CN107405147A - 包含辅助材料的钉仓 - Google Patents
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
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- 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
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- 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
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- 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
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- 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
- A61B2017/07285—Stapler heads characterised by its cutter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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Abstract
本发明公开了包括仓体和层的外科缝合设备。所述层可通过从所述仓体部署并且由砧座导致变形的钉贴靠组织植入。所述仓和所述层包括协同工作的特征结构,所述特征结构减少所述仓与所述层之间的相对运动。此类协同工作的特征结构也可以可释放的方式将所述层保持到所述仓体。所述层可包括例如支撑材料和/或组织厚度补偿件。
Description
背景技术
本发明涉及缝合器械,并且在各种实施方案中,涉及用于制备一个或多个钉排的外科缝合器械。
缝合器械可包括一对协同工作的细长钳口构件,其中每个钳口构件能够插入患者体内并且相对于待缝合和/或切入的组织定位。在各种实施方案中,钳口构件中的一者可支撑其中容纳有至少两个侧向地间隔开的钉排的钉仓,并且另一个钳口构件可支撑具有与钉仓中的钉排对准的钉成形凹坑的砧座。一般来讲,缝合器械还可包括推杆和刀片,所述推杆和刀片可相对于钳口构件滑动以通过推杆上的凸轮表面和/或由推杆推压的楔形滑动件上的凸轮表面将钉从钉仓中依次顶出。在至少一个实施方案中,凸轮表面可被配置成能够启动由仓承载并与钉相关联的多个钉驱动器,以推压钉贴靠在砧座上并且在夹持于钳口构件之间的组织中形成侧向地间隔的变形钉排。在至少一个实施方案中,刀片可跟随凸轮表面并且沿着钉排之间的路线切割组织。此类缝合器械的示例在名称为“SURGICAL STAPLESHAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN ANDSTAPLING INSTRUMENTS FOR DEPLOYING THE SAME”的美国专利7,794,475中有所公开,该专利的全部公开内容以引用方式并入本文。
上述讨论仅是为了举例说明本发明的领域中相关技术目前的各个方面,而不应当视为对权利要求范围的否定。
附图说明
本文所述的实施方案的各种特征在所附权利要求书中进行了具体描述。然而,关于操作的组织和方法的各种实施方案及其优点的各种实施方案可结合如下附图根据以下描述来加以理解:
图1是根据包括阶梯式平台(deck)表面的至少一个实施方案的钉仓的透视图;
图2是图1的钉仓的平台表面的细部图;
图3是图1的钉仓的平面图;
图4是图1的钉仓的正视图;
图5是沿着图3的线5-5截取的图1的钉仓的剖视图;
图6是沿着图3的线6-6截取的图1的钉仓的剖视图;
图6A是可与图1的钉仓一起使用的层的透视图;
图7是根据包括脊状平台表面的至少一个实施方案的钉仓的透视图;
图8是图7的钉仓的平台表面的细部图;
图9是图7的钉仓的平面图;
图10是图7的钉仓的正视图;
图11是沿着图9的线11-11截取的图7的钉仓的剖视图;
图12是沿着图9的线12-12截取的图7的钉仓的剖视图;
图12A是可与图7的钉仓一起使用的层的透视图;
图13是根据包括限定于平台表面中的凹陷的至少一个实施方案的钉仓的透视图;
图14是图13的钉仓的平台表面的细部图;
图15是图13的钉仓的平面图;
图16是图13的钉仓的正视图;
图17是沿着图15的线17-17截取的图13的钉仓的剖视图;
图18是沿着图15的线18-18截取的图13的钉仓的剖视图;
图18A是可与图13的钉仓一起使用的层的透视图;
图19是根据包括波形平台表面的至少一个实施方案的钉仓的透视图;
图20是图19的钉仓的平台表面的细部图;
图21是图19的钉仓的平面图;
图22是图19的钉仓的正视图;
图22A是可与图19的钉仓一起使用的层的透视图;
图23是根据包括波形平台表面的至少一个实施方案的钉仓的透视图;
图24是图23的钉仓的平台表面的细部图;
图25是图23的钉仓的平面图;
图26是图23的钉仓的正视图;
图26A是可与图23的钉仓一起使用的层的透视图;
图27是沿着图21的线27-27截取的图19的钉仓的剖视图;
图28是沿着图25的线28-28截取的图23的钉仓的剖视图;
图29是沿着图21的线29-29截取的图19的钉仓的剖视图;
图30是沿着图25的线30-30截取的图23的钉仓的剖视图;
图31是图19的仓的波形平台表面的细部图;
图32是图23的仓的波形平台表面的细部图;
图33是根据包括仓体和层的至少一个实施方案的钉仓的透视图;
图34是示出相对于仓体滑动的层的图33的钉仓的透视图;
图35是示出被提离仓体的层的图33的钉仓的透视图;
图36是根据至少一个另选实施方案的层的局部透视图;并且
图37是根据至少一个另选实施方案的层的局部透视图。
在若干视图中,对应的参考符号指示对应的部件。本文所述的范例以一种形式示出了本发明的各种实施方案,并且这种范例不应被解释为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人还拥有在下文中标识的美国专利申请,这些美国专利申请各自全文以引用方式并入本文:
名称为“SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS”的美国专利申请序列号12/894,311;现为美国专利申请公布2012/0080496;
名称为“SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGEDSTAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS”的美国专利申请序列号12/894,340;现为美国专利申请公布2012/0080482;
名称为“JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS”的美国专利申请序列号12/894,327;现为美国专利申请公布2012/0080499;
名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE ANDDISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS”的美国专利申请序列号12/894,351;现为美国专利申请公布2012/0080502;
名称为“IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORMARRANGEMENT”的美国专利申请序列号12/894,338;现为美国专利申请公布2012/0080481;
名称为“IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER”的美国专利申请序列号12/894,369;现为美国专利申请公布2012/0080344;
名称为“IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS”的美国专利申请序列号12/894,312;现为美国专利申请公布2012/0080479;
名称为“SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE”的美国专利申请序列号12/894,377;现为美国专利8,393,514;
名称为“SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROLARRANGEMENT”的美国专利申请序列号12/894,339;现为美国专利申请公布2012/0080500;
名称为“SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMINGSYSTEM”的美国专利申请序列号12/894,360;现为美国专利申请公布2012/0080484;
名称为“SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLECARTRIDGE ARRANGEMENTS”的美国专利申请序列号12/894,322;现为美国专利申请公布2012/0080501;
名称为“SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES”的美国专利申请序列号12/894,350;现为美国专利申请公布2012/0080478;
名称为“IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLELAYERS”的美国专利申请序列号12/894,383;现为美国专利申请公布2012/0080345;
名称为“COMPRESSIBLE FASTENER CARTRIDGE”的美国专利申请序列号12/894,389;现为美国专利申请公布2012/0080335;
名称为“FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT”的美国专利申请序列号12/894,345;现为美国专利申请公布2012/0080483;
名称为“COLLAPSIBLE FASTENER CARTRIDGE”的美国专利申请序列号12/894,306;现为美国专利申请公布2012/0080332;
名称为“FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTIONMATRIX ELEMENTS”的美国专利申请序列号12/894,318;现为美国专利申请公布2012/0080480;
名称为“FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENTMATRIX”的美国专利申请序列号12/894,330;现为美国专利申请公布2012/0080503;
名称为“FASTENER SYSTEM COMPRISING A RETENTION MATRIX”的美国专利申请序列号12/894,361;现为美国专利8,529,600;
名称为“FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEMCOMPRISING A RETENTION MATRIX”的美国专利申请序列号12/894,367;现为美国专利申请公布2012/0080485;
名称为“FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER”的美国专利申请序列号12/894,388;现为美国专利8,474,677;
名称为“FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES”的美国专利申请序列号12/894,376;现为美国专利申请公布2012/0080486;
名称为“SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMINGPOCKETS”的美国专利申请序列号13/097,865;现为美国专利申请公布2012/0080488;
名称为“TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER”的美国专利申请序列号13/097,936;现为美国专利申请公布2012/0080339;
名称为“STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLEPORTION”的美国专利申请序列号13/097,954;现为美国专利申请公布2012/0080340;
名称为“STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN ACOMPRESSIBLE PORTION THEREOF”的美国专利申请序列号13/097,856;现为美国专利申请公布2012/0080336;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS”的美国专利申请序列号13/097,928;现为美国专利申请公布2012/0080490;
名称为“TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISINGAN ADJUSTABLE ANVIL”的美国专利申请序列号13/097,891;现为美国专利申请公布2012/0080489;
名称为“STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION”的美国专利申请序列号13/097,948;现为美国专利申请公布2012/0083836;
名称为“COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY”的美国专利申请序列号13/097,907;现为美国专利申请公布2012/0080338;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVINGDIFFERENT PROPERTIES”的美国专利申请序列号13/097,861;现为美国专利申请公布2012/0080337;
名称为“STAPLE CARTRIDGE LOADING ASSEMBLY”的美国专利申请序列号13/097,869;现为美国专利申请公布2012/0160721;
名称为“COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS”的美国专利申请序列号13/097,917;现为美国专利申请公布2012/0083834;
名称为“STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION”的美国专利申请序列号13/097,873;现为美国专利申请公布2012/0083833;
名称为“STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANTCOMPONENTS”的美国专利申请序列号13/097,938;现为美国专利申请公布2012/0080491;
名称为“STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/097,924;现为美国专利申请公布2012/0083835;
名称为“SURGICAL STAPLER WITH FLOATING ANVIL”的美国专利申请序列号13/242,029;现为美国专利申请公布2012/0080493;
名称为“CURVED END EFFECTOR FOR A STAPLING INSTRUMENT”的美国专利申请序列号13/242,066;现为美国专利申请公布2012/0080498;
名称为“STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK”的美国专利申请序列号13/242,086;现为美国专利申请公布2013/0075450;
名称为“STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT”的美国专利申请序列号13/241,912;现为美国专利申请公布2013/0075448;
名称为“SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS”的美国专利申请序列号13/241,922;现为美国专利申请公布2013/0075449;
名称为“SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATINGMULTIPLE ACTUATION MOTIONS”的美国专利申请序列号13/241,637;现为美国专利申请公布2012/0074201;
名称为“SSURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE ENDEFFECTOR”的美国专利申请序列号13/241,629;现为美国专利申请公布2012/0074200;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OFCAPSULES”的美国专利申请序列号13/433,096;现为美国专利申请公布2012/0241496;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS”的美国专利申请序列号13/433,103;现为美国专利申请公布2012/0241498;
名称为“EXPANDABLE TISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/433,098;现为美国专利申请公布2012/0241491;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR”的美国专利申请序列号13/433,102;现为美国专利申请公布2012/0241497;
名称为“RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/433,114;现为美国专利申请公布2012/0241499;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONEMEDICAMENT”的美国专利申请序列号13/433,136;现为美国专利申请公布2012/0241492;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE ANDEXPANSION”的美国专利申请序列号13/433,141;现为美国专利申请公布2012/0241493;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE ARESILIENT LOAD”的美国专利申请序列号13/433,144;现为美国专利申请公布2012/0241500;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE ARESILIENT LOAD”的美国专利申请序列号13/433,148;现为美国专利申请公布2012/0241501;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS”的美国专利申请序列号13/433,155;现为美国专利申请公布2012/0241502;
名称为“METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTSFOR SURGICAL STAPLERS”的美国专利申请序列号13/433,163;现为美国专利申请公布2012/0248169;
名称为“TISSUE THICKNESS COMPENSATORS”的美国专利申请序列号13/433,167;现为美国专利申请公布2012/0241503;
名称为“LAYERED TISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/433,175;现为美国专利申请公布2012/0253298;
名称为“TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS”的美国专利申请序列号13/433,179;现为美国专利申请公布2012/0241505;
名称为“ADHESIVE FILM LAMINATE”的美国专利申请序列号13/763,028;现为美国专利申请公布2013/0146643;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING ALOW PRESSURE ENVIRONMENT”的美国专利申请序列号13/433,115;现为美国专利申请公布2013/0256372;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OFMATERIALS”的美国专利申请序列号13/433,118;现为美国专利申请公布2013/0256365;
名称为“MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/433,135;现为美国专利申请公布2013/0256382;
名称为“TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME”的美国专利申请序列号13/433,140;现为美国专利申请公布2013/0256368;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OFMEDICAMENTS”的美国专利申请序列号13/433,129;现为美国专利申请公布2013/0256367;
名称为“STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMEDSTAPLE HEIGHTS”的美国专利申请序列号11/216,562;现为美国专利7,669,746;
名称为“SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMINGPOCKETS OF VARYING DEPTHS”的美国专利申请序列号11/714,049;现为美国专利申请公布2007/0194082;
名称为“SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVINGDIFFERENT LENGTHS”的美国专利申请序列号11/711,979;现为美国专利8,317,070;
名称为“SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENTHEIGHT”的美国专利申请序列号11/711,975;现为美国专利申请公布2007/0194079;
名称为“SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTSMULTIPLE WIRE DIAMETER STAPLES”的美国专利申请序列号11/711,977;现为美国专利7,673,781;
名称为“SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGECAMS FOR DRIVING STAPLE DRIVERS”的美国专利申请序列号11/712,315;现为美国专利7,500,979;
名称为“STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMEDSTAPLE HEIGHTS”的美国专利申请序列号12/038,939;现为美国专利7,934,630;
名称为“SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVINGDIFFERENT LENGTHS”的美国专利申请序列号13/020,263;现为美国专利申请公布2011/0147434;
名称为“ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCEFORMED STAPLES HAVING DIFFERENT LENGTHS”的美国专利申请序列号13/118,278;现为美国专利申请公布2011/0290851;
名称为“ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS”的美国专利申请序列号13/369,629;现为美国专利申请公布2012/0138660;
名称为“SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENTFORMED HEIGHTS”的美国专利申请序列号12/695,359;现为美国专利8,464,923;
名称为“STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMEDSTAPLE HEIGHTS”的美国专利申请序列号13/072,923;现为美国专利8,567,656;
名称为“LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR”的美国专利申请序列号13/766,325;现为美国专利申请公布2013/0256380;
名称为“ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR”的美国专利申请序列号13/763,078;现为美国专利申请公布2013/0256383;
名称为“LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS”的美国专利申请序列号13/763,094;现为美国专利申请公布2013/0256377;
名称为“END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER”的美国专利申请序列号13/763,106;现为美国专利申请公布2013/0256378;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS”的美国专利申请序列号13/433,147;现为美国专利申请公布2013/0256369;
名称为“SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES”的美国专利申请序列号13/763,112;现为美国专利申请公布2013/0256379;
名称为“ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM AFASTENER CARTRIDGE”的美国专利申请序列号13/763,035;现为美国专利申请公布2013/0214030;
名称为“RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGEHAVING THE SAME”的美国专利申请序列号13/763,042;现为美国专利申请公布2013/0221063;
名称为“FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESSCOMPENSATOR”的美国专利申请序列号13/763,048;现为美国专利申请公布2013/0221064;
名称为“FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING ATISSUE THICKNESS COMPENSATOR”的美国专利申请序列号13/763,054;现为美国专利申请公布2014/0097227;
名称为“FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUETHICKNESS COMPENSATOR”的美国专利申请序列号13/763,065;现为美国专利申请公布2013/0221065;
名称为“STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER”的美国专利申请序列号13/763,021;现为美国专利申请公布2014/0224686;
名称为“ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR”的美国专利申请序列号13/763,078;现为美国专利申请公布2013/0256383;
名称为“LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”的美国专利申请序列号13/763,095;现为美国专利申请公布2013/0161374;
名称为“IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”的美国专利申请序列号13/463,147;现为美国专利申请公布2013/0292398;
名称为“MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLINGDEVICES”的美国专利申请序列号13/763,192;现为美国专利申请公布2013/0146642;
名称为“RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVINGTHE SAME”的美国专利申请序列号13/763,161;现为美国专利申请公布2013/0153641;
名称为“ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL ENDEFFECTOR”的美国专利申请序列号13/763,177;现为美国专利申请公布2013/0146641;
名称为“STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION”的美国专利申请序列号13/763,037;现为美国专利申请公布2014/0224857;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTHFEATURES”的美国专利申请序列号13/433,126;现为美国专利申请公布2013/0256366;
名称为“DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESSCOMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS”的美国专利申请序列号13/433,132;现为美国专利申请公布2013/0256373;
名称为“FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATORINCLUDING OPENINGS THEREIN”的美国专利申请序列号13/851,703;现为美国专利申请公布2014/0291382;
名称为“TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH”的美国专利申请序列号13/851,676;现为美国专利申请公布2014/0291379;
名称为“FASTENER CARTRIDGE ASSEMBLIES”的美国专利申请序列号13/851,693;现为美国专利申请公布2014/0291381;
名称为“FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATORAND A GAP SETTING ELEMENT”的美国专利申请序列号13/851,684;现为美国专利申请公布2014/0291380;
名称为“STAPLE CARTRIDGE INCLUDING A BARBED STAPLE”的美国专利申请序列号14/187,387;现为美国专利申请公布2014/0166724;
名称为“STAPLE CARTRIDGE INCLUDING A BARBED STAPLE”的美国专利申请序列号14/187,395;现为美国专利申请公布2014/0166725;
名称为“STAPLE CARTRIDGE INCLUDING A BARBED STAPLE”的美国专利申请序列号14/187,400;现为美国专利申请公布2014/0166726;
名称为“IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERSFOR USE WITH SURGICAL FASTENING INSTRUMENTS”的美国专利申请序列号14/187,383;
名称为“IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MOREPROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS”的美国专利申请序列号14/187,386;
名称为“IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THEIMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT”的美国专利申请序列号14/187,390;
名称为“IMPLANTABLE LAYER ASSEMBLIES”的美国专利申请序列号14/187,389;
名称为“IMPLANTABLE LAYERS COMPRISING A PRESSED REGION”的美国专利申请序列号14/187,385;以及
名称为“FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT”的美国专利申请序列号14/187,384。
本文列出了许多具体细节,以提供对说明书中所述和附图中所示的实施方案的整体结构、功能、制造和用途的透彻理解。然而,本领域的技术人员将会理解,可以在没有这样的具体细节的情况下实施这些实施方案。在其它情况下,没有详细阐述熟知的操作、部件和元件,以免使说明书中阐述的实施方案模糊不清。本领域的普通技术人员将会理解,本文所述和所示的实施方案为非限制性示例,从而可认识到,本文所公开的特定结构和功能细节可为代表性和示例性的。在不脱离权利要求的范围的情况下可对这些实施方案进行变型和改变。
术语“包括”(以及“包括”的任何形式,诸如“包括(comprises)”和“包括(comprising)”)、(和“具有”的任何形式,诸如“具有(has)”和“具有(having)”)、“包含”(和“包含”的任何形式,诸如“包含(includes)”、和“包含(including)”以及“含有”(和“含有”的任何形式,诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此,“包括”、“具有”、“包含”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件,但不限于仅具有这些一个或多个元件。同样,“包括”、“具有”、“包含”或“含有”一个或多个特征的系统、装置、或设备的元件具有这些一个或多个特征,但不限于仅具有这些一个或多个特征。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分,并且术语“远侧”是指远离临床医生定位的部分。还应当理解,为简洁和清楚起见,本文可以结合附图使用空间术语诸如“垂直”、“水平”、“上”和“下”。然而,外科器械在许多取向和位置使用,并且这些术语并非限制性和/或绝对化的。
提供各种示例性装置和方法以执行腹腔镜式和微创外科手术规程。然而,本领域的普通技术人员将容易理解,本文所公开的各种方法和装置可用于许多外科规程和应用中,包括例如与开放式外科规程相结合。继续参阅本具体实施方式,本领域中的普通技术人员将进一步理解,本文所公开的各种器械可以任何方式插入体内,诸如通过自然腔道、通过形成于组织中的切口或穿刺孔(puncture hole)等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置插入,外科器械的端部执行器和细长轴可通过所述工作通道而推进。
以上列出的专利申请中的许多公开了结合钉仓使用的各种层。从钉仓部署钉时,钉可捕集至少一个层并贴靠组织植入单个层或多个层。下文提供了外科缝合系统的简单描述。本文所公开的钉仓和层可与该外科缝合系统和/或任何合适的缝合系统一起使用。
外科缝合系统可包括轴和从轴延伸的端部执行器。端部执行器包括第一钳口和第二钳口。第一钳口包括钉仓。钉仓能够插入第一钳口并且能够从第一钳口移除;然而设想了其中钉仓不能够从第一钳口移除或至少不易于从第一钳口替换的其它实施方案。第二钳口包括被配置成能够使从钉仓射出的钉变形的砧座。第二钳口能够围绕闭合轴相对于第一钳口枢转;然而设想了其中第一钳口能够相对于第二钳口枢转的其它实施方案。外科缝合系统还包括被配置成能够允许端部执行器相对于轴旋转或进行关节运动的关节运动接头。端部执行器能够围绕延伸穿过关节运动接头的关节运动轴旋转。设想了不包括关节运动接头的其它实施方案。
钉仓包括仓体。仓体包括近侧端部、远侧端部、以及在近侧端部和远侧端部之间延伸的平台。在使用中,钉仓定位在待缝合组织的第一侧上,并且砧座定位在该组织的第二侧上。砧座朝向钉仓运动,以贴靠平台压缩并夹紧组织。然后,可移除地储存在仓体中的钉可部署到组织中。仓体包括限定于其中的钉腔,其中钉可移除地储存在钉腔中。钉腔布置成六个纵向排。三排钉腔定位在纵向狭槽的第一侧上,并且三排钉腔定位在纵向狭槽的第二侧上。钉腔和钉的其它布置也是可以的。
钉由仓体中的钉驱动器支撑。驱动器能够在第一或非击发位置与第二或击发位置之间运动,以从钉仓射出钉。驱动器通过保持器保留在仓体中,保持器围绕仓体的底部延伸并且包括被配置成能够夹持仓体以及将保持器保持至仓体的弹性构件。驱动器能够通过滑动件在其非击发位置与击发位置之间运动。滑动件能够在邻近近侧端部的近侧位置与邻近远侧端部的远侧位置之间运动。滑动件包括多个斜坡表面,该斜坡表面被配置成能够朝向砧座在驱动器下方滑动以及提升驱动器,并且钉在驱动器上受到支撑。
除上述以外,滑动件还可通过击发构件在远侧运动。击发构件被配置成能够接触滑动件并朝向远侧端部推动滑动件。限定于仓体中的纵向狭槽被配置成能够接纳击发构件。砧座还包括被配置成能够接纳击发构件的狭槽。击发构件还包括接合第一钳口的第一凸轮和接合第二钳口的第二凸轮。随着击发构件在远侧推进,第一凸轮和第二凸轮可控制钉仓的平台与砧座之间的距离或组织间隙。击发构件还包括被配置成能够切入在钉仓和砧座中间捕集的组织的刀片。希望刀片定位成至少部分接近斜坡表面,使得钉先于刀片射出。
钉仓组件1000示于图1-图6A中。钉仓组件1000包括仓体1010和层1020(图6A)。仓体1010包括近侧端部1011和远侧端部1012。仓体1010还包括限定于其中的纵向狭槽1013,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1013从近侧端部1011朝向远侧端部1012延伸。仓体1010还包括限定于其中的多个钉腔。钉腔布置成纵向狭槽1013的第一侧上的三个纵向排和纵向狭槽1013的第二侧上的三个纵向排。在纵向狭槽1013的每一侧上,第一纵向排钉腔1015a沿纵向狭槽1013延伸,第二排钉腔1015b沿第一排钉腔1015a延伸,并且第三排钉腔1015c沿第二排钉腔1015c延伸。第一排钉腔1015a、第二排钉腔1015b和第三排钉腔1015c彼此平行并且与纵向狭槽1013平行;然而设想了其中第一排钉腔1015a、第二排钉腔1015b和/或第三排钉腔1015c不彼此平行和/或不与纵向狭槽1013平行的实施方案。除上述以外,击发构件可被配置成能够提升定位在仓体1010内的钉驱动器,以在击发构件朝向钉仓1000的远侧端部1012运动时,射出可移除地储存在钉腔1015a、1015b和1015c中的钉。
钉仓体1010还包括组织支撑平台1014。平台1014包括阶梯式表面。在纵向狭槽1013的每一侧上,平台1014包括邻近纵向狭槽1013的第一台阶1014a、邻近第一台阶1014a的第二台阶1014b和邻近第二台阶1014b的第三台阶1014c。第一台阶1014包括具有第一高度的第一平台(first plateau),第二台阶1014b包括具有第二高度的第二平台(secondplateau),并且第三台阶1014c包括具有第三高度的第三平台(third plateau)。第一平台和第三平台具有相同高度。第一平台和第三平台比第二平台高。设想了其中第一台阶、第二台阶和第三台阶具有任何合适高度的其它实施方案。
除上述以外,平台1014的第二台阶1014b相对于第一台阶1014a和第三台阶1014c凹陷。第二台阶1014b包括在第一台阶1014a与第三台阶1014c之间延伸的纵向凹入部或凹陷1019b。纵向凹入部1019b在仓体1010的近侧端部1011与远侧端部1012之间延伸。第二钉腔1015b定位在纵向凹入部1019b内。纵向凹入部1019b由内部侧壁1016a、外部侧壁1016c、近侧壁1017和远侧壁1018界定。近侧壁1017相对于钉腔1015a、1015b和1015c定位在近侧。远侧壁1018相对于钉腔1015a、1015b和1015c定位在远侧。内壁1016a横切第一钉腔1015a。内壁1016a至少部分由第一钉腔1015a的侧壁组成。围绕第一钉腔1015a的平台1014沿第一台阶1014a和第二台阶1014b延伸。外壁1016c横切第三钉腔1015c。外壁1016c至少部分由第三钉腔1015c的侧壁组成。围绕第三钉腔1015c的平台1014沿第三台阶1014c和第二台阶1014b延伸。
钉仓1000可与能够贴靠待缝合的组织植入的任何合适的层一起使用。在钉仓1000插入患者体内之前,层可包含定位在仓体1010的平台1014上的辅助材料。此类辅助材料可包括例如支撑材料和/或组织厚度补偿件。在各种情况下,当钉仓1000和层相对于待缝合的组织定位时,层可相对于平台1014运动。
现在转向图6A,层1020包括被配置成能够接触仓体1010的平台1014并由其支撑的底部表面1024。层1020还包括从其延伸的纵向突出部1029,该纵向突出部被配置成能够接纳在纵向凹陷1019b中。突出部1029可限制层1020与仓体1010之间的相对运动。突出部1029密集接纳于内壁1016a与外壁1016c之间,因此突出部1029可邻接内壁1016a和/或外壁1016c以限制层1020的侧向和/或纵向运动。在各种情况下,每个突出部1029包括被配置成能够接合内壁1016a的第一侧向侧壁1026a和被配置成能够接合外壁1016b的第二侧向侧壁1026b。突出部1029的尺寸和配置可被设定成使得它们被压缩或楔入内壁1016a与外壁1016c之间。该压缩或楔入不仅限制层1020的侧向和纵向运动,还可限制层1020远离平台1014的无意垂直运动。如读者将理解的那样,侧向压缩或楔入足以将层1020保持到位,同时可以克服该侧向压缩或楔入以允许层1020在钉已击发并且层1020已贴靠组织植入后与仓体1010分离。
除了或代替上文所述,突出部1029可限制层1020与仓体1010之间的纵向运动。突出部1029密集接纳于近侧壁1017与远侧壁1018之间,因此突出部1029可邻接近侧壁1017和/或远侧壁1018以限制层1020的纵向运动。在各种情况下,每个突出部1029包括被配置成能够接合近侧壁1017的近侧端部壁1027和被配置成能够接合远侧壁1018的远侧端部壁1028。突出部1029的尺寸和配置可设定成使得它们被压缩或楔入近侧壁1017与远侧壁1018之间。该压缩或楔入不仅可限制层1020的纵向运动,还可限制层1020远离平台1014的无意垂直运动。如读者将理解的那样,纵向压缩或楔入足以将层1020保持在适当的位置,同时可以克服该纵向压缩或楔入以允许层1020在钉已击发并且层1020已贴靠组织植入后与仓体1010分离。
突出部1029包括由凹陷1019b形成的空隙的凹腔;然而,突出部1029可包括任何合适的配置。突出部1029由使得突出部1029在凹陷1019b内紧密贴合的轮廓限定。突出部1029可大于凹陷1019b,使得突出部1029在其定位在凹陷1019b中时被压缩。这样的布置方式可在层1020与仓体1010之间产生偏压力和/或保持力。
每个钉腔1015a、1015b和1015c被配置成能够将钉可移除地储存在其中。在各种情况下,储存在钉腔1015a、1015b和1015c中的钉具有相同未成形高度。在砧座导致钉变形之前,钉的未成形高度是钉的整体高度。在某些情况下,这样的钉可变形成相同成形高度。在其它情况下,这样的钉可变形成不同成形高度。例如,从第一钉腔1015a射出的钉可变形成第一变形高度,从第二钉腔1015b射出的钉可变形成第二变形高度,并且从第三钉腔1015c射出的钉可变形成第三变形高度。第一变形高度可短于第二变形高度,并且第二变形高度可短于第三变形高度。这样的布置方式可相对于在组织中创建的切口提供组织压缩梯度。在各种情况下,储存在钉腔1015a、1015b和1015c中的钉可具有不同未成形高度。例如,从第一钉腔1015a射出的钉可具有第一未成形高度,从第二钉腔1015b射出的钉可具有第二未成形高度,并且从第三钉腔1015c射出的钉可具有第三未成形高度。第一未成形高度可短于第二未成形高度,并且第二未成形高度可短于第三未成形高度。在各种其它情况下,第二未成形高度可短于第一未成形高度和第三未成形高度。在至少一种此类情况下,第一未成形高度和第三未成形高度可相同。
以下专利的公开内容据此各自全文以引用方式并入本文:公布于2011年1月1日的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,866,528;公布于2010年6月1日的名称为“SURGICAL STAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP”的美国专利7,726,537;公布于2010年1月5日的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,641,091;公布于2009年12月22日的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,635,074;以及公布于2011年8月16日的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,997,469。公布于2012年11月27日的名称为“SURGICAL STAPLING DEVICES THAT PRODUCE FORMEDSTAPLES HAVING DIFFERENT LENGTHS”的美国专利8,317,070的公开内容全文以引用方式并入。
参考图1和图6A,层1020包括被配置成能够延伸到仓体1010的纵向狭槽1013中的纵向突起部1023。突起部1023的尺寸和配置可设定成使得它被楔入狭槽1013中并在狭槽1013内被压缩。随着击发构件在远侧被推进,突起部1023可被击发构件的切割部分切入。这样的切入可有利于从仓体1010释放层1020。
钉仓组件1100示于图7-图12A中。钉仓组件1100包括仓体1110和层1120(图12A)。仓体1110包括近侧端部1111和远侧端部1112。仓体1110还包括限定于其中的纵向狭槽1113,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1113从近侧端部1111朝向远侧端部1112延伸。仓体1110还包括限定于其中的多个钉腔。钉腔布置成纵向狭槽1113的第一侧上的三个纵向排和纵向狭槽1113的第二侧上的三个纵向排。在纵向狭槽1113的每一侧上,第一纵向排钉腔1115a沿纵向狭槽1113延伸,第二排钉腔1115b沿第一排钉腔1115a延伸,并且第三排钉腔1115c沿第二排钉腔1115b延伸。第一排钉腔1115a、第二排钉腔1115b和第三排钉腔1115c彼此平行并且与纵向狭槽1113平行;然而设想了其中第一排钉腔1115a、第二排钉腔1115b和/或第三排钉腔1115c不彼此平行和/或不与纵向狭槽1113平行的实施方案。除上述以外,击发构件可被配置成能够提升定位在仓体1110内的钉驱动器,以在击发构件朝向钉仓1100的远侧端部1112运动时,射出可移除地储存在钉腔1115a、1115b和1115c中的钉。
第一钉腔1115a沿第一纵向轴线以规则间隔定位。相邻第一钉腔1115a之间的空间可被称为第一纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第一钉腔1115a射出的钉缝合。第二钉腔1115b也沿第二纵向轴线以规则间隔定位。第二钉腔1115b相对于第一钉腔1115a交错。第二钉腔1115b相对于第一排钉腔1115a中的钉间隙侧向定位。相邻第二钉腔1115b之间的空间也可被称为第二纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第二钉腔1115b射出的钉缝合。第三钉腔1115c也沿第三纵向轴线以规则间隔定位。第三钉腔1115c相对于第二钉腔1115b交错。第三钉腔1115c相对于第二排钉腔1115b中的钉间隙侧向定位。
钉仓体1110还包括组织支撑平台1114。平台1114包括阶梯式表面。平台1114包括邻近纵向狭槽1113的第一台阶1114a、邻近第一台阶1114a的第二台阶1114b和邻近第二台阶1114b的第三台阶1114c。在纵向狭槽1113的每一侧上,平台1114包括第一台阶1114a、第二台阶1114b和第三台阶1114c。第一台阶1114a包括具有第一高度的第一平台,第二台阶1114b包括具有第二高度的多个壁,并且第三台阶1114c包括具有第三高度的第三平台。多个壁可共同限定第二平台。第一平台和第二平台具有相同高度。第一平台和第二平台比第三平台高。设想了其中第一台阶、第二台阶和第三台阶具有任何合适高度的其它实施方案。
除上述以外,第二台阶1114b的壁向外延伸或从第一台阶1114a侧向延伸。第二台阶1114b的壁连接至第一台阶1114a;然而,但设想了其中壁未连接至第一台阶1114a的实施方案。每个壁围绕第一钉腔1115a、第二钉腔1115b和/或第三钉腔1115c的端部延伸。由于钉腔1115a、1115b和1115c具有上述交错布置方式,每个壁交织穿过第一排钉腔1115a、第二排钉腔1115b和/或第三排钉腔1115c。每个壁可包括直段和/或弯曲段。在各种情况下,弯曲段围绕钉腔的端部延伸,而直段在钉腔排之间延伸。
平台1114包括多个凹入部或凹陷1119。凹陷1119由第一台阶1114a、第二台阶1114b的壁、近侧壁1117和/或远侧壁1118限定。凹陷1119未完全封闭。每个凹陷1119在三侧上界定,即近侧、远侧和内侧。外侧未受界定,或至少大体上未受界定;然而设想了其中凹陷在少于三侧上被界定的其它实施方案。设想了其中凹陷被完全界定的某些其它实施方案。每个凹陷1119包括底部1119b。凹陷1119的底部1119b具有与第三台阶1114c相同的高度;然而设想了其中凹陷底部1119b具有与第三台阶1114c不同高度的其它实施方案。
钉仓1100可与能够贴靠待缝合的组织植入的任何合适的层一起使用。在钉仓1100插入患者体内之前,层可包含定位在仓体1110的平台1114上的辅助材料。此类辅助材料可包括例如支撑材料和/或组织厚度补偿件。在各种情况下,当钉仓1100和层相对于待缝合的组织定位时,层可相对于平台1114运动。
现在转向图12A,层1120包括被配置成能够接触仓体1110的平台1114并由其支撑的底部表面1124。层1120还包括被配置成能够接纳第二台阶1114b的壁的狭缝1124b。狭缝1124b与壁之间的相互作用可限制层1120与仓体1110之间的相对运动。第二台阶1114b的壁密集接纳于狭缝1124b中,因此狭缝1124b的侧壁可邻接和/或夹持第二台阶1114b的壁的侧壁以限制层1120的侧向运动。这样的布置方式可在层1120与仓体1110之间产生偏压力和/或保持力。第二台阶1114b的壁的尺寸和配置可设定成使得它们被压缩或楔入在狭缝1124b内。该压缩或楔入不仅可限制层1120的侧向运动和纵向运动,还可限制层1120远离平台1114的无意垂直运动。如读者将理解的那样,侧向和纵向压缩或楔入足以将层1120保持在适当的位置,同时可以克服该侧向和纵向压缩或楔入以允许层1120在钉已击发并且层1120已贴靠组织植入后与仓体1110分离。
层1120密集接纳于近侧壁1117与远侧壁1118之间,因此层1120可邻接近侧壁1117和/或远侧壁1118以限制层1120的纵向运动。层1120包括被配置成能够接合近侧壁1117的近侧端部壁1127和被配置成能够接合远侧壁1118的远侧端部壁1128。层1120的尺寸和配置可设定成使得它被压缩或楔入近侧壁1117与远侧壁1118之间。该压缩或楔入不仅可限制层1120的纵向运动,还可限制层1120远离平台1114的无意垂直运动。如读者将理解的那样,纵向压缩或楔入足以将层1120保持在适当的位置,同时可以克服该纵向压缩或楔入以允许层1120在钉已击发并且层1120已贴靠组织植入后与仓体1110分离。
每个钉腔1115a、1115b和1115c被配置成能够将钉可移除地储存在其中。在各种情况下,储存在钉腔1115a、1115b和1115c中的钉具有相同未成形高度。在某些情况下,这样的钉可变形成相同成形高度。在其它情况下,这样的钉可变形成不同成形高度。例如,从第一钉腔1115a射出的钉可变形成第一变形高度,从第二钉腔1115b射出的钉可变形成第二变形高度,并且从第三钉腔1115c射出的钉可变形成第三变形高度。第一变形高度可短于第二变形高度,并且第二变形高度可短于第三变形高度。这样的布置方式可相对于在组织中创建的切口提供组织压缩梯度。在各种情况下,储存在钉腔1115a、1115b和1115c中的钉可具有不同未成形高度。例如,从第一钉腔1115a射出的钉可具有第一未成形高度,从第二钉腔1115b射出的钉可具有第二未成形高度,并且从第三钉腔1115c射出的钉可具有第三未成形高度。第一未成形高度可短于第二未成形高度,并且第二未成形高度可短于第三未成形高度。在各种其它情况下,第二未成形高度可短于第一未成形高度。在至少一种情况下,第二未成形高度和第三未成形的高度可相同。
在各种情况下,第二台阶1114a的壁可被配置成能够在钉从钉腔1115a、1115b和/或1115c射出时引导钉。在某些情况下,第二台阶1114a的壁可延伸钉腔1115a、1115b和/或1115c,以在储存于其中的钉射出时控制这些钉。
参考图7和图12A,层1120包括被配置成能够延伸到仓体1110的纵向狭槽1113中的纵向突起部1123。突起部1123的尺寸和配置可设定成使得它被楔入狭槽1113中并在狭槽1113内被压缩。随着击发构件在远侧被推进,突起部1123可被击发构件的切割部分切入。这样的切入可有利于从仓体1110释放层1120。
钉仓组件1200示于图13-图18A中。钉仓组件1200包括仓体1210和层1220(图18A)。仓体1210包括近侧端部1211和远侧端部1212。仓体1210还包括限定于其中的纵向狭槽1213,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1213从近侧端部1211朝向远侧端部1212延伸。仓体1210还包括限定于其中的多个钉腔。钉腔布置成纵向狭槽1213的第一侧上的三个纵向排和纵向狭槽1213的第二侧上的三个纵向排。在纵向狭槽1213的每一侧上,第一纵向排钉腔1215a沿纵向狭槽1213延伸,第二排钉腔1215b沿第一排钉腔1215a延伸,并且第三排钉腔1215c沿第二排钉腔1215b延伸。第一排钉腔1215a、第二排钉腔1215b和第三排钉腔1215c彼此平行并且与纵向狭槽1213平行;然而设想了其中第一排钉腔1215a、第二排钉腔1215b和/或第三排钉腔1215c不彼此平行和/或不与纵向狭槽1213平行的实施方案。除上述以外,击发构件可被配置成能够提升定位在仓体1210内的钉驱动器,以在击发构件朝向钉仓1200的远侧端部1212运动时,射出可移除地储存在钉腔1215a、1215b和1215c中的钉。
第一钉腔1215a沿第一纵向轴线以规则间隔定位。相邻第一钉腔1215a之间的空间可被称为第一纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第一钉腔1215a射出的钉缝合。第二钉腔1215b也沿第二纵向轴线以规则间隔定位。第二钉腔1215b相对于第一钉腔1215a交错。第二钉腔1215b相对于第一排钉腔1215a中的钉间隙侧向定位。相邻第二钉腔1215b之间的空间也可被称为第二纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第二钉腔1215b射出的钉缝合。第三钉腔1215c也沿第三纵向轴线以规则间隔定位。第三钉腔1215c相对于第二钉腔1215b交错。第三钉腔1215c相对于第二排钉腔1215b中的钉间隙侧向定位。
钉仓体1210还包括组织支撑平台1214。平台1214包括限定于其中的多个凹入部或凹陷。第一凹陷1219a围绕每个第一钉腔1215a。每个第一凹陷1219a由大体为三角形的壁1216a限定,该壁包括指向近侧的顶点、指向远侧的顶点和侧向外侧指向的顶点。每个第一凹陷1219a包括距离平台1214第一深度的第一底板1214a。第二凹陷1219b围绕每个第二钉腔1215b。每个第二凹陷1219b由大体为菱形的壁1216b限定,该壁包括指向近侧的顶点、指向远侧的顶点、侧向内侧指向的顶点和侧向外侧指向的顶点。每个第二凹陷1219b包括距离平台1214第二深度的第二底板1214b。第三凹陷1219c围绕每个第三钉腔1215c。每个第三凹陷1219c由大体为三角形的壁1216c限定,该壁包括指向近侧的顶点、指向远侧的顶点和侧向内侧指向的顶点。每个第三凹陷1219c包括距离平台1214第三深度的第三底板1214c。
第一凹陷1219a沿第一纵向轴线以规则间隔定位。相邻的第一凹陷1219a之间存在间隙。第二凹陷1219b也沿第二纵向轴线以规则间隔定位。第二凹陷1219b相对于第一凹陷1219b交错。第二凹陷1219b相对于第一排凹陷1219a中的间隙侧向定位。相邻的第二凹陷1219b之间存在间隙。第三凹陷1219c也沿第三纵向轴线以规则间隔定位。第三凹陷1219c相对于第二凹陷1219b交错。第三凹陷1219c相对于第二排凹陷1219b中的间隙侧向定位。
除上述以外,第一凹陷1219a的第一深度、第二凹陷1219b的第二深度和第三凹陷1219c的第三深度可具有相同深度。在其它情况下,第一深度、第二深度和/或第三深度可以不同。
钉仓1200可与能够贴靠待缝合的组织植入的任何合适的层一起使用。在钉仓1200插入患者体内之前,层可包含定位在仓体1210的平台1214上的辅助材料。此类辅助材料可包括例如支撑材料和/或组织厚度补偿件。在各种情况下,当钉仓1200和层相对于待缝合的组织定位时,层可相对于平台1214运动。
现在转向图18A,层1220包括被配置成能够接触仓体1210的平台1214并由其支撑的底部表面1224。层1220还包括从其延伸的突出部1229a、1229b和1229c,这些突出部被配置成能够分别接纳在凹陷1219a、1219b和1219c中。突出部1229a、1229b和1229c可限制层1220与仓体1210之间的相对运动。突出部1229a、1229b和1229c分别密集接纳于凹陷1219a、1219b和1219c中,因此突出部1229a、1229b和1229c可邻接凹陷1219a、1219b和1219c的侧壁以限制层1220的侧向运动和纵向运动。突出部1229a、1229b和1229c的尺寸和配置可设定成使得它们分别被压缩或楔入在凹陷1219a、1219b和1219c内。该压缩或楔入不仅可限制层1220的侧向运动和纵向运动,还可限制层1220远离平台1214的无意垂直运动。如读者将理解的那样,侧向和纵向压缩或楔入足以将层1220保持在适当的位置,同时可以克服该侧向和纵向压缩或楔入以允许层1220在钉已击发并且层1220已贴靠组织植入后与仓体1210分离。
层1220密集接纳于近侧壁1217与远侧壁1218之间,因此层1220可邻接近侧壁1217和/或远侧壁1218以限制层1220的纵向运动。层1220包括被配置成能够接合近侧壁1217的近侧端部壁1227和被配置成能够接合远侧壁1218的远侧端部壁1228。层1220的尺寸和配置可设定成使得它被压缩或楔入在近侧壁1217与远侧壁1218之间。该压缩或楔入不仅可限制层1220的纵向运动,还可限制层1220远离平台1214的无意垂直运动。如读者将理解的那样,纵向压缩或楔入足以将层1220保持在适当的位置,同时可以克服该纵向压缩或楔入以允许层1220在钉已击发并且层1220已贴靠组织植入后与仓体1210分离。
突出部1229a、1229b和1229c分别包括由凹陷1219a、1219b和1219c形成的空隙的凹腔,然而,突出部1229a、1229b和1229c可包括任何合适的配置。突出部1229a、1229b和1229c由使得突出部1229a、1229b和1229c分别在凹陷1219a、1219b和1219c内紧密贴合的轮廓限定。突出部1229a、1229b和1229c可分别大于凹陷1219a、1219b和1219c,使得突出部1229a、1229b和1229c在它们定位在凹陷1219a、1219b和1219c中时被压缩。这样的布置方式可在层1220与仓体1210之间产生偏压力和/或保持力。
每个钉腔1215a、1215b和1215c被配置成能够将钉可移除地储存在其中。在各种情况下,储存在钉腔1215a、1215b和1215c中的钉具有相同未成形高度。在某些情况下,这样的钉可变形成相同成形高度。在其它情况下,这样的钉可变形成不同成形高度。例如,从第一钉腔1215a射出的钉可变形成第一变形高度,从第二钉腔1215b射出的钉可变形成第二变形高度,并且从第三钉腔1215c射出的钉可变形成第三变形高度。第一变形高度可短于第二变形高度,并且第二变形高度可短于第三变形高度。这样的布置方式可相对于在组织中创建的切口提供组织压缩梯度。在各种情况下,储存在钉腔1215a、1215b和1215c中的钉可具有不同未成形高度。例如,从第一钉腔1215a射出的钉可具有第一未成形高度,从第二钉腔1215b射出的钉可具有第二未成形高度,并且从第三钉腔1215c射出的钉可具有第三未成形高度。第一未成形高度可短于第二未成形高度,并且第二未成形高度可短于第三未成形高度。
钉仓组件1400示于图23-图26A、图28、图30和图32中。钉仓组件1400包括仓体1410和层1420(图26A)。仓体1410包括近侧端部1411和远侧端部1412。仓体1410还包括限定于其中的纵向狭槽1413,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1413从近侧端部1411朝向远侧端部1412延伸。仓体1410还包括限定于其中的多个钉腔。钉腔布置成纵向狭槽1413的第一侧上的三个纵向排和纵向狭槽1413的第二侧上的三个纵向排。在纵向狭槽1413的每一侧上,第一纵向排钉腔1415a沿纵向狭槽1413延伸,第二排钉腔1415b沿第一排钉腔1415a延伸,并且第三排钉腔1415c沿第二排钉腔1415b延伸。第一排钉腔1415a、第二排钉腔1415b和第三排钉腔1415c彼此平行并且与纵向狭槽1413平行;然而设想了其中第一排钉腔1415a、第二排钉腔1415b和/或第三排钉腔1415c不彼此平行和/或不与纵向狭槽1413平行的实施方案。除上述以外,击发构件可被配置成能够提升定位在仓体1410中的钉驱动器,以在击发构件朝向钉仓1400的远侧端部1412运动时,射出可移除地储存在钉腔1415a、1415b和1415c中的钉。
第一钉腔1415a沿第一纵向轴线以规则间隔定位。相邻第一钉腔1415a之间的空间可被称为第一纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第一钉腔1415a射出的钉缝合。第二钉腔1415b也沿第二纵向轴线以规则间隔定位。第二钉腔1415b相对于第一钉腔1415a交错。第二钉腔1415b相对于第一排钉腔1415a中的钉间隙侧向定位。相邻第二钉腔1415b之间的空间也可被称为第二纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第二钉腔1415b射出的钉缝合。第三钉腔1415c也沿第三纵向轴线以规则间隔定位。第三钉腔1415c相对于第二钉腔1415b交错。第三钉腔1415c相对于第二排钉腔1415b中的钉间隙侧向定位。
钉仓体1410还包括组织支撑平台1414。平台1414包括限定于其中的多个峰1416和谷1419。谷1419与第一钉腔1415a、第二钉腔1415b和第三钉腔1415c对准。峰1416与第一钉腔1415a之间的间隙对准。峰1416还与第二钉腔1415b之间的间隙对准。类似地,峰1416与第三钉腔1415c之间的间隙对准。第一排钉腔1415a中的峰1416可连接至第二排钉腔1415b中的峰1416。类似地,第二排钉腔1415b中的峰1416可连接至第三排钉腔1415c中的峰1416。凹陷1419各自具有相同深度;然而设想了其中凹陷具有不同深度的其它实施方案。例如,与第一钉腔1415a对准的凹陷可具有第一深度,与第二钉腔1415b对准的凹陷可具有第二深度,并且与第三钉腔1415c对准的凹陷可具有第三深度,其中第一深度、第二深度和/或第三深度可不同。峰1416各自具有相同高度;然而设想了其中峰具有不同高度的其它实施方案。例如,定位在第一钉腔1415a之间的峰可具有第一高度,定位在第二钉腔1415b之间的峰可具有第二高度,并且定位在第三钉腔1415c之间的峰可具有第三高度,其中第一高度、第二高度和/或第三高度可不同。
钉仓1400可与能够贴靠待缝合的组织植入的任何合适的层一起使用。在钉仓1400插入患者体内之前,层可包含定位在仓体1410的平台1414上的辅助材料。此类辅助材料可包括例如支撑材料和/或组织厚度补偿件。在各种情况下,当钉仓1400和层相对于待缝合的组织定位时,层可相对于平台1414运动。
现在转向图26A,层1420包括被配置成能够接触仓体1410的平台1414并由其支撑的底部表面1424。底部表面1424包括从其延伸的峰1429,该峰被配置成能够接纳在平台1414中限定的谷1419中。峰1429可限制层1420与仓体1410之间的相对运动。峰1429密集接纳于谷1419内,因此峰1429可邻接谷1419的壁以限制层1420的侧向和/或纵向运动。底部表面1424还包括限定于其中的谷1426,该谷被配置成能够接纳从仓体1410延伸的峰1416。谷1426可限制层1420与仓体1410之间的相对运动。峰1416密集接纳于谷1426内,因此峰1416可邻接谷1426的壁以限制层1420的侧向和/或纵向运动。
除了或代替上文所述,层1420密集接纳于仓体1410的近侧壁1417与远侧壁1418之间,因此层1420可邻接近侧壁1417和/或远侧壁1418以限制层1420的纵向运动。层1420包括被配置成能够接合近侧壁1417的近侧端部壁1427和被配置成能够接合远侧壁1418的远侧端部壁1428。层1420的尺寸和配置可设定成使得它被压缩或楔入近侧壁1417与远侧壁1418之间。该压缩或楔入不仅可限制层1420的纵向运动,还可限制层1420远离平台1414的无意垂直运动。纵向压缩或楔入足以将层1420保持在适当的位置,同时可以克服该纵向压缩或楔入以允许层1420在钉已击发并且层1420已贴靠组织植入后与仓体1410分离。
谷1426和峰1429分别包括峰1416和谷1419的凹腔;然而,层1420可包括任何合适的配置。谷1426和峰1429由使得谷1426和峰1429分别在峰1416和谷1419内紧密贴合的轮廓限定。
每个钉腔1415a、1415b和1415c被配置成能够将钉可移除地储存在其中。在各种情况下,储存在钉腔1415a、1415b和1415c中的钉具有相同未成形高度。在某些情况下,这样的钉可变形成相同成形高度。在其它情况下,这样的钉可变形成不同成形高度。例如,从第一钉腔1415a射出的钉可变形成第一变形高度,从第二钉腔1415b射出的钉可变形成第二变形高度,并且从第三钉腔1415c射出的钉可变形成第三变形高度。第一变形高度可短于第二变形高度,并且第二变形高度可短于第三变形高度。这样的布置方式可相对于在组织中创建的切口提供组织压缩梯度。在各种情况下,储存在钉腔1415a、1415b和1415c中的钉可具有不同未成形高度。例如,从第一钉腔1415a射出的钉可具有第一未成形高度,从第二钉腔1415b射出的钉可具有第二未成形高度,并且从第三钉腔1415c射出的钉可具有第三未成形高度。第一未成形高度可短于第二未成形高度,并且第二未成形高度可短于第三未成形高度。
钉仓组件1300示于图19-图22A、图27、图29和图31中。钉仓组件1300包括仓体1310和层1320(图22A)。仓体1310包括近侧端部1311和远侧端部1312。仓体1310还包括限定于其中的纵向狭槽1313,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1313从近侧端部1311朝向远侧端部1312延伸。仓体1310还包括限定于其中的多个钉腔。钉腔布置成纵向狭槽1313的第一侧上的三个纵向排和纵向狭槽1313的第二侧上的三个纵向排。在纵向狭槽1313的每一侧上,第一纵向排钉腔1315a沿纵向狭槽1313延伸,第二排钉腔1315b沿第一排钉腔1315a延伸,并且第三排钉腔1315c沿第二排钉腔1315b延伸。第一排钉腔1315a、第二排钉腔1315b和第三排钉腔1315c彼此平行并且与纵向狭槽1313平行;然而设想了其中第一排钉腔1315a、第二排钉腔1315b和/或第三排钉腔1315c不彼此平行和/或不与纵向狭槽1313平行的实施方案。除上述以外,击发构件可被配置成能够提升定位在仓体1310内的钉驱动器,以在击发构件朝向钉仓1300的远侧端部1312运动时,射出可移除地储存在钉腔1315a、1315b和1315c中的钉。
第一钉腔1315a沿第一纵向轴线以规则间隔定位。相邻第一钉腔1315a之间的空间可被称为第一纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第一钉腔1315a射出的钉缝合。第二钉腔1315b也沿第二纵向轴线以规则间隔定位。第二钉腔1315b相对于第一钉腔1315a交错。第二钉腔1315b相对于第一排钉腔1315a中的钉间隙侧向定位。相邻第二钉腔1315b之间的空间也可被称为第二纵向排中的钉间隙,因为定位在此类空间上方的组织将不由从第二钉腔1315b射出的钉缝合。第三钉腔1315c也沿第三纵向轴线以规则间隔定位。第三钉腔1315c相对于第二钉腔1315b交错。第三钉腔1315c相对于第二排钉腔1315b中的钉间隙侧向定位。
钉仓体1310还包括组织支撑平台1314。平台1314包括限定于其中的多个峰和谷。谷1319a与第一钉腔1315a对准,谷1319b与第二钉腔1315b对准,并且谷1319c与第三钉腔1315c对准。峰1316a与第一钉腔1315a之间的间隙对准。峰1316b与第二钉腔1315b之间的间隙对准。类似地,峰1316c与第三钉腔1315c之间的间隙对准。第一排钉腔1315a中的峰1316a可连接至第二排钉腔1315b中的峰1316b。类似地,第二排钉腔1315b中的峰1316b可连接至第三排钉腔1315c中的峰1316c。凹陷1319a、1319b和1319c可各自具有相同深度;然而设想了其中凹陷1319a、1319b和1319c具有不同深度的其它实施方案。例如,与第一钉腔1315a对准的凹陷1319a可具有第一深度,与第二钉腔1315b对准的凹陷1319b可具有第二深度,并且与第三钉腔1315c对准的凹陷1319c可具有第三深度,其中第一深度、第二深度和/或第三深度可不同。定位在第一钉腔1315a之间的峰1316a具有第一高度,定位在第二钉腔1315b之间的峰1316b具有第二高度,并且定位在第三钉腔1315c之间的峰1316c具有第三高度,其中第一高度、第二高度和/或第三高度可不同。例如,峰1316a的第一高度高于峰1316b的第二高度和峰1316c的第三高度。例如,峰1316b的第二高度可高于峰1316c的第三高度。这样的布置方式可向定位在钉腔1315a上方的组织施加第一压力,向定位在钉腔1315b上方的组织施加第二压力,并且向定位在钉腔1315c上方的组织施加第三压力。第一压力大于第二压力,并且第二压力大于第三压力。这样的压力梯度可将液体从由刀片穿过纵向狭槽1313而形成的切口推离。
钉仓1300可与能够贴靠待缝合的组织植入的任何合适的层一起使用。在钉仓1300插入患者体内之前,层可包含定位在仓体1310的平台1314上的辅助材料。此类辅助材料可包括例如支撑材料和/或组织厚度补偿件。在各种情况下,当钉仓1300和层相对于待缝合的组织定位时,层可相对于平台1314运动。
现在转向图22A,层1320包括被配置成能够接触仓体1310的平台1314并由其支撑的底部表面1324。底部表面1324包括从其延伸的峰1329,该峰被配置成能够接纳在平台1314中限定的谷1319a-1319c中。峰1329可限制层1320与仓体1310之间的相对运动。峰1329密集接纳于谷1319a-1319c内,因此峰1329可邻接谷1319a-1319c的壁以限制层1320的侧向和/或纵向运动。底部表面1324还包括限定于其中的谷1326,该谷被配置成能够接纳从仓体1310延伸的峰1316a-1316c。谷1326可限制层1320与仓体1310之间的相对运动。峰1316a-1316c密集接纳于谷1326中,因此峰1316a-1316c可邻接谷1326的壁以限制层1320的侧向和/或纵向运动。
除了或代替上文所述,层1320密集接纳于仓体1310的近侧壁1317与远侧壁1318之间,因此层1320可邻接近侧壁1317和/或远侧壁1318以限制层1320的纵向运动。层1320包括被配置成能够接合近侧壁1317的近侧端部壁1327和被配置成能够接合远侧壁1318的远侧端部壁1328。层1320的尺寸和配置可设定成使得它被压缩或楔入近侧壁1317与远侧壁1318之间。该压缩或楔入不仅可限制层1320的纵向运动,还可限制层1320远离平台1314的无意垂直运动。纵向压缩或楔入足以将层1320保持在适当的位置,同时可以克服该纵向压缩或楔入以允许层1320在钉已击发并且层1320已贴靠组织植入后与仓体1310分离。
谷1326和峰1329分别包括峰1316a-1316c和谷1319a-1319c的凹腔;然而,层1320可包括任何合适的配置。谷1326和峰1329由使得谷1326和峰1329分别在峰1316a-1316c和谷1319a-1319c内紧密贴合的轮廓限定。
每个钉腔1315a、1315b和1315c被配置成能够将钉可移除地储存在其中。在各种情况下,储存在钉腔1315a、1315b和1315c中的钉具有相同未成形高度。在某些情况下,这样的钉可变形成相同成形高度。在其它情况下,这样的钉可变形成不同成形高度。例如,从第一钉腔1315a射出的钉可变形成第一变形高度,从第二钉腔1315b射出的钉可变形成第二变形高度,并且从第三钉腔1315c射出的钉可变形成第三变形高度。第一变形高度可短于第二变形高度,并且第二变形高度可短于第三变形高度。这样的布置方式可相对于在组织中创建的切口提供组织压缩梯度。在各种情况下,储存在钉腔1315a、1315b和1315c中的钉可具有不同未成形高度。例如,从第一钉腔1315a射出的钉可具有第一未成形高度,从第二钉腔1315b射出的钉可具有第二未成形高度,并且从第三钉腔1315c射出的钉可具有第三未成形高度。第一未成形高度可短于第二未成形高度,并且第二未成形高度可短于第三未成形高度。
钉仓组件1500示于图33-图35中。钉仓组件1500包括仓体1510和层1520。仓体1510包括近侧端部1511和远侧端部1512。仓体1510还包括限定于其中的纵向狭槽1513,该纵向狭槽被配置成能够在其中接纳击发构件的至少一部分。狭槽1513从近侧端部1511朝向远侧端部1512延伸。仓体1510还包括限定于仓体1510的平台1514中的多个钉腔1515。钉腔1515布置成纵向狭槽1513的第一侧上的三个纵向排和纵向狭槽1513的第二侧上的三个纵向排。除上述以外,击发构件可被配置成能够提升定位在仓体1510内的钉驱动器,以在击发构件朝向钉仓1500的远侧端部1512运动时,射出可移除地储存在钉腔1515中的钉。
仓体1510还包括从平台1514向上延伸的突出部1519。突出部1519在平台1514上方延伸钉腔1515。在通过钉驱动器朝向砧座提升钉之前、期间和/或之后,突出部1519可支撑储存在钉腔1515中的钉。突出部1519可在朝向砧座提升钉时引导钉。突出部1519可定位在钉腔1515的近侧端部、钉腔1515的远侧端部和/或钉腔1515的两个端部。图33-图35中示出的所有钉腔1515在两个端部处由突出部1519围绕;然而设想了其它实施方案,其中钉腔1515中的一些由两个突出部、由一个突出部围绕,和/或没有突出部围绕。
突出部1519布置成与纵向排钉腔1515对应的纵向排。设想了各种实施方案,其中仓体1510包括相同数目的突出部1519的排和钉腔1515的排。例如,六排突出部1519与六排钉腔1515对准。设想了其中仓体1510包括的钉腔1515的排多于突出部1519的排的其它实施方案。例如,突出部1519的排可与钉腔1515的每个最内排对准,而钉腔1515的最外排可能没有与其对准的突出部的排。设想了其中一个突出部或一排突出部相对于一个钉腔或一排钉腔侧向偏置某些实施方案。
再次参见图33-图35,层1520包括邻近仓体1510的近侧端部1511定位的近侧端部1521,此外还包括邻近仓体1510的远侧端部1511定位的远侧端部1522。层1520还包括被配置成能够接触仓体1510的平台1514并由其支撑的底部表面1524,此外还包括定位在其相对侧上的组织接触表面1526。组织接触表面1526包括平坦表面;但设想了其它实施方案,其中组织接触表面包括被配置成能够减少组织与层1520之间不期望的相对滑动运动的纹理化和/或夹持表面。层1520还包括与限定于仓体1510中的狭槽1513对准或能够对准的纵向狭槽1523。狭槽1523限定层1520的包括由击发构件的切割构件切入的层1520的减小的横截面厚度而不穿过仓体1510的狭槽1513的部分。狭槽1523提供的横截面减小有利于横断层1520。
层1520包括限定于其中的多个纵向狭槽1529。狭槽1529限定于底部表面1524中并且与突出部1519的排对准。狭槽1529还与钉腔1515对准。层1520包括例如与六排突出部1519和六排钉腔1515对准的六个狭槽1529。当钉从钉腔1515射出时,钉可进入狭槽1529并刺穿层1520。当砧座导致针变形时,钉可捕集层1520的其中包括纵向狭槽1529的部分。每个狭槽1529可在层1520的近侧端部1521与远侧端部1522之间延伸;然而设想了其中狭槽1529延伸小于层1520的整个长度的长度的其它实施方案。例如,可闭合或封端狭槽1529的近侧端部和/或远侧端部。可选择狭槽1529的配置,以便在层1520包括组织厚度补偿件时提供适当的组织厚度补偿。
每个狭槽1529由狭槽宽度W和狭槽深度D限定。在各种实施方案中,狭槽宽度W的尺寸和配置可设定成使得狭槽1529的侧壁可接合突出部1519。在至少一个此类实施方案中,突出部1519可按压配合在狭槽1529内,其中层1520可通过突出部1519与狭槽1529之间的相互作用以可释放的方式保持至仓体1510。在其它实施方案中,狭槽宽度W的尺寸和配置可设定成使得狭槽1529的侧壁与突出部1519之间存在间隙配合(clearance-fit)。
在各种实施方案中,除上述以外,狭槽深度D的尺寸和配置可设定成使得狭槽1529的底部壁接触突出部1519的顶部表面。在至少一种情况下,当层1520的底部表面1524接触平台1514时,狭槽1529的底部壁可接触突出部1519的顶部表面。在某些其它情况下,当狭槽1529的底部表面贴靠突出部1519的顶部表面定位时,层1520的底部表面1524可能不与平台1514接触。在此类情况下,层1520可保持在平台1514上方的升高位置。在使用中,当组织夹紧在钉仓1500与砧座之间时,施加至层1520的压缩压力可朝向平台1514推动层1520。在某些情况下,当层1520的底部表面1524贴靠平台1514定位时,狭槽1529的底部壁可能不与突出部1519接触。类似于以上所述,当组织夹紧在钉仓1500与砧座之间时,施加至层1520的压缩压力可贴靠突出部1519推动狭槽1529的底部表面。
再次参见图35,在层1520中限定的纵向狭槽1529限定层1520的部分,这些部分具有比层1520的其它部分的横截面薄的横截面。现在转向图36,层1620包括远侧端部1622、底部表面1624、顶部表面1626以及限定于其中的纵向狭槽1623,该纵向狭槽与例如在仓体1510中限定的纵向狭槽1513对准或能够对准。类似于以上所述,层1620包括纵向狭槽1629,纵向狭槽1629与从仓体1510延伸的纵向排突出部1519对准或能够对准。层1620还包括从顶部表面1626延伸的脊1628。脊1628与狭槽1629对准或至少基本上对准。脊1628增大层1620的包括纵向狭槽1629的部分的横截面。脊1628还与钉腔1515对准。例如当钉(诸如钉1630)从钉腔1515射出时,钉1630可捕集层1620的包括狭槽1629和脊1628的部分。
如图36中所示,例如,狭槽1629减小的层1620的横截面厚度大于脊1628增大的层1620的横截面厚度。在其它实施方案中,例如,狭槽1629可减小的层1620的横截面厚度小于脊1628增大的层1620的横截面厚度。在某些实施方案中,例如,狭槽1629可减小的层1620的横截面厚度等于脊1628增大的层1620的横截面厚度。可选择脊1628和狭槽1629的配置,以便在层1620包括组织厚度补偿件时提供适当的组织厚度补偿。
再次参见图35,层1520由单件材料构成;然而设想了其中层由装配在一起的两件或更多件材料构成的其它实施方案。现在转向图37,例如,层1720包括与层1720的纵向狭槽1629和仓体1510的钉腔1515对准的插件1728。插件1728嵌入层1720中。在至少一种情况下,层1720可围绕插件1728模制成型。在某些情况下,层1720可包括限定于其中的沟槽,其中插件1728可定位在沟槽中。在至少一种此类情况下,可利用至少一种粘合剂以将插件1728保持在沟槽中。插件1728由不同于层1720的其它部分的材料构成;然而设想了其中它们由相同材料构成的其它实施方案。插件1728由密度比层1720的其它部分大的材料构成;然而设想了其中插件1728具有任意合适密度的其它实施方案。类似于以上所述,例如,钉1630可被配置成能够在钉1630变形时在其中捕集插件1728。可选择插件1728的配置,以便在层1720包括组织厚度补偿件时提供适当的组织厚度补偿。
在各种情况下,材料层可包括例如支撑材料和/或组织厚度补偿件。材料层可由例如Gore SeamGuard材料、Synovis Peri-Strips材料和/或聚氨酯构成。提交于2013年2月28日的名称为“LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”的美国专利申请序列号13/763,095的全部公开内容以引用方式并入本文。下列申请的全部公开内容以引用方式并入本文:提交于2012年6月25日的名称为“TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT”的美国专利申请序列号13/531,619,提交于2012年6月25日的名称为“TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT”的美国专利申请序列号13/531,623,提交于2012年6月25日的名称为“TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT”的美国专利申请序列号13/531,627,以及提交于2012年6月25日的名称为“TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT”的美国专利申请序列号13/531,630。层可由可生物吸收材料和/或不可生物吸收材料构成。在一些情况下,材料层可附接到平台。在至少一种情况下,可利用至少一种粘合剂将层可释放地粘附到平台。在一些情况下,材料层可利用例如一个或多个缝合线或带来可释放地附接到平台。在某些情况下,层可包括固体材料片。在一些情况下,层可包括限定于其中的开孔。
除上述以外,从钉仓部署的钉可在进入组织中之前刺穿层。随着砧座导致针变形,针也可重新刺穿层。在各种情况下,例如,可将更厚或更耐受刺穿的聚合物条整合到层中。例如,此类条可整合到层的组织接触表面中。在至少一种情况下,每个条可为0.003英寸厚,并且由例如90/10PLA/PCL构成。在某些情况下,每个条例如可为0.006英寸厚的25/75PGA/PCL。例如,作为制毡工艺的一部分可将条焊接到泡沫中。名称为“IMPLANTABLE LAYERS ANDMETHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENINGINSTRUMENTS”的美国专利申请序列号14/187,383的公开内容全文以引用方式并入。制毡工艺可用于另一目的,即,形成闭孔泡沫和/或连续的组织接触表面。在一些情况下,可将单独的薄膜条焊接到泡沫的组织接触面中。本文公开的各种方法可形成具有与钉对准的特征结构或区的复合吸收性材料,其中钉具有用于初始钉穿孔、成形和再刺穿的不同特性。
层诸如支撑材料例如可由任何生物相容性材料制成。支撑材料可由天然材料和/或合成材料形成。支撑材料可为可生物吸收的和/或不可生物吸收的。应当理解,可使用天然、合成、可生物吸收和不可生物吸收材料的任意组合来形成支撑材料。可由其制成支撑材料的材料的一些非限制性示例包括但不限于例如聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(膦嗪)、聚酯、聚乙二醇、聚环氧乙烷、聚丙烯酰胺、聚羟乙基丙烯酸甲酯、聚乙烯吡咯烷酮、聚乙烯醇、聚丙烯酸、聚乙酸酯、聚己内酯、聚丙烯、脂族聚酯、甘油、聚(氨基酸)、共聚(醚酯)、聚亚烷基草酸酯、聚酰胺、聚(亚氨基碳酸酯)、聚亚烷基草酸酯、聚含氧酸酯、聚原酸酯、聚磷腈以及它们的共聚物、嵌段共聚物、均聚物、共混物和/或它们的组合。
可使用天然生物聚合物来形成支撑材料。合适的天然生物聚合物包括但不限于例如胶原、明胶、血纤蛋白、纤维蛋白原、弹性蛋白、角蛋白、白蛋白、羟乙基纤维素、纤维素、氧化纤维素、羟丙基纤维素、羧乙基纤维素、羧甲基纤维素、chitan、脱乙酰壳多糖和/或它们的组合。天然生物聚合物可与本文所述的其它聚合物材料组合以制备支撑材料。人和/或动物来源的胶原,例如I型猪或牛胶原、I型人胶原或III型人胶原,可用于形成支撑材料。支撑材料可由变性胶原或通过加热或任何其它方法至少部分地损失其螺旋结构的胶原制成,该胶原主要由分子量接近例如100kDa的非水合链组成。术语“变性胶原”是指损失其螺旋结构的胶原。用于本文所述的多孔层的胶原可为例如特别是如通过胃蛋白酶消化和/或在如先前定义的适度加热之后获得的天然胶原或去端肽胶原(atellocollagen)。胶原可能先前已通过氧化、甲基化、琥珀酰化、乙基化和/或任何其它已知过程进行化学改性。
在支撑材料为纤维的情况下,纤维可为适用于针织或机织的长细或线,或者可为短纤维诸如常用于制备非织造材料的那些。纤维可由任何生物相容性材料形成。纤维可由天然材料或合成材料形成。形成纤维的材料可为生物吸收性材料或非生物吸收性材料。应当理解,天然材料、合成材料、可生物吸收材料和不可生物吸收材料的任何组合都可用于形成纤维。可制成纤维的材料的一些非限制性示例包括但不限于聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(膦嗪)、聚酯、聚乙二醇、聚环氧乙烷、聚丙烯酰胺、聚羟乙基丙烯酸甲酯、聚乙烯吡咯烷酮、聚乙烯醇、聚丙烯酸、聚乙酸酯、聚己内酯、聚丙烯、脂族聚酯、甘油、聚(氨基酸)、共聚(醚酯)、聚亚烷基草酸酯、聚酰胺、聚(亚氨基碳酸酯)、聚亚烷基草酸酯、聚含氧酸酯、聚原酸酯、聚磷腈以及它们的共聚物、嵌段共聚物、均聚物、共混物和/或它们的组合。在支撑材料为纤维的情况下,支撑材料可使用适用于形成纤维结构的任何方法来形成,所述方法包括但不限于例如针织、机织、非织造技术等。在支撑材料为泡沫的情况下,多孔层可使用适于形成泡沫或海绵的任何方法形成,包括但不限于例如组合物的冻干和冷冻干燥。
支撑材料可具有止血性质。可用来提供具有辅助停止流血或出血的能力的支撑材料的材料的例示性示例包括但不限于例如聚(乳酸)、聚(乙醇酸)、聚(羟基丁酸酯)、聚(己内酯)、聚(二氧环己酮)、聚环氧烷、共聚(醚酯)、胶原、明胶、凝血酶、血纤蛋白、纤维蛋白原、纤粘蛋白、弹性蛋白、白蛋白、血红蛋白、卵清蛋白、多糖、透明质酸、硫酸软骨素、羟乙基淀粉、羟乙基纤维素、纤维素、氧化纤维素、羟丙基纤维素、羧乙基纤维素、羧甲基纤维素、chitan、脱乙酰壳多糖、琼脂糖、麦芽糖、麦芽糖糊精、藻酸盐、凝血因子、丙烯酸甲酯、聚氨酯、氰基丙烯酸酯、血小板激动剂、血管收缩剂、明矾、钙、RGD肽、蛋白、硫酸鱼精蛋白、ε-氨基己酸、硫酸铁、亚硫酸铁、氯化铁、锌、氯化锌、氯化铝、硫酸铝、乙酸铝、高锰酸盐、单宁、骨蜡、聚乙二醇、岩藻聚糖和/或它们的组合。对天然生物聚合物且特别是蛋白的使用可用于形成具有止血性质的支撑材料。合适的天然生物聚合物包括但不限于例如胶原、明胶、血纤维蛋白、纤维蛋白原、弹性蛋白、角蛋白、白蛋白和/或它们的组合。天然生物聚合物可与任何其它止血剂组合以制备支撑的多孔层。公布于2013年7月30日的名称为“BUTTRESS ANDSURGICAL STAPLING APPARATUS”的美国专利8,496,683的全部公开内容以引用方式并入本文。
在各种情况下,组织厚度补偿件组件可包含聚合物组合物。聚合物组合物可包含一种或多种合成聚合物和/或一种或多种非合成聚合物。合成聚合物可包括合成的可吸收聚合物和/或合成的非可吸收聚合物。在各种情况下,聚合物组合物可包含例如生物相容性泡沫。生物相容性泡沫可包括例如多孔的开孔泡沫和/或多孔的闭孔泡沫。生物相容性泡沫可具有均匀的孔形态,或者可具有梯度孔形态(即,在一个方向跨泡沫的厚度,小孔尺寸逐渐增加变成大孔)。在各种情况下,聚合物组合物可包括多孔支架、多孔基质、凝胶基质、水凝胶基质、溶液基质、丝状基质、管状基质、复合基质、膜基质、生物稳定聚合物和可生物降解的聚合物中的一种或多种、以及它们的组合。例如,组织厚度补偿件组件可包括通过丝状基质增强的泡沫,或者可包括具有附加的水凝胶层的泡沫,该附加的水凝胶层在体液存在下伸展,以在组织上进一步提供压缩。在各种情况下,组织厚度补偿件组件还可由材料和/或第二层或第三层上的涂层构成,该涂层在体液存在下伸展,以在组织上进一步提供压缩。此类层可为水凝胶,该水凝胶可为合成的和/或天然源材料,并且例如可为生物耐用的和/或可生物降解的。在某些情况下,可使用例如能提供附加柔韧性、刚度、和/或强度的纤维非织造材料或纤维网孔类型元件来增强组织厚度补偿件组件。在各种情况下,组织厚度补偿件组件具有多孔形态,该多孔形态表现出梯度结构,诸如例如,在一个表面上是小孔,而在另一表面上是较大的孔。此类形态对于生长中的组织或止血行为而言更为理想。另外,梯度还可与变化的生物吸收剖面相组合。短期吸收剖面可能更适合实现止血,而长期吸收剖面可以实现更好的组织愈合又不会渗漏。
非合成聚合物的示例包括但不限于冻干多糖、糖蛋白类、弹性蛋白、蛋白聚糖、明胶、胶原和氧化再生纤维素(ORC)。合成的可吸收聚合物的示例包括但不限于聚(乳酸)(PLA)、聚(L-乳酸)(PLLA)、聚己内酯(PCL)、聚乙醇酸(PGA)、聚(三亚甲基碳酸酯)(TMC)、聚对苯二甲酸乙二醇酯(PET)、多羟基链烷酸酯(PHA)、乙交酯和ε-己内酯的共聚物(PGCL)、乙交酯和三亚甲基碳酸酯的共聚物、聚(癸二酸甘油酯)(PGS)、聚二氧六环酮、聚(原酸酯)、聚酸酐、多糖、聚(酯-酰胺)、基于酪氨酸的聚芳酯、基于酪氨酸的聚亚氨基碳酸酯、基于酪氨酸的聚碳酸酯、聚(D,L-丙交酯-氨基甲酸酯)、聚(B-羟基丁酸酯)、聚(E-己内酯)、聚乙二醇(PEG)、聚[二(羧基苯氧基)磷腈](poly[bis(carboxylatophenoxy)phosphazene])、聚(氨基酸)、拟聚(氨基酸)、可吸收聚氨酯、以及它们的组合。在各种情况下,该聚合物组合物可包含例如按聚合物组合物的重量计约50%至约90%的PLLA和按聚合物组合物的重量计约50%至约10%的PCL。在至少一个实施方案中,该聚合物组合物可包含例如按重量计约70%的PLLA和按重量计约30%的PCL。在各种情况下,该聚合物组合物可包含例如按聚合物组合物的重量计约55%至约85%的PGA和按聚合物组合物的重量计15%至45%的PCL。在至少一个实施方案中,该聚合物组合物可包含例如约65重量%的PGA和约35重量%的PCL。在各种情况下,该聚合物组合物可包含例如按聚合物组合物的重量计约90%至约95%的PGA和按聚合物组合物的重量计约5%至约10%的PLA。
在各种情况下,合成的可吸收聚合物可包含可生物吸收的生物相容性弹性体共聚物。合适的可生物吸收的生物相容性弹性体共聚物包括但不限于ε-己内酯和乙交酯的共聚物(ε-己内酯与乙交酯的摩尔比优选地为约30:70至约70:30,优选地为35:65至约65:35,并且更优选地为45:55至35:65);ε-己内酯和丙交酯(包括L-丙交酯、D-丙交酯、它们的共混物或乳酸共聚物)的弹性体共聚物(ε-己内酯与丙交酯的摩尔比优选地为约35:65至约65:35,并且更优选地为45:55至30:70);对二氧杂环己酮(1,4-二氧六环-2-酮)和丙交酯(包括L-丙交酯、D-丙交酯和乳酸)的弹性体共聚物(对二氧杂环己酮与丙交酯的摩尔比优选地为约40:60至约60:40);ε-己内酯和对二氧杂环己酮的弹性体共聚物(ε-己内酯与对二氧杂环己酮的摩尔比优选地为约30:70至约70:30);对二氧杂环己酮和三亚甲基碳酸酯的弹性体共聚物(对二氧杂环己酮与三亚甲基碳酸酯的摩尔比优选地为约30:70至约70:30);三亚甲基碳酸酯和乙交酯的弹性体共聚物(三亚甲基碳酸酯与乙交酯的摩尔比优选地为约30:70至约70:30);三亚甲基碳酸酯和丙交酯(包括L-丙交酯、D-丙交酯、它们的共混物或乳酸共聚物)的弹性体共聚物(三亚甲基碳酸酯与丙交酯的摩尔比优选地为约30:70至约70:30);以及它们的共混物。在一个实施方案中,弹性体共聚物为乙交酯和ε-己内酯的共聚物。在另一个实施方案中,弹性体共聚物为丙交酯和ε-己内酯的共聚物。
公布于1995年11月21日的名称为“ELASTOMERIC MEDICAL DEVICE”的美国专利5,468,253和公布于2001年12月4日的名称为“FOAM BUTTRESS FOR STAPLING APPARATUS”的美国专利6,325,810的公开内容据此各自全文以引用方式并入本文。
在各种情况下,合成的可吸收聚合物可例如包含下列物质中的一种或多种:可以商品名称VICRYL(polyglactic 910)从Ethicon,Inc.商购获得的90/10聚(乙交酯-L-丙交酯)共聚物、可以商品名称DEXON从American Cyanamid Co.商购获得的聚乙交酯、可以商品名称PDS从Ethicon,Inc.商购获得的聚二氧六环酮、可以商品名称MAXON从AmericanCyanamid Co.商购获得的聚(乙交酯-三亚甲基碳酸酯)无规嵌段共聚物、可以商品名称MONOCRYL从Ethicon商购获得的75/25聚(乙交酯-E-己内酯-poliglecaprolactone 25)共聚物。
合成的非可吸收聚合物的示例包括但不限于聚氨酯泡沫塑料、聚丙烯(PP)、聚乙烯(PE)、聚碳酸酯、聚酰胺诸如尼龙、聚氯乙烯(PVC)、聚甲基丙烯酸甲酯(PMMA)、聚苯乙烯(PS)、聚酯、聚醚醚酮(PEEK)、聚四氟乙烯(PTFE)、聚三氟氯乙烯(PTFCE)、聚氟乙烯(PVF)、氟化乙烯丙烯(FEP)、聚缩醛、聚砜、以及它们的组合。合成的非可吸收聚合物可包括但不限于泡沫弹性体和多孔弹性体,诸如例如硅树脂、聚异戊二烯和橡胶。在各种情况下,合成聚合物可包括可以商品名称GORE-TEX Soft Tissue Patch从W.L.Gore&Associates,Inc.商购获得的膨体聚四氟乙烯(ePTFE),和可以商品名称NASOPORE从Polyganics商购获得的共聚醚酯聚氨酯泡沫。
组织厚度补偿件组件的聚合物组合物的特征可在于例如孔隙率百分比、孔尺寸、和/或硬度。在各种情况下,该聚合物组合物可具有例如约30体积%至约99体积%的孔隙率百分比。在某些情况下,该聚合物组合物可具有例如约60体积%至约98体积%的孔隙率百分比。在各种情况下,该聚合物组合物可具有例如约85体积%至约97体积%的孔隙率百分比。在至少一个实施方案中,该聚合物组合物可包含例如约70重量%的PLLA和约30重量%的PCL,并且可包括例如约90体积%的孔隙率。在至少一个此类实施方案中,因此,该聚合物组合物将包含约10体积%的共聚物。在至少一个实施方案中,该聚合物组合物可包含例如约65重量%的PGA和约35重量%的PCL,并且可具有例如约93体积%至约95体积%的孔隙率百分比。在各种情况下,聚合物组合物可包括大于85体积%的孔隙率。聚合物组合物可具有例如约5微米至约2000微米的孔尺寸。在各种情况下,聚合物组合物可具有例如介于约10微米至约100微米之间的孔尺寸。在至少一个此类实施方案中,该聚合物组合物可包含例如PGA和PCL的共聚物。在某些情况下,聚合物组合物可具有例如介于约100微米至约1000微米之间的孔尺寸。在至少一个此类实施方案中,该聚合物组合物可包含例如PLLA和PCL的共聚物。根据某些方面,聚合物组合物的硬度可以用肖氏硬度表示,该肖氏硬度可被定义为用硬度计(诸如肖氏硬度计)测定的材料对永久压痕的抗性。为了评估给定材料的硬度计值,根据名称为“Standard Test Method for Rubber Property-Durometer Hardness”的ASTM规程D2240-00(其全文以引用方式并入本文),用硬度计压头脚向材料施压。可将硬度计压头脚施加至材料持续足够的时间段,诸如15秒,然后通过适当的标度获取读数。根据所用的标度类型,当压头脚完全穿透材料时,可获得读数0,并且当材料未被穿透时,可获得读数100。该读数无量纲。在各种情况下,可根据ASTM D2240-00,采用任何合适的标度诸如例如A类和/或OO类标度来测定硬度。在各种情况下,组织厚度补偿件组件的聚合物组合物可具有例如约4A至约16A的肖氏A硬度值,该硬度值在肖氏OO范围内为约45OO至约65OO。在至少一个此类实施方案中,该聚合物组合物可包含例如PLLA/PCL共聚物或PGA/PCL共聚物。在各种情况下,组织厚度补偿件组件的聚合物组合物可具有小于15A的肖氏A硬度值。在各种情况下,组织厚度补偿件组件的聚合物组合物可具有小于10A的肖氏A硬度值。在各种情况下,组织厚度补偿件组件的聚合物组合物可具有小于5A的肖氏A硬度值。在某些情况下,聚合物材料可具有例如约35OO至约75OO的肖氏OO组合物值。
在各种情况下,聚合物组合物可具有上述识别的特性中的至少两种。在各种情况下,聚合物组合物可具有上述识别的特性中的至少三种。该聚合物组合物可具有例如85体积%至97体积%的孔隙率、5微米至2000微米的孔尺寸、和4A至16A的肖氏A硬度值,以及45OO至65OO的肖氏OO硬度值。在至少一个实施方案中,例如,聚合物组合物可包含按聚合物组合物的重量计70%的PLLA和按聚合物组合物的重量计30%的PCL,并具有90体积%的孔隙率、100微米至1000微米的孔尺寸、和4A至16A的肖氏A硬度值、以及45OO至65OO的肖氏OO硬度值。在至少一个实施方案中,例如,聚合物组合物可包含按聚合物组合物的重量计65%的PGA和按聚合物组合物的重量计35%的PCL,并具有93体积%至95体积%的孔隙率、10微米至100微米的孔尺寸、和4A至16A的肖氏A硬度值、以及45OO至65OO的肖氏OO硬度值。
在各种情况下,聚合物组合物可包含药物活性剂。聚合物组合物可释放治疗有效量的药物活性剂。在各种情况下,当聚合物组合物被解吸/吸收时药物活性剂可被释放。在各种情况下,药物活性剂可被释放到流体诸如例如流经聚合物组合物上方或穿过聚合物组合物的血液中。药物活性剂的示例可包括但不限于止血剂和药物,诸如例如血纤蛋白、凝血酶和氧化再生纤维素(ORC);抗炎剂药物,诸如例如双氯芬酸、阿司匹林、萘普生、舒林酸和氢化可的松;抗生素和抗微生物药物或抗微生物剂,诸如例如三氯生、离子银、氨苄青霉素、庆大霉素、多粘菌素B、氯霉素;以及抗癌剂,诸如例如顺铂、丝裂霉素、阿霉素。
本文公开了用于制造组织厚度补偿件的各种方法。此类方法可用于制造与例如紧固件仓和/或外科紧固器械一起使用的任何适合的层。此类层可包含可使用任何合适的工艺形成的小于百分之百致密的组合物。例如,此类工艺可包括例如挤出、注模、织造、冻干、气体发泡和/或熔喷工艺。一些工艺可能产生泡沫,而其它工艺可能不产生泡沫;然而,在任何情况下,都可设想到将所有此类实施方案与本文所公开的所有实施方案一起使用。
以下专利的全部公开内容据此以引用方式并入本文:
公布于1995年4月4日的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,403,312;
公布于2006年2月21日的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818;
公布于2008年9月9日的名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利7,422,139;
公布于2008年12月16日的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利7,464,849;
公布于2010年3月2日的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR”的美国专利7,670,334;
公布于2010年7月13日的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245;
公布于2013年3月12日的名称为“SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE”的美国专利8,393,514;
名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利申请序列号11/343,803,现为美国专利7,845,537;
提交于2008年2月14日的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING RF ELECTRODES”的美国专利申请序列号12/031,573;
提交于2008年2月15日的名称为“END EFFECTORS FOR A SURGICAL CUTTING ANDSTAPLING INSTRUMENT)”的美国专利申请序列号12/031,873;现为美国专利7,980,443;
名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT”的美国专利申请序列号12/235,782,现为美国专利8,210,411;
名称为“POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLYRETRACTABLE FIRING SYSTEM”的美国专利申请序列号12/249,117,现为美国专利8,608,045;
提交于2009年12月24日的名称为“MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENTWITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY”的美国专利申请序列号12/647,100,现为美国专利8,220,688;
提交于2012年9月29日的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461,现为美国专利8,733,613;
提交于2011年2月28日的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647,现为美国专利8,561,870;
名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利申请序列号13/118,241,现为美国专利申请公布2012/0298719;
2012年6月15日提交的名称为“ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING A FIRING DRIVE”的美国专利申请序列号13/524,049,现为美国专利申请公布2013/0334278;
提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,025;现为美国专利申请公布2014/0263551;
提交于2013年3月13日的名称为“STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM”的美国专利申请序列号13/800,067,现为美国专利申请公布2014/0263552;
提交于2006年1月31日的名称为“SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGER LOCKING MECHANISM”的美国专利申请公布2007/0175955;以及
提交于2010年4月22日的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请公布2010/0264194,现为美国专利8,308,040。
尽管本文已结合某些公开的实施方案阐述了装置的各种实施方案,但可实施对这些实施方案的诸多修改和变型。另外,在公开用于某些部件的材料的情况下,可使用其它材料。此外,根据多种实施方案,单个部件可被替换为多个部件,并且多个部件也可被替换为单个部件,以执行给定的一种或多种功能。上述具体实施方式和下述权利要求旨在涵盖所有这样的修改和变型。
本文所公开的装置可被设计成在单次使用后被丢弃,或者其可被设计成使用多次。然而,在任一种情况下,可修复装置以在至少一次使用之后重复使用。修复可包括以下步骤的任意组合:拆卸装置,然后清洁或替换特定零件以及随后进行重新组装。具体地讲,可拆卸装置,并且可选择性地以任何组合形式替换或移除装置的任意数量的特定零件或部件。在清洁和/或替换特定部件后,可重新组装装置以供随后在修复设施处或在即将进行外科规程之前由手术团队使用。本领域的技术人员应当理解,装置的重新修复可利用多种用于拆卸、清洗/替换和重新组装的技术。这些技术的用途以及所得的修复装置全在本申请的范围内。
优选地,本文所述的发明将在外科手术之前处理。首先,获取新的或用过的器械,并根据需要进行清洁。然后可对器械进行灭菌。在一种灭菌技术中,将器械放置在闭合且密封的容器中,诸如塑料或TYVEK袋中。然后将容器和器械放置在可穿透该容器的辐射场(诸如γ辐射、X射线或高能电子)中。辐射可杀灭器械上和容器中的细菌。然后可将经灭菌的器械储存在无菌容器中。密封容器使器械保持无菌,直到其在医疗设施中被打开。
尽管本发明已被描述为具有示例性的设计,但可在本公开的实质和范围内进一步修改本发明。因此,本申请旨在涵盖采用本发明一般原理的本发明的任何变型、用途或改型。此外,本申请旨在涵盖归属于本发明所属领域中的已知或习惯做法的相对于本公开的此类偏离。
据称以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本公开所提出的现有定义、陈述或其它公开材料相冲突的范围内并入本文。同样地并且在必要的程度下,本文明确阐述的公开内容取代了以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (23)
1.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
近侧端部;
远侧端部;
平台,所述平台包括组织支撑表面;
凹陷,所述凹陷限定在所述平台中;
多个钉腔,其中所述钉腔中的至少一个限定在所述凹陷中;
多个钉,所述多个钉可移除地储存在所述钉腔中;
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,其中所述层延伸到所述凹陷中,并且其中所述层与所述凹陷之间的相互作用被配置成能够减少所述层与所述仓体之间的相对运动。
2.根据权利要求1所述的外科缝合设备,其中所述层包括组织厚度补偿件。
3.根据权利要求1所述的外科缝合设备,其中所述层包括支撑材料。
4.根据权利要求1所述的外科缝合设备,其中所述层楔入所述凹陷中。
5.根据权利要求1所述的外科缝合设备,其中所述凹陷包括在所述近侧端部与所述远侧端部之间延伸的纵向的凹陷,并且多于一个的所述钉腔限定在所述凹陷中。
6.根据权利要求1所述的外科缝合设备,其中所述凹陷包括独立的凹陷,并且其中所述钉腔中的仅一个限定在所述独立的凹陷中。
7.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
平台,所述平台包括组织支撑表面;
多个钉腔;以及
多个凹陷,其中每个所述凹陷围绕一个所述钉腔;
多个钉,所述多个钉可移除地储存在所述钉腔中;
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,其中所述层延伸到所述凹陷中,并且其中所述层与所述凹陷之间的相互作用被配置成能够将所述层可释放地保持到所述仓体。
8.根据权利要求7所述的外科缝合设备,其中所述层包括组织厚度补偿件。
9.根据权利要求7所述的外科缝合设备,其中所述层包括支撑材料。
10.根据权利要求7所述的外科缝合设备,其中所述层楔入所述凹陷中。
11.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
近侧端部;
远侧端部;
平台,所述平台包括:
组织支撑表面;
纵向狭槽,所述纵向狭槽被配置成能够接纳击发构件;
以及
纵向的通道;
多个钉腔,所述多个钉腔包括:
沿第一纵向轴线布置的第一排钉腔;
沿第二纵向轴线布置的第二排钉腔,其中所述第二排钉腔限定在所述纵向的通道中;以及
多个钉,所述多个钉可移除地储存在所述钉腔中;
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,其中所述层延伸到所述通道中,并且其中所述层与所述通道之间的相互作用被配置成能够减少所述层与所述仓体之间的相对运动。
12.根据权利要求11所述的外科缝合设备,其中所述层包括组织厚度补偿件。
13.根据权利要求11所述的外科缝合设备,其中所述层包括支撑材料。
14.根据权利要求11所述的外科缝合设备,其中所述层楔入所述通道中。
15.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
平台,所述平台包括组织支撑表面,其中所述组织支撑表面由多个波形部限定;
多个钉腔;以及
多个钉,所述多个钉可移除地储存在所述钉腔中;
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,其中所述层包括所述波形表面的凹腔,并且其中所述层与所述波形部之间的相互作用被配置成能够减少所述层与所述仓体之间的相对运动。
16.根据权利要求15所述的外科缝合设备,其中所述层包括组织厚度补偿件。
17.根据权利要求15所述的外科缝合设备,其中所述层包括支撑材料。
18.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
近侧端部;
远侧端部;
平台,所述平台包括组织支撑表面;
多个脊,所述多个脊跨所述组织支撑表面侧向延伸;以及
多个钉腔;
多个钉,所述多个钉可移除地储存在所述钉腔中;以及
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,其中所述层包括被配置成能够接纳所述脊的多个狭缝,并且其中所述狭缝与所述脊之间的相互作用被配置成能够减少所述层与所述仓体之间的相对运动。
19.根据权利要求18所述的外科缝合设备,其中所述层包括组织厚度补偿件。
20.根据权利要求18所述的外科缝合设备,其中所述层包括支撑材料。
21.根据权利要求18所述的外科缝合设备,其中所述脊楔入所述狭缝中。
22.一种用于缝合组织的外科缝合设备,包括:
仓体,所述仓体包括:
近侧端部;
远侧端部;
平台,所述平台包括组织支撑表面;
钉腔排;以及
凹坑扩展部排,所述凹坑扩展部排与所述钉腔排对准地从所述平台延伸;
多个钉,所述多个钉可移除地储存在所述钉腔中;以及
层,所述层定位在所述平台上方,其中所述钉被配置成能够在所述钉从所述钉腔射出时贴靠所述组织植入所述层,并且其中所述层包括被配置成能够接纳所述凹坑扩展部排的纵向狭缝。
23.根据权利要求22所述的外科缝合设备,其中在所述凹坑扩展部与所述纵向狭槽之间存在间隙配合。
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US14/516,277 US9924944B2 (en) | 2014-10-16 | 2014-10-16 | Staple cartridge comprising an adjunct material |
PCT/US2015/052558 WO2016060828A1 (en) | 2014-10-16 | 2015-09-28 | Staple cartridge comprising an adjunct material |
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EP (1) | EP3009082B1 (zh) |
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US20220387027A1 (en) | 2022-12-08 |
US20200000469A1 (en) | 2020-01-02 |
US20210393260A1 (en) | 2021-12-23 |
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EP3009082B1 (en) | 2019-05-01 |
JP2020114468A (ja) | 2020-07-30 |
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JP2017531516A (ja) | 2017-10-26 |
BR112017007744B1 (pt) | 2022-07-12 |
US11931031B2 (en) | 2024-03-19 |
JP6740223B2 (ja) | 2020-08-12 |
BR112017007744A2 (pt) | 2018-01-30 |
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CN107405147B (zh) | 2020-05-15 |
US20220313253A1 (en) | 2022-10-06 |
US11918210B2 (en) | 2024-03-05 |
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