CN107427300B - 外科缝合支撑物和辅助材料 - Google Patents

外科缝合支撑物和辅助材料 Download PDF

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CN107427300B
CN107427300B CN201580064512.7A CN201580064512A CN107427300B CN 107427300 B CN107427300 B CN 107427300B CN 201580064512 A CN201580064512 A CN 201580064512A CN 107427300 B CN107427300 B CN 107427300B
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staple
staples
edge
cartridge
row
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CN107427300A (zh
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J·L·哈里斯
C·J·谢尔布
B·W·史密斯
L·M·卡塞拉
J·R·摩根
F·E·谢尔顿四世
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Ethicon LLC
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Abstract

本发明公开了一种用于与外科钉仓一起使用的支撑材料。在各种形式中，所述支撑材料包括支撑主体，所述支撑主体的大小被设计成可操作地接收在所述外科钉仓的平台上。所述支撑主体包括至少四个边缘和中心部分。所述边缘中的至少两个边缘具有形成于其中的多个边缘凹口。所述中心部分可包括在其中形成的多个切口开口。

Description

外科缝合支撑物和辅助材料
背景技术
本发明涉及缝合器械，并且在各种实施方案中，涉及一种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，其中每个钳口构件可适于插入患者体内并相对于待缝合和/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齐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射出。在至少一个实施方案中，凸轮表面可被构造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 STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLINGINSTRUMENTS 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每个方面，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详细描述。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说明来加以理解：
图1是根据至少一个实施方案的外科紧固器械的透视图；
图2是图1的外科紧固器械的端部执行器的分解图；
图3是图2的端部执行器的紧固件仓的顶部平面图；
图4是图2的端部执行器的砧座的底部平面图；
图5是根据至少一个实施方案的砧座的局部底部平面图；
图6是根据至少一个实施方案的砧座的局部底部平面图；
图7是根据本公开的各种实施方案的包括钉仓的端部执行器的分解透视图，该钉仓包括成角度地取向的钉、一组第一多钉驱动器，以及一组第二多钉驱动器；
图8是图7的第一多钉驱动器中的一个多钉驱动器的透视图；
图8A是图8的第一多钉驱动器的平面图；
图8B是图8的第一多钉驱动器的透视图，并且进一步示出由多钉驱动器支撑的图7的钉；
图8C是图7的第二多钉驱动器中的一个多钉驱动器的透视图；
图8D是图8C的第二多钉驱动器的平面图；
图9是图8C的第二多钉驱动器的透视图，并且进一步示出由多钉驱动器支撑的图7的钉；
图10是根据本公开的各种实施方案的钉仓的平面图；
图11是根据本公开的各种实施方案的多钉驱动器和驱动楔形件的布置的平面图；
图12是根据本公开的各种实施方案的多钉驱动器和驱动楔形件的布置的平面图；
图13是根据本公开的各种实施方案的多钉驱动器和驱动楔形件的布置的平面图；
图14是根据本公开的各种实施方案的单钉驱动器和驱动楔形件的布置的平面图；
图15是图14的驱动楔形件的正视图；
图16是根据本公开的各种实施方案的钉和驱动楔形件的布置的平面图；
图17是根据至少一个实施方案的被示为处于未形成或未击发构型的钉的透视图；
图18是图17的钉的正视图；
图19是处于形成或击发构型的图17的钉的正视图；
图20是根据至少一个实施方案的被示为处于未形成或未击发构型的包括可膨胀涂层的钉的正视图；
图21是部署到患者组织中的图20的钉的局部底部平面图；
图22是部署到患者组织中的图20的钉的局部底部平面图，示出处于膨胀状态的涂层；
图23示出根据至少一个实施方案的由钉线缝合的组织；
图24示出根据至少一个实施方案的由钉线缝合的组织；
图25示出根据至少一个实施方案的由钉线缝合的组织；
图26是根据本公开的各种实施方案的驱动楔形件和钉的正视图；
图27是图26的驱动楔形件和钉的透视图；
图28是图26的驱动楔形件和钉的平面图；
图29是圆形缝合装置的透视图；
图29A是圆形缝合装置的缝合头的一部分和紧固件仓组件的透视图；
图30是圆形缝合装置的缝合头的部分和另一个紧固件仓组件的透视图；
图31是圆形缝合装置的缝合头的部分和另一个紧固件仓组件的透视图；
图32示出根据至少一个实施方案的由钉线缝合的组织，其中钉线中的钉中的至少一些钉重叠；
图33是被构造成能够部署图32的钉线的钉仓的局部平面图；
图34是被构造成能够使从图33的钉仓射出的钉变形的砧座的局部平面图；
图35是根据至少一个实施方案的被构造成能够部署钉线的钉仓的局部平面图；
图36是被构造成能够使从图35的钉仓射出的钉变形的砧座的局部平面图；
图37是根据本公开的各种实施方案的包括具有滑动件的无驱动器钉仓的端部执行器的分解透视图；
图38是图37的滑动件的透视图；
图38A是图37的滑动件和钉的局部平面图，其示出钉的部署进程；
图38B是图37的滑动件和钉的正视图，其示出钉的部署进程；
图39是根据本公开的各种实施方案的示于图37中的无驱动器钉仓的滑动件的透视图；
图39A是根据本公开的各种实施方案的具有成角度钉和图39的滑动件的无驱动器钉仓的局部平面图；
图39B是根据本公开的各种实施方案的图39的滑动件和图20的钉的局部透视图；
图40是根据本公开的各种实施方案的滑动件和钉的局部透视图；
图41是根据本公开的各种实施方案的钉的阵列的平面图；
图42是根据本公开的各种实施方案的钉和驱动楔形件的阵列的平面图；
图43是根据本公开的各种实施方案的其中具有成角度钉腔的布置的钉仓的局部透视图；
图44是图43的钉仓的局部平面图；
图45是图43的钉仓的透视剖面局部视图，其示出定位在钉仓内的钉和驱动器；
图46是根据本公开的各种实施方案的其中具有成角度钉腔的布置的钉仓的局部透视图；
图47是图46的钉仓的局部平面图；
图48是图46的钉仓的局部透视剖面图；
图49是根据本公开的各种实施方案的其中具有成角度钉腔的布置的钉仓的局部透视图；
图50是图49的钉仓的局部平面图；
图51是图49的钉仓的局部透视剖面图，其示出定位在钉仓内的钉和多钉驱动器；
图52示出植入组织中的先前钉图案；
图52A示出由图3的钉仓部署的钉图案；
图52B示出处于伸展状态的图52A的钉图案；
图53是根据至少一个实施方案的钉仓的局部平面图，该钉仓包括仓体和定位在仓体上的可植入辅助材料；
图54是根据至少一个实施方案的可植入辅助材料的局部平面图；
图55是根据至少一个实施方案的钉仓的局部平面图，该钉仓包括仓体和定位在仓体上的可植入辅助材料；
图56是根据至少一个实施方案的可植入辅助材料的局部平面图；
图57是根据至少一个实施方案的可植入辅助材料的局部平面图；
图58是外科缝合器械的一部分和端部执行器的分解透视图；
图59是具有支撑构件的外科钉仓的透视图，该支撑构件在其中支撑物可从仓移除的位置中支撑在钉仓的平台上；
图60是图59的外科钉仓和支撑构件的俯视图；
图61是图59和图60的外科钉仓和支撑构件的一部分的透视图；
图62是图59-图61的外科钉仓和支撑构件的另一部分的俯视图；
图63是图59-图62的外科钉仓和支撑构件的近侧端部的透视图；
图64是图59-图63的外科钉仓和支撑构件的近侧端部的另一透视图，其中保持凸片折叠以用于插入仓中的纵向狭槽中；
图65是图59-图64的外科钉仓和支撑构件的近侧端部的另一透视图，其中保持凸片插入纵向狭槽中并且由钉滑动件保持在其中；
图66是另一个外科钉仓和另一个支撑构件的分解组装视图；
图67是图66的支撑构件的仰视图；
图68是图67的支撑构件的一部分的放大视图，其中下面的钉腔在钉仓中的位置以虚线示出；
图69是另一个支撑构件的一部分的放大视图，其中下面的钉腔在钉仓中的位置以虚线示出；
图70是另一个支撑构件的一部分的俯视图，其中下面的钉腔在钉仓中的位置以虚线示出；
图71是另一个支撑构件的一部分的俯视图；
图72是沿着图71中的线72-72截取的图71的支撑构件的剖视图；
图73是另一个外科钉仓的透视图；
图74是图73的外科钉仓的俯视图；
图75是图73和图74的外科钉仓的一部分的放大透视图；
图76是另一个外科钉仓的俯视图；
图77是外科缝合装置的一部分的侧正视图，其中组织“T”夹持在图76的外科钉仓和装置的砧座之间；
图78是图76和图77的外科钉仓的一部分的放大视图，其一部分以横截面示出；
图79是根据本公开的各种实施方案的钉仓和砧座的局部剖面正视图；并且
图80是根据本公开的各种实施方案的钉仓和砧座的局部剖面正视图。
在所有若干视图中，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，并且此类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
本申请的申请人拥有与本申请同日提交的下列专利申请，这些专利申请各自全文以引用方式并入本文：
名称为“CIRCULAR FASTENER CARTRIDGES FOR APPLYING RADIALLY EXPANDABLEFASTENER LINES”的代理人案卷号为END7503USNP/140283的美国专利申请序列号__________；
名称为“SURGICAL STAPLE AND DRIVER ARRANGEMENTS FOR STAPLE CARTRIDGES”的代理人案卷号为END7504USNP/140284的美国专利申请序列号__________；
名称为“SURGICAL STAPLE AND DRIVER ARRANGEMENTS FOR STAPLE CARTRIDGES”的代理人案卷号为END7505USNP/140285的美国专利申请序列号__________；
名称为“FASTENER CARTRIDGE FOR CREATING A FLEXIBLE STAPLE LINE”的代理人案卷号为END7507USNP/140287的美国专利申请序列号__________；和
名称为“METHOD FOR CREATING A FLEXIBLE STAPLE LINE”的代理人案卷号为END7508USNP/140288的美国专利申请序列号__________。
本申请的申请人拥有2014年6月30日提交的下列专利申请，这些专利申请各自全文以引用方式并入本文：
名称为“FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENTCONFIGURATIONS”的美国专利申请序列号14/318,996；
名称为“FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDINGFASTENER CONTROL FEATURES”的美国专利申请序列号14/319,006；
名称为“END EFFECTOR COMPRISING AN ANVIL INCLUDING PROJECTIONSEXTENDING THEREFROM”的美国专利申请序列号14/319,014；
名称为“SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZINGARRANGEMENTS”的美国专利申请序列号14/318,991；
名称为“SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORINGARRANGEMENTS”的美国专利申请序列号14/319,004；
名称为“FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”的美国专利申请序列号14/319,008；
名称为“FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGINGMEMBERS”的美国专利申请序列号14/318,997；
名称为“FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES”的美国专利申请序列号14/319,002；
名称为“FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVERARRANGEMENTS”的美国专利申请序列号14/319,013；和
名称为“FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO”的美国专利申请序列号14/319,016。
本文对许多特定细节作了阐述，以使读者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、制造和用途有透彻理解。然而，本领域的技术人员将理解，可以在没有这些特定细节的情况下实施所述实施方案。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(comprise)”(以及包括的任何形式，诸如“包括(comprises)”和“包括(comprising)”)、“具有(have)”(和具有的任何形式，诸如“具有(has)”和“具有(having)”)、“包含(include)”(和包含的任何形式，诸如“包含(includes)”、和“包含(including)”以及“含有(contain)”(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，外科器械能够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。
外科紧固器械100示于图1中。外科紧固器械100被构造成能够部署可膨胀钉线。各种可膨胀钉线在本文中都有所公开并且外科紧固器械100能够部署这些可膨胀钉线中的任一个可膨胀钉线。此外，除了外科紧固器械100之外的外科器械能够部署本文所公开的可膨胀钉线中的任一个可膨胀钉线。
外科紧固器械100包括柄部110、轴120和端部执行器200。柄部110包括手枪式握把140、被构造成能够操作闭合系统的闭合触发器150、被构造成能够操作击发系统的击发触发器160、以及被构造成能够操作关节运动系统以用于使端部执行器200相对于轴120进行关节运动的关节运动致动器170。2010年12月7日公布的名称为“SURGICAL INSTRUMENTHAVING RECORDING CAPABILITIES”的美国专利7,845,537的公开内容全文以引用方式并入本文。可以设想到包括被构造成能够操作闭合系统和击发系统的单个触发器的其它实施方案。可以设想到各种实施方案，其中外科器械的端部执行器不能进行关节运动。2013年8月23日提交的名称为“FIRING MEMBER RETRACTION DEVICES FOR POWERED SURGICALINSTRUMENTS”的美国专利申请序列号13/974,166的公开内容全文以引用方式并入。
闭合触发器150可朝向手枪式握把140旋转以致动闭合系统。首先参见图2，闭合系统包括闭合管122，当闭合触发器150朝向手枪式握把140移动时，该闭合管朝远侧推进。闭合管122与包括端部执行器200的砧座220的第一钳口接合。在至少一种情况下，砧座220包括从其延伸的一个或多个突出部228，该突出部被定位在限定在第二钳口中的一个或多个细长狭槽212中。突出部228和细长狭槽212被结构化并且布置成使砧座220能够相对于第二钳口的静止或固定的仓通道210在打开位置和闭合位置之间旋转。在各种另选的实施方案中，仓通道可相对于静止或固定的砧座220旋转。不管端部执行器的仓通道或砧座是否被固定，端部执行器都可相对于轴是可关节运动或不可关节运动的。
再次参见图2，砧座220包括凸片226，该凸片与限定在闭合管122中的狭槽124接合。当闭合管122由闭合触发器150朝远侧移动时，狭槽124的侧壁可接合凸片226并且使仓通道210朝向砧座220旋转。当闭合管122朝近侧移动时，狭槽124的另一个侧壁可接合凸片226并且使砧座220远离仓通道210旋转。在一些情况下，偏置弹簧可被定位在砧座220和仓通道210中间，该偏置弹簧可被构造成能够将砧座220偏置远离仓通道210。
再次参见图2，击发触发器160可朝向手枪式握把140旋转以致动击发系统。击发系统包括在轴120内延伸的击发构件。击发系统还包括滑动件250，该滑动件可操作地与击发构件接合。当击发触发器160朝向手枪式握把140旋转时，击发触发器160将击发构件和滑动件250在端部执行器200内朝远侧驱动。端部执行器200还包括定位在仓通道210内的钉仓230。钉仓230是可替换的，并因此可从仓通道210移除；然而，可以设想到其它实施方案，其中钉仓230不容易替换并且/或者从仓通道210移除。
钉仓230包括多个钉腔270。每个钉腔270被构造成能够在其中可移除地储存钉，但可能的是，一些钉腔270可能不容纳储存在其中的钉。钉仓230还包括可移动地定位在其中的多个钉驱动器240。每个驱动器240被构造成能够支撑三个钉和/或同时或并发地将三个钉提升出它们相应的钉腔270。虽然图1-图4所示的实施方案的每个驱动器240同时部署三个钉，但可以设想其它实施方案，其中驱动器可同时部署少于三个钉或多于三个钉。滑动件250包括一个或多个斜坡表面252，该斜坡表面被构造成能够在驱动器240下滑动并且将驱动器240向上朝向钉仓230的平台表面233提升。滑动件250能够从钉仓230的近侧端部231朝向远侧端部232移动以依次提升驱动器240。当驱动器240被滑动件250朝向平台提升时，驱动器240将钉朝向砧座220提升。在滑动件250朝远侧行进时，钉被抵靠砧座220驱动并且由驱动器240从钉腔270射出。钉仓230还可包括附接到其上的支撑盘260，该支撑盘围绕钉仓230的底部延伸并且将驱动器240、钉和/或滑动件250保持在仓230内。
滑动件250和/或将滑动件250朝远侧推进的推杆构件可被构造成能够接合包括砧座220的第一钳口和/或包括钉仓230的第二钳口并且将砧座220和钉仓230相对于彼此定位。在至少一种情况下，滑动件250包括从其延伸的至少一个第一突出部256，该第一突出部被构造成能够接合砧座220，以及至少一个第二突出部258，该第二突出部被构造成能够接合仓通道210。突出部256和258可将砧座220和钉仓230相对于彼此定位。在滑动件250朝远侧推进时，突出部256和258可定位砧座220并且在砧座220和平台233之间设置组织间隙。
端部执行器200还可包括切割构件，该切割构件被构造成能够切入被捕获在钉仓230和砧座220之间的组织。再次参见图2，滑动件250包括刀254；然而，可使用任何合适的切割构件。在滑动件250朝远侧推进以从钉腔270部署钉时，刀254朝远侧移动以横切组织。在某些另选的实施方案中，将滑动件250朝远侧推动的击发构件可包括切割构件。仓230包括被构造成能够至少部分地接收刀254的纵向狭槽234。砧座220还包括被构造成能够至少部分地接收刀254的纵向狭槽；然而，可以设想到这样的实施方案，其中仓230和砧座220中的仅一者包括被构造成能够接收切割构件的狭槽。
除上述以外，主要参见图1，外科器械100的柄部110包括关节运动致动器170，当致动时，该关节运动致动器可使端部执行器200围绕关节运动接头180进行关节运动。当致动器170沿第一方向推动时，端部执行器200可沿第一方向旋转，并且当致动器170沿第二方向推动时，端部执行器200可沿第二或相反的方向旋转。现在参见图2，端部执行器200包括安装到其近侧端部的关节运动锁板182。在图示的实施方案中，锁板182通过销184安装到仓通道210，该销延伸穿过限定在仓通道210和锁板182中的开孔214。轴120还可包括能够在第一接合位置和第二或脱离位置之间移动的锁，在该第一接合位置时锁与锁板182接合，在该第二或脱离位置时锁与锁板脱离接合。当锁处于其接合位置时，锁可将端部执行器200保持在适当位置。当锁处于其脱离位置时，端部执行器200可围绕关节运动接头180旋转。2014年6月25日提交的名称为“ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMSFOR SURGICAL INSTRUMENTS”的美国专利申请序列号14/314,788的公开内容全文以引用方式并入。2013年2月26日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR”的美国专利申请序列号2013/0168435的公开内容全文以引用方式并入。
现在转到图3和图4，钉仓200的钉腔270可被定位和布置成使得储存在钉腔中的钉作为可延展钉线的一部分部署。钉腔270被布置在钉腔阵列中。钉腔阵列包括可移除地储存第一排钉的第一排钉腔270a。第一排钉腔270a沿着与纵向狭槽234相邻的第一纵向轴线272a延伸。钉腔阵列包括可移除地储存第二排钉的第二排钉腔270b。第二排钉腔270b沿着与第一排钉腔270a相邻的第二纵向轴线272b延伸。钉腔阵列包括可移除地储存第三排钉的第三排钉腔270c。第三排钉腔270c沿着第二排钉腔270b延伸。
再次参见图3和图4，第一纵向轴线272a平行于或至少基本上平行于第二纵向轴线272b；然而，其它布置是可能的，其中第一纵向轴线272a不平行于第二纵向轴线272b。第二纵向轴线272b平行于或至少基本上平行于第三纵向轴线272c；然而，其它布置是可能的，其中第二纵向轴线272b不平行于第三纵向轴线272c。第一纵向轴线272a平行于或至少基本上平行于第三纵向轴线272c；然而，其它布置是可能的，其中第一纵向轴线272a不平行于第三纵向轴线272c。
再次参见图3和图4，钉仓230包括钉腔阵列的第一部分和该腔阵列的第二部分，该钉腔阵列的第一部分包括位于纵向狭槽234的第一侧上的第一排270a、第二排270b和第三排270c，该腔阵列的第二部分包括位于纵向狭槽234的第二侧上的第一排270a、第二排270b和第三排270c。第一腔阵列部分是第二腔阵列部分相对于纵向槽的镜像；然而，可以使用其它布置。
钉仓230被构造成能够部署图52A中所示的钉阵列。钉仓230被构造成能够沿着第一纵向轴线282a部署第一排钉280a，沿着第二纵向轴线282b部署第二排钉280b，并且沿着第三纵向轴线282c部署第三排钉280c。在各种情况下，钉仓230被构造成能够将第一排钉280a、第二排钉280b和第三排钉280c部署在纵向切口284的第一侧上，并且将第一排钉280a、第二排钉280b和第三排钉280c部署在纵向切口284的第二侧上。第一排钉280a可被定位成与纵向切口284相邻，并且第三排钉280c可被定位成离纵向切口284最远。每个第二排钉280b可被定位在第一排钉280a和第三排钉280c中间。
除上述以外，第一钉280a可移除地储存在第一钉腔270a中，第二钉280b可移除地储存在第二钉腔270b中，并且第三钉280c可移除地储存在第三钉腔270c中。钉腔270a-270c被构造和布置成以图52A所示的布置部署钉280a-280c。第一钉280a相对于纵向轴线282a以第一角度274a取向。第二钉280b相对于纵向轴线282b以第二角度274b取向。第三钉280c相对于纵向轴线282c以第三角度274c取向。第一角度274a不同于第二角度274b；然而，在其它实施方案中，第一角度274a和第二角度274b可为相同的。第三角度274c不同于第二角度274b；然而，在其它实施方案中，第三角度274c和第二角度274b可为相同的。第一角度274a与第三角度274c相同；然而，在其它实施方案中，第一角度274a和第三角度274c可为不同的。
除上述以外，第一角度274a可相对于第一纵向轴线282a测量，第二角度274b可相对于第二纵向轴线282b测量，并且第三角度274c可相对于第三纵向轴线282c测量。当第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c彼此平行时，第一角度274a、第二角度274b和/或第三角度274c可相对于第一纵向轴线282a、第二纵向轴线282b和第三纵向轴线282c中的任一者测量。当第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c平行于纵向狭槽234时，第一角度274a、第二角度274b和/或第三角度274c可相对于纵向狭槽234测量。相应地，当第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c平行于组织横切284时，第一角度274a、第二角度274b和/或第三角度274c可相对于组织横切284测量。
第一钉280a、第二钉280b和第三钉280c可被定位和布置成使得它们提供侧向重叠的钉线。更具体地讲，再次参见图52A，第二钉280b的纵向排相对于第一钉280a的纵向排侧向定位，使得第二钉280b与第一钉280a之间的间隙对齐，并且类似地，第三钉280c的纵向排相对于第二钉280b的纵向排侧向定位，使得第三钉280c与第二钉280b之间的间隙对齐。这样的布置可限制血液从组织T到横切面284的流动。
在图示的实施方案中，每个第一钉280a包括相对于相邻第二钉280b的远侧腿部283b位于远侧的远侧腿部283a，以及另外相对于远侧腿部283b位于近侧的近侧腿部285a。类似地，每个第三钉280c包括相对于相邻第二钉280b的远侧腿部283b位于远侧的远侧腿部283c，以及另外相对于远侧腿部283b位于近侧的近侧腿部285c。与上述第一钉280a和第三钉280c相邻的第二钉280b包括相对于第一钉280a的近侧腿部285a和第三钉280c的近侧腿部285c位于近侧的近侧腿部285b。这仅是一个示例性实施方案，并且可使用任何合适的布置。
除上述以外，第一钉280a跨越第一纵向轴线282a。第一钉280a的远侧腿部283a被定位在第一纵向轴线282a的一侧上，并且近侧腿部285a被定位在第一纵向轴线282a的另一侧上。换句话讲，第一钉280a的腿部相对于第一纵向轴线282a偏置。可以设想到另选的实施方案，其中第一钉280a与第一纵向轴线282a对齐或共线。
第二钉280b跨越第二纵向轴线282b。第二钉280b的远侧腿部283b被定位在第二纵向轴线282b的一侧上，并且近侧腿部285b被定位在第二纵向轴线282b的另一侧上。换句话讲，第二钉280b的腿部相对于第二纵向轴线282b偏置。可以设想到另选的实施方案，其中第二钉280b与第二纵向轴线282b对齐或共线。
第三钉280c跨越第三纵向轴线282c。第三钉280c的远侧腿部283c被定位在第三纵向轴线282c的一侧上，并且近侧腿部285c被定位在第三纵向轴线282c的另一侧上。换句话讲，第三钉280c的腿部相对于第三纵向轴线282c偏置。可以设想到另选的实施方案，其中第三钉280c与第三纵向轴线282c对齐或共线。
在某些实施方案中，第一钉280a可包括与相邻第二钉280b的远侧腿部283b对齐的近侧腿部285a。类似地，第三钉280c可包括与相邻第二钉280b的远侧腿部283b对齐的近侧腿部285c。在各种实施方案中，第一钉280a可包括近侧腿部285a，该近侧腿部相对于相邻第二钉280b的远侧腿部283b在远侧定位。类似地，第三钉280c可包括近侧腿部285c，该近侧腿部相对于相邻第二钉280b的远侧腿部283b在远侧定位。
第二钉280b的排由第一钉280a的排和第三钉280c的排界定。第二钉280b在一侧上由第一钉280a界定并且在另一侧上由第三钉280c界定。更具体地讲，第一钉280a相对于第二钉280b的近侧腿部285b侧向向内定位，并且类似地，第三钉280c相对于第二钉280b的远侧腿部283b侧向向外定位。因此，第一钉280a可在第二钉280b的一侧上提供边界，并且第三钉280b可在第二钉280b的另一侧上提供边界。
传统钉阵列示于图52中。该钉阵列包括定位在组织T中的切口384的第一侧上沿着第一纵向轴线382a定位的第一排钉380a、沿着第二纵向轴线382b定位的第二排钉380b、以及沿着第三纵向轴线382c定位的第三排钉380c。钉380a与第一纵向轴线382a对齐或至少基本上对齐；钉380b与第二纵向轴线382b对齐或至少基本上对齐；并且钉380c与第三纵向轴线382c对齐或至少基本上对齐。换句话讲，第一钉380a不相对于第一纵向轴线382a以一定角度取向，第二钉380b不相对于第二纵向轴线382b以一定角度取向，并且第三钉380c不相对于第三纵向轴线382c以一定角度取向。该钉阵列还包括定位在切口384的第二或相对侧上沿着第一纵向轴线382a定位的第一排钉380a、沿着第二纵向轴线382b定位的第二排钉380b、以及沿着第三纵向轴线382c定位的第三排钉380c。
当将纵向拉力施加到由图52所示的钉阵列缝合的组织T上时，组织将纵向伸展。此外，在各种情况下，在组织被纵向伸展时，钉380a、380b和380c可纵向平移。这样的布置在许多情况下可为合适的；然而，钉380a、380b和380c可限制组织的伸展和/或移动。在一些情况下，已由钉380a、380b和380c缝合的组织可比尚未缝合的相邻组织柔性低得多。换句话讲，包括钉380a、380b和380c的钉阵列可能导致组织的材料特性的突然变化。在至少一种情况下，大的应变梯度可由于钉阵列而在组织内产生，这继而可在组织内产生大的应力梯度。
当钉380a-380c从钉仓射出时，钉的腿部可刺穿组织T。因此，钉腿在组织中产生孔。各种类型的组织是弹性的，并且在钉腿穿过组织时可围绕钉腿伸展。在各种情况下，组织的弹性可使组织能够朝向钉腿伸展并弹性地返回以减少或消除组织和钉腿之间存在的间隙。这样的弹性还可使组织能够在向组织施加伸展力时伸展；然而，这样的弹性可被某些钉图案抑制。在至少一种情况下，示于图52中的钉图案可抑制组织的纵向伸展。当将纵向伸展力施加到由图52的钉图案缝合的组织上时，组织可开始从钉腿拉离并且在其间产生间隙。在一些情况下，特别是在肥胖症治疗切除应用中，此类间隙可导致从胃组织的出血增多。在某些情况下，特别是在肺切除应用中，空气泄漏可导致肺组织。
示于图52A中的钉阵列比示于图52中的钉阵列更具柔性。现在参见图52B，当将纵向拉力施加到组织T上时，钉280a、280b和280c可(第一)在组织被纵向伸展时纵向平移并且/或者(第二)在组织被纵向伸展时旋转。示于图52中的柔顺钉阵列可沿着钉线诸如沿例如由钉线限定的纵向方向产生显著的延伸性。这种纵向延伸性可减小缝合组织T和/或缝合组织T周围的组织T内的应力和/或应变梯度。此外，当将纵向伸展力施加到组织上时，图52A中所示的柔顺钉阵列可减少或消除钉腿和组织T之间的间隙，并因此减少钉腿和组织之间的出血和/或空气泄漏。
对于钉280a、280b和280c的纵向平移，第一钉280a可沿着第一纵向轴线282a移动，第二钉280b可沿着第二纵向轴线282b移动，并且第三钉280c可沿着第三纵向轴线282c移动。当第一钉280a沿着第一纵向轴线282a移动时，第一钉280a可在第一纵向轴线282a上铺开。换句话讲，当将纵向力沿着和/或平行于第一纵向轴线282a施加到组织上时，第一钉280a之间的距离或间隙距离可增加。类似地，当第二钉280b沿着第二纵向轴线282b移动时，第二钉280b可在第二纵向轴线282b上铺开。当将纵向力沿着和/或平行于第二纵向轴线282b施加到组织上时，第二钉280b之间的距离或间隙距离可增加。另外，类似地，当第三钉280c沿着第三纵向轴线282c移动时，第三钉280c可在第三纵向轴线282c上铺开。当将纵向力沿着和/或平行于第三纵向轴线282c施加到组织上时，第三钉280c之间的距离或间隙距离可增加。
如上所述，当组织T被伸展时，钉280a、280b和/或280c可随着组织T移动。当组织T被纵向拉动时，除上述以外，第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c可保持彼此平行。在一些情况下，诸如当将横向力(即，横向于纵向力的力)施加到例如组织T上时，第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c的取向可变得不平行。在某些情况下，当将组织T纵向拉动时，第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c可移动到更靠近彼此。当将纵向伸展力施加到组织T上时，这样的移动可为组织T内发生的横向收缩的结果。在一些情况下，诸如当将横向力施加到例如组织T上时，第一纵向轴线282a、第二纵向轴线282b和/或第三纵向轴线282c可远离彼此移动。
对于钉280a、280b和280c的旋转移动，当将纵向拉力施加到组织T上时，第一钉280a可相对于第一纵向轴线282a旋转。当将纵向拉力施加到组织T上时，每个第一钉280a可在初始第一角度274a和另一个第一角度274a之间旋转。在至少一种情况下，每个第一钉280a可在初始取向和另一个取向之间旋转，在该初始取向时第一钉280a沿横向方向延伸到第一纵向轴线282a，该另一个取向更接近与第一纵向轴线282a对齐。在一些情况下，将纵向拉力施加到组织T可导致第一钉280a旋转到与第一纵向轴线282a共线的取向。在各种情况下，每个第一钉280a可围绕延伸穿过第一纵向轴线282a的轴线旋转。
如上所述，当将纵向拉力施加到组织T上时，第一钉280a可在初始第一角度274a和另一个第一角度274a之间旋转。在各种实施方案中，初始或未伸展的第一角度274a可介于例如约5度和约85度之间。在某些实施方案中，初始或未伸展的第一角度274a可介于例如约30度和约60度之间。在至少一个实施方案中，初始或未伸展的第一角度274a可为例如约45度。在至少一个实施方案中，初始或未伸展的第一角度274a可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，伸展的第一角度274a可介于例如约5度和约85度之间。在某些情况下，伸展的第一角度274a可介于例如约30度和约60度之间。在至少一种情况下，伸展的第一角度274a可为例如约45度。在至少一种情况下，伸展的第一角度274a可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，未伸展的第一角度274a和伸展的第一角度274a之间的差值可介于例如约1度和约45度之间。在某些情况下，未伸展的第一角度274a和伸展的第一角度274a之间的差值可为例如约1度、约2度、约3度、约4度，和/或约5度。在某些情况下，未伸展的第一角度274a和伸展的第一角度274a之间的差值可为例如约5度、约10度、约15度、约20度，和/或约25度。
除上述以外，当将纵向拉力施加到组织T上时，第二钉280b可相对于第二纵向轴线282b旋转。当将纵向拉力施加到组织T上时，每个第二钉280b可在初始第二角度274b和另一个第二角度274b之间旋转。在至少一种情况下，每个第二钉280b可在初始取向和另一个取向之间旋转，在该初始取向时第二钉280b沿横向方向延伸到第二纵向轴线282b，该另一个取向更接近于与第二纵向轴线282b对齐。在一些情况下，将纵向拉力施加到组织T可导致第二钉280b旋转到与第二纵向轴线282b共线的取向。在各种情况下，每个第二钉280b可围绕与第二纵向轴线282b对齐和/或延伸穿过第二纵向轴线282b的轴线旋转。
如上所述，当将纵向拉力施加到组织T上时，第二钉280b可在初始第二角度274b和另一个第二角度274b之间旋转。在各种实施方案中，初始或未伸展的第二角度274a可介于例如约5度和约85度之间。在某些实施方案中，初始或未伸展的第二角度274b可介于例如约30度和约60度之间。在至少一个实施方案中，初始或未伸展的第二角度274b可为例如约45度。在至少一个实施方案中，初始或未伸展的第二角度274b可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，伸展的第二角度274b可介于例如约5度和约85度之间。在某些情况下，伸展的第二角度274b可介于例如约30度和约60度之间。在至少一种情况下，伸展的第二角度274b可为例如约45度。在至少一种情况下，伸展的第二角度274b可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，未伸展的第二角度274b和伸展的第二角度274b之间的差值可介于例如约1度和约45度之间。在某些情况下，未伸展的第二角度274b和伸展的第二角度274b之间的差值可为例如约1度、约2度、约3度、约4度，和/或约5度。在某些情况下，未伸展的第二角度274b和伸展的第二角度274b之间的差值可为例如约5度、约10度、约15度、约20度，和/或约25度。
除上述以外，当将纵向拉力施加到组织T上时，第三钉280c可相对于第三纵向轴线282c旋转。当将纵向拉力施加到组织T上时，每个第三钉280c可在初始第三角度274c和另一个第三角度274c之间旋转。在至少一种情况下，每个第三钉280c可在初始取向和另一个取向之间旋转，在该初始取向时第三钉280c沿横向方向延伸到第三纵向轴线282c，该另一个取向更接近与第三纵向轴线282c对齐。在一些情况下，将纵向拉力施加到组织T可导致第三钉280c旋转到与第三纵向轴线282c共线的取向。在各种情况下，每个第三钉280c可围绕与第三纵向轴线282c对齐和/或延伸穿过第三纵向轴线282c的轴线旋转。
如上所述，当将纵向拉力施加到组织T上时，第三钉280c可在初始第三角度274c和另一个第三角度274c之间旋转。在各种实施方案中，初始或未伸展的第三角度274c可介于例如约5度和约85度之间。在某些实施方案中，初始或未伸展的第三角度274c可介于例如约30度和约60度之间。在至少一个实施方案中，初始或未伸展的第三角度274c可为例如约45度。在至少一个实施方案中，初始或未伸展的第三角度274c可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，伸展的第三角度274c可介于例如约5度和约85度之间。在某些情况下，伸展的第三角度274c可介于例如约30度和约60度之间。在至少一种情况下，伸展的第三角度274c可为例如约45度。在至少一种情况下，伸展的第三角度274c可为例如约10度、约20度、约30度、约40度、约50度、约60度、约70度，和/或约80度。
在各种情况下，未伸展的第三角度274c和伸展的第三角度274c之间的差值可介于例如约1度和约45度之间。在某些情况下，未伸展的第三角度274c和伸展的第三角度274c之间的差值可为例如约1度、约2度、约3度、约4度，和/或约5度。在某些情况下，未伸展的第三角度274c和伸展的第三角度274c之间的差值可为例如约5度、约10度、约15度、约20度，和/或约25度。
在各种情况下，第一排钉中的第一钉280a可旋转第一量，并且第二排钉中的第二钉280b可旋转与第一量不同的第二量。第一量可小于或大于第二量。在各种情况下，第一排钉中的第一钉280a可旋转第一量，并且第三排钉中的第三钉280c可旋转与第一量不同的第三量。第一量可小于或大于第三量。在各种情况下，第三排钉中的第三钉280c可旋转第三量，并且第二排钉中的第二钉280b可旋转与第三量不同的第二量。第三量可小于或大于第二量。
在至少一个应用中，对于最内钉排，即最靠近切口的钉排，可能期望的是比其它钉排更不具柔性或不可延展。对于最外钉排，即离切口最远的钉排，可能期望的是比其它钉排更具柔性或可延展。当第一钉轴线和第一纵向轴线之间的角度小于第二钉轴线和第二纵向轴线之间的角度时，第一钉可比第二钉必须朝向第二纵向轴线旋转具有更少的朝向第一纵向轴线旋转的空间，并因此可比第二钉使组织更加硬化。类似地，当第二钉轴线和第二纵向轴线之间的角度小于第三钉轴线和第三纵向轴线之间的角度时，第二钉可比第三钉必须朝向第三纵向轴线旋转具有更少的朝向第二纵向轴线旋转的空间，并因此可比第三钉使组织更加硬化。
除上述以外，图52A中公开的钉图案包括六个纵向钉排。可以设想到其它实施方案，例如，其包括少于六个钉排，诸如四个钉排，或多于六个钉排，诸如八个钉排。
第一钉280a、第二钉280和第三钉280c可包括任何合适的构型，诸如V形构型或U形构型。包括V形构型的钉可包括基部、从基部的第一端部延伸的第一腿部、以及从基部的第二端部延伸的第二腿部，其中第一腿部和第二腿部沿彼此不平行的方向延伸。包括U形构型的钉可包括基部、从基部的第一端部延伸的第一腿部、以及从基部的第二端部延伸的第二腿部，其中第一腿部和第二腿部沿彼此平行的方向延伸。
对于例如图52A中公开的钉图案，每个第一钉280a包括近侧钉腿285a和远侧钉腿283a。被构造成能够部署图52A中公开的钉图案的钉仓可包括近侧端部和远侧端部。近侧钉腿285a可比远侧钉腿283a更靠近钉仓的近侧端部，并且类似地，远侧钉腿283a可比近侧钉腿285a更靠近钉仓的远侧端部。每个第一钉280a的基部可限定第一基部轴线。近侧钉腿285a和远侧钉腿283a可从第一基部轴线延伸。第一钉280a可被定位和布置成使得第一基部轴线朝向纵向切割线284并且朝向钉仓的远侧端部延伸。
对于例如图52A中公开的钉图案，每个第二钉280b包括近侧钉腿285b和远侧钉腿283b。如上所述，被构造成能够部署图52A中公开的钉图案的钉仓可包括近侧端部和远侧端部。近侧钉腿285b可比远侧钉腿283b更靠近钉仓的近侧端部，并且类似地，远侧钉腿283b可比近侧钉腿285b更靠近钉仓的远侧端部。每个第二钉280b的基部可限定第二基部轴线。近侧钉腿285b和远侧钉腿283b可从第二基部轴线延伸。第二钉280b可被定位和布置成使得第二基部轴线朝向纵向切割线284并且朝向钉仓的近侧端部延伸。
对于例如图52A中公开的钉图案，每个第三钉280c包括近侧钉腿285c和远侧钉腿283c。如上所述，被构造成能够部署图52A中公开的钉图案的钉仓可包括近侧端部和远侧端部。近侧钉腿285c可比远侧钉腿283c更靠近钉仓的近侧端部，并且类似地，远侧钉腿283c可比近侧钉腿285c更靠近钉仓的远侧端部。每个第三钉280c的基部可限定第三基部轴线。近侧钉腿285c和远侧钉腿283c可从第三基部轴线延伸。第三钉280c可被定位和布置成使得第三基部轴线朝向纵向切割线284并且朝向钉仓的远侧端部延伸。
对于例如图52A中公开的钉图案，第一钉280a可与第三钉280c对齐。第一钉280a的近侧钉腿285a可与第三钉280c的近侧钉腿285c对齐。当近侧钉腿285a与近侧钉腿285c对齐时，近侧钉腿285a和近侧腿部285c可沿着垂直于切割线284的轴线定位。第一钉280a的远侧钉腿283a可与第三钉280c的远侧钉腿283c对齐。当远侧钉腿283a与远侧钉腿283c对齐时，远侧钉腿283a和远侧钉腿283c可沿着垂直于切割线284的轴线定位。在此类情况下，第三钉280c可在第一钉280a变形的情况下密封组织。类似地，第一钉280a可在第三钉280c变形的情况下将组织保持在一起。在其它实施方案中，第一钉280a可不与第三钉280c对齐。
除上述以外，当钉图案处于未伸展状态时，第一钉280a可与第三钉280c对齐。当钉图案被纵向伸展时，第一钉280a和/或第三钉280c可平移和/或旋转。在各种情况下，当组织被纵向伸展时，第一钉280a可与第三钉280c保持对齐。在其它情况下，第一钉280a可不与第三钉280c保持对齐。
再次对于图52A中公开的钉图案，第二钉280b的远侧钉腿283b可与第一钉280a的近侧钉腿285a和/或第三钉280c的近侧腿部285c对齐。第二钉280b的远侧钉腿283b、第一钉280a的近侧钉腿285a和/或第三钉280c的近侧钉腿285c可沿着垂直于切割线284的轴线定位。第二钉280b的近侧钉腿285b可与第一钉280a的远侧钉腿283a和/或第三钉280c的远侧钉腿283c对齐。第二钉280b的近侧钉腿285b、第一钉280a的远侧钉腿283a和/或第三钉280c的远侧钉腿283c可沿着垂直于切割线284的轴线定位。
除上述以外，当钉图案处于未伸展状态时，第二钉280b的钉腿可与第一钉280a和/或第三钉280c的钉腿对齐。当钉图案被纵向伸展时，第一钉280a、第二钉280b和/或第三钉280c可平移和/或旋转。在各种情况下，当组织被纵向伸展时，第二钉280b的腿部可不与第一钉280a和/或第三钉280c的腿部保持对齐。在其它情况下，当组织被纵向伸展时，第二钉280b的腿部可与第一钉280a和/或第三钉280c的腿部保持对齐。
在各种实施方案中，钉图案可被布置成使得一个纵向钉排中的钉与另一个纵向钉排中的钉重叠。例如，第二钉280b的远侧钉腿283b可相对于第一钉280a的近侧钉腿285a和/或第三钉280c的近侧腿部285c定位在远侧。例如，第二钉280b的近侧钉腿285b可被定位在第一钉280a的远侧钉腿283a和/或第三钉280c的远侧钉腿283c近侧。第二钉280b的近侧钉腿285b、第一钉280a的远侧钉腿283a和/或第三钉280c的远侧钉腿283c可沿着垂直于切割线284的轴线定位。
如上所述，当钉图案处于未伸展状态时，第二钉280b可与第一钉280a和/或第三钉280c重叠。当钉图案被纵向伸展时，第一钉280a、第二钉280b和/或第三钉280c可平移和/或旋转。在各种情况下，当组织被纵向伸展时，第二钉280b可与第一钉280a和/或第三钉280c保持重叠。在一些情况下，当组织被纵向伸展时，第二钉280b可不再与第一钉280a和/或第三钉280c重叠。
图52A所示的钉图案被示为处于未伸展状态。当由图52A所示的钉图案缝合的组织被纵向伸展时，钉可随着组织纵向移动并且/或者在组织内旋转，如图52B所示。这样的移动也示于图24中。
外科器械100被构造成能够在腹腔镜式外科手术期间使用。端部执行器200和轴120的大小和尺寸被设计成穿过套管针或插管插入患者体内。套管针可包括内部通道，该内部通道包含内径。在一些情况下，内径可为例如大约5mm或大约12mm。端部执行器200是沿着直线施加钉的线性端部执行器。可以设想到其它外科器械，其沿着至少部分弯曲的线施加钉，诸如2014年9月9日公布的名称为“SURGICAL STAPLING DEVICE HAVING SUPPORTS FORA FLEXIBLE DRIVE MECHANISM”的美国专利8,827,133中所公开的那些。2014年9月9日公布的名称为“SURGICAL STAPLING DEVICE HAVING SUPPORTS FOR A FLEXIBLE DRIVEMECHANISM”的美国专利8,827,133的全部公开内容全文以引用方式并入。此类外科器械能够利用本文公开的原理来施加弯曲的可膨胀钉线。虽然外科器械100能够在腹腔镜式外科手术期间使用，但也可在开放式外科手术期间使用外科器械100，在该开放式外科手术中外科器械100被插入穿过患者体内的大切口。此外，本文所公开的可膨胀钉线可由开放式外科缝合器施加，诸如2013年10月21日提交的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请公布2014/0042205中所公开的那些。2013年10月21日提交的名称为“SURGICALSTAPLING INSTRUMENT”的美国专利申请公布2014/0042205的公开内容全文以引用方式并入本文。
现在转到图4，砧座220包括限定于其中的成形凹坑290a、290b和290c的阵列，其分别被构造成能够使钉280a、280b和280c变形。第一成形凹坑290a沿着第一纵向轴线292a定位，第二纵向凹坑290b沿着第二纵向轴线292b定位，并且第三成形凹坑290c沿着第三纵向轴线292c定位。纵向轴线292a、292b和292c平行并且在砧座220的近侧端部221和远侧端部222之间延伸。砧座220还包括限定于其中的纵向狭槽224，该纵向狭槽被构造成能够接收击发构件的至少一部分。在至少一种情况下，击发构件包括在砧座220和钉仓230之间延伸的切割部分。砧座220包括在纵向狭槽224的一侧上的一排第一成形凹坑290a、一排第二成形凹坑290b和一排第三成形凹坑290c，以及在纵向狭槽224的另一侧上的另一排第一成形凹坑290a、另一排第二成形凹坑290b和另一排第三成形凹坑290c。如读者将理解的，成形凹坑290a、290b和290c与分别限定在钉仓230中的钉腔270a、270b和270c对齐并对应。
成形凹坑290a、290b和290c被构造成能够使钉280a、280b和280c变形成例如B形构型。在各种情况下，成形凹坑290a、290b和290c被构造成能够使U形钉和/或V形钉变形成例如此类B形构型。每个成形凹坑290a、290b和290c包括被构造成能够接收钉的近侧腿部的近侧端部以及被构造成能够接收钉的远侧腿部的远侧端部。也就是说，任何合适的砧座可用于将从钉仓射出的钉形成为任何合适的形状。每个成形凹坑290a、290b和290c可包括在其近侧端部和远侧端部之间延伸的沟槽。沟槽可包括侧壁，该侧壁被构造成能够使平面内的钉变形并且防止或至少限制在钉腿变形时钉腿从该平面移出。
现在转到图5，砧座320包括限定于其中的成形凹坑390a、390b和390c的阵列。类似于以上所述，多个第一成形凹坑390a沿着第一纵向轴线布置，多个第二成形凹坑390b沿着第二纵向轴线布置，并且多个第三成形凹坑390c沿着第三纵向轴线布置。每个成形凹坑390a、390b和390c包括近侧成形凹坑端部和远侧成形凹坑端部。例如，每个第一成形凹坑390a包括被构造成能够接收第一钉的近侧腿部的近侧端部393a以及被构造成能够接收第一钉的远侧腿部的远侧端部395a，每个第二成形凹坑390b包括被构造成能够接收第二钉的近侧腿部的近侧端部393b以及被构造成能够接收第二钉的远侧腿部的远侧端部395b，并且每个成形凹坑390c包括被构造成能够接收第三钉的近侧腿部的近侧端部393c以及被构造成能够接收第三钉的远侧腿部的远侧端部395c。
近侧端部393a、393b和393c以及远侧端部395a、395b和395c可包括任何合适的构型。再次参见图5，近侧端部393a、393b和393c以及远侧端部395a、395b和395c各自包括放大杯。放大杯比限定在其间的沟槽397宽。在某些情况下，放大杯和在其间延伸的沟槽可包括例如沙漏形状。当钉的腿部进入这样的成形凹坑时，腿可进入放大杯，并且在钉腿变形时，放大杯可将钉腿引导到沟槽397中。每个放大杯可包括弯曲和/或成角度的侧壁，该侧壁可被构造成能够将钉腿朝向沟槽397引导。在某些情况下，放大杯可调整未对齐钉腿的取向。
钉成形凹坑390a、390b和390c是嵌套的。例如，第二成形凹坑390b的远侧放大杯395b定位在相邻的第三钉成形凹坑390c的放大杯393c、395c中间，并且另外，第二成形凹坑390b的近侧放大杯393b定位在相邻的第一成形凹坑390a的放大杯393a、395a中间。另外，例如，第一成形凹坑390a的近侧放大杯393a定位在相邻的第二成形凹坑390b的放大杯393b、395b中间。另外，例如，第三成形凹坑390c的远侧放大杯395c定位在相邻的第二成形凹坑390b的放大杯393b、395b中间。每个钉腔的放大成形杯可限定矩形周边，整个成形凹坑可被定位在该矩形周边内。作为上述嵌套布置的结果，一个钉成形腔的矩形周边可与另一个成形腔的矩形周边重叠。例如，第二成形腔390b的矩形周边可与第一成形腔390a的矩形周边和/或第三成形腔390c的矩形周边重叠。
现在转到图6，砧座420包括限定于其中的成形凹坑490a、490b和490c的阵列。类似于以上所述，多个第一成形凹坑490a沿着第一纵向轴线布置，多个第二成形凹坑490b沿着第二纵向轴线布置，并且多个第三成形凹坑490c沿着第三纵向轴线布置。每个成形凹坑490a、490b和490c包括近侧成形凹坑端部和远侧成形凹坑端部。例如，每个第一成形凹坑490a包括被构造成能够接收第一钉的近侧腿部的近侧端部493a以及被构造成能够接收第一钉的远侧腿部的远侧端部495a，每个第二成形凹坑490b包括被构造成能够接收第二钉的近侧腿部的近侧端部493b以及被构造成能够接收第二钉的远侧腿部的远侧端部495b，并且每个成形凹坑490c包括被构造成能够接收第三钉的近侧腿部的近侧端部493c以及被构造成能够接收第三钉的远侧腿部的远侧端部495c。
近侧端部493a、493b和493c以及远侧端部495a、495b和495c可包括任何合适的构型。再次参见图6，近侧端部493a、493b和493c以及远侧端部495a、495b和495c各自包括放大杯。放大杯比限定在其间的沟槽497宽。在某些情况下，放大杯和在其间延伸的沟槽可包括例如沙漏形状。当钉的腿部进入这样的成形凹坑时，腿可进入放大杯，并且在钉腿变形时，放大杯可将钉腿引导到沟槽497中。每个放大杯可包括弯曲和/或成角度的侧壁，该侧壁可被构造成能够将钉腿朝向沟槽497引导。在某些情况下，放大杯可调整未对齐钉腿的取向。
钉成形凹坑490a、490b和490c是嵌套的。例如，第二成形凹坑490b的远侧放大杯495b定位在相邻的第三钉成形凹坑490c的放大杯493c、495c中间，并且另外，第二成形凹坑490b的近侧放大杯493b定位在相邻的第一成形凹坑490a的放大杯493a、495a中间。另外，例如，第一成形凹坑490a的近侧放大杯493a定位在相邻第二成形凹坑490b的放大杯493b、495b中间。另外，例如，第三成形凹坑490c的远侧放大杯495c定位在相邻第二成形凹坑490b的放大杯493b、495b中间。每个钉腔的放大成形杯可限定矩形周边，整个成形凹坑可被定位在该矩形周边内。作为上述嵌套布置的结果，一个钉成形腔的矩形周边可与另一个成形腔的矩形周边重叠。例如，第二成形腔490b的矩形周边可与第一成形腔490a的矩形周边和/或第三成形腔490c的矩形周边重叠。
再次参见图52A，钉280a、280b和280c不重叠。可以设想到其它实施方案，其中钉图案中的钉中的至少一些钉重叠。现在转到图32，其中所公开的钉图案包括第一排纵向钉580a和第二排纵向钉580b。如读者将理解的，第一排中的钉580a中的一些钉和第二排中的钉580b重叠。在至少一种情况下，第二钉580b的基部在第一钉580a的基部下方延伸。在此类情况下，第二钉580b的远侧腿部585b被定位在第一钉580a的基部的一侧上，并且第二钉580b的近侧腿部583b被定位在第一钉580a的基部的另一侧上。类似地，在至少一种情况下，第一钉580a的基部在第二钉580b的基部下方延伸。在此类情况下，第一钉580a的远侧腿部585a被定位在第二钉580b的基部的一侧上，并且第一钉580a的近侧腿部583a被定位在第二钉580b的基部的另一侧上。作为上述的结果，第一钉580a与第二钉580b交织。
再次参见图32，钉图案包括定位在纵向组织切口的一侧上的第一排钉580a和第二排钉580b，以及定位在纵向组织切口的另一侧上的第一排钉580a和第二排钉580b。第一钉580a朝远侧并朝向纵向组织切口取向，而第二钉580b朝近侧并朝向纵向组织切口取向。
再次参见图32，第一排钉580a沿着第一纵向轴线定位，并且第二排钉580b沿着第二纵向轴线定位。由于第一钉580a和第二钉580b之间的重叠，在某些情况下，第一纵向轴线可与第二纵向轴线相邻。在一些情况下，第一排钉和第二排钉之间的重叠可使这些钉排中的成角度钉能够具有相同的中心线间隔，该中心线间隔可用传统的纵向布置的钉图案(例如诸如图52所示的钉图案)实现。在一些情况下，第一排钉和第二排钉之间的重叠可使这些钉排中的成角度钉能够具有比可用传统的纵向布置的钉图案实现的中心线间隔近的中心线间隔。在至少一个实施方案中，第一纵向轴线可与第二纵向轴线共线。
示于图32中的钉图案包括重复图案。重复图案包括两个第一钉580a，随后是两个第二钉580b，随后是两个第一钉580a，随后是两个第二钉580b，以此类推。该重复图案沿近侧-远侧方向纵向延伸。第一排钉580a在其中具有由钉580b填充的裂口，并且类似地，第二排钉580b在其中具有由钉580a填充的裂口。重复图案存在于纵向切口的一侧上，并且重复图案存在于纵向切口的另一侧上。这些重复图案是彼此的镜像。可以设想到其它重复图案。
被构造成能够可移除地储存并部署图32中所公开的钉图案的钉仓530示于图33中。钉仓530包括用于可移除地储存第一钉580a的第一排钉腔570a以及用于可移除地储存第二钉580b的第二排钉腔570b。第一钉腔570a和第二钉腔570b中的至少一些互连以可移除地储存重叠的第一钉580a和第二钉580b。第一排钉腔570a可沿着第一纵向轴线布置，并且一排第二钉腔570b可沿着第二纵向轴线布置。第一纵向轴线和第二纵向轴线可视情况而定为相邻或共线的，以便部署本文所公开的钉图案。第一排钉腔570a和第二排钉腔570b被定位在纵向狭槽534的第一侧上，并且第一排钉腔570a和第二排钉腔570b被定位在纵向狭槽534的第二侧上。纵向狭槽534被构造成能够接收击发构件。击发构件可包括切割元件，诸如刀。
被构造成能够使图32中所公开的钉图案的钉变形的砧座520示于图34中。砧座520包括成形腔的重复图案，该成形腔包括被构造成能够使第一钉580a的腿部变形的第一成形腔590a以及被构造成能够使第二钉580b的腿部变形的第二成形腔590b。第一成形腔590a和第二成形腔590b以交替图案布置。交替图案包括定位在纵向狭槽524的一侧上沿着第一纵向轴线定位的第一成形腔590a和第二成形腔590b的阵列，以及沿着第二纵向轴线定位的第一成形腔590a和第二成形腔590b的阵列。交替图案还包括定位在纵向狭槽524的另一侧上沿着第一纵向轴线定位的第一成形腔590a和第二成形腔590b的阵列，以及沿着第二纵向轴线定位的第一成形腔590a和第二成形腔590b的阵列。成形腔590a、590b的阵列可相对于纵向狭槽524限定镜像。纵向狭槽524被构造成能够接收击发构件。击发构件可包括切割元件，诸如刀。
示于图32中的钉图案包括位于纵向组织切口的每一侧上的两排钉；然而，这样的钉图案可包括不止两排钉，例如诸如三排钉。这样的第三排钉可与第一排钉580a和/或第二排钉580b交织。或者，这样的第三排钉可不与第一排钉580a或第二排钉580b交织。在这样的实施方案中，第一排钉580a和第二排钉580b可交织，并且第三排钉可与例如第一排钉580a和/或第二排钉580b相邻。
示于图35中的钉图案包括第一钉680a的纵向排、第二钉680b的纵向排和第三钉6870c的纵向排。第一钉680a具有第一基部宽度。第二钉680b具有第二基部宽度。第三钉680c具有第三基部宽度。钉基部的宽度可被限定为从基部延伸的第一钉腿和从基部延伸的第二钉腿之间的距离，该距离沿着在第一钉腿和第二钉腿之间延伸的基部测量。在至少一种情况下，基部宽度是在第一钉腿的横截面中心和第二钉腿的横截面中心之间测量的。在任何情况下，第一基部宽度短于第二基部宽度；然而，可以设想到其它实施方案，其中第二基部宽度短于第一基部宽度。第三基部宽度短于第一基部宽度和第二基部宽度；然而，可以设想到其它实施方案，其中第三基部宽度长于第一基部宽度和/或第二基部宽度。
在示于图35的实施方案中，第二钉680b具有最长基部宽度。因此，当钉图案中的钉随组织被纵向伸展而在组织内旋转时，第二钉680b将扫过比第一钉680a更大的弧长。类似地，第一钉680a将扫过比第三钉680c更大的弧长。因此，在各种情况下，第一钉680a将扫过第一弧长，第二钉680b将扫过第二弧长，并且第三钉680c将扫过第三弧长，其中第一弧长、第二弧长和第三弧长是不同的。即使其中钉680a、680b和/或680c的角度是相同的，此类弧长也可不同。在某些情况下，第一弧长、第二弧长和/或第三弧长可为相同的。
在示于图35中的实施方案中，第一钉680a以交替布置的方式定位和布置在钉仓630中。最远侧第一钉680a朝向钉仓630的远侧端部并且朝向限定在钉仓630中的纵向狭槽634取向。第二纵向排中的下一个第一钉680a朝向钉仓630的近侧端部并且朝向纵向狭槽634取向。然后该图案在第一钉680a的纵向排内重复。
第二钉680b以交替布置的方式定位和布置在钉仓630中。最远侧第二钉680b朝向钉仓630的远侧端部并且朝向限定在钉仓630中的纵向狭槽634取向。第二纵向排中的下一个第二钉680b朝向钉仓630的近侧端部并且朝向纵向狭槽634取向。然后该图案在第二钉680b的纵向排内重复。
第三钉680c以交替布置的方式定位和布置在钉仓630中。最远侧第三钉680c朝向钉仓630的远侧端部并且朝向限定在钉仓630中的纵向狭槽634取向。第三纵向排中的下一个第三钉680c朝向钉仓630的近侧端部并且朝向纵向狭槽634取向。然后该图案在第三钉680c的纵向排内重复。
进一步参考图35所示的钉图案，第一钉380a的纵向排嵌套在第二钉380b的纵向排内。类似地，第三钉380c的纵向排嵌套在第二钉380b的纵向排内。
除上述以外，钉仓630包括被构造成能够在其中可移除地储存第一钉680a的多个第一钉腔670a。钉仓630还包括被构造成能够可移除地储存第二钉680b的多个第二钉腔670b，以及被构造成能够可移除地储存第三钉680c的多个第三钉腔670c。参见图36，砧座620可被构造成能够在钉680a、680b和680c从钉仓630射出时使它们变形。砧座620包括与钉腔670a、670b和670c对齐的钉成形凹坑图案。例如，砧座620包括与第一钉腔670a对齐的多个第一成形凹坑690a，与第二钉腔670b对齐的多个第二成形凹坑690b，以及与第三钉腔670c对齐的多个第三成形凹坑690c。
如上所述，钉图案可包括若干排。每排中的钉可具有相同取向或不同取向。图23示出包括一排钉的实施方案，该排钉具有以第一方向取向的第一组钉780a，以及以第二方向取向的第二组钉780b。第一钉780a和第二钉780b沿着纵向轴线定位。第一钉780a相对于纵向轴线成角度，并且第二钉780b与纵向轴线对齐。其它布置是可能的。钉780a与钉780b以交替图案布置。
继续参考图23并且再次参见图24，当组织被纵向伸展时，钉排内的钉可在组织内平移并旋转。在一些情况下，钉在组织内的平移和/或旋转可在钉和组织之间产生孔或间隙。此类孔或间隙可产生泄漏。即使本文所公开的各种钉图案可使此类泄漏最小化，但可对钉本身进行某些改善以减少和/或消除这些泄漏。
现在转到图17和图18，诸如钉280a、280b、280c、380a、380b、380c、580a、580b、680a、680b、680c、780a和/或780b的钉以未击发构型示出。该钉的未击发构型是V形的；然而，本文所讨论的原理可应用于任何适当形状的钉。图19示出处于击发构型的图17和图18的钉。该钉的击发构型是B形的；然而，本文所讨论的原理可应用于任何适当形状的钉。图20示出在其上包括涂层的图17-图19的钉881；该钉将在下文中称为钉880。图21示出部署到组织中的钉880以及存在于钉880和组织之间的孔或间隙882。图22示出钉880上的处于膨胀状态的涂层881。膨胀涂层881可填充整个间隙882。在一些情况下，膨胀涂层881可伸展组织。在各种其它情况下，涂层881可不填充整个间隙882。
钉880可由任何合适的材料构成，例如诸如金属。在某些情况下，钉880可由例如钛和/或不锈钢构成。
可膨胀钉涂层881可由任何合适的材料构成。钉涂层881可由例如聚-L-乳酸和/或聚-95L/5D-乳酸构成。可使用PLA的其它共聚物组合物。在各种情况下，一旦钉880被植入到组织中，钉涂层881便可开始形成凝胶，其中凝胶可膨胀以填充或至少部分地填充间隙882。在各种情况下，可通过将钉线浸入涂覆线的一种或多种溶液中来将涂层881施加到钉880。在至少一种情况下，例如，钉线可被浸入第一溶液中以施加基部涂层，然后浸入第二溶液中以施加PLA。在一些情况下，当钉880被定位在钉仓中时，涂层881可被施加到钉880。Q.Chen等人的ELASTOMERIC BIOMATERIALS FOR TISSUE ENGINEERING，Progress In PolymerScience(第38卷，第584-671页，2013年)据此以引用方式并入本文。
钉涂层881可由例如亲水性材料构成。亲水性材料可包括例如用含有RGD肽序列微球的肽衍生的水凝胶。钉880的金属线可涂覆有例如天然生物聚合物，诸如玻尿酸或透明质酸。可使用其它水凝胶。在各种情况下，一旦钉880被植入到组织中，钉涂层881便可开始膨胀，其中涂层881可膨胀以填充或至少部分地填充间隙882。在各种情况下，可通过将钉线浸入涂覆线的一种或多种溶液中来将涂层881施加到钉880。在至少一种情况下，例如，钉线可被浸入第一溶液中以施加基部涂层，然后浸入第二溶液中以施加加载有肽的玻尿酸。在一些情况下，当钉880被定位在钉仓中时，涂层881可被施加到钉880。William G.Pitt等人的ATTACHMENT OF HYALURONAN TO METALLIC SURFACES，J.Biomed.Mater.Res.(第68A卷，第95-106页，2004年)的全部公开内容以引用方式并入本文。
钉涂层881可由例如干凝胶构成。钉涂层881可由例如明胶微球和/或纳米球构成。明胶包括至少部分变性或完全变性形式的胶原，细胞可结合到该胶原并且通过酶促作用降解。在各种情况下，明胶可加载有例如成纤维细胞和/或血小板衍生生长因子。在涂层881降解时，涂层881可至少部分地填充并至少部分地密封间隙882。在各种情况下，涂层881可通过以下方式施加到钉880：将钉线浸入油包水乳液中，然后将明胶微球和/或纳米球冻干到钉线上。Luis Solorio等人的TGELATIN MICROSPHERES CROSS-LINKED WITH GENIPIN FORLOCAL DELIVERY OF GROWTH FACTORS，J.Tissue Eng.Regen.Med.(第4卷，第514-523页，2010年)的全部公开内容以引用方式并入本文。
钉880由具有圆形横截面的线构成；然而，钉880可由具有任何合适横截面例如诸如多边形横截面的线构成。对于某个整体宽度，非圆形横截面可具有比圆形横截面更大的周长。此类非圆形横截面可支撑比圆形横截面更大量的涂层材料，该圆形横截面可使涂层能够膨胀并填充比具有圆形横截面的钉更大的孔。在某些情况下，非圆形横截面可形成为在圆形横截面中产生一个或多个沟槽。在至少一种此类情况下，此类沟槽可沿着钉腿纵向延伸。在一些情况下，纵向沟槽可沿着轴线延伸。在某些情况下，纵向沟槽可环绕在钉腿周围。在至少一种情况下，这样的纵向沟槽可围绕腿以螺旋方式延伸。
可在使用或不使用例如辅助材料(诸如支撑材料)的情况下部署钉仓的钉。通常，辅助材料可被放置在钉仓的顶部表面或平台上，使得当钉从钉仓射出时，钉可抵靠组织捕获辅助材料。图55示出定位在钉仓230的平台表面238上的两块辅助材料239。第一块辅助材料239被定位在纵向狭槽234的第一侧上，并且第二块辅助材料239被定位在纵向狭槽234的第二侧上。可以设想到另选的实施方案，其中单块辅助材料由平台表面238支撑，该平台表面在纵向狭槽234和钉仓230的两侧上延伸。再次参见图55，每块辅助材料239基本上是矩形的并且在包括一排第一钉腔270a、一排第二钉腔270b和一排第三钉腔270c的钉图案上方延伸。分别储存在钉腔270a、270b和270c中的钉280a、280b和280c在从钉仓230射出时穿透辅助材料239，并且在钉280a、280b和280c由砧座220形成时将辅助材料239的一部分捕获在其中。
除了或代替定位在钉仓上的辅助材料，辅助材料可被定位在砧座上。穿透组织的钉可在接触砧座之前穿透砧座辅助物，然后在重新进入组织之前重新穿透砧座辅助物。
在钉280a、280b和280c已由砧座220变形之后，除上述以外，辅助材料239抵靠组织由钉280a、280b和280c捕获。换句话讲，由钉280a、280b和280c将辅助材料239抵靠组织而植入。当组织被纵向伸展时，如上所述，辅助材料239可随组织伸展。
辅助材料可提供许多益处。辅助材料可帮助密封由钉腿产生的穿刺孔。在各种情况下，在钉腿穿过组织时，钉腿可将辅助材料推动到穿刺孔中。当组织被纵向伸展时，辅助材料也可帮助密封在钉腿和组织之间产生的间隙。辅助材料可支持组织。在各种情况下，辅助材料可加强组织并且抑制钉撕裂组织。
再次参见图55，读者将理解，辅料材料239的部分不被钉280a、280b和280c捕获。例如，辅助材料的围绕钉周边延伸的部分可能不被钉捕获。类似地，辅助材料的定位在钉中间的部分可能不被钉捕获。辅助材料239的此类未捕获部分可不提供上述的密封益处，并且同时抑制由本文所讨论的钉图案提供的延展性。此类未捕获部分也可抑制钉在组织内的旋转，如上所述。对图55的实施方案的改善示于图53、图54、图56和图57中。此类实施方案包括凹陷部、凹口、切口、狭缝、开孔和/或被构造成能够增加辅助材料的延伸性的任何其它合适的中断。此外，此类中断可有利于钉在组织内的旋转。
参见图53，辅助材料939包括扇形边缘或侧面938。扇形侧面938包括限定于其中的凹陷部或凹口937。凹口937包括弯曲构型；然而，可使用合适的构型。凹口937减小围绕辅助材料939的周边延伸的未捕获材料的周长并且增加辅助材料939的柔性和延伸性。
再次参见图53，辅助材料939还包括限定于其中的开孔936。开孔936是椭圆形的，并且包括通孔；然而，可以设想到另选的实施方案。开孔936位于相邻第二钉腔270b中间，以及第一钉腔270a和第三钉腔270c中间；然而，可以设想到另选的位置。开孔936减少钉线内的未捕获材料并且增加辅助材料939的柔性和延伸性。
再次参见图53，辅助材料939的主体在钉腔270a、270b和270c上方延伸。可以设想到另选的实施方案，其中辅助材料939不在钉腔270a、270b和/或270c上延伸。现在转到图54，辅助材料939’包括狭槽或开口935a、935b和935c，其分别在钉腔270a、270b和270c上部分地延伸。开口935a、935b和935c比开孔936大；然而，开口935a、935b和/或935c可与开孔936尺寸相同并且/或者比开孔936大。
参见图56，辅助材料1039包括凹口边缘或侧面1038。凹口侧面1038包括限定于其中的凹陷部或凹口1037。凹口1037包括成角度的构型；然而，可使用合适的构型。凹口1037减小围绕辅助材料1039延伸的未捕获材料的周长并且增加辅助材料1039的柔性和延伸性。
再次参见图56，辅助材料1039还包括限定于其中的狭缝1036。狭缝1036是椭圆形的，并且包括通孔；然而，可以设想到另选的实施方案。辅助材料1039包括第一排狭缝1036a和第二排狭缝1036b。狭缝1036a位于相邻第二钉1080b中间以及第一钉1080a和第三钉1080c中间；然而，可以设想到另选的位置。狭缝1036b位于相邻第三钉1080c中间以及第二钉1080b和第四钉1080d中间；然而，可以设想到另选的位置。狭缝1036a平行于第一钉1080a和第三钉1080c，并且类似地，狭缝1036b平行于第二钉1080b和第四钉1080d；然而，狭缝可具有任何合适的方向。狭缝1036a和1036b减少钉线内的未捕获材料并且增加辅助材料1039的柔性和延伸性。狭缝1036a和1036b短于钉1080a、1080b、1080c和1080d的基部；然而，可以设想到这样的实施方案，其中狭缝1036a和/或1036b与钉1080a、1080b、1080c和1080d的基部长度相同并且/或者长于所述基部。
参见图57，辅助材料1139包括凹口边缘或侧面1138。凹口侧面1138包括限定于其中的凹陷部或凹口1137。凹口1137包括弯曲构型；然而，可使用合适的构型。凹口1137减小围绕辅助材料1139延伸的未捕获材料的周长并且增加辅助材料1139的柔性和延伸性。
再次参见图57，辅助材料1139还包括限定于其中的狭缝1136。狭缝1136是椭圆形的，并且包括通孔；然而，可以设想到另选的实施方案。辅助材料1139包括第一排狭缝1136a和第二排狭缝1136b。狭缝1136a位于相邻第二钉1180b中间以及第一钉1180a和第三钉1180c中间；然而，可以设想到另选的位置。狭缝1136b位于相邻第三钉1180c中间以及第二钉1180b和第四钉1180d中间；然而，可以设想到另选的位置。狭缝1136a平行于第一钉1180a和第三钉1180c，并且类似地，狭缝1136b平行于第二钉1180b和第四钉1180d；然而，狭缝可具有任何合适的方向。狭缝1136a和1136b减少钉线内的未捕获材料并且增加辅助材料1139的柔性和延伸性。狭缝1136a和1136b短于钉1180a、1180b、1180c和1180d的基部；然而，可以设想到这样的实施方案，其中狭缝1136a和/或1136b与钉1180a、1180b、1180c和1180d的基部长度相同并且/或者长于所述基部。
如本文所述，击发构件和/或楔形滑动件可横贯钉仓以击发钉并且/或者将钉从限定到钉仓中的钉腔射出。例如，击发构件和/或楔形滑动件可沿着钉仓内的击发路径平移，并且击发构件和/或楔形滑动件可沿着击发路径接合钉驱动器和/或钉本身以从钉腔驱动钉。另外如本文所述，包括成角度地取向的钉的钉布置可提供各种益处和优点。例如，成角度地取向的钉的阵列可在缝合的组织内提供增加的柔性和/或纵向伸展性。
当钉相对于击发路径成角度地取向时，钉驱动器和/或钉的至少一部分可不与击发路径重叠并且/或者覆盖在击发路径上。例如，成角度地取向的钉的基部可跨过击发路径，使得钉腿被定位在击发路径的相对侧上。另外，成角度地取向的钉驱动器可横贯击发路径，并且钉驱动器的端部可被定位在击发路径的相对侧上。在其它情况下，只有钉和/或钉驱动器的端部可覆盖在击发路径上，并且在另外的情况下，钉和/或钉驱动器可完全从例如击发路径偏置。
在其中钉和/或钉驱动器的至少一部分从击发路径偏置的情况下，击发路径与定位在击发路径的任一侧上的钉和/或钉驱动器的部分之间的力矩臂可在钉内和/或在钉驱动器内产生扭矩。在部署期间扭矩可影响钉的倾斜和/或倾翻。因此，扭转钉的钉腿可不以等效的力和/或速度接合组织，并且/或者钉腿可不同时刺穿和/或捕获组织。因为在部署期间钉的扭转和/或旋转可能不利地影响组织穿透和/或钉成形，所以在各种情况下，可能期望防止和/或最小化在成角度地取向的钉的部署期间的扭矩生成。
当钉驱动器相对于楔形滑动件的击发路径成角度时，仅有成角度的驱动器的一部分可从楔形滑动件接收驱动或提升力。例如，可沿着对角路径将驱动力施加到成角度的驱动器。为了稳定成角度的驱动器并且防止驱动器的扭转和/或旋转以及因此支撑在其上的钉的扭转和/或旋转，楔形滑动件可包括多个驱动楔形件，并且至少两个驱动楔形件可接触驱动器以将驱动力施加在驱动器上的多个位置处。例如，一对侧向间隔的驱动楔形件可接合并提升成角度的驱动器，使得驱动力沿着驱动器的长度以侧向间隔的间隔分布。此外，在至少一种情况下，侧向间隔的驱动楔形件可与成角度的驱动器的质心等距，使得驱动器相对于多个驱动楔形件质量平衡。
除此之外或另选地，为了稳定成角度的驱动器并且防止驱动器的扭转和/或旋转以及因此支撑在其上的成角度钉的扭转和/或旋转，多个驱动器可连接和/或连在一起。在一些情况下，成角度的多钉驱动器可一体形成。连接的驱动器和/或多钉驱动器可支撑多个钉，这可减少钉仓内的移动部件的数量，并且可防止每个互连和/或一体形成的钉支架的钉支撑表面之间的相对移动。此外，成角度的多钉驱动器可大于(即宽于和/或长于)单钉驱动器。因此，多钉驱动器可具有增加的纵横比。例如，多钉驱动器可具有1:1的纵横比。在某些情况下，纵横比可为3:2或2:1。在另外的情况下，纵横比可例如小于1:1或大于2:1。更大纵横比的多钉驱动器可向支撑在其上的钉提供更大的稳定性。
在各种情况下，单个驱动楔形件可接合成角度的多钉驱动器，并且在某些情况下，由驱动楔形件施加在驱动器上的驱动力可相对于驱动器的质心平衡。在其它情况下，多个驱动楔形件可接合成角度的多钉驱动器，该成角度的多钉驱动器可在驱动器上侧向分配驱动力。在各种情况下，由侧向间隔的驱动楔形件施加在成角度的多钉驱动器上的累积驱动力可相对于驱动器的质心平衡。
在其它情况下，为了稳定钉仓内的成角度钉并且防止其在部署期间的扭转和/或旋转，钉可在没有驱动器的情况下被击发。例如，楔形滑动件可包括钉接合表面，该钉接合表面直接接合无驱动器钉仓中的钉的滑动件接合表面。楔形滑动件可沿着钉的基部在多个侧向间隔的位置处接触每个钉。例如，楔形滑动件可包括多个驱动楔形件，并且至少两个驱动楔形件可接触成角度钉以在多个位置处施加驱动力。在各种情况下，一对侧向间隔的驱动楔形件可接合并提升成角度钉，使得驱动力沿着钉的基部的长度以侧向间隔的间隔均匀分布。此外，在至少一种情况下，侧向间隔的驱动楔形件可与成角度钉的质心等距，使得钉相对于驱动楔形件质量平衡。
端部执行器组件2000在图7中有所公开。如图所示，端部执行器组件2000包括第一钳口2002、第二钳口2004、闭合管或框架2006，以及端部执行器关节运动接头2009。端部执行器组件2000能够在第一或打开位置和第二或闭合位置之间移动。如图所示，第一钳口2002包括枢轴销2008，该枢轴销可移动地在第二钳口2004的闭合狭槽2010内定位。例如，枢轴销2008被构造成能够在第一钳口2002相对于第二钳口2004并且相对于所示端部执行器组件2000的框架2006枢转时在第二钳口2004的闭合狭槽2010中枢转并平移。
在其它情况下，第一钳口2002可相对于框架2006固定，并且第二钳口2004可相对于第一钳口2002枢转以打开和闭合端部执行器组件2000的钳口2002、2004。在其它情况下，钳口2002、2004都可枢转并且/或者以其它方式移动以打开和/或闭合端部执行器组件2000的钳口2002、2004。例如，钳口2002、2004中的至少一个可相对于另一个钳口2002、2004并且/或者相对于框架2006旋转、转动、滑动和/或平移以打开和/或闭合端部执行器组件2000的钳口2002、2004。
仍然参见图7，端部执行器组件2000的尺寸和结构被设计成接收钉仓2020，该钉仓被构造成用于可移除地定位在端部执行器组件2000内。例如，所示钉仓2020可为单次使用和/或一次性仓，该仓可在从其击发钉2012之后用另一个钉仓替换。图7中公开的钉仓2020包括平台2026、仓体2024和壳体2022，该壳体部分地包围或包封仓体2024。所示钉仓2020还包括钉2012，该钉可射出地定位在仓体2024中。图7中公开的钉2012为大致“V形”钉，该钉具有非平行延伸的腿部。
在各种情况下，钉仓(诸如钉仓2020)例如可与端部执行器组件2000一体形成并且/或者可永久地固定在例如钳口2002、2004中的一个钳口内。在此类情况下，端部执行器组件2000可为单次使用和/或一次性端部执行器。在其它情况下，固定到端部执行器组件2000的钉仓可重新加载有附加钉以用于例如后续击发。
再次参见图7中公开的钉仓2020，纵向狭槽2032被限定成至少部分地穿过仓体2024。所示纵向狭槽2032沿着纵向轴线L延伸，该纵向轴线L在仓体2024的近侧端部2023和远侧端部2025之间延伸。示于图7中的纵向狭槽2032从近侧端部2023朝向远侧端部2025延伸并且横贯仓体2024的长度的一部分。
在一些情况下，纵向狭槽2032可横贯仓体2024的整个长度。在其它情况下，纵向狭槽2032可例如从远侧端部2023朝向近侧端部2025延伸。在另外的情况下，仓体2024可不包括预定和/或预成形的纵向狭槽。例如，击发构件和/或切割元件可在击发行程期间横切和/或切割仓体2024以在其中形成狭槽。
图7中公开的钉仓2020被构造成能够将钉2012的阵列2011击发到组织中。示于图7中的钉阵列2011包括成角度钉2012，该成角度钉相对于纵向轴线L并且相对于驱动楔形件2064a、2064b的击发路径成角度，所述驱动楔形件在本文中进一步描述。图7中公开的钉仓2020也包括多钉驱动器2040a、2040b以驱动地支撑阵列2011中的成角度钉2012，所述多钉驱动器在本文中进一步描述。
成角度钉2012可移除地定位在成角度钉腔2028中，该成角度钉腔被限定到图7中公开的仓体2024中。例如，所示钉腔2028相对于纵向轴线L成角度地取向。钉腔2028的所示布置对应于定位在钉仓2020中的所示钉阵列2011。示于图7中的每个钉腔2028包括平台2026中的开口2030，并且每个开口2030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钉轴线。开口2030的钉轴线相对于仓体2024的纵向轴线L偏斜和/或成角度。例如，在图7的钉仓2020中，限定到仓体2024中的所有钉腔2028相对于纵向轴线L成角度地取向，并且各种钉腔2028相对于其它钉腔2028成角度地取向。
图7中公开的钉腔2028在纵向狭槽2032的每一侧上以多排布置。例如，钉腔2028的一部分在纵向狭槽2032的第一侧2027上布置在第一内侧排2033、第一外侧排2035和第一中间排2037中，并且钉腔2028的另一部分在纵向狭槽2032的第二侧2029上布置在第二内侧排2034、第二外侧排2038和第二中间排2036中。在示于图7中的钉仓2020中，钉腔2028及其排2033、2034、2035、2036、2037、2038相对于纵向狭槽2032是对称的。
虽然所示钉腔2028不交叉或以其它方式彼此接触，但钉腔2028的纵向排2033、2034、2035、2036、2037、2038重叠。例如，示于图7中的各种钉腔2028在侧向外侧和/或在侧向内侧延伸经过相邻排的钉腔2028中的钉腔2028。另外，各种所示钉腔2028朝近侧和/或朝远侧延伸经过相邻排的钉腔2028中的钉腔2028。因为钉2012布置在重叠阵列2011中，所以可控制缝合组织中的出血和/或流体流动。钉的重叠阵列(如钉阵列2011)例如可并入本文公开的其它钉仓和/或端部执行器组件中。
在其它情况下，多于或少于三排的钉腔2028可被定位在纵向狭槽2032的任一侧2027、2029上。在一些情况下，钉仓2020的侧面2027、2029中的一个侧面可包括与另一个侧面2027、2029不同数量的钉腔2028的排。在一些情况下，钉腔2028可不与相邻排中的钉腔2028纵向和/或侧向重叠。除此之外或另选地，在某些情况下，钉腔2028和/或其排可相对于纵向狭槽2032和/或纵向轴线L不对称。
仍然参见图7，每个纵向排中的所示钉腔2028平行或基本平行。例如，如图7中所公开，第一内侧排2033中的钉腔2028彼此平行，第一外侧排2035中的钉腔2028彼此平行，第一中间排2037中的钉腔2028彼此平行，第二内侧排2034中的钉腔2028彼此平行，第二外侧排2036中的钉腔2028彼此平行，并且第二中间排2038中的钉腔2028彼此平行。
另外如图7中所公开，每个纵向排中的钉腔2028相对于相邻纵向排中的钉腔2028成角度地取向。例如，在所示仓体2024的第一侧2027上，第一中间排2037中的钉腔2028相对于第一内排2033中以及第一外排2035中的钉腔2028成角度地取向。另外，在所示仓体2024的第二侧2029上，第二中间排2038中的钉腔2028相对于第二内排2034以及第二外排2036中的钉腔2028成角度地取向。
在其它情况下，每个纵向排2033、2034、2035、2036、2037、2038中的钉腔2028的仅一部分可彼此平行并且/或者少于所有的纵向排2033、2034、2035、2036、2037、2038可包括彼此平行的钉腔2028。除此之外或另选地，在某些情况下，钉腔2028的至少一部分可随机取向。在一些情况下，纵向排2033、2034、2035、2036、2037、2038中的钉腔2028中的至少一个钉腔可平行于相邻纵向排2033、2034、2035、2036、2037、2038中的钉腔2028中的至少一个钉腔。在某些情况下，钉仓2020可包括至少一个钉腔2028和/或平行于仓体2024的纵向轴线L的至少一排钉腔。参见例如图10。
图7中公开的钉仓2020包括驱动器2040a、2040b，所述驱动器的结构和尺寸被设计成可移动地配合在仓体2024(图7)内。参见图7-图9，驱动器2040a、2040b包括第一驱动器2040a(图8-图8B)和第二驱动器2040b(图8C-图9)。第一驱动器2040a和第二驱动器2040b被各自构造成能够支撑多个钉2012。如图7-图9所示，多钉第一驱动器2040a具有第一几何形状，并且多钉第二驱动器2040b具有第二几何形状。多钉驱动器2040a、2040b的几何形状对应于钉2012的阵列2011并且对应于示于图7的钉腔2028的布置。
如本文所述，钉2012和钉腔2028在纵向狭槽2032的第一侧2027上的布置是钉2012和钉腔2028在纵向狭槽2032的第二侧2029上的布置的镜像。另外，第一驱动器2040a的几何形状是第二驱动器2040b的几何形状的镜像。如图7所示，第一驱动器2040a被定位在纵向狭槽2032的第一侧2027上，并且第二驱动器2040b被定位在纵向狭槽2032的第二侧2029上。
在一些情况下，在仓体的一侧上的驱动器可不是仓体的另一侧上的驱动器的镜像。另外，第一多钉驱动器2040a和/或第二多钉驱动器2040b可被定位在纵向狭槽2032的不同侧和/或两侧2027、2029上。例如，具有不同几何形状的多钉驱动器可被定位在纵向狭槽2032的相同侧上。在另外的情况下，钉仓2020可包括具有三种或更多种不同几何形状的多钉驱动器。例如，专门的和/或不同的钉驱动器可对应于特定钉和/或特定组的钉。或者，在一些情况下，钉仓2020中的所有多钉驱动器可具有相同几何形状。
图7-图9中公开的第一多钉驱动器2040a和第二多钉驱动器2040b包括多个槽或钉支撑支架2042。此外，每个所示驱动器2040a、2040b被构造成能够驱动多个钉2012。例如，第一驱动器2040a(图8-图8B)包括第一支架2042a、第二支架2042b和第三支架2042c，所述支架各自的尺寸和结构被设计成支撑一个钉2012。例如，钉2012的基部2014(图8B)被定位在第一驱动器2040a的每个支架2042a、2042b、2042c中。另外，主要参见图8C-图9，第二驱动器2040b还包括第一支架2042a、第二支架2042b和第三支架2042c，所述支架各自的尺寸和结构被设计成支撑一个钉2012。例如，钉2012的基部2014(图9)被定位在第二驱动器2040a的每个支架2042a、2042b、2042c中。
如图7中所公开，第一驱动器2040a是右侧驱动器，该右侧驱动器被定位在钉仓2020的右侧或第一侧2027。每个第一驱动器2040a的第一支架2042a(图8-图8B)被构造成能够与钉腔2028的第一外排2035中的钉2012对齐，每个第一驱动器2040a的第二支架2042b(图8-图8B)被构造成能够与钉腔2028的第一中间排2037中的钉2012对齐，并且每个第一驱动器2040a的第三支架2042c(图8-图8B)被构造成能够与钉腔2028的第一内排2033中的钉2012对齐。
如图7中进一步所公开，第二驱动器2040b是左侧驱动器，该左侧驱动器被定位在钉仓2020的左侧或第二侧2029。例如，每个第二驱动器2040b的第一支架2042a(图8C-图9)被构造成能够与钉腔2028的第二外排2036中的钉2012对齐，每个第二驱动器2040b的第二支架2042b(图8C-图9)被构造成能够与钉腔2028的第二中间排2038中的钉2012对齐，并且每个第二驱动器2040b的第三支架2042c(图8C-图9)被构造成能够与钉腔2028的第二内排2034中的钉2012对齐。
图8-图9中公开的每个支架2042a、2042b、2042c被限定到第一驱动器2040a或第二驱动器2040b的台阶或平台2045中。例如，所示第一驱动器2040a和所示第二驱动器2040b包括平台2045，并且支架2042a、2042b、2042c被限定到平台2045中的每个平台中。驱动器2040a、2040b的图8-图9中公开的平台2045为相同高度或高程，并被构造成能够将阵列2011中的每个钉2012相对于阵列2011中的其它钉2012保持在相同高度或高程。仍然参见图8-图9，还公开了连接凸缘2048，该连接凸缘在每个驱动器2040a、2040b的台阶2045之间延伸。连接凸缘2048可限制和/或约束台阶2045之间的相对移动。
在其它情况下，台阶或平台2045可具有不同高度和/或高程。例如，每个台阶2045的高度可被改变以控制钉2012的成形高度，从而控制捕获在成形钉2012内的组织的压缩。除此之外或另选地，每个支架2042a、2042b、2042c的深度可被改变以控制成形钉2012的高度，从而控制捕获在成形钉2012内的组织的压缩。
将第一驱动器2040a和第二驱动器2040b及其支架2042a、2042b、2042c以与钉仓2020中的钉腔2028和钉阵列2011的布置互补的布置取向。如图8A和图8D中所公开，每个支架2042a、2042b、2042c包括第一端部2044和第二端部2046，并且每个支架2042a、2042b、2042c的第一端部2044在相同支架2042a、2042b、2042c的第二端部2046的远侧。另外，轴线被限定在每个支架2042a、2042b、2042的第一端部2044和第二端部2046之间。例如，第一轴线Aa由第一支架2042a限定，第二轴线Ab由第二支架2042b限定，并且第三轴线Ac由第三支架2042c限定。
在所示布置中，第一轴线Aa的取向被构造成能够匹配或对应于由第一支架2042a支撑的成角度钉2012的取向，第二轴线Ab的取向被构造成能够匹配或对应于由第二支架2042b支撑的成角度钉2012的取向，并且第三轴线Ac的取向被构造成能够匹配或对应于由第三支架2042c支撑的成角度钉2012的取向。
如图8A和图8D中所公开，第一轴线Aa平行或大致平行于第三轴线Ac。另外，示于图8A和图8D中的第二轴线Ab同时横贯第一轴线Aa和第三轴线Ac。例如，如图8A和图8D中所公开，第二轴线Ab垂直或大致垂直于第一轴线Aa和第三轴线Ac。
在驱动器2040a、2040b用于具有钉2012和钉腔2028的不同布置的钉仓中的情况下，支架2042a、2042b、2042c的相对取向可不同。在一些布置中，例如，所有轴线Aa、Ab、Ac可为平行的。在另外的布置中，例如，所有轴线Aa、Ab、Ac可交叉。在某些情况下，一个轴线Aa、Ab、Ac可垂直于至少另一个轴线Aa、Ab、Ac。除此之外或另选地，在一些情况下，一个轴线Aa、Ab、Ac可平行于至少另一个轴线Aa、Ab、Ac。
主要参见图8-图8C，第一驱动器2040a和第二驱动器2040b为一体形成的零件。例如，每个驱动器2040a、2040b由一体成型的部件组成。在其它情况下，至少一个台阶2045和/或连接凸缘2048可独立地形成。在此类情况下，多个零件可例如被胶合、焊接和/或以其它方式粘附在一起，以形成一体件。
图7-图9中公开的多钉驱动器2040a、2040b被构造成能够将来自钉腔2028的钉2012驱动穿过多个纵向排2033、2034、2035、2036、2037、2039。在示于图7中的钉仓2020中，钉2012在狭槽2032的每一侧上被布置在三个纵向排中，并且驱动器2040a、2040b被构造成能够支撑并驱动三个纵向排中的每个中的钉2012。例如，每个所示第一驱动器2040a被构造成能够驱动定位在第一内排2033中的钉2012，定位在第一中间排2037中的钉2012，以及定位在钉腔2028的第一外排2035中的钉2012。另外，每个所示第二驱动器2040b被构造成能够驱动定位在第二内排2034中的钉2012，定位在第二中间排2038中的钉2012，以及定位在钉腔2028的第二外排2036中的钉2012。
在其它情况下，钉2012可在狭槽2032的每一侧上被布置在多于三个纵向排或少于三个纵向排中，并且驱动器2040a、2040b可被构造成能够在狭槽2032的每一侧上接合纵向排中的每个排中的钉2012。例如，钉仓2020可在纵向轴线L的任一侧上具有两排钉腔2028，并且定位在其中的多钉驱动器可包括两个支架，所述支架可被构造成能够支撑两排中的每排中的钉。在一些情况下，多钉驱动器可从相同排的钉腔2028击发多个钉2012。例如，多钉驱动器可击发相同排中的相邻钉2012，例如诸如更近侧钉2012和更远侧钉2012。在某些情况下，多钉驱动器可不在纵向狭槽2032的侧面上接合每一排中的钉2012。例如，单独和不同的驱动器可接合排(例如诸如最外排和/或最内排)中的一个排中的钉。除此之外或另选地，在某些情况下，钉仓2020可包括至少一个多钉驱动器和至少一个单钉驱动器。参见例如图12。
图7中公开的端部执行器组件2000还包括击发构件2060，该击发构件被构造成能够相对于仓体2024移动。在击发行程期间，击发构件2060被构造成能够横贯仓体2024，并且驱动地接合滑动件2058以将滑动件2058移动穿过仓体2024。例如，所示击发构件2060的一部分的尺寸和位置被设计成配合在纵向狭槽2032内。如图7中所公开，击发构件2060的被构造成能够配合在纵向狭槽2032内的部分包括切割刃2061，该切割刃被构造成能够切入夹持在端部执行器组件2000的第一钳口2002和第二钳口2004之间的组织。
图7中公开的楔形滑动件2058被构造成能够接合驱动器2040a、2040b以提升驱动器2040a、2040b，从而将支撑在其上的钉2012击发到组织中。在所示端部执行器组件2000中，滑动件2058的中间楔形件2062可在纵向狭槽2032内滑动和/或平移，并且限定在滑动件2058上的侧向定位的驱动楔形件或驱动导轨2064a、2064b可接合钉驱动器2040a、2040b。例如，示于图7中的滑动件2058包括驱动楔形件或导轨2064a、2064b，其被构造成能够在击发行程期间沿着击发路径F1(图8A)和F2(图8D)移动以接触与击发路径F1、F2纵向对齐的多钉第一驱动器2040a和第二驱动器2040b。
如图7中所公开，滑动件2058在中心部分2062的任一侧上包括驱动楔形件2064a、2064b。钉仓2020的第一侧2027上的驱动楔形件2064a被构造成能够沿着第一击发路径F1(图8A)移动，并且钉仓2020的第二侧2029上的驱动楔形件2064b被构造成能够沿着第二击发路径F2(图8D)移动。
图7中公开的每个驱动楔形件2064a、2064b被构造成能够接合多钉驱动器2040a、2040b中的一个多钉驱动器以提升钉腔2028内的驱动器2040a、2040b并且从仓体2024射出钉2012。在所示布置中，每个第一驱动器2040a的三个台阶2045相对于彼此保持固定，并且每个第二驱动器2040b的三个台阶2045相对于彼此保持固定。换句话讲，单个驱动器2040a、2040b的台阶2045不相对于彼此移动和/或旋转。因为单个驱动器2040a、2040b的台阶2045不相对于彼此移动和/或旋转，所以也约束了由每个驱动器2040a、2040b支撑的钉2012的相对移动。另外，每个驱动器2040a、2040b在仓体2042内具有较大基部或占有面积，这可以进一步减小驱动器2040a、2040b的旋转和/或扭转。因此，钉2012在部署期间的移位和/或倾斜可由多钉驱动器2040a、2040b来防止、最小化和/或控制。多钉驱动器如驱动器2040a、2040b例如可并入本文公开的其它钉仓和/或端部执行器组件中。
在各种情况下，滑动件2058的驱动楔形件2064a、2064b的尺寸、结构和位置可被设计成分别接合驱动器2040a、2040b的驱动表面。例如，驱动器2040a、2040b可包括斜坡表面和/或轨道，其被构造成能够在击发构件2060和滑动件2058移动穿过钉仓2020时分别引导和/或接收驱动楔形件2064a、2064b的一部分。
驱动楔形件2064a、2064b的相对放置及该驱动楔形件分别到驱动器2040a、2040b和由驱动器2040a、2040b支撑的钉2012的对应击发路径F1、F2可被选择成防止、减少和/或控制在击发期间驱动器2040a、2040b和/或钉2012的扭转。例如，驱动器2040a、2040b的几何形状和/或材料可被选择成将每个驱动器2040a、2040b的质心(COM)分别放置成与对应击发路径F1、F2对齐。除此之外或另选地，驱动楔形件2064a、2064b以及因此击发路径F1、F2可分别被定位在仓2020内以分别延伸穿过驱动器2040a、2040b的质心(COM)。
在其它情况下，如本文进一步所述，滑动件2058可在中间部分2062的每一侧上可包括不止一个驱动楔形件2064a、2064b。例如，多个驱动楔形件2064a、2064b可移动穿过仓体2024的任一侧2027、2029。除此之外或另选地，楔形滑动件2058的驱动楔形件2064a、2064b可被构造成能够直接接合并驱动钉2012，如本文进一步所述。
主要参见图8A和图8D，第一驱动器2040a和第二驱动器2040b分别覆盖在驱动楔形件2064a、2064b的击发路径F1、F2上。例如，第一驱动器2040a覆盖在第一击发路径F1上，并且第二驱动器2040b覆盖在第二击发路径F2上。此外，每个驱动器2040a、2040b的各个部分被定位在相应驱动楔形件2064a、2064b的任一侧上，并因此定位在击发路径F1、F2的任一侧上。仍然参见图8A和图8D，所示驱动器2040a、2040b的尺寸和结构被设计成使得每个驱动器2040a、2040b的质心(COM)分别与例如驱动楔形件2064a、2064b的对应击发路径F1、F2重叠。换句话讲，每个所示驱动器2040a、2040b相对于对应击发路径F1、F2质量平衡。
例如，如图8A中所公开，第一驱动器2040a的第一部分2047被定位在击发路径F1的第一侧上，并且第一驱动器2040a的第二部分2049被定位在击发路径F1的第二侧上。第一驱动器2040a的第一部分2047具有第一质量m1，并且第一驱动器2040a的第二部分2049具有等于或基本上等于第一质量m1的质量m2。另外，如图8D中所公开，第二驱动器2040b的第一部分2047被定位在击发路径F2的第一侧上，并且第二驱动器2040b的第二部分2049被定位在击发路径F2的第二侧上。第二驱动器2040b的第一部分2047具有第一质量m1，并且第二驱动器2040b的第二部分2049具有等于或基本上等于第一质量m1的质量m2。因为驱动器2040a、2040b相对于相应击发路径F1、F2质量平衡，所以驱动器2040a、2040b和支撑在其上的钉2012在击发期间的扭转可被最小化并且/或者以其它方式控制。另外，由每个驱动器2040a、2040b部署的钉2012的组可相对于仓体2024同步地提升，并同时驱动或击发到组织中。质量平衡的驱动器(如驱动器2040a、2040b)例如可并入本文公开的其它实施方案中。
另外，如图8-图9中所公开，至少一个切口2050被限定到第一多钉驱动器2040a和第二多钉驱动器2040b中。例如，各个切口2050被限定到驱动器2040a、2040b的连接凸缘2048中。切口2050的尺寸和位置被设计成调整驱动器2040a、2040b的质量，并且相对于击发路径F1、F2平衡每个驱动器2040a、2040b的质心(COM)。另外，切口2050的尺寸和位置被设计成适应钉腔2028的几何形状，其中驱动器2040a、2040b被可移动地定位。
在某些情况下，多个钉腔可被限定到钉仓中，至少一个钉腔可平行于钉仓的纵向轴线，并且至少一个钉腔可相对于钉仓的纵向轴线成角度地取向。参见图10所示的钉仓2120，例如，多个钉腔2128被限定到钉仓2120中，并且多个钉腔2128平行于钉仓2120的纵向轴线L。
在所示钉仓2120中，纵向狭槽2032被部分地穿过仓体2124限定。另外限定在仓体2124中的是在纵向狭槽2032的任一侧上的一排钉腔2128，其包括平行于纵向轴线L取向的钉腔2128。在所示钉仓2120中，钉腔2128的第一排2137和钉腔2128的第二排2138与纵向狭槽2032相邻，并且在第一排2137中以及在第二排2138中的钉腔2128平行于纵向轴线L取向。例如，如图10中所公开，第一排2137中的钉腔2128与平行于纵向轴线L的轴线Ab对齐。
图10中公开的钉仓2120包括钉腔2128的附加排。例如，所示钉仓2120包括钉腔2128的第三排2135和钉腔2128的第四排2136，其包括相对于纵向轴线L成角度地取向的钉腔2128。在此类情况下，第三排2135和第四排2136中的钉腔2128也相对于第一排2137和第二排2138中的钉腔2128成角度地取向，并且也相对于彼此成角度地取向。例如，第三排2135中的钉腔2128与轴线Aa对齐，该轴线Aa横贯纵向轴线L并且横贯钉腔2128的第一排2137的轴线Ab。如图10中进一步所公开，第四排2136中的钉腔2128沿着横贯第三排2135中的钉腔2128的轴线Aa的轴线延伸。钉腔2128的第一排2137和第三排2135被定位在所示仓体2124的第一侧2127上，并且第二排2136和第四排2138被定位在所示仓体2124的第二侧2129上。
在各种情况下，图10中公开的钉仓2120可与图7中示出的端部执行器组件2000一起使用。例如，钉仓2120可被加载到端部执行器组件2000的第二钳口2004的细长通道中。钉仓2120可用单钉驱动器、多钉驱动器和/或它们的组合来击发。例如，多钉驱动器可被构造成能够在仓体2124的第一侧2127上从第一排2137和第三排2135中的钉腔2128击发钉，并且另一个多钉驱动器可被构造成能够在仓体2124的第二侧2129上从第二排2136和第四排2138中的钉腔2128击发钉。在各种情况下，驱动器可被定位在仓体2124内，使得驱动器的支架与定位在钉腔2128中的钉对齐。在此类情况下，驱动器和/或支撑在其上的钉可例如相对于滑动件(诸如滑动件2058(图7))的击发路径质量平衡，该击发路径可被构造成能够横贯仓体2124并且在其中接合驱动器。
在其它情况下，钉仓2120可不包括驱动器。例如，击发构件和/或滑动件(诸如击发构件2060和/或滑动件2058(图7))例如可被构造成能够直接接触、接合和/或驱动可移动地定位在钉腔2128中的钉。在此类情况下，钉可相对于滑动件2058的击发路径质量平衡。在另外的情况下，钉可在仓体2124内被保持在适当位置，并且可例如在仓体2124内被压溃和/或以其它方式变形。
在各种情况下，多钉驱动器可相对于多个驱动楔形件平衡，该驱动楔形件在部署期间同时接合并协作地提升驱动器。例如，多钉驱动器2240和一对驱动楔形件2264a、2264b示于图11中。多钉驱动器2240被构造成用于例如与钉仓2020一起使用。除此之外或另选地，驱动器2240可与具有钉阵列的各种其它钉仓一起使用，该钉阵列匹配阵列2011(图7)并且对应于示于图11中的驱动器2240的布置。
在各种情况下，从钉仓2120击发的钉可被形成为可变成形高度。例如，钉在钉腿中的一个钉腿和基部之间的高度可大于在另一个钉腿和基部之间的高度。在此类情况下，钉可在钉的更短端部处在组织上施加更大的压缩力。如本文中更详细地所述，当钉驱动器包括台阶或高度差(参见例如图79)时，并且/或者当砧座中的钉成形凹坑包括台阶或高度差(参见例如图80)时，钉的高度可改变。
当成角度钉变形到可变高度时，由成角度钉施加在组织上的压缩力可纵向和侧向地改变。在某些情况下，例如，可能期望比远离(即，侧向外侧)切割线的组织更多地压缩靠近(即，侧向内侧)切割线的组织。在此类情况下，由已经变形到不同压缩高度的成角度钉提供的侧向组织变化可在组织的侧向内侧部分上施加更大的压缩力，并且在组织的侧向外侧部分上施加减小的压缩力。
再次参见图10，在某些情况下，从钉腔2128的第三排2135以及从钉腔2128的第四排2136射出的钉可变形成可变高度。例如，钉可具有靠近纵向轴线L的减小高度，以及远离纵向轴线L的更大高度。除此之外或另选地，从钉腔2128的第一排2137以及从第二排钉腔2138射出的钉可变形成均匀高度，该均匀高度可小于从钉腔2128的第三排2135和第四排2136射出的钉的减小或更小的高度。在此类情况下，施加在组织上的压缩力可最大靠近切割线，并且可朝向钉线的侧向侧在更远的外侧逐渐减小。
图11中公开的每个驱动器2240包括多个槽或钉支撑支架2242a、2242b、2242c。例如，每个驱动器2240包括第一支架2242a、第二支架2242b和第三支架2242c，这些支架各自的尺寸和结构被设计成支撑一个钉，诸如钉2012(图7)中的一个钉。例如，钉的基部可被定位在每个支架2242a、2242b、2242c中。再次参见示于图7中的钉仓2020，第一支架2242a可与钉腔2028的第一外排2035中的钉2012对齐，第二支架2242b可与钉腔2028的第一中间排2037中的钉2012对齐，并且第三支架2242c可与钉腔2028的第一内排2033中的钉2012对齐。在此类情况下，第一支架2242a对应于外支架，第二支架2242b对应于中间支架，并且第三支架2242c对应于内支架。在各种情况下，另一个驱动器布置可被定位在钉仓的相对侧上，并且另一个驱动器布置可为图11中所示的驱动器布置的镜像反射。
示于图11中的支架2242a、2242b、2242c被限定到支撑构件2248中。支撑构件2248可支撑多排钉腔上的钉。另外，支撑构件2248可支撑例如相对于钉仓的纵向轴线L并且/或者相对于驱动楔形件2264a、2264b的纵向击发路径以不同角度取向的钉2012。参见所示支撑构件2248，该支撑构件2248相对于驱动楔形件2264a、2264b的击发路径成角度地取向。另外，支撑构件2248相对于限定于其中的支架2242a、2242b、2242c中的至少一个支架成角度地取向。例如，图11中所公开的中间支架2242b相对于支撑构件2248成角度地取向。此外，如图11中所公开，外支架2242c和内支架2242a与支撑构件2248对齐。
在某些情况下，支撑构件2248的高度可为均匀的，或大致均匀的，使得由支撑构件2248支撑的每个钉被定位在相同高度或高程。在其它情况下，支撑构件2248可包括具有不同高度和/或高程的台阶。例如，台阶的高度可改变以控制成形钉的高度，从而控制捕获在成形钉内的组织的压缩。除此之外或另选地，每个支架2242a、2242b、2242c的深度可被改变以控制成形钉的高度，从而控制捕获在成形钉内的组织的压缩。
图11中公开的每个支架2242a、2242b、2242c包括第一端部2244和第二端部2246。每个支架2242a、2242b、2242c的第一端部2244在相同支架2242a、2242b、2242c的第二端部2246的远侧。另外，轴线被限定在每个支架2242a、2242b、2242c的第一端部2244和第二端部2246之间。例如，第一轴线Aa由第一支架2242a和第三支架2242c限定，并且第二轴线Ab由第二支架2242b限定。如图11所示，第二轴线Ab横贯第一轴线Aa。在某些情况下，第二轴线Ab可垂直或大致垂直于第一轴线Aa。
仍然参见图11，多钉驱动器2240包括连接到支撑构件2248的导轨2245a、2045b。导轨2245a、2245b被定位成接合楔形滑动件的驱动楔形件2264a、2264b。例如，所示导轨2245a、2245b与驱动楔形件2264a、2264b的击发路径F1、F2对齐。在此类情况下，导轨2245a、2245b可提供细长表面区域以用于接收来自驱动楔形件的驱动力，并且用于在驱动楔形件2264a、2264b驱动地接合导轨2245a、2245b时稳定多钉驱动器2240。
驱动器2240可包括多个独立形成的部件，其可被胶合、焊接和/或以其它方式粘附在一起。例如，支撑构件2248可与导轨2245a、2245b连接在一起以形成驱动器2240。在其它情况下，每个驱动器2240可为一体成型部件，其包括支撑构件2248和导轨2245a、2245b。
图11中公开的驱动器2240覆盖在驱动楔形件2264a、2264b的击发路径F1、F2上。此外，每个所示驱动器2240的各个部分被定位在楔形件2264a、2264b的任一侧上。如图11所示，驱动器2240的尺寸和结构被设计成使得每个驱动器2240的质心(COM)与驱动轴线等距，例如与驱动楔形件2264a、2264b的击发路径F1、F2等距。例如，示于图11中的击发路径F1、F2被宽度w分开，并且每个驱动器2240的质心被定位在击发路径F1、F2之间。如图11所示，每个驱动器2240的质心从第一击发路径F1侧向偏置宽度w/2并且从第二击发路径F2侧向偏置宽度w/2。因此，每个所示驱动器2240相对于击发路径F1、F2质量平衡。因为驱动器2240相对于击发路径F1、F2质量平衡，所以在部署期间驱动器2240和钉的扭转可被防止、最小化并且/或者以其它方式控制。质量平衡的驱动器(如驱动器2240)例如可并入本文公开的其它钉仓和端部执行器组件中。
在其它情况下，击发构件可包括与驱动器2240对齐的单个驱动楔形件，并且驱动器2240可相对于驱动楔形件质量平衡。例如，驱动楔形件可限定延伸穿过每个驱动器2240的质心(COM)的击发路径。在此类情况下，驱动楔形件可具有更大的宽度以增加驱动器2240的稳定性。在其它情况下，击发构件可包括三个或更多个驱动楔形件，并且由驱动楔形件施加的累积驱动力可相对于驱动器2240的几何形状平衡。
图11中公开的每个导轨2245a、2245b与击发路径F1、F2中的一个对齐。具体地讲，第一导轨2245a与第一击发路径F1对齐，并且第二导轨2245b与第二击发路径F2对齐。驱动楔形件2264a、2264b被构造成能够接触导轨2245a、2245b以提升驱动器2240和支撑在其上的钉。仍然参见图11，所示驱动楔形件2264a、2264b沿纵向交错距离x。例如，第一楔形件2264a跟随第二楔形件2264b图11中所示的距离x。另外，第一导轨2245a相对于第二导轨2245b沿纵向交错。例如，第二导轨2245b从第一导轨2245a朝远侧偏置图11中所示的距离y。在图11中所公开的布置中，距离x等于或基本上等于距离y，使得驱动楔形件2264a、2264b在击发行程期间分别同时接触并驱动导轨2245a、2245b。
因为图11中公开的驱动楔形件2264a、2264b在驱动器2240的质心(COM)的任一侧上分别同时接合并且驱动地提升导轨2245a、2245b而且与其等距，所以累积驱动力在驱动器2240的整个部署中平衡。因此，驱动器2240的扭转和/或旋转，以及因此支撑在其上的钉的扭转和/或旋转可被阻止、最小化和/或控制。沿纵向偏置的驱动楔形件(如驱动楔形件2264a、2264b)例如可并入本文公开的其它实施方案中。
多钉驱动器2340a和单钉驱动器2340b的布置在图12中有所公开。因为驱动器2340a、2340b的布置对应于图7中所示的钉2012的阵列2011，所以驱动器2340a、2340b可与钉仓2020(图7)一起使用。除此之外或另选地，驱动器2340a、2340b可与具有钉阵列的各种其它钉仓一起使用，该钉阵列对应于示于图12中的驱动器2340a、2340b的布置。
驱动器2340a、2340b包括多个槽或钉支撑支架2342a、2342b、2342c。例如，多钉驱动器2340a包括第一支架2342a和第二支架2342b，所述支架各自的尺寸和结构被设计成支撑钉，诸如示于图7中的钉2012中的两个。另外，单钉驱动器2340b包括第三支架2342c，该支架的尺寸和结构被设计成支撑另一个钉，诸如示于图7中的钉2012中的另一个钉。例如，钉2012的基部可驻留在每个支架2342a、2342b、2342c中。
再次参见示于图7中的钉仓2020，第一支架2342a可与钉腔2028的第一外排2035中的钉2012对齐，第二支架2342b可与钉腔2028的中间排2037中的钉2012对齐，并且第三支架2342c可与钉腔2028的内排2033中的钉2012对齐。在此类情况下，第一支架2342a对应于外支架，第二支架2342b对应于中间支架，并且第三支架2342c对应于内支架。另外，另一个驱动器布置可被定位在钉仓2020的相反侧上，其可为图12中所公开的驱动器布置的镜像。
仍然参见图12，每个支架2342a、2342b、2342c被限定到台阶和/或支撑部分2345中。另外，驱动器2340a、2340b中的每个驱动器分别包括基部2348、2349。每个多钉驱动器2340a的基部2348在驱动器2340a的台阶2345之间延伸。另外，每个单钉驱动器2340b的基部2349从其台阶2345延伸。
如图12中所公开，每个驱动器2340a、2340b与钉仓内的击发路径F1、F2对齐。具体地讲，每个第一驱动器2340a与第一击发路径F1对齐，并且每个第二驱动器2340b与第二击发路径F2对齐。所示驱动楔形件2364a、2364b被构造成能够在击发行程期间沿着击发路径F1、F2移动。另外，驱动楔形件2364a、2364b分别接触驱动器2340a、2340b以提升驱动器2240a、2340b和支撑在其上的钉。
基部2348、2349可用作平衡物以调整和/或控制驱动器2340a、2340b的质心。例如，每个基部2348、2349的几何形状和材料可被选择成将每个驱动器2340a、2340b的质心保持和/或移位成与对应击发路径F1、F2对齐。如图12所示，第一基部2348包括至少一个切口2350。切口2350的尺寸、放置和几何形状被选择成使第一驱动器2340a相对于第一击发路径F1质量平衡。例如，每个第一基部2348可被构造成能够将多钉驱动器2340a的质心移位或保持成与第一击发路径F1对齐，并且每个第二基部2349可被构造成能够将单钉驱动器2340b的质心移位成与第二击发路径F2对齐。
另外，基部2348、2349提供了细长表面区域以用于在驱动楔形件2364a、2364b驱动地接合驱动器2340a、2340b时稳定驱动器2340。例如，驱动器2340a、2340b的较大占有面积可提升稳定性并且防止在部署期间驱动器2340a、2340b的扭矩和/或旋转。此外，因为基部2348、2349提供了较大表面区域，所以驱动力可被分配以促进平衡的驱动器和钉部署。例如，具有细长表面区域(诸如基部2348、2349)的驱动器
可并入本文所公开的其它实施方案中。
仍然参见图12，所示驱动楔形件2364a、2364b沿纵向交错距离x。例如，第一楔形件2364a以距离x跟随第二楔形件2364b。如图12进一步所示，所示驱动器2340a、2340b沿纵向交错距离y。在所示布置中，距离x不同于距离y，使得驱动楔形件2364a、2364b不同时接触驱动器2340a、2340。例如，在所示布置中，第一楔形件2364a在第二楔形件2364b接触第二驱动器2340b之前接触第一驱动器2340a。在此类情况下，在第二钉2340b的部署以及因此第三支架2342c的移动之前，引发第一驱动器2340a的部署以及因此第一支架2342a和第二支架2342c的移动。因此，在与第二驱动器2340b对齐的钉之前击发与第一驱动器2340a对齐的钉。
在某些情况下，期望在击发另一个钉或另一组钉之前击发一个钉或一组钉。例如，为了控制缝合组织内的出血和/或流体流动，定位在更内侧的钉，诸如与纵向狭槽相邻以及因此与切割线相邻的钉可在更外侧的钉之前被击发。
在其它情况下，可在与第一驱动器2340a对齐的钉之前击发与第二驱动器2340b对齐的钉。或者，第一驱动器2340a和第二驱动器2340b可被同时击发，使得由相邻多钉驱动器2340a和单钉驱动器2340b支撑的三个钉同时刺穿并捕获组织。
双钉驱动器2440的布置示于图13中。如图13中所布置，双钉驱动器2440被构造成能够从具有四个相邻排的钉腔的钉仓击发钉。例如，示于图13中的驱动器布置可被构造成能够在仓体中的纵向狭槽的一侧上从四排钉腔击发钉，并且对应的镜像驱动器布置可被构造成能够在纵向狭槽的另一侧上从四排钉腔击发钉。
在其它情况下，单排双钉驱动器2440可被定位在钉仓的第一侧上，并且单排双钉驱动器2440可被定位在钉仓的相反的第二侧上。在此类情况下，双钉驱动器2440可被布置成在切割线的任一侧上从两个相邻排的钉腔击发钉。在其它情况下，可将双钉驱动器2440的排添加到图13中所示的布置。例如，双钉驱动器可被布置成从六个或更多个相邻排的钉腔击发钉。
示于图13中的双钉驱动器2440包括一对槽或钉支撑支架2442a、2442b。例如，每个双钉驱动器2440包括第一支架2442a和第二支架2442b，所述支架的尺寸和结构被设计成支撑钉，诸如钉2012(图7)中的一个钉。例如，钉的基部可被定位在每个支架2442a、2442b中。
双钉驱动器2440中的一个双钉驱动器的第一支架2442a可与一排钉腔中的钉对齐，并且相同双钉驱动器2440的第二支架2442b可与另一排钉腔中的钉对齐。此外，另一个双钉驱动器2440的第一支架2442a可与另一排钉腔中的钉对齐，并且该双钉驱动器2440的第二支架2442b可与又一排钉腔中的钉对齐。
仍然参见图13，每个双钉驱动器2440包括台阶和/或支撑部分2445，并且每个支架2442a、2442b被限定到台阶2445中的一个台阶中。另外，驱动器2440中的每个驱动器包括在双钉驱动器2440的台阶2445之间延伸的基部或连接凸缘2448。因为台阶2445由连接凸缘2448连接，所以支架2442a、2442b被连接成使得协调和/或同步的钉部署可由双钉驱动器2440引发。
驱动器2440的台阶2445可为相同高度。或者，在一些情况下，驱动器2440可包括不同高度的台阶。在另外的情况下，不同驱动器2440可例如具有不同高度的台阶。
如图13中所公开，每个双钉驱动器2440覆盖在一对击发路径上。具体地讲，驱动器2440中的一个覆盖驱动器在第一击发路径F1和第二击发路径F2上，并且驱动器2440中的另一个驱动器覆盖在第三击发路径F3和第四击发路径F4上。多个驱动楔形件2464a、2464b、2464b、2464d也示于图13中。如图13所示，驱动楔形件2464a、2464b、2464c、2464d被构造成能够接触双钉驱动器2440以提升双钉驱动器2240和定位在其上的钉。
仍然参见图13，每个台阶2445包括质心(COM)。另外，击发路径F1、F2、F3、F4中的每个击发路径与台阶2045的质心对齐。因此，每个台阶2445相对于对应的击发路径F1、F2、F3、F4质量平衡。
在各种情况下，在台阶2445之间延伸的基部2448也可相对于相应击发路径F1、F2、F3、F4质量平衡，使得基部2448保持双钉驱动器2440的质量平衡。在一些
情况下，基部2448可为双钉驱动器2440的质量平衡贡献不显著和/或可忽略不计的移位和/或变化。在此类情况下，驱动器2240的质量平衡可通过例如其台阶2445的质量平衡近似。
仍然参见图13，所示驱动楔形件2464a、2464b沿纵向交错距离x。例如，第一楔形件2464a跟随第二楔形件2464b距离x。另外，每个双钉驱动器2440的台阶2445的质心(COM)以距离x沿纵向交错。在此类情况下，驱动楔形件2464a、2464b可同时移动到与驱动器2440接合。因为楔形件2464a、2464c同时接触每个驱动器2444，所以由每个驱动器2440支撑的钉对的部署可被同步，并且钉可被同时驱动或击发到组织中。例如，沿纵向交错的楔形件如楔形件2464a、2464b可并入本文公开的其它实施方案中。
在各种情况下，可结合钉和驱动器在钉仓内的布置将驱动楔形件的几何形状选择成平衡在部署期间施加在钉和驱动器上的力。另外，在某些情况下，驱动楔形件的几何形状可被选择成协调钉的部署。
例如，驱动器可包括交错和/或沿纵向偏置的驱动楔形件，其可被构造成能够同时接合钉仓内的成角度地取向的钉和/或成角度地取向的驱动器。例如，交错的驱动楔形件可移动到同时与驱动器的第一或近侧端部以及相同驱动器的第二或远侧端部接合。因为成角度的驱动器的两个端部由交错的楔形件同时接合，所以交错的驱动楔形件同时提升驱动器。因此，在部署期间驱动器的扭转和/或旋转，以及因此支撑在其上的钉的扭转和/或旋转可被阻止、限制和/或控制。
在本文中进一步描述的其它无驱动器实施方案中，交错的驱动楔形件可移动到同时与成角度钉的第一或近侧端部以及相同成角度钉的第二或远侧端部接合。因为成角度钉的两个端部由交错的楔形件同时接合，所以交错的驱动楔形件同时提升钉。因此，在部署期间钉的扭转和/或旋转可被阻止、限制和/或控制。
除此之外或另选地，驱动器的几何形状可限定至少一个击发路径，该击发路径与钉仓内的不成角度地取向的钉和/或驱动器对齐。例如，击发路径可与各种驱动器和钉的轴线共线，该轴线平行于钉仓的纵向轴线取向。因为击发路径与钉和/或驱动器轴线共线，所以钉和/或驱动器可相对于驱动楔形件平衡，并且驱动器和/或钉的扭矩和/或旋转可被防止、限制和/或控制。
楔形滑动件2558的驱动器2540，钉2512a、2512b和驱动楔形件2564a、2564b、2564c的布置示于图14和图15中。图14和图15中公开的驱动楔形件2564a、2564b、2564c被构造成能够沿着分别延伸穿过钉仓的击发路径F1、F2和F3(图14)移动。在各种情况下，驱动器2540的布置可用于钉仓中，该钉仓具有钉2512a、2512b和钉腔的对应于所示驱动器布置的布置。
如图14所公开，驱动器2540和钉2512a、2512b被布置成多排2534、2536。另外，每个排中的各种驱动器2540和钉2512a平行于纵向轴线L取向，并且每个排中的各种驱动器2540和钉2512b相对于纵向轴线L成角度地取向。例如，所示布置包括一对纵向排2534、2536，并且每个排2534、2536中的驱动器2540和钉2512a、2512b在相对于纵向轴线L平行取向和成角度取向之间交替。例如，示于第一排2534中的驱动器2540包括相对于纵向轴线L成角度地取向的第一驱动器2540a，平行于纵向轴线L取向的第二驱动器2540b，相对于纵向轴线L成角度地取向的第三驱动器2540c，以及平行于纵向轴线L取向的第四驱动器2540d。
如图14中所公开，第一排2534的第二驱动器2540b和第四驱动器2540d与第一击发路径F1对齐。更具体地讲，第二驱动器2540b和第四驱动器2540d的近侧端部2546和远侧端部2544与第一击发路径F1对齐。在此类情况下，第一击发路径F1延伸穿过第二驱动器2540b和第四驱动器2540d的质心(COM)。因为第一击发路径F1与第二驱动器2540b和第四驱动器2540d对齐，所以第二驱动器2540b和第四驱动器2540d相对于第一击发路径F1质量平衡，并且示于图14中的第二驱动器2540b和第四驱动器2540d的扭转和/或旋转，以及因此支撑在其上的钉的扭转和/或旋转可被防止、限制和/或控制。
如图14中所公开，第一驱动器2540a与轴线A对齐，该轴线A横贯纵向轴线L以及击发路径F1、F2和F3。另外，第三驱动器2540c平行于轴线A取向。如图14所示，第一驱动器2540a和第三驱动器2540c相对于纵向轴线L成角度地取向并且覆盖在多个击发路径上。例如，所示第一驱动器2540a和第三驱动器2540c覆盖在第一击发路径F1和第二击发路径F2上。如图14所示，第一击发路径F1延伸穿过第一驱动器2540a和第三驱动器2540c的近侧端部2546，并且第二击发路径F2延伸穿过第一驱动器2540a和第三驱动器2540c的远侧端部2544。
第一驱动器2540a和第二驱动器2540c的质心(COM)在第一击发路径F1和第二击发路径F2中间。例如，第一驱动器2540a和第二驱动器2540c的质心与第一击发路径F1和第二击发路径F2等距，并且因此驱动器2540a、2540c相对于第一击发路径F1和第二击发路径F2质量平衡。因此，示于图14中的第二驱动器2540b和第四驱动器2540d的扭转和/或旋转，以及因此支撑在其上的钉的扭转和/或旋转可被阻止、限制和/或控制。
另外，示于图14和图15中的驱动楔形件2564a、2564c、2564c沿纵向交错。例如，第一驱动楔形件2564a朝远侧以距离x跟随第二驱动楔形件2564b，并且第二驱动楔形件2564b朝远侧以距离x跟随第三驱动楔形件2564c。如图14所示，成角度地取向的第三驱动器2540c的近侧端部2546和远侧端部2544偏置纵向距离y。在图14和图15中所示的布置中，第三驱动器2540c的近侧端部2546和远侧端部2544之间的纵向距离y等于第一驱动楔形件2564a和第二驱动楔形件2564b之间的纵向距离x，该第一驱动楔形件与第三驱动器2540c的近侧端部2546对齐，该第二驱动楔形件与第三驱动器2540c的远侧端部2544对齐。
在图14和图15中所公开的布置中，第一驱动楔形件2564a和第二驱动楔形件2564b同时移动到与第三驱动器2540c接合。例如，在第二驱动楔形件2564b接触第三钉驱动器2540c的远侧端部2544时，第一驱动楔形件2564a接触第三钉驱动器2540c的近侧端部2546。因为示于图14中的驱动楔形件2564a、2564b、2564c被构造成能够接合成角度的驱动器的端部，所以将提升力直接施加在支撑在成角度的第三驱动器2540c上的钉的腿部下方。因此，钉腿被进一步稳定，并且在部署期间钉腿的倾斜和/或倾翻可被阻止、最小化和/或控制。
示于图14和图15中的第一驱动楔形件2564a和第二驱动楔形件2564b被构造成能够类似地接合第一排2534中的附加驱动器2540，并且可依次部署支撑在其上的钉2512a、2512b。例如，第一驱动楔形件2564a被构造成能够在第二驱动楔形件2564b接触第一驱动器2440a的远侧端部2544时随后接触第一驱动器2540a的近侧端部2546。另外，第一驱动楔形件2564a被构造成能够依次接合并击发第一排2534中的平行驱动器2540b、2540d和钉2512a。
在各种情况下，第三驱动器2540c的近侧端部2546和远侧端部2544可与第三驱动器2540c的质心等距。因为图14和图15中所公开的驱动楔形件2464a和2464b被构造成能够同时接触成角度地取向的第三钉驱动器2540c的相反端部并且将驱动力和/或提升力施加在与质心等距的钉驱动器2540c的相对端部上，所以钉驱动器2540c在其整个部署过程中平衡。因此，第三钉驱动器2540c的旋转和/或扭转可被阻止、避免和/或控制。
在其它情况下，驱动楔形件2564a、2564b可不接触成角度钉驱动器2540的端部2546、2544。然而，在此类情况下，驱动楔形件2564a、2564b可被构造成能够在与驱动器2540的质心等距的位置处接合成角度钉驱动器2540。此外，驱动楔形件2564a、2564b可被充分偏置以同时接触并提升驱动器2540c的间隔位置。
另外，示于图14和图15中的第二驱动楔形件2564b和第三驱动楔形件2564c被构造成能够类似地接合第二排2536中的驱动器2540，并且依次部署支撑在其上的钉2512a、2512b。例如仍然参见图14中所示的布置，第二排2536中的驱动器2540以一定角度取向，使得每个驱动器的近侧端部2546和远侧端部2544之间的距离也被纵向距离y分开，该纵向距离y等于第二驱动楔形件2564b和第三驱动楔形件2564c之间的纵向距离x。
在其它情况下，第二驱动楔形件2564b和第三驱动楔形件2564c之间的纵向距离可大于和/或小于第一驱动楔形件2564a和第二驱动楔形件2564b之间的纵向距离。除此之外或另选地，第二排2536中的成角度钉2512b可以与第一排2534中的成角度钉2512b不同的角度取向。此外，在各种情况下，可将附加排的驱动器2540和钉2512a、2512b添加到图14中所示的布置，并且附加驱动楔形件可被构造成能够接合附加驱动器2540以击发附加钉2512a、2512b。在另外的情况下，布置还可包括例如单排的驱动器2540和钉2512a、2512b。
示于图14中的钉2512a、2512b的布置也可从无驱动器钉仓击发。例如，参见图16，钉2512a、2512b可被布置在无驱动器仓内，诸如本文进一步描述的钉仓2620(图37)。无驱动器钉仓中的钉2512a、2512b可由滑动件和/或击发构件直接接合和/或驱动。例如，钉2512a、2512b可包括滑动件接合表面，该滑动件接合表面被构造成能够直接由楔形滑动件2558的驱动楔形件2564a、2564b和/或2564c中的一个或多个的钉接合表面接合。
如本文所述，每个钉2512a、2512b可相对于与钉2512a、2512b对齐的击发路径F1、F2、F3质量平衡。例如，参见图16，与纵向轴线L平行布置的钉2512a与击发路径F1、F2、F3中的一个对齐。在所示布置中，驱动楔形件2564a、2564b、2564c中的一个驱动楔形件沿着钉2512a的基部的长度驱动地接合平行钉2512a。另外，每个平行钉2512a的质心与击发路径F1、F2、F3中的一个击发路径对齐。换句话讲，击发路径F1、F2、F3中的一个击发路径延伸穿过每个平行钉2512a的质心，并因此在部署期间钉2512a相对于相应击发路径F1、F2、F3质量平衡。在此类布置中，在击发期间钉2512a的扭转和/或旋转可被阻止、最小化和/或控制。
另外，在示于图14中的钉布置用于无驱动器仓中的情况下，一对偏置驱动楔形件2564a、2564b、2564c被构造成能够同时移动到与每个成角度地取向的钉2512b接合。例如，第一驱动楔形件2564a和第二驱动楔形件2564b被构造成能够同时接触第一排2534中的成角度钉2512b，并且第二驱动楔形件2564b和第三驱动楔形件2564c可被构造成能够同时接触第二排2536中的成角度钉2512b。然后，楔形滑动件2558被构造成能够继续相对于钉2512a、2512b平移，以依次接触并且从无驱动器钉仓直接驱动钉2512a、2512b。
如本文所述，无驱动器钉仓可用于保持并击发包括成角度地取向的钉的钉阵列。包括第一钳口2002、第二钳口2004、框架2006、关节运动接头2009和无驱动器钉仓2620的端部执行器组件2600在图37中有所公开。钉仓2620可为单次使用和/或一次性仓，该仓可在击发之后用另一个钉仓替换。图37公开了包括平台2626、仓体2624和壳体2622的钉仓2620，该壳体部分地包围或包封仓体2624。另外，例如诸如钉2612(图39A和图39B)的钉的阵列可以可移除地定位在仓体2624中。
在某些情况下，钉仓2620可与端部执行器组件2600一体形成并且/或者可永久地固定在例如钳口2002、2004中的一个钳口内。在此类情况下，端部执行器组件2600可为单次使用和/或一次性端部执行器。在其它情况下，钉仓2620可被固定到端部执行器组件2600，并且可重新加载有附加钉以用于例如后续击发。
参见图37中所示的钉仓2620，纵向狭槽2632被限定成至少部分地穿过仓体2624。纵向狭槽2632沿着纵向轴线L延伸，该纵向轴线L在仓体2624的近侧端部2623和远侧端部2625之间延伸。示于图37中的纵向狭槽2632从近侧端部2623朝向远侧端部2625延伸并且横贯仓体2624的长度的一部分。
在一些情况下，纵向狭槽2632可横贯仓体2624的整个长度。在其它情况下，纵向狭槽2632可例如从远侧端部2623朝向近侧端部2625延伸。在另外的情况下，仓体2624可不包括预定和/或预成形的纵向狭槽。例如，击发构件和/或切割元件可例如在击发行程期间横切和/或切割仓体2624。
图37中公开的钉仓2620被构造成能够击发成角度钉2612(图38A和图38B)的阵列，该阵列可如同例如图7中所示的钉阵列2011那样取向。成角度钉2612可以可移除地定位在示于图37中的成角度钉腔2628中，该钉腔被限定到仓体2624中。例如，所示钉腔2628相对于纵向轴线L成角度地取向。另外，钉腔2628的所示布置对应于定位在仓2620中的钉2612的布置。示于图37中的每个钉腔2628包括平台2626中的开口2630，并且每个开口2630包括近侧端部和远侧端部。钉轴线可在近侧端部和远侧端部之间延伸，并且示于图37中的开口2630的钉轴线相对于仓体2624的纵向轴线L偏斜和/或成角度。在图37的钉仓2620中，所有钉腔2628相对于纵向轴线L成角度地取向，并且各种钉腔2628相对于其它钉腔2628成角度地取向。
示于图37中的钉腔2628在纵向狭槽2632的每一侧上以多排布置。例如，钉腔2628在纵向狭槽2632的第一侧2627上布置在第一内侧排2633、第一外侧排2635和第一中间排2637中，并且钉腔2628在纵向狭槽2632的第二侧2629上布置在第二内侧排2634、第二外侧排2638和第二中间排2636中。虽然钉腔2628不交叉或以其它方式彼此接触，但钉腔2628的纵向排2633、2634、2635、2636、2637、2638重叠。例如，钉腔2628在侧向外侧和/或内侧延伸经过相邻排的钉腔2628中的钉腔2628，并且钉腔2628朝近侧和/或朝远侧延伸经过相邻排的钉腔2628中的钉腔2628。因为钉腔2628和定位在其中的钉布置在重叠阵列中，所以可控制缝合组织中的出血和/或流体流动。在示于图37中的钉仓2620中，钉腔2628及其排相对于纵向狭槽2632是对称的。
在其它情况下，多于或少于三排的钉腔2628可被定位在纵向狭槽2632的每一侧上，并且在一些情况下，钉仓2620的侧面2627、2629中的一个可包括与钉仓2620的另一个侧面2627、2629不同数量的钉腔2628的排。在一些情况下，钉腔2628可不与相邻排中的钉腔2628纵向和/或侧向重叠。除此之外或另选地，在某些情况下，钉腔2628和/或其排可相对于纵向狭槽2632和/或纵向轴线L不对称。
仍然参见图37，每个纵向排中的所示钉腔2628平行或基本平行。换句话讲，第一内侧排2633中的钉腔2628彼此平行，第一外侧排2635中的钉腔2628彼此平行，第一中间排2637中的钉腔2628彼此平行，第二内侧排2634中的钉腔2628彼此平行，第二外侧排2636中的钉腔2628彼此平行，并且第二中间排2638中的钉腔2628彼此平行。
另外如图37所示，每个纵向排中的钉腔2628在纵向狭槽2632的相同侧上相对于相邻纵向排中的钉腔2628成角度地取向。例如，在仓体2624的第一侧2627上，第一中间排2637中的钉腔2628相对于第一内排2633中以及第一外排2635中的钉腔2628成角度地取向。另外，在仓体2624的第二侧2629上，第二中间排2638中的钉腔2628相对于第二内排2634以及第二外排2636中的钉腔2628成角度地取向。
在其它情况下，每个纵向排2633、2634、2635、2636、2637、2638中的钉腔2628的仅一部分可彼此平行并且/或者少于所有的纵向排2633、2634、2635、2636、2637、2638可包括彼此平行的钉腔2628。除此之外或另选地，在某些情况下，钉腔2628的至少一部分可随机取向。在一些情况下，纵向排2633、2634、2635、2636、2637、2638中的钉腔2628中的至少一个钉腔可平行于相邻纵向排2633、2634、2635、2636、2637、2638中的钉腔2628中的至少一个钉腔。在某些情况下，钉仓2620可包括平行于仓体2624的纵向轴线L的至少一个钉腔2628。例如，参见图11。
仍然参见图37，所示端部执行器组件2600包括相对于仓体2624可移动地定位的击发杆2660。击发杆2660被构造成能够横贯仓体2624以从钉腔2628击发钉2612(图38A和图38B)。所示击发杆2660还包括切割刃2661，该切割刃被构造成能够在击发杆2660在第一钳口2002和第二钳口2004之间平移时切入组织。
所示击发构件2660的尺寸和位置被设计成配合在纵向狭槽2632内，并且驱动地接合滑动件，诸如可移动地定位在无驱动器仓2620内的滑动件2658(图37-图38B)、滑动件2758(图39-图39B)或滑动件2858(图40)。在击发杆2660平移穿过纵向狭槽2632时，击发杆2660将滑动件2658(图37-图38B)、2758(图39-图39B)或2858(图40)移动穿过仓体2624。
滑动件2658在图37-图38B中有所公开。滑动件2658的尺寸和位置被设计成直接接合定位在无驱动器仓2620(图37)中的钉2612。所示滑动件2658包括中心部分2659和驱动楔形件或驱动导轨2664。驱动楔形件2664包括钉接合表面或钉接触表面2666，该表面为从滑动件2658的远侧端部延伸到近侧端部的倾斜表面和/或斜坡表面。如图37-图38B所示，楔形件2664的倾斜表面2666具有相等或基本上相等的倾斜度或角度。
示于图37-图38B中的每个钉接触表面2666被定位成直接接触定位在钉仓2620中的钉2612(图38A和图38B)。更具体地讲，驱动楔形件2664的钉接触表面2666被构造成能够接触每个钉2612的基部2614(图38B)，并且将钉2612的基部2614向上提升以从钉腔2628射出钉2612。例如，要将钉2612从降下和/或未击发位置提升到升起和/或击发位置，每个倾斜表面2666的远侧端部2667接合钉2612的基部2614，并且倾斜表面2666朝远侧移动穿过钉2612的基部2614。
在所示布置中，击发杆2660及其切割刃2661被构造成能够在纵向狭槽2632内滑动和/或平移。另外，示于图37-图38B中的驱动楔形件2664(其被示为在击发杆2660和切割刃2661的侧向外侧)被构造成能够接触定位在钉腔2628(图37)中的钉2612(图38A和图38B)。多个驱动楔形件2664被定位在楔形滑动件2658的中心部分2659的任一侧上。例如，在所示滑动件2658中，四个驱动楔形件2664a、2664b、2664c、2664d被定位在中心部分2659的每一侧上。
此外，在图37-图38B中所公开的布置中，多个驱动楔形件2664a、2664b、2664c、2664d被构造成能够接合单个成角度钉2612。例如，第一楔形件2664a和第二楔形件2664b被构造成能够接合定位在钉腔2628的第一外排2633中的钉6212，第二楔形件2664b和第三楔形件2664c被构造成能够接合定位在第一中间排2637中的钉2612，第三楔形件2664c和第四楔形件2664d被构造成能够接合定位在第一外排2635中的钉2612。
在各种情况下，期望的是沿着钉2612的基部2614(图38B)从多个位置支撑和驱动图37中公开的钉仓2620中的钉2612。例如，将与驱动楔形件2664的击发路径纵向对齐的钉2612沿着钉2612的基部2614的整个长度支撑。例如，当钉2612相对于滑动件2658的击发路径成角度时，如图37-图38B所示，可通过使用多个驱动楔形件2664将钉2612沿着基部支撑在多个位置处。因为成角度钉2612沿着其基部2614驱动地支撑在多个位置处，所以钉2612可被平衡和/或稳定，使得在部署期间钉2612的旋转和/或扭转可被阻止、减少和/或控制。例如，相对于多个滑动件接合表面质量平衡的直接驱动钉如钉2612可并入本文公开的其它实施方案中。
图37-图38B中公开的倾斜表面2666交错。例如，所示倾斜表面2666沿纵向交错，使得至少一个倾斜表面2666纵向引导至少一个其它倾斜表面2666。第二驱动楔形件2664b和第四驱动楔形件2664d的倾斜表面2666纵向引导第一驱动楔形件2664a和第三驱动楔形件2664c的倾斜表面2666。第二驱动楔形件2664b和第四驱动楔形件2664d的倾斜表面2666在对齐的远侧端部2667处高于第一驱动楔形件2664a和第三驱动楔形件2664c的倾斜表面2666。例如，如图38和图38B所示，第一驱动楔形件2664a和第三驱动楔形件2664c具有远侧高度y，并且第二驱动楔形件2664b和第四驱动楔形件2664d具有远侧高度x，高度x小于高度y。
沿纵向交错的倾斜表面2666被构造成能够同时移动到与成角度钉2612接合。例如，第一楔形件2664a和第二楔形件2664b的钉接合表面2666被构造成能够同时接合钉腔2628的第一外排2633(图37)中的成角度钉2612。另外，第二楔形件2664b和第三楔形件2664c的钉接合表面2666被构造成能够同时接合第一中间排2637(图37)中的成角度钉2612。此外，第三楔形件2664c和第四楔形件2664d的钉接合表面2666被构造成能够同时接合定位在第一外排2635(图37)中的钉2612。
钉2612的部署或击发示于图38A和图38B中，其中驱动器2658的第三楔形件2664c和第四楔形件2664d与钉2612驱动接合。第三楔形件2664c可在点A处最初接触钉2612，并且第四楔形件2664d可在点B处最初接触钉2612。第三楔形件2664c和第四楔形件2664d被构造成能够同时接合钉2612，使得钉2612同时或几乎同时接触点A和B。由于第三楔形件2664c和第四楔形件2664d的钉接合表面2666之间的高度差，点A和B可沿纵向偏置，使得点A和B处于相同或基本上相同的高程。
仍然参见图38A和图38B，在驱动器2658在钉仓2620中继续朝远侧移动时，钉2612可使第三楔形件2664c和第四楔形件2664d的钉接合表面2666分别向上滑动到第三楔形件2664c和第四楔形件2664d上的点A’和B’。如图38B所示，钉2612在部署期间保持沿竖直方向直立的取向。然后，钉2612可使第三楔形件2664c和第四楔形件2664d的钉接合表面2666分别继续向上滑动到第三楔形件2664c和第四楔形件2664d上的点A”和B”。如图38B所示，钉2612继续保持沿竖直方向直立的取向。换句话讲，该对钉接合表面2666在部署期间稳定和/或平衡钉2612，使得钉2612的旋转或扭转可被阻止、最小化和/或控制。
在其它情况下，楔形滑动件的驱动楔形件或导轨可全部下降到零或基本上零的高度。例如，现在参见图39-图39B，示出了楔形滑动件2758。楔形滑动件2758可用于钉仓2620和端部执行器2600(图37)中以从钉仓2620(图39A)击发钉2612。
类似于滑动件2658，图39-图39B中所公开的楔形滑动件2758在中心部分2759的任一侧上包括四个驱动楔形件2764。每个驱动楔形件2764包括倾斜的钉接合表面2766，其被构造成能够直接接合并从钉腔2628驱动钉2612。同样类似于滑动件2658，图39-图39B中所示的驱动楔形件2764的钉接合表面2766沿纵向交错，使得第一驱动楔形件2764a和第三驱动楔形件2764c纵向跟随第二驱动楔形件2764b和第四驱动楔形件2764d。
图39-图39B中所公开的驱动楔形件2764a、2764b、2764c、2764d的沿纵向交错倾斜表面2766被构造成能够同时移动到与成角度钉2612接合。例如，第一楔形件2764a和第二楔形件2764b的钉接合表面2766被构造成能够同时接合定位在第一外排2635(图37)中的成角度钉2612。另外，第二楔形件2764b和第三楔形件2764c的钉接合表面2766被构造成能够同时接合定位在第一中间排2637(图37)中的成角度钉2612。此外，第三楔形件2764c和第四楔形件2764d的钉接合表面2766被构造成能够同时接合定位在第一内排2633(图37)中的成角度钉2612。
另外，图39-图39B中所公开的驱动楔形件2764a、2764b、2764c、2764d的沿纵向交错倾斜表面2666被构造成能够同时驱动成角度钉2612。例如，第一楔形件2764a和第二楔形件2764b的钉接合表面2766被构造成能够同时驱动钉腔2628(图37)的第一外排2635中的成角度钉2612。另外，第二楔形件2764b和第三楔形件2764c的钉接合表面2766被构造成能够同时驱动定位在第一中间排2637(图37)中的成角度钉2612。此外，第三楔形件2764c和第四楔形件2764d的钉接合表面2766被构造成能够同时驱动定位在第一内排2633(图37)中的成角度钉2612。
主要参见图39A，仓体2624的第一侧2627上的第二楔形件2764b和第三楔形件2764c被构造成能够移动到与第二钉2612b接合，该第二钉为最近侧钉并且与第二楔形件2764b和第三楔形件2764c的击发路径对齐。另外，第二楔形件2764b和第三楔形件2764c可与第二钉2612b的质心(COM)等距。在滑动件2758继续朝远侧平移时，第二楔形件2764b和第三楔形件2764c被构造成能够驱动地接合第二钉2612b以提升并击发钉2612b。
在图39A所公开的布置中，在第二楔形件2764b和第三楔形件2764c提升第二钉2612b时，仓体2624的第一侧2627上的第一楔形件2764a和第二楔形件2764b被构造成能够移动到与第一钉2612a接合，并且第一侧2627上的第三楔形件2764c和第四楔形件2764d被构造成能够移动到与第三钉2612c接合。另外，如图39A所示，第一楔形件2764a和第二楔形件2764b与第一钉2612a的质心(COM)等距，并且第三楔形件2764c和第四楔形件2764d与第三钉2612c的质心(COM)等距。在滑动件2758继续朝远侧平移时，第一楔形件2764a和第二楔形件2764b驱动地接合第一钉2612a以提升并击发钉2612b，并且第三楔形件2764c和第四楔形件2764d驱动地接合第三钉2612c以提升并击发钉2612c。
以上所述并示于图39A中的成对驱动楔形件布置被构造成在滑动件2758继续朝远侧平移时继续同时接合并提升钉仓2620中的钉2612。因为滑动件2758在多个位置处沿着其基部支撑每个钉2612，所以钉2612在部署期间被稳定和/或平衡。另外，因为滑动件2758的钉接合表面2766与每个接触钉2612的质心(COM)等距，所以钉2612的旋转和/或扭转可被进一步阻止、最小化或控制。此外，因为驱动楔形件2764a、2764b、2764c、2764沿纵向交错，所以多个驱动楔形件2764a、2764b、2764c、2764与每个钉2612的接合被定时和/或同步以平衡在其整个部署期间施加在每个钉2612上的驱动力。
驱动滑动件2858示于图40中。楔形滑动件2758可用于钉仓2620和端部执行器2600(图37)中以从钉腔2620(图39A)击发钉2612。类似于滑动件2658和2758，驱动滑动件2858在中心部分2859的任一侧上包括多个驱动楔形件2864。每个驱动楔形件2864包括倾斜的钉接合表面2866，其被构造成能够直接接合并从钉腔2628驱动钉2612。此外，倾斜的钉接合表面2866侧向地成角度或倾斜。因为钉接合表面2866侧向和纵向倾斜，所以每个表面2866包括沿纵向偏置的支撑部分，该支撑部分在其整个部署和击发期间驱动地接合成角度钉2612。
例如，图40中所公开的倾斜的钉接合表面2866被构造成能够沿着每个钉2612的基部的一部分驱动地接合钉2612。在图40中所示的布置中，施加在钉2612上的驱动力分布在更大的表面积上。例如，钉接合表面2866可接触钉2612的基部的长度的至少50％。在其它情况下，钉接合表面可接触钉2612的基部的长度的至少75％。在另外的情况下，钉接合表面可接触钉2612的基部的长度的小于50％或多于75％。此外，来自滑动件2858的驱动力相对于每个钉2612的质心平衡，以在部署期间进一步稳定和平衡钉2612。因此，钉2612的旋转和/或扭转可被阻止、最小化或控制。
如本文所述，这样的钉阵列提供了各种益处：包括相对于钉仓的纵向轴线和/或击发构件的击发路径成角度地取向的钉。例如，这样的钉阵列可在缝合组织内提供改善的柔性和/或伸展性。因此，可减小组织撕裂的发生率。在某些情况下，钉阵列还可包括具有不同长度基部的钉。钉阵列内的可变长度基部可促进缝合组织中增加的柔性和/或伸展性。另外，在某些布置中，具有较短基部的钉可嵌套在钉阵列内。例如，具有较短基部的钉可被定位在具有较长基部的钉之间的较窄空间中。这样的布置可使钉线致密化，这可改善对缝合组织中的出血和/或流体流动的控制。
钉阵列3011示于图41中。阵列3011包括长钉3012和短钉3013。如图41所示，长钉3012具有l1的基部长度，并且短钉3013具有l2的基部长度，l2小于l1。在所示阵列3011中，第一长钉3012a与轴线Aa对齐，并且第一短钉3013与轴线Ab对齐，该轴线Ab平行于轴线Aa。附加长钉3012和短钉3013(诸如钉3012e、3013b、3013c和3013d)例如平行于轴线Aa和Ab。如示于图41中的阵列3011中进一步所公开，第二长钉3012与轴线Ac对齐，该轴线Ac横贯轴线Aa和Ab。例如，附加长钉3012诸如钉3012c、3012d和3012f平行于轴线Ac。
在其它布置中，附加短钉3012也可平行于轴线Ac。在一些情况下，各种钉可沿着不平行于轴线Aa、Ab和Ac的轴线布置。例如，钉阵列3011可包括平行于钉仓的纵向轴线和/或平行于驱动滑动件的击发路径取向的钉。另外，在各种情况下，钉阵列3011可包括具有不同于l2和l1的基部长度的钉。在一些情况下，钉阵列3011可包括附加和/或更少的纵向排的钉3012、3013。例如，与第一长钉3012a对齐的长钉3012的排可被移除，并且/或者与第二长钉3012b对齐的长钉3012的排可被移除，并且/或者与第一短钉3013a对齐的短钉的排可被移除，并且/或者与第三长钉3012c对齐的长钉3012的排可被移除，并且/或者与第二短钉3013b对齐的短钉3013的排可被移除，并且/或者与第四长钉3012d对齐的长钉3013的排可被移除。
再次参见图41，短钉3013嵌入在两个长钉3012中间的钉阵列3011中。例如，阵列3011中的两个长钉3012诸如示于图41中的第三长钉3012c和第六长钉3012f平行并且侧向对齐。在这样的布置中，在第三长钉3012c和第六长钉3012f之间限定空间，并且该空间被构造成能够容纳第三短钉3013c。因此，所示阵列3011中的第三短钉3013c嵌套在第三长钉3012c和第六长钉3012f之间。在此类布置中，第三短钉3013c以及阵列3011中类似放置的短钉3013可通过填充长钉3012之间的空间来使钉线致密化。在各种情况下，因为钉线在阵列3011中被致密化，所以出血和/或流体流动控制得以改善。
致密化钉线如钉阵列3011例如可并入本文公开的其它实施方案中。
在其它情况下，在其间限定用于容纳短钉的空间的长钉3012可彼此不平行。例如，第三长钉3012c和第六长钉3012f可彼此偏斜和/或以其它方式不平行。除此之外或另选地，在其间限定用于容纳短钉3013的空间的长钉3012可仅部分地侧向重叠。例如，在某些情况下，第三长钉3012c可相对于第六长钉3012f在侧向外侧或侧向内侧，使得第三钉3012c和第六钉3012f的仅一部分侧向对齐。
钉的阵列，诸如阵列3011例如可被定位在无驱动器钉仓诸如无驱动器钉仓2620(图37)中，并且可由驱动滑动件直接接合并从钉仓驱动。在此类情况下，阵列3011中的钉3012、3013可相对于滑动件的驱动楔形件质量平衡，该滑动件接触并驱动钉3012、3013。例如，驱动楔形件可将击发力施加在与每个钉3012、3013的质心等距的钉基部的端部处。在其它情况下，可沿着钉3012、3013的基部将击发力施加在各个间隔位置处，并且累积击发力可相对于钉3012、3013平衡。在钉不覆盖在击发路径上并且/或者不相对于击发路径平衡的情况下，可采用钉驱动器。例如，如本文进一步所述，多钉驱动器可从钉仓同时提升多个钉。
钉阵列3111示于图42中。阵列3111包括长钉3112和短钉3113。如图42所示，长钉3112具有l1的基部长度，并且短钉3113具有l2的基部长度，l2小于l1。在所示阵列3111中，第一短钉3113a与轴线Aa对齐，并且第一长钉3112a与轴线Ab对齐，该轴线Ab横贯轴线Aa。附加短钉3113平行于轴线Aa取向，并且附加长钉3112平行于轴线Ab取向。
在其它布置中，至少一个短钉3113可平行于轴线Ab取向，并且/或者至少一个长钉3112可平行于轴线Aa取向。在一些情况下，各种钉3112、3113可沿着不平行于轴线Aa和Ab的轴线布置。例如，钉阵列3111可包括平行于钉仓的纵向轴线和/或平行于驱动楔形件3064的击发路径取向的钉，其也示于图42中。另外，在各种情况下，钉阵列3111可包括具有不同于l2和l1的基部长度的钉，并且/或者钉阵列3111可包括附加和/或更少的纵向排的钉3112、3113。
仍然参见图42，短钉3113可被嵌入在至少两个侧向重叠长钉3112中间的钉阵列3111中。在这样的布置中，阵列3111中的嵌套短钉3113可通过填充相邻长钉3112之间的空间来使钉线致密化。因为钉线在阵列3111中被致密化，所以可改善出血和/或流体流动。例如，致密化钉线(如钉阵列3111)可并入本文公开的其它实施方案中。
在其它情况下，在其间限定用于容纳短钉的空间的长钉3112可彼此不平行。除此之外或另选地，在其间限定用于容纳短钉3113的空间的长钉3112可仅部分地重叠。
钉的阵列，诸如阵列3111例如可被定位在无驱动器钉仓，诸如无驱动器钉仓2620(图37)中，并且可由驱动滑动件，诸如滑动件2058(图37)直接接合并从钉仓驱动。在此类情况下，阵列3111中的钉3112、3113可相对于滑动件的驱动楔形件3064质量平衡，该滑动件接触并驱动钉3112、3113。例如，驱动楔形件3064可将击发力施加在与钉3112、3113的质心等距的钉基部的端部处。
在其它情况下，可沿着钉3112、3113的基部将击发力施加在各个间隔位置处，并且累积击发力可相对于钉3112、3113平衡。在其中钉3112、3113不覆盖在击发路径上并且/或者不相对于击发路径平衡的情况下，可采用钉驱动器。例如，如本文进一步所述，多钉驱动器可从钉仓同时提升多个钉。
在各种情况下，在滑动件被构造成能够直接驱动钉的情况下，钉可包括滑动件接合表面，并且滑动件可包括钉接合表面。钉可为具有基部和不平行延伸的腿部的大致“V形”钉。例如，再次参见示于图39B和图40中的钉2612，例如，钉2612包括基部2614、从基部2614的第一端部延伸的第一腿部2616、以及从基部2614的第二端部延伸的第二腿部2618。钉2612可由线诸如具有圆形横截面的线形成，并且因此，钉2612的外周边可由圆形表面组成。因此，钉2612的滑动件接合表面可包括圆形和/或曲形表面。
在其它情况下，钉2612可由具有多边形横截面的线形成，并且因此，钉2612的外周边可包括边缘和平坦表面或平面表面。在此类实施方案中，钉2612的滑动件接合表面可包括例如至少一个平坦表面和/或平面表面。在另外的情况下，钉2612的外周边可包括曲形表面和平面表面两者。例如，钉2612可由具有圆形横截面的线形成，该线可被平坦化和/或以其它方式变形以形成平坦的滑动件接合表面。
在某些情况下，钉可由一块材料形成。例如，钉可由材料片冲压、切割和/或模制。各种冲压钉在2013年12月23日提交的美国专利申请14/138,481中有所描述，该申请据此全文以引用方式并入本文。在各种情况下，钉可例如由单块材料冲压形成或以其它方式形成，并且可例如保持为单块材料和/或一体块的材料。在各种情况下，诸如冲压钉之类的钉的滑动件接合表面可包括冲压形成零件或以其它方式形成的零件的平坦表面或平面表面。另外，在某些情况下，滑动件接合表面可包括沟槽和/或切口，其可被构造成能够接收楔形滑动件的驱动楔形件。当钉相对于驱动楔形件的击发路径成角度地取向时，沟槽可以一定角度横贯钉的基部。
冲压钉2912示于图26-图28中。钉2912包括基部2914、第一腿部2916和第二腿部2918。如图26-图28所示，钉2912的外周边包括平坦表面和曲形表面。此外，钉2912包括沟槽或轨道2915(图27和图28)，其已被切入基部2914。沟槽2915被构造成能够接收驱动滑动件2958的驱动楔形件2964。
在各种情况下，沟槽2915的宽度可略微大于接收在其中的驱动楔形件2964的宽度。例如，沟槽2915的宽度的尺寸可被设计成接收驱动楔形件2964并且防止钉2915相对于楔形件2964的侧向移位。
示于图26-图28中的钉2912相对于驱动楔形件2964的击发路径F(图28)成角度地取向。例如，钉2912沿着轴线A(图27)延伸，该轴线A横贯击发路径F。因此，所示沟槽2915穿过钉2912的基部2914成角度地取向。例如，轴线A可相对于击发路径F以角度θ取向。示于图28中的角度θ为45°。
基部2914具有延伸长度l。例如，基部2914的长度l大于钉腿2916、2918的长度。因为基部2914是细长的，所以沟槽2915包括用于驱动楔形件2964的细长导向表面或轨道，其促进在部署期间钉2912的稳定性。具有用于接收驱动楔形件的细长导向件或轨道的钉(如钉2912)例如可并入本文公开的其它实施方案中。
主要参见图28，钉2912具有与击发路径F重合的质心(COM)。例如，击发路径F延伸穿过钉2912的质心(COM)，使得钉2912相对于驱动楔形件2964平衡。因此，施加在钉2912上的驱动力可同时提升钉腿2916、2918，并且钉2912的扭转或旋转可被阻止、最小化和/或控制。
在各种情况下，类似于沟槽2915的沟槽或轨道可被限定到未冲压钉中。例如，线钉可被切割、冲压和/或研磨以产生用于可滑动地接收驱动楔形件的轨道。在此类情况下，钉基部可具有与钉腿相同的长度，或者在其它情况下，钉基部可被平坦化以增加或伸长其长度。另外，在某些情况下，如本文进一步所述，多个驱动楔形件可驱动地接合钉。在此类情况下，钉可包括多个沟槽或轨道，其可各自被构造成能够接收驱动楔形件。此外，在某些情况下，具有类似于沟槽2915的导向轨道的钉例如可平行于钉仓的纵向轴线取向。例如，平行钉可与驱动楔形件的击发路径纵向对齐。在此类情况下，限定到钉的基部中的导向轨道可沿着平行于其的钉的基部延伸。
如本文所述，成角度地取向的钉可向缝合组织提供增加的柔性和/或伸展性。例如，击发钉的阵列中的成角度钉可枢转和/或旋转向与钉线的切割线和/或纵向轴线对齐，以便于缝合组织的加长和/或纵向变形。因为成角度钉可在缝合组织的阵列中枢转和/或旋转，所以可减少和/或防止组织的撕裂和/或伸展。此外，组织中的应力和/或缝合组织的创伤可被最小化。
除了由击发钉的可纵向伸展阵列提供的纵向柔性之外，还可能期望向由钉的阵列处理的组织提供侧向定制。例如，施加在组织上的压缩力可基于组织相对于钉线的相对侧向位置来优化和/或调整。在某些情况下，可能期望在缝合之前和/或在缝合期间定制组织上的压缩力。在其它情况下，可能期望定制缝合组织上的压缩力。此外，在另外的情况下，可能期望例如在缝合之前，在缝合期间，以及在缝合之后定制组织上的压缩力。
侧向组织压缩定制和纵向组织柔性的组合可提供协同组织效应。例如，当在缝合期间和/或之后施加在组织上的压缩力在压缩组织中生成较小应力和/或影响减少的组织创伤时，压缩的组织可适应增加的弹性变形。换句话讲，在最佳压缩的组织被伸展和/或伸长时，该最佳压缩的组织可更好地适应其中的钉的旋转和/或枢转。此外，当缝合组织容易地适应钉枢转和/或移位时，可减小缝合组织中的应力，并且对缝合组织的创伤可被最小化。因此，在钉枢转和/或移位以适应组织伸长或纵向伸展时，对最佳压缩组织的应力和/或创伤可进一步被最小化。
钉仓3420示于图43-图45中。所示钉仓3420包括仓体3424和平台3422。多个钉腔3428被限定到所示钉仓3420的主体3424中，并且每个钉腔3428在平台3422中形成开口3430。另外，示于图43-图45中的钉腔3428相对于钉仓3420的纵向轴线L(图44)成角度地取向。在所示钉仓3420中，纵向狭槽3432被部分地穿过仓体3424限定，并且三排钉腔3428被定位在纵向狭槽3432的任一侧上。示于图43-图45中的钉腔3428的布置被构造成能够接收成角度钉的阵列。例如，多个钉诸如钉3412(图45)被可移除地定位在钉腔3428中。
在所示钉仓3420中，纵向狭槽3432的第一侧上的外侧排中的钉腔3428相对于纵向轴线L(图44)以第一角度取向，纵向狭槽3432的第一侧上的中间排中的钉腔3428相对于纵向轴线L以第二角度取向，并且纵向狭槽3432的第一侧上的内排中的钉腔3428相对于纵向轴线L以第三角度取向。在所示钉仓3420中，第三角度与第一角度相同或大致相同，并且第二角度与第一角度以及与第三角度偏置90度或约90度。
如图43-图45中进一步所示，纵向狭槽3432的第二侧上的外侧排中的钉腔3428相对于纵向轴线L(图44)以第四角度取向，纵向狭槽3432的第二侧上的中间排中的钉腔3428相对于纵向轴线L以第五角度取向，并且纵向狭槽3432的第二侧上的内侧排中的钉腔3428相对于纵向轴线L以第六角度取向。在所示钉仓3420中，第六角度与第四角度相同或大致相同，并且第五角度与第四角度以及与第六角度偏置90度或约90度。另外，在示于图43-图45中的布置中，第二角度与第四角度和第六角度相同或大致相同，并且第一角度与第三角度和第五角度相同或大致相同。
在其它情况下，钉仓3420可包括钉腔的附加和/或更少排。除此之外或另选地，钉3412在每排中的角度取向可被调整和/或修改以适应不同阵列。例如，在某些情况下，至少一个钉腔可平行于纵向轴线L。
在各种情况下，示于图43-图45中的钉仓3420可与示于图7中的端部执行器2000一起使用。例如，钉仓3420可被加载到第二钳口2004的细长通道中。另外，在某些情况下，钉仓3420可用单钉驱动器、多钉驱动器和/或它们的组合来击发。例如，单钉驱动器3440(图45)可被定位在每个钉腔3428中，并且可驱动地接合支撑在其上的钉3412。示于图45中的驱动器3440可被定位在仓体3424内，使得每个驱动器3440的支架与定位在钉腔3428中的一个钉腔中的钉3412中的一个钉对齐。
在某些情况下，钉仓3420可包括多钉驱动器。例如，多钉驱动器可被构造成能够从第一组钉腔3428击发钉3412(图45)，并且另一个多钉驱动器可被构造成能够从第二组钉腔3428击发钉3412。在其它情况下，钉仓3420可不包括驱动器。例如，击发构件和/或滑动件(诸如击发构件2660和滑动件2658(图37))例如可被构造成能够直接接触、接合和/或驱动钉3412。在各种情况下，例如在部署期间，驱动器3440和/或钉3412可相对于滑动件(诸如滑动件2058(图7)和/或滑动件2658(图37))的击发路径进行质量平衡。
示于图43-图45中的平台3422包括多个纵向延伸部分。例如，平台3422包括在纵向狭槽3432的一侧上的第一纵向部分3422a、第二纵向部分3422b和第三纵向部分3422c，以及在纵向狭槽3432的另一侧上的第四纵向部分3422d、第五纵向部分3422e和第六纵向部分3422f。如图43-图45所示，纵向排钉腔3428与每个纵向延伸部分3422a、3422b、3422c、3422d、3422e、3422f对齐。例如，纵向狭槽3432的第一侧上的外侧排钉腔3428与第一纵向部分3422a对齐，纵向狭槽3432的第一侧上的中间排钉腔3428与第二纵向部分3422b对齐，并且纵向狭槽3432的第一侧上的内侧排钉腔3428与第三纵向部分3422c对齐。另外，纵向狭槽3432的第二侧上的外侧排钉腔3428与第四纵向部分3422d对齐，纵向狭槽3432的第二侧上的中间排钉腔3428与第五纵向部分3422e对齐，并且纵向狭槽3432的第二侧上的内侧排钉腔3428与第六纵向部分3422f对齐。
在其它情况下，钉仓3420可包括附加和/或更少的纵向延伸部分。例如，纵向部分可被调整和/或修改以对应于钉腔和钉的不同布置。在某些实施方案中，不止一个纵向排钉腔可与至少一个纵向部分重合。除此之外或另选地，至少一个纵向部分可不包括例如钉腔和/或一排钉。
在所示钉仓3420中，相邻纵向部分3422a、3422b、3422c、3422d、3422e和3422f通过脊3423相对于彼此沿竖直方向偏置。例如，脊3423在第一部分3422a和第二部分3422b之间延伸，并且另一个脊3423在第二部分3422b车第三部分3422c之间延伸。除此之外，在所示布置中，脊3423在第四部分3422d和第五部分3422e之间延伸，并且另一个脊3423在第五部分3422e和第六部分3422f之间延伸。如图43-图45所示，纵向狭槽3432在第三部分3422c和第四部分3422d之间延伸。
图43-图45中公开的脊3423限定平台3422中的高程变化。例如，第一部分3422a和第二部分3422b之间的脊3423限定向上的台阶，使得第二部分3422b具有比第一部分3422高的高程。在各种情况下，脊3423侧向调整平台3422的高度。例如，脊3423向内增加平台3422的高度并且向外减小平台3422的高度，使得最大高度与纵向狭槽3432相邻，并且侧向侧翼部分具有最短高度。
当端部执行器的钳口，诸如端部执行器2000(图7)的第一钳口2002和第二钳口2004被夹持时，平台3422和砧座的钉成形表面之间的间隙控制组织压缩的程度。因此，平台3422的高度可影响夹持钳口之间的组织压缩程度。例如，在平台3422更高的区域中，相邻的组织可在夹持钳口之间相对更多地压缩，并且在其中平台3422更短的区域中，相邻的组织可在夹持钳口之间相对更少地压缩。因此，图43-图45中所公开的脊3423可影响组织压缩的侧向变化。如本文进一步所述，组织压缩程度可被选择和/或优化以减小对压缩组织的应力和/或创伤。此外，因为钉仓3420被构造成能够击发钉3412的纵向柔性阵列，所以可进一步保留缝合组织的完整性。
图43-图45中公开的脊3423影响相邻的纵向部分3422a、3422b、3422c、3422d、3422e和3422f之间的陡直和/或陡峭台阶。图43-图45进一步公开了脊3423围绕相邻排的钉腔3428中的钉腔3428弯曲。例如，脊3423通常沿着路径延伸，该路径对应于和/或匹配与其相邻的一个或多个钉腔3428的角度取向。因此，脊3423包括多个曲形和/或弯曲部。另外，脊3423包括在曲形中间的多个直的或大致直的部分。
在其它情况下，脊3423可限定较不陡峭的高程变化。例如，至少一个脊3423和/或其部分可逐渐倾斜和/或递增地步进到不同高程。另外，在某些情况下，纵向部分3422a、3422b、3422c、3422d、3422e、3422f的高度可改变。例如，每个纵向部分3422a、3422b、3422c、3422d、3422e、3422f的高度可侧向和/或纵向改变。在此类情况下，平台可限定例如在脊3423中间的倾斜和/或成角度表面。
在其它钉仓中，脊可沿着钉排和钉腔之间的不同路径延伸。例如，示于图46-图48中的钉仓3520类似于钉仓3420(图43-图45)，并且类似的附图标记表示相似的元件。例如，钉仓3520包括仓体3524和平台3522。多个钉腔3528被限定到所示钉仓3520的主体3524中，并且每个钉腔3528在平台3422中形成开口3530。另外，示于图46-图48中的钉腔3528匹配示于图43-图45中的钉腔3428的阵列。例如，在所示钉仓3520中，纵向狭槽3532被部分地穿过仓体3524限定，并且三排钉腔3528被定位在纵向狭槽3532的任一侧上。示于图46-图48中的钉腔3528的布置被构造成能够接收成角度钉的阵列。例如，多个钉诸如钉3412(图45)可被可移除地定位在钉腔3528中。
图46-图48中公开的平台3522包括多个纵向延伸部分。例如，所示平台3522包括在纵向狭槽3532的一侧上的第一纵向部分3522a、第二纵向部分3522b和第三纵向部分3522c，以及在纵向狭槽3432的另一侧上的第四纵向部分3522d、第五纵向部分3522e和第六纵向部分3522f。如图46-图48所示，纵向排钉腔3528与每个纵向延伸部分3522a、3522b、3522c、3522d、3522e、3522f对齐。另外，在所示钉仓3520中，相邻纵向部分3522a、3522b、3522c、3522d、3522e和3522f通过脊3523相对于彼此沿竖直方向偏置。
图46-图48中公开的脊3523沿着与平台3422(图43-图45)的脊3423不同的路径延伸。例如，脊3423包括例如多个切口，诸如切口3523a、3523b、3523c和3523d(图47)，其中脊3523不沿着和/或邻近钉腔3528延伸。切口3523a、3523b、3523c和3523d的几何形状可被选择成调整组织压缩。例如，切口可扩大压力降低的区域并且减小压力增加的相邻区域。在各种情况下，可能期望向刀狭槽3532提供切口3523a、3523b、3523c和3523d以提供例如减小组织压缩的区域。
如本文进一步所述，图46-图48中公开的脊3523可影响组织压缩的侧向变化。例如，组织压缩程度可被选择和/或优化以减小对压缩组织的应力和/或创伤。此外，因为钉仓3520被构造成能够击发钉3512的纵向柔性阵列，所以可进一步保留缝合组织的完整性。
在其它情况下，仓平台上的脊可为直的或大致直的。例如，示于图49-图51中的钉仓3620类似于钉仓3420(图43-图45)，并且类似的附图标记表示相似的元件。例如，钉仓3620包括仓体3624和平台3622。多个钉腔3628被限定到所示钉仓3620的主体3624中，并且每个钉腔3628在平台3622中形成开口3630。另外，示于图49-图51中的钉腔3628匹配示于图46-图48中的钉腔3528的布置。例如，在所示钉仓3620中，纵向狭槽3632被部分地穿过仓体3624限定，并且三排钉腔3628被定位在纵向狭槽3632的任一侧上。示于图46-图48中的钉腔3628的布置被构造成能够接收成角度钉的阵列。例如，多个钉诸如钉3612(图51)被可移除地定位在钉腔3628中。
图49-图51中公开的平台3622包括多个纵向延伸部分。例如，所示平台3622包括在纵向狭槽3632的一侧上的第一纵向部分3622a、第二纵向部分3622b和第三纵向部分3622c，以及在纵向狭槽3632的另一侧上的第四纵向部分3622d、第五纵向部分3622e和第六纵向部分3622f。如图49-图51所示，纵向排钉腔3628与每个纵向延伸部分3622a、3622b、3622c、3622d、3622e、3622f对齐。另外，在所示钉仓3620中，相邻纵向部分3622a、3622b、3622c、3622d、3622e和3622f通过脊3623相对于彼此沿竖直方向偏置。
图49-图51中公开的脊3623沿着与平台3422(图43-图45)的脊3423和平台3522(图46-图48)的脊3523不同的路径延伸。例如，脊3623沿着直线路径延伸，该直线路径平行于纵向狭槽3632延伸。此外，纵向脊3523的一部分延伸穿过钉仓3620中的钉腔3628。因此，钉腔3628的一个端部或侧面被定位在纵向平台部分3622a、3622b、3622c、3622d、3622e或3622f中的一者中，并且相同钉腔3628的另一个端部或侧面被定位在纵向平台部分3622a、3622b、3622c、3622d、3622e或3622f中的另一者中。
如本文进一步所述，图49-图51中公开的脊3623可影响组织压缩的侧向变化。例如，组织压缩程度可被选择和/或优化以减小对压缩组织的应力和/或创伤。此外，因为钉仓3620被构造成能够击发钉3612的纵向柔性阵列，所以可进一步保留缝合组织的完整性。
在某些情况下，钉仓3620包括多钉驱动器，诸如图51中公开的多钉驱动器3640。每个多钉驱动器3640被构造成能够从一组钉腔3628击发钉3612。例如，类似于多钉驱动器2040a、2040b(图7-图9)，多钉驱动器3640包括三个台阶3645，并且槽或支架3642被限定到每个台阶3645中。另外，多钉驱动器3640的台阶3645被连接凸缘3648连接。示于图51中的每个多钉驱动器3640支撑在多排钉腔3628上的钉3612，并且被构造成能够从多个排中的钉腔3628击发钉3612。在图51中，每个台阶3645的高度和限定于其中的每个支架3642的深度是相同的，使得在台阶3645之间形成的钉3612和砧座上的钉成形表面具有相同成形高度。
如本文进一步所述，可能期望定制和/或优化成形钉高度以影响成形钉内的改变组织压缩。因此，多钉驱动器3640中的至少一个可被修改以形成不同成形高度的钉3612。例如，钉多钉驱动器3640的台阶3645和/或支架3642可被修改成具有不同尺寸，使得由修改的多钉驱动器3640形成的钉3612中的至少两个钉具有不同成形高度。在其它情况下，不同钉驱动器3640的台阶3645和/或支架3642可被修改，使得第一驱动器3640被构造成能够形成具有第一成形高度的钉3612并且第二驱动器3640被构造成能够形成具有不同的第二成形高度的钉3612。
在另外的情况下，钉仓3620可包括单钉驱动器。或者，钉仓3620可不包括驱动器。例如，击发构件和/或滑动件(诸如击发构件2660和滑动件2658(图37))例如可被构造成能够直接接触、接合和/或驱动钉3612。在各种情况下，驱动器3640和/或钉3612可例如相对于滑动件(诸如滑动件2058(图7)和/或滑动件2658(图37))的击发路径进行质量平衡。
如本文所述，为了定制和/或优化成形钉内的组织压缩，钉阵列中的钉可被形成为不同成形高度。例如，在各种情况下，期望的是侧向改变组织压缩，从而改变成形钉尺寸。在此类情况下，例如，靠近切割线的组织可比远离切割线的组织被更多地压缩。具有不同未成形高度和/或不同成形高度的各种钉阵列在以下专利中有所描述：2011年1月1日公布的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,866,528；2010年6月1日公布的名称为“SURGICAL STAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP”的美国专利7,726,537；2010年1月5日公布的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,641,091；2009年12月22日公布的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,635,074；以及2011年8月16日公布的名称为“STAPLE DRIVE ASSEMBLY”的美国专利7,997,469，所述专利据此全文以引用方式并入本文。
再次参见图49-图51，在各种情况下，钉仓3620可与端部执行器一起采用，该端部执行器被构造成能够使钉3612变形成不同成形高度。钉仓3620中的成角度钉腔3628被布置成多个排。例如，成角度钉腔3628在钉仓3620的第一侧上布置在第一外排、第一中间排和第一内排中，并且成角度钉腔3628在钉仓3620的第二侧上布置在第二外排、第二中间排和第二内排中。在各种情况下，从第一外排中的钉腔3628击发的钉3612可比从第一中间排中的钉腔3628击发的钉2612呈现更高的成形高度，并且/或者从第一中间排中的钉腔3628击发的钉3612可比从第一内排中的钉腔3628击发的钉2612呈现更高的成形高度。除此之外或另选地，从第二外排中的钉腔3628击发的钉3612可比从第二中间排中的钉腔3628击发的钉2612呈现更高的成形高度，并且/或者从第二中间排中的钉腔3628击发的钉3612可比从第二内排中的钉腔3628击发的钉2612呈现更高的成形高度。
在某些情况下，从钉仓3620击发的钉3612可具有不同未成形高度。例如，从第一外排中的钉腔3628击发的钉3612可比从第一中间排中的钉腔3628击发的钉2612具有更大的未成形高度，并且/或者从第一中间排中的钉腔3628击发的钉3612可比从第一内排中的钉腔3628击发的钉2612具有更大的未成形高度。除此之外或另选地，从第二外排中的钉腔3628击发的钉3612可比从第二中间排中的钉腔3628击发的钉2612具有更大的未成形高度，并且/或者从第二中间排中的钉腔3628击发的钉3612可比从第二内排中的钉腔3628击发的钉2612具有更大的未成形高度。
在各种情况下，具有不同未成形高度和/或不同成形高度的钉阵列可被并入本文所述的各种钉仓中。例如，钉仓3420(图43-图45)和钉仓3520(图46-图48)可包括具有不同未成形高度的钉并且/或者可被构造成能够将钉击发到不同成形高度。在此类情况下，台阶形仓平台3422(图43-图45)、3522(图46-图48)和3622(图49-图51)可影响例如可变的预击发组织压缩，并且不同的成形钉高度可影响例如可变的后击发组织压缩。
如本文所述，成角度钉阵列为缝合组织提供改善的柔性。相对于钉仓的切割线和/或纵向轴线成角度的钉可具有比另一个钉腿更靠近切割线的一个钉腿。在这样的布置中，为了侧向定制和/或优化组织压缩，钉可被形成为不同成形高度。例如，钉的一个端部可形成为第一高度，并且钉的另一个端部可形成为第二不同高度。在此类情况下，被相同排的钉处理的组织可经受不同压缩力。
钉仓3720和砧座3703示于图79中。钉仓3720类似于钉仓3620(图49-图51)，并且类似的附图标记表示相似的元件。例如，钉仓3720包括仓体3724和平台3722。平台3722包括多个纵向延伸部分3722a、3722b、3722c，并且相邻纵向部分3722a、3722b、3722c被脊3723分开。脊3723沿着仓体3722的长度的至少一部分纵向延伸。成角度钉腔3728被限定到仓体3724中，并且脊3723延伸穿过钉腔3728。因此，所示钉腔3728的第一端部被定位在第一纵向部分3722a中，并且所示钉仓3728的第二端部被定位在第二纵向部分3722b中。另外，纵向狭槽3732被限定为部分地穿过所示仓体3724。
在各种情况下，钉仓3720可包括多个钉腔3728，其被构造成能够接收成角度钉3712的阵列。例如，钉仓3720可包括钉腔3728的布置，该布置对应于图49-图51中所示的钉腔3628的布置。在某些情况下，三排钉腔3728可被定位在例如纵向狭槽3732的两侧上。
未成形钉3712和变形钉3712’示于图79中。钉3712包括基部3714、从基部3714延伸的第一腿部3716、以及从基部3714延伸的第二腿部3718。驱动器3740也示于图79中。驱动器3740包括槽或支架3742，该槽或支架被构造成能够支撑钉3712的基部3714。驱动器3740和限定于其中的支架3742在驱动器3740的第一端部3741和第二端部3743之间具有可变高度。例如，驱动器3740的第一端部3741限定第一高度，并且驱动器3740的第二端部3743限定第二高度，该第二高度小于第一高度。
在驱动器3740在钉腔3728内被击发和升起时，钉3712向上骑在提升驱动器3740上，并且被砧座3703的钉成形凹坑3705变形。成形钉3712’也示于图79中。钉3712’的成形高度是提升的驱动器3740与砧座3703的钉成形凹坑3705之间的距离或间隙的函数。因为提升的驱动器3740的钉支撑表面3742与钉成形凹坑3705之间的距离在图79中所公开的钉仓3720中改变，所以成形钉3712’具有可变高度。例如，成形钉3712’的高度在第一腿部3716’和基部3714’之间比在第二腿部3718’和基部3714’之间更大。在各种情况下，钉3712’的角度取向可将第一腿部3716’放置成比第二腿部3718’更远离纵向狭槽3732。在此类情况下，第一腿部3716’可为钉3712’的外腿，并且第二腿部3718’可为钉3712’的内腿。在这样的布置中，组织压缩在内腿3718’和基部3714’之间可比在外腿3716’和基部3714’之间大。
被构造成能够使成角度钉变形成不同成形高度的钉仓和砧座布置(如钉仓3720和砧座3705)例如可并入本文公开的其它实施方案中。例如，具有可变高度钉支撑支架的驱动器(如驱动器2740)例如可并入本文公开的其它钉仓和/或端部执行器组件中。
示于图79中的未成形钉3712也具有可变高度。例如，钉3712在第一腿部3716处限定第一高度并且在第二腿部3718处限定第二高度，该第二高度小于第一高度。另外，钉3712的基部3714限定弯曲部或台阶3715，其相对于第一腿部3716提升第二腿部3718。
在其它情况下，未成形钉3712可具有均匀高度。除此之外或另选地，未成形钉3712的基部3714在第一腿部3716和第二腿部3718之间可为直的或大致直的。在此类情况下，当提升的驱动器3740的钉支撑表面3742与钉成形凹坑3705之间的距离为可变时，钉3712可仍然呈现可变成形高度。例如，钉腿3716、3718中的一个钉腿可比另一个钉腿3716、3718更加变形和/或压实以适应附加腿长度。另外，因为钉支撑表面3742和钉成形凹坑3705之间的距离改变，所以基部3714可在击发期间弯曲和/或以其它方式变形以适应高度差。
钉仓3820和砧座3803示于图80中。钉仓3820类似于钉仓3620(图49-图51)，并且类似的附图标记表示相似的元件。例如，钉仓3820包括仓体3824和平台3822。与平台3622(图49-图51)不同，平台3822具有平坦或大致平坦的非台阶式表面。成角度钉腔3828被限定到仓体3824中。另外，纵向狭槽3832被部分地穿过所示仓体3824限定。
在各种情况下，钉仓3820可包括多个钉腔3828，其被构造成能够接收成角度钉的阵列。例如，钉仓3820可包括钉腔的布置，该布置对应于图49-图51中所示的钉腔3628的布置。在某些情况下，三排钉腔3828可被定位在例如纵向狭槽3832的任一侧上。
未成形钉3812示于图80中。钉3812包括基部3814、从基部3814延伸的第一腿部3816、以及从基部3814延伸的第二腿部3818。驱动器3840也示于图80中。驱动器3840包括槽或支架3842，其被构造成能够支撑钉3812的基部3814。
砧座3803包括面向仓的侧向台阶式表面3801。第一钉成形凹坑3805a和第二钉成形凹坑3805b被限定到台阶式表面3801中。如图80所示，第一钉成形凹坑3805a处于台阶式表面3801的第一台阶3801a中，并且第二钉成形凹坑3805b处于台阶式表面3801的第二台阶3801b中。
在驱动器3840在钉腔3828内被击发并提升时，钉3812向上骑在提升驱动器3840上，并且被砧座3803的钉成形凹坑3805a、3805b变形。成形钉3812’也示于图80中。钉3812’的成形高度是提升的驱动器3840与砧座3803的钉成形凹坑3805a、3805b之间的距离或间隙的函数。因为提升的驱动器3840的钉支撑表面3842与每个钉成形凹坑3805a、3805b之间的距离在图79所示的钉仓3720中不同，所以成形钉3812’呈现可变高度。例如，成形钉3812’的高度在第一腿部3816’和基部3814’之间比在第二腿部3818’和基部3814’之间更大。在各种情况下，钉3812’的角度取向可将第一腿部3816’放置成比第二腿部3818’更远离纵向狭槽3832。在此类情况下，第一腿部3816’可为钉3812’的外腿，并且第二腿部3818’可为钉3812’的内腿。在这样的布置中，组织压缩在内腿3818’和基部3814’之间可比在外腿3816’和基部3814’之间更大。
在其它情况下，钉3812’可在外腿3816’处变形成更小的高度。因此，组织压缩在外腿3816’和基部3814’之间可比在内腿3818’和基部3814’之间更大。
被构造成能够使成角度钉变形成不同成形高度的钉仓和砧座布置(如钉仓3820和砧座3805a、3805b)例如可并入本文公开的其它实施方案中。例如，可变深度凹坑(如凹坑3805a、3805b)例如可并入本文公开的其它实施方案中。
示于图80中的未成形钉3812具有可变高度。例如，钉3812在第一腿部3816处限定第一高度并且在第二腿部3818处限定第二高度，该第二高度小于第一高度。
在其它情况下，未成形钉3812可具有均匀高度。在此类情况下，当提升的驱动器3840的钉支撑表面3842与钉成形凹坑3805之间的距离为可变时，钉3812可仍然呈现可变成形高度。例如，钉腿3816、3818中的一个可比另一个钉腿3816、3818更加变形和/或压实以适应附加长度。
在某些类型的外科手术中，外科钉或外科紧固件的使用已成为接合组织的优选方法，并且已开发出用于这些应用的特别构造的外科缝合器或圆形外科紧固装置。例如，腔内或圆形缝合器已被开发以用于在用于形成“吻合”的外科手术中使用。可用于执行吻合术的圆形缝合器例如在以下专利中有所公开：名称为“INTRALUMINAL ANASTOMOTIC SURGICALSTAPLER WITH DETACHED ANVIL”的美国专利5,104,025，名称为“CIRCULAR STAPLERTISSUE RETENTION SPRING METHOD”的美国专利5,309,927，名称为“SURGICAL CUTTINGAND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUECOMPRESSION FORCE”的美国专利7,665,647，名称为“SURGICAL STAPLING SYSTEMS ANDSTAPLE CARTRIDGES FOR DEPLOYING SURGICAL STAPLES WITH TISSUE COMPRESSIONFEATURES”的美国专利8,668,130，每个专利的全部公开内容据此以引用方式并入本文。
一种形式的“吻合术”包括先切除连接段(通常为患病段)然后将肠的各个段连接到一起的外科手术。该手术需要将两个管状段的端部连接到一起，以形成连续的管状通道。以前，这种外科手术是费时费力的手术。外科医生必须准确切割和对齐肠的端部，并且在通过多次缝合将端部连接起来时保持对齐状态。圆形紧固装置的开发大大简化了吻合术程序，并且也缩短了执行吻合术所需的时间。
一般来讲，常规圆形缝合器或紧固装置由细长轴组成，该细长轴包括近侧致动机构和安装在该轴上的远侧缝合机构。远侧缝合机构通常由固定的钉仓构成，该钉仓容纳布置成同心圆形阵列的多个钉。圆形切割刀也同心地安装在仓中，使得其在钉的内部。刀可沿远侧方向轴向移动。从仓的中心轴向延伸的是套管针轴。套管针轴也可在细长轴内轴向移动。套管针轴被构造成能够可移除地附接到砧座构件。砧座构件包括钉成形下表面，其被布置成面对钉仓以在钉被推进到与其接触时形成钉的端部。钉仓的远侧面与砧座的钉成形下表面之间的距离通常由安装到缝合器轴的近侧的调节机构控制。当外科医生致动致动机构时，同时缝合并切割被容纳在钉仓和钉砧之间的组织。
当使用圆形缝合器执行吻合术时，最初通常使用常规外科缝合器来缝合肠，该外科缝合器在肠的目标段(即，患病段或标本)的任一侧上安置两排缝钉。通常在缝合的同时切割目标段。接下来，在移除样本后，外科医生通常在钉线近侧将砧座插入管腔(即肠)的近侧端部。这通过将砧座头部插入外科医生在近侧管腔(肠)切开的入口来完成。有时，砧座可经肛门放置，即通过将砧座头部放在缝合器的远侧端部上并通过直肠插入器械。然后使用缝合线或其它常规的系结装置将肠的近侧端部缝合到砧座轴。接下来，外科医生切除邻近系结的多余组织，并将砧座附接到缝合器的套管针轴。外科医生然后通过将砧座朝向钉仓拉动来闭合砧座和仓之间的间隙。在砧座朝向仓移动时，肠的近侧端部和远侧端部夹持在其间。然后致动缝合器，从而导致钉排穿过肠的两个端部被驱动到与砧座成形接触。同时，在驱动钉并使钉成形时，驱动圆形刀片穿过肠组织端部，从而切割邻近内排钉的端部。接着，外科医生从肠中取出缝合器，并完成吻合术。
结肠直肠吻合术的有效愈合可受到若干因素和条件的挑战。例如，愈合可受到吻合区域中细菌污染物的存在的影响。在一般实践中，吻合术的成功率往往随着患者恢复移动性而改善。期望的是患者尽快恢复内容物传递。内容物传递的一个抑制因素是“狭窄”的风险。如果结肠内容物不能通过钉线，或者如果它们显著压紧钉线，则可能发生撕裂、破裂或泄漏。对于高度膨胀的器官(如肺)，开发了可线性膨胀的钉线。然而，这样的钉构型不适于结合圆形缝合器使用。
图29示出通常命名为5000的一种形式的圆形缝合器或缝合装置。各种圆形缝合装置是众所周知的并且用于安装手术钉或紧固件。因此，除了可能需要了解本文公开并在附图中示出的创新和布置，关于圆形缝合装置的构造和操作的各种细节将不在本文中详细讨论。关于圆形紧固件和缝合装置的更多细节可见于名称为“SURGICAL CUTTING ANDSTAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITING MAXIMUM TISSUECOMPRESSION FORCE”的美国专利7,665,647(该专利全文以引用方式并入本文)以及以引用方式并入本文的其它美国专利。一般来讲，适于图29中的圆形缝合装置5000包括头部5002、砧座5004、调整旋钮组件5006以及将触发器5008支撑在其上的柄部5010。柄部组件5010通过弓形轴组件5012联接到头部5002。在所示布置中，触发器5008被柄部组件5010可枢转地支撑，并且用于在安全机构(未示出)被释放时操作缝合器5000。当触发器5008被启用时，击发机构在轴组件5012内可移动地推进，使得钉或紧固件从头部5002被排出或部署成与砧座5004的砧座成形下表面5005的成形接触。同时，可操作地支撑在头部5002内的圆形刀(图29中不可见)被朝向砧座5004朝远侧推进，并且用于以已知方式切割已被夹持在头部5002和砧座5004之间的组织。然后从手术部位移除缝合装置5000，从而将缝合组织留在适当位置。
如从图29也可以看到，砧座5004包括圆形主体部分5014，该圆形主体部分具有从其突出的砧座轴5016。砧座轴5016被构造成能够可移除地附接到可操作地支撑在轴组件5012内的套管针轴5050。参见图29A。众所周知，套管针轴5050用轴组件5012可移动地支撑，并且与调整旋钮组件5006可操作地交接，该调整旋钮组件可旋转地支撑在柄部组件5010上。砧座轴5016可由固定夹5052可移除地附接到套管针轴5050，或者其它可释放紧固装置也可用于将砧座轴5016可移除地固定到套管针轴5050。一旦砧座轴5016已附接到套管针轴5050，临床医生可通过将调整旋钮5006沿适当旋转方向旋转来将砧座5004朝向和远离头部5002移动。
图29A示出头部5002，该头部具有可操作地安装在其中的独特且新颖的紧固件仓组件5020。如从该图可见，紧固件仓组件5020包括仓体5022，该仓体包括圆形平台5030。圆形平台5030可形成平面表面5032，该平面表面被布置成当砧座轴5016附接到套管针轴5050时面对砧座5004的钉成形下表面5005。多个紧固件腔5040设置在圆形平台5030中并且被构造成能够将至少一个外科钉或外科紧固件接收在其中(未示出)，该外科钉或外科紧固件可操作地支撑在驱动器组件5060上，该驱动器组件可移动地支撑在紧固件仓组件5020的主体5022中。驱动器组件5060可操作地联接到轴组件5012的与触发器5008可操作地交接的对应可移动部分。触发器5008的启用例如将导致驱动器组件5060沿远侧方向“DD”的轴向移动。驱动器组件5060沿远侧方向“DD”的移动将导致支撑在每个紧固件腔5040中的外科钉或紧固件移动或排出，从而与砧座5004上的钉成形下表面5005成形接触。
仍然参见图29A，例如，每个紧固件腔5040包括两个腔端部5042、5044。在所示布置中，每个腔端部5042(其也可在本文中称为“第一腔端部”)被定位在具有第一半径“FR”的第一圆形轴线“FCA”上。第一半径“FR”可从器械轴轴线“SA”测量。另外在所示布置中，腔端部5044(其也可在本文中称为“第二腔端部”被定位在具有第二半径“SR”的第二圆形轴线“SCA”上，该第二半径“SR”不同于第一半径“FR”。在所示实施例中，也从轴轴线“SA”测量的第二半径“SR”大于第一半径“FR”。另外在图示的实施方案中，每个紧固件腔5040包括腔轴线“CA”。在图示的实施方案中，每个紧固件腔5040相对于第一圆形轴线“FCA”和第二圆形轴线“SCA”被布置在圆形平台5030中，使得每个腔轴线“CA”与第一圆形轴线“FCA”和第二圆形轴线“SCA”形成锐角。换句话讲，相邻紧固件腔5040的腔端部5042彼此相邻，并且相同紧固件腔5040的端部5044彼此间隔开。这样的布置可在本文中称为“锯齿形”取向。然而，在其它布置中，腔轴线“CA”可垂直于第一圆形轴线“FCA”和第二圆形轴线“SCA”。
在示于图29A中的布置中，每个腔端部5042、5044可为V形的，使得它们通常终止于一点。例如，每个腔端部5042可通常终止于点5043并且每个端部5044可终止于点5045。点5043可被定位在第一圆形轴线“FCA”上或与其相交，并且点5045可被定位在第二圆形轴线“SCA”上或与其相交。此类腔布置导致外科钉或紧固件以与组织相似的图案施加。在所示布置中，紧固件腔5040各自将一个外科钉或外科紧固件支撑在其中。然而，在其它布置中，不止一个钉或紧固件可被支撑在每个腔中。紧固件仓组件5020在每个紧固件腔5040中采用类似大小的钉。在其它布置中，不同大小的外科钉或紧固件可用于紧固件仓组件中。可采用的外科钉例如包括从中心主体部分或冠部延伸的两个钉腿。腿可被接收在紧固件腔5040的V形端部5042、5044中，使得当它们从腔5040中射出时，腿延伸穿过第一圆形轴线或第二圆形轴线，这在任何情况下都可以。这些钉取向可解决一些与上述钉狭窄相关联的问题。具体地讲，当采用紧固件仓组件5020时形成的钉构型可使钉线能够比常规钉线更像原始结肠地膨胀和弯曲。例如，钉或紧固件可在其被径向拉动时扭曲，从而允许它们使愈合区域上的应力最小化并且使柔性和强度最大化。
与结肠直肠吻合术程规程相关联的另一个关注领域涉及通过附接区域的径向泄漏。上述紧固件仓组件5020也可解决该领域的问题。另一个紧固件仓组件5120示于图30中并且也可解决上述各种问题和顾虑。如从该图可见，紧固件腔是以“不对称图案”的布置，其中通过腔的内环或内部圆形阵列施加的钉与通过腔的外环或外部圆形阵列施加的那些钉或紧固件的功能不同。
更具体地讲并且参照图30，紧固件仓组件5120包括仓体5122，该仓体包括圆形平台5130。圆形平台5130可形成平面表面5132，该平面表面被布置成当砧座轴5016附接到套管针轴5050时面对砧座5004的钉成形下表面5005。第一腔5040的第一环5036设置在圆形平台5130中，并且第二腔5170的第二环5160穿过仓平台5130设置，如图所示。第一腔5040和第二腔5170中的每个被构造成能够将至少一个外科钉或外科紧固件接收在其中(未示出)，该外科钉或外科紧固件可操作地支撑在驱动器组件5060上，该驱动器组件可移动地支撑在紧固件仓组件5120的主体5122中。
每个紧固件腔5040包括两个腔端部5042、5044。每个腔端部5042被定位在具有第一半径“FR”的第一圆形轴线“FCA”上。第一半径“FR”可从器械轴轴线“SA”测量。每个腔端部5044被定位在具有第二半径“SR”的第二圆形轴线“SCA”上，该第二半径“SR”不同于第一半径“FR”。在所示实施例中，也从轴轴线“SA”测量的第二半径“SR”大于第一半径“FR”。每个紧固件腔5040包括腔轴线“CA”。在图示的实施方案中，每个紧固件腔5040相对于第一圆形轴线“FCA”和第二圆形轴线“SCA”被布置在圆形平台5130中，使得每个腔轴线“CA”与第一圆形轴线“FCA”和第二圆形轴线“SCA”形成锐角。换句话讲，相邻紧固件腔5040的腔端部5042彼此相邻，并且相同紧固件腔5040的端部5044彼此间隔开。这样的布置可在本文中称为“锯齿形”取向。然而，在其它布置中，腔轴线“CA”可垂直于第一圆形轴线“FCA”和第二圆形轴线“SCA”。
另外在示于图30中的布置中，每个腔端部5042、5044可为V形的，使得它们通常终止于一点。例如，每个腔端部5042可通常终止于点5043并且每个端部5044可通常终止于点5045。点5043可被定位在第一圆形轴线“FCA”上或与其相交，并且点5045可被定位在第二圆形轴线“SCA”上或与其相交。此类腔布置导致外科钉或紧固件以与组织相似的图案施加。另外在所示布置中，第二环5160包括多个第二紧固件腔5170，该第二紧固件腔在第三圆形轴线“TCA”上对齐，该第三圆形轴线从轴轴线“SA”布置在第三半径“TR”处。在所示布置中，第三半径“TR”小于第一半径和第二半径。然而，在其它布置中，第三半径“TR”大于第一半径。然而，在另外的布置中，第三半径“TR”大于第一半径和第二半径。
独特且新颖的紧固件仓组件5120用于使组织中的钉或紧固件取向成使得它们相对于施加到钉线的膨胀的量将是“可调节的”。可采用的外科钉例如包括从中心主体部分或冠部延伸的两个钉腿。腿可被接收在紧固件腔的V形端部中，使得当它们从腔中射出时，腿延伸穿过第一圆形轴线“FCA”、第二圆形轴线“SCA”或第三圆形轴线“TCA”，这在任何情况下都可以。这些钉取向可导致与上述钉狭窄相关联的问题的改善。例如，钉或紧固件的一个环(例如，第二环5160)提供标准密封特征结构，并且第一环5036可与钉线的径向和柔性方面更一致。因此，这样的布置也可提供与上文关于紧固件仓组件5020讨论的相同或相似的优点。
图31示出另一个独特且新颖的紧固件仓组件5220，该紧固件仓组件也可解决上述各种问题和顾虑。如从该图可见，紧固件腔是以“不对称图案”的布置，其中通过腔的内环施加的钉与通过腔的外环施加的那些钉或紧固件的功能不同。
更具体地讲并且参照图31，紧固件仓组件5220包括仓体5222，该仓体包括圆形平台5230。圆形平台5230可形成平面表面5232，该平面表面被布置成当砧座轴5016附接到套管针轴5050时面对砧座5004的钉成形下表面5005。第一腔5240的第一环5236设置在圆形平台5230中，并且第二腔5270的第二环5260通过仓平台5230设置，如图所示。第一腔5240和第二腔5270中的每个被构造成能够将至少一个外科钉或外科紧固件接收在其中(未示出)，该外科钉或外科紧固件可操作地支撑在驱动器组件5060上，该驱动器组件可移动地支撑在紧固件仓组件5220的主体5222中。
每个紧固件腔5240包括两个腔端部5242、5244。每个腔端部5242被定位在具有第一半径“FR”的第一圆形轴线“FCA”上。第一半径“FR”可从器械轴轴线“SA”测量。每个腔端部5244被定位在具有第二半径“SR”的第二圆形轴线“SCA”上，该第二半径“SR”不同于第一半径“FR”。在所示实施例中，也从轴轴线“SA”测量的第二半径“SR”大于第一半径“FR”。每个紧固件腔5240包括腔轴线“CA”。在图示的实施方案中，每个紧固件腔5240相对于第一圆形轴线“FCA”和第二圆形轴线“SCA”被布置在圆形平台5230中，使得每个腔轴线“CA”与第一圆形轴线“FCA”和第二圆形轴线“SCA”形成锐角。
另外在示于图31中的布置中，每个腔端部5242、5244可为V形的，使得它们通常终止于一点。例如，每个腔端部5242可通常终止于点5243并且每个端部5244可通常终止于点5245。点5243可被定位在第一圆形轴线“FCA”上或与其相交，并且点5245可被定位在第二圆形轴线“SCA”上或与其相交。此类腔布置导致外科钉或紧固件以与组织相似的图案施加。另外在所示布置中，第二环5260包括多个第二紧固件腔5270，该第二紧固件腔在第三圆形轴线“TCA”上对齐，该第三圆形轴线从轴轴线“SA”布置在第三半径“TR”处。在所示布置中，第三半径“TR”小于第一半径和第二半径。然而，在其它布置中，第三半径“TR”大于第一半径。然而，在另外的布置中，第三半径“TR”大于第一半径和第二半径。这些钉取向可导致与上述钉结构相关联的问题的改善。具体地讲，当采用紧固件仓组件5220时形成的钉构型可使钉线能够比常规钉线更像原始结肠地膨胀和弯曲。例如，钉或紧固件可在其被径向拉动时扭曲，从而允许它们使愈合区域上的应力最小化并且使柔性和强度最大化。
已经证明，辅助膜/支撑材料能够通过密封在钉末端周围来改善止血和气肿。在许多应用中，支撑材料用于硬化和/或加强软组织。各种支撑材料布置已被开发并且被构造成用于布置在外科缝合装置的外科钉仓或砧座上。将支撑构件附接到仓或砧座，然后从其释放支撑材料可能是具有挑战性的。图58示出外科端部执行器5300以及外科切割和紧固器械5400的部分。端部执行器5300采用独特且新颖的布置以用于将支撑构件5500附接到外科钉仓5320并将其从中释放。示于图58中的类型的外科切割和紧固器械的示例在2014年6月30日提交的名称为“SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZINGARRANGEMENTS”的美国专利申请序列号14/318,991中有所公开，该申请的全部公开内容据此以引用方式并入本文。除了理解端部执行器5300的构造和用途所需之外的另外细节可以参考该文献以及以引用方式并入本文的许多其它文献来收集。
如图58中可见，示于其中的端部执行器5300包括细长钉通道5302，该细长钉通道被构造成能够在其中可操作地支撑钉仓5320。细长钉通道5302联接到脊部分5404，该脊部分可操作地支撑在外科缝合器械5400的细长轴组件5402内。钉仓5320包括仓体5322，该仓体可由聚合物材料制成。在图示的实施方案中，金属底盘5324附接到仓体5322。仓体5322包括平台5330，该平台具有限定于其中的多个钉腔5332。每个钉腔5332被构造成能够将钉可移除地储存在其中。仓体5322还包括纵向狭槽，该纵向狭槽被构造成能够将击发构件5410可移除地接收在其中。仓体5320还可包括远侧端部5326、近侧端部5328、以及在远侧端部5326和近侧端部5328之间延伸的相对纵向侧5329。在各种情况下，每个纵向侧5329可包括限定于其中的无中断的邻接或连续边缘。
定位在每个钉腔5332内的是钉5342，该钉支撑在对应钉驱动器5340上，该钉驱动器可移动地支撑在仓体5322内。当击发构件5410穿过钉仓5320朝远侧驱动时，钉驱动器5340被向上提升。如在美国专利申请序列号14/318,991中更详细地讨论，击发构件5410被构造成能够朝远侧推进钉滑动件5350以将钉驱动器5340和钉5342向上提升并且提升出钉腔5332。端部执行器5300还包括安装到细长钉通道5302的砧座5360。在图示的实施方案中，砧座5360包括可移动地接收在细长钉通道5302中的凸耳狭槽5304中的一对凸耳5362。如在图58中进一步可见，砧座5360包括砧座凸片5364，该砧座凸片与闭合管段5420相互作用。闭合管段5420沿远侧方向“DD”的移动可沿朝向钉仓5320的方向移动砧座5360。闭合管5420沿近侧方向“PD”的移动导致砧座移动远离钉仓5320。其它实施方案可采用仓和砧座布置，其中砧座是静止的(例如，不可移动地固定到外科装置的细长轴)，并且细长通道和/或钉仓能够朝向和远离砧座移动。
如图58和图59中可见，支撑构件5500被构造成能够接收在外科钉仓5320和砧座5360之间。更准确地讲，支撑构件5500被构造成能够接收在砧座5360的钉成形下表面5366和钉仓5320的平台5330之间。在图示的实施方案中，支撑构件5500被构造成能够被张紧地安装在钉仓5320的平台5330上。构成支撑构件5500的支撑材料可包括例如Gore SeamGuard材料、Synovis Peri-Strips材料和/或聚氨酯。其它合适的支撑材料或辅助材料在2014年6月30日提交的名称为“SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZINGARRANGEMENTS”的美国专利申请序列号14/318,991中有所公开，该专利申请的全部公开内容先前以引用的方式并入本文。各种其它合适的支撑材料和辅助材料也在2013年2月28日提交的名称为“LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”的美国专利申请序列号13/763,095中有所公开，该专利申请的全部公开内容据此以引用的方式并入本文。下列申请的全部公开内容也以引用方式并入本文中：2012年6月25日提交的名称为“TISSUESTAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATICAGENT”的美国专利申请序列号13/531,619、2012年6月25日提交的名称为“TISSUE STAPLERHAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT”的美国专利申请序列号13/531,623、2012年6月25日提交的名称为“TISSUE STAPLER HAVING ATHICKNESS COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT”的美国专利申请序列号13/531,627和2012年6月25日提交的名称为“TISSUE STAPLER HAVING A THICKNESSCOMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT”的美国专利申请序列号13/531,630。
在图示的实施方案中，钉仓5320包括突出部5336，该突出部以美国专利申请序列号14/318,991中详细所述的各种方式和布置从邻近每个钉腔5332的平台5330向上延伸。在其它实施方案中，钉仓不具有此类突出部。在图示的实施方案中，支撑构件5500包括在其中形成的孔5502，该孔对应于突出部5336。参见例如图61和图62。然而，如那些图中可见，孔5502仅容纳突出部5336，使得支撑材料跨越对应于支撑在腔中的钉的冠部的至少一部分的区域。支撑材料的对应于钉冠部分的那些部分通常在图61和图62中标识为5504。
支撑构件5500包括用于将支撑构件5500可释放地固定到仓体5322的装置，使得支撑构件5500在外科器械的致动之前在其上保持张紧，然后在致动或“击发”外科器械之后立即从仓体5322释放。例如，如图58中可见，支撑构件5500包括远侧端部5503，该远侧端部在其中具有至少一个远侧保持特征结构5506。在所示布置中，两个远侧孔5506被设置在远侧端部5503中并且被构造成能够接收从仓体5322的远侧端部5326突出的对应保持构件5338。如图59和图60所示，保持构件5338被构造成能够接收在支撑构件5500的远侧端部部分5503中的远侧孔5506内，以将支撑构件5500的远侧端部可释放地保持在仓5320的远侧端部部分5326上。当将张力沿近侧方向和/或远侧方向施加到支撑构件5500时，还可采用其它形式的可释放保持构件(形状、数量、大小、构型)和布置来将支撑构件5500可释放地保持在钉仓5320上。
转到图63-图65，支撑构件5500包括近侧端部部分5510，该近侧端部部分在其上具有近侧保持特征结构5511。在图示的实施方案中，近侧保持特征结构5511包括从其朝近侧突出的至少一个保持凸片5512。保持凸片5512被定位成使得当孔5506被插入仓体5322上的保持构件5338上方并且支撑构件5500被接收在仓平台5330上时，保持凸片5512与仓体5322中的细长狭槽5334对齐。参见图64。当钉滑动件5350在仓5320内处于其近侧起始位置时，保持凸片5512被折叠到仓体的近侧端部上，并且由钉滑动件5350保持在细长狭槽5334内。钉滑动件5350可为美国专利序列号14/318,991中公开的类型和构造，其包括稳定构件5352，该稳定构件朝远侧延伸以稳定滑动件5350并且防止和/或抑制钉滑动件5350的摇动或旋转。如图65中可见，保持凸片5512由稳定构件5352和/或钉滑动件5350的其它部分保持在细长狭槽5534内。这样的布置用于将支撑构件5500在钉平台5330上保持张紧。换句话讲，支撑构件5500可在保持构件5338和钉仓5320的近侧端部5328之间伸展。当临床医生致动外科器械以开始击发过程时，击发构件5410沿远侧方向“DD”朝远侧推进。击发构件5410与钉滑动件5350交接，并且如美国专利申请序列号14/318,991中所讨论，击发构件5410将钉滑动件5350朝远侧移动穿过钉仓5320以向上驱动钉驱动器5340，使得支撑在其上的钉5342被驱动到与砧座5360的下侧5366成形接触，并且夹持在砧座5360和钉仓5320之间的组织被切割构件5410切断。一旦钉滑动件5350已脱离与保持凸片5512的保持接合，保持凸片5512便被释放，从而使得支撑材料5500能够与缝合组织从钉仓5320移除。这样的布置用于在击发过程开始时释放支撑材料5500中的张力。此外，这样的支撑布置不需要附加释放部件或构型。
现有的缝合技术不是特别适用于愈合过程期间经历伸展的组织。例如，在胸薄壁组织缝合中，钉线在处于塌缩构型的肺上被击发。手术完成后，肺膨胀，这经常导致肺的表面积加倍。现有的缝合技术通常不具有与肺组织相同程度的伸展能力。这可能导致紧邻钉线的显著应变梯度，这可能导致钉线内的高应力，特别是在离切割刃最远的钉排中。因此，为了减轻应变梯度和相关应力以消除或至少减少潜在的漏气源，需要允许钉线伸展和/或增加长度的技术。
已经证明，辅助膜/支撑材料能够通过密封在钉末端周围来改善止血和气肿。在许多应用中，支撑材料用于硬化和/或加强软组织。然而，现有的支撑材料可能不具有足够的弹性，从而不妨碍弹性钉线的顺应性。图66-图68示出一种形式的支撑材料6100，该支撑材料可解决这样的问题。如在这些图中可见，支撑材料6100包括支撑主体6102，该支撑主体的大小被设计成可操作地接收在外科钉仓6000的平台6004上。在所示实施例中，外科钉仓6000包括限定平台6004的仓体6002。仓体6002包括居中设置的细长狭槽6006，该细长狭槽被构造成能够穿过其接收组织切割构件(未示出)。多个钉凹坑或钉腔在细长狭槽6006的每一侧上被设置在平台6004中。如图所示，第一腔6012的第一排6010被设置在细长狭槽6006的每一侧上。每个第一排6010中的第一腔6012彼此平行。第一腔6012中的每个被布置成相对于细长狭槽6006成角度并且与其相邻。所示仓体6002还包括被布置成相对于第一钉腔6012成角度的第二钉腔6022的两排6020。第三钉腔6032的两排6030也被设置在仓体6002中，如图所示。在至少一种形式中，第三钉腔6032与对应第一钉腔6012平行。然而，可采用其它钉或紧固件腔布置。此外，钉仓体6002可具有从其侧向突出的侧向凸缘6008。另外如图66中可见，仓体6002的近侧端部6003比仓体6002的剩余部分更窄。
在图示的实施方案中，支撑主体6102包括四个边缘6110、6140、6150、6160和中心部分6152。边缘6110、6140、6150、6160中的至少两个包括各种边缘凹口构型。在图示的实施方案中，边缘6110、6160包括在其中形成的边缘凹口。更具体地讲，如图67中可见，第一组第一边缘凹口6114形成于第一边缘6110的第一部分6112中。在图示的实施方案中，第一边缘凹口6114以第一锐角6115(“凹口角”)从第一边缘部分6112向内延伸并且彼此平行。如图66和图67中进一步可见，第二边缘凹口6118从第一边缘部分6112的第二部分6116向内延伸。在一种布置中，例如，第二边缘凹口6118从第二部分6116垂直地向内延伸(“凹口角”)。如图66和图67中进一步可见，第三边缘凹口6122从第一边缘部分6110的第三部分6120向内延伸。在一种布置中，例如，第三边缘凹口6122从第三部分6120垂直地向内延伸(“凹口角”)。如图66和图67中进一步可见，第四边缘凹口6126从第一边缘部分6110的第四部分6124向内延伸。在一种布置中，例如，第四边缘凹口6126以锐角(“凹口角”)从第四部分6124向内延伸。如图66和图67中进一步可见，第五边缘凹口6130从第一边缘部分6110的第五部分6128向内延伸。在一种布置中，例如，第五边缘凹口6130以锐角(“凹口角”)从第五部分6128向内延伸。
仍然参见图66和图67，一系列初级边缘凹口6164从第二边缘部分6160的主要部分6162向内延伸。在所示布置中，主要边缘凹口6164从初级边缘部分6162垂直地向内延伸(“凹口角”)。如图66和图67中进一步可见，次级边缘凹口6168从第二边缘6160的次级部分6166向内延伸。在一种布置中，例如，次级边缘凹口6168以锐角(“凹口角”)从次级边缘部分6166向内延伸。如图66和图67中进一步可见，三级边缘凹口6172从第二边缘6160的三级部分6170向内延伸。在一种布置中，例如，三级边缘凹口6172以锐角(“凹口角”)从三级部分6170向内延伸。如图66和图67中进一步可见，四级边缘凹口6176从第二边缘6160的四级部分6174向内延伸。在一种布置中，例如，四级边缘凹口6176从四级部分6174垂直地向内延伸(“凹口角”)。如图66和图67中进一步可见，五级边缘凹口6180从第二边缘部分6160的五级部分6178向内延伸。在一种布置中，例如，五级边缘凹口6180从五级部分6178垂直地向内延伸(“凹口角”)。
示于图66和图67中的支撑材料6100也沿着支撑物6100的总长度具有五种不同宽度W1、W2、W3、W4、W5。W1对应于边缘部分6112、6162。W2对应于边缘部分6116、6166。W3对应于边缘部分6120、6170。W4对应于边缘部分6124、6174。W5对应于边缘部分6128、6178。其它支撑材料实施方案可具有恒定宽度或不同数量的宽度，其有助于在外科缝合器械的钉仓和/或砧座上的可操作支撑。此外，边缘凹口的数量、形状、大小和布置可根据实施方案而变化。
在示于图66和图67中的实施方案中，支撑材料6100在其中包括多个切口开口。如在那些图中可见，切口被布置成平行排。具体地讲，排6200中的切口6204包括狭缝，该狭缝相对于边缘部分成角度地布置，使得每排6200中的切口6204彼此平行。切口6204可以或可以不完全延伸穿过支撑材料6100。类似地，排6202中的切口6206包括狭缝，该狭缝垂直地横向于支撑材料6100的边缘部分。切口6206可以或可以不完全延伸穿过支撑材料6100。在其它实施方案中，此类切口的数量、形状、大小、取向、间距、深度和位置可以变化。
图68示出一种切口布置，其中钉腔位置6012、6022和6032以虚线示出。如从该图可见，当支撑材料6100定位成配准在外科钉仓6000的平台6004上时，任何切口6204、6206中没有一个部分被定位在钉腔6012、6022、6032中的任何一个上。图69示出类似支撑材料布置，其中钉腔6012、6022和6032以虚线示出。支撑材料6100’的其中钉/紧固件腿将最终穿透的部分6103也以虚线示出。部分6103在本文中也可称为“钉穿透区”。如从该图可见，切口6208、6209中的任一个中没有一个部分位于任何或钉穿透区6103上方。切口6208和6209在支撑材料6100’中被布置成纵向排。每排中的切口6208大致彼此平行，并且相对于支撑材料6100’的边缘以锐角布置。类似地，每排中的切口6209大致彼此平行，并且被布置成使得它们垂直于相邻排中的切口6208。切口6208可以或可以不完全延伸穿过支撑材料6100’。另外如图69中可见，一整排切口6208位于紧固件腔6032的位置和支撑材料6100’的边缘之间，以有助于支撑材料6100’的进一步的柔性。与其它实施方案一样，此类切口的数量、形状、大小、取向、间距、深度和位置可以变化。
图70示出另一个支撑构件实施方案6100”。在该实施方案中，支撑材料包括多个边缘凹口6300，该边缘凹口包括形成蛇形边缘的起伏的波状曲线。此类边缘凹口/蛇形边缘允许钉旋转同时减少膨胀期间的材料应力。
图71和图72示出另一个支撑构件6400，该支撑构件由可以是可生物吸收的或可以不是可生物吸收的织造材料制成。另外，支撑材料可包括本文所述的支撑材料中的任一者，并且包括下文所述的独特且新颖的属性。例如，支撑构件6400可包括穿过其的孔或开口6402，以用于与外科钉仓或砧座的对应成形的部分(例如，柱、突起等)配合，以将支撑构件6400相对于钉仓中的钉/紧固件以所需的取向/配准支撑。在所示布置中，支撑构件6400包括位于其中的多个钉区6404、6406、6408，以用于在支撑构件6400被支撑在仓平台上时与外科钉仓中的对应紧固件腔6012、6022、6032配准。钉区可通过压缩材料并对其加热以促使材料永久地呈现压缩状态而形成。如图72中可见，压缩钉区域(通常表示为6410)具有比支撑构件6400的相邻非压缩部分(通常表示为6412)更小的横截面厚度。此外，支撑构件6400可具有线性边缘6420、6422、6424和/或蛇形边缘6426。支撑构件可具有与外科器械的外科钉仓和/或砧座的形状对应的形状。
所有前述支撑构件实施方案可用于外科钉仓的平台上，或者与外科缝合装置的砧座结合使用。所有支撑构件可具有与外科钉仓和/或砧座的形状对应的形状，并且可具有直线或线性边缘或边缘部分和/或波浪形、锯齿形和/或蛇形边缘、或此类边缘构型的组合。支撑构件可具有恒定宽度或者它们可具有多个宽度。穿过支撑材料的切口移除多余的材料以促进或允许支撑物的更多变形、扭曲等，其中在纵向膨胀期间在整个支撑材料中的应力较小。换句话讲，切口使得支撑物能够以与在钉本身正在移动时相同的方式“折叠”。蛇形或不规则边缘允许钉旋转同时减少膨胀期间的材料应力。上述支撑构型包括“软化结构”，该软化结构允许增加的延伸性，同时仍密封相关区域。此外，上述支撑构件不仅不抑制钉扭曲，而且还允许钉和辅助物(支撑物)在伸展时以相同的方式移动。此类支撑构件布置包括支撑构件，该支撑构件基本上包括允许钉线的最佳性能的各种机械行为的区域。
图73-图78示出在构造上类似于上述钉仓6000的另一个钉仓6500，不同的是钉仓6500额外包括多个突出部。在所示实施例中，外科钉仓6500包括限定平台6504的仓体6502。仓体6502被安装在底盘6524中并且包括居中设置的细长狭槽6506，该细长狭槽被构造成能够穿过其接收组织切割构件(未示出)。钉腔的多个钉凹坑在细长狭槽6506的每一侧上被设置在平台6504中。如图所示，第一腔6512的第一排6510被设置在细长狭槽6506的每一侧上。每个第一排6510中的第一腔6512彼此平行。第一腔6512中的每个被布置成相对于细长狭槽6506成角度并且与其相邻。所示仓体6502还包括被布置成相对于第一钉腔6512成角度的第二钉腔6522的两排6520。第三钉腔6532的两排6530也被设置在仓体中，如图所示。在至少一种形式中，第三钉腔6532与对应第一钉腔6512平行。仓体6502还具有两个纵向侧6508。
仓体6502还可包括从平台表面6504延伸的多个突出部6550。突出部6550可被构造成能够接合定位在砧座5360和仓6500中间的组织，并且控制组织相对于仓6500的移动。组织可在各种情况下相对于仓6500运动。在至少一种情况下，当砧座在打开位置与闭合位置(其中组织被挤压在砧座和仓6500之间)之间移动时，组织可相对于仓6500流动。在此类情况下，组织可朝向纵向侧6508侧向流动、朝向远侧端部6503朝远侧流动并且/或者朝向近侧端部6505朝近侧流动。在至少一种其它情况下，当切割构件朝远侧推进穿过捕获于砧座和仓6500之间的组织时，组织可相对于仓6500流动。在此类情况下，组织可侧向地、朝远侧和/或朝近侧流动，但由于切割刃朝远侧移动，所以组织主要朝远侧流动。在各种情况下，突出部6550可被构造成能够限制或防止组织相对于钉仓的流动。突出部6550可定位在钉腔6512、6522、6532的近侧端部和/或远侧端部处。在各种情况下，每个突出部6550可包括围绕对应钉腔6512、6522和6532的端部延伸的套。在某些情况下，每个突出部6550可包括围绕对应钉腔6512、6522和6532延伸的弓形脊。
图76-图78示出包括突出部6550的仓布置。示于图73-图75中的仓布置类似于图76-图78的仓，但是也包括形成在平台表面6504上的突出柱6560的排。在图73-图75的布置中，例如，将突出柱6560设置在每排钉腔中的每个钉腔6512、6522和6532之间。突出柱6560用于在夹持和击发过程期间进一步控制组织的流动。
主要参见图73，仓体6502包括在仓体6502的远侧末端和平台表面6504之间延伸的倾斜过渡6570。在将仓6500和砧座定位在手术部位内时，倾斜过渡6570有利于仓6500相对于组织运动。在这种情况下，组织可在倾斜表面6570上滑动。在其它布置中，倾斜表面6570包括圆角表面。在所示布置中，倾斜表面6570包括成角度表面。在另外的布置中，倾斜表面6570包括凹表面和/或凸表面。
限定在仓体6502中的钉腔6512、6522和6532在纵向狭槽6506的每一侧上以纵向排布置。每个突出部6550可被构造成能够支撑可移除地储存在钉腔6512、6522和6532中的钉6542的至少一部分。在各种情况下，每个突出部6550可使钉腔6512、6522和6532的端壁6513、6515在平台6504上方延伸。在某些情况下，大体参见图78，定位在钉腔6512、6522、6532内的钉6542包括基部6543、以第一角度从基部6543延伸的第一腿部6545以及以第二角度从基部6543延伸的第二腿部6547。第一腿部6545可与钉腔6532的第一端壁6513接触，并且第二腿部6547可与钉腔6512、6522、6532的第二端壁6515接触。在某些情况下，钉6542的第一腿部6545和第二腿部6547之间的距离或扩展可宽于端壁6513、6515之间的距离，使得当钉6542定位在钉腔6512、6522、6532内时，腿6545、6547被端壁6513、6515向内偏置。当钉6542以其未击发或未提升位置储存在钉腔6512、6522、6532内时，钉腿6545、6547的末端可定位在突出部6550内。在这种情况下，突出部6550可支撑并保护平台6504上方的钉腿末端6545、6547。在一些情况下，当钉6542处于其未击发位置时，钉腿6545、6547的末端可定位在突出部6550下方，并且因此，当钉6542处于其未击发位置时，突出部6550可不支撑钉腿6545、6547。当这样的钉6542被击发或提升出钉腔6512、6522、6532时，钉腿6545、6547则可接触到突出部6550并且由其支撑。在任何情况下，突出部6550均可在部署钉6542时继续支撑钉腿6545、6547直至钉6542已被充分击发和/或提升出钉腔6512、6522、6532，使得钉腿6545、6547不再与突出部6550接触。
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、聚氧杂酯、聚原酸酯、聚磷腈及其共聚物、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持材料。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、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、甲壳质、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a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细丝或线，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制成。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、聚氧杂酯、聚原酸酯、聚磷腈及其共聚物、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说明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、血纤维蛋白、血纤维蛋白原、纤维粘连蛋白、弹力蛋白、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、壳聚糖、壳聚糖、琼脂糖、麦芽糖、麦芽糖糊精、藻酸盐、凝血因子、丙烯酸甲酯、聚胺基甲酸酯、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适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物的多孔层。2013年7月30日公布的名称为“BUTTRESSAND SURGICAL STAPLING APPARATUS”的美国专利8,496,683的完整公开内容以引用方式并入本文。
以下专利的完整公开内容据此以引用方式并入本文：
1995年4月4日公布的名称为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,403,312；
2006年2月21日公布的名称为“SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS”的美国专利7,000,818；
2008年9月9日公布的名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK”的美国专利7,422,139；
2008年12月16日公布的名称为“ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS”的美国专利7,464,849；
2010年3月2日公布的名称为“SURGICAL INSTRUMENT HAVING AN ARTICULATINGEND EFFECTOR”的美国专利7,670,334；
2010年7月13日公布的名称为“SURGICAL STAPLING INSTRUMENTS”的美国专利7,753,245；
2013年3月12日公布的名称为“SELECTIVELY ORIENTABLE IMPLANTABLE FASTENERCARTRIDGE”的美国专利8,393,514；
名称为“具有记录能力的外科器械(SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES)”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“具有RF电极的外科切割及紧固器械(SURGICALCUTTING AND FASTENING INSTRUMENT HAVING 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“用于外科切割及缝合器械的端部执行器(ENDEFFECTORS FOR A SURGICAL CUTTING AND STAPLING 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“马达驱动外科切割器械(MOTOR-DRIVEN SURGICAL CUTTINGINSTRUMENT)”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“具有可手动缩回的击发系统的带电外科切割及缝合设备(POWEREDSURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRINGSYSTEM)”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“具有电致动器方向控制组件的马达驱动外科切割器械(MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATORDIRECTIONAL 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“钉仓(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“外科缝合器械(SURGICAL STAPLINGINSTRUMENT)”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)；
提交于2012年6月15日的名称为“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；
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；
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。上述说明和下述权利要求旨在涵盖所有此类修改和变型。
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手术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，获得并且如果必要的话清洁新的或用过的器械。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。辐射杀死器械中和容器中的细菌。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技术中的已知或习惯做法的相对于本公开的此类偏离。
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。任何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 (9)

1.一种用于与包括成角度地取向的钉的外科钉仓一起使用的支撑材料，所述支撑材料包括支撑主体，所述支撑主体的大小被设计成可操作地接收在所述外科钉仓的平台上，所述支撑主体包括至少四个边缘和中心部分，其中所述边缘中的至少两个边缘包括形成于其中的多个边缘凹口，并且其中所述中心部分包括在其中形成的多个切口开口，
其中所述多个切口开口被布置成所述中心部分中的切口开口的平行线，其中切口开口的所述平行线中的一条平行线中的所述切口开口彼此平行，并且相对于所述切口开口的至少一条相邻的所述平行线中的所述切口开口成角度地布置，其中所述边缘的第一边缘中的所述边缘凹口包括：
位于所述边缘的所述第一边缘中的第一组第一边缘凹口，所述第一组第一边缘凹口以第一凹口长度向内延伸到所述中心部分中；
位于所述边缘的所述第一边缘中的第二组第二边缘凹口，所述第二组第二边缘凹口以第二凹口长度向内延伸到所述中心部分中；和
位于所述边缘的所述第一边缘中的第三组第三边缘凹口，所述第三组第三边缘凹口以第三凹口长度向内延伸到所述中心部分中。
2.根据权利要求1所述的支撑材料，其中所述第一组第一边缘凹口设置在所述第一边缘的第一部分中，其中所述第二组第二边缘凹口设置在所述第一边缘的第二部分中，并且其中所述第三组第三边缘凹口设置在所述第一边缘的第三部分中。
3.根据权利要求1所述的支撑材料，其中所述第一组第一边缘凹口相对于所述第一边缘以第一角度从所述第一边缘向内延伸，并且其中所述第二组所述第二边缘凹口相对于所述第一边缘以第二角度从所述第一边缘向内延伸，并且其中所述第三组所述第三凹口相对于所述第一边缘以第三角度从所述第一边缘向内延伸，并且其中所述第一角度不同于所述第二角度和所述第三角度中的至少一者。
4.根据权利要求1所述的支撑材料，其中所述边缘的第二边缘中的所述边缘凹口包括：
位于所述边缘的所述第二边缘中的初级组初级边缘凹口，所述初级组初级边缘凹口以初级凹口长度向内延伸到所述中心部分中；
位于所述边缘的所述第二边缘中的次级组次级边缘凹口，所述次级组次级边缘凹口以次级凹口长度向内延伸到所述中心部分中；和
位于所述边缘的所述第二边缘中的三级组三级边缘凹口，所述三级组三级边缘凹口以三级凹口长度向内延伸到所述中心部分中。
5.根据权利要求4所述的支撑材料，其中所述初级组初级边缘凹口设置在所述第二边缘的初级部分中，其中所述次级组次级边缘凹口设置在所述第二边缘的次级部分中，并且其中所述三级组三级边缘凹口设置在所述第二边缘的三级部分中。
6.根据权利要求4所述的支撑材料，其中所述初级组初级边缘凹口相对于所述第二边缘以初级角度从所述第二边缘向内延伸，其中所述次级组所述次级边缘凹口相对于所述第二边缘以次级角度从所述第二边缘向内延伸，其中所述三级组所述三级凹口相对于所述第二边缘以三级角度从所述第二边缘向内延伸，并且其中所述初级角度不同于所述次级角度和所述三级角度中的至少一者。
7.根据权利要求1所述的支撑材料，其中所述多个所述边缘凹口包括多个起伏的波状曲线。
8.根据权利要求1所述的支撑材料，其中所述多个边缘凹口被构造成能够为所述至少两个边缘提供蛇形。
9.根据权利要求1所述的支撑材料，其中所述支撑主体具有长度并沿着所述长度具有多个不同宽度。
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