked second nail cavity 570b, to be arranged along second longitudinal direction axis.First longitudinal direction axis and second longitudinal direction axis can depend on the circumstances To be adjacent or conllinear, to dispose nail pattern disclosed herein.First row nail cavity 570a and second row nail cavity 570b are determined Position is on the first side of longitudinal slit 534, and first row nail cavity 570a and second row nail cavity 570b are positioned in longitudinal slit On 534 the second side.Longitudinal slit 534 is configured to receive firing member.Firing member may include cutting element, such as Knife.
The anvil block 520 of the nail deformation for the nail pattern for being configured to make disclosed in Figure 32 is shown in Figure 34.Anvil block 520 Repeat patterns including forming cavity, the forming cavity includes being configured to the first shaping that the leg for making the first nail 580a is deformed Chamber 590a and it is configured to the second forming cavity 590b for deforming the second nail 580b leg.First forming cavity 590a and Second forming cavity 590b is arranged with alternating pattern.Alternating pattern, which includes being positioned on the side of longitudinal slit 524 along first, to be indulged To the first forming cavity 590a and the second forming cavity 590b of axis location array, and along the of second longitudinal direction axis location One forming cavity 590a and the second forming cavity 590b array.Alternating pattern also includes being positioned on the opposite side of longitudinal slit 524 Along the first forming cavity 590a and the second forming cavity 590b of first longitudinal direction axis location array, and along second longitudinal direction axle The the first forming cavity 590a and the second forming cavity 590b of line positioning array.The array of forming cavity 590a, 590b can be relative to vertical Mirror image is limited to slit 524.Longitudinal slit 524 is configured to receive firing member.Firing member may include cutting element, Such as knife.
The nail pattern being shown in Figure 32 includes two nails on every side of longitudinal tissue's otch；However, such Nail pattern may include that more than two rows are followed closely, such as such as three nails.Such 3rd nail can be with the first nail 580a and/or second Nail 580b interweaves.Or, such 3rd nail can not interweave with the first nail 580a or the second nail 580b.Such In embodiment, the first nail 580a and the second nail 580b can interweave, and the 3rd nail can be with such as the first nail 580a And/or second nail 580b it is adjacent.
The nail pattern being shown in Figure 35 includes the first nail 680a longitudinal direction row, the second nail 680b longitudinal direction row and the 3rd nail 6870c longitudinal direction row.First nail 680a has the first base widths.Second nail 680b has the second base widths.3rd nail 680c has the 3rd base widths.The width of base portion can be defined as the first nail leg portion extended from base portion and extend from base portion The distance between the second nail leg portion, the distance measures along the base portion extended between the first nail leg portion and the second nail leg portion. In the case of at least one, base widths be the first nail leg portion cross-section center and the second nail leg portion cross-section center it Between measure.Under any circumstance, the first base widths are shorter than the second base widths；However, it is contemplated that other embodiment party Case, wherein the second base widths are shorter than the first base widths.3rd base widths are shorter than the first base widths and the second base portion is wide Degree；However, it is contemplated that other embodiments, wherein the 3rd base widths are longer than the first base widths and/or the second base portion Width.
In Figure 35 embodiment is shown in, the second nail 680b has most long base widths.Therefore, when the nail in nail pattern When being rotated with tissue by extending longitudinally in tissue, second follows closely 680b by the inswept arc length bigger than the first nail 680a.It is similar Ground, the first nail 680a follows closely the bigger arc length of 680c than the 3rd by inswept.Therefore, in all cases, the first nail 680a will be inswept First arc length, the second nail 680b will inswept second arc length, and the 3rd follow closely 680c by inswept 3rd arc length, wherein the first arc length, Second arc length and the 3rd arc length are different.Even if wherein nail 680a, 680b and/or 680c angle is identical, such arc Length also can be different.In some cases, the first arc length, the second arc length and/or the 3rd arc length can be identical.
In the embodiment being shown in Figure 35, the first nail 680a positions and is arranged in nail bin in the way of being alternately arranged In 630.Farthest side first follows closely 680a towards the distal end of nail bin 630 and towards the longitudinal slit being limited in nail bin 630 634 orientations.Next first nail 680a in second longitudinal direction row towards nail bin 630 proximal end and towards longitudinal slit 634 orientations.Then the pattern is repeated in the first nail 680a longitudinal direction row.
Second nail 680b is positioned and is arranged in the way of being alternately arranged in nail bin 630.Farthest side second follows closely 680b directions The distal end of nail bin 630 and it is orientated towards the longitudinal slit 634 being limited in nail bin 630.It is next in second longitudinal direction row Individual second follows closely 680b towards the proximal end of nail bin 630 and is orientated towards longitudinal slit 634.Then the pattern is in the second nail Repeated in 680b longitudinal direction row.
3rd nail 680c is positioned and is arranged in the way of being alternately arranged in nail bin 630.Farthest side the 3rd follows closely 680c directions The distal end of nail bin 630 and it is orientated towards the longitudinal slit 634 being limited in nail bin 630.It is next in 3rd longitudinal direction row Individual 3rd follows closely 680c towards the proximal end of nail bin 630 and is orientated towards longitudinal slit 634.Then the pattern is in the 3rd nail Repeated in 680c longitudinal direction row.
With further reference to the nail pattern shown in Figure 35, the first nail 380a longitudinal direction row is nested in the second nail 380b longitudinal direction row It is interior.Similarly, the 3rd nail 380c longitudinal direction row is nested in the second nail 380b longitudinal direction row.
Than that described above, nail bin 630 includes being configured to removedly store the multiple of the first nail 680a wherein First nail cavity 670a.Nail bin 630 also includes multiple second nail cavities for being configured to removedly store the second nail 680b 670b, and it is configured to removedly store the 3rd nail 680c multiple 3rd nail cavity 670c.Referring to Figure 36, anvil block 620 are configured to deform them when nail 680a, 680b and 680c are projected from nail bin 630.Anvil block 620 includes and nail The nail shapes pit pattern of chamber 670a, 670b and 670c alignment.For example, anvil block 620 is more including what is alignd with the first nail cavity 670a Individual first forming pit 690a, the multiple second forming pit 690b alignd with the second nail cavity 670b, and with the 3rd nail cavity Multiple 3rd forming pit 690c of 670c alignment.
As described above, nail pattern may include some rows.Nail in often arranging can have same orientation or different orientation.Figure 23 shows Going out includes the embodiment of a nail, and the nail has first group of nail 780a being orientated with first direction, and with second direction Second group of nail 780b of orientation.First nail 780a and the second nail 780b are positioned along longitudinal axis.First nail 780a is relative to vertical It is at an angle of to axis, and the second nail 780b aligns with longitudinal axis.Other arrangements are possible.780a is followed closely with nail 780b to hand over Arranged for pattern.
With continued reference to Figure 23 and referring again to Figure 24, when tissue is by extending longitudinally, the nail in staple can be in tissue Translate and rotate.In some cases, translation of the nail in tissue and/or rotation can be produced between nail and tissue hole or Gap.This pores or gap can produce leakage.Even if various nail patterns disclosed herein can minimize such leakage, but can be right Nail carries out some improvement to reduce and/or eliminate these leakages in itself.
Turning now to Figure 17 and Figure 18, such as follow closely 280a, 280b, 280c, 380a, 380b, 380c, 580a, 580b, 680a, 680b, 680c, 780a and/or 780b nail are shown with non-percussion configuration.The non-percussion configuration of the nail is V-arrangement；So And, principle discussed in this article can be applied to the nail of any suitable shape.Figure 19 shows Figure 17 and Figure 18 in percussion configuration Nail.The percussion configuration of the nail is B shapes；However, principle discussed in this article can be applied to the nail of any suitable shape.Figure 20 Nail 881 in Figure 17-Figure 19 for including coating thereon is shown；The nail will be hereinafter referred to as nail 880.Figure 21 shows to be deployed to group The nail 880 knitted and the hole or gap 882 that are present between nail 880 and tissue.Figure 22 shows to be in expansion shape on nail 880 The coating 881 of state.Expansion coating 881 can fill whole gap 882.In some cases, the extensible tissue of coating 881 is expanded. In the case of various other, coating 881 can be not filled with whole gap 882.
Nail 880 can be made up of any suitable material, such as such as metal.In some cases, nail 880 can be by such as titanium And/or stainless steel is constituted.
Inflatable nail coating 881 can be made up of any suitable material.Follow closely coating 881 can by such as Poly-L-lactide and/or Poly- 95L/5D- lactic acid is constituted.PLA other copolymer compositions can be used.In all cases, once nail 880 is implanted to In tissue, nail coating 881 just can initially form gel, and wherein gel may expand to fill or fill at least in part gap 882. In all cases, coating 881 is applied to nail 880 in one or more solution that can be by the way that staple line to be immersed to coating line. In the case of at least one, for example, staple line can be dipped into the first solution to apply base portion coating, it is then immersed in the second solution To apply PLA.In some cases, when nail 880 is positioned in nail bin, coating 881 can be applied to nail 880.Q.Chen Et al. ELASTOMERIC BIOMATERIALS FOR TISSUE ENGINEERING, Progress In Polymer Science (volume 38, the 584-671 pages, 2013) is hereby incorporated by reference.
Nail coating 881 can be made up of such as hydrophilic material.Hydrophilic material may include for example with micro- containing RGD peptide sequence Hydrogel derived from the peptide of ball.The metal wire of nail 880 can be coated with such as natural biological copolymer, such as sodium hyaluronate or hyalomitome Acid.Other hydrogels can be used.In all cases, once nail 880 is implanted in tissue, nail coating 881 just can start swollen Swollen, its floating coat 881 may expand to fill or fill at least in part gap 882.In all cases, can be by the way that staple line be soaked Coating 881 is applied to nail 880 in the one or more solution for entering coating line.In the case of at least one, for example, staple line can It is dipped into the first solution to apply base portion coating, is then immersed in the second solution to be loaded with the sodium hyaluronate of peptide.One In the case of a little, when nail 880 is positioned in nail bin, coating 881 can be applied to nail 880.William G.Pitt's et al. ATTACHMENT OF HYALURONAN TO METALLIC SURFACES, J.Biomed.Mater.Res. (the 68A volumes, the 95-106 pages, 2004) complete disclosure be herein incorporated by reference.
Nail coating 881 can be made up of such as xerogel.Nail coating 881 can be made up of such as gelatine microsphere and/or nanosphere. Gelatin includes at least partly denaturation or the completely collagen of denatured form, and cell can be coupled to the collagen and be dropped by enzymatic catalysis Solution.In all cases, gelatin can be loaded with such as fibroblast and/or platelet derived growth factor.Dropped in coating 881 Xie Shi, coating 881 can be filled and seal clearance 882 at least in part at least in part.In all cases, coating 881 can lead to Cross in the following manner and be applied to nail 880：Staple line is immersed in water-in-oil emulsion, then gelatine microsphere and/or nanosphere is freezed In staple line.Luis Solorio et al. TGELATIN MICROSPHERES CROSS-LINKED WITH GENIPIN FOR LOCAL DELIVERY OF GROWTH FACTORS, J.Tissue Eng.Regen.Med. (volume 4, the 514-523 pages, 2010) complete disclosure be herein incorporated by reference.
Nail 880 is made up of the line with circular cross section；However, nail 880 can be by for example all with any suitable cross section Line such as polygonal crosssection is constituted.For some overall width, non-circular cross sections can have bigger than circular cross section Girth.The sustainable coating material more a greater amount of than circular cross section of such non-circular cross sections, the circular cross section can make coating It can expand and packing ratio has the bigger hole of the nail of circular cross section.In some cases, non-circular cross sections are formed as One or more grooves are produced in circular cross section.In the case of at least one is such, such groove can be vertical along nail leg portion To extension.In some cases, longitudinal groove can extend along axis.In some cases, longitudinal groove can be looped around nail leg Around portion.In the case of at least one, such longitudinal groove can in a spiral manner extend around leg.
The nail of nail bin can be disposed in the case of use or without using such as auxiliary material (such as backing material).Generally, Auxiliary material can be placed on the top surface of nail bin or platform so that when nail is projected from nail bin, nail can be caught against tissue Obtain auxiliary material.Figure 55 shows two pieces of auxiliary materials 239 being positioned on the platform surface 238 of nail bin 230.First block of auxiliary material Material 239 is positioned on the first side of longitudinal slit 234, and second piece of auxiliary material 239 is positioned in longitudinal slit 234 On second side.It is contemplated that alternative embodiment, wherein monolithic auxiliary material is supported by platform surface 238, the platform table Face extends on the both sides of longitudinal slit 234 and nail bin 230.Referring again to Figure 55, every piece of auxiliary material 239 is substantially rectangle And ranked first nail cavity 270a including one, one ranked second nail cavity 270b and one and ranked third and prolong above nail cavity 270c nail pattern Stretch.Nail 280a, 280b and the 280c being separately stored in nail cavity 270a, 270b and 270c penetrate auxiliary when being projected from nail bin 230 Material 239 is helped, and is being followed closely the part capture of auxiliary material 239 when 280a, 280b and 280c are formed by anvil block 220 at it In.
Except or replace being positioned at auxiliary material on nail bin, auxiliary material can be positioned on anvil block.Penetrate tissue Nail can penetrate anvil block adminicle before contact anvil block, then penetrate anvil block adminicle again before tissue is reentered.
In nail 280a, 280b and 280c after anvil block 220 is deformed, than that described above, auxiliary material 239 is against tissue By following closely 280a, 280b and 280c capture.In other words, auxiliary material 239 is planted against tissue by following closely 280a, 280b and 280c Enter.When tissue is by extending longitudinally, as described above, auxiliary material 239 can be with stretching tissue.
Auxiliary material can provide many benefits.Auxiliary material can help to seal the puncturing hole produced by nail leg portion.Various In the case of, when passing through tissue in nail leg portion, auxiliary material can be pushed in puncturing hole by nail leg portion.When tissue is by extending longitudinally When, auxiliary material may also aid in the gap for being sealed in and being produced between nail leg portion and tissue.Auxiliary material can supporting tissue.Various In the case of, auxiliary material can strengthen tissue and suppress nail tear tissue.
Referring again to Figure 55, it will be appreciate that, the part of dressing material 239 is not by nail 280a, 280b and 280c capture.Example Such as, the part around the extension of nail periphery of auxiliary material may not be captured by nail.Similarly, being positioned at for auxiliary material follows closely middle Part may not by nail capture.Such non-capture portion of auxiliary material 239 can not provide above-mentioned sealing benefit, and together When suppress by it is discussed in this article nail pattern provide ductility.Such non-capture portion can also suppress to follow closely the rotation in tissue Turn, as described above.Improvement to Figure 55 embodiment is shown in Figure 53, Figure 54, Figure 56 and Figure 57.Such embodiment includes Depressed part, recess, otch, slit, perforate and/or be configured to increase auxiliary material extensibility it is any other suitable Interruption.In addition, such interruption can be conducive to following closely the rotation in tissue.
Referring to Figure 53, auxiliary material 939 includes fan-shaped edge or side 938.Fan-shaped side 938 is therein including being defined in Depressed part or recess 937.Recess 937 includes curved configuration；However, suitable configuration can be used.Recess 937 reduces around auxiliary Material 939 periphery extension non-capture material girth and increase the flexibility and extensibility of auxiliary material 939.
Referring again to Figure 53, auxiliary material 939 also includes being defined in perforate 936 therein.Perforate 936 be it is oval, And including through hole；However, it is contemplated that alternative embodiment.Perforate 936 is located in the middle of adjacent second nail cavity 270b, with And first in the middle of nail cavity 270a and the 3rd nail cavity 270c；However, it is contemplated that alternative position.Perforate 936 is reduced in staple line Non- capture material and increase the flexibility and extensibility of auxiliary material 939.
Referring again to Figure 53, the main body of auxiliary material 939 extends above nail cavity 270a, 270b and 270c.It is contemplated that To alternative embodiment, wherein auxiliary material 939 extends not in nail cavity 270a, 270b and/or 270c.Turning now to figure 54, auxiliary material 939 ' includes slit or opening 935a, 935b and 935c, and it is respectively on nail cavity 270a, 270b and 270c tops Divide ground extension.935a, 935b and 935c ratio perforate 936 that is open are big；However, opening 935a, 935b and/or 935c can be with perforates 936 sizes are identical and/or bigger than perforate 936.
Referring to Figure 56, auxiliary material 1039 includes notch edge or side 1038.Recess side 1038 includes being defined in it In depressed part or recess 1037.Recess 1037 includes angled configuration；However, suitable configuration can be used.Recess 1037 Reduce the girth of the non-capture material extended around auxiliary material 1039 and increase the flexibility and extensibility of auxiliary material 1039.
Referring again to Figure 56, auxiliary material 1039 also includes being defined in slit 1036 therein.Slit 1036 is ellipse , and including through hole；However, it is contemplated that alternative embodiment.Auxiliary material 1039 includes first row slit 1036a With second row slit 1036b.Slit 1036a is located in the middle of the adjacent second nail 1080b and the first nail 1080a and the 3rd nail In the middle of 1080c；However, it is contemplated that alternative position.Slit 1036b is located at the adjacent 3rd nail 1080c centres and second Follow closely in the middle of the nails of 1080b and the 4th 1080d；However, it is contemplated that alternative position.Slit 1036a is parallel to the first nail 1080a 1080c is followed closely with the 3rd, and similarly, slit 1036b is parallel to the second nail 1080b and the 4th nail 1080d；However, slit can With any suitable direction.Slit 1036a and 1036b reduce the non-capture material in staple line and increase auxiliary material 1039 Flexibility and extensibility.Slit 1036a and 1036b are shorter than nail 1080a, 1080b, 1080c and 1080d base portion；However, it is possible to It is susceptible to such embodiment, wherein slit 1036a and/or 1036b and nail 1080a, 1080b, 1080c and 1080d base Minister's degree is identical and/or is longer than the base portion.
Referring to Figure 57, auxiliary material 1139 includes notch edge or side 1138.Recess side 1138 includes being defined in it In depressed part or recess 1137.Recess 1137 includes curved configuration；However, suitable configuration can be used.Recess 1137 reduces Around auxiliary material 1139 extend non-capture material girth and increase the flexibility and extensibility of auxiliary material 1139.
Referring again to Figure 57, auxiliary material 1139 also includes being defined in slit 1136 therein.Slit 1136 is ellipse , and including through hole；However, it is contemplated that alternative embodiment.Auxiliary material 1139 includes first row slit 1136a With second row slit 1136b.Slit 1136a is located in the middle of the adjacent second nail 1180b and the first nail 1180a and the 3rd nail In the middle of 1180c；However, it is contemplated that alternative position.Slit 1136b is located at the adjacent 3rd nail 1180c centres and second Follow closely in the middle of the nails of 1180b and the 4th 1180d；However, it is contemplated that alternative position.Slit 1136a is parallel to the first nail 1180a 1180c is followed closely with the 3rd, and similarly, slit 1136b is parallel to the second nail 1180b and the 4th nail 1180d；However, slit can With any suitable direction.Slit 1136a and 1136b reduce the non-capture material in staple line and increase auxiliary material 1139 Flexibility and extensibility.Slit 1136a and 1136b are shorter than nail 1180a, 1180b, 1180c and 1180d base portion；However, it is possible to It is susceptible to such embodiment, wherein slit 1136a and/or 1136b and nail 1180a, 1180b, 1180c and 1180d base Minister's degree is identical and/or is longer than the base portion.
As described herein, firing member and/or wedge-shaped slides can traverse nail bin with percussion nail and/or will follow closely from limit The fixed nail cavity into nail bin is projected.For example, firing member and/or wedge-shaped slides can along the percussion path shift in nail bin, And firing member and/or wedge-shaped slides can drive from nail cavity in itself along percussion path engagement staple drivers and/or nail Nail.In addition it is as described herein, including the nail being angularly orientated nail arrangement various benefits and advantage can be provided.For example, angulation The array of the nail of degree ground orientation can provide increased flexible and/or longitudinal stretchability in the tissue of suture.
When nail is angularly orientated relative to percussion path, at least a portion of staple drivers and/or nail can not be with hitting Send out path overlap and/or be covered on percussion path.For example, the base portion for the nail being angularly orientated may extend across percussion road Footpath so that nail leg portion is positioned on the opposite side in percussion path.In addition, the staple drivers being angularly orientated can traverse percussion Path, and staple drivers end can be positioned in percussion path opposite side on.In other cases, only nail and/or The end of staple drivers can be covered on percussion path, and in other situations, nail and/or staple drivers can completely with example Such as fire path biasing.
In the case that at least a portion of nail and/or staple drivers is biased with percussion path wherein, path is fired and fixed Moment arm between the part of nail and/or staple drivers of the position on the either side in percussion path can drive in nail and/or in nail Moment of torsion is produced in dynamic device.Moment of torsion can influence the inclination of nail and/or tumble during disposing.Therefore, the nail leg portion for reversing nail can not It can be pierced through and/or capture tissue during difference with equivalent power and/or speed engagement tissue, and/or nail leg portion.Because in portion The torsion and/or rotation followed closely during administration may negatively affect tissue penetration and/or nail shaping, so in all cases, can The moment of torsion generation during the deployment for the nail being angularly orientated can be expected to prevent and/or minimize.
When staple drivers are angled relative to the percussion path of wedge-shaped slides, one of the driver being only at an angle of Driving or lifting force can be received from wedge-shaped slides by dividing.For example, driving force can be applied to angled drive along diagonal path Dynamic device.For stable angled driver and prevent the torsion and/or rotation of driver and be therefore supported on The torsion and/or rotation of nail, wedge-shaped slides may include multiple driving wedges, and at least two driving wedges can contact Driver is so that driving force to be applied at multiple positions on a drive.For example, the driving wedge of a pair of lateral spacings can connect Merge the angled driver of lifting so that length of the driving force along driver being spaced apart with lateral lateral spacing.This Outside, in the case of at least one, the driving wedge of lateral lateral spacing can be equidistant with the barycenter of angled driver so that Driver is relative to multiple driving wedge mass balances.
In addition or alternatively, for stable angled driver and the torsion and/or rotation of driver are prevented And the torsion and/or rotation for the angled nail being therefore supported on, multiple drivers can connect and/or connect together. Under certain situation, angled many staple drivers may be integrally formed.The driver of connection and/or many staple drivers can support multiple Nail, this can reduce the quantity of the moving parts in nail bin, and can prevent each interconnection and/or the nail of integrally formed nail support Relative movement between support surface.In addition, angled many staple drivers can be more than (be wider than and/or be longer than) singly nail driving Device.Therefore, many staple drivers can have increased aspect ratio.For example, many staple drivers can have 1:1 aspect ratio.Some In the case of, aspect ratio can be 3:2 or 2:1.In other situations, aspect ratio can be, for example, less than 1:1 or more than 2:1.It is bigger vertical Many staple drivers of horizontal ratio can provide bigger stability to the nail being supported on.
In all cases, the single driving engageable angled many staple drivers of wedge, and in some cases, The driving force applied on a drive by driving wedge can be balanced relative to the barycenter of driver.In other cases, it is multiple The engageable angled many staple drivers of wedge are driven, angled many staple drivers can laterally distribute drive on a drive Power.In all cases, the accumulation being applied to by the driving wedge of lateral spacing on angled many staple drivers drives Power can be balanced relative to the barycenter of driver.
In other cases, for the torsion stablizing the angled nail in nail bin and prevent it during disposing and/or Rotation, nail can be fired in the case of no driver.For example, wedge-shaped slides may include to follow closely composition surface, the nail joint is closed Surface directly engages the sliding part composition surface without the nail in driver nail bin.Wedge-shaped slides can be along the base portion of nail multiple Each nail is contacted at the position of lateral spacing.For example, wedge-shaped slides may include multiple driving wedges, and at least two drive The dynamic accessible angled nail of wedge is with the application driving force at multiple positions.In all cases, the drive of a pair of lateral spacings Dynamic wedge is engageable and lifts angled nail so that length of the driving force along the base portion of nail is uniform with the interval of lateral spacing Distribution.In addition, in the case of at least one, the driving wedge of lateral spacing can be equidistant with the barycenter of angled nail so that nail Relative to driving wedge mass balance.
End effector assemblies 2000 have disclosed in the figure 7.As illustrated, end effector assemblies 2000 include first Jaw 2002, the second jaw 2004, closed tube or framework 2006, and end effector joint 2009.Hold end Row device assembly 2000 can be moved between first or open position and second or closing position.As illustrated, the first jaw 2002 include pivot pin 2008, and the pivot pin is movably positioned in the closure slit 2010 of the second jaw 2004.For example, pivot Pivot pin 2008 is configured in the first jaw 2002 relative to the second jaw 2004 and relative to shown end effector The framework 2006 of component 2000 is pivoted and translated in the closure slit 2010 of the second jaw 2004 when pivoting.
In other cases, the first jaw 2002 can be fixed relative to framework 2006, and the second jaw 2004 can be relative The jaw 2002,2004 of end effector assemblies 2000 is pivoted to open and closes in the first jaw 2002.In other cases, Jaw 2002,2004 is all pivotable and/or otherwise moves to open and/or close end effector assemblies 2000 Jaw 2002,2004.For example, at least one in jaw 2002,2004 can be relative to another jaw 2002,2004 simultaneously And/or person rotates, rotates, slides and/or translated relative to framework 2006 to open and/or close end effector assemblies 2000 Jaw 2002,2004.
Referring still to Fig. 7, end effector assemblies 2000 be sized and configured to receive nail bin 2020, the nail bin It is configured for being removably positioned in end effector assemblies 2000.For example, shown nail bin 2020 can be to be intended for single use And/or disposable storehouse, the storehouse can be replaced after its percussion nail 2012 with another nail bin.Nail bin 2020 disclosed in Fig. 7 Including platform 2026, warehouse 2024 and housing 2022, warehouse 2024 is surrounded or encapsulated the housing parts.Shown nail bin 2020 is also Including nail 2012, the nail is positioned in warehouse 2024 in which can project.Nail 2012 disclosed in Fig. 7 is followed closely for substantially " v-shaped ", nail tool There is the leg of non-parallel extension.
In all cases, nail bin (such as nail bin 2020) for example can be integrally formed simultaneously with end effector assemblies 2000 And/or person can be permanently attached in a jaw in such as jaw 2002,2004.In such cases, end effector Component 2000 can be to be intended for single use and/or disposable end actuator.In other cases, fixed to end effector assemblies 2000 nail bin can reload additional nail for for example follow-up percussion.
Referring again to the nail bin 2020 disclosed in Fig. 7, longitudinal slit 2032 is defined as at least partially through warehouse 2024.Shown longitudinal slit 2032 extends along longitudinal axes L, proximal end 2023 He of the longitudinal axes L in warehouse 2024 Extend between distal end 2025.Longitudinal slit 2032 shown in Figure 7 proximally is prolonged towards distal end 2025 by end 2023 Stretch and traverse a part for the length of warehouse 2024.
In some cases, longitudinal slit 2032 can traverse the whole length of warehouse 2024.In other cases, longitudinal direction is narrow Groove 2032 can for example distally the proximally facing end 2025 in end 2023 extends.In other situations, warehouse 2024 can not be wrapped Include predetermined and/or preformed longitudinal slit.For example, firing member and/or cutting element can it is crosscutting during firing schedule and/ Or cut warehouse 2024 to form slit wherein.
Nail bin 2020 disclosed in Fig. 7 is configured to the array 2011 for following closely 2012 being fired into tissue.It is shown in Fig. 7 In nail array 2011 include angled nail 2012, the angled nail is relative to longitudinal axes L and relative to driving wedge 2064a, 2064b percussion path are at an angle of, and the driving wedge is described further herein.Nail bin disclosed in Fig. 7 2020 also include many staple drivers 2040a, 2040b drivingly to support the angled nail 2012 in array 2011, many nails Driver is described further herein.
Angled nail 2012 is removably positioned in angled nail cavity 2028, and the angled nail cavity is limited in Fig. 7 In disclosed warehouse 2024.For example, shown nail cavity 2028 is angularly orientated relative to longitudinal axes L.Nail cavity 2028 it is shown Arrangement corresponds to the shown nail array 2011 being positioned in nail bin 2020.Each nail cavity 2028 shown in Figure 7 includes platform Opening 2030 in 2026, and each opening 2030 includes proximal end, distal end and in proximal end and distal end portion The nail axis extended between portion.The nail axis of opening 2030 is relative to the longitudinal axes L deflection of warehouse 2024 and/or angled. For example, in Fig. 7 nail bin 2020, all nail cavities 2028 in warehouse 2024 are limited to relative to longitudinal axes L angularly It is orientated, and various nail cavities 2028 are angularly orientated relative to other nail cavities 2028.
Nail cavity 2028 disclosed in Fig. 7 is arranged in rows on every side of longitudinal slit 2032.For example, nail cavity 2028 A part is arranged on the first side 2027 of longitudinal slit 2032 in first inboard row 2033, the first outboard row 2035 and first Between in row 2037, and another part of nail cavity 2028 is arranged in the second inboard row on the second side 2029 of longitudinal slit 2032 2034th, in the second outboard row 2038 and the second intermediate row 2036.In nail bin 2020 shown in Figure 7, nail cavity 2028 and its row 2033rd, 2034,2035,2036,2037,2038 be symmetrical relative to longitudinal slit 2032.
Although shown nail cavity 2028 is not intersected or is otherwise in contact with each other, the longitudinal direction row 2033 of nail cavity 2028, 2034th, 2035,2036,2037,2038 is overlapping.For example, various nail cavities 2028 shown in Figure 7 are in laterally outside and/or in side Nail cavity 2028 in the nail cavity 2028 for extending past from adjacent row to inner side.In addition, nail cavities 2028 shown in various are proximally and/or court Distal side extends past the nail cavity 2028 in the nail cavity 2028 of adjacent row.Because nail 2012 is arranged in overlapping arrays 2011, Bleeding and/or flow of fluid in controllable suture tissue.The overlapping arrays (such as nail array 2011) of nail for example may be incorporated into herein In disclosed other nail bins and/or end effector assemblies.
In other cases, the nail cavity 2028 more or less than three rows can be positioned in the either side of longitudinal slit 2032 2027th, on 2029.In some cases, a side in the side 2027,2029 of nail bin 2020 may include and another side Face 2027, the row of the nail cavity 2028 of 2029 varying numbers.In some cases, nail cavity 2028 can not be with the nail cavity in adjacent row 2028 longitudinal directions and/or lateral overlap.In addition or alternatively, in some cases, nail cavity 2028 and/or its row can be relative to Longitudinal slit 2032 and/or longitudinal axes L are asymmetric.
Referring still to Fig. 7, the shown nail cavity 2028 in arranging longitudinally in each is parallel or substantially parallel.For example, such as institute's public affairs in Fig. 7 Open, the nail cavity 2028 in the first inboard row 2033 is parallel to each other, the nail cavity 2028 in the first outboard row 2035 is parallel to each other, first Nail cavity 2028 in intermediate row 2037 is parallel to each other, and the nail cavity 2028 in the second inboard row 2034 is parallel to each other, the second outboard row Nail cavity 2028 in 2036 is parallel to each other, and the nail cavity 2028 in the second intermediate row 2038 is parallel to each other.
In addition as disclosed in Fig. 7, the nail cavity 2028 in arranging longitudinally in each is relative to the nail cavity 2028 in adjacent longitudinal direction row Angularly it is orientated.For example, on the first side 2027 of shown warehouse 2024, the nail cavity 2028 in the first intermediate row 2037 is relative Nail cavity 2028 in row 2033 in first and in the first outer row 2035 is angularly orientated.In addition, in shown warehouse 2024 The second side 2029 on, nail cavity 2028 in the second intermediate row 2038 relative to second in the outer row 2036 of row 2034 and second Nail cavity 2028 be angularly orientated.
In other cases, longitudinally in each row 2033,2034,2035,2036,2037,2038 in nail cavity 2028 only A part can it is parallel to each other and/or all or fewer than longitudinal direction row 2033,2034,2035,2036,2037,2038 may include Nail cavity 2028 parallel to each other.In addition or alternatively, in some cases, at least a portion of nail cavity 2028 can take at random To.In some cases, at least one nail in the nail cavity 2028 in longitudinal direction row 2033,2034,2035,2036,2037,2038 Chamber can be parallel at least one nail in the nail cavity 2028 in adjacent longitudinal direction row 2033,2034,2035,2036,2037,2038 Chamber.In some cases, nail bin 2020 may include at least one nail cavity 2028 and/or the longitudinal axes L parallel to warehouse 2024 An at least nail chamber.See, for example, Figure 10.
Nail bin 2020 disclosed in Fig. 7 includes driver 2040a, 2040b, and the structure snd size of the driver are designed It is interior in warehouse 2024 (Fig. 7) into movably coordinating.Include the first driver referring to Fig. 7-Fig. 9, driver 2040a, 2040b 2040a (Fig. 8-Fig. 8 B) and the second driver 2040b (Fig. 8 C- Fig. 9).First driver 2040a and the second driver 2040b quilts It is individually configured to that multiple nails 2012 can be supported.As shown in figs. 7 to 9, the first driver 2040a of many nails has the first geometric form Shape, and follow closely the second driver 2040b with the second geometry more.Many staple drivers 2040a, 2040b geometry pair Should be in the array 2011 for following closely 2012 and corresponding to the arrangement for the nail cavity 2028 for being shown in Fig. 7.
As described herein, the arrangement of nail 2012 and nail cavity 2028 on the first side 2027 of longitudinal slit 2032 is nail 2012 With the mirror image of arrangement of the nail cavity 2028 on the second side 2029 of longitudinal slit 2032.In addition, the first driver 2040a geometry Shape is the mirror image of the second driver 2040b geometry.As shown in fig. 7, the first driver 2040a be positioned in longitudinal direction it is narrow On first side 2027 of groove 2032, and the second driver 2040b is positioned on the second side 2029 of longitudinal slit 2032.
In some cases, the driver on the side of warehouse is not the mirror of the driver on the opposite side of warehouse Picture.In addition, the 2040a of staple drivers more than first and/or the 2040b of staple drivers more than second can be positioned in longitudinal slit 2032 not On homonymy and/or both sides 2027,2029.For example, many staple drivers with different geometries can be positioned in longitudinal slit On 2032 phase homonymy.In other situations, nail bin 2020 may include with many of three or more different geometries Staple drivers.For example, special and/or different staple drivers may correspond to specific nail and/or the nail of specific group.Or, Under certain situation, all many staple drivers in nail bin 2020 can have same geometry.
The 2040a of staple drivers more than first disclosed in Fig. 7-Fig. 9 and 2040b of staple drivers more than second includes multiple grooves or nail Supporting support 2042.In addition, driver 2040a, 2040b shown in each are configured to drive multiple nails 2012.For example, the One driver 2040a (Fig. 8-Fig. 8 B) includes first support 2042a, second support 2042b and the 3rd support 2042c, the branch Frame is respective to be sized and configured to one nail 2012 of support.For example, the base portion 2014 (Fig. 8 B) of nail 2012 is positioned in In first driver 2040a each support 2042a, 2042b, 2042c.In addition, referring primarily to Fig. 8 C- Fig. 9, the second driver 2040b also includes first support 2042a, second support 2042b and the 3rd support 2042c, the respective size of support and knot Structure is designed to support a nail 2012.For example, the base portion 2014 (Fig. 9) of nail 2012 is positioned in the second driver 2040a's In each support 2042a, 2042b, 2042c.
As disclosed in Fig. 7, the first driver 2040a is right driver, and the right driver is positioned in nail bin 2020 right side or the first side 2027.Each first driver 2040a first support 2042a (Fig. 8-Fig. 8 B) is adapted to Nail 2012 in enough the first outer rows 2035 with nail cavity 2028 aligns, each first driver 2040a second support 2042b The nail 2012 that (Fig. 8-Fig. 8 B) is configured in the first intermediate row 2037 with nail cavity 2028 aligns, and each first drives Dynamic device 2040a the 3rd support 2042c (Fig. 8-Fig. 8 B) is configured to the nail in the first interior row 2033 with nail cavity 2028 2012 alignment.
As disclosed in Fig. 7 further, the second driver 2040b is left side drive, and the left side drive is positioned in The left side of nail bin 2020 or the second side 2029.For example, each second driver 2040b first support 2042a (Fig. 8 C- Fig. 9) The nail 2012 being configured in the second outer row 2036 with nail cavity 2028 aligns, and the second of each second driver 2040b The nail 2012 that support 2042b (Fig. 8 C- Fig. 9) is configured in the second intermediate row 2038 with nail cavity 2028 aligns, and Each second driver 2040b the 3rd support 2042c (Fig. 8 C- Fig. 9) is configured to the second interior row with nail cavity 2028 Nail 2012 in 2034 aligns.
Each support 2042a, 2042b, 2042c disclosed in Fig. 8-Fig. 9 are limited to the first driver 2040a or second In driver 2040b step or platform 2045.For example, shown first driver 2040a and shown second driver 2040b bags Platform 2045 is included, and support 2042a, 2042b, 2042c are limited in each platform in platform 2045.Driver Platform 2045 disclosed in 2040a, 2040b Fig. 8-Fig. 9 is identical height or elevation, and is configured to array 2011 In each nail 2012 be maintained at identical height or elevation relative to other nails 2012 in array 2011.Referring still to Fig. 8-figure 9, flange connector 2048 is also disclosed, the flange connector extends between each driver 2040a, 2040b step 2045.Even The relative movement between step 2045 can be limited and/or constrain by connecing flange 2048.
In other cases, step or platform 2045 can have different height and/or elevation.For example, each step 2045 Height can be varied to control the forming height of nail 2012, so as to control to capture the compression of tissue in forming nail 2012. In addition or alternatively, each support 2042a, 2042b, 2042c depth can be varied to control the height of forming nail 2012 Degree, so as to control to capture the compression of the tissue in forming nail 2012.
By the first driver 2040a and the second driver 2040b and its support 2042a, 2042b, 2042c with nail bin The arrangement that the arrangement of nail cavity 2028 and nail array 2011 in 2020 is complementary is orientated.As disclosed in Fig. 8 A and Fig. 8 D, Mei Gezhi Frame 2042a, 2042b, 2042c include first end 2044 and the second end 2046, and each support 2042a, 2042b, 2042c first end 2044 is in the distal side of same supports 2042a, 2042b, 2042c the second end 2046.In addition, axis It is limited between each support 2042a, 2042b, 2042 first end 2044 and the second end 2046.For example, first axle Line AaLimited by first support 2042a, second axis AbLimited by second support 2042b, and the 3rd axis AcBy the 3rd support 2042c is limited.
In shown arrangement, first axle AaOrientation be configured to match or correspond to by first support 2042a The orientation of the angled nail 2012 of support, second axis AbOrientation be configured to match or correspond to by second support The orientation of the angled nail 2012 of 2042b supports, and the 3rd axis AcOrientation be configured to match or correspond to by The orientation of the angled nail 2012 of 3rd support 2042c supports.
As disclosed in Fig. 8 A and Fig. 8 D, first axle AaParallel or substantially parallel to the 3rd axis Ac.In addition, being shown in figure Second axis A in 8A and Fig. 8 DbTraverse first axle A simultaneouslyaWith the 3rd axis Ac.For example, such as institute's public affairs in Fig. 8 A and Fig. 8 D Open, second axis AbIt is vertical or be approximately perpendicular to first axle AaWith the 3rd axis Ac。
In driver 2040a, 2040b for having a case that in the nail bins of the different arrangements of nail 2012 and nail cavity 2028 Under, support 2042a, 2042b, 2042c relative orientation can be different.In some arrangements, for example, all axis Aa、Ab、AcCan To be parallel.In other arrangement, for example, all axis Aa、Ab、AcIt can intersect.In some cases, an axis Aa、Ab、 AcCan be perpendicular at least another axis Aa、Ab、Ac.In addition or alternatively, in some cases, an axis Aa、Ab、Ac Can be parallel at least another axis Aa、Ab、Ac。
Referring primarily to Fig. 8-Fig. 8 C, the part that the first driver 2040a and the second driver 2040b are formed as one.Example Such as, each driver 2040a, 2040b are made up of integrally formed part.In other cases, at least one step 2045 and/ Or flange connector 2048 can be separately formed.In such cases, multiple parts can for example be glued, weld and/or with other Mode adheres to each other, to form integral piece.
Many staple drivers 2040a, 2040b disclosed in Fig. 7-Fig. 9 are configured to the nail from nail cavity 2028 2012 are driven across multiple longitudinal direction rows 2033,2034,2035,2036,2037,2039.In nail bin 2020 shown in Figure 7, Nail 2012 is disposed on every side of slit 2032 in three longitudinal direction rows, and driver 2040a, 2040b are configured to Can support and drive three longitudinal direction row in it is each in nail 2012.For example, the first driver 2040a shown in each is constructed The first interior nail 2012 arranged in 2033 is positioned at into that can drive, the nail 2012, Yi Jiding in the first intermediate row 2037 is positioned at The first outer nail 2012 arranged 2035 in of the position in nail cavity 2028.In addition, the second driver 2040b shown in each is configured to Driving is positioned at the nail 2012 in row 2034 in second, is positioned at the nail 2012 in the second intermediate row 2038, and be positioned at nail Nail 2012 in the outer row 2036 of the second of chamber 2028.
In other cases, nail 2012 can be disposed on every side of slit 2032 more than three longitudinal direction arrange or less than In three longitudinal direction rows, and driver 2040a, 2040b are configured on every side of slit 2032 engage longitudinal direction The nail 2012 in each row in row.For example, nail bin 2020 can have two nail chambers 2028 on the either side of longitudinal axes L, And many staple drivers being positioned in may include two supports, the support is configured to support every in two rows Nail in row.In some cases, many staple drivers can fire multiple nails 2012 from the nail cavity 2028 of identical row.For example, many nails Driver can fire the adjacent nail 2012 in identical row, such as such as closer to side nail 2012 and farther side nail 2012.In some feelings Under condition, many staple drivers can not engage the nail 2012 in each row on the side of longitudinal slit 2032.For example, individually and different The engageable row of driver (for example such as outermost row and/or most interior row) in one row in nail.In addition or alternatively, In some cases, nail bin 2020 may include at least one many staple drivers and at least one single staple drivers.See, for example, figure 12。
End effector assemblies 2000 disclosed in Fig. 7 also include firing member 2060, and the firing member is adapted to It is enough to be moved relative to warehouse 2024.During firing schedule, firing member 2060 is configured to traverse warehouse 2024, and It is drivingly engaged sliding part 2058 sliding part 2058 is moved through into warehouse 2024.For example, the one of shown firing member 2060 Partial size and position is designed to coordinate in longitudinal slit 2032.As disclosed in Fig. 7, firing member 2060 by structure Cause to coordinate the part in longitudinal slit 2032 to include cutting edge 2061, the cutting edge is configured to incision clamping Tissue between the first jaw 2002 and the second jaw 2004 of end effector assemblies 2000.
Wedge-shaped slides 2058 disclosed in Fig. 7 are configured to engagement driver 2040a, 2040b to lift driving Device 2040a, 2040b, so that the nail 2012 being supported on is fired into tissue.In shown end effector assemblies 2000 In, the intermediate wedge part 2062 of sliding part 2058 can be slided and/or translated in longitudinal slit 2032, and be limited to sliding part The driving wedge or driving guide rail 2064a, 2064b engageable staple drivers 2040a, 2040b of lateral register on 2058.Example Such as, sliding part 2058 shown in Figure 7 includes driving wedge or guide rail 2064a, 2064b, and it is configured in percussion Along percussion path F during stroke1(Fig. 8 A) and F2(Fig. 8 D) moves to contact and fire path F1、F2Longitudinally-aligned many nails First driver 2040a and the second driver 2040b.
As disclosed in Fig. 7, sliding part 2058 include on the either side of core 2062 driving wedge 2064a, 2064b.Driving wedge 2064a on first side 2027 of nail bin 2020 is configured to along the first percussion path F1 (Fig. 8 A) is mobile, and the driving wedge 2064b on the second side 2029 of nail bin 2020 is configured to hit along second Send out path F2(Fig. 8 D) is mobile.
Each driving wedge 2064a, 2064b disclosed in Fig. 7 be configured to engage many staple drivers 2040a, Staple drivers more than one in 2040b are to lift driver 2040a, 2040b in nail cavity 2028 and be projected from warehouse 2024 Nail 2012.In shown arrangement, each first driver 2040a three steps 2045 are held stationary relative to each other, and Each second driver 2040b three steps 2045 are held stationary relative to each other.In other words, single driver 2040a, 2040b step 2045 is not moved relative to each other and/or rotated.Because single driver 2040a, 2040b step 2045 It is not moved relative to each other and/or rotates, so constrains by the phase of each driver 2040a, 2040b nail 2012 supported yet To movement.In addition, each driver 2040a, 2040b have larger base portion or occupied area in warehouse 2042, this can enter One step reduces driver 2040a, 2040b rotation and/or torsion.Therefore, 2012 displacement and/or inclination during disposing is followed closely It can be prevented, minimize and/or be controlled by many staple drivers 2040a, 2040b.Many staple drivers such as driver 2040a, 2040b For example it may be incorporated into other nail bins disclosed herein and/or end effector assemblies.
In all cases, driving wedge 2064a, 2064b of sliding part 2058 size, structure and position can be set Count into the driving surface of engagement driver 2040a, 2040b respectively.For example, driver 2040a, 2040b may include ramped surfaces And/or track, it is configured to guide respectively when firing member 2060 and sliding part 2058 move through nail bin 2020 And/or receive a driving wedge 2064a, 2064b part.
Driving wedge 2064a, 2064b staggered relatively and driving wedge arrive driver 2040a, 2040b respectively With the correspondence percussion path F by driver 2040a, 2040b nail 2012 supported1、F2It can be selected to prevent, reduce and/or control Make the torsion of driver 2040a, 2040b and/or nail 2012 during firing.For example, driver 2040a, 2040b geometric form Shape and/or material can be selected to each driver 2040a, 2040b barycenter (COM) being respectively placed to and corresponding percussion road Footpath F1、F2Alignment.In addition or alternatively, driving wedge 2064a, 2064b and therefore percussion path F1、F2It can distinguish It is positioned in storehouse 2020 to extend respectively through driver 2040a, 2040b barycenter (COM).
In other cases, as further described herein, sliding part 2058 can on every side of center section 2062 Including more than one driving wedge 2064a, 2064b.For example, multiple driving wedge 2064a, 2064b move through storehouse The either side 2027,2029 of body 2024.In addition or alternatively, the driving wedge 2064a of wedge-shaped slides 2058, 2064b is configured to directly engage and drives nail 2012, as further described herein.
Referring primarily to Fig. 8 A and Fig. 8 D, the first driver 2040a and the second driver 2040b are respectively overlay in driving wedge shape Part 2064a, 2064b percussion path F1、F2On.For example, the first driver 2040a is covered in the first percussion path F1On, and Second driver 2040b is covered in the second percussion path F2On.In addition, each driver 2040a, 2040b various pieces quilt On the either side for being positioned at respective drive wedge 2064a, 2064b, and therefore it is positioned at percussion path F1、F2Either side on. Referring still to Fig. 8 A and Fig. 8 D, shown driver 2040a, 2040b's is sized and configured to so that each driver The corresponding percussion path F of 2040a, 2040b barycenter (COM) respectively with such as driving wedge 2064a, 2064b1、F2It is overlapping. In other words, each shown driver 2040a, 2040b fire path F relative to correspondence1、F2Mass balance.
For example, as disclosed in Fig. 8 A, the first driver 2040a Part I 2047 is positioned in percussion path F1's On first side, and the first driver 2040a Part II 2049 is positioned in percussion path F1The second side on.First drives Dynamic device 2040a Part I 2047 has the first mass m1, and the first driver 2040a Part II 2049 have etc. In or be substantially equal to the first mass m1Quality m2.In addition, as disclosed in Fig. 8 D, the second driver 2040b Part I 2047 are positioned in percussion path F2The first side on, and the second driver 2040b Part II 2049 is positioned in and hits Send out path F2The second side on.Second driver 2040b Part I 2047 has the first mass m1, and the second driver 2040b Part II 2049 has equal or substantially equal to the first mass m1Quality m2.Because driver 2040a, 2040b is relative to corresponding percussion path F1、F2Mass balance, so driver 2040a, 2040b and the nail 2012 being supported on Torsion during firing can be minimized and/or otherwise control.In addition, by each driver 2040a, The group of the nail 2012 of 2040b deployment can synchronously be lifted relative to warehouse 2024, and driven or be fired into tissue simultaneously.Quality The driver (such as driver 2040a, 2040b) of balance for example may be incorporated into other embodiments disclosed herein.
In addition, as disclosed in Fig. 8-Fig. 9, at least one otch 2050 be limited to the 2040a of staple drivers more than first and In the 2040b of staple drivers more than second.For example, each otch 2050 is limited to driver 2040a, 2040b flange connector In 2048.The size of otch 2050 and position are designed to the quality of adjust drivers 2040a, 2040b, and relative to percussion Path F1、F2Balance each driver 2040a, 2040b barycenter (COM).In addition, the size of otch 2050 and position are designed Into the geometry for adapting to nail cavity 2028, wherein driver 2040a, 2040b is movably positioned.
In some cases, multiple nail cavities can be limited in nail bin, at least one nail cavity can parallel to nail bin longitudinal direction Axis, and at least one nail cavity can angularly be orientated relative to the longitudinal axis of nail bin.Nail bin shown in Figure 10 2120, for example, multiple nail cavities 2128 are limited in nail bin 2120, and multiple nail cavities 2128 are parallel to the longitudinal direction of nail bin 2120 Axis L.
In shown nail bin 2120, longitudinal slit 2032 is limited partially across warehouse 2124.Warehouse is limited in addition In 2124 is the nail chamber 2128 on the either side of longitudinal slit 2032, and it includes what is be orientated parallel to longitudinal axes L Nail cavity 2128.In shown nail bin 2120, the first row 2137 of nail cavity 2128 and the second row 2138 of nail cavity 2128 and longitudinal direction are narrow Groove 2032 is adjacent, and the nail cavity 2128 in first row 2137 and in second row 2138 is orientated parallel to longitudinal axes L. For example, as disclosed in Figure 10, the nail cavity 2128 and axis A parallel to longitudinal axes L in first row 2137bAlignment.
Nail bin 2120 disclosed in Figure 10 includes the additional row of nail cavity 2128.For example, shown nail bin 2120 includes nail cavity 2128 the 3rd row 2135 and the 4th row 2136 of nail cavity 2128, it includes the nail being angularly orientated relative to longitudinal axes L Chamber 2128.In such cases, the nail cavity 2128 in the 3rd row 2135 and the 4th row 2136 is also relative to first row 2137 and Nail cavity 2128 in two rows 2138 is angularly orientated, and also relative to being orientated angularly in relation to one another.For example, the 3rd row 2135 In nail cavity 2128 and axis AaAlignment, axis AaTraverse longitudinal axes L and traverse the axle of the first row 2137 of nail cavity 2128 Line Ab.As further disclosed in Figure 10, the nail cavity 2128 in the 4th row 2136 extends along axis, and the axis traverses the 3rd row The axis A of nail cavity 2128 in 2135a.The row 2135 of first row 2137 and the 3rd of nail cavity 2128 is positioned in shown warehouse 2124 The first side 2127 on, and the row 2138 of second row 2136 and the 4th is positioned on the second side 2129 of shown warehouse 2124.
In all cases, the nail bin 2120 disclosed in Figure 10 can be with the end effector assemblies 2,000 1 that are shown in Fig. 7 Rise and use.For example, nail bin 2120 can be loaded into the elongated passageway of the second jaw 2004 of end effector assemblies 2000.Nail Storehouse 2120 can be fired with single staple drivers, many staple drivers and/or combinations thereof.For example, many staple drivers can be constructed Into can on the first side 2127 of warehouse 2124 from the percussion nail of nail cavity 2128 in the row 2135 of first row 2137 and the 3rd, and Another many staple drivers is configured on the second side 2129 of warehouse 2124 from the row of second row 2136 and the 4th The percussion nail of nail cavity 2128 in 2138.In all cases, driver can be positioned in warehouse 2124 so that the branch of driver Frame aligns with the nail being positioned in nail cavity 2128.In such cases, driver and/or the nail being supported on can be for example relative Balanced in the percussion path quality of sliding part (such as sliding part 2058 (Fig. 7)), the percussion path is configured to traverse Warehouse 2124 and driver is engaged wherein.
In other cases, nail bin 2120 may not include driver.For example, firing member and/or sliding part (are such as fired Component 2060 and/or sliding part 2058 (Fig. 7)) for example it is configured to directly contact, engagement and/or drives movably It is positioned at the nail in nail cavity 2128.In such cases, nail can be balanced relative to the percussion path quality of sliding part 2058.Another In the case of outer, nail can be maintained at appropriate location in warehouse 2124, and can for example in warehouse 2124 by conquassation and/or It is otherwise deformed.
In all cases, many staple drivers can be relative to multiple driving wedge balances, and the driving wedge is in deployment Period simultaneously engages with and collaboratively lifts driver.For example, many staple drivers 2240 and a pair of driving wedges 2264a, 2264b It is shown in Figure 11.Many staple drivers 2240 are configured for for example being used together with nail bin 2020.In addition or alternatively, Driver 2240 can with nail array various other nail bins be used together, the nail microwell array array 2011 (Fig. 7) and Corresponding to the arrangement for the driver 2240 being shown in Figure 11.
In all cases, the nail fired from nail bin 2120 can be formed variable forming height.For example, nail is in nail leg portion In a nail leg portion and base portion between height can be more than height between another nail leg portion and base portion.In such situation Under, nail can organizationally apply bigger compression stress in the shorter end of nail.It is such as described in more detail herein, when nail driving When device includes step or difference in height (see, for example, Figure 79), and/or when the nail shapes pit in anvil block includes step or height When spending poor (see, for example, Figure 80), the height of nail can change.
When being deformed to variable height as angle nail, being applied to structural compression stress by angled nail can be longitudinally and laterally Ground changes.In some cases, leaned on for example, it may be desired to more be compressed than the tissue away from (that is, laterally outside) line of cut The tissue of line of cut closely (that is, on the inside of lateral).In such cases, carried by the angled nail for being deformed to different compression heights The lateral tissue change supplied can apply bigger compression stress on the lateral inboard portion of tissue, and in the laterally outside of tissue Apply the compression stress of reduction on part.
Referring again to Figure 10, in some cases, the from the 3rd row 2135 of nail cavity 2128 and from nail cavity 2128 the 4th The nail that row 2136 projects may be deformed to variable height.For example, nail can have the reduction height close to longitudinal axes L, and it is remote The bigger height of longitudinal axes L.In addition or alternatively, from the first row 2137 of nail cavity 2128 and from second row nail cavity 2138 nails projected may be deformed to even height, and the even height is smaller than from the 3rd row 2135 of nail cavity 2128 and the 4th row The reduction of 2136 nails projected or smaller height.In such cases, being applied to structural compression stress can be maximum close to cutting Secant, and can be gradually reduced towards the lateral side of staple line in farther outside.
Each driver 2240 disclosed in Figure 11 includes multiple grooves or nail supporting support 2242a, 2242b, 2242c.Example Such as, each driver 2240 includes first support 2242a, second support 2242b and the 3rd support 2242c, and these supports are each Be sized and configured to support one nail, such as follow closely 2012 (Fig. 7) in one nail.For example, the base portion of nail can be determined Position is in each support 2242a, 2242b, 2242c.Referring again to nail bin 2020 shown in Figure 7, first support 2242a can be with Nail 2012 in the outer row 2035 of the first of nail cavity 2028 aligns, the first intermediate row that second support 2242b can be with nail cavity 2028 Nail 2012 in 2037 aligns, and the 3rd support 2242c can align with the nail 2012 in row 2033 in the first of nail cavity 2028. In such cases, first support 2242a corresponds to support arm, and second support 2242b corresponds to intermediate support, and the 3rd Frame 2242c corresponds to inner support.In all cases, another driver arrangement can be positioned on the opposite side of nail bin, and And the mirror reflection that another driver arrangement can arrange for the driver shown in Figure 11.
Support 2242a, 2242b, the 2242c being shown in Figure 11 are limited in supporting member 2248.Supporting member 2248 It can support the nail in multiple rows of nail cavity.In addition, supporting member 2248 it is sustainable for example relative to nail bin longitudinal axes L and/or Longitudinal direction percussion path of the person relative to driving wedge 2264a, 2264b is with the nail 2012 of different angular orientations.Referring to shown branch Component 2248 is supportted, the supporting member 2248 is angularly orientated relative to driving wedge 2264a, 2264b percussion path.Separately Outside, supporting member 2248 is angled relative at least one support being defined in support 2242a, 2242b, 2242c therein Ground is orientated.For example, the intermediate support 2242b disclosed in Figure 11 is angularly orientated relative to supporting member 2248.In addition, such as Disclosed in Figure 11, support arm 2242c and inner support 2242a align with supporting member 2248.
In some cases, the height of supporting member 2248 can be uniform, or substantially uniform so that by supporting member Each nail of 2248 supports is positioned in identical height or elevation.In other cases, supporting member 2248 may include have not With height and/or the step of elevation.For example, the height of step can change to control the height of forming nail, so as to control capture to exist The compression of tissue in forming nail.In addition or alternatively, each support 2242a, 2242b, 2242c depth can be changed To control the height of forming nail, so as to control to capture the compression of the tissue in forming nail.
Each support 2242a, 2242b, 2242c disclosed in Figure 11 include first end 2244 and the second end 2246. The second end of each support 2242a, 2242b, 2242c first end 2244 in same supports 2242a, 2242b, 2242c 2246 distal side.In addition, axis is limited at each support 2242a, 2242b, 2242c first end 2244 and the second end Between 2246.For example, first axle AaLimited by first support 2242a and the 3rd support 2242c, and second axis AbBy Two support 2242b are limited.As shown in figure 11, second axis AbTraverse first axle Aa.In some cases, second axis AbCan It is vertical or be approximately perpendicular to first axle Aa。
Referring still to Figure 11, many staple drivers 2240 include guide rail 2245a, the 2045b for being connected to supporting member 2248.Lead Rail 2245a, 2245b are oriented to driving wedge 2264a, 2264b of engaged wedge sliding part.For example, shown guide rail 2245a, 2245b and driving wedge 2264a, 2264b percussion path F1、F2Alignment.In such cases, guide rail 2245a, 2245b can provide elongated surface area for receiving the driving force of next self-driven wedge, and in driving wedge 2264a, 2264b stablize many staple drivers 2240 when being drivingly engaged guide rail 2245a, 2245b.
Driver 2240 may include multiple parts being individually formed, and it can be glued, welds and/or otherwise adhere to Together.For example, supporting member 2248 can be joined together to form driver 2240 with guide rail 2245a, 2245b.Other In the case of, each driver 2240 can be formed in one part, and it includes supporting member 2248 and guide rail 2245a, 2245b.
Driver 2240 disclosed in Figure 11 is covered in driving wedge 2264a, 2264b percussion path F1、F2On.This Outside, the various pieces of each shown driver 2240 are positioned on wedge 2264a, 2264b either side.Such as Figure 11 institutes Show, the barycenter (COM) and driving axis that are sized and configured to cause each driver 2240 of driver 2240 are equidistant, Percussion path F for example with driving wedge 2264a, 2264b1、F2Equidistantly.For example, the percussion path F being shown in Figure 111、F2 Separated by width w, and the barycenter of each driver 2240 is positioned in percussion path F1、F2Between.As shown in figure 11, each The barycenter of driver 2240 and the first percussion path F1Strategic Lateral Offset width w/2 and with second percussion path F2Strategic Lateral Offset is wide Spend w/2.Therefore, each shown driver 2240 is relative to percussion path F1、F2Mass balance.Because driver 2240 relative to Fire path F1、F2Mass balance, thus during disposing driver 2240 and nail torsion can be prevented from, minimize and/or Person otherwise controls.The driver (such as driver 2240) of mass balance for example may be incorporated into other nail bins disclosed herein and In end effector assemblies.
In other cases, firing member may include the single driving wedge alignd with driver 2240, and drive Device 2240 can be relative to driving wedge mass balance.For example, driving wedge can limit and extend through each driver 2240 Barycenter (COM) percussion path.In such cases, driving wedge can have bigger width to increase driver 2240 Stability.In other cases, firing member may include three or more driving wedges, and be applied by driving wedge Plus accumulation driving force can relative to driver 2240 geometry balance.
Each guide rail 2245a, 2245b and percussion path F disclosed in Figure 111、F2In one percussion path alignment.Tool Say, the percussions of the first guide rail 2245a and first path F body1Alignment, and the percussions of the second guide rail 2245b and second path F2It is right Together.Driving wedge 2264a, 2264b are configured to contact guide rail 2245a, 2245b to lift driver 2240 and support In nail thereon.Referring still to Figure 11, shown driving wedge 2264a, 2264b is along longitudinally staggered apart from x.For example, first wedge Shape part 2264a follow shown in second wedge 2264b Figure 11 apart from x.In addition, the first guide rail 2245a is led relative to second Rail 2245b is along longitudinally staggered.For example, the second guide rail 2245b and the first guide rail 2245a bias the distance shown in Figure 11 towards distal side y.In fig. 11 in disclosed arrangement, it is equal or substantially equal to apart from x apart from y so that driving wedge 2264a, 2264b Contact simultaneously respectively during firing schedule and drive guide rail 2245a, 2245b.
Because driving wedge 2264a, 2264b in the either side of the barycenter (COM) of driver 2240 disclosed in Figure 11 It is upper to simultaneously engage with respectively and drivingly lift rail 2245a, 2245b and equidistant with it, so accumulation driving force is in driving Balanced in the whole deployment of device 2240.Therefore, the torsion and/or rotation of driver 2240, and the nail being therefore supported on Torsion and/or rotation can be prevented from, minimize and/or control.Along the driving wedge of longitudinal biasing (such as driving wedge 2264a, 2264b) for example it may be incorporated into other embodiments disclosed herein.
Many staple drivers 2340a and single staple drivers 2340b arrangement have disclosed in fig. 12.Because driver 2340a, 2340b arrangement correspond to the array 2011 of the nail 2012 shown in Fig. 7, so driver 2340a, 2340b can be with Nail bin 2020 (Fig. 7) is used together.In addition or alternatively, driver 2340a, 2340b can with nail array it is various Other nail bins are used together, and the nail array corresponds to driver 2340a, 2340b for being shown in Figure 12 arrangement.
Driver 2340a, 2340b include multiple grooves or nail supporting support 2342a, 2342b, 2342c.For example, many nails drive Dynamic device 2340a includes first support 2342a and second support 2342b, and the support is respective to be sized and configured to branch Two in nail, nail 2012 such as shown in Figure 7.In addition, single staple drivers 2340b includes the 3rd support 2342c, the branch Frame is sized and configured to support another nail, another nail in nail 2012 such as shown in Figure 7.For example, nail 2012 base portion can reside in each support 2342a, 2342b, 2342c.
Referring again to nail bin 2020 shown in Figure 7, first support 2342a can be with arranging in 2035 outside the first of nail cavity 2028 Nail 2012 align, second support 2342b can align with the nail 2012 in the intermediate row 2037 of nail cavity 2028, and the 3rd support 2342c can align with the nail 2012 in the interior row 2033 of nail cavity 2028.In such cases, first support 2342a corresponds to outer Support, second support 2342b corresponds to intermediate support, and the 3rd support 2342c corresponds to inner support.In addition, another drives Dynamic device arrangement can be positioned on the opposite side of nail bin 2020, the mirror image for the driver arrangement that it can be disclosed in Figure 12.
Referring still to Figure 12, each support 2342a, 2342b, 2342c are limited to step and/or support section 2345 In.In addition, each driver in driver 2340a, 2340b includes base portion 2348,2349 respectively.Each many staple drivers 2340a base portion 2348 extends between driver 2340a step 2345.In addition, each list staple drivers 2340b base portion 2349 extend from its step 2345.
As disclosed in fig 12, the percussion path F in each driver 2340a, 2340b and nail bin1、F2Alignment.Specifically Say, the percussions of each first driver 2340a and first path F1Alignment, and the percussions of each second driver 2340b and second Path F2Alignment.Shown driving wedge 2364a, 2364b are configured to during firing schedule along percussion path F1、 F2It is mobile.In addition, driving wedge 2364a, 2364b contact driver 2340a, 2340b respectively with lifted driver 2240a, 2340b and the nail being supported on.
Base portion 2348,2349 can be used as counterbalance to adjust and/or control driver 2340a, 2340b barycenter.For example, The geometry and material of each base portion 2348,2349 can be selected to each driver 2340a, 2340b barycenter holding And/or shift into and corresponding percussion path F1、F2Alignment.As shown in figure 12, the first base portion 2348 includes at least one otch 2350.Size, placement and the geometry of otch 2350 are selected to make the first driver 2340a relative to the first percussion path F1Mass balance.For example, each first base portion 2348 is configured to many staple drivers 2340a barycenter displacement or protected Hold into and the first percussion path F1Align, and each second base portion 2349 is configured to single staple drivers 2340b Barycenter shift into and second percussion path F2Alignment.
In addition, base portion 2348,2349 provides elongated surface area in driving wedge 2364a, 2364b driving Robust driver 2340 when ground engages driver 2340a, 2340b.For example, driver 2340a, 2340b larger occupied area Improving stability and driver 2340a, 2340b moment of torsion and/or rotation during disposing can be prevented.In addition, because base portion 2348th, 2349 larger surface region is provided, so driver and nail that driving force can be assigned to promote balance are disposed.Example Such as, the driver with elongated surface area (such as base portion 2348,2349)
It may be incorporated into the other embodiments disclosed herein.
Referring still to Figure 12, shown driving wedge 2364a, 2364b is along longitudinally staggered apart from x.For example, the first wedge 2364a apart from x to follow the second wedge 2364b.As shown further in figure 12, shown driver 2340a, 2340b are along longitudinal direction Staggeredly apart from y.In shown arrangement, it is different from apart from x apart from y so that contact is driven when driving wedge 2364a, 2364b are different Dynamic device 2340a, 2340.For example, in shown arrangement, the first wedge 2364a drives in the second wedge 2364b contacts second The first driver 2340a is contacted before device 2340b.In such cases, second nail 2340b deployment and therefore the 3rd Before frame 2342c movement, the first driver 2340a of initiation deployment and therefore first support 2342a and second support 2342c movement.Therefore, fire what is alignd with the first driver 2340a before the nail alignd with the second driver 2340b Nail.
In some cases, it is desired to which percussion one is followed closely or one group of nail before another nail or another group of nail is fired.For example, In order to control suture tissue in bleeding and/or flow of fluid, be positioned at the nail of inside, it is such as adjacent with longitudinal slit and Therefore the nail adjacent with line of cut can be fired before the nail of more lateral.
In other cases, it can be fired before the nail alignd with the first driver 2340a and 2340b pairs of the second driver Neat nail.Or, the first driver 2340a and the second driver 2340b can be fired simultaneously so that by adjacent many staple drivers 2340a and three nails of single staple drivers 2340b supports pierce through simultaneously and capture tissue.
The arrangement of double staple drivers 2440 is shown in Figure 13.As arranged in Figure 13, double staple drivers 2440 are configured to Can be from the nail bin percussion nail of the nail cavity with four adjacent rows.For example, the driver arrangement being shown in Figure 13 is configurable to From four nail chamber percussion nails on the side of longitudinal slit that can be in warehouse, and corresponding mirrored drive arrangement can be by structure Causing can be on the opposite side of longitudinal slit from four nail chamber percussion nails.
In other cases, single pair of staple drivers 2440 can be positioned on the first side of nail bin, and single double nails Driver 2440 can be positioned on the second opposite side of nail bin.In such cases, double staple drivers 2440 can be arranged Into the nail cavity percussion nail on the either side of line of cut from two adjacent rows.In other cases, can be by double staple drivers 2440 Row be added to arrangement shown in Figure 13.For example, double staple drivers can be arranged to the nail from six or more adjacent rows Chamber percussion nail.
The double staple drivers 2440 being shown in Figure 13 include a pair of grooves or nail supporting support 2442a, 2442b.For example, each Double staple drivers 2440 include first support 2442a and second support 2442b, the support be sized and configured to branch Nail, such as follows closely a nail in 2012 (Fig. 7).For example, the base portion of nail can be positioned in each support 2442a, 2442b.
The first support 2442a of a double staple drivers in double staple drivers 2440 can be with the nail pair in a nail chamber Together, and the second support 2442b of identical pair of staple drivers 2440 can align with the nail in another nail chamber.In addition, another The first support 2442a of double staple drivers 2440 can align with the nail in another nail chamber, and this pair of staple drivers 2440 Second support 2442b can align with the nail in another nail chamber.
Referring still to Figure 13, each double staple drivers 2440 include step and/or support section 2445, and each support 2442a, 2442b are limited in a step in step 2445.In addition, each driver in driver 2440 is included in The base portion or flange connector 2448 extended between the step 2445 of double staple drivers 2440.Because step 2445 is by flange connector 2448 connections, so support 2442a, 2442b are connected so as to coordinate and/or the nail deployment of synchronization can be by double staple drivers 2440 trigger.
The step 2445 of driver 2440 can be identical height.Or, in some cases, driver 2440 may include not Level step.In other situations, different driving device 2440 can such as step with different height.
As disclosed in Figure 13, each double staple drivers 2440 are covered on a pair of percussion paths.Specifically, driver A covering driver in 2440 fires path F first1With the second percussion path F2On, and it is another in driver 2440 One driver is covered in the 3rd percussion path F3With the 4th percussion path F4On.Multiple driving wedge 2464a, 2464b, 2464b, 2464d are also depicted in Figure 13.As shown in figure 13, driving wedge 2464a, 2464b, 2464c, 2464d is configured to The nail that double staple drivers 2440 can be contacted to lift double staple drivers 2240 and be positioned on.
Referring still to Figure 13, each step 2445 includes barycenter (COM).In addition, percussion path F1、F2、F3、F4In it is every Alignd with the barycenter of step 2045 in individual percussion path.Therefore, each step 2445 is relative to corresponding percussion path F1、F2、F3、 F4Mass balance.
In all cases, the base portion 2448 extended between step 2445 also can be relative to corresponding percussion path F1、F2、 F3、F4Mass balance so that base portion 2448 keeps the mass balance of double staple drivers 2440.In some cases, base portion 2448 can Not notable and/or negligible displacement and/or change are contributed for the mass balance of double staple drivers 2440.In such situation Under, the mass balance of driver 2240 can be approximate for example, by the mass balance of its step 2445.
Referring still to Figure 13, shown driving wedge 2464a, 2464b is along longitudinally staggered apart from x.For example, the first wedge 2464a follows the second wedge 2464b apart from x.In addition, the barycenter (COM) of the step 2445 of each double staple drivers 2440 with Apart from x along longitudinally staggered.In such cases, driving wedge 2464a, 2464b can be moved to simultaneously connects with driver 2440 Close.Because wedge 2464a, 2464c contact each driver 2444 simultaneously, the nail pair supported by each driver 2440 Deployment can be by synchronization, and follow closely and can be driven via storage capacitors simultaneously or be fired into tissue.For example, such as wedge-shaped along longitudinally staggered wedge Part 2464a, 2464b may be incorporated into other embodiments disclosed herein.
In all cases, nail and arrangement of the driver in nail bin can be combined to select the geometry for driving wedge The power on nail and driver is applied to during disposing into balance.In addition, in some cases, driving the geometry of wedge The deployment of nail can be selected to coordinate.
For example, driver may include that it is configured to simultaneously staggeredly and/or along the driving wedge of longitudinal biasing Engage the nail being angularly orientated and/or the driver being angularly orientated in nail bin.For example, driving wedge staggeredly can It is moved to while being engaged with first or proximal end of driver and second or distal end of identical drivers.Because angulation Two ends of the driver of degree are simultaneously engaged with by wedge staggeredly, so driving wedge staggeredly lifts driving simultaneously Device.Therefore, during disposing driver torsion and/or rotation, and the nail being therefore supported on torsion and/or rotation It can be prevented from, limit and/or control.
In the other embodiments without driver being described further herein, driving wedge staggeredly is movable to together When engaged with first or proximal end of angled nail and second or distal end of identical angled nail.Because angled nail Two ends by staggeredly wedge simultaneously engage with, so staggeredly driving wedge simultaneously lift nail.Therefore, in the deployment phase Between the torsion followed closely and/or rotation can be prevented from, limit and/or control.
In addition or alternatively, the geometry of driver can limit at least one percussion path, the percussion path with The nail not being orientated angularly and/or driver alignment in nail bin.For example, percussion path can be with various drivers and the axle of nail Line is conllinear, and the diameter parallel is orientated in the longitudinal axis of nail bin.Because it is conllinear with nail and/or actuator axis to fire path, institute It can be balanced with nail and/or driver relative to driving wedge, and the moment of torsion and/or rotation of driver and/or nail can be prevented Only, limit and/or control.
The driver 2540 of wedge-shaped slides 2558, nail 2512a, 2512b and driving wedge 2564a, 2564b, 2564c Arrangement be shown in Figure 14 and Figure 15.Driving wedge 2564a, 2564b, 2564c disclosed in Figure 14 and Figure 15 are configured to Can be along the percussion path F for extending respectively through nail bin1、F2And F3(Figure 14) is mobile.In all cases, driver 2540 Arrangement can be used in nail bin, the nail bin has the arrangement for corresponding to shown driver arrangement of nail 2512a, 2512b and nail cavity.
As disclosed in Figure 14, driver 2540 and nail 2512a, 2512b are arranged to multiple rows of 2534,2536.In addition, each Various drivers 2540 and nail 2512a in row are orientated parallel to longitudinal axes L, and each various drivers 2540 in row Angularly it is orientated relative to longitudinal axes L with nail 2512b.For example, shown arrangement includes a pair of longitudinal direction rows 2534,2536, and And each the driver 2540 and nail 2512a, 2512b in row 2534,2536 relative to longitudinal axes L is parallel-oriented and angulation Between degree orientation alternately.For example, the driver 2540 being shown in first row 2534 includes angularly taking relative to longitudinal axes L To the first driver 2540a, parallel to longitudinal axes L be orientated the second driver 2540b, relative to longitudinal axes L angulation 3rd driver 2540c of degree ground orientation, and parallel to the fourth drive 2540d that longitudinal axes L is orientated.
As disclosed in Figure 14, the second driver 2540b and fourth drive 2540d of first row 2534 and the first percussion Path F1Alignment.More particularly, the second driver 2540b and fourth drive 2540d proximal end 2546 and distal end portion Portion 2544 and first fires path F1Alignment.In such cases, the first percussion path F1Extend through the second driver 2540b With fourth drive 2540d barycenter (COM).Because the first percussion path F1With the second driver 2540b and fourth drive 2540d aligns, so the second driver 2540b and fourth drive 2540d is relative to the first percussion path F1Mass balance, and And the second driver 2540b in Figure 14 and fourth drive 2540d torsion and/or rotation are shown in, and be therefore supported on The torsion and/or rotation of nail thereon can be prevented from, limit and/or control.
As disclosed in Figure 14, the first driver 2540a aligns with axis A, and axis A traverses longitudinal axes L and hit Send out path F1、F2And F3.In addition, the 3rd driver 2540c is orientated parallel to axis A.As shown in figure 14, the first driver 2540a Angularly it is orientated and is covered on multiple percussion paths relative to longitudinal axes L with the 3rd driver 2540c.For example, institute Show that the first driver 2540a and the 3rd driver 2540c are covered in the first percussion path F1With the second percussion path F2On.As schemed Shown in 14, the first percussion path F1The first driver 2540a and the 3rd driver 2540c proximal end 2546 are extended through, And the second percussion path F2Extend through the first driver 2540a and the 3rd driver 2540c distal end 2544.
First driver 2540a and the second driver 2540c barycenter (COM) fires path F first1With the second percussion Path F2It is middle.For example, the first driver 2540a and the second driver 2540c barycenter and the first percussion path F1Hit with second Send out path F2Equidistantly, and therefore driver 2540a, 2540c is relative to the first percussion path F1With the second percussion path F2Quality Balance.Therefore, the second driver 2540b and fourth drive 2540d that are shown in Figure 14 torsion and/or rotation, Yi Jiyin The torsion and/or rotation of this nail being supported on can be prevented from, limit and/or control.
In addition, driving wedge 2564a, 2564c, the 2564c being shown in Figure 14 and Figure 15 is along longitudinally staggered.For example, the One drives wedge 2564a towards distal side to follow the second driving wedge 2564b, and the second driving wedge 2564b apart from x Towards distal side to follow the 3rd driving wedge 2564c apart from x.As shown in figure 14, the 3rd driver 2540c being angularly orientated Proximal end 2546 and the biasing of distal end 2544 fore-and-aft distance y.In figures 14 and 15 in shown arrangement, the 3rd driving Fore-and-aft distance y between device 2540c proximal end 2546 and distal end 2544 is equal to the first driving wedge 2564a and the Fore-and-aft distance x between two driving wedge 2564b, the first driving wedge and the 3rd driver 2540c proximal end 2546 alignment, the second driving wedge aligns with the 3rd driver 2540c distal end 2544.
In figures 14 and 15 in disclosed arrangement, the first driving wedge 2564a and the second driving wedge 2564b It is moved to and is engaged with the 3rd driver 2540c simultaneously.For example, contacting the 3rd staple drivers in the second driving wedge 2564b During 2540c distal end 2544, the first driving wedge 2564a contacts the 3rd staple drivers 2540c proximal end 2546. Because driving wedge 2564a, 2564b, 2564c for being shown in Figure 14 are configured to the end of the angled driver of engagement Portion, so lifting force is applied directly to below the leg for the nail being supported on the 3rd angled driver 2540c.Therefore, Nail leg portion is further stabilized, and the inclination in nail leg portion and/or is tumbled during disposing and can be prevented from, minimize and/or control System.
The the first driving wedge 2564a and the second driving wedge 2564b being shown in Figure 14 and Figure 15 are adapted to Additional actuators 2540 in enough similarly engagement first rows 2534, and can dispose successively be supported on nail 2512a, 2512b.For example, the first driving wedge 2564a is configured to contact the first driver in the second driving wedge 2564b The first driver 2540a proximal end 2546 is then contacted during 2440a distal end 2544.In addition, the first driving wedge shape Part 2564a is configured to engage and fire successively driven in parallel device 2540b, 2540d and nail in first row 2534 2512a。
In all cases, the 3rd driver 2540c proximal end 2546 and distal end 2544 can be with the 3rd driving Device 2540c barycenter is equidistant.Because driving the wedge 2464a and 2464b disclosed in Figure 14 and Figure 15 are configured to The opposite end for the 3rd staple drivers 2540c being angularly orientated is contacted simultaneously and applies driving force and/or lifting force On the staple drivers 2540c equidistant with barycenter opposed end, so staple drivers 2540c is put down during its whole deployment Weighing apparatus.Therefore, the 3rd staple drivers 2540c rotation and/or torsion can be prevented from, avoid and/or control.
In other cases, driving wedge 2564a, 2564b can not make contact to the end of angle staple drivers 2540 2546、2544.However, in such cases, driving wedge 2564a, 2564b be configured to driver 2540 Barycenter equidistant position at be bonded into angle staple drivers 2540.In addition, driving wedge 2564a, 2564b can be by fully partially Put with while contacting and being lifted driver 2540c interval location.
In addition, the second driving wedge 2564b and the 3rd driving wedge 2564c that are shown in Figure 14 and Figure 15 are constructed Into the driver 2540 that can similarly engage in second row 2536, and dispose successively be supported on nail 2512a, 2512b.For example referring still to the arrangement shown in Figure 14, the driver 2540 in second row 2536 is orientated at a certain angle, is made Each driver proximal end 2546 and the distance between distal end 2544 also separated by fore-and-aft distance y, the longitudinal direction away from It is equal to the fore-and-aft distance x between the second driving wedge 2564b and the 3rd driving wedge 2564c from y.
In other cases, the fore-and-aft distance between the second driving wedge 2564b and the 3rd driving wedge 2564c can It is more than and/or less than the fore-and-aft distance between the first driving wedge 2564a and the second driving wedge 2564b.In addition Or alternatively, the angle that the angled nail 2512b in second row 2536 can be different from the angled nail 2512b in first row 2534 Degree orientation.In addition, in all cases, the driver 2540 of additional row and nail 2512a, 2512b can be added into institute in Figure 14 The arrangement shown, and additional drives wedge be configured to engagement additional actuators 2540 with fire additional nail 2512a, 2512b.In other situations, arrangement may also include for example single driver 2540 and nail 2512a, 2512b.
Nail 2512a, 2512b for being shown in Figure 14 arrangement also can be from without the percussions of driver nail bin.For example, with reference to Figure 16, Nail 2512a, 2512b can be disposed in no driver storehouse, all nail bins 2620 (Figure 37) as further described herein.Without driving Nail 2512a, 2512b in device nail bin directly can be engaged and/or driven by sliding part and/or firing member.For example, nail 2512a, 2512b may include sliding part composition surface, and the sliding part composition surface is configured to directly by wedge-shaped slides 2558 Drive one or more of wedge 2564a, 2564b and/or 2564c nail composition surface engagement.
As described herein, each following closely 2512a, 2512b can be relative to the percussion path F alignd with nail 2512a, 2512b1、 F2、F3Mass balance.For example, with reference to Figure 16, the nail 2512a being arranged in parallel with longitudinal axes L and percussion path F1、F2、F3In One percussion path alignment.In shown arrangement, a driving wedge edge in wedge 2564a, 2564b, 2564c is driven Engage parallel nail 2512a with the length drives of nail 2512a base portion.In addition, each parallel nail 2512a barycenter and percussion road Footpath F1、F2、F3In one percussion path alignment.In other words, path F is fired1、F2、F3In one percussion path extend through Each parallel nail 2512a barycenter is crossed, and therefore follows closely 2512a relative to corresponding percussion path F during disposing1、F2、F3Quality Balance.In such arrangement, 2512a torsion and/or rotation are followed closely during firing can be prevented from, minimizes and/or control.
In addition, in the case of during the nail being shown in Figure 14 is arranged for without driver storehouse, a pair of biasing driving wedges 2564a, 2564b, 2564c are configured to engage with each nail 2512b being angularly orientated while being moved to.For example, First driving wedge 2564a and second driving wedge 2564b be configured to and meanwhile contact first row 2534 in into Angle nail 2512b, and the second driving wedge 2564b and the 3rd drives wedge 2564c to be configured to while connecing Touch the angled nail 2512b in second row 2536.Then, wedge-shaped slides 2558 are configured to continue relative to nail 2512a, 2512b are translated, to contact successively and follow closely 2512a, 2512b from without the direct drive of driver nail bin.
As described herein, no driver nail bin can be used for the nail array for keeping and firing the nail including being angularly orientated. Including the first jaw 2002, the second jaw 2004, framework 2006, actuated articulation joints 2009 and end without driver nail bin 2620 Portion's actuator assembly 2600 has disclosed in Figure 37.Nail bin 2620 can be to be intended for single use and/or disposable storehouse, and the storehouse can hit Replaced after hair with another nail bin.Figure 37 discloses the nail bin 2620 including platform 2626, warehouse 2624 and housing 2622, should Surround or encapsulate housing parts warehouse 2624.In addition, the array of such as such as 2612 (Figure 39 A and Figure 39 B) of nail nail can be with It is removably positioned in warehouse 2624.
In some cases, nail bin 2620 can be integrally formed with end effector assemblies 2600 and/or can be for good and all It is fixed in a jaw in such as jaw 2002,2004.In such cases, end effector assemblies 2600 can be single Using and/or disposable end actuator.In other cases, nail bin 2620 can be fixed to end effector assemblies 2600, And additional nail can have been reloaded for for example follow-up percussion.
Referring to the nail bin 2620 shown in Figure 37, longitudinal slit 2632 is defined as at least partially through warehouse 2624. Longitudinal slit 2632 extends along longitudinal axes L, proximal end 2623 and distal end of the longitudinal axes L in warehouse 2624 Extend between 2625.Proximally end 2623 extends and horizontal the longitudinal slit 2632 being shown in Figure 37 towards distal end 2625 Pass through a part for the length of warehouse 2624.
In some cases, longitudinal slit 2632 can traverse the whole length of warehouse 2624.In other cases, longitudinal direction is narrow Groove 2632 can for example distally the proximally facing end 2625 in end 2623 extends.In other situations, warehouse 2624 can not be wrapped Include predetermined and/or preformed longitudinal slit.For example, firing member and/or cutting element can be horizontal for example during firing schedule Cut and/or cut warehouse 2624.
Nail bin 2620 disclosed in Figure 37 is configured to fire 2612 (Figure 38 A and Figure 38 B) of angled nail array, It is orientated the nail array 2011 that the array can be as shown in such as Fig. 7.Angled nail 2612 can be removably positioned in It is shown in the angled nail cavity 2628 in Figure 37, the nail cavity is limited in warehouse 2624.For example, shown nail cavity 2628 relative to Longitudinal axes L is angularly orientated.In addition, the shown arrangement of nail cavity 2628 corresponds to the cloth for the nail 2612 being positioned in storehouse 2620 Put.Being shown in each nail cavity 2628 in Figure 37 includes the opening 2630 in platform 2626, and each opening 2630 includes nearside End and distal end.Nail axis can extend between proximal end and distal end, and the opening 2630 being shown in Figure 37 Nail axis relative to the longitudinal axes L deflection of warehouse 2624 and/or angled.In Figure 37 nail bin 2620, all nail cavities 2628 are angularly orientated relative to longitudinal axes L, and various nail cavities 2628 angularly take relative to other nail cavities 2628 To.
It is shown in the nail cavity 2628 in Figure 37 arranged in rows on every side of longitudinal slit 2632.For example, nail cavity 2628 The first inboard row 2633, the first outboard row 2635 and the first intermediate row are arranged on the first side 2627 of longitudinal slit 2632 In 2637, and nail cavity 2628 is arranged in second the 2634, second outside of inboard row on the second side 2629 of longitudinal slit 2632 In the intermediate row 2636 of row 2638 and second.Although nail cavity 2628 is not intersected or is otherwise in contact with each other, nail cavity 2628 Longitudinal direction row 2633,2634,2635,2636,2637,2638 is overlapping.For example, nail cavity 2628 extends in laterally outside and/or inner side By the nail cavity 2628 in the nail cavity 2628 of adjacent row, and nail cavity 2628 proximally and/or towards distal side extends past adjacent row Nail cavity 2628 in nail cavity 2628.Because nail cavity 2628 and the nail being positioned in are arranged in overlapping arrays, controllable Bleeding and/or flow of fluid in system suture tissue.In the nail bin 2620 being shown in Figure 37, nail cavity 2628 and its arrange relative to Longitudinal slit 2632 is symmetrical.
In other cases, the nail cavity 2628 more or less than three rows can be positioned in every side of longitudinal slit 2632 On, and in some cases, one in the side 2627,2629 of nail bin 2620 may include another side with nail bin 2620 Face 2627, the row of the nail cavity 2628 of 2629 varying numbers.In some cases, nail cavity 2628 can not be with the nail cavity in adjacent row 2628 longitudinal directions and/or lateral overlap.In addition or alternatively, in some cases, nail cavity 2628 and/or its row can be relative to Longitudinal slit 2632 and/or longitudinal axes L are asymmetric.
Referring still to Figure 37, the shown nail cavity 2628 in arranging longitudinally in each is parallel or substantially parallel.In other words, in first Nail cavity 2628 in side row 2633 is parallel to each other, and the nail cavity 2628 in the first outboard row 2635 is parallel to each other, the first intermediate row Nail cavity 2628 in 2637 is parallel to each other, and the nail cavity 2628 in the second inboard row 2634 is parallel to each other, in the second outboard row 2636 Nail cavity 2628 it is parallel to each other, and the nail cavity 2628 in the second intermediate row 2638 is parallel to each other.
In addition as shown in figure 37, the nail cavity 2628 in arranging longitudinally in each is on the phase homonymy of longitudinal slit 2632 relative to phase Nail cavity 2628 in adjacent longitudinal direction row is angularly orientated.For example, on the first side 2627 of warehouse 2624, the first intermediate row 2637 In nail cavity 2628 be angularly orientated relative to the nail cavity 2628 in row 2633 in first and in the first outer row 2635.Separately Outside, on the second side 2629 of warehouse 2624, nail cavity 2628 in the second intermediate row 2638 relative to second in row 2634 and Nail cavity 2628 in second outer row 2636 is angularly orientated.
In other cases, longitudinally in each row 2633,2634,2635,2636,2637,2638 in nail cavity 2628 only A part can it is parallel to each other and/or all or fewer than longitudinal direction row 2633,2634,2635,2636,2637,2638 may include Nail cavity 2628 parallel to each other.In addition or alternatively, in some cases, at least a portion of nail cavity 2628 can take at random To.In some cases, at least one nail in the nail cavity 2628 in longitudinal direction row 2633,2634,2635,2636,2637,2638 Chamber can be parallel at least one nail in the nail cavity 2628 in adjacent longitudinal direction row 2633,2634,2635,2636,2637,2638 Chamber.In some cases, nail bin 2620 may include at least one nail cavity 2628 of the longitudinal axes L parallel to warehouse 2624.Example Such as, referring to Figure 11.
Referring still to Figure 37, shown end effector assemblies 2600 are included relative to hitting that warehouse 2624 is movably positioned Send out bar 2660.Trigger shaft 2660 is configured to traverse warehouse 2624 with from 2628 percussion nail of nail cavity 2612 (Figure 38 A and figure 38B).Shown trigger shaft 2660 also includes cutting edge 2661, and the cutting edge is configured in trigger shaft 2660 in the first pincers Tissue is cut when being translated between the jaw 2004 of mouth 2002 and second.
The size of shown firing member 2660 and position are designed to coordinate to be connect in longitudinal slit 2632, and drivingly Sliding part is closed, sliding part 2658 (Figure 37-Figure 38 B), sliding part in no driver storehouse 2620 is such as movably positioned in 2758 (Figure 39-Figure 39 B) or sliding part 2858 (Figure 40).When trigger shaft 2660 translates across longitudinal slit 2632, trigger shaft Sliding part 2658 (Figure 37-Figure 38 B), 2758 (Figure 39-Figure 39 B) or 2858 (Figure 40) are moved through warehouse 2624 by 2660.
Sliding part 2658 has disclosed in Figure 37-Figure 38 B.The size of sliding part 2658 and position are designed to directly connect Conjunction is positioned at the nail 2612 in no driver storehouse 2620 (Figure 37).Shown sliding part 2658 includes core 2659 and driving wedge Shape part or driving guide rail 2664.Wedge 2664 is driven to include nail composition surface or the tactile surface 2666 of nail joint, the surface is from cunning The distal end of moving part 2658 extends to the inclined surface and/or ramped surfaces of proximal end.As shown in Figure 37-Figure 38 B, wedge shape The inclined surface 2666 of part 2664 has gradient or angle equal or be substantially identical.
The tactile surface 2666 of each nail joint being shown in Figure 37-Figure 38 B is oriented to directly contact and is positioned in nail bin 2620 Nail 2612 (Figure 38 A and Figure 38 B).More particularly, the nail joint of driving wedge 2664 is touched surface 2666 and is configured to The base portion 2614 (Figure 38 B) of each nail 2612 of contact, and the base portion 2614 for following closely 2612 is lifted up to be penetrated from nail cavity 2628 Go out nail 2612.For example, will nail 2612 from falling and/or the lifting of non-firing position is to rising and/or firing position, it is each to tilt The base portion 2614 of the jointing nail 2612 of distal end 2667 on surface 2666, and inclined surface 2666 is moved distally through nail 2612 base portion 2614.
In shown arrangement, trigger shaft 2660 and its cutting edge 2661 are configured to slide in longitudinal slit 2632 And/or translation.In addition, being shown in the outside that being illustrated as in Figure 37-Figure 38 B is located laterally in trigger shaft 2660 and cutting edge 2661 Driving wedge 2664 be configured to the nail 2612 (Figure 38 A and Figure 38 B) that contact is positioned in nail cavity 2628 (Figure 37). Multiple driving wedges 2664 are positioned on the either side of core 2659 of wedge-shaped slides 2658.For example, shown In sliding part 2658, four drivings wedge 2664a, 2664b, 2664c, 2664d are positioned in each of core 2659 On side.
In addition, in the arrangement disclosed in Figure 37-Figure 38 B, multiple driving wedge 2664a, 2664b, 2664c, 2664d is configured to the single angled nail 2612 of engagement.For example, the first wedge 2664a and the second wedge 2664b quilts It is constructed to be permeable to engage the nail 6212 in the be positioned at nail cavity 2628 first outer row 2633, the second wedge 2664b and the 3rd wedge Shape part 2664c is configured to engage the nail 2612 being positioned in the first intermediate row 2637, the 3rd wedge 2664c and the 4th Wedge 2664d is configured to engage the nail 2612 being positioned in the first outer row 2635.
In all cases, it may be desirable to support and drive along the base portion 2614 (Figure 38 B) of nail 2612 from multiple positions The nail 2612 in nail bin 2620 disclosed in Figure 37.For example, by the longitudinally-aligned nail in percussion path with driving wedge 2664 2612 support along the whole length of the base portion 2614 of nail 2612.For example, when percussion road of the nail 2612 relative to sliding part 2658 When footpath is at an angle of, as shown in Figure 37-Figure 38 B, 2612 can will be followed closely along base portion supports by using multiple driving wedges 2664 At multiple positions.Because angled nail 2612 is drivingly supported at multiple positions along its base portion 2614, nail 2612 It can be balanced and/or stably so that 2612 rotation and/or torsion are followed closely during disposing can be prevented from, reduces and/or control. For example, relative to multiple sliding part composition surface mass balances direct drive nail as nail 2612 may be incorporated into it is disclosed herein other In embodiment.
Inclined surface 2666 disclosed in Figure 37-Figure 38 B interlocks.For example, shown inclined surface 2666 makes along longitudinally staggered Obtain at least one at least one other inclined surface 2666 of the longitudinal guide of inclined surface 2666.Second driving wedge 2664b and The 4th driving wedge 2664d longitudinal guide first of the inclined surface 2666 driving wedges of driving wedge 2664a and the 3rd 2664c inclined surface 2666.Second driving wedge 2664b and the 4th driving wedge 2664d inclined surface 2666 exist Higher than the first driving wedge 2664a and the 3rd driving wedge 2664c inclined surface at the distal end 2667 of alignment 2666.For example, as shown in Figure 38 and Figure 38 B, the first driving wedge 2664a and the 3rd driving wedge 2664c have distal side Height y, and there is distal side height x, height x to be less than height by the second driving wedge 2664b and the 4th driving wedge 2664d y。
It is configured to engage with angled nail 2612 while being moved to along longitudinally staggered inclined surface 2666.Example Such as, the first wedge 2664a and the second wedge 2664b nail composition surface 2666 are configured to simultaneously engage with nail cavity Angled nail 2612 in 2633 (Figure 37) of the outer row of the first of 2628.In addition, the second wedge 2664b and the 3rd wedge 2664c nail composition surface 2666 is configured to simultaneously engage with the angled nail in the first intermediate row 2637 (Figure 37) 2612.In addition, the 3rd wedge 2664c and the 4th wedge 2664d nail composition surface 2666 is configured to while connecing Conjunction is positioned at the nail 2612 in first 2635 (Figure 37) of outer row.
The deployment or percussion of nail 2612 are shown in Figure 38 A and Figure 38 B, wherein the 3rd wedge 2664c of driver 2658 Engaged with the 4th wedge 2664d with the driving of nail 2612.3rd wedge 2664c can at point A initial contact stud 2612, and 4th wedge 2664d can at point B initial contact stud 2612.3rd wedge 2664c and the 4th wedge 2664d are constructed Into nail 2612 can be simultaneously engaged with so that the simultaneously or almost simultaneously contact point A and B of nail 2612.Due to the 3rd wedge 2664c and Difference in height between 4th wedge 2664d nail composition surface 2666, point A and B can be along longitudinal biasings so that point A and B are in Identical or substantially the same elevation.
Referring still to Figure 38 A and Figure 38 B, when driver 2658 continues to be moved distally in nail bin 2620, nail 2612 The 3rd wedge 2664c and the 4th wedge 2664d nail composition surface 2666 can be made to slide up to the 3rd wedge respectively 2664c and point A ' and B ' on the 4th wedge 2664d.As shown in fig. 38b, nail 2612 is kept vertically during disposing Upright orientation.Then, nail 2612 can make the 3rd wedge 2664c and the 4th wedge 2664d 2666 points of nail composition surface Do not continue to slide up to the point A " and B " on the 3rd wedge 2664c and the 4th wedge 2664d.As shown in fig. 38b, follow closely 2612 continue to keep vertically upright orientation.In other words, this pair follow closely composition surface 2666 it is stable during disposing and/ Or balanced nail 2612 so that the rotation or torsion of nail 2612 can be prevented from, minimize and/or control.
In other cases, the driving wedge or guide rail of wedge-shaped slides can all drop to zero or substantially zero height Degree.For example, referring now to Figure 39-Figure 39 B, showing wedge-shaped slides 2758.Wedge-shaped slides 2758 can be used for nail bin 2620 With in end effector 2600 (Figure 37) with from nail bin 2620 (Figure 39 A) percussion nail 2612.
Similar to sliding part 2658, the appointing in core 2759 of wedge-shaped slides 2758 disclosed in Figure 39-Figure 39 B Include four driving wedges 2764 on side.Each driving wedge 2764 includes inclined nail composition surface 2766, its quilt It is constructed to be permeable to directly engagement and follows closely 2612 from the driving of nail cavity 2628.It is also similarly to institute in sliding part 2658, Figure 39-Figure 39 B The nail composition surface 2766 of the driving wedge 2764 shown is along longitudinally staggered so that the first driving wedge 2764a and the 3rd drives Dynamic wedge 2764c longitudinally follows the second driving wedge 2764b and the 4th to drive wedge 2764d.
Being tilted along longitudinally staggered for wedge 2764a, 2764b, 2764c, 2764d is driven disclosed in Figure 39-Figure 39 B Surface 2766 is configured to engage with angled nail 2612 while being moved to.For example, the first wedge 2764a and the second wedge Shape part 2764b nail composition surface 2766 is configured to simultaneously engage with the angulation being positioned in first 2635 (Figure 37) of outer row Degree nail 2612.In addition, the second wedge 2764b and the 3rd wedge 2764c nail composition surface 2766 is configured to together When engage angled nail 2612 in the first intermediate row 2637 (Figure 37).In addition, the 3rd wedge 2764c and the 4th wedge 2764d nail composition surface 2766 is configured to simultaneously engage with the angled nail being positioned in first in 2633 (Figure 37) of row 2612。
In addition, driving being handed over along longitudinal for wedge 2764a, 2764b, 2764c, 2764d disclosed in Figure 39-Figure 39 B Wrong inclined surface 2666 is configured to while driving angled nail 2612.For example, the wedge shapes of the first wedge 2764a and second Part 2764b nail composition surface 2766 be configured to and meanwhile drive in the first outer row 2635 of nail cavity 2628 (Figure 37) into Angle nail 2612.In addition, the second wedge 2764b and the 3rd wedge 2764c nail composition surface 2766 is configured to The angled nail 2612 in the first intermediate row 2637 (Figure 37) is driven simultaneously.In addition, the 3rd wedge 2764c and the 4th wedge 2764d nail composition surface 2766 is configured to while driving is positioned at the angled nail in 2633 (Figure 37) of row in first 2612。
Referring primarily to Figure 39 A, the second wedge 2764b and the 3rd wedge on the first side 2627 of warehouse 2624 2764c is configured to be moved to engage with the second nail 2612b, second nail be proximal nail and with the second wedge 2764b and the 3rd wedge 2764c percussion path alignment.In addition, the second wedge 2764b and the 3rd wedge 2764c can Barycenter (COM) with the second nail 2612b is equidistant.When sliding part 2758 continues towards distal translation, the second wedge 2764b and Three wedge 2764c are configured to be drivingly engaged the second nail 2612b to lift simultaneously percussion nail 2612b.
In the arrangement disclosed in Figure 39 A, followed closely in the second wedge 2764b and the 3rd wedge 2764c liftings second During 2612b, the first wedge 2764a and the second wedge 2764b on the first side 2627 of warehouse 2624 are configured to It is moved to and is engaged with the first nail 2612a, and the 3rd wedge 2764c and the 4th wedge 2764d quilts on the first side 2627 It is constructed to be permeable to be moved to and is engaged with the 3rd nail 2612c.In addition, as shown in Figure 39 A, the wedge shapes of the first wedge 2764a and second The nails of part 2764b and first 2612a barycenter (COM) equidistantly, and the 3rd wedge 2764c and the 4th wedge 2764d and the Three nail 2612c barycenter (COM) is equidistant.When sliding part 2758 continues towards distal translation, the first wedge 2764a and the second wedge Shape part 2764b is drivingly engaged the first nail 2612a to lift simultaneously percussion nail 2612b, and the 3rd wedge 2764c and the 4th wedge Shape part 2764d is drivingly engaged the 3rd nail 2612c to lift simultaneously percussion nail 2612c.
It is described above and be shown in the paired driving wedge in Figure 39 A arrangement be configured to continue towards remote in sliding part 2758 Continue to simultaneously engage with and lift the nail 2612 in nail bin 2620 when translating in side.Because sliding part 2758 is at multiple positions along it Base portion supports each follow closely 2612, so nail 2612 is stablized and/or balanced during disposing.In addition, because sliding part 2758 The barycenter (COM) of composition surface 2766 and each contact stud 2612 is followed closely equidistantly, so the rotation and/or torsion of nail 2612 can be entered One step is prevented, minimizes or controlled.In addition, because driving wedge 2764a, 2764b, 2764c, 2764 are along longitudinally staggered, institute It is timed with multiple driving wedge 2764a, 2764b, 2764c, 2764 engagements with each following closely 2612 and/or synchronous to balance The driving force on each nail 2612 is applied to during its whole deployment.
Driving sliding part 2858 is shown in Figure 40.Wedge-shaped slides 2758 can be used for nail bin 2620 and end effector 2600 With from nail cavity 2620 (Figure 39 A) percussion nail 2612 in (Figure 37).Similar to sliding part 2658 and 2758, driving sliding part 2858 exists Include multiple driving wedges 2864 on the either side of core 2859.Each driving wedge 2864 includes inclined nail joint Surface 2866 is closed, it is configured to directly engagement and follows closely 2612 from the driving of nail cavity 2628.In addition, inclined nail composition surface 2866 are laterally at an angle of or tilt.Because nail composition surface 2866 is laterally and longitudinally tilted, each surface 2866 includes Along the support section of longitudinal biasing, the support section is drivingly engaged angled nail 2612 during its whole deployment and percussion.
For example, the inclined nail composition surface 2866 disclosed in Figure 40 is configured to the base along each nail 2612 The part in portion is drivingly engaged nail 2612.In arrangement shown in Figure 40, the driving force distributed being applied on nail 2612 exists On bigger surface area.For example, at least the 50% of the length of the base portion of the accessible nail 2612 of nail composition surface 2866.In other feelings Under condition, at least the 75% of the length of the base portion of Surface accessible nail 2612 is closed in nail joint.In other situations, nail composition surface can The length of the base portion of contact stud 2612 is less than 50% or more than 75%.In addition, the driving force from sliding part 2858 relative to The barycenter balance of each nail 2612, with the further stable and balanced nail 2612 during disposing.Therefore, nail 2612 rotation and/ Or torsion can be prevented from, minimizes or control.
As described herein, such nail array provides various benefits：Longitudinal axis including relative to nail bin and/or hit The nail that the percussion path of hair component is angularly orientated.For example, such nail array can provide the soft of improvement in suture tissue Property and/or extensibility.Therefore, the incidence of torn tissue can be reduced.In some cases, nail array may also include with difference The nail of length base portion.Variable-length base portion in nail array can promote increased flexible and/or extensibility in suture tissue.Separately Outside, in some arrangements, the nail with shorter base portion can be nested in nail array.For example, the nail with shorter base portion can be determined In narrower space of the position between the nail with longer base portion.Such arrangement can be densified staple line, and this can improve to suture The control of bleeding and/or flow of fluid in tissue.
Nail array 3011 is shown in Figure 41.Array 3011 includes spike 3012 and short nail 3013.As shown in figure 41, spike 3012 have l1Base length, and it is short nail 3013 have l2Base length, l2Less than l1.In shown array 3011, the One spike 3012a and axis AaAlignment, and the first short nail 3013 and axis AbAlignment, axis AbParallel to axis Aa.It is additional Spike 3012 and short nail 3013 (such as following closely 3012e, 3013b, 3013c and 3013d) are for example parallel to axis AaAnd Ab.As shown in It is further disclosed in array 3011 in Figure 41, the second spike 3012 and axis AcAlignment, axis AcTraverse axis AaWith Ab.For example, additional spike 3012 such as follows closely 3012c, 3012d and 3012f parallel to axis Ac。
In other arrangements, adding short nail 3012 also can be parallel to axis Ac.In some cases, various nails can be along not Parallel to axis Aa、AbAnd AcAxis arrangement.For example, nail array 3011 may include parallel to the longitudinal axis of nail bin and/or flat Row is in the nail of the percussion path orientation of driving sliding part.In addition, in all cases, nail array 3011 may include to have and be different from l2And l1Base length nail.In some cases, nail array 3011 may include the nail of additional and/or less longitudinal direction row 3012、3013.For example, can be removed with the row of the first spike 3012a spikes 3012 alignd, and/or with the second spike The row of the spike 3012 of 3012b alignment can be removed, and/or can be moved with the row of the first short nail 3013a short nails alignd Remove, and/or can be removed with the row of the 3rd spike 3012c spikes 3012 alignd, and/or with the second short nail The row of the short nail 3013 of 3013b alignment can be removed, and/or can with the row of the 4th spike 3012d spikes 3013 alignd It is removed.
Referring again to Figure 41, short nail 3013 is embedded in the nail array 3011 in the middle of two spikes 3012.For example, array Two spikes 3012 in 3011 are all parallel and lateral as shown in the 3rd spike 3012c and the 6th spike 3012f in Figure 41 Alignment.In such an arrangement, space is limited between the 3rd spike 3012c and the 6th spike 3012f, and the space is by structure Cause that the 3rd short nail 3013c can be accommodated.Therefore, the 3rd short nail 3013c in shown array 3011 is nested in the 3rd spike Between 3012c and the 6th spike 3012f.In such arrangement, similar placement is short in the 3rd short nail 3013c and array 3011 Nail 3013 can be densified staple line by filling the space between spike 3012.In all cases, because staple line is in array It is densified in 3011, so bleeding and/or flow of fluid control are improved.
Densification staple line for example may be incorporated into other embodiments disclosed herein as followed closely array 3011.
In other cases, the spike 3012 that the space for accommodating short nail is limited therebetween can be not parallel each other.For example, 3rd spike 3012c and the 6th spike 3012f can deflection and/or otherwise not parallel each other.In addition or alternatively, The spike 3012 for limiting the space for accommodating short nail 3013 therebetween can only partially lateral overlap.For example, in some situations Under, the 3rd spike 3012c can be relative to the 6th spike 3012f in laterally outside or lateral inner side so that the 3rd nail 3012c and the Six nail 3012f only a part is laterally aligned.
The array of nail, such as array 3011 can for example be positioned in no driver nail bin such as without driver nail bin 2620 In (Figure 37), and it can directly be engaged and be driven from nail bin by driving sliding part.In such cases, the nail in array 3011 3012nd, 3013 can relative to sliding part driving wedge mass balance, the sliding part contacts and drives nail 3012,3013.Example Such as, percussion force can be applied to the end of the base portion equidistant with the barycenter of each nail 3012,3013 by driving wedge.At it In the case of it, percussion force can be applied at each interval location along the base portion of nail 3012,3013, and accumulation percussion force can Balanced relative to nail 3012,3013.It is not covered on percussion path and/or not relative to the feelings of percussion Path balance in nail Under condition, staple drivers can be used.For example, as further described herein, many staple drivers can lift multiple nails simultaneously from nail bin.
Nail array 3111 is shown in Figure 42.Array 3111 includes spike 3112 and short nail 3113.As shown in figure 42, spike 3112 have l1Base length, and it is short nail 3113 have l2Base length, l2Less than l1.In shown array 3111, the One short nail 3113a and axis AaAlignment, and the first spike 3112a and axis AbAlignment, axis AbTraverse axis Aa.It is additional Short nail 3113 is parallel to axis AaOrientation, and additional spike 3112 is parallel to axis AbOrientation.
In other arrangements, at least one short nail 3113 can be parallel to axis AbOrientation, and/or at least one spike 3112 can be parallel to axis AaOrientation.In some cases, various nails 3112,3113 can be along being not parallel to axis AaAnd Ab's Axis is arranged.For example, nail array 3111 may include parallel to the longitudinal axis of nail bin and/or parallel to driving wedge 3064 The nail of path orientation is fired, it is also depicted in Figure 42.In addition, in all cases, nail array 3111 may include to have and be different from l2And l1Base length nail, and/or nail array 3111 may include additional and/or less longitudinal direction row nail 3112, 3113。
Referring still to Figure 42, short nail 3113 can be embedded in the nail array in the middle of at least two lateral overlap spike 3112 In 3111.In such an arrangement, the sky that the nested short nail 3113 in array 3111 can be by filling between adjacent spike 3112 Between be densified staple line.Because staple line is densified in array 3111, bleeding and/or flow of fluid can be improved.Example Such as, densification staple line (such as nail array 3111) may be incorporated into other embodiments disclosed herein.
In other cases, the spike 3112 that the space for accommodating short nail is limited therebetween can be not parallel each other.Except this Outside or alternatively, limiting therebetween can be only partially overlapping for accommodating the spike 3112 in space of short nail 3113.
The array of nail, such as array 3111 can for example be positioned in no driver nail bin, such as without driver nail bin 2620 In (Figure 37), and it can directly be engaged and be driven from nail bin by driving sliding part, such as sliding part 2058 (Figure 37).In such feelings Under condition, nail 3112,3113 in array 3111 can relative to sliding part the mass balance of driving wedge 3064, the sliding part connects Touch and drive nail 3112,3113.For example, percussion force can be applied to and follow closely 3112,3113 barycenter etc. by driving wedge 3064 Away from base portion end.
In other cases, percussion force can be applied at each interval location along the base portion of nail 3112,3113, and Accumulation percussion force can be balanced relative to nail 3112,3113.Wherein nail 3112,3113 be not covered in percussion path on and/or In the case that person is not relative to percussion Path balance, staple drivers can be used.For example, as further described herein, many nail drivings Device can lift multiple nails simultaneously from nail bin.
In all cases, in the case where sliding part is configured to direct drive nail, nail may include that sliding part connects Surface is closed, and sliding part may include to follow closely composition surface.Nail can be the substantially " v-shaped " of the leg with base portion and not parallel extension Nail.For example, referring again to the nail 2612 being shown in Figure 39 B and Figure 40, for example, nail 2612 includes base portion 2614, from base portion 2614 First end extension the first leg 2616 and the second leg 2618 for extending from the second end of base portion 2614.Nail 2612 can be formed by the line such as line with circular cross section, and therefore, the neighboring of nail 2612 can be made up of circular surface. Therefore, the sliding part composition surface of nail 2612 may include circular and/or contoured surface.
In other cases, nail 2612 can be formed by the line with polygonal crosssection, and therefore, the periphery of nail 2612 While may include edge and flat surfaces or plane surface.In such embodiment, the sliding part composition surface of nail 2612 can be wrapped Include for example, at least one flat surfaces and/or plane surface.In other situations, the neighboring of nail 2612 may include wavy outer Both shape surface and plane surface.For example, nail 2612 can be formed by the line with circular cross section, the line can be flattened and/ Or be otherwise deformed form flat sliding part composition surface.
In some cases, nail can be formed by a block of material.For example, nail can be by material piece punching press, cutting and/or molding. Various punching press nails are described in the U.S. Patent application 14/138,481 that on December 23rd, 2013 submits, and this application is complete accordingly Text is herein incorporated by reference.In all cases, nail can be for example stamped and formed out by single piece of material or otherwise be formed, And it can for example remain the material of single piece of material and/or integral block.In all cases, such as cunning of the nail of punching press nail etc Moving part composition surface may include the flat surfaces or plane surface for the part for being stamped and formed out part or otherwise being formed.Separately Outside, in some cases, sliding part composition surface may include groove and/or otch, and it is configured to receive wedge-shaped cunning The driving wedge of moving part.When nail is angularly orientated relative to the percussion path of driving wedge, groove can necessarily angle Degree traverses the base portion of nail.
Punching press nail 2912 is shown in Figure 26-Figure 28.Nail 2912 includes base portion 2914, the first leg 2916 and the second leg 2918.As shown in Figure 26-Figure 28, the neighboring of nail 2912 includes flat surfaces and contoured surface.In addition, nail 2912 includes Groove or track 2915 (Figure 27 and Figure 28), it has been cut into base portion 2914.Groove 2915 is configured to receive driving cunning The driving wedge 2964 of moving part 2958.
In all cases, the width of groove 2915 can be slightly larger than the width for receiving driving wedge 2964 wherein Degree.For example, the size of the width of groove 2915 be designed to receive driving wedge 2964 and anti-non-magnetic shim 2915 relative to The lateral displacement of wedge 2964.
Be shown in nail 2912 in Figure 26-Figure 28 relative to driving wedge 2964 percussion path F (Figure 28) angularly Orientation.For example, nail 2912 extends along axis A (Figure 27), axis A traverses percussion path F.Therefore, shown groove 2915 is worn The base portion 2914 for crossing nail 2912 is angularly orientated.For example, axis A can be orientated relative to percussion path F with angle, θ.It is shown in figure Angle, θ in 28 is 45 °.
Base portion 2914 has development length l.For example, the length l of base portion 2914 is more than the length in nail leg portion 2916,2918. Because base portion 2914 is elongated, groove 2915 includes elongated guide surface or the track for being used to drive wedge 2964, It promotes the stability of the nail 2912 during disposing.With for receiving the elongate guide of driving wedge or the nail of track (such as nail 2912) for example may be incorporated into other embodiments disclosed herein.
Referring primarily to Figure 28, nail 2912 has the barycenter (COM) overlapped with percussion path F.For example, percussion path F extensions Through the barycenter (COM) of nail 2912 so that nail 2912 is balanced relative to driving wedge 2964.Therefore, it is applied on nail 2912 Driving force can lift nail leg portion 2916,2918 simultaneously, and follow closely 2912 torsion or rotation can be prevented from, minimize and/or Control.
In all cases, the groove or track similar to groove 2915 can be limited in non-punching press nail.For example, tailor's tack Can be cut, punching press and/or grinding with produce for slideably received within driving wedge track.In such cases, follow closely Base portion can have with nail leg portion identical length, or in other cases, base portion can be flattened to increase or extend it Length.In addition, in some cases, as further described herein, multiple driving wedges drivably engage nail.In such feelings Under condition, nail may include multiple grooves or track, and it can each be configured to receive driving wedge.In addition, in some feelings Under condition, the nail with the guide rail similar to groove 2915 can be for example orientated parallel to the longitudinal axis of nail bin.For example, parallel Nail can be with driving the percussion path of wedge longitudinally-aligned.In such cases, the guide rail being limited in the base portion of nail can Extend along the base portion of the nail parallel to it.
As described herein, the nail being angularly orientated can provide increased flexible and/or extensibility to suture tissue.Example Such as, in the array of percussion nail angled nail pivotably and/or rotates and alignd to the line of cut and/or longitudinal axis with staple line, In order to suture the lengthening and/or linear deformation of tissue.Because angled nail can be pivoted and/or revolved in the array of suture tissue Turn, so the tear and/or stretching, extension of tissue can be reduced and/or prevented.In addition, the wound of the stress and/or suture tissue in tissue Wound can be minimized.
Except by percussion nail can extending longitudinally array provide longitudinal flexible in addition to, it is also possible to expect to the array by following closely The tissue of processing provides lateral customization.For example, being applied to the opposite side that structural compression stress can be based on tissue relative to staple line Optimize to position and/or adjust.In certain cases, it may be desirable to customize tissue before quilting and/or during suturing On compression stress.In other cases, it may be desirable to customize the structural compression stress of suture.In addition, in other situations, can It can expect for example before quilting, during suturing, and to customize structural compression stress after stapling.
Lateral tissue compression customization and the flexible combination of longitudinal tissue can provide joint management effect.For example, when in suture During and/or after be applied to structural compression stress smaller stress and/or the reduced tissue of influence generated in compression organization During wound, the tissue of compression is suitable for increased elastic deformation.In other words, the tissue in optimal compression is extended and/or stretched When long, the tissue of the optimal compression can better adapt to rotation and/or the pivot of nail therein.In addition, when suture tissue is easy When ground adapts to nail pivot and/or shifted, the stress in suture tissue can be reduced, and the charge-coupled wound knitted of opposite joint can be minimum Change.Therefore, when nail is pivoted and/or is shifted to adapt to tissue lengthening or extending longitudinally, stress to optimal compression tissue and/or Wound can be further minimized.
Nail bin 3420 is shown in Figure 43-Figure 45.Shown nail bin 3420 includes warehouse 3424 and platform 3422.Multiple nail cavities 3428 are limited in the main body 3424 of shown nail bin 3420, and each nail cavity 3428 forms opening in platform 3422 3430.In addition, the nail cavity 3428 being shown in Figure 43-Figure 45 angularly takes relative to the longitudinal axes L (Figure 44) of nail bin 3420 To.In shown nail bin 3420, longitudinal slit 3432 is limited partially across warehouse 3424, and three nail chambers 3428 are determined Position is on the either side of longitudinal slit 3432.The arrangement for the nail cavity 3428 being shown in Figure 43-Figure 45 is configured to receive into The array of angle nail.For example, multiple nails such as 3412 (Figure 45) of nail are removably positioned in nail cavity 3428.
In shown nail bin 3420, the nail cavity 3428 in outboard row on the first side of longitudinal slit 3432 is relative to longitudinal direction Axis L (Figure 44) is orientated with first angle, and the nail cavity 3428 in intermediate row on the first side of longitudinal slit 3432 is relative to vertical It is orientated to axis L with second angle, and the nail cavity 3428 in the interior row on the first side of longitudinal slit 3432 is relative to longitudinal direction Axis L is orientated with third angle.In shown nail bin 3420, third angle is same or about with first angle, and the Two angles bias 90 degree or about 90 degree with first angle and with third angle.
As being further illustrated in Figure 43-Figure 45, the phase of nail cavity 3428 in the outboard row on the second side of longitudinal slit 3432 It is orientated for longitudinal axes L (Figure 44) with fourth angle, the nail cavity 3428 in intermediate row on the second side of longitudinal slit 3432 Relative to longitudinal axes L with the nail cavity 3428 in the inboard row in the 5th angular orientation, and the second side of longitudinal slit 3432 Relative to longitudinal axes L with the 6th angular orientation.In shown nail bin 3420, hexagonal degree is identical with fourth angle or substantially phase Together, and the 5th angle and fourth angle and with 90 degree or about 90 degree of the 6th angle offset.In addition, being shown in Figure 43-figure In arrangement in 45, second angle and fourth angle and hexagonal degree are same or about, and first angle and the third angle Degree and the 5th angle are same or about.
In other cases, nail bin 3420 may include the additional and/or less row of nail cavity.In addition or alternatively, follow closely 3412 angular orientation in that, in each row can be adjusted and/or change to adapt to different arrays.For example, in some cases, at least One nail cavity can be parallel to longitudinal axes L.
In all cases, the nail bin 3420 being shown in Figure 43-Figure 45 can be with end effector 2,000 1 shown in Figure 7 Rise and use.For example, nail bin 3420 can be loaded into the elongated passageway of the second jaw 2004.In addition, in some cases, nail bin 3420 can be fired with single staple drivers, many staple drivers and/or combinations thereof.For example, single staple drivers 3440 (Figure 45) It can be positioned in each nail cavity 3428, and drivably engage the nail 3412 being supported on.It is shown in the driving in Figure 45 Device 3440 can be positioned in warehouse 3424 so that the support of each driver 3440 and a nail being positioned in nail cavity 3428 A nail alignment in nail 3412 in chamber.
In some cases, nail bin 3420 may include many staple drivers.For example, many staple drivers be configured to from First group of percussion nail 3412 (Figure 45) of nail cavity 3428, and another many staple drivers is configured to from second group of nail cavity 3428 percussion nails 3412.In other cases, nail bin 3420 may not include driver.For example, firing member and/or sliding part (such as firing member 2660 and sliding part 2658 (Figure 37)) is for example configured to directly contact, engagement and/or driven Nail 3412.In all cases, for example during disposing, driver 3440 and/or nail 3412 (can such as be slided relative to sliding part Moving part 2058 (Fig. 7) and/or sliding part 2658 (Figure 37)) percussion path carry out mass balance.
The platform 3422 being shown in Figure 43-Figure 45 includes multiple longitudinally extending portions.For example, platform 3422 is included in longitudinal direction First longitudinal direction part 3422a, second longitudinal direction part 3422b and the 3rd longitudinal component 3422c on the side of slit 3432, and The 4th longitudinal component 3422d, the 5th longitudinal component 3422e and the 6th longitudinal component on the opposite side of longitudinal slit 3432 3422f.As shown in Figure 43-Figure 45, longitudinal nail chamber 3428 and extension 3422a longitudinally in each, 3422b, 3422c, 3422d, 3422e, 3422f align.For example, outboard row nail cavity 3428 and first longitudinal direction portion on the first side of longitudinal slit 3432 The intermediate row nail cavity 3428 divided on 3422a alignment, the first side of longitudinal slit 3432 is alignd with second longitudinal direction part 3422b, and And the inboard row nail cavity 3428 on the first side of longitudinal slit 3432 is alignd with the 3rd longitudinal component 3422c.In addition, longitudinal slit Outboard row nail cavity 3428 on 3432 the second side is alignd with the 4th longitudinal component 3422d, on the second side of longitudinal slit 3432 Intermediate row nail cavity 3428 alignd with the 5th longitudinal component 3422e, and the inner side nail on the second side of longitudinal slit 3432 Chamber 3428 aligns with the 6th longitudinal component 3422f.
In other cases, nail bin 3420 may include additional and/or less longitudinally extending portion.For example, longitudinal component It can be adjusted and/or change to arrange corresponding to nail cavity and the different of nail.In certain embodiments, the longitudinal nail of more than one Chamber can be overlapped with least one longitudinal component.In addition or alternatively, at least one longitudinal component may not include such as nail cavity And/or a nail.
In shown nail bin 3420, adjacent longitudinal portions 3422a, 3422b, 3422c, 3422d, 3422e and 3422f pass through Ridge 3423 with vertically biasing each other.For example, ridge 3423 extends between Part I 3422a and Part II 3422b, And another ridge 3423 extends between Part II 3422b car Part III 3422c.In addition, in shown arrangement, Ridge 3423 extends between Part IV 3422d and Part V 3422e, and another ridge 3423 is in Part V 3422e Extend between Part VI 3422f.As shown in Figure 43-Figure 45, longitudinal slit 3432 is in Part III 3422c and Part IV Extend between 3422d.
Ridge 3423 disclosed in Figure 43-Figure 45 limits the elevation change in platform 3422.For example, Part I 3422a and Ridge 3423 between Part II 3422b limits upward step so that Part II 3422b has higher than Part I 3422 Elevation.In all cases, ridge 3423 laterally adjusts the height of platform 3422.For example, ridge 3423 inwardly increases platform 3422 Height and outwards reduce platform 3422 height so that maximum height is adjacent with longitudinal slit 3432, and laterally flank Part has most short height.
When the jaw of end effector, the first jaw 2002 and the second jaw of such as end effector 2000 (Fig. 7) 2004 it is clamped when, the degree of the clearance control tissue compression between the nail profiled surface of platform 3422 and anvil block.Therefore, platform 3422 height can influence to clamp the tissue compression degree between jaw.For example, in the higher region of platform 3422, it is adjacent Tissue can more compress relatively between clamping jaw, and in the shorter region of wherein platform 3422, adjacent tissue Can less it be compressed relatively between clamping jaw.Therefore, the ridge 3423 disclosed in Figure 43-Figure 45 can influence tissue compression Laterally vary.As further described herein, tissue compression degree can be chosen and/or optimize to reduce the stress to compression organization And/or wound.In addition, because nail bin 3420 is configured to the longitudinal flexible array of percussion nail 3412, can be further Retain the integrality of suture tissue.
Ridge 3423 disclosed in Figure 43-Figure 45 influence adjacent longitudinal component 3422a, 3422b, 3422c, 3422d, Steep and/or steep steps between 3422e and 3422f.Figure 43-Figure 45 further discloses the nail that ridge 3423 surrounds adjacent row Nail cavity 3428 in chamber 3428 is bent.For example, ridge 3423 extends generally along path, the path corresponds to and/or matched and it The angular orientation of adjacent one or more nail cavities 3428.Therefore, ridge 3423 includes multiple contoured portions and/or bending section. In addition, ridge 3423 is included in multiple straight or substantially straight parts in the middle of contoured portion.
In other cases, ridge 3423 can limit less precipitous elevation change.For example, at least one ridge 3423 and/or Its part gradually can tilt and/or be incrementally stepped different elevations.In addition, in some cases, longitudinal component 3422a, 3422b, 3422c, 3422d, 3422e, 3422f height can change.For example, longitudinally in each part 3422a, 3422b, 3422c, 3422d, 3422e, 3422f height can laterally and/or longitudinally change.In such cases, platform can be limited for example in ridge Inclination and/or angled surface in the middle of 3423.
In other nail bins, ridge can extend along the different paths between staple and nail cavity.For example, being shown in Figure 46-Figure 48 In nail bin 3520 be similar to nail bin 3420 (Figure 43-Figure 45), and similar reference represents similar element.For example, Nail bin 3520 includes warehouse 3524 and platform 3522.Multiple nail cavities 3528 are limited in the main body 3524 of shown nail bin 3520, And each nail cavity 3528 forms opening 3530 in platform 3422.In addition, the matching of nail cavity 3528 being shown in Figure 46-Figure 48 is shown The array of nail cavity 3428 in Figure 43-Figure 45.For example, in shown nail bin 3520, longitudinal slit 3532 by partially across Warehouse 3524 is limited, and three nail chambers 3528 are positioned on the either side of longitudinal slit 3532.It is shown in Figure 46-Figure 48 The arrangement of nail cavity 3528 is configured to receive the array of angled nail.For example, multiple nails such as 3412 (Figure 45) of nail can quilt It is removably positioned in nail cavity 3528.
Platform 3522 disclosed in Figure 46-Figure 48 includes multiple longitudinally extending portions.For example, shown platform 3522 is included in First longitudinal direction part 3522a, second longitudinal direction part 3522b and the 3rd longitudinal component 3522c on the side of longitudinal slit 3532, And the 4th longitudinal component 3522d, the 5th longitudinal component 3522e and the 6th longitudinal direction portion on the opposite side of longitudinal slit 3432 Divide 3522f.As shown in Figure 46-Figure 48, longitudinal nail chamber 3528 and extension 3522a longitudinally in each, 3522b, 3522c, 3522d, 3522e, 3522f align.In addition, in shown nail bin 3520, adjacent longitudinal portions 3522a, 3522b, 3522c, 3522d, 3522e and 3522f are by ridge 3523 with vertically biasing each other.
Ridge 3523 disclosed in Figure 46-Figure 48 prolongs along the path different from the ridge 3423 of platform 3422 (Figure 43-Figure 45) Stretch.For example, ridge 3423 includes for example multiple otch, such as otch 3523a, 3523b, 3523c and 3523d (Figure 47), its median ridge 3523 not along and/or neighbouring nail cavity 3528 extend.Otch 3523a, 3523b, 3523c and 3523d geometry can be chosen It is selected to adjust tissue compression.For example, otch can expand the region of pressure reduction and reduce the increased adjacent area of pressure.Each In the case of kind, it may be desirable to provide otch 3523a, 3523b, 3523c and 3523d to provide such as reduction group to cutter slit 3532 Knit the region of compression.
As further described herein, the ridge 3523 disclosed in Figure 46-Figure 48 can influence laterally varying for tissue compression.Example Such as, tissue compression degree can be chosen and/or optimize to reduce stress and/or wound to compression organization.In addition, because nail bin 3520 are configured to the longitudinal flexible array of percussion nail 3512, so can further retain the integrality of suture tissue.
In other cases, the ridge on the platform of storehouse can be straight or substantially straight.For example, being shown in the nail in Figure 49-Figure 51 Storehouse 3620 is similar to nail bin 3420 (Figure 43-Figure 45), and similar reference represents similar element.For example, nail bin 3620 include warehouse 3624 and platform 3622.Multiple nail cavities 3628 are limited in the main body 3624 of shown nail bin 3620, and Each nail cavity 3628 forms opening 3630 in platform 3622.In addition, the matching of nail cavity 3628 being shown in Figure 49-Figure 51 is shown in figure The arrangement of nail cavity 3528 in 46- Figure 48.For example, in shown nail bin 3620, longitudinal slit 3632 is by partially across warehouse 3624 are limited, and three nail chambers 3628 are positioned on the either side of longitudinal slit 3632.It is shown in the nail cavity in Figure 46-Figure 48 3628 arrangement is configured to receive the array of angled nail.For example, multiple nails such as 3612 (Figure 51) of nail can be removed Ground is positioned in nail cavity 3628.
Platform 3622 disclosed in Figure 49-Figure 51 includes multiple longitudinally extending portions.For example, shown platform 3622 is included in First longitudinal direction part 3622a, second longitudinal direction part 3622b and the 3rd longitudinal component 3622c on the side of longitudinal slit 3632, And the 4th longitudinal component 3622d, the 5th longitudinal component 3622e and the 6th longitudinal direction portion on the opposite side of longitudinal slit 3632 Divide 3622f.As shown in Figure 49-Figure 51, longitudinal nail chamber 3628 and extension 3622a longitudinally in each, 3622b, 3622c, 3622d, 3622e, 3622f align.In addition, in shown nail bin 3620, adjacent longitudinal portions 3622a, 3622b, 3622c, 3622d, 3622e and 3622f are by ridge 3623 with vertically biasing each other.
Ridge 3623 disclosed in Figure 49-Figure 51 (is schemed along the ridge 3423 and platform 3522 with platform 3422 (Figure 43-Figure 45) 46- Figure 48) ridge 3523 it is different path extension.For example, ridge 3623 extends along straight line path, the straight line path is parallel to vertical Extend to slit 3632.In addition, a part for longitudinal ridge 3523 extends through the nail cavity 3628 in nail bin 3620.Therefore, nail cavity 3628 end or side are positioned in longitudinal terrace part 3622a, 3622b, 3622c, 3622d, 3622e or 3622f One of in, and identical nail cavity 3628 another end or side be positioned in longitudinal terrace part 3622a, 3622b, In the other of 3622c, 3622d, 3622e or 3622f.
As further described herein, the ridge 3623 disclosed in Figure 49-Figure 51 can influence laterally varying for tissue compression.Example Such as, tissue compression degree can be chosen and/or optimize to reduce stress and/or wound to compression organization.In addition, because nail bin 3620 are configured to the longitudinal flexible array of percussion nail 3612, so can further retain the integrality of suture tissue.
In some cases, nail bin 3620 includes many staple drivers, many staple drivers 3640 such as disclosed in Figure 51.Often Individual many staple drivers 3640 are configured to from one group of percussion nail 3612 of nail cavity 3628.For example, similar to many staple drivers 2040a, 2040b (Fig. 7-Fig. 9), many staple drivers 3640 include three steps 3645, and groove or support 3642 are limited to In each step 3645.Connected in addition, the step 3645 of many staple drivers 3640 is connected flange 3648.It is shown in every in Figure 51 Individual many staple drivers 3640 are supported on the nail 3612 in multiple rows of nail cavity 3628, and are configured to from the nail cavity in multiple rows 3628 percussion nails 3612.In Figure 51, the height of each step 3645 and it is defined in the depth of each support 3642 therein and is Identical so that the nail profiled surface on nail 3612 and anvil block formed between step 3645 has identical forming height.
As further described herein, it may be desirable to which customization and/or Optimize the forming scheme staple height are to influence the change in forming nail Tissue compression.Therefore, at least one nail 3612 that can be modified to form differing formed height in many staple drivers 3640.Example Such as, following closely the step 3645 and/or support 3642 of many staple drivers 3640 can be modified to different sizes so that by what is changed At least two nails in the nail 3612 of many formation of staple drivers 3640 have differing formed height.In other cases, different nails The step 3645 and/or support 3642 of driver 3640 can be changed so that the first driver 3640 is configured to be formed Nail 3612 with the first forming height and the second driver 3640 are configured to be formed with the second different shapings The nail 3612 of height.
In other situations, nail bin 3620 may include single staple drivers.Or, nail bin 3620 may not include driver. For example, firing member and/or sliding part (such as firing member 2660 and sliding part 2658 (Figure 37)) are for example configured to Enough directly contacts, engagement and/or driving nail 3612.In all cases, driver 3640 and/or nail 3612 can for example relative to The percussion path of sliding part (such as sliding part 2058 (Fig. 7) and/or sliding part 2658 (Figure 37)) carries out mass balance.
It is as described herein, it can be formed to customize and/or be optimized to the nail in the tissue compression in staple, nail array Differing formed height.For example, in all cases, it may be desirable to laterally change tissue compression, so as to change forming nail size. In the case of such, for example, the tissue close to line of cut is more compressed than the tissue away from line of cut.With it is different not into The various nail arrays of shape height and/or differing formed height are described in following patent：The name that on January 1st, 2011 announces Referred to as " STAPLE DRIVE ASSEMBLY " United States Patent (USP) 7,866,528；It is entitled that on June 1st, 2010 announces " SURGICAL STAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP " United States Patent (USP) 7,726,537；Entitled " the STAPLE DRIVE ASSEMBLY " United States Patent (USP) 7,641,091 that on January 5th, 2010 announces； Entitled " the STAPLE DRIVE ASSEMBLY " United States Patent (USP) 7,635,074 that on December 22nd, 2009 announces；And 2011 On August announce within 16 entitled " STAPLE DRIVE ASSEMBLY " United States Patent (USP) 7,997,469, the patent is accordingly It is incorporated by reference in its entirety herein.
Referring again to Figure 49-Figure 51, in all cases, nail bin 3620 can be used together with end effector, the end Actuator is configured to make nail 3612 be deformed into differing formed height.Angled nail cavity 3628 in nail bin 3620 is arranged Into multiple rows.For example, angled nail cavity 3628 is arranged in the first outer row, the first intermediate row and the on the first side of nail bin 3620 In arranging in one, and angled nail cavity 3628 is arranged in the second outer row, the second intermediate row and the on the second side of nail bin 3620 In being arranged in two.In all cases, the nail 3612 from the percussion of nail cavity 3628 in the first outer row is than from the first intermediate row Higher forming height is presented in the nail 2612 that nail cavity 3628 is fired, and/or is fired from the nail cavity 3628 in the first intermediate row Nail 3612 higher forming height is presented than the nail 2612 that the nail cavity 3628 in arranging out of first is fired.In addition or separately Selection of land, the nail that the comparable nail cavity 3628 from the second intermediate row of nail 3612 fired from the nail cavity 3628 in the second outer row is fired 2612 are presented higher forming height, and/or the nail 3612 fired from the nail cavity 3628 in the second intermediate row is than from the Higher forming height is presented in the nail 2612 that nail cavity 3628 in being arranged in two is fired.
In some cases, the nail 3612 fired from nail bin 3620 can have different unshapeds height.For example, outside first The nail 3612 that nail cavity 3628 in row is fired has bigger than the nail 2612 fired from the nail cavity 3628 in the first intermediate row Unshaped height, and/or the nail 3612 fired from the nail cavity 3628 in the first intermediate row is than the nail in being arranged out of first The nail 2612 that chamber 3628 is fired has bigger unshaped height.In addition or alternatively, from the nail cavity in the second outer row The nail 3612 of 3628 percussions has bigger unshaped height than the nail 2612 fired from the nail cavity 3628 in the second intermediate row, And/or the nail 3612 fired from the nail cavity 3628 in the second intermediate row is fired than the nail cavity 3628 in being arranged out of second Nail 2612 has bigger unshaped height.
In all cases, the nail array with different unshapeds height and/or differing formed height can be incorporated into that herein In described various nail bins.For example, nail bin 3420 (Figure 43-Figure 45) and nail bin 3520 (Figure 46-Figure 48) may include there is difference The nail of unshaped height and/or it is configured to nail being fired into differing formed height.In such cases, step Formula storehouse platform 3422 (Figure 43-Figure 45), 3522 (Figure 46-Figure 48) and 3622 (Figure 49-Figure 51) can influence for example variable preshot Tissue compression is sent out, and different forming nail heights can influence for example variable rear percussion tissue compression.
As described herein, angled nail array provides improved flexibility for suture tissue.Relative to nail bin line of cut and/ Or the angled nail of longitudinal axis can have than another nail leg portion closer to a nail leg portion of line of cut.In such arrangement In, customized and/or optimizing tissue compression in order to lateral, nail can be formed differing formed height.For example, an end of nail can Be formed as the first height, and another end followed closely is formed as the second different height.In such cases, by identical row's The tissue of nail processing can be subjected to different compression stresses.
Nail bin 3720 and anvil block 3703 are shown in Figure 79.Nail bin 3720 is similar to nail bin 3620 (Figure 49-Figure 51), and class As reference represent similar element.For example, nail bin 3720 includes warehouse 3724 and platform 3722.Platform 3722 includes many Individual longitudinally extending portion 3722a, 3722b, 3722c, and adjacent longitudinal portions 3722a, 3722b, 3722c are by 3723 points of ridge Open.At least a portion Longitudinal extending of length of the ridge 3723 along warehouse 3722.Angled nail cavity 3728 is limited to warehouse In 3724, and ridge 3723 extends through nail cavity 3728.Therefore, the first end of shown nail cavity 3728 is positioned in first longitudinal direction In the 3722a of part, and the second end of shown nail bin 3728 is positioned in the 3722b of second longitudinal direction part.In addition, longitudinal direction is narrow Groove 3732 is defined as partially across shown warehouse 3724.
In all cases, nail bin 3720 may include multiple nail cavities 3728, and it is configured to receive angled nail 3712 array.For example, nail bin 3720 may include the arrangement of nail cavity 3728, the arrangement corresponds to the nail shown in Figure 49-Figure 51 The arrangement of chamber 3628.In some cases, three nail chambers 3728 can be positioned on such as both sides of longitudinal slit 3732.
Unshaped nail 3712 and change staple 3712 ' are shown in Figure 79.Nail 3712 includes base portion 3714, extended from base portion 3714 The first leg 3716 and from base portion 3714 extend the second leg 3718.Driver 3740 is also depicted in Figure 79.Driver 3740 include groove or support 3742, and the groove or support are configured to the base portion 3714 of support nail 3712.The He of driver 3740 Be defined in support 3742 therein has variable height between the first end 3741 and the second end 3743 of driver 3740. For example, the first end 3741 of driver 3740 limits the first height, and the second end 3743 of driver 3740 limits the Two height, second height is less than the first height.
Driver 3740 in the nail cavity 3728 by percussion and rise when, nail 3712 rides over lifting driver 3740 upwards On, and deformed by the nail shapes pit 3705 of anvil block 3703.Forming nail 3712 ' is also depicted in Figure 79.The shaping of nail 3712 ' is high Degree is the function in the distance between nail shapes pit 3705 of the driver 3740 and anvil block 3703 lifted or gap.Because lifting The distance between nail support surface 3742 and nail shapes pit 3705 of driver 3740 in the nail bin disclosed in Figure 79 Change in 3720, so forming nail 3712 ' has variable height.For example, the height of forming nail 3712 ' is in the first leg 3716 ' It is bigger than between the second leg 3718 ' and base portion 3714 ' between base portion 3714 '.In all cases, the angle of nail 3712 ' First leg 3716 ' can be positioned to than the second leg 3718 ' further from longitudinal slit 3732 by degree orientation.In such cases, First leg 3716 ' can be the outer leg of nail 3712 ', and the second leg 3718 ' can be the interior leg of nail 3712 '.So Arrangement in, tissue compression is between interior leg 3718 ' and base portion 3714 ' than between outer leg 3716 ' and base portion 3714 ' Greatly.
It is configured to nail bin and anvil block arrangement (such as He of nail bin 3720 for angled nail is deformed into differing formed height Anvil block 3705) for example it may be incorporated into other embodiments disclosed herein.For example, following closely the driving of supporting support with variable height Device (such as driver 2740) for example may be incorporated into other nail bins disclosed herein and/or end effector assemblies.
The unshaped nail 3712 being shown in Figure 79 also has variable height.For example, nail 3712 is limited at the first leg 3716 Fixed first height and the height of restriction second at the second leg 3718, second height are less than the first height.In addition, nail 3712 Base portion 3714 limit bending section or step 3715, it lifts the second leg 3718 relative to the first leg 3716.
In other cases, unshaped nail 3712 can have even height.In addition or alternatively, unshaped nail 3712 Base portion 3714 can be straight or substantially straight between the first leg 3716 and the second leg 3718.In such cases, when When the distance between nail support surface 3742 and nail shapes pit 3705 of the driver 3740 of lifting are variable, nail 3712 can be still Variable forming height is so presented.For example, a nail leg portion in nail leg portion 3716,3718 than another nail leg portion 3716, 3718 more deform and/or are compacted adapt to additional leg length.In addition, because nail support surface 3742 and nail shapes pit The distance between 3705 change, so base portion 3714 can bend and/or be otherwise deformed during firing to adapt to height Difference.
Nail bin 3820 and anvil block 3803 are shown in Figure 80.Nail bin 3820 is similar to nail bin 3620 (Figure 49-Figure 51), and class As reference represent similar element.For example, nail bin 3820 includes warehouse 3824 and platform 3822.With (the figure of platform 3622 49- Figure 51) it is different, platform 3822 has flat or general planar non-stepped surface.Angled nail cavity 3828 is limited to In warehouse 3824.In addition, longitudinal slit 3832 is limited partially across shown warehouse 3824.
In all cases, nail bin 3820 may include multiple nail cavities 3828, and it is configured to receive angled nail Array.For example, nail bin 3820 may include the arrangement of nail cavity, the arrangement corresponds to the cloth of the nail cavity 3628 shown in Figure 49-Figure 51 Put.In some cases, three nail chambers 3828 can be positioned on such as either side of longitudinal slit 3832.
Unshaped nail 3812 is shown in Figure 80.Nail 3812 includes base portion 3814, the first leg extended from base portion 3814 3816 and from base portion 3814 extend the second leg 3818.Driver 3840 is also depicted in Figure 80.Driver 3840 includes groove Or support 3842, it is configured to the base portion 3814 of support nail 3812.
Anvil block 3803 includes the lateral step formula surface 3801 towards storehouse.First nail shapes pit 3805a and second is followed closely into Shape pit 3805b is limited in stepped surface 3801.As shown in Figure 80, the first nail shapes pit 3805a is in step In the first step 3801a on surface 3801, and the second nail shapes pit 3805b is in the second step of stepped surface 3801 In 3801b.
Driver 3840 in the nail cavity 3828 by percussion and when being lifted, nail 3812 rides over lifting driver 3840 upwards On, and deformed by nail shapes pit 3805a, 3805b of anvil block 3803.Forming nail 3812 ' is also depicted in Figure 80.Nail 3812 ' Forming height be the distance between nail shapes pit 3805a, 3805b of driver 3840 and anvil block 3803 of lifting or gap Function.Because between the nail support surface 3842 of the driver 3840 of lifting and each nail shapes pit 3805a, 3805b Distance is different in the nail bin 3720 shown in Figure 79, so variable height is presented in forming nail 3812 '.For example, forming nail 3812 ' Height is bigger than between the second leg 3818 ' and base portion 3814 ' between the first leg 3816 ' and base portion 3814 '.Various In the case of, the first leg 3816 ' can be positioned to than the second leg 3818 ' further from longitudinal slit by the angular orientation of nail 3812 ' 3832.In such cases, the first leg 3816 ' can be the outer leg of nail 3812 ', and the second leg 3818 ' can be nail 3812 ' interior leg.In such an arrangement, tissue compression is comparable in outer leg between interior leg 3818 ' and base portion 3814 ' It is bigger between 3816 ' and base portion 3814 '.
In other cases, nail 3812 ' can be deformed into smaller height at the outer place of leg 3816 '.Therefore, tissue compression exists Than bigger between interior leg 3818 ' and base portion 3814 ' between outer leg 3816 ' and base portion 3814 '.
It is configured to nail bin and anvil block arrangement (such as He of nail bin 3820 for angled nail is deformed into differing formed height Anvil block 3805a, 3805b) for example it may be incorporated into other embodiments disclosed herein.For example, variable depth pit (such as pit 3805a, 3805b) for example it may be incorporated into other embodiments disclosed herein.
The unshaped nail 3812 being shown in Figure 80 has variable height.For example, nail 3812 is limited at the first leg 3816 First height and the height of restriction second at the second leg 3818, second height are less than the first height.
In other cases, unshaped nail 3812 can have even height.In such cases, when the driver of lifting When the distance between 3840 nail support surface 3842 and nail shapes pit 3805 are variable, nail 3812, which can be still presented, to be become Shape height.For example, one in nail leg portion 3816,3818 more deforms and/or is compacted than another nail leg portion 3816,3818 To adapt to additional length.
In certain form of surgical operation, the use of surgical staples or surgical fastener turns into the preferred side of engagement tissue Method, and developed specifically-built surgical stapling device or circular surgical fastener for these applications.For example, intracavitary Or circular stapler has been developed that to use in the surgical operation for forming " identical ".Available for execution anastomosis Circular stapler for example has disclosed in following patent：Entitled " INTRALUMINAL ANASTOMOTIC SURGICAL STAPLER WITH DETACHED ANVIL " United States Patent (USP) 5,104,025, entitled " CIRCULAR STAPLER TISSUE RETENTION SPRING METHOD " United States Patent (USP) 5,309,927, entitled " SURGICAL CUTTING AND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION FORCE " United States Patent (USP) 7,665,647, entitled " SURGICAL STAPLING SYSTEMS AND STAPLE CARTRIDGES FOR DEPLOYING SURGICAL STAPLES WITH TISSUE COMPRESSION FEATURES " United States Patent (USP) 8,668,130, the complete disclosure of each patent is hereby incorporated by reference.
A form of " anastomosis " includes first excision linkage section (being usually ill section) and then connects each section of intestines To surgical operation together.The operation needs to connect together the end of two tubular sections, to form continuous tubular conduit. In the past, this surgical operation was the operation wasted time and energy.Surgeon must accurately cut and the intestines that align end, and logical Cross and keep aligned condition when repeatedly suture connects end.The exploitation of circular fastener enormously simplify anastomosis journey Sequence, and also shorten the time performed needed for anastomosis.
In general, conventional circular stitching unstrument or fastener are made up of slender axles, and the slender axles include nearside actuator Structure and distal side suturing mechanism mounted on the shaft.Distal side suturing mechanism is generally made up of fixed nail bin, the cartridge cloth It is set to multiple nails of circular concentric array.Round cutter is also concentrically attached in storehouse so that it is in the inside of nail.Knife can edge Distal direction is moved axially.What it is from the central axial extension in storehouse is trocar shaft.Trocar shaft also can axially be moved in slender axles It is dynamic.Trocar shaft is configured to be removably attached to anvil member.Anvil member includes nail shaped lower face, and it is by cloth It is set in face of nail bin to form the end of nail when nail is advanced to and is in contact with it.Under the distal face of nail bin and the nail shaping of anvil block The distance between surface is generally controlled by the governor motion for the nearside for being installed to stapler shaft.When surgeon activates actuating mechanism When, while suturing and cutting the tissue being accommodated between nail bin and nail anvil.
When performing anastomosis using circular stapler, intestines initially are sutured usually using conventional surgical stitching unstrument, this is outer Section's stitching unstrument disposes two row's staples on the either side of the target phase (that is, ill section or sample) of intestines.Generally while suture Cut target phase.Next, after sample is removed, anvil block is generally inserted the near of tube chamber (i.e. intestines) by surgeon in staple line nearside Side end.This is completed by the way that anvil head is inserted into surgeon in the entrance that nearside tube chamber (intestines) is cut.Sometimes, anvil block can Per anum is placed, i.e., by the way that anvil head is placed in the distal end of stitching unstrument and by rectal insert tool.Then use The proximal end of intestines is sewn onto anvil shaft by suture or other conventional fastening devices.Next, surgeon's excision is neighbouring The excess tissue of tying, and anvil block is attached to the trocar shaft of stitching unstrument.Surgeon then by by anvil block towards nail bin Pull to close the gap between anvil block and storehouse.When anvil block is moved towards storehouse, the proximal end and distal end of intestines are clamped in Therebetween.Then stitching unstrument is activated, so as to cause staple to be driven to and anvil block shaping contact through two ends of intestines.Meanwhile, When driving is followed closely and shapes nail, driving circular shear blade passes through intestinal tissue end, so as to cut the end of neighbouring interior nail.Connect , surgeon takes out stitching unstrument from intestines, and completes anastomosis.
Effective healing of coloproctosomy can be challenged by a number of factors and condition.For example, healing can be kissed Close the influence of the presence of bacterial pollutant in region.In general practice, the success rate of anastomosis is often as patient recovers to move Move property and improve.Desirably patient recovers content transmission as early as possible.One restraining factors of content transmission are " narrow " Risk.If colonic contents can not be by staple line, or if they significantly compress staple line, then may occur tear, rupture Or leakage.For the organ (such as lung) of high level expansion, develop can linear expansion staple line.However, such nail configuration is uncomfortable Used in reference to circular stapler.
Figure 29 shows to be generally termed as 5000 a form of circular stapler or stitching devices.Various circular seams are attached together Put is well-known and for installing operation nail or fastener.Therefore, except possible it should be understood that being disclosed herein and attached The innovation shown in figure and arrangement, will not be begged in detail herein on the construction of circular stapling device and the various details of operation By.More details on circular fastener and stitching devices are found in entitled " SURGICAL CUTTING AND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION FORCE " United States Patent (USP) 7,665,647 (full patent texts are herein incorporated by reference) and with quote Other United States Patent (USP)s that mode is incorporated herein.In general, suitable for the circular stapling device 5000 in Figure 29 include head 5002, Anvil block 5004, adjustment knob assembly 5006 and the shank 5010 for being supported on trigger 5008.Shank assembly 5010 is led to Cross arch shaft assembly 5012 and be connected to head 5002.In shown arrangement, trigger 5008 by shank assembly 5010 pivotly Support, and for operating stitching unstrument 5000 when release mechanism (not shown) is released.When trigger 5008 is activated, hit Hair mechanism is movably promoted in shaft assembly 5012 so that nail or fastener are discharged or are deployed to and anvil block from head 5002 The shaping contact of 5004 anvil block shaped lower face 5005.Meanwhile, it is operatively supported at circular knife (Figure 29 in head 5002 In it is invisible) promoted towards anvil block 5004 towards distal side, and be clamped in the He of head 5002 for cutting in a known way Tissue between anvil block 5004.Then stitching devices 5000 are removed from operative site, so that suture tissue is stayed in into appropriate location.
Such as from Figure 29 it can also be seen that anvil block 5004 include annular body portion 5014, the annular body portion have from Its anvil shaft 5016 protruded.Anvil shaft 5016 is configured to be removably attached to be operatively supported at shaft assembly Trocar shaft 5050 in 5012.Referring to Figure 29 A.It is well known that trocar shaft 5050 is movably supported with shaft assembly 5012, And operationally join with adjustment knob assembly 5006, the adjustment knob assembly is pivotally supported at shank assembly 5010 On.Anvil shaft 5016 can be removably attached to trocar shaft 5050, or other releasable fasteners by geometrical clamp 5052 It can also be used for anvil shaft 5016 being removably secured to trocar shaft 5050.Once anvil shaft 5016 has been attached to trocar shaft 5050, clinician can be by the way that adjustment knob 5006 be rotated anvil block 5004 toward and away from head along appropriate direction of rotation 5002 movements.
Figure 29 A show head 5002, and the head has the unique and novel fastener cartridge being operably mounted therein Component 5020.As seen from Figure, fastener cartridge assembly 5020 includes warehouse 5022, and the warehouse includes circular platform 5030.Circle Shape platform 5030 can form plane surface 5032, and the plane surface is arranged to when anvil shaft 5016 is attached to trocar shaft 5050 When in face of anvil block 5004 nail shaped lower face 5005.Multiple securing member chambers 5040 are arranged in circular platform 5030 and by structure Cause at least one surgical staples or surgical fastener can be received into (not shown) wherein, the surgical staples or surgical fastener can It is operatively supported on actuator assembly 5060, the actuator assembly is movably supported at the main body of fastener cartridge assembly 5020 In 5022.Actuator assembly 5060 be operably linked to shaft assembly 5012 with trigger 5008 operationally join it is corresponding Moveable part.Enabling for trigger 5008 will for example cause axial movement of the actuator assembly 5060 along distal direction " DD ". Movement of the actuator assembly 5060 along distal direction " DD " will cause the surgical staples that are supported in each securing member chamber 5040 or tight Firmware move or discharge so that with the shaping contact of nail shaped lower face 5005 on anvil block 5004.
Referring still to Figure 29 A, for example, each securing member chamber 5040 includes two chamber ends 5042,5044.In shown arrangement In, each chamber end 5042 (it can also be referred to herein as " the first chamber end ") is positioned in the first radius " FR " In one circular axis " FCA ".First radius " FR " can be measured from apparatus axis axis " SA ".In addition in shown arrangement, chamber end 5044 (it can also be referred to herein as " the second chamber end " and be positioned in the second circular axis with the second radius " SR " On " SCA ", second radius " SR " is different from the first radius " FR ".In the embodiment shown, also measured from axle axis " SA " Second radius " SR " is more than the first radius " FR ".In addition in the embodiment shown in the drawing, each securing member chamber 5040 includes chamber axle Line " CA ".In the embodiment shown in the drawing, each securing member chamber 5040 is relative to the first circular axis " FCA " and the second circular shaft Line " SCA " is disposed in circular platform 5030 so that each cavity axis " CA " and the first circular axis " FCA " and second are circular Axis " SCA " formation acute angle.In other words, the chamber end 5042 of adjacent fastener chamber 5040 is adjacent to each other, and identical fastening The end 5044 of part chamber 5040 is spaced apart from each other.Such arrangement can be referred to herein as " zigzag " orientation.However, other In arrangement, cavity axis " CA " can be perpendicular to the first circular axis " FCA " and the second circular axis " SCA ".
In the arrangement being shown in Figure 29 A, each chamber end 5042,5044 can be V-arrangement so that they are commonly terminated in A bit.For example, each chamber end 5042 can be commonly terminated in a little 5043 and each end 5044 may terminate at a little 5045.Point 5043 can be positioned in the first circular axis " FCA " or intersect with it, and point 5045 can be positioned in the second circular axis Intersect on " SCA " or with it.Such chamber arrangement causes surgical staples or fastener to apply with the pattern similar to tissue.In shown cloth In putting, securing member chamber 5040 each supports a surgical staples or surgical fastener wherein.However, in other arrangements, no Only a nail or fastener can be supported in each chamber.Fastener cartridge assembly 5020 uses class in each securing member chamber 5040 Like the nail of size.In other arrangements, different size of surgical staples or fastener can be used in fastener cartridge assembly.It is adoptable Surgical staples such as two nail leg portions including extending from center body portion or bizet.Leg can be received in securing member chamber 5040 V-arrangement end 5042,5044 in so that when they are projected from chamber 5040, leg extension is through the first circular axis or the Two circular axis, this under any circumstance can.These nail orientations can solve the problem of some are narrow associated with above-mentioned nail. Specifically, the nail configuration formed when using fastener cartridge assembly 5020 can enable staple line than conventional staple line more like original knot Expand and bend intestines.For example, nail or fastener can be distorted when it is radially pulled, so as to allow them to make on healing area Stress minimize and make flexible and maximum intensity.
Another Focus Area associated with coloproctosomy journey code is related to is let out by the radial direction of attachment area Leakage.The problem of above-mentioned fastener cartridge assembly 5020 also can solve the field.Another fastener cartridge assembly 5120 is shown in Figure 30 And it can also solve above-mentioned various problems and misgivings.As seen from Figure, securing member chamber be with the arrangement of " asymmetric pattern ", its Those nails that the nail and the outer shroud or outer circular array of transit chamber that the inner ring or inner circular array of middle transit chamber apply apply Or the function of fastener is different.
More particularly and reference picture 30, fastener cartridge assembly 5120 includes warehouse 5122, and the warehouse includes circular flat Platform 5130.Circular platform 5130 can form plane surface 5132, and the plane surface is arranged to when anvil shaft 5016 is attached to set In face of the nail shaped lower face 5005 of anvil block 5004 during pipe needle shaft 5050.First ring 5036 of the first chamber 5040 is arranged on circular flat In platform 5130, and the second ring 5160 of the second chamber 5170 is set through storehouse platform 5130, as shown in the figure.First chamber 5040 and At least one surgical staples or surgical fastener are received (not shown) wherein by being each configured in two chambers 5170, should Surgical staples or surgical fastener are operatively supported on actuator assembly 5060, and the actuator assembly is movably supported at tightly In the main body 5122 of firmware storehouse component 5120.
Each securing member chamber 5040 includes two chamber ends 5042,5044.Each chamber end 5042 is positioned in the In the first circular axis " FCA " of Radius " FR ".First radius " FR " can be measured from apparatus axis axis " SA ".Each chamber end 5044 are positioned in the second circular axis " SCA " with the second radius " SR ", and second radius " SR " is different from the first half Footpath " FR ".In the embodiment shown, the second radius " SR " also measured from axle axis " SA " is more than the first radius " FR ".It is each tight Firmware chamber 5040 includes cavity axis " CA ".In the embodiment shown in the drawing, each securing member chamber 5040 is relative to the first circular shaft Line " FCA " and the second circular axis " SCA " are disposed in circular platform 5130 so that each cavity axis " CA " and the first circle Axis " FCA " and the second circular axis " SCA " formation acute angle.In other words, the chamber end 5042 of adjacent fastener chamber 5040 that This is adjacent, and the end 5044 of same fasteners chamber 5040 is spaced apart from each other.Such arrangement can be referred to herein as " sawtooth Shape " is orientated.However, in other arrangements, cavity axis " CA " can be perpendicular to the first circular axis " FCA " and the second circular axis “SCA”。
In addition in the arrangement being shown in Figure 30, each chamber end 5042,5044 can be V-arrangement so that they are generally eventually Terminate in a bit.For example, each chamber end 5042 can be commonly terminated in a little 5043 and each end 5044 can be commonly terminated in a little 5045.Point 5043 can be positioned in the first circular axis " FCA " or intersect with it, and point 5045 can be positioned in the second circle Intersect on shape axis " SCA " or with it.Such chamber arrangement causes surgical staples or fastener to apply with the pattern similar to tissue.Separately In being arranged shown in external, the second ring 5160 includes multiple second securing member chambers 5170, and second securing member chamber is in the 3rd circular shaft Alignd on line " TCA ", the 3rd circular axis is arranged in from the 3rd radius " TR " from axle axis " SA ".In shown arrangement, the Three radiuses " TR " are less than the first radius and the second radius.However, in other arrangements, the 3rd radius " TR " is more than the first radius. However, in other arrangement, the 3rd radius " TR " is more than the first radius and the second radius.
Unique and novel fastener cartridge assembly 5120 is used to make nail or fastener in tissue be oriented such that their phases The amount of expansion for being applied to staple line will be " adjustable ".Adoptable surgical staples for example including from center body portion or Two nail leg portions of bizet extension.Leg can be received in the V-arrangement end of securing member chamber so that when they are projected from chamber When, leg extension passes through the first circular axis " FCA ", the second circular axis " SCA " or the 3rd circular axis " TCA ", and this is in office Can in the case of what.These nail orientations can cause the improvement with above-mentioned nail the problem of narrow associated.For example, nail or fastener A ring (for example, second ring 5160) standard seal feature structure is provided, and the first ring 5036 can with the radial direction of staple line and Flexible aspect is more consistent.Therefore, such arrangement can also provide with above for discuss identical of fastener cartridge assembly 5020 or Similar advantage.
Figure 31 shows another unique and novel fastener cartridge assembly 5220, and the fastener cartridge assembly can also solve above-mentioned Various problems and misgivings.As seen from Figure, securing member chamber is that, with the arrangement of " asymmetric pattern ", the inner ring of wherein transit chamber is applied Plus nail and transit chamber those nails for applying of outer shroud or fastener function it is different.
More particularly and reference picture 31, fastener cartridge assembly 5220 includes warehouse 5222, and the warehouse includes circular flat Platform 5230.Circular platform 5230 can form plane surface 5232, and the plane surface is arranged to when anvil shaft 5016 is attached to set In face of the nail shaped lower face 5005 of anvil block 5004 during pipe needle shaft 5050.First ring 5236 of the first chamber 5240 is arranged on circular flat In platform 5230, and the second ring 5260 of the second chamber 5270 is set by storehouse platform 5230, as shown in the figure.First chamber 5240 and At least one surgical staples or surgical fastener are received (not shown) wherein by being each configured in two chambers 5270, should Surgical staples or surgical fastener are operatively supported on actuator assembly 5060, and the actuator assembly is movably supported at tightly In the main body 5222 of firmware storehouse component 5220.
Each securing member chamber 5240 includes two chamber ends 5242,5244.Each chamber end 5242 is positioned in the In the first circular axis " FCA " of Radius " FR ".First radius " FR " can be measured from apparatus axis axis " SA ".Each chamber end 5244 are positioned in the second circular axis " SCA " with the second radius " SR ", and second radius " SR " is different from the first half Footpath " FR ".In the embodiment shown, the second radius " SR " also measured from axle axis " SA " is more than the first radius " FR ".It is each tight Firmware chamber 5240 includes cavity axis " CA ".In the embodiment shown in the drawing, each securing member chamber 5240 is relative to the first circular shaft Line " FCA " and the second circular axis " SCA " are disposed in circular platform 5230 so that each cavity axis " CA " and the first circle Axis " FCA " and the second circular axis " SCA " formation acute angle.
In addition in the arrangement being shown in Figure 31, each chamber end 5242,5244 can be V-arrangement so that they are generally eventually Terminate in a bit.For example, each chamber end 5242 can be commonly terminated in a little 5243 and each end 5244 can be commonly terminated in a little 5245.Point 5243 can be positioned in the first circular axis " FCA " or intersect with it, and point 5245 can be positioned in the second circle Intersect on shape axis " SCA " or with it.Such chamber arrangement causes surgical staples or fastener to apply with the pattern similar to tissue.Separately In being arranged shown in external, the second ring 5260 includes multiple second securing member chambers 5270, and second securing member chamber is in the 3rd circular shaft Alignd on line " TCA ", the 3rd circular axis is arranged in from the 3rd radius " TR " from axle axis " SA ".In shown arrangement, the Three radiuses " TR " are less than the first radius and the second radius.However, in other arrangements, the 3rd radius " TR " is more than the first radius. However, in other arrangement, the 3rd radius " TR " is more than the first radius and the second radius.These nail orientations can cause with it is above-mentioned The improvement for the problem of pin structure is associated.Specifically, the nail configuration formed when using fastener cartridge assembly 5220 can make nail Line more like original colon can expand and bend than conventional staple line.For example, nail or fastener can be turned round when it is radially pulled Song, so as to allow them to minimize the stress on healing area and make flexible and maximum intensity.
It has been proved that auxiliary film/backing material can improve hemostasis and wind-puff by being sealed in around nail end.Permitted In many applications, backing material is used to harden and/or strengthen soft tissue.Various backing material arrangements have been developed that and are configured to Surgery nail bin or anvil block for being arranged in surgical stapling device.Supporting member is attached to storehouse or anvil block, then released from it It is probably challenging to put backing material.Figure 58 shows surgical end-effector 5300 and surgery cuts and fastening instrument 5400 part.End effector 5300 uses unique and novel arrangement supporting member 5500 is attached into surgical staples Storehouse 5320 simultaneously therefrom discharges it.The surgery cuts for the type being shown in Figure 58 and the example of fastening instrument were June 30 in 2014 Entitled " the SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING that day submits Have disclosed in ARRANGEMENTS " U.S. Patent Application Serial Number 14/318,991, the complete disclosure evidence of this application This is herein incorporated by reference.Other details in addition to needed for the construction and purposes that understand end effector 5300 can be with Collected with reference to the document and many other documents being herein incorporated by reference.
Visible in such as Figure 58, being shown in end effector 5300 therein includes elongate staple channel 5302, the elongate staple channel It is configured to be operably supported nail bin 5320 wherein.Elongate staple channel 5302 is connected to ridge part 5404, the spine Divide and be operatively supported in the Slender axles assembly 5402 of surgery suturing appliance 5400.Nail bin 5320 includes warehouse 5322, the storehouse Body can be made up of polymeric material.In the embodiment shown in the drawing, metal chassis 5324 is attached to warehouse 5322.Warehouse 5322 is wrapped Platform 5330 is included, the platform, which has, is defined in multiple nail cavities 5332 therein.Each nail cavity 5332 is configured to can by nail It is stored therein in removing.Warehouse 5322 also includes longitudinal slit, and the longitudinal slit is configured to firing member 5410 It is removably received in wherein.Warehouse 5320 may also include distal end 5326, proximal end 5328 and in distal end The relative longitudinal direction side 5329 extended between 5326 and proximal end 5328.In all cases, side 5329 may include longitudinally in each It is defined in the adjoining therein without interruption or continuous boundary.
It is nail 5342 to be positioned in each nail cavity 5332, and the nail is supported on correspondence staple drivers 5340, nail driving Device is movably supported in warehouse 5322.When firing member 5410 drives through nail bin 5320 towards distal side, staple drivers 5340 are moving upward.Such as discussed in more detail in U.S. Patent Application Serial Number 14/318,991, the quilt of firing member 5410 It is constructed to be permeable to promote nail sliding part 5350 towards distal side to be lifted up staple drivers 5340 and nail 5342 and be lifted out nail Chamber 5332.End effector 5300 also includes the anvil block 5360 for being installed to elongate staple channel 5302.In the embodiment shown in the drawing, Anvil block 5360 includes a pair of the lugs 5362 being movably received in the lug slit 5304 in elongate staple channel 5302.Such as exist Furthermore, it can be seen that anvil block 5360 includes anvil block lug 5364 in Figure 58, the anvil block lug interacts with closure pipeline section 5420.Close Anvil block 5360 can be moved along the direction towards nail bin 5320 by closing movement of the pipeline section 5420 along distal direction " DD ".The edge of closed tube 5420 The movement of proximal direction " PD " causes anvil block to move away from nail bin 5320.Other embodiments can be using storehouse and anvil block arrangement, its Middle anvil block is static (for example, the slender axles for the surgical device that is immovably secured to), and elongated passageway and/or nail bin energy It is enough to be moved toward and away from anvil block.
Visible in such as Figure 58 and Figure 59, supporting member 5500 is configured to receive in surgery nail bin 5320 and anvil block Between 5360.More precisely, supporting member 5500 is configured to receive the nail shaped lower face 5366 in anvil block 5360 Between the platform 5330 of nail bin 5320.In the embodiment shown in the drawing, supporting member 5500 is configured to be tensioned ground On the platform 5330 of nail bin 5320.Constituting the backing material of supporting member 5500 may include such as Gore SeamGuard Material, Synovis Peri-Strips materials and/or polyurethane.Other suitable backing materials or auxiliary material were at 2014 6 Entitled " the SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING that the moon is submitted on the 30th Have disclosed in ARRANGEMENTS " U.S. Patent Application Serial Number 14/318,991, in the entire disclosure of the patent application Appearance is previously hereby incorporated herein by.Various other suitable backing materials and auxiliary material are also on 2 28th, 2013 Entitled " the LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES " U.S. Patent application submitted Have disclosed in sequence number 13/763,095, the complete disclosure of the patent application is hereby incorporated herein by accordingly. The complete disclosure of following application is also incorporated herein by reference：Entitled " the TISSUE that on June 25th, 2012 submits STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC Entitled " the TISSUE STAPLER that AGENT " U.S. Patent Application Serial Number 13/531,619, on June 25th, 2012 submit HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT " U.S. Entitled " the TISSUE STAPLER HAVING A submitted in state's patent application serial number 13/531,623, on June 25th, 2012 THICKNESS COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT " U.S. Patent application sequence Entitled " the TISSUE STAPLER HAVING A THICKNESS submitted in row number 13/531,627 and on June 25th, 2012 COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT " U.S. Patent Application Serial Number 13/ 531,630。
In the embodiment shown in the drawing, nail bin 5320 includes protuberance 5336, and the protuberance is with U.S. Patent Application Serial The platform 5330 of the various modes and arrangement from the neighbouring each nail cavity 5332 that are described in detail in number 14/318,991 is upwardly extended. In other embodiments, nail bin does not have such protuberance.In the embodiment shown in the drawing, supporting member 5500 includes wherein Hole 5502, the hole corresponds to protuberance 5336.See, for example, Figure 61 and Figure 62.However, visible in such as those figures, hole 5502 only holds Receive protuberance 5336 so that backing material crosses at least one of region for the bizet for corresponding to the nail being supported in chamber.Branch Those parts corresponding to crown part of timbering material are generally designated 5504 in Figure 61 and Figure 62.
Supporting member 5500 includes the device for being used to being releasably secured to supporting member 5500 into warehouse 5322 so that branch Support component 5500 is maintained at thereon with being tensioned before the actuating of surgical instruments, is then activated or " percussion " in surgical instruments When discharged from warehouse 5322.For example, visible in such as Figure 58, supporting member 5500 includes distal end 5503, and the distal end exists Wherein there is at least one distal side to keep feature structure 5506.In shown arrangement, two distal apertures 5506 are arranged on distal side In end 5503 and it is configured to receive the corresponding holding member 5338 protruded from the distal end 5326 of warehouse 5322. As shown in Figure 59 and Figure 60, holding member 5338 is configured to receive the distal end portion 5503 in supporting member 5500 In distal aperture 5506 in, the distal end of supporting member 5500 is releasably held in the distal end portion in storehouse 5320 On 5326.When tension force is applied into supporting member 5500 along proximal direction and/or distal direction, it can also take other form Supporting member 5500 is releasably held in nail bin by releasable holding member (shape, quantity, size, configuration) and arrangement On 5320.
Figure 63-Figure 65 is gone to, supporting member 5500 includes proximal end part 5510, and the proximal end part has thereon There is nearside to keep feature structure 5511.In the embodiment shown in the drawing, nearside keeps feature structure 5511 to include from it proximally At least one prominent keeps lug 5512.Lug 5512 is kept to be positioned such that when hole 5506 is inserted on warehouse 5322 Above holding member 5338 and when supporting member 5500 is received on storehouse platform 5330, lug 5512 and warehouse 5322 are kept In elongated slot 5334 align.Referring to Figure 64.When nail sliding part 5350 is in its nearside original position in storehouse 5320, protect Hold lug 5512 to be folded in the proximal end of warehouse, and be maintained at by nail sliding part 5350 in elongated slot 5334.Nail Sliding part 5350 can be U.S. Patents Serial numbers 14/318, type and construction disclosed in 991, it includes stabilizing member 5352, The stabilizing member extends with Stable sliding part 5350 towards distal side and prevents and/or suppress the shake or rotation of nail sliding part 5350 Turn.It is visible in such as Figure 65, keep lug 5512 to be maintained at thin by the other parts of stabilizing member 5352 and/or nail sliding part 5350 In long slit 5534.Such arrange is tightly retained in nail platform 5330 for 5500 by supporting member.In other words, prop up Support component 5500 can stretch between the proximal end 5328 of holding member 5338 and nail bin 5320.When clinician activates surgery Apparatus is to start during percussion process, and firing member 5410 is promoted along distal direction " DD " towards distal side.Firing member 5410 is slided with nail Moving part 5350 joins, and such as U.S. Patent Application Serial Number 14/318, discussed in 991, and firing member 5410 will be followed closely and slided Part 5350 is moved distally through nail bin 5320 to drive up staple drivers 5340 so that the nail 5342 being supported on is driven The shaping contact of downside 5366 with anvil block 5360 is moved, and the tissue being clamped between anvil block 5360 and nail bin 5320 is cut Component 5410 is cut off.Once nail sliding part 5350 is had disengaged from keeping lug 5512 to remain engaged with, holding lug 5512 just by Release, so that backing material 5500 can be removed with suture tissue from nail bin 5320.It is such to arrange for firing The tension force in backing material 5500 is discharged when journey starts.In addition, such support arrangement does not need additional releasing parts or configuration.
Existing suturing skill is not particularly well-suited for undergoing the tissue of stretching, extension during agglutination.For example, in chest thin-walled In tissue apposition, staple line is fired on the lung in collapsed configuration.After the completion of operation, atelectasis, this frequently results in the table of lung Area is doubled.Existing suturing skill is generally without the expansion service with lung tissue same degree.This may cause close to nail The notable strain gradient of line, this may cause the high stress in staple line, particularly in the staple farthest from cutting edge.Therefore, In order to mitigate strain gradient and related stress with eliminate or at least reduce potential leaking source, it is necessary to allow staple line stretch and/or Increase the technology of length.
It has been proved that auxiliary film/backing material can improve hemostasis and wind-puff by being sealed in around nail end.Permitted In many applications, backing material is used to harden and/or strengthen soft tissue.However, existing backing material may not have enough Elasticity, so that the compliance of without prejudice to elasticity staple line.Figure 66-Figure 68 shows a form of backing material 6100, the fid The problem of material can solve such.Such as visible in these figures, backing material 6100 includes supportive body 6102, the supportive body It is sized to operationally receive on the platform 6004 of surgery nail bin 6000.In the embodiment shown, surgery nail bin 6000 include limiting the warehouse 6002 of platform 6004.Warehouse 6002 includes the elongated slot 6006 being centrally located, the elongated slot It is configured to receive tissue cutting element (not shown) through it.Multiple nail pits or nail cavity are in the every of elongated slot 6006 It is arranged on side in platform 6004.As illustrated, the first row 6010 of the first chamber 6012 is arranged on elongated slot 6006 Every side on.The first chamber 6012 in each first row 6010 is parallel to each other.Each it is arranged to phase in first chamber 6012 It is angled and adjacent thereto for elongated slot 6006.Shown warehouse 6002 also includes being arranged to relative to the first nail cavity Two rows 6020 of 6012 the second angled nail cavities 6022.Two rows 6030 of the 3rd nail cavity 6032 are also disposed in warehouse 6002 In, as shown in the figure.In at least one form, the 3rd nail cavity 6032 is parallel with corresponding first nail cavity 6012.However, it can be used It is followed closely or securing member chamber arrangement.In addition, staple cartridge body 6002 can have the lateral lip 6008 projected laterally therefrom.In addition such as Figure 66 In it is visible, the proximal end 6003 of warehouse 6002 is more narrower than the remainder of warehouse 6002.
In the embodiment shown in the drawing, supportive body 6102 includes four edges 6110,6140,6150,6160 and center Part 6152.At least two in edge 6110,6140,6150,6160 include various edge notches configurations.In the implementation of diagram In scheme, edge 6110,6160 includes edge notches wherein.More particularly, such as visible, first group of first edge in Figure 67 Recess 6114 is formed in the Part I 6112 of first edge 6110.In the embodiment shown in the drawing, first edge recess 6114 are extended internally and parallel to each other with the first acute angle 6115 (" recess angle ") from first edge part 6112.Such as Figure 66 and figure Furthermore, it can be seen that second edge recess 6118 extends internally from the Part II 6116 of first edge part 6112 in 67.One Plant in arrangement, for example, second edge recess 6118 extends (" recess angle ") from Part II 6116 perpendicularly inward.Such as Figure 66 and Furthermore, it can be seen that the 3rd edge notches 6122 extend internally from the Part III 6120 of first edge part 6110 in Figure 67. In one kind arrangement, for example, the 3rd edge notches 6122 extend (" recess angle ") from Part III 6120 perpendicularly inward.Such as Figure 66 With in Figure 67 furthermore, it can be seen that the 4th edge notches 6126 extend internally from the Part IV 6124 of first edge part 6110. In one arrangement, for example, the 4th edge notches 6126 are extended internally with acute angle (" recess angle ") from Part IV 6124.As schemed Furthermore, it can be seen that the 5th edge notches 6130 are inwardly prolonged from the Part V 6128 of first edge part 6110 in 66 and Figure 67 Stretch.In one arrangement, for example, the 5th edge notches 6130 are extended internally with acute angle (" recess angle ") from Part V 6128.
Referring still to Figure 66 and Figure 67, a series of primary part of primary edge notches 6164 from second edge portion 6160 6162 extend internally.In shown arrangement, primary edge notches 6164 extend perpendicularly inward from primary marginal portion 6162 (" recess angle ").As in Figure 66 and Figure 67 furthermore, it can be seen that secondary edge notches 6168 are from the sub-section of second edge 6160 6166 extend internally.In one arrangement, for example, secondary edge notches 6168 with acute angle (" recess angle ") from secondary marginal portion 6166 extend internally.As in Figure 66 and Figure 67 furthermore, it can be seen that three-level edge notches 6172 are from the three-level portion of second edge 6160 6170 are divided to extend internally.In one arrangement, for example, three-level edge notches 6172 with acute angle (" recess angle ") from three-level part 6170 extend internally.As in Figure 66 and Figure 67 furthermore, it can be seen that level Four edge notches 6176 are from the level Four portion of second edge 6160 6174 are divided to extend internally.In one arrangement, for example, level Four edge notches 6176 extend perpendicularly inward from level Four part 6174 (" recess angle ").As in Figure 66 and Figure 67 furthermore, it can be seen that Pyatyi edge notches 6180 are from the Pyatyi of second edge portion 6160 Part 6178 extends internally.In one arrangement, for example, Pyatyi edge notches 6180 are prolonged perpendicularly inward from Pyatyi part 6178 Stretch at (" recess angle ").
Be shown in Figure 66 has five kinds of different width with the backing material 6100 in Figure 67 also along the total length of supporter 6100 Spend W1, W2, W3, W4, W5.W1 corresponds to marginal portion 6112,6162.W2 corresponds to marginal portion 6116,6166.W3 corresponds to Marginal portion 6120,6170.W4 corresponds to marginal portion 6124,6174.W5 corresponds to marginal portion 6128,6178.Other The width of constant width or varying number can be had by supportting material embodiments, its contribute to surgery suturing appliance nail bin and/ Or the operable support on anvil block.In addition, the quantity of edge notches, shape, size and arrangement can change according to embodiment.
In the embodiment being shown in Figure 66 and Figure 67, backing material 6100 includes multiple cutouts wherein.Such as Visible in those figures, otch is arranged to parallel.Specifically, the otch 6204 in row 6200 includes slit, the slit Angularly arranged relative to marginal portion so that the otch 6204 often arranged in 6200 is parallel to each other.Otch 6204 can with or can Not extend completely through backing material 6100.Similarly, the otch 6206 in row 6202 includes slit, and the slit is vertically horizontal To in the marginal portion of backing material 6100.Otch 6206 may or may not extend fully through backing material 6100.At it In its embodiment, quantity, shape, size, orientation, spacing, depth and the position of such otch can change.
Figure 68 shows a kind of otch arrangement, and wherein nail cavity position 6012,6022 and 6032 are shown in broken lines.Such as can from the figure See, when backing material 6100 is positioned to be registered on the platform 6004 of surgery nail bin 6000, do not have in any otch 6204,6206 Have in any one that a part is positioned in nail cavity 6012,6022,6032.Figure 69 shows similar backing material arrangement, Wherein nail cavity 6012,6022 and 6032 are shown in broken lines.Wherein nail/fastener leg of backing material 6100 ' will finally be penetrated Part 6103 it is also shown in broken lines.Part 6103 is alternatively referred to as " nail penetrating region " herein.As seen from Figure, otch 6208th, no one of any one in 6209 part is located at any or top of nail penetrating region 6103.Otch 6208 and 6209 exists It is arranged to longitudinal row in backing material 6100 '.Otch 6208 in often arranging is substantially parallel to one another, and relative to backing material 6100 ' edge is arranged with acute angle.Similarly, the otch 6209 in often arranging is substantially parallel to one another, and is arranged such that it Otch 6208 in adjacent row.Otch 6208 may or may not extend fully through backing material 6100 '.In addition Visible in such as Figure 69, an entire row otch 6208 is located between the position of securing member chamber 6032 and the edge of backing material 6100 ', with Contribute to the further flexibility of backing material 6100 '.It is the quantity of such otch, shape, big as other embodiments Small, orientation, spacing, depth and position can change.
Figure 70 shows another supporting member embodiment 6100 ".In this embodiment, backing material includes multiple sides Emargination mouthful 6300, the edge notches include forming the wavy curve of the fluctuating at snakelike edge.Such edge notches/snakelike edge permits Xu Ding rotations reduce the material stress during expansion simultaneously.
Figure 71 and Figure 72 show another supporting member 6400, and the supporting member is by that can be bioabsorbable or can be with It is not made of bioabsorbable weaving material.In addition, backing material may include any one of backing material as described herein, And including unique and novel attribute described below.For example, supporting member 6400 may include the hole through it or opening 6402, for coordinating with the part (for example, post, projection etc.) of surgery nail bin or the corresponding shaping of anvil block, by supporting member 6400 are supported relative to nail/fastener in nail bin with required orientation/registration.In shown arrangement, supporting member 6400 is wrapped The multiple nail areas 6404,6406,6408 being located therein are included, for when supporting member 6400 is supported on the platform of storehouse and outer The registration of corresponding securing member chamber 6012,6022,6032 in section's nail bin.Nail area can heat to promote material by compression material and to it Material is for good and all presented compressive state and formed.Visible in such as Figure 72, compression nail region (being typically expressed as 6410) has than support The smaller tranverse sectional thickness of the adjacent uncompressed part (being typically expressed as 6412) of component 6400.In addition, supporting member 6400 can With linear edge 6420,6422,6424 and/or snakelike edge 6426.Supporting member can have the surgical staples with surgical instruments The corresponding shape of shape of storehouse and/or anvil block.
All foregoing supporting member embodiments can be used on the platform of surgery nail bin, or the anvil with surgical stapling device Seat is used in combination.All supporting members can have shape corresponding with the shape of surgery nail bin and/or anvil block, and can have straight Line or linear edge or marginal portion and/or the combination of waveform, zigzag and/or snakelike edge or such edge configuration.Branch Support component can have constant width or they can have multiple width.Through backing material otch remove unnecessary material with Promote or allow more shape changeable, distortion etc. of supporter, wherein the stress during longitudinal dilatation in whole backing material compared with It is small.In other words, otch enable supporter with identical mode " folding " when nail is moved in itself.It is snakelike or not Regular edge allows nail rotation while reducing the material stress during expansion.Above-mentioned support configuration includes " softening structure ", and this is soft Changing structure allows increased extensibility, while still sealing relevant range.In addition, above-mentioned supporting member does not suppress nail distortion not only, But also allow nail and adminicle (supporter) to be moved in an identical manner when stretching.Such supporting member arrangement includes support Component, the supporting member consists essentially of the region of the various mechanical behaviors for the optimum performance for allowing staple line.
Figure 73-Figure 78 shows to be similar in construction to another nail bin 6500 of above-mentioned nail bin 6000, the difference is that nail bin 6500 additionally include multiple protruding portion.In the embodiment shown, surgery nail bin 6500 includes limiting the warehouse 6502 of platform 6504. Warehouse 6502 is installed in chassis 6524 and the elongated slot 6506 including being centrally located, and the elongated slot is adapted to It is enough to receive tissue cutting element (not shown) through it.Multiple nail pits of nail cavity are set on every side of elongated slot 6506 Put in platform 6504.As illustrated, the first row 6510 of the first chamber 6512 is arranged on every side of elongated slot 6506. The first chamber 6512 in each first row 6510 is parallel to each other.Being each arranged to relative to elongated slot in the first chamber 6512 6506 is angled and adjacent thereto.Shown warehouse 6502 also includes being arranged to the be at an angle of relative to the first nail cavity 6512 Two rows 6520 of two nail cavities 6522.Two rows 6530 of the 3rd nail cavity 6532 are also disposed in warehouse, as shown in the figure.At least one In the form of kind, the 3rd nail cavity 6532 is parallel with corresponding first nail cavity 6512.Warehouse 6502 also has two longitudinal direction sides 6508.
Warehouse 6502 may also include the multiple protruding portion 6550 extended from platform surface 6504.Protuberance 6550 can be constructed Into the tissue that is positioned in the middle of anvil block 5360 and storehouse 6500 can be engaged, and tissue is controlled relative to the movement in storehouse 6500.Group Knit to move relative to storehouse 6500 in all cases.In the case of at least one, when anvil block is in open position and closing position When being moved between (wherein tissue is compressed between anvil block and storehouse 6500), tissue can flow relative to storehouse 6500.In such feelings Under condition, tissue can flow and/or proximally facing towards the lateral flow of longitudinal direction side 6508, towards distal end 6503 towards distal side Proximally flow end 6505.In the case of at least one other, when cutting element be advanced through towards distal side be trapped in anvil block and During tissue between storehouse 6500, tissue can flow relative to storehouse 6500.In such cases, tissue can laterally, towards distal side and/ Or proximally flow, but because cutting edge is moved distally, so tissue is main towards distal side flowing.In all cases, it is prominent Portion 6550 is configured to that flowing of the tissue relative to nail bin is restricted or prevented.Protuberance 6550 can be positioned on nail cavity 6512nd, at 6522,6532 proximal end and/or distal end.In all cases, each protuberance 6550 may include to surround The set of the end extension of correspondence nail cavity 6512,6522 and 6532.In some cases, each protuberance 6550 may include around pair The arcuate ridge for answering nail cavity 6512,6522 and 6532 to extend.
Figure 76-Figure 78 shows to include the storehouse arrangement of protuberance 6550.The storehouse arrangement being shown in Figure 73-Figure 75 is similar to figure 76- Figure 78 storehouse, but also include the row of protrusion post 6560 formed on platform surface 6504.In Figure 73-Figure 75 arrangement In, for example, prominent post 6560 is arranged between each nail cavity 6512,6522 and 6532 in every nail chamber.Prominent post 6560 For the further flowing of control tissue during clamping and percussion process.
Referring primarily to Figure 73, warehouse 6502 is included in what is extended between the distal end of warehouse 6502 and platform surface 6504 Angled transition 6570.When by storehouse 6500 and anvil positioning in operative site, angled transition 6570 is conducive to storehouse 6500 relative In histokinesis.In this case, tissue can be slided on inclined surface 6570.In other arrangements, inclined surface 6570 Including radiused surface.In shown arrangement, inclined surface 6570 includes angled surface.In other arrangement, inclined surface 6570 include concave surface and/or nonreentrant surface.
The nail cavity 6512,6522 and 6532 in warehouse 6502 is limited on every side of longitudinal slit 6506 with longitudinal row Arrangement.Each protuberance 6550 is configured to support the nail being removedly stored in nail cavity 6512,6522 and 6532 6542 at least a portion.In all cases, each protuberance 6550 can make the end wall of nail cavity 6512,6522 and 6532 6513rd, 6515 extend in the top of platform 6504.In some cases, referring generally to Figure 78, be positioned at nail cavity 6512,6522, Nail 6542 in 6532 includes base portion 6543, the first leg 6545 extended with first angle from base portion 6543 and with second jiao Spend the second leg 6547 extended from base portion 6543.First leg 6545 can be contacted with the first end wall 6513 of nail cavity 6532, and And second leg 6547 can be contacted with the second end wall 6515 of nail cavity 6512,6522,6532.In some cases, 6542 are followed closely The distance between first leg 6545 and the second leg 6547 or extension can be wider than end wall 6513, the distance between 6515 so that When nail 6542 is positioned in nail cavity 6512,6522,6532, leg 6545,6547 is inwardly biased by end wall 6513,6515.When When nail 6542 is not fired with it or non-raised position is stored in nail cavity 6512,6522,6532, the end in nail leg portion 6545,6547 End can be positioned in protuberance 6550.In this case, the nail leg of sustainable simultaneously protecting platform 6504 top of protuberance 6550 Portion end 6545,6547.In some cases, when following closely 6542 in its non-firing position, the end in nail leg portion 6545,6547 The lower section of protuberance 6550 is can be positioned on, and therefore, when following closely 6542 in its non-firing position, protuberance 6550 can not be supported Nail leg portion 6545,6547.When such nail 6542 is fired or is lifted out nail cavity 6512,6522,6532, nail leg portion 6545, 6547 can contact protuberance 6550 and be supported by it.Under any circumstance, protuberance 6550 can be in deployment nail 6542 Shi Jixu support nails leg 6545,6547 is fully fired and/or is lifted out nail cavity 6512,6522,6532 until following closely 6542, So that nail leg portion 6545,6547 is no longer contacted with protuberance 6550.
Layer (such as backing material) can for example be made up of any biocompatible materials.Backing material can be by natural material And/or synthetic material is formed.Backing material can be bioabsorbable and/or not bioabsorbable.It should be appreciated that can be used Naturally, synthesis, bioabsorbable and not bioabsorbable material any combination form backing material.It can be made into backing material Some non-limiting examples of material include but is not limited to for example poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, PEO, polyacrylamide, poly-hydroxyethyl methyl acrylate, polyvinylpyrrolidone, Polyvinyl alcohol, polyacrylic acid, poly- acetic acid esters, polycaprolactone, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether Ester), polyalkylenes oxalates, polyamide, poly- (iminocarbonic ester), polyalkylenes oxalates, polyoxaesters, poe, Polyphosphazene and its copolymer, block copolymer, homopolymer, blend and/or combinations thereof.
Natural biological copolymer can be used to form support material.Suitable natural biological copolymer includes but is not limited to example As collagen, gelatin, fibrin, fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl cellulose, cellulose, Oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, and/or it Combination.Natural biological copolymer can be combined to prepare backing material with other polymeric materials as described herein.People and/or The collagen of animal origin, such as I types pig or bovine collagen, I types people's collagen or type III people's collagen, available for forming backing material.Branch The collagen that timbering material can lose its helical structure at least in part by denatured collagen or by heating or any other method is made, The main non-hydrated a chains by molecular weight close to such as 100kDa of the collagen are constituted.Term " denatured collagen " refers to lose its spiral The collagen of structure.For porous layer as described herein collagen can exemplified by particular such as such as by pepsin digestion and/or The natural collagen or Atelocollagen (atellocollagen) obtained after such as appropriate heating of previous definition.Collagen may be first It is preceding by aoxidizing, methylating, succinylation, ethylization and/or any other known procedure carry out chemical modification.
In the case where backing material is fiber, fiber can be that, suitable for knitting or woven filament or line, or can be Chopped fiber is such as usually used in preparing those of non-woven material.Fiber can be made up of any biocompatible materials.Fiber can be by Natural material or synthetic material are formed.The material for forming fiber can be biological absorptive material or non-bioabsorbable materials.Should Work as understanding, natural material, synthetic material, any combinations of bioabsorbable material and non-bioabsorbable material can be used in shape Into fiber.It can be made into some non-limiting examples including but not limited to poly- (lactic acid) of the material of fiber, poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, PEO, polyacrylamide, poly-hydroxyethyl methyl acrylate, Polyvinylpyrrolidone, polyvinyl alcohol, polyacrylic acid, poly- acetic acid esters, polycaprolactone, polypropylene, aliphatic polyester, glycerine, poly- (ammonia Base acid), copolymerization (ether-ether), polyalkylenes oxalates, polyamide, poly- (iminocarbonic ester), polyalkylenes oxalates, polyoxy it is miscellaneous Ester, poe, polyphosphazene and its copolymer, block copolymer, homopolymer, blend and/or combinations thereof.In fid In the case of expecting for fiber, backing material can be used suitable for forming any method of fibre structure to be formed, methods described bag Include but be not limited to such as knitting, woven, nonwoven techniques.In the case where backing material is foam, porous layer can be used suitable Formed in any method for forming foam or sponge, include but is not limited to the lyophilized of such as composition and be freeze-dried.
Backing material can have hemostatic properties.Can be used to provide with auxiliary stop bleed or bleeding ability fid The explanation example of the material of material includes but is not limited to for example poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (in oneself Ester), poly- (dioxanone), polyalkylene oxide, copolymerization (ether-ether), collagen, gelatin, fibrin ferment, fibrin, fibrin Original, fibronectin splicing variants, elastin, albumin, hemoglobin, ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, hydroxyl Hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose Element, chitosan, chitosan, agarose, maltose, maltodextrin, alginates, clotting factor, methyl acrylate, polyamine group first Acid esters, cyanoacrylate, platelet agonist, vasoconstrictor, alum, calcium, RGD peptide, albumen, protamine sulfate, ε- Aminocaproic acid, ferric sulfate, iron sulfite, iron chloride, zinc, zinc chloride, aluminium chloride, aluminum sulfate, aluminium acetate, permanganate, tannin, Bone wax, polyethylene glycol, fucosan and/or combinations thereof.Use to natural biological copolymer and particularly albumen can be fitted For forming the backing material with hemostatic properties.Suitable natural biological copolymer include but is not limited to for example collagen, gelatin, Fibrin, fibrinogen, elastin laminin, keratin, albumin and/or combinations thereof.Natural biological copolymer can Combine to prepare the porous layer of supporter with any other styptic.Entitled " the BUTTRESS that on July 30th, 2013 announces The entire disclosure of AND SURGICAL STAPLING APPARATUS " United States Patent (USP) 8,496,683 is by reference simultaneously Enter herein.
The entire disclosure of following patent is hereby incorporated by reference：
Entitled " the ELECTROSURGICAL HEMOSTATIC DEVICE " United States Patent (USP) that April 4 nineteen ninety-five announces 5,403,312；
Entitled " the SURGICAL STAPLING INSTRUMENT HAVING announced on 2 21st, 2006 SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " United States Patent (USP) 7,000,818；
Entitled " the MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING that September in 2008 is announced on the 9th INSTRUMENT WITH TACTILE POSITION FEEDBACK " United States Patent (USP) 7,422,139；
Entitled " the ELECTRO-MECHANICAL SURGICAL INSTRUMENT that on December 16th, 2008 announces WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS " United States Patent (USP) 7,464,849；
Entitled " the SURGICAL INSTRUMENT HAVING AN ARTICULATING that on March 2nd, 2010 announces END EFFECTOR " United States Patent (USP) 7,670,334；
On July 13rd, 2010 announce it is entitled " SURGICAL STAPLING INSTRUMENTS " United States Patent (USP) 7, 753,245；
Entitled " the SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER that on March 12nd, 2013 announces CARTRIDGE " United States Patent (USP) 8,393,514；
It is entitled " to there is surgical instruments (the SURGICAL INSTRUMENT HAVING RECORDING of registering capacity CAPABILITIES U.S. Patent Application Serial Number 11/343,803 (being now United States Patent (USP) 7,845,537)) "；
It is filed in entitled " surgery cuts and fastening instrument (SURGICAL with RF electrodes of on 2 14th, 2008 CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES) " U.S. Patent Application Serial Number 12/031,573；
Be filed on 2 15th, 2008 entitled " is used for the end effector (END of surgery cuts and suture instruments EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT) " U.S. Patent Application Serial Number 12/031,873 (being now United States Patent (USP) 7,980,443)；
Entitled " motor driving surgical cutting instrument (MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT U.S. Patent Application Serial Number 12/235,782 (being now United States Patent (USP) 8,210,411)) "；
It is entitled " have can manual refraction trigger system band electrosurgical cut and robotic suturing device (POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM U.S. Patent Application Serial Number 12/249,117 (being now United States Patent (USP) 8,608,045)) "；
Be filed on December 24th, 2009 it is entitled " have electric actuator Direction Control Unit motor driving surgery cut Cutter tool (MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY) " U.S. Patent Application Serial Number 12/647,100 (be now United States Patent (USP) 8, 220,688)；
It is filed in the U.S. Patent Application Serial of in September, 2012 entitled " nail bin (the STAPLE CARTRIDGE) " of 29 days Number 12/893,461 (being now United States Patent (USP) 8,733,613)；
It is filed in entitled " surgery suturing appliance (the SURGICAL STAPLING of on 2 28th, 2011 INSTRUMENT U.S. Patent Application Serial Number 13/036,647 (being now United States Patent (USP) 8,561,870)) "；
Entitled " SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS " U.S. Patent Application Serial Number 13/118,241 (is now U.S. Patent Application Publication 2012/ 0298719)；
It is filed in entitled " the ARTICULATABLE SURGICAL INSTRUMENT on June 15th, 2012 COMPRISING A FIRING DRIVE " U.S. Patent Application Serial Number 13/524,049 (is now U.S. Patent Application Publication 2013/0334278)；
It is filed in entitled " the STAPLE CARTRIDGE TISSUE THICKNESS SENSOR on March 13rd, 2013 SYSTEM " U.S. Patent Application Serial Number 13/800,025；
It is filed in entitled " the STAPLE CARTRIDGE TISSUE THICKNESS SENSOR on March 13rd, 2013 SYSTEM " U.S. Patent Application Serial Number 13/800,067；
It is filed in entitled " the SURGICAL CUTTING AND FASTENING INSTRUMENT on January 31st, 2006 WITH CLOSURE TRIGGER LOCKING MECHANISM " U.S. Patent Application Publication 2007/0175955；And
It is filed in entitled " the SURGICAL STAPLING INSTRUMENT WITH AN on April 22nd, 2010 ARTICULATABLE END EFFECTOR " U.S. Patent Application Publication 2010/0264194 (be now United States Patent (USP) 8,308, 040)。
Although elaborating the various embodiments of device with reference to some disclosed embodiments herein, it can implement to this Many modifications and variations of a little embodiments.In addition, in the case of the open material for some parts, other materials can be used Material.In addition, according to multiple embodiments, single part can be replaced by multiple parts, and multiple parts can be also replaced by Single part, to perform given one or more functions.Described above and the claims below are intended to all such repair Change and modification.
Apparatus as disclosed herein is designed to be dropped after a single use, or it is designed to using many It is secondary.However, in either case, can prosthetic device to be reused after use at least one times.Reparation may include following Any combination of step：Provision for disengagement, then cleans or replaces specific component and then re-assemblied.Specifically, Detachable apparatus, and optionally replace or remove in any combination any number of specific component or the portion of device Part.After cleaning and/or replacing particular elements, device can be re-assemblied for then at restoration facilities or outside it will carry out Used before section's operation by operating team.It will be understood by those of skill in the art that the reparation again of device can be used using a variety of In the technology of dismounting, cleaning/replace and re-assembly.The full model in the application of the purposes and gained prosthetic device of these technologies In enclosing.
Preferably, invention as described herein will be handled before surgical operation.First, obtain and if necessary clear Clean new or used apparatus.Then apparatus can be sterilized.In a kind of sterilization technology, apparatus is placed on closure and close In the container of envelope, in such as plastics or TYVEK bag.Then container and apparatus are placed on can penetrate the container radiation field it is (all Such as γ radiation, X-ray or high energy electron) in.The bacterium in apparatus and in container is killed in radiation.Then can be by sterilized apparatus It is stored in sterile chamber.Sealing container makes apparatus keep sterile, until it is opened in medical facilities.
, can be in the spirit and scope of the disclosure further although the present invention has been described as having exemplary design The modification present invention.Therefore, the application is intended to any modification, purposes or remodeling using its general principles.In addition, this Application is intended to belong to known or usual practice such deviation relative to the disclosure in technology belonging to the present invention.
By reference in full or any patent, announcement or the other open materials that are partly incorporated herein only simultaneously It is incorporated herein in existing definition, statement or the afoul scope of other open materials that the material entered is not proposed with the disclosure. Similarly and under necessary degree, the disclosure being expressly recited herein instead of be herein incorporated by reference any Conflict material.It is any to be herein incorporated by reference but mutually rushed with existing definition as described herein, statement or other open materials This is incorporated under prominent material or part thereof, the degree for only not producing conflict between the material and existing open material being incorporated to Text.

Claims (35)

1. a kind of nail bin, including：
Warehouse, plurality of nail cavity is limited in the warehouse, and wherein longitudinal slit is defined as wearing at least in part Cross the warehouse；With
Multiple nails, the multiple nail is removably positioned in the nail cavity, wherein the multiple nail includes the first nail and second Nail, wherein each nail in the nail relative to the longitudinal slit to stretch elimination angular orientation, it is and wherein the multiple Nail is arranged in interior formed of suture tissue can longitudinally extending array；
Each nail in wherein described nail never percussion configuration can be deformed to percussion configuration, wherein first nail is in institute There is the first forming height when stating percussion configuration, wherein second nail has the second shaping high when in the percussion configuration Degree, wherein first forming height is different from second forming height, and wherein described first nail and the described second nail Strategic Lateral Offset, with provide can the tissue that can be compressed in longitudinally extending array lateral alterable.
2. nail bin according to claim 1, wherein the multiple nail also includes the 3rd nail, wherein the 3rd nail in There is the 3rd forming height during the percussion configuration, and wherein described 3rd forming height is different from first forming height And different from second forming height.
3. nail bin according to claim 2, wherein the 3rd forming height is more than second forming height, and its Described in the second forming height be more than first forming height.
4. nail bin according to claim 3, wherein first nail is adjacent with the longitudinal slit, wherein second nail It is located at laterally outside relative to the described first nail, and wherein described 3rd nail is located at laterally outside relative to the second nail.
5. nail bin according to claim 1, wherein each stretching, extension elimination angle eliminated in angle that stretches includes being situated between In relative to the angle between about 45 degree and about 135 degree of the longitudinal slit.
6. nail bin according to claim 5, wherein it is described can the first nail described in longitudinally extending array relative to institute State the second nail and angularly bias about 90 degree.
7. nail bin according to claim 1, in addition to multiple nail driving surfaces, wherein the nail driving surface is configured to Each nail never firing position in the nail can be moved to firing position, and wherein when the driving surface of following closely is by institute State nail from the non-firing position be moved to the firing position when, the nail can be deformed to described from the non-percussion configuration Percussion configuration.
8. a kind of end effector, including：
First jaw；
Second jaw, second jaw includes nail bin, wherein the nail bin includes；
Warehouse, plurality of nail cavity is limited in the warehouse, and wherein longitudinal slit extends through the warehouse extremely A few part；With
Array is followed closely, the nail array is removably positioned in the nail cavity；
Cutting element, the cutting element is movably positioned along the longitudinal slit；
Drive device, the drive device be used for by it is described nail array be driven into from the nail cavity be positioned at first jaw and In tissue in the middle of second jaw；
Compression control device, the compression control device is used to provide lateral in compression to the tissue by the nail array suture Change；With
Adjusting means is stretched, the stretching, extension adjusting means is used to adjust the extending longitudinally by the tissue of the nail array suture.
9. a kind of nail bin, including：
Warehouse, the warehouse includes platform, and wherein longitudinal slit is defined as at least partially through the warehouse, plurality of Nail cavity is limited in the warehouse, and wherein described platform includes：
Part I, the Part I, which has, to be configured to influence the first elevation of the first tissue compression；With
Part II, the Part II, which has, to be configured to influence the second elevation of minor microstructure compression, wherein described Second elevation is different from first elevation, and minor microstructure compression is different from the first tissue compression, and its Described in Part II be oriented to it is more remote from the longitudinal slit than the Part I；With
Nail, the nail is removably positioned in a nail cavity in the nail cavity, wherein the nail includes：
First leg and the second leg, wherein second leg is oriented to than first leg from the longitudinal slit Far；With
Base portion, the base portion is located in the middle of first leg and second leg.
10. nail bin according to claim 9, wherein first leg is alignd with the Part I of the platform, And wherein described second leg is alignd with the Part II of the platform.
11. nail bin according to claim 10, wherein the platform also includes being located at the Part I and described second Step in the middle of part, and at least one nail cavity in wherein described nail cavity includes traversing the step in the platform Opening.
12. nail bin according to claim 11, wherein the step is along the axle for being arranged essentially parallel to the longitudinal slit Line extends.
13. nail bin according to claim 9, wherein the multiple nail cavity includes the first chamber, wherein the nail is removedly It is positioned in first chamber, wherein first chamber is included in the opening in the platform, wherein the opening includes first End and the second end, and wherein described first end and the second end are positioned in described first of the platform In point.
14. nail bin according to claim 13, wherein the platform also includes being located at the Part I and described second Step in the middle of part, and wherein described step extends along contoured path.
15. nail bin according to claim 14, wherein the nail cavity is arranged on the first side of the longitudinal slit Multiple rows, wherein the multiple row includes first row and second row, and wherein described contoured path is described first Extend between row and the second row.
16. nail bin according to claim 9, wherein the base portion includes first end and the second end, wherein described the One leg extends from the first end, wherein second leg extends from the second end, wherein the nail is constructed Into can be presented at the first end the first forming height and at the second end present the second forming height, and Wherein described second forming height is different from first forming height.
17. nail bin according to claim 9, wherein the first leg described in when the nail is in unshaped configuration includes the One end and from the first end to the first length of the base portion, wherein when the nail is in the unshaped configuration when institute The second leg is stated including second end and from the second end to the second length of the base portion, wherein second length is not It is same as first length.
18. a kind of end effector, including：
Clamping device, the clamping device is used to clamp tissue, wherein the clamping device includes longitudinal slit；
Nail arrangement, the nail arrangement is removably positioned in the clamping device；
Cutter device, the cutter device is used to cut the tissue clamped along the longitudinal slit；
Percussion lock, the percussion lock is used to the nail arrangement being fired into clamping tissue；
Tissue flowing reduces device, and the tissue flowing, which reduces device, to be used to reduce in the tissue by the gripping apparatus grips Lateral tissue flowing；With
Stretching tissue adjusting means, the stretching tissue adjusting means is used for the tissue offer longitudinal direction that suture is arranged by the nail Strain relief.
19. a kind of surgical end-effector, including：
First jaw, first jaw includes nail profiled surface；
Second jaw, second jaw includes nail bin, wherein first jaw and second jaw can open structure Moved between type and closed configuration, and wherein described nail bin includes：
Warehouse, the warehouse includes platform, wherein when first jaw and second jaw are in the closed configuration Tissue compression gap is limited between the platform and the nail profiled surface, wherein the platform includes Part I and the Two parts, and wherein described tissue compression gap is included between first in the middle of the Part I and the nail profiled surface Gap height and the second clearance height in the middle of the Part II and the nail profiled surface, and wherein described second gap Highly it is different from first clearance height；And
Plurality of nail cavity is limited in the warehouse, wherein the multiple nail cavity includes the first chamber and the second chamber, wherein institute State the opening that each nail cavity in nail cavity is included in the platform, and wherein described first chamber the opening relative to institute The opening for stating the second chamber is angularly orientated；With
Multiple nails, the multiple nail is removably positioned in the nail cavity, wherein the multiple nail includes removedly positioning First in first chamber the second nail followed closely and be removably positioned in second chamber.
20. surgical end-effector according to claim 19, wherein each nail in the nail can never fire position Put and be moved to firing position, wherein the energy when being moved to the firing position from the non-firing position of each nail in the nail Enough never deformed configurations are deformed to deformed configuration, wherein first nail has the first deformation high when in the deformed configuration Degree, and wherein described second nail has the second Deformation Height when in the deformed configuration, and wherein described first becomes Shape is highly different from second Deformation Height.
21. surgical end-effector according to claim 19, wherein longitudinal slit are limited in the warehouse, and The opening of wherein described first chamber and the opening of second chamber are positioned on the first side of the longitudinal slit And be angularly orientated relative to the longitudinal slit.
22. surgical end-effector according to claim 19, wherein the multiple nail is arranged to multiple rows, wherein institute Stating multiple rows includes first row and second row, wherein first chamber is located in the first row, and wherein described second chamber In the second row.
23. surgical end-effector according to claim 22, wherein the first row and described the first of the platform Section aligned, and wherein described second row aligns with the Part II of the platform.
24. surgical end-effector according to claim 22, in addition to the drive being movably positioned in the nail bin Dynamic device, wherein the driver includes the first groove and the second groove, wherein second groove is relative to first groove angularly Orientation, wherein it is described first nail include the first base portion, wherein it is described second nail include the second base portion, wherein first base portion and First groove aligns, and wherein described second base portion aligns with second groove.
25. a kind of end effector, including：
First jaw, first jaw includes multiple nail shapes pits, wherein the multiple nail shapes pit includes first pair Pit；With
Second jaw, second jaw includes nail bin, wherein first jaw and second jaw can open structure Moved between type and closed configuration, and wherein described nail bin includes：
Warehouse, plurality of nail cavity is limited in the warehouse, and wherein the multiple nail cavity includes the first chamber；With
First nail, first nail is removably positioned in first chamber, wherein first nail includes：
Base portion, the base portion includes first end and the second end；
First leg, first leg extends from the first end；With
Second leg, second leg extends from the second end；With
First driver, wherein first nail is positioned in the middle of first driver and first pair of pit, wherein First driver is configured to institute when first jaw and second jaw are in the closed configuration The first nail is stated to be moved into engaging with first pair of pit formation so that the first nail never shaped configuration is deformed to shaping structure Type, wherein first nail has at the first end the first height and described the when in the shaped configuration Two ends have the second height, and wherein described first height is different from the described second height.
26. end effector according to claim 25, wherein first driver, which includes step, promotes surface.
27. end effector according to claim 26, wherein the step promotes surface to include：
First elevation adjacent with the first end of the base portion；
Second elevation adjacent with the second end of the base portion；With
Step in the middle of first elevation and second elevation.
28. end effector according to claim 25, wherein first pair of pit includes having the near of the first depth Side pit and the distal side pit with the second depth, and wherein described first depth is different from second depth.
29. end effector according to claim 25, wherein the warehouse also includes platform, wherein longitudinal knife slot is prolonged At least a portion of the platform is extended through, wherein first chamber is included in the first opening in the platform, wherein described First opening extends along axis, and wherein described axis traverses the longitudinal knife slot.
30. end effector according to claim 25, wherein the multiple nail shapes pit also includes second pair of pit, Wherein the multiple nail cavity also includes the second chamber, and wherein described nail bin also includes：
The second nail in second chamber is removably positioned in, wherein second nail includes：
Second base portion, second base portion includes the 3rd end and the 4th end；
3rd leg, the 3rd leg extends from the 3rd end；With
4th leg, the 4th leg extends from the 4th end；With
Second driver, wherein second nail is positioned in the middle of second driver and second pair of pit, wherein Second driver is configured to institute when first jaw and second jaw are in the closed configuration The second nail is stated to be moved into engaging with second pair of pit formation so that the second nail never shaped configuration is deformed to shaping structure Type, wherein second nail has in the 3rd end third height and described the when in the shaped configuration Four ends have the 4th height, and wherein described third height is different from the described 4th height.
31. end effector according to claim 30, wherein second leg than first leg in more lateral, And wherein described 4th leg is than the 3rd leg in more lateral.
32. end effector according to claim 31, wherein second height is more than the described first height, and its Described in the 4th height be more than the third height.
33. end effector according to claim 32, wherein second leg than the 3rd leg in more lateral.
34. end effector according to claim 36, wherein second height is more than the third height.
35. a kind of nail bin, including：
Warehouse, the warehouse includes platform, and plurality of nail cavity is limited in the warehouse, wherein each in the nail cavity Nail cavity is included in the opening in the platform；
Multiple nails, the multiple nail is removably positioned in the nail cavity, wherein each nail in the nail includes：
Base portion, the base portion includes first end and the second end；
First leg, first leg extends from the first end；With
Second leg, second leg extends from the second end；With
Multiple drivers, wherein at least one driver in the driver includes uneven building mortion, so as to purposeful Ground by first leg and second leg of one in nail nail relative to the base portion be formed as it is different into Shape height.
CN201580064655.8A 2014-09-26 2015-09-08 Surgical staple and driver arrangement for a staple cartridge Active CN106999183B (en)

Applications Claiming Priority (3)

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US14/498,105 2014-09-26
US14/498,105 US9801628B2 (en) 2014-09-26 2014-09-26 Surgical staple and driver arrangements for staple cartridges
PCT/US2015/048869 WO2016048646A2 (en) 2014-09-26 2015-09-08 Surgical staple and driver arrangements for staple cartridges

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CN106999183B CN106999183B (en) 2021-08-10

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CN112754576A (en) * 2021-01-23 2021-05-07 常州安康医疗器械有限公司 Minimally invasive endoscope anastomat convenient to locate
CN113288268A (en) * 2021-05-25 2021-08-24 常州安康医疗器械有限公司 Endoscope anastomat capable of being sewn in staggered mode
CN114557745A (en) * 2022-03-24 2022-05-31 杭州圣石科技股份有限公司 Ligation clip for continuous hair

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