CN110198673B

CN110198673B - End effector comprising a distal tissue abutment member

Info

Publication number: CN110198673B
Application number: CN201480020293.8A
Authority: CN
Inventors: K·J·施密德; B·W·史密斯; F·E·谢尔顿四世
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2013-02-08
Filing date: 2014-02-07
Publication date: 2022-04-15
Anticipated expiration: 2034-02-07
Also published as: RU2015138092A; CN110198673A; MX362624B; JP2016506829A; JP6290262B2; BR112015018972B1; BR112015018972A2; RU2662861C2; BR112015018972A8; MX2015010284A

Abstract

A fastener cartridge can include a cartridge body having fastener cavities, fasteners at least partially stored within the cartridge body, and a layer (11150) positioned over the cartridge body. The cartridge body can comprise a proximal end and a distal end. Similarly, the layer may include a proximal end and a distal end. The distal end of the layer can extend distally relative to the distal end of the cartridge body. Further, the layer can include a distal portion (11156) that extends distally relative to the fastener cavities defined in the cartridge body. The distal portion may be positioned against the secured tissue and may flexibly support the tissue after the layer is implanted against the tissue. The layer can include a proximal portion (11158) extending proximally relative to the fastener lumen, which can flexibly support the tissue after the layer is implanted.

Description

End effector comprising a distal tissue abutment member

Cross Reference to Related Applications

This non-provisional patent application is a continuation-in-part application, filed 3/28/2012 under the designation "Tissue Thickness Compensator compliance of documents" in accordance with the 35 u.s.c. 120 specification, entitled U.S. patent application serial No. 13/433,129, the entire disclosure of which is hereby incorporated by reference.

Background

The present invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling instruments and staple cartridges therefor that are designed to cut and staple tissue.

Drawings

The features and advantages of the invention, as well as the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein:

FIG. 1 is a front left perspective view of a surgical stapling and severing instrument with a handle portion including a link-activated automatic retraction mechanism and a ratchet manual retraction mechanism;

FIG. 2 is a rear right perspective view of the surgical stapling and severing instrument of FIG. 1 with a portion of the elongate shaft cut away and a right half of the handle housing removed to expose the automatic firing end advancing retraction mechanism and the manual firing retraction mechanism;

FIG. 3 is a rear right perspective disassembled view of the handle portion and elongated shaft of the surgical stapling and severing instrument of FIG. 1;

FIG. 4 is a right side elevational view of the surgical stapling and severing instrument of FIG. 1, partially disassembled;

FIG. 5 is a rear right perspective view of the partially disassembled surgical stapling and severing instrument of FIG. 1, with the closure mechanism closed and clamped, and the side pawl firing mechanism completing a first stroke, and with the manual retraction mechanism removed to expose a distal link of the linked rack that triggers automatic retraction of the firing mechanism;

FIG. 6 is a left side elevational view of the partially disassembled surgical stapling and severing instrument of FIG. 4 in an initial state with the end effector open and the anti-backup mechanism engaged;

FIG. 7 is a left side detail elevation view of the disassembled surgical stapling and severing instrument of FIG. 1 immediately after the distal link has been actuated and forwardly locks the anti-backup release lever to allow retraction of the linked rack;

FIG. 8 is a right exploded perspective view of the idler and rear gears and the manual retraction lever and ratchet pawl of the manual retraction mechanism of the surgical stapling and severing instrument of FIG. 1;

FIG. 9 is a left side elevational view, partially broken away, of the surgical stapling and severing instrument of FIG. 1 with the anti-backup mechanism engaged to a fully fired linked rack disconnected from the combined tension/compression spring prior to actuation of the manual retraction lever of FIG. 8;

FIG. 10 is a left side elevational view, partially broken away, of the surgical stapling and severing instrument of FIG. 9, with hidden portions of the anti-backup release lever, the rear gear, and the manual firing release lever shown in phantom;

FIG. 11 is a partially disassembled left side elevational view of the surgical stapling and severing instrument of FIG. 10 after actuation of the manual firing release lever has manually retracted the linked rack;

FIG. 12 is a left side elevational view, partially broken away, of the surgical stapling and severing instrument of FIG. 11 with the linked rack omitted to depict a manual firing release lever disengaged from the anti-backup mechanism;

FIG. 13 is a right side elevational view of an alternative anti-backup release mechanism with the linked rack in a retracted position and the anti-backup release lever positioned proximally with the anti-backup plate engaged to the firing rod;

FIG. 14 is a right side detail elevation view of the rear gear, automatic retraction cam and distal-most link of FIG. 13;

FIG. 15 is a right side elevational view of the automatic release mechanism after another firing stroke has slid the automatic retraction cam distally and locked the anti-backup release lever out of engagement with the anti-backup mechanism;

FIG. 16 is a front left perspective view of the open staple applying assembly with the right half-section of the replaceable staple cartridge included in the staple channel;

FIG. 17 is an exploded perspective view of the staple applying assembly of FIG. 16 with a complete replaceable staple cartridge and an unarticulated shaft configuration;

FIG. 18 is a perspective view of a plurality of staple drivers positionable within a cartridge body of a staple cartridge;

FIG. 19 is a perspective view of a two-blade knife and firing bar (E-beam) of the staple applying assembly of FIG. 16;

FIG. 20 is a perspective view of a wedge sled of a staple cartridge of the staple applying assembly;

FIG. 21 is a left side elevational view taken in longitudinal cross section along the centerline 21-21 of the staple applying assembly of FIG. 16;

FIG. 22 is a perspective view of the open staple applying assembly of FIG. 16 without the replaceable staple cartridge and without the distal portion of the staple channel;

FIG. 23 is a front elevational view, taken in cross-section along line 23-23 of the staple applying assembly of FIG. 16, depicting portions of the internal staple drivers and the two-blade knife and firing bar of the staple cartridge;

FIG. 24 is a left side elevational view taken generally along the longitudinal axis 24-24 of the closed staple applying assembly of FIG. 16 to include a central point of contact between the two-blade knife and the wedge sled, but also laterally offset to show the staples and staple drivers located within the staple cartridge;

FIG. 25 is a left side detail elevation view of the staple applying assembly of FIG. 24 with the two-blade knife retracted slightly more than is typical when replacing a staple cartridge;

FIG. 26 is a left side detail elevational view of the staple applying assembly of FIG. 25 corresponding to the configuration depicted in FIG. 24, with a two-blade knife being fired;

FIG. 27 is a left side elevational view in cross-section of the closed staple applying assembly of FIG. 24 after the two-blade knife and firing bar have been distally fired;

FIG. 28 is a left side elevational view in cross section of the closed staple applying assembly of FIG. 27 after firing of the staple cartridge and retraction of the two blades;

FIG. 29 is a left side cross-sectional detail elevation view of the staple applying assembly of FIG. 28 with the two-bladed knife being allowed to fall into a latched position;

FIG. 29A is a partial perspective view of jaws of an end effector assembly with various elements removed therefrom, depicting a firing assembly in an unfired position, and further depicting a sled engaged with a release stop of an actuator, according to various embodiments of the present disclosure;

FIG. 29B is a partial perspective view of the jaws of FIG. 29A with various components removed therefrom, depicting the firing assembly in a partially fired position, and further depicting the sled disengaged from the release stop of the actuator;

FIG. 30 is a perspective view of a surgical stapling instrument including a shaft and a detachable end effector;

FIG. 31 is a partial perspective view of the shaft and end effector of the surgical stapling instrument of FIG. 30;

FIG. 32 is a partial perspective view of the end effector being assembled to the shaft of the surgical stapling instrument of FIG. 30;

FIG. 33 is another partial perspective view of the end effector being assembled to the shaft of the surgical stapling instrument of FIG. 30;

FIG. 34 is a partially sectioned elevational view showing the end effector not coupled to the shaft of the surgical stapling instrument of FIG. 30;

FIG. 35 is a partial cross-sectional elevation view showing the end effector coupled to the shaft of the surgical stapling instrument of FIG. 30, and further showing the sliding collar in an open unlocked position;

FIG. 36 is a partial cross-sectional elevation view showing the end effector coupled to the shaft of the surgical stapling instrument of FIG. 30, and further showing the sliding collar in a closed, locked position;

FIG. 37 is an exploded view of the end effector of FIG. 30, shown with components removed;

FIG. 38 is an exploded view of the shaft of FIG. 30;

FIG. 39 is a longitudinal cross-sectional view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator and an anvil in a closed position showing staples moving from an unfired position to a fired position during a first sequence;

FIG. 40 is another cross-sectional view of the anvil and staple cartridge of FIG. 39, showing the anvil in an open position after the firing sequence has been completed;

FIG. 41 is a partial detail view of the staple cartridge of FIG. 39, illustrating the staples in an unfired position;

FIG. 42 is a cross-sectional elevation view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator showing the staples in an unfired position;

FIG. 43 is a detail view of the staple cartridge of FIG. 42;

FIG. 44 is an elevational view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator and an anvil in an open position showing the staples in an unfired position;

FIG. 45 is an elevational view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator and an anvil in a closed position showing the staples in an unfired position and tissue captured between the anvil and the tissue thickness compensator;

FIG. 46 is a detail view of the anvil and staple cartridge of FIG. 45;

FIG. 47 is an elevational view of the anvil and staple cartridge of FIG. 45 showing tissue of different thicknesses positioned therebetween;

FIG. 48 is a detail view of the anvil and staple cartridge of FIG. 45 as illustrated in FIG. 47;

FIG. 49 is a schematic view showing a tissue thickness compensator compensating for different tissue thicknesses captured within different staples;

FIG. 50 is a schematic view showing a tissue thickness compensator applying a compressive force to one or more blood vessels that have been transected by a staple line;

FIG. 51 is a schematic view showing tissue captured within a staple;

FIG. 52 is a schematic view showing thick tissue and a tissue thickness compensator captured within a staple;

FIG. 53 is a schematic view showing thin tissue and a tissue thickness compensator captured within a staple;

FIG. 54 is a schematic view showing the tissue thickness compensator captured within the staples and tissue having an intermediate thickness;

FIG. 55 is a partial cross-sectional view of an end effector of a surgical stapling instrument in accordance with at least one embodiment;

FIG. 56 is a partial cross-sectional view of an end effector according to at least one alternative embodiment;

FIG. 57 is a partial cross-sectional view of an end effector according to another alternative embodiment;

FIG. 58 is a partial cross-sectional view of the end effector shown in a flexed condition;

FIG. 59 is a partial cross-sectional view of the end effector of FIG. 58 in a released state;

FIG. 60 is a cutaway perspective view of a staple cartridge including a lateral retention member configured to retain a tissue thickness compensator to a support portion;

FIG. 61 is a cross-sectional view of the staple cartridge of FIG. 60 being used to staple tissue;

FIG. 62 is a perspective view of a staple cartridge including a cartridge body and a tissue thickness compensator attached to the cartridge body by a plurality of cockable attachment members;

FIG. 63 is an exploded view of the staple cartridge of FIG. 62;

FIG. 64 is a front view of the staple cartridge of FIG. 62;

FIG. 65 is a cross-sectional view of the staple cartridge of FIG. 62 taken along the section line in FIG. 64, showing the cocked attachment member in an unfired position;

FIG. 66 is a cross-sectional view of the staple cartridge of FIG. 62 taken along the section line in FIG. 64, showing the cocked attachment member in a broken firing position;

FIG. 67 is a perspective view of a tissue thickness compensator;

FIG. 68 is a perspective view of the tissue thickness compensator of FIG. 167 being assembled to a staple cartridge;

FIG. 69 is an exploded view of the tissue thickness compensator and staple cartridge of FIG. 68;

FIG. 70 is a detail view of the proximal end of the tissue thickness compensator;

FIG. 71 is a partial front view of the tissue thickness compensator of FIG. 70 assembled to a staple cartridge;

FIG. 72 is a plan view of the tissue thickness compensator and staple cartridge of FIG. 71;

FIG. 73 is a front view of a mount for holding a tissue thickness compensator to a staple cartridge;

FIG. 74 is a side view of the mount of FIG. 73;

FIG. 75 is a rear view of the mount of FIG. 73;

FIG. 76 is a bottom view of the mount of FIG. 73;

FIG. 77 is a partial cross-sectional view of a staple cartridge including a retaining pin configured to releasably retain a tissue thickness compensator to the cartridge body;

FIG. 77A is a partial cross-sectional perspective view of the staple cartridge of FIG. 77 with a portion of the staple cartridge removed for purposes of illustration;

FIG. 78 is a partial cross-sectional view of the staple cartridge of FIG. 77 showing the retaining pin in a withdrawn state;

FIG. 79 is a perspective view, partially in section, of the staple cartridge of FIG. 77 also showing the retaining pin in a withdrawn condition;

FIG. 80 is a partial cross-sectional view of the staple cartridge including jaws configured to releasably retain the tissue thickness compensator to the cartridge body, showing the jaws in a closed state;

FIG. 81 is a partial cross-sectional view of the staple cartridge of FIG. 80 showing the jaws in an open condition;

FIG. 81A is a perspective view of a staple cartridge having a layer, such as a tissue thickness compensator and/or buttress material, disposed thereon, wherein the staple cartridge is disposed relative to a cutting blade of an end effector, and wherein the remainder of the end effector has been removed for purposes of illustration;

FIG. 82 is a cross-sectional plan view of the staple cartridge of FIG. 81A, showing a cutting blade for severing the distal end of a layer disposed in the distal cavity of the staple cartridge, wherein the cutting blade is undeployed and the staples therein are omitted for clarity;

FIG. 83 is a cross-sectional plan view of the staple cartridge of FIG. 81A with the cutting blade for cutting the distal end of the layer deployed and with the staples omitted therefrom for clarity;

fig. 84 is a perspective view of the jaws of the end effector assembly depicting a tissue thickness compensator secured to the cartridge body by a proximal connector and a distal connector, and further depicting the firing assembly in an unfired position, in accordance with various embodiments of the present disclosure;

FIG. 85A is a partial plan view of the jaws of FIG. 84, depicting the actuator in a pre-actuated position;

FIG. 85B is a partial plan view of the jaws of FIG. 84, depicting the actuator in an actuated position;

FIG. 85C is a detail view of the jaws of FIG. 85B;

FIG. 85D is an elevational view of the jaws of FIG. 84, depicting the actuator in the actuated position, and further depicting the proximal and distal connectors disconnected;

FIG. 86 is a partial front view of the jaws of FIG. 84 with various elements removed therefrom, depicting the sled in the cartridge body engaged with the tabs of the actuator of FIG. 85A;

FIG. 87 is a partial front view of the jaws of FIG. 84 with various elements removed from the jaws, depicting the sled in the cartridge body disengaged from the tabs of the actuator;

FIG. 87A is a partial plan view of jaws of an end effector assembly depicting a firing bar of the firing assembly abutting a release stop of the actuator according to various embodiments of the present disclosure;

FIG. 87B is a partial plan view of the jaws of FIG. 87A, depicting a firing bar in the firing assembly extending through a release stop of the actuator;

fig. 88 is a perspective view of jaws of an end effector assembly depicting a tissue thickness compensator secured to a cartridge body, and further depicting a firing assembly in an unfired position, in accordance with various embodiments of the present disclosure;

FIG. 89 is a partial front elevational view of the jaws of FIG. 88 with various elements shown in phantom, depicting an actuator extending through the jaws, and further depicting the firing assembly in an unfired position;

FIG. 90 is a partial cross-sectional view of a staple cartridge including retaining pins configured to releasably retain a tissue thickness compensator to the cartridge body, showing the retaining pins in an activated state;

FIG. 91 is a partial cross-sectional view of the staple cartridge of FIG. 90 showing the retaining pin in a deactivated state;

FIG. 92 is a perspective view of an actuator of the staple cartridge of FIG. 90 configured to deactivate the retention pin;

FIG. 93A is a perspective view of a fastener cartridge assembly of an end effector assembly depicting a tissue thickness compensator released from a cartridge body of the fastener cartridge assembly according to various embodiments of the present disclosure;

FIG. 93B is a perspective view of the fastener cartridge assembly of FIG. 93A depicting a tissue thickness compensator secured to the cartridge body of the staple cartridge assembly;

FIG. 93C is an elevational view of the fastener cartridge assembly of FIG. 93A with various components removed therefrom, depicting the firing assembly in a pre-firing position;

FIG. 93D is an elevation view of the fastener cartridge assembly of FIG. 93A with various components removed therefrom, depicting the firing assembly in a partially fired position;

FIG. 94 is a partial perspective view of the fastener cartridge assembly of the end effector assembly depicting the tissue thickness compensator released from the cartridge body of the fastener cartridge assembly in accordance with various embodiments of the present disclosure;

FIG. 95 is a partial perspective view of a fastener cartridge assembly of the end effector assembly depicting the tissue thickness compensator released from the cartridge body of the fastener cartridge assembly according to various embodiments of the present disclosure;

FIG. 96 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 95, depicting a mount of a tissue thickness compensator retained in a bridge of the cartridge body;

FIG. 97 is a perspective view of a fastener cartridge assembly of the end effector assembly depicting the tissue thickness compensator released from the cartridge body of the fastener cartridge assembly according to various embodiments of the present disclosure;

FIG. 98 is a perspective view of the fastener cartridge assembly of FIG. 97, depicting a tissue thickness compensator secured to the cartridge body of the fastener cartridge assembly;

FIG. 99 is a cross-sectional, elevational view of the end effector assembly of FIG. 97, depicting the tissue thickness compensator secured to the cartridge body of the fastener cartridge assembly, and further depicting the end effector in an undamped position;

FIG. 100 is a cross-sectional, elevational view of the end effector assembly of FIG. 97, depicting the tissue thickness compensator unsecured to the cartridge body of the fastener cartridge assembly, and further depicting the end effector assembly in a clamped position;

FIG. 101 is a perspective view of a staple cartridge applicator assembly including an upper tissue thickness compensator including a plurality of retention features extending therefrom and a staple cartridge including a lower tissue thickness compensator;

FIG. 102 is an elevational view of the cartridge applicator assembly of FIG. 101 positioned within the cartridge channel and an anvil being closed thereon;

FIG. 103 is a front view of the anvil of FIG. 102 in a re-opened position and the staple cartridge applicator of FIG. 101 being removed from the end effector;

FIG. 104 is a cross-sectional view of tissue positioned intermediate the upper and lower tissue thickness compensators of FIG. 101;

FIG. 105 is a cross-sectional view showing the upper and lower tissue thickness compensators sutured to the tissue and severed by the cutting member;

FIG. 106 is a perspective view of a cartridge applicator assembly including an upper tissue thickness compensator configured to be attached to an anvil in accordance with at least one embodiment;

FIG. 106A is an elevation view of the staple cartridge applicator assembly of FIG. 106 positioned within a staple cartridge channel and an anvil being moved toward an upper tissue thickness compensator;

FIG. 106B illustrates the staple cartridge applicator of FIG. 106 being removed from the end effector after the upper tissue thickness compensator has been engaged with the anvil;

FIG. 107 is a cross-sectional end view of the anvil being moved toward the upper tissue thickness compensator of FIG. 106;

FIG. 108 is a cross-sectional end view of the anvil engaged with the upper tissue thickness compensator;

FIG. 109 is a perspective view of a staple cartridge to which a piece of buttress material is releasably retained in accordance with one non-limiting embodiment of the present invention;

FIG. 110 is an exploded perspective view of the staple cartridge of FIG. 109 and a sheet of buttress material including a plurality of members extending therefrom;

FIG. 111 is a cross-sectional view taken along line 111-111 in FIG. 109, showing the member of FIG. 110 engaged with a staple cavity in accordance with one non-limiting embodiment of the present invention;

FIG. 112 is a cross-sectional view of a piece of buttress material including members that engage the staple cavities of a staple cartridge in accordance with one non-limiting embodiment of the present invention;

FIG. 113 is an exploded view of FIG. 112 showing components separated from the staple cavities of the staple cartridge in accordance with one non-limiting embodiment of the present invention;

FIG. 114 is a partial perspective view of a support portion of a staple cartridge including removable and/or replaceable staple leg guides;

FIG. 115 is a partial cross-sectional view of the staple cartridge of FIG. 114 showing staples being deployed therefrom;

FIG. 116 is a detail view of the cross-sectional view of FIG. 114 after the staple cartridge has been fired;

fig. 117 is a partial perspective view of the cartridge body, outer shell, and tissue thickness compensator in accordance with various embodiments of the present disclosure, depicting the projections extending from the cartridge body;

fig. 118 is a partial perspective view of the cartridge body, outer shell, and tissue thickness compensator according to various embodiments of the present disclosure, depicting the projections extending from the outer shell;

FIG. 119 is a partial cross-sectional view of an end effector assembly depicting staples positioned in staple cavities of a cartridge body of the end effector assembly, and further depicting the staples in an unformed configuration, according to various embodiments of the present disclosure;

FIG. 120 is a partial cross-sectional view of the end effector assembly of FIG. 119, depicting staples ejected from the staple cavities, and further depicting the staples in a formed configuration;

FIG. 121 is a perspective view of a staple and lock depicting the lock in a locked configuration according to various embodiments of the present disclosure;

FIG. 122 is a perspective view of the staple and lock of FIG. 121, depicting the lock in a locked configuration;

FIG. 123 is a perspective view of the staples and locks of FIG. 121, depicting the locks in a pre-fired position in the staple cavities, and further depicting the locks in a locked configuration;

FIG. 124 is a perspective view of the staples and locks of FIG. 121, depicting the locks in a fired position in the staple cavities, and further depicting the locks in an unlocked configuration;

FIG. 125 is a perspective view of a fastener cartridge assembly of an end effector assembly depicting locks extending from lock cavities in a cartridge body of the fastener cartridge assembly, according to various embodiments of the present disclosure;

FIG. 126 is a cross-sectional view of the lock of FIG. 125 depicting the lock and a connector unsecured to the lock in an unlocked configuration;

FIG. 126A is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125, depicting the cartridge body, connector, tissue thickness compensator, and lock in a partially assembled position;

FIG. 127 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125, depicting the lock in a locked configuration, depicting the anvil in a clamped position, and depicting the driver key in an unfired position;

FIG. 128 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125, depicting the lock in a locked configuration, depicting the anvil in a clamped position, and further depicting the driver key in a partially fired position;

FIG. 129 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125, depicting the lock in an unlocked configuration, depicting the anvil in a clamped position, and further depicting the driver key in a fired position;

FIG. 130 is a cross-sectional view of the end effector showing the firing member in a partially fired position;

FIG. 131 is a cross-sectional view of the end effector of FIG. 130, showing the support portion being moved away from the partially implanted tissue thickness compensator;

FIG. 132 is a partial cross-sectional view of a staple cartridge including staple drivers having different heights in accordance with at least one embodiment;

FIG. 133 is a schematic view showing the staple drivers of FIG. 132 and staples supported thereon having different unfired heights;

FIG. 134 is a cross-sectional view of a staple cartridge including a tissue thickness compensator and a support portion according to at least one embodiment;

FIG. 135 is a partial cross-sectional view of the tissue thickness compensator, staple guide layer and staples in an unfired position;

FIG. 136 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 137 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 138 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 139 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 140 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 141 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 142 is a detail view of the area surrounding the tip of the nail of FIG. 141;

FIG. 143 is a partial cross sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 144 is a detail view of the area around the tip of the nail of FIG. 143;

FIG. 145 is a partial cross-sectional view of a tissue thickness compensator, staple guide layer and staples in an unfired position according to at least one alternative embodiment;

FIG. 146 is a perspective view of a staple guide layer and a plurality of staples in an unfired position in accordance with at least one alternative embodiment;

FIG. 147 is an exploded view of the tissue thickness compensator and staple cartridge body;

FIG. 148 is an elevational view of the disposable loading unit including a pivotable jaw configured to support a staple cartridge;

FIG. 149 is a perspective view of a tissue thickness compensator applicator positioned within an actuator of a disposable loading unit;

FIG. 150 is a top perspective view of the tissue thickness compensator applicator of FIG. 149;

FIG. 151 is a bottom perspective view of the tissue thickness compensator applicator of FIG. 149;

FIG. 152 is a cross-sectional view of an end effector of a surgical stapling instrument including staple drivers having different heights and contoured deck surfaces in accordance with at least one embodiment;

FIG. 153 is a cross-sectional view of an end effector of a surgical stapling instrument including staple drivers having different heights and stepped deck surfaces in accordance with at least one embodiment;

FIG. 154 is a schematic view showing a staple driver having different heights and staples having different unformed heights including a tissue thickness compensator of varying thickness;

FIG. 155 is a schematic view showing the staple and tissue thickness compensator of FIG. 154 implanted into tissue;

FIG. 156 is a partial cross-sectional view of the tissue thickness compensator attached to the cartridge body;

FIG. 157 is a partial cross-sectional view of the tissue thickness compensator and staple cartridge body of FIG. 156;

FIG. 158 is a partial exploded view of the tissue thickness compensator of FIG. 156;

FIG. 159 is a partially exploded view of the tissue thickness compensator, staple cartridge body and firing member;

FIG. 160 is a partial front view of the embodiment of FIG. 159;

FIG. 161 is a bottom view of the staple cartridge;

FIG. 162 is a bottom detail view of the staple cartridge of FIG. 161;

FIG. 163 is an exploded view of the staple cartridge, showing the staple driver arrangement;

FIG. 164 is a perspective view of one embodiment of a retainer attached to a staple cartridge and having a layer (such as a tissue thickness compensator) disposed intermediate the retainer and the staple cartridge, wherein the retainer, layer, and staple cartridge are disposed relative to a surgical stapler, and wherein the staple cartridge channel has been removed for illustration purposes;

FIG. 165 is a perspective view of the retainer of FIG. 164;

FIG. 166 is a plan view of the retainer, layer and staple cartridge of FIG. 164;

FIG. 167 is a cross-sectional view of the retainer, layer, and staple cartridge of FIG. 164, with the tips of the staples extending from the staple cavities in the staple cartridge and into the layer;

FIG. 168 is a perspective view of one embodiment of a retainer including a movable cam portion and a locking tab;

FIG. 169 is a perspective view of the retainer of FIG. 168 attached to a staple cartridge, wherein the staple cartridge and retainer are positioned for insertion into a staple cartridge channel of an end effector of a surgical stapler;

FIG. 170 is a plan view of the retainer of FIG. 168 positioned for insertion, but not complete insertion, into a cartridge channel of an end effector of a surgical stapler;

FIG. 171 is a cross-sectional end view of the retainer of FIG. 168 positioned for insertion, but not full insertion, into the staple cartridge channel of FIG. 170;

FIG. 172 is a plan view of the retainer of FIG. 168 fully inserted into the staple cartridge channel of FIG. 170;

FIG. 173 is a cross-sectional end view of the retainer of FIG. 168 fully inserted into the staple cartridge channel of FIG. 170, with the retainer in an unlocked state and being removed from the staple cartridge;

FIG. 174 is a plan view of an end effector insert according to at least one embodiment;

FIG. 175 is a front view of the end effector insert of FIG. 174;

FIG. 176 is a perspective view of the end effector insert of FIG. 174;

FIG. 177 is a partial perspective view of the end effector insert of FIG. 174 depicting the end effector insert engaging an anvil of an end effector of a surgical instrument;

FIG. 178 is a partial perspective view of the end effector insert of FIG. 174 depicting the end effector insert engaging a staple cartridge of an end effector of a surgical instrument;

FIG. 179 is an elevational view of the end effector insert of FIG. 174 depicting the end effector insert engaging an end effector of a surgical instrument;

FIG. 180 is an elevation view of the end effector insert of FIG. 174 positioned in an end effector of a surgical instrument;

FIG. 181 is a partial perspective view of an embodiment of a staple cartridge assembly including a layer of staple cartridges and an anvil-attachable layer positioned relative to the staple cartridges;

FIG. 182 is a partial perspective view of the staple cartridge assembly of FIG. 181 with an anvil-attachable layer secured to the staple cartridge;

FIG. 183 is a partial perspective view of one embodiment of a staple cartridge assembly comprising a layer of staple cartridges and an anvil-attachable layer positioned relative to the staple cartridge, wherein a proximal end portion of the anvil-attachable layer is attached to an attachment feature of the staple cartridge by an adhesive or by welding, and wherein a portion of the anvil-attachable layer is shown as transparent for illustration purposes;

FIG. 184 is a partial perspective view of the staple cartridge assembly of FIG. 183 with the corners of the proximal end portion of the anvil-attachable layer shown separated from and lifted away from the staple cartridge;

FIG. 185 is a partial perspective view of an embodiment of a staple cartridge assembly including a layer of staple cartridges and an anvil-attachable layer positioned relative to the staple cartridge, wherein the anvil-attachable layer is attached to the layer of staple cartridges;

FIG. 186 is a detail view of the cartridge layer of FIG. 185 and an anvil-attachable layer attached thereto;

FIG. 187 is a partial plan view of an anvil-attachable layer embodiment;

FIG. 188 is a partial plan view of the anvil-attachable layer of FIG. 187 being cut by a cutting blade;

FIG. 189 is a plan view of a tissue compensator of a sleeve according to at least one embodiment;

FIG. 190 is a perspective view of the tissue compensator of FIG. 189;

FIG. 191 is a front view of the tissue compensator of FIG. 189;

FIG. 192 is a perspective view of a tissue thickness compensator;

FIG. 193 is a perspective view of the tissue thickness compensator of FIG. 192 attached to a staple cartridge;

FIG. 194 is a detail view of another tissue thickness compensator of FIG. 192 at least partially overlapping with one tissue thickness compensator of FIG. 192;

FIG. 195 is a perspective view of a staple cartridge with a tissue thickness compensator attached thereto;

FIG. 196 is a detail view of another tissue thickness compensator of FIG. 195 at least partially overlapping with one of the tissue thickness compensators of FIG. 195;

FIG. 197 is an exploded view of a staple cartridge including a tissue thickness compensator comprising a plurality of layers;

FIG. 198 is a cross-sectional schematic view showing one tissue thickness compensator of FIG. 197 implanted on one side of a patient's tissue and another tissue thickness compensator of FIG. 197 implanted on the other side of the tissue;

FIG. 199 is an exploded perspective view of an end effector of a stapling instrument including a staple cartridge and a tissue thickness compensator, in accordance with various embodiments;

Fig. 200 is a cross-sectional view of the tissue thickness compensator of fig. 199 according to various embodiments;

FIG. 201 is a top view of a tissue thickness compensator comprising a plurality of circular sheets according to various embodiments;

figure 202 is a top view of a tissue thickness compensator comprising a plurality of circular sheets according to various embodiments;

FIG. 202A is a cross-sectional view of a tissue thickness compensator according to various embodiments;

fig. 203 is a top view of a tissue thickness compensator, according to various embodiments;

figure 204 is a top view of a tissue thickness compensator comprising a plurality of hexagonal plates according to various embodiments;

figure 205 is a top view of a fastened tissue thickness compensator comprising a plurality of sheets according to various embodiments;

FIG. 206 is a top view of a tissue thickness compensator comprising a plurality of slits according to various embodiments;

FIG. 207A is an exploded view of a staple cartridge and layers according to at least one embodiment;

FIG. 207B is a cross-sectional view of the layer and tissue T captured between the staple cartridge and the anvil according to at least one embodiment;

FIG. 207C is a perspective view of a layer including cylindrical cleats in accordance with at least one embodiment;

FIG. 208 is a cross-sectional view of the layers in FIG. 207C;

FIG. 209 is a perspective view of a layer including linear protrusions in accordance with at least one embodiment;

FIG. 210 is a cross-sectional view of the layer of FIG. 209;

FIG. 211 is a perspective view of a layer including dome-shaped protrusions in accordance with at least one embodiment;

FIG. 212 is a cross-sectional view of the layers of FIG. 211;

FIG. 213 is a perspective view of a layer including linear depressions in accordance with at least one embodiment;

FIG. 214 is a cross-sectional view of the layers in FIG. 213;

FIG. 215 is a perspective view of a layer including linear protrusions in accordance with at least one embodiment;

FIG. 216 is a cross-sectional view of the layers in FIG. 215;

FIG. 217 is a perspective view of a layer including linear protrusions in accordance with at least one embodiment;

FIG. 218 is a perspective view of a layer including conical protrusions in accordance with at least one embodiment;

FIG. 219 is a perspective view of a layer including pyramidal protrusions in accordance with at least one embodiment;

FIG. 220 is a cross-sectional view of the layers in FIG. 219 in accordance with at least one embodiment;

FIG. 221 is a perspective view of a layer according to at least one embodiment;

FIG. 222 is a cross-sectional view of the layers of FIG. 221;

FIG. 223 is a perspective view of a layer including a depression according to at least one embodiment;

FIG. 224 is a cross-sectional view of the layers in FIG. 223;

FIG. 224A is a cross-sectional view of a layer including a reduced thickness portion and tissue T captured between an anvil including a plurality of staple forming pockets and a staple cartridge in accordance with at least one embodiment;

FIG. 224B is a cross-sectional view of a layer comprising a plurality of protrusions and tissue T captured between an anvil comprising a plurality of staple forming pockets and a staple cartridge in accordance with at least one embodiment;

FIG. 225 is a perspective cutaway view of a layer, such as a tissue thickness compensator, secured to an anvil of a surgical instrument end effector, in accordance with at least one embodiment;

FIG. 226 is a cross-sectional view of the layer of FIG. 225 secured to an anvil;

FIG. 227 is a cross-sectional view of the layers of FIG. 225;

FIG. 228 is a perspective view of an embodiment of a retainer for use with a staple cartridge;

FIG. 229 is a perspective view of a staple cartridge assembly including the retainer of FIG. 228 engaged with a layer to which the staple cartridge and anvil may be attached;

FIG. 230 is a plan view of the staple cartridge assembly of FIG. 229;

FIG. 231 is a cross-sectional end view of the cartridge assembly of FIG. 229, with the cartridge assembly inserted into the cartridge channel of the end effector and the anvil of the end effector positioned relative to the cartridge assembly;

FIG. 232 is a cross-sectional end view of the cartridge assembly and end effector illustrated in FIG. 231 with the anvil pressed against the anvil-attachable layer and retainer;

FIG. 233 is a cross-sectional plan view of the cartridge assembly and end effector illustrated in FIG. 231, with the anvil lifted away from the retainer to thereby remove the attached anvil-attachable layer from the retainer;

FIG. 234 is a cross-sectional plan view of the end effector illustrated in FIG. 231 with the anvil-attachable layer attached thereto and the retainer removed;

fig. 235 is a perspective view of an anvil-attachable layer embodiment in accordance with at least one embodiment;

fig. 236 is a perspective view of an anvil-attachable layer embodiment in accordance with at least one embodiment;

FIG. 237 is a perspective view of an anvil-attachable layer embodiment in accordance with at least one embodiment;

FIG. 238 is a perspective view of an anvil-attachable layer embodiment having a deployable attachment feature in an undeployed configuration;

FIG. 239 is a perspective view of the anvil-attachable layer of FIG. 238, with the deployable attachment features shown in a deployed configuration;

fig. 240 is a cross-sectional plan view of the anvil-attachable layer of fig. 238 positioned relative to an anvil of an end effector with a deployable attachment feature deployed in a slot of the anvil;

fig. 241 is a perspective view of an anvil-attachable layer embodiment having a deployable attachment feature in an undeployed configuration;

Fig. 242 is a perspective view of the anvil-attachable layer of fig. 241, with the deployable attachment features shown in a deployed configuration;

FIG. 243 is a cross-sectional plan view of the anvil-attachable layer of FIG. 241 positioned against an anvil of the end effector with the deployable attachment features deployed in slots of the anvil;

FIG. 244 is an exploded perspective view of an anvil and tissue thickness compensator according to at least one embodiment;

FIG. 245 is a cross-sectional plan view of an anvil including a plurality of staple forming pockets and an anvil-attachable layer (such as a tissue thickness compensator) including a plurality of bladders aligned with the forming pockets in accordance with at least one embodiment;

FIG. 246 is a detail view of the bladder of the anvil-attachable layer of FIG. 245;

FIG. 247 is a schematic view of the anvil of FIG. 245 and an anvil-attachable layer shown positioned against tissue to be stapled by staples from a staple cartridge positioned on the opposite side of the tissue;

FIG. 248 is a schematic view of the FIG. 245 anvil and partially fired staples therefrom shown moving toward the staple cartridge of FIG. 247;

FIG. 249 is a cross-sectional view of an embodiment of an anvil-attachable layer disposed relative to an anvil and patient tissue with staples of a staple cartridge fired through the anvil-attachable layer and the patient tissue;

FIG. 250 is a cross-sectional view of an embodiment of an anvil-attachable layer positioned relative to an anvil and patient tissue, wherein staples of a staple cartridge are fired through the anvil-attachable layer and the patient tissue;

FIG. 251 illustrates the retainer assembly being inserted into a surgical instrument, wherein the surgical instrument includes an anvil and a staple cartridge channel, and wherein a portion of an insertion tool has been removed for purposes of illustration;

FIG. 252 shows the holder assembly of FIG. 251 being inserted into a surgical instrument with a portion of the insertion tool removed for illustration purposes;

FIG. 253 shows the insertion tool of FIG. 251 being moved relative to a retainer to engage a staple cartridge in a staple cartridge channel and to engage an anvil-attachable layer (such as a tissue thickness compensator) with an anvil, with a portion of the insertion tool removed for illustration purposes;

FIG. 254 shows the insertion tool of FIG. 251 with a portion of the insertion tool removed for purposes of illustration, in relative retainer movement to disengage the retainer from the anvil-attachable layer and the staple cartridge;

FIG. 255 is a perspective view of an embodiment of a retainer engaged with a staple cartridge, wherein an anvil-attachable layer having deployable attachment features is engaged with the retainer, and wherein the retainer is positioned for insertion into an end effector;

FIG. 256 is a perspective view of the retainer of FIG. 255;

FIG. 257 is a front view of the holder of FIG. 255;

FIG. 258 is an elevation view of the retainer, staple cartridge, and anvil-attachable layer of FIG. 255 inserted into an end effector with the deployable attachment features of the anvil-attachable layer deployed, and with a portion of the anvil and anvil-attachable layer removed for illustration purposes;

FIG. 259 is an elevation view of an embodiment of a retainer inserted into an end effector, with an anvil-attachable layer having deployable attachment features disposed over the retainer, and with the retainer, anvil-attachable layer, and a portion of the anvil removed for illustration purposes;

fig. 260 is an elevation view of the retainer of fig. 259, with the retainer having deployed the deployable attachment feature of the anvil-attachable layer, and with the retainer, the anvil-attachable layer, and a portion of the anvil removed for illustration purposes;

fig. 261 is a detail elevation view of the retainer, anvil-attachable layer, and anvil of fig. 259, with the deployable attachment features not yet deployed, and with portions of the retainer, anvil-attachable layer, and anvil removed for illustration purposes;

Fig. 262 is a detail elevation view of the retainer, anvil-attachable layer, and anvil of fig. 259, with the deployable attachment features deployed into the slots of the anvil, and with portions of the retainer, anvil-attachable layer, and anvil removed for illustration purposes;

FIG. 263 illustrates a tissue thickness compensator including a flowable attachment portion, according to certain non-limiting embodiments;

FIG. 264 illustrates the pressure sensitive adhesive laminate in an unstressed position aligned with a slot in a staple cartridge in accordance with certain non-limiting embodiments;

FIG. 265 illustrates the pressure sensitive adhesive laminate of FIG. 264 releasably attached to a staple cartridge in accordance with certain non-limiting embodiments;

FIG. 266 illustrates a tissue thickness compensator including a flowable attachment portion according to certain non-limiting embodiments;

FIG. 267 illustrates the pressure sensitive adhesive laminate in an unstressed position aligned with staple cavities in a staple cartridge, according to certain non-limiting embodiments;

FIG. 268 shows the pressure sensitive adhesive laminate of FIG. 267 releasably attached to a staple cartridge in accordance with certain non-limiting embodiments;

fig. 269-273 illustrate a pressure sensitive adhesive laminate including adhesive tabs according to certain non-limiting embodiments;

FIGS. 274-279 illustrate a pressure sensitive adhesive laminate including adhesive tabs according to certain non-limiting embodiments;

fig. 280-283 illustrate a pressure sensitive adhesive laminate including tabs for releasable attachment to an anvil according to certain non-limiting embodiments;

fig. 284-288 illustrate a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments;

fig. 289-292 illustrate a pressure sensitive adhesive laminate releasably attached to an anvil, according to certain non-limiting embodiments;

FIG. 293 is a perspective view of an end effector of the surgical stapling instrument including an implantable transition portion extending from an anvil and an implantable transition portion extending from a staple cartridge;

fig. 294 is a schematic view depicting tissue positioned between an anvil and a staple cartridge of the surgical stapling instrument of fig. 293.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate certain embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

Detailed Description

The applicant of the present application also owns the following identified U.S. patent applications, each of which is hereby incorporated by reference in their respective entireties:

U.S. patent application Ser. No. 12/894,311 (now U.S. patent publication 2012/0080496) entitled "SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS";

U.S. patent application Ser. No. 12/894,340 entitled "SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS" (now U.S. patent publication 2012/0080482);

U.S. patent application Ser. No. 12/894,327 entitled "JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS" (now U.S. patent publication 2012/0080499);

U.S. patent application Ser. No. 12/894,351 entitled "SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS" (now U.S. patent publication 2012/0080502);

U.S. patent application Ser. No. 12/894,338 (now U.S. patent publication 2012/0080481) entitled "IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT";

U.S. patent application Ser. No. 12/894,369 entitled "IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER" (now U.S. patent publication 2012/0080344);

U.S. patent application Ser. No. 12/894,312 entitled "IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS" (now U.S. patent publication 2012/0080479);

U.S. patent application serial No. 12/894,377 entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE" (now U.S. patent publication 2012/0080334);

U.S. patent application Ser. No. 12/894,339 entitled "SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT" (now U.S. patent publication 2012/0080500);

U.S. patent application Ser. No. 12/894,360 entitled "SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM" (now U.S. patent publication 2012/0080484);

U.S. patent application Ser. No. 12/894,322 (now U.S. patent publication 2012/0080501), entitled "SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS";

U.S. patent application Ser. No. 12/894,350 entitled "SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT" (now U.S. patent publication 2012/0080478);

U.S. patent application Ser. No. 12/894,383 entitled "IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS" (now U.S. patent publication 2012/0080345);

U.S. patent application serial No. 12/894,389 entitled "compact FASTENER CARTRIDGE" (now U.S. patent publication 2012/0080335);

U.S. patent application serial No. 12/894,345 entitled "FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT" (now U.S. patent publication 2012/0080483);

U.S. patent application serial No. 12/894,306 entitled "COLLAPSIBLE FASTENER CARTRIDGE" (now U.S. patent publication 2012/0080332);

U.S. patent application Ser. No. 12/894,318 entitled "FASTENER SYSTEM composition A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS" (now U.S. patent publication 2012/0080480);

U.S. patent application Ser. No. 12/894,330 entitled "FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX" (now U.S. patent publication 2012/0080503);

U.S. patent application Ser. No. 12/894,361 entitled "FASTENER SYSTEM COMPRISING A RETENTION MATRIX" (now U.S. patent publication 2012/0080333);

U.S. patent application Ser. No. 12/894,367 entitled "FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX" (now U.S. patent publication 2012/0080485);

U.S. patent application Ser. No. 12/894,388 entitled "FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER" (now U.S. patent publication 2012/0080487);

U.S. patent application Ser. No. 12/894,376 entitled "FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES" (now U.S. patent publication 2012/0080486);

U.S. patent application Ser. No. 13/097,865 entitled "SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS" (now U.S. patent publication 2012/0080488);

U.S. patent application Ser. No. 13/097,936 entitled "TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER" (now U.S. patent publication 2012/0080339);

U.S. patent application Ser. No. 13/097,954 entitled "STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION" (now U.S. patent publication 2012/0080340);

U.S. patent application Ser. No. 13/097,856 entitled "STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF" (now U.S. patent publication 2012/0080336);

U.S. patent application Ser. No. 13/097,928 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING DEACABLE PORTIONS" (now U.S. patent publication 2012/0080490);

U.S. patent application Ser. No. 13/097,891 entitled "TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL" (now U.S. patent publication 2012/0080489);

U.S. patent application Ser. No. 13/097,948 (now U.S. patent publication 2012/0083836), entitled "STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION";

U.S. patent application serial No. 13/097,907 entitled "compact STAPLE CARTRIDGE asset" (now U.S. patent publication 2012/0080338);

U.S. patent application Ser. No. 13/097,861 entitled "TISSUE THICKNESS COMPENSATOR COMPATINING PORTIONS HAVING DIFFERENT PROPERTIES" (now U.S. patent publication 2012/0080337);

U.S. patent application Ser. No. 13/097,869 (now U.S. patent publication 2012/0160721), entitled "STAPLE CARTRIDGE LOADING ASSEMBLY";

U.S. patent application Ser. No. 13/097,917 entitled "COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS" (now U.S. patent publication 2012/0083834);

U.S. patent application Ser. No. 13/097,873 entitled "STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION" (now U.S. patent publication 2012/0083833);

U.S. patent application Ser. No. 13/097,938 entitled "STAPLE CARTRIDGE composite curable resin compositions" (now U.S. patent publication 2012/0080491);

U.S. patent application Ser. No. 13/097,924 entitled "STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR" (now U.S. patent publication 2012/0083835);

U.S. patent application Ser. No. 13/242,029 entitled "SURGICAL STAPLER WITH FLOATING ANVIL" (now U.S. patent publication 2012/0080493);

U.S. patent application Ser. No. 13/242,066 (now U.S. patent publication 2012/0080498), entitled "CURVED END EFFECTOR FOR A STAPLING INSTRUMENTS";

U.S. patent application Ser. No. 13/242,086 entitled "STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK";

U.S. patent application serial No. 13/241,912 entitled "STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT";

U.S. patent application Ser. No. 13/241,922 entitled "SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS";

U.S. patent application Ser. No. 13/241,637 (now U.S. patent publication 2012/0074201) entitled "SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTION MOTIONS";

U.S. patent application Ser. No. 13/241,629 (now U.S. patent publication 2012/0074200), entitled "SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR";

U.S. patent application Ser. No. 13/433,096 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES" (now U.S. patent publication 2012/0241496);

U.S. patent application Ser. No. 13/433,103 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS" (now U.S. patent publication 2012/0241498);

U.S. patent application Ser. No. 13/433,098 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR" (now U.S. patent publication 2012/0241491);

U.S. patent application Ser. No. 13/433,102 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR" (now U.S. patent publication 2012/0241497);

U.S. patent application Ser. No. 13/433,114 entitled "RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR" (now U.S. patent publication 2012/0241499);

U.S. patent application Ser. No. 12/433,136 entitled "TISSUE THICKNESS COMPENSATOR COMPISING AT LEAST ONE MEDICAMENT" (now U.S. patent publication 2012/0241492);

U.S. patent application Ser. No. 13/433,141 entitled "TISSUE THICKNESS COMPENSATOR COMPATINING CONTROLLED RELEASE AND EXPANSION" (now U.S. patent publication 2012/0241493);

U.S. patent application Ser. No. 13/433,144 (now U.S. patent publication 2012/0241500), entitled "TISSUE THICKNESS COMPENSATOR COMPISING FIBERS TO PRODUCE A RESILIENT LOAD";

U.S. patent application Ser. No. 13/433,148 entitled "TISSUE THICKNESS COMPENSATOR COMPISING STRUCTURE TO PRODUCE A RESILIENT LOAD" (now U.S. patent publication 2012/0241501);

U.S. patent application Ser. No. 13/433,155 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING RESILINT MEMBERS" (now U.S. patent publication 2012/0241502);

U.S. patent application Ser. No. 13/433,163 entitled "METHOD FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS" (now U.S. patent publication 2012/0248169);

U.S. patent application Ser. No. 13/433,167 entitled "TISSUE THICKNESS COMPENSATORS" (now U.S. patent publication 2012/0241503);

U.S. patent application Ser. No. 13/433,175 entitled "laminated TISSUE THICKNESS COMPENSATOR" (now U.S. patent publication 2012/0253298);

U.S. patent application Ser. No. 13/433,179 entitled "TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS" (now U.S. patent publication 2012/0241505);

U.S. patent application Ser. No. 13/433,115 entitled "TISSUE THICKNESS COMPENSATOR COMPLEMENTING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT";

U.S. patent application Ser. No. 13/433,118 entitled "TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS";

U.S. patent application Ser. No. 13/433,135 entitled "Movable Membrane FOR USE WITH A TISSUE THICKNESS COMPENSATOR";

U.S. patent application Ser. No. 13/433,140 entitled "TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME";

U.S. patent application Ser. No. 13/433,147 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS";

U.S. patent application Ser. No. 13/433,126 entitled "TISSUE THICKNESS COMPENSATOR COMPISING TISSUE INGROWTH FEATURES";

U.S. patent application Ser. No. 13/433,132 entitled "DEVICES AND METHODS FOR ATTACHING titanium catalyst TO minor catalyst insertion systems"; and

U.S. patent application Ser. No. 13/433,129 entitled "TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS".

U.S. patent application Ser. No. 11/216,562 (now U.S. Pat. No. 7,669,746) entitled "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS";

U.S. patent application Ser. No. 11/714,049 entitled "SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS" (now U.S. patent publication 2007/0194082);

U.S. patent application Ser. No. 11/711,979 (now U.S. Pat. No. 8,317,070) entitled "SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS";

U.S. patent application serial No. 11/711,975 entitled "SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT" (now U.S. patent publication 2007/0194079);

U.S. patent application Ser. No. 11/711,977 entitled "SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES" (now U.S. Pat. No. 7,673,781);

U.S. patent application Ser. No. 11/712,315 (now U.S. Pat. No. 7,500,979) entitled "SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS";

U.S. patent application Ser. No. 12/038,939 (now U.S. Pat. No. 7,934,630) entitled "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS";

U.S. patent application Ser. No. 13/020,263 entitled "SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS" (now U.S. patent publication 2011/0147434);

U.S. patent application Ser. No. 13/118,278 (now U.S. patent publication 2011/0290851), entitled "ROBOTIC-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS";

U.S. patent application Ser. No. 13/369,629 entitled "ROBOTIC-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS" (now U.S. patent publication 2012/0138660);

U.S. patent application Ser. No. 12/695,359 entitled "SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS" (now U.S. patent publication 2010/0127042); and

U.S. patent application Ser. No. 13/072,923 (now U.S. patent publication 2011/0174863), entitled "STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS".

The applicant of the present application also owns the following identified U.S. patent applications filed on the same day as the present application and each of which is herein incorporated by reference in its respective entirety:

U.S. patent application Ser. No. _______________ entitled "SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES" (attorney docket number END7104USCIP1/110606CIP 1);

U.S. patent application Ser. No. _______________ entitled "ADHESIVE FILM LAMINATE" (attorney docket number END6843USCIP19/100528CP 19);

U.S. patent application Ser. No. _______________ entitled "ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE" (attorney docket number END6848USCIP2/100533CIP 2);

U.S. patent application Ser. No. _______________ entitled "RELEABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME" (attorney docket number END6848USCIP3/100533CIP 3);

U.S. patent application Ser. No. _______________ entitled "FASTENER CARTRIDGE COMPRISING A RELEABLE TISSUE THICKNESS COMPENSATOR" (attorney docket number END6848USCIP4/100533CIP 4);

U.S. patent application Ser. No. _______________ entitled "FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR" (attorney docket number END6848USCIP5/100533CIP 5);

U.S. patent application Ser. No. _______________ entitled "FASTENER CARTRIDGE COMPRISING A RELEASABLE ATTACHED TISSUE THICKNESS COMPENSATOR" (attorney docket number END6848USCIP6/100533CIP 6);

U.S. patent application Ser. No. _______________ entitled "STAPLE CARTRIDGE COMPRISING A RELEASBECODECOVER" (attorney docket number END7201 USNP/120294);

U.S. patent application Ser. No. _______________ entitled "ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR" (attorney docket number END7102USCIP2/110604CIP 2);

U.S. patent application Ser. No. _______________ entitled "LAYER compring DEPLOYABLE ATTACHMENT MEMBERS" (attorney docket number END7102USCIP3/110604CIP 3);

U.S. patent application Ser. No. _______________ entitled "LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES" (attorney docket number END6232USCIP1/070348CIP 1);

U.S. patent application Ser. No. _______________ entitled "IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES" (attorney docket number END6232USCIP2/070348CIP 2);

U.S. patent application Ser. No. _______________ entitled "MULTIPLE THICKNESESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES" (attorney docket number END6840USCIP2/100525CIP 2);

U.S. patent application Ser. No. _______________ entitled "RELEABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME" (attorney docket number END6232USCIP3/070348CIP 3);

U.S. patent application Ser. No. _______________ entitled "ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR" (attorney docket number END6232USCIP4/070348CIP 4); and

U.S. patent application Ser. No. _______________ entitled "STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION" (attorney docket number END7200 USNP/120302).

Certain exemplary embodiments will now be described to provide an overall understanding of the structure, function, principles of manufacture, and uses of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

Reference throughout this specification to "various embodiments," "some embodiments," "one embodiment," or "an embodiment," etc., means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases "in various embodiments," "in some embodiments," "in one embodiment," or "in an embodiment," or the like, throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics shown or described in connection with one embodiment may be combined, in whole or in part, with the features, structures, or characteristics of one or more other embodiments, without limitation. Such modifications and variations are intended to be included within the scope of the present invention.

The terms "proximal" and "distal" are used herein with respect to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion away from the clinician. It will be further appreciated that for simplicity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein with respect to the drawings. However, surgical instruments are capable of use in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided. However, one of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein may be used in a number of surgical procedures and applications, including, for example, in conjunction with open surgery. With continued reference to the present detailed description, those of ordinary skill in the art will further appreciate that the various instruments disclosed herein may be inserted into the body in any manner, such as through a natural orifice, through an incision or puncture formed in tissue, and the like. The working portion or end effector portion of the instrument can be inserted directly into a patient or can be inserted through an access device having a working channel through which the end effector and elongate shaft of the surgical instrument can be advanced.

In fig. 1 and 2, a surgical stapling and severing instrument 8010 can include an anvil 8014 that can be repeatedly opened and closed about its pivotal attachment to an elongate staple channel 8016. The staple applying assembly 8012 can comprise an anvil 8014 and a channel 8016, wherein the assembly 8012 can be attached proximally to an elongate shaft 8018 that forms an implement portion 8022. When the staple applying assembly 8012 is closed, or at least substantially closed, the implement portion 8022 can present a sufficiently small cross-section that is suitable for insertion of the staple applying assembly 8012 through a trocar. In various embodiments, the assembly 8012 can be manipulated by a handle 8020 connected to the shaft 8018. The handle 8020 can include user controls such as a knob 8030 that rotates the elongate shaft 8018 and staple applying assembly 8012 about the longitudinal axis of the shaft 8018. The closure trigger 8026, which can be depressed to close the staple applying assembly 8012, can pivot in front of the pistol grip 8036 about a closure trigger pin 8152 (fig. 3) engaged laterally across the handle housing 8154. In various embodiments, when the closure trigger 8026 is clamped, the closure release button 8038 can be presented outwardly on the handle 8020 such that the release button 8038 can be depressed to release the closure trigger 8026 and open the staple applying assembly 8012, as described in more detail below. A firing trigger 8034, which can be pivoted before the closure trigger 8026, can cause the staple applying assembly 8012 to simultaneously sever and staple tissue clamped therein. In various circumstances, as described in more detail below, multiple firing strokes can be employed using the firing trigger 8034 to reduce the amount of force required to be applied by the surgeon's hand per stroke. In certain embodiments, the handle 8020 can include a rotatable right indicator wheel 8040 and/or a left indicator wheel 8041 (fig. 3) that can indicate firing progress. For example, full firing travel may require three full firing strokes of the firing trigger 8034, and thus the

indicator wheels

8040 and 8041 may each rotate up to one-third of a revolution per stroke of the firing trigger 8034. As described in more detail below, the manual firing release lever 8042 can allow the firing system to retract before full firing travel is complete, if desired, and further, the firing release lever 8042 can allow a surgeon or other clinician to retract the firing system if the firing system jams and/or fails.

Referring to fig. 1 and 3, the elongate shaft 8018 can comprise an outer structure that includes a longitudinally reciprocating closure tube 8024 that pivots the anvil 8014 toward its closed position in response to proximal depression of a closure trigger 8026 of the handle 8020. The elongate channel 8018 may be connected to the handle 8020 by a frame 8028 (fig. 3) inside the closure tube 8024. The frame 8028 is rotatably coupled to the handle 8020 such that rotation of the knob 8030 (fig. 1) can rotate the implement portion 8022. With particular reference to fig. 3, the knob 8030 may be constructed from two half-shells that may include one or more inward projections 8031 that may extend through one or more elongated side openings 8070 in the closure tube 8024 and engage the frame 8028. Thus, the knob 8030 and the frame 8028 may be rotated together or simultaneously, such that the rotational position of the knob 8030 determines the rotational position of the implement portion 8022. In various embodiments, the longitudinal length of the longer opening 8070 is long enough to enable the closure tube 8024 to undergo longitudinal closing and opening motions. With respect to generating the closing motion of the closure tube 8024, referring primarily to fig. 3 and 5, an upper portion 8160 of the closure trigger 8026 can push a closure yoke 8162 (fig. 4) forward via a closure link 8164. The closure link 8164 is pivotally attached at its distal end to the closure yoke 8162 by a closure yoke pin 8166 and pivotally attached at its proximal end by a closure link pin 8168. In various embodiments, the closure trigger 8026 can be urged to the open position by a closure trigger tension spring 8246 that is proximally connected to the upper portion 8160 of the closure trigger 8026 and the handle housing 8154 formed by the right and left

half shells

8156, 8158. The tension applied by the tension spring 8246 can be overcome by the closing force applied to the closure trigger 8026 in order to advance the yoke 8162, closure link 8164, and closure tube 8024 distally.

When the closure trigger 8026 is actuated or depressed as described above, the closure release button 8038 can be positioned to enable a surgeon or other clinician to depress the closure release button 8038, and enable the closure trigger 8026 and the rest of the surgical instrument to return to an unactuated state, if desired. In various embodiments, the closure release button 8038 can be connected to a pivoting locking arm 8172 by a central transverse pivot 8173, such that motion can be transferred between the release button 8038 and the locking arm 8172. Referring again to fig. 3, the compression spring 8174 can bias the closure release button 8038 proximally, i.e., clockwise about the central transverse pivot 8173 as viewed from the right, and the upper portion 8160 of the closure trigger 8026 can include a proximal crest 8170 having an aft recess 8171. When the closure trigger 8026 is depressed, the pivoting locking arm 8172 can ride over the proximal crest 8170, and when the closure trigger 8026 reaches its fully depressed position, it will be appreciated that the rear notch 8171 resides beneath the pivoting locking arm 8172, which drops into the rear notch 8171 and locks the rear notch 8171 under the urging of the compression spring 8174. At this point, manual depression of the closure release button 8038 rotates the pivoting locking arm 8172 upward and out of the rear notch 8171, thereby unlocking the closure trigger 8026 and allowing the closure trigger 8026 to return to its undamped position.

Once the closure trigger 8026 is clamped proximally as described above, the firing trigger 8034 can be pulled toward the pistol grip 8036 to advance the firing bar 8032 distally from the handle 8020. In various embodiments, the firing trigger 8034 can pivot about a firing trigger pin 8202 that traverses through and engages the right and left

half shells

8156, 8158 of the handle 8020. When the firing trigger 8034 is actuated, it can advance the linked transmission firing mechanism 8150. The linked transmission firing mechanism 8150 can be urged to a retracted, unfired position by a spring 8184 that is 1) attached to the pistol grip 8036 of the handle 8020, and 2) attached to one of the links of the linked transmission firing mechanism 8150, for example, as described in more detail below. Spring 8184 may include a non-moving tip 8186 connected to housing 8154, and a moving tip 8188 connected to a proximal end 8190 of a steel band 8192. A distally disposed tip 8194 of the steel band 8192 may be attached to an attachment feature 8195 on a forward link 8196a of the plurality of links 8196 a-8196 d, the plurality of links 8196 a-8196 d forming a linked rack 8200. The linked rack 8200 can be flexible such that it can be easily retracted into the pistol grip 8036 and minimize the length of the handle 8020, creating a straight, rigid rack assembly that can transfer significant firing forces to and/or through the firing bar 8032. As described in more detail below, the firing trigger 8034 can be engaged with the first link 8196a during a first actuation of the firing trigger 8034, engaged with the second link 8196b during a second actuation of the firing trigger 8034, engaged with the third link 8196c during a third actuation of the firing trigger 8034, and engaged with the fourth link 8196d during a fourth actuation of the firing trigger 8034, wherein each actuation of the firing trigger 8034 can advance the linked rack 8200 distally an incremental amount. In various embodiments, in addition to the above, multiple strokes of the firing trigger 8034 can rotate the right and left

indicator wheels

8040, 8041 to indicate the distance the linked rack 8200 has advanced.

Referring now to fig. 3 and 5, an anti-backup mechanism 8250 can prevent the combined tension/compression spring 8184 from retracting the linked rack 8200 between firing strokes. In various embodiments, a coupling slide tube 8131 abuts the first link 8196a and connects to the firing bar 8032 to transfer the firing motion. The firing rod 8032 extends proximally out of the proximal end of the frame 8028 and through the through-hole 8408 of the anti-backup plate 8266. The through hole 8408 is sized to slidingly receive the firing bar 8032 when vertically aligned with the firing bar 8032 and to allow the firing bar 8032 to jam in the through hole when tilted. A lower tab attachment 8271 extends proximally from a lower lip of the proximal end of the frame 8028, extending through an aperture 8269 on a lower edge of the anti-backup plate 8266. This lower tab attachment 8271 pulls a lower portion of the anti-backup plate 8266 adjacent to the frame 8028 such that the anti-backup plate 8266 is vertical when the firing rod 8032 is advanced distally and the anti-backup plate 8266 enables the top to tip back to a restrained state when the firing rod 8032 attempts to retract. The anti-backup compression spring 8264 is distally constrained by the proximal end of the frame 8028 and proximally abuts a top portion of the anti-backup plate 8266, biasing the anti-backup plate 8266 to a locked state. An anti-backup cam tube 8268 slidingly surrounds the coupling slide tube 8131 against a spring bias and abuts the anti-backup plate 8266. A proximally projecting anti-backup yoke 8256 attached to the anti-backup cam tube 8268 extends beyond the closure yoke 8162.

Referring to FIG. 3, a linkage triggered automatic retraction mechanism 8289 is incorporated into the surgical stapling and severing instrument 8010 to retract the knife at the end of the full firing travel. To this end, the distal link 8196d includes a tang 8290, the tang 8290 protruding upward when the distal link 8196d is advanced into a rack channel 8291 (fig. 3) formed in the closure yoke 8162. The tang 8290 is aligned to activate the bottom proximal cam 8292 on the anti-backup release lever 8248 (FIG. 6). Referring specifically to fig. 6, structure formed in the right and left

half shells

8156, 8158 constrains movement of the anti-backup release lever 8248. A pin receptacle 8296 and a circular pin 8293, formed respectively between the right and left

half shells

8156, 8158, are received through a longitudinally elongated hole 8294, the hole 8294 being formed in the anti-backup release lever 8248 distal to the bottom proximal cam 8292, allowing longitudinal translation as well as rotation about the circular pin 8293. In the right half shell 8156, the proximally open channel includes a proximal horizontal portion in communication with an upwardly and distally angled portion that receives the rightward aft pin 8297 near the proximal end of the anti-backup release lever 8248, imparting an upward rotation when the anti-backup release lever 8248 reaches its translating distal-most portion. Once the anti-backup release lever 8248 is assembled, a blocking structure formed in the right half shell 8156 proximal to the anti-backup release lever 8248 prevents the anti-backup release lever 8248 from moving proximally to retain the rightward aft pin 8297 in the proximally open channel as described above.

In addition to the above, referring now to fig. 3 and 7, the distal end 8254 of the anti-backup release lever 8248 is thus urged distally and downwardly with the rightward front pin 8298 falling into the distally open stepped structure 8299 formed in the right half shell 8156, this engagement being achieved by securing a compression spring 8300 (fig. 3) to the leftward hook 8301 on the anti-backup release lever 8248 between the rightward front pin 8298 and the longitudinally elongated hole 8294. The other end of the compression spring 8300 is attached to a hook 8302 (fig. 6) formed in the right half shell 8156 at a position closer and lower immediately above the closure yoke 8266. The compression spring 8300 thus pulls the distal end 8254 of the anti-backup release lever 8248 downward and rearward, locking the rightward front pin 8298 into the distally open step structure 8299 as it is advanced distally. Thus, once released, referring to FIG. 7, the anti-backup release lever 8248 remains forward, vertically holding the anti-backup plate 8266, thereby enabling the linked rack 8200 to retract. When the closure yoke 8266 is subsequently retracted upon release of the end effector 8012, the upwardly projecting reset tang 8303 on the closure yoke 8266 contacts the bottom distal cam 8305 of the anti-backup release lever 8248, lifting the rightward front pin 8298 from the distally open step structure 8299 such that the anti-backup compression spring 8264 can urge the anti-backup cam tube 8268 and the anti-backup release lever 8248 proximally to their retracted positions (fig. 6).

In various embodiments, referring to fig. 1-3, the firing trigger 8034 can be operably engaged to the linked rack 8200 in any suitable manner. With specific reference to fig. 2 and 3, the firing trigger 8034 pivots about a firing trigger pin 8202 connected to the housing 8154. As the firing trigger 8034 is depressed toward the pistol grip 8036, an upper portion 8204 of the firing trigger 8034 moves distally about a firing trigger pin 8202, stretching a proximally placed firing trigger tension spring 8206 (fig. 3), which tension spring 8206 is proximally connected between the upper portion 8204 of the firing trigger 8034 and the housing 8154. During each firing trigger depression, an upper portion 8204 of the firing trigger 8034 engages the linked rack 8200 via a spring-biased side pawl mechanism 8210. When the firing trigger is released, the side pawl mechanism is disengaged from the linked rack 8200 and the firing trigger can return to an undepressed, i.e., unfired, position. In use, the angled right side track formed by the proximally and rightwardly facing ramps 8284 in each of the links 8196 a-8196 d is engaged by the side pawl assembly 8285. Specifically, the pawl slide 8270 (fig. 3 and 4) has left and right lower guides 8272 that slide in left and right tracks 8274 (fig. 3) and 8275, respectively, formed in a closure yoke 8266 below the rack channel 8291 and in a closure yoke guide rail 8276 that is parallel to the rack channel 8291 and attached to a rack channel cover 8277 that closes a rightward opening portion of the rack channel 8291 in the closure yoke 8266, the rightward opening portion being distal in the direction of travel of the pawl slide 8270. In fig. 3-5, a compression spring 8278 is attached between a hook 8279 located on the closure yoke rail 8276 at a top proximal location and a hook 8280 located on the distal right side of the pawl slide 8270, which causes the pawl slide 8270 to be pulled proximally into contact with the upper portion 8204 of the firing trigger 8034.

Referring specifically to fig. 3, the pawl block 8318 is positioned on the pawl slide 8270 to pivot about a vertical rear pin 8320, the rear pin 8320 passing through the pawl block 8318 and a left proximal corner of the pawl slide 8270. A kick-out block recess 8322 is formed on a distal portion of the top surface of the pawl block 8318 to receive a kick-out block 8324 pivotally secured therein by a vertical pin 8326, the bottom tip of which vertical pin 8326 extends into a pawl spring recess 8328 on the top surface of the pawl slide 8270. A pawl spring 8330 in the pawl spring recess 8328 extends to the right of the vertical front pin 8326 forcing the pawl block 8318 to rotate counterclockwise when viewed from above into engagement with the angled right track 8282. A small coil spring 8332 in the kick-out block recess 8322 forces the kick-out block 8324 to rotate clockwise when viewed from above, causing its proximal end to be forced into contact with a contoured lip 8334 formed in the closure yoke 8266 above the rack channel 8291. As shown in fig. 5, the greater mechanical advantage of the pawl spring 8330 over the small coil spring 8332 means that the pawl block 8318 is susceptible to engagement with the kick-out block 8324 rotating clockwise. In FIG. 3, when the firing trigger 8034 is fully depressed and begins to be released, the kick-out block 8324 encounters a ridge 8336 in the contoured lip 8334 as the pawl slide 8270 retracts, forcing the kick-out block 8324 to rotate clockwise when viewed from above, kicking the pawl block 8318 out of engagement with the linked rack 8200. The shape of the kick-out block recess 8322 stops clockwise rotation of the kick-out block 8324 to an orientation perpendicular to the contoured lip 8334, maintaining the disengagement during full retraction to eliminate ratcheting noise.

In fig. 3, 4, 8, and 12, the surgical stapling and severing instrument 8010 can include a manual retraction mechanism 8500 that provides for manual release of the firing mechanism, manual retraction, and in one version (fig. 13-15) also performs automatic retraction at the end of full firing travel. Referring now to fig. 3 and 8, specifically, a forward idler gear 8220 is engaged with the toothed left upper surface 8222 of the linked rack 8200, with the forward idler gear 8220 also engaging an aft idler gear 8230 having a smaller right-side ratchet gear 8231. The forward 8220 and aft 8230 idler gears are rotatably connected to the handle housing 8154 on forward 8232 and aft 8234 idler shafts, respectively. Each end of the aft idler shaft 8232 extends through the respective right and left

half shells

8156, 8158 and is attached to the left and

right indicator wheels

8040,8041, and the

indicator wheels

8040,8041 and aft idler gear 8230 rotate together as the aft idler shaft 8234 is free to rotate in the handle housing 8154 and is splined to the aft idler gear 8230. The gear relationship between the linked rack 8200, the forward idler gear 8220, and the aft idler gear 8230 can be advantageously selected such that the toothed upper surface 8222 has tooth dimensions of suitable strength and such that the aft idler gear 8230 does not rotate more than one revolution during the full firing travel of the linked transmission firing mechanism 8150. The gear mechanism 8502, in addition to visually indicating the firing stroke or progress, may also be used to manually retract the knife. In various embodiments, the smaller right-side ratchet gear 8231 of the aft idler gear 8230 extends into the hub 8506 of the manual retraction lever 8042, specifically, in alignment with a vertical, longitudinally aligned slot 8508 (fig. 8) bisecting the hub 8506. The transverse through-hole 8510 of the hub 8506 communicates with the upper recess 8512. The front portion 8514 is shaped to receive a proximally directed locking pawl 8516, which locking pawl 8516 pivots about a rightward transverse pin 8518 formed in the distal end of the upper recess 8512. The rear portion 8520 is shaped to receive an L-shaped spring tab 8522, which spring tab 8522 forces the locking pawl 8516 downward into engagement with the right smaller ratchet gear 8231. A blocking structure 8524 (fig. 6) protrudes from the right half shell 8156 into the upper recess 8512; when the manual retraction lever 8042 is down (fig. 10), the blocking structure 8524 prevents the locking pawl 8516 from engaging the smaller right side ratchet gear 8231. A coil spring 8525 (fig. 3) forces the manual retraction lever 8042 downward.

In use, as depicted in fig. 9 and 10, the combined tension/compression spring 8184 can be disconnected from the distally positioned linked rack. In fig. 11 and 12, when the manual retraction lever 8042 is raised, the locking pawl 8516 rotates clockwise and is no longer stopped by the blocking structure 8524 and engages the smaller right-side ratchet gear 8231, rotating the aft idler gear 8230 clockwise when viewed from the left. Thus, the forward idler gear 8220 responds counterclockwise, retracting the linked rack 8200. Further, a rightward curved ridge 8510 protrudes from the hub 8506, sized to contact and move the anti-backup release lever 8248 distally, releasing the anti-backup mechanism 8250 upon rotation of the manual retraction lever 8042.

In fig. 13-15, an automatic retraction mechanism 8600 of a surgical stapling and severing instrument may incorporate automatic retraction into a forward idler gear 8220a having teeth 8602 at the end of a full firing stroke; the front idler gear 8220a moves within a circular groove 8604 in the cam 8606 until encountering an obstruction after nearly a full rotation corresponding to three firing strokes. In such circumstances, the rightward ridge 8610 rotates upward into contact with the bottom cam groove 8612 to move the anti-backup release lever 8248a distally. Referring specifically to fig. 13, the anti-backup release lever 8248a includes a distal end 8254 that operates as previously described. The circular pin 8293 and pin socket 8296 formed between the right and left

half shells

8156, 8158 are received through a generally rectangular aperture 8294a formed in the anti-backup release lever 8248a behind the bottom cam 8192, allowing longitudinal translation and downward locking movement of the distal end 8254 of the anti-backup release lever 8248 a. In the right half shell 8156, a horizontal proximally open channel receives a rightward rear pin near the proximal end of the anti-backup release lever 8248 a.

In operation, prior to firing in fig. 13 and 14, the linked rack 8200 and the anti-backup cam tube 8268 are in a retracted position, locking the anti-backup mechanism 8250 as the anti-backup compression spring 8264 tilts the anti-backup plate 8266 proximally. The automatic retraction mechanism 8600 is in an initial state with the anti-backup release lever 8248a retracted and the link 8196a in contact with the front idler gear 8220 a. Tooth 8602 is in the six o' clock position and the full travel of circular groove 8604 is counterclockwise, with rightward ridge 8610 just adjacent tooth 8602. After one firing stroke, the linked rack 8200 has moved a distal link 8196b upward into contact with the forward idler gear 8220 a. The tooth 8602 has advanced one-third of a turn through the circular groove 8604 of the fixed cam 8606. After the second firing stroke, the linked rack has moved yet another link 8196c upward into contact with the forward idler gear 8220 a. The tooth 8602 has advanced two thirds of a turn through the circular groove 8604 of the fixed cam 8606. After the third firing stroke, the linked rack 8200 has moved yet another distal link 8196d upward into contact with the forward idler gear 8220 a. The teeth 8602 have advanced all the way around the circular groove 8604 into contact with the above-mentioned obstruction, thereby initiating counterclockwise rotation (when viewed from the right) of the cam 8606, which in turn brings the rightward ridge into contact with the anti-backup release lever 8248 a. In fig. 15, the anti-backup release lever 8248a has moved distally in response thereto, locking the rightward front pin 8298 into the distally open stepped structure 8299 and releasing the anti-backup mechanism 8250. A similar surgical stapling instrument is disclosed in U.S. patent 7,083,075, published 2006, 8/1, the entire disclosure of which is incorporated herein by reference.

Referring to fig. 16, the staple applying assembly 9012 of the surgical stapling instrument 9010 performs the following functions: clamping on the tissue, driving the staples and severing the tissue by two distinct motions transmitted longitudinally down the shaft 9016 relative to the shaft carrier 9070. The shaft bracket 9070 is attached proximally to a handle of the surgical stapling instrument and is coupled to the handle for rotation about a longitudinal axis. An exemplary multi-stroke handle for a SURGICAL STAPLING AND severing INSTRUMENT is described in more detail in co-pending AND commonly owned U.S. patent application Ser. No. 10/374,026 entitled "SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM", the disclosure of which is hereby incorporated by reference in its entirety. Other applications consistent with the present invention may incorporate a single-shot stroke, such as described in co-pending and commonly owned U.S. patent application serial No. 10/441,632, entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS," the disclosure of which is hereby incorporated by reference in its entirety.

Referring specifically to fig. 17, the distal end of the shaft housing 9070 is attached to the staple channel 9018. The anvil 9022 has a proximal pivot end 9072 that is pivotally received within the proximal end 9074 of the staple channel 9018 just distal of its junction with the shaft carrier 9070. As the anvil 9022 pivots downward, the anvil 9022 moves the tissue contacting surface 9028 and the forming pockets 9026 toward the opposing staple cartridge as described in further detail below. The pivot end 9072 of the anvil 9022 includes a closure feature 9076 adjacent to its pivotal attachment to the staple channel 9018, but distal to its pivotal attachment to the staple channel 9018. Thus, the closure tube 9078 (the distal end of which includes the horseshoe-shaped aperture 9080 that engages the closure feature 9076) selectively imparts an opening motion to the anvil 9022 during proximal longitudinal movement and a closing motion to the anvil 9022 during distal longitudinal movement, the closure tube 9078 sliding over the shaft housing 9070 in response to the closure trigger, similar to that described above. The shaft carriage 9070 facilitates and guides the firing motion from the handle through the longitudinally reciprocating two-blade knife and firing bar 9090. In particular, the shaft housing 9070 includes a longitudinal firing bar slot 9092 that receives a proximal portion of a two-piece knife and firing bar 9090, in particular a laminate tapered firing bar 9094. It should be appreciated that the laminated tapered firing bar 9094 may be replaced by a solid firing bar and/or any other suitable material.

The E-beam 9102 is the distal portion of the two-piece knife and firing bar 9090, which facilitates separate closure and firing, as well as spacing the anvil 9022 from the elongate staple channel 9018 during firing. With particular reference to fig. 17 and 19, in addition to any attachment process such as brazing or adhesives, the two-piece knife and firing bar 9090 is also formed with a female vertical attachment hole 9104 formed proximally in the E-beam 9102, which attachment hole 9104 receives a corresponding male attachment member 9106 distally presented by the laminated tapered firing bar 9094, such that each portion is formed of a selected material and method suitable for its different function (e.g., strength, flexibility, friction). The E-beam 9102 may be advantageously formed from a material having suitable material properties. Such material is used to form a pair of top pins 9110, a pair of middle pins 9112, and a bottom pin or foot 9114, and can achieve a sharp cutting edge 9116. In addition, the proximally projecting integrally formed top guide 9118 and middle guide 9120 that cradle each vertical end of the cutting edge 9116 also defines a tissue staging area 9122 that helps guide tissue to the sharp cutting edge 9116 prior to severing the tissue. The intermediate guide 9120 also serves to engage and fire the staple applying assembly 9012 through a stepped central member 9124 that abuts a wedge sled 9126 (fig. 20) to effect staple formation by the staple applying assembly 9012, as described in greater detail below. Integrally molding these features (e.g., the top pins 9110, the middle pins 9112, and the bottom legs 9114) with the E-beam 9102 facilitates manufacturing the desired structure with tighter tolerances relative to each other than if it were assembled from multiple parts, thereby ensuring that the desired operation is achieved during firing and/or during effective interaction with the various lockout features of the staple applying assembly 9012.

In fig. 21 and 22, the staple applying assembly 9012 is shown in an open state with the E-beam 9102 fully retracted. During assembly, the lower leg 9114 of the E-beam 9102 drops through a widened hole 9130 in the staple channel 9018, and the E-beam 9102 is then advanced, causing the E-beam 9102 to slide distally along a lower track 9132 formed in the staple channel 9018. In particular, the lower track 9132 includes a narrow slot 9133 that opens into a widened slot 9134 on the lower surface of the staple channel 9018 to form an inverted T-shape in transverse cross-section, as particularly depicted in fig. 109322 and 23; the narrow slot 9133 communicates with a widened hole 9130. Once the components proximally coupled to the laminated tapered firing bar 9094 are assembled, they no longer allow the lower leg 9114 to travel proximally to the widened hole 9130, allowing disengagement therefrom. Referring to fig. 24, laminating the tapered firing bar 9094 facilitates insertion of the staple applying assembly 9012 through a trocar. Specifically, when the E-beam 9102 is fully retracted, the more distal downward projection 9136 lifts the E-beam 9102. This is achieved by the downward projection 9136 being displaced at a point where the projection 9136 is ejected upward over the proximal edge of the widened hole 9130 in the staple channel 9018. Referring now to fig. 25, the laminated tapered firing bar 9094 also enhances the operation of certain lockout features that may be incorporated into the staple channel 9018 by including a more proximal upward projection 9138. The more proximal upward projection 9138 is urged downward by the carriage 9070 during the initial portion of the firing stroke. In particular, the transverse rod 9140 is defined between a pair of square holes 9142 in the pedestal 9070 (fig. 17). The clamp spring 9144 surrounding the transverse rod 9140 forces a portion of the laminated tapered firing bar 9094 to protrude distally from the longitudinal firing bar slot 9092 downward, ensuring that certain advantageous lockout features are engaged when appropriate. When the upward projection 9138 contacts the clamp spring 9144, the urging force is more pronounced or limited to only that portion of the firing stroke.

In fig. 21 and 22, the E-beam 9102 is retracted with its top pin 9110 positioned within the anvil pocket 9150 near the pivot proximal end of the anvil 9022. A downwardly opening vertical anvil slot 9152 (fig. 16) widens laterally in the anvil 9022 into an anvil inner track 9154, which track 9154 captures the top pins 9110 of the E-beam 9102 as it advances distally during firing, as depicted in fig. 24 and 25, thereby positively separating the anvil 9022 from the staple channel 9018. Thus, when the E-beam 9102 is retracted, the surgeon can repeatedly open and close the staple applying assembly 9012 until satisfactory placement and orientation of the tissue captured therein to be stapled and severed, and the E-beam 9102 facilitates proper positioning of the tissue even with a reduced diameter and a correspondingly reduced stiffness of the staple applying assembly 9012. In fig. 16, 17, 20, 21, 23, and 29, the staple applying assembly 9012 is shown with an alternative staple cartridge 9020 that includes a wedge sled 9126. A plurality of longitudinally aligned and parallel downwardly opening wedge slots 9202 (fig. 23) receive respective wedges 9204 integral with wedge sled 9126. In fig. 23-25, the wedge sled 9126 thus lifts the plurality of staple drivers 9206 upwardly, which can slide vertically within the staple driver recesses 9208. In this exemplary version, each staple driver 9206 includes two vertical prongs, each translating upward into a respective staple hole 9210 or cavity 9024 to force a staple 9023 up against the vertical prong and deform the staple 9023 against the staple forming surface 9214 (fig. 25) of the anvil 9022. A central firing recess 9216 (fig. 17) defined within the staple cartridge 9020 adjacent the staple channel 9018 allows passage of the bottom horizontal portion 9218 (fig. 20) of the wedge sled 9126 as well as the middle pin 9112 of the E-beam 9102. Specifically, a staple cartridge tray 9220 (fig. 17 and 23) is attached to and underlies the polymeric staple cartridge body 9222; the polymeric staple cartridge body 9222 has staple driver recesses 9208, staple holes 9210, and a central firing recess 9216 formed therein. When the staple 9023 is thus formed on either side, the sharp cutting edge 9116 enters a vertical channel 9230 that passes through the longitudinal axis of the staple cartridge 9020 except for only the distal-most end of the vertical channel.

Firing the staple applying assembly 9012 begins as depicted in fig. 25. In fig. 25, the two-blade knife and firing bar 9090 are pulled proximally until the downward projections 9136 jack the middle guide 9120 on the E-beam 9102 up and rearward, whereby a new staple cartridge 9020 can be inserted into the staple channel 9018 when the anvil 9022 is opened, as depicted in fig. 16 and 21. In fig. 26, the two-bladed knife and firing bar 9090 has been advanced distally a small distance, and the downward projection 9136 may drop into the widened hole 9130 of the lower track 9132 as the clamp spring 9144 acts on the upward projection 9138 of the laminated tapered firing bar 9094. The middle guide 9120 prevents further downward rotation due to resting on the stepped central member 9124 of the wedge sled 9126, thereby retaining the middle pin 9112 of the E-beam within the central firing recess 9216. In fig. 27, the two knife and firing bar 9090 has been distally fired advancing the wedge sled 9126 to form the staples 9023 while severing tissue 9242 clamped between the anvil 9022 and the staple cartridge 9020 with the sharp cutting edge 9116. Subsequently, in fig. 28, the two-blade knife and firing bar 9090 is retracted, leaving the distally positioned wedge sled 9126. In fig. 29, the middle pin 9112 is allowed to translate downward into a lockout recess 9240 formed in the staple channel 9018 (see also fig. 22 and 25). Thus, when the wedge sled 9126 (not shown in fig. 29) is not positioned proximally (i.e., the staple cartridge 9020 is missing or the staple cartridge 9020 is depleted), the operator will receive a tactile indication if the middle pin 9112 encounters the distal edge of the lockout recess 9240. A similar surgical stapling instrument is disclosed in U.S. patent 7,380,696, published 3/6/2008, the entire disclosure of which is incorporated herein by reference.

In various embodiments, turning now to fig. 30-38, a surgical instrument 12000 can include a handle 12010, a shaft 12020 extending from the handle 12010, and an end effector 12040 configured to be removably attached to the shaft 12020, as described in more detail further below. The handle 12010 may include a trigger 12014, which trigger 12014 may be actuated to: 1) closing the end effector 12040, and 2) advancing the firing member 12043 distally through the end effector 12040. Although not shown in fig. 30-38, the handle 12010 can include any suitable drive train configured to transmit rotational motion of the trigger 12014 and convert the rotational motion into linear motion of the firing member 12023 extending through the shaft 12010. In use, the trigger 12014 can be actuated toward the pistol grip 12012 of the handle 12010 to advance the firing member 12023 distally along the longitudinal axis 12039 within the shaft 12020, and when the shaft firing member 12023 is operably coupled with the end effector firing member 12043, as described in more detail further below, distal motion of the shaft firing member 12023 can be transferred to the end effector firing member 12043. As the end effector firing member 12043 is advanced distally, the end effector firing member 12043 is configured to engage a first jaw 12040a including an anvil and/or a second jaw 12040b including a staple cartridge channel and move at least one of the first jaw 12040a and the second jaw 12040b toward the other jaw. In addition to the above, referring primarily to fig. 30-32, the end effector 12040 may be assembled to the shaft 12010 in a direction transverse to the longitudinal axis 12039. For example, the end effector 12040 may be assembled to the shaft 12010, e.g., in a direction perpendicular to the longitudinal axis 12039. In such instances, the end effector 12040 can be moved toward the shaft 12010 such that the frame 12041 of the end effector 12040 engages and is connected to the frame 12021, and such that the proximal end 12044 of the firing member 12043 engages and is connected to the distal end 12024 of the firing member 12023. The shaft carrier 12021 can include a channel 12022 defined therein, which can be configured to slidably receive a shaft firing member 12023 and define a longitudinal axis 12039. To align the end effector frame 12041 with the shaft mount 12021, in various embodiments, the proximal end 12045 of the end effector frame 12041 and the distal end 12025 of the shaft mount 12021 can include cooperating dovetail features that, for example, enable the end effector 12040 to be oriented relative to the shaft 12020. The shaft mounts 12021 can also include mounting holes 12026 defined therein, which mounting holes 12026 can be configured to receive mounting tabs 12046 extending from the end effector frame 12041. Due to the mounting features 12026 and 12046, and/or the cooperating dovetail features of the

ends

12025 and 12045, the end effector 12040 can be securely mounted to the shaft 12020 in all circumstances. In various embodiments, the surgical instrument 12000 can further comprise a lock collar 12030, which lock collar 12030 can be configured to lock the end effector 12040 to the shaft 12020. Referring now primarily to fig. 34-36, the lock collar 12030 can be moved between an unlocked position (fig. 34 and 35) and a locked position (fig. 36). When the lock collar 12030 is in its unlocked position (see fig. 34), the end effector 12040 can be assembled to the shaft 12020. Once the end effector 12040 has been engaged with the shaft 12020, the lock collar 12030 can be slid over the interconnection between the end effector 12040 and the shaft 12020 to lock the end effector 12040 in place. More specifically, in at least one embodiment, the lock collar 12030 can define an inner bore 12031, and the inner bore 12031 can be configured to closely receive the outer periphery of the end effector 12040 and the shaft 12020. In certain embodiments, the surgical instrument 12000 can include a spring or biasing member configured to bias the lock collar 12030 into its locked position. In such embodiments, the clinician may pull the lock collar 12030 proximally against the biasing force of the spring and then release the lock collar 12030, allowing the spring to return the lock collar 12030 to its locked position.

Referring again to fig. 30-38, and primarily to fig. 32 and 33, the surgical instrument 12000 can include an articulation joint 12050. In various embodiments, the articulation joint 12050 can be configured to allow a distal portion of the end effector 12040 to pivot about an axis defined by the articulation joint 12050. In this embodiment, the end effector 12040 can include a proximal portion fixedly mounted to the shaft 12020 and a distal portion rotatable relative to the proximal portion about the articulation joint 12050. In certain embodiments, the surgical instrument 12000 can comprise a lock configured to engage and disengage a distal portion of the end effector 12040. For example, the end effector 12040 can include an end effector lock portion 12047, which end effector lock portion 12047 can be pushed distally to lock a distal portion of the end effector 12040 into place, and/or can be pulled proximally to unlock a distal portion of the end effector 12040. The surgical instrument 12000 can further include a lock actuator 12060 adjacent to the handle 12010, for example, the lock actuator 12060 can be pulled proximally to pull the end effector lock portion 12047 proximally. In such embodiments, the lock actuator 12060 can be operably coupled with a lock portion 12027 extending through a shaft 12020, the shaft 12020 being operably coupled, or can be operably coupled, to the end effector lock portion 12047. In at least one such embodiment, the proximal end 12048 of the end effector lock portion 12047 can be assembled to the distal end 12028 of the lock portion 12027 when the end effector 12040 is assembled to the shaft 12020. In at least one such embodiment, the end effector lock portion 12047 can be assembled to the lock portion 12027 at the same time the end effector firing member 12043 is assembled to the shaft firing member 12023.

In various embodiments, as described above, a staple cartridge can comprise a cartridge body comprising a plurality of staple cavities defined therein. The cartridge body can comprise a deck and a top deck surface, wherein each staple cavity can define an opening in the deck surface. As also described above, staples can be positioned within each staple cavity such that the staples are stored within the cartridge body until they are ejected from the cartridge body. In various embodiments, the staples can be loaded within the cartridge body before being ejected from the cartridge body such that the staples do not protrude above the deck surface. In such embodiments, the likelihood of staples being damaged and/or prematurely contacting the target tissue may be reduced when the staples are positioned below the deck surface. In various circumstances, the staples can be moved between an unfired position, wherein the staples do not protrude from the cartridge body, and a fired position; in the fired position, the staples have been exposed from the cartridge body and can contact an anvil positioned opposite the staple cartridge. In various embodiments, the anvil and/or staple forming pockets defined within the anvil can be positioned a predetermined distance above the deck surface such that the staples are deformed to a predetermined formed height when deployed from the cartridge body. In some instances, the thickness of the tissue captured between the anvil and the staple cartridge can vary. Thus, thicker tissue may be captured within some staples, while thinner tissue may be captured within some other staples. In either case, the clamping pressure or force applied by the staples to the tissue may vary from staple to staple, for example, or may vary between staples at one end of a row of staples and staples at the other end of the row of staples. In some instances, the gap between the anvil and the staple cartridge deck may be controlled such that the staples exert a certain minimum clamping pressure within each staple. In some such situations, however, significant variations in the clamping pressure within different staples may still exist.

In use, in addition to the above, and referring primarily to fig. 39, for example, an anvil (such as anvil 10060) can be moved to a closed position opposite the staple cartridge 10000. As described in greater detail below, the anvil 10060 can position tissue against the tissue thickness compensator 10020 and, in various embodiments, press the tissue thickness compensator 10020 against the deck surface 10011 of the support portion 10010, for example. Once the anvil 10060 has been properly positioned, the staples 10030 can be deployed, which is also illustrated in fig. 39. In various embodiments, as described above, the staple firing sled 10050 can be moved from the proximal end 10001 toward the distal end 10002 of the staple cartridge 10000, as shown in fig. 40. As the sled 10050 is advanced, the sled 10050 can contact the staple drivers 10040 and lift the staple drivers 10040 upwardly within the staple cavities 10012. In at least one embodiment, the sled 10050 and the staple drivers 10040 can each comprise one or more ramps or inclined surfaces that can cooperate to move the staple drivers 10040 upwardly from their unfired positions. In at least one such embodiment, each staple driver 10040 can comprise at least one ramped surface, and the sled 10050 can comprise one or more ramped surfaces such that the sled ramped surfaces can slide under the driver ramped surfaces as the sled 10050 is advanced distally within the staple cartridge. As the staple drivers 10040 are lifted upwardly within their respective staple cavities 10012, the staple drivers 10040 can lift the staples 10030 upwardly such that the staples 10030 can be exposed from their staple cavities 10012 through openings in the staple deck 10011 (fig. 41). In an exemplary firing sequence, the sled 10050 can contact the first staples 10030 and begin lifting the first staples 10030 upward. As the sled 10050 is advanced farther laterally, the sled 10050 can begin to lift additional staples 10030, and any other subsequent staples, in a sequential order. The sled 10050 can drive the staples 10030 upward such that the legs 10032 of the staples, which are in contact with the opposing anvil, are deformed to a desired shape and ejected from the support portion 10010. In various circumstances, as part of the firing sequence, the sled 10050 can simultaneously move a plurality of staples upward.

Referring to fig. 49-54, each staple 10030 can be deformed such that a compressed area 10039 is defined therein. For example, each staple 10030 can comprise a base 10031 and one or more legs 10032 extending from the base 10031. As these legs deform, the base 10031 can cooperate to define an area in which tissue T and tissue thickness compensator 10020 can be captured. Within the compression region 10039, the tissue thickness compensator 10020 can apply pressure to the tissue T and, in some instances, assume different compressed heights depending on the thickness of the tissue T. In some instances, the tissue thickness compensator 10020 can resiliently fill gaps, i.e., free spaces, within the compression regions 10039 defined by the staples 10030.

As described above and referring to fig. 41, the staple legs 10032 of the staples 10030 can extend above the deck surface 10011 of the support portion 10010 when the staples 10030 are in their unfired positions. In various embodiments, the tips of the staple legs 10032, or any other portion of the staple legs 10032, may not protrude through the top tissue-contacting surface 10021 of the tissue thickness compensator 10020 when the staples 10030 are in their unfired position. As the staples 10030 are moved from their unfired positions to their fired positions, the tips of the staple legs can protrude through the tissue contacting surface. In various embodiments, the tips of the staple legs 10032 can comprise sharp tips that can cut into and penetrate the tissue thickness compensator 10020. In certain embodiments, the tissue thickness compensator 10020 can comprise a plurality of apertures which can be configured to receive the staple legs 10032 and allow the staple legs 10032 to slide relative to the tissue thickness compensator 10020. In certain embodiments, the support portion 10010 can further comprise a plurality of guides 10013 (fig. 41) extending from the platform surface 10011. The guides 10013 can be positioned adjacent to the staple cavity openings in the deck surface 10011 such that the staple legs 10032 can be at least partially supported by the guides 10013. In certain embodiments, the guide 10013 can be positioned at the proximal and/or distal ends of the staple cavity opening. In various embodiments, a first guide 10013 can be positioned at a first end of each staple cavity opening and a second guide 10013 can be positioned at a second end of each staple cavity opening such that each first guide 10013 can support a first staple leg 10032 of a staple 10030 and each second guide 10013 can support a second staple leg 10032 of a staple 10030. In at least one embodiment, referring to fig. 41, each guide 10013 can, for example, comprise a channel or slot, such as channel 10016, in which the staple legs 10032 can be slidably received. In various embodiments, each guide 10013 can comprise cleats, protrusions, and/or spikes that can extend from the deck surface 10011 and into the tissue thickness compensator 10020. In at least one embodiment, as described in greater detail below, cleats, protrusions, and/or spikes can reduce relative movement between the tissue thickness compensator 10020 and the support portion 10010. In certain embodiments, the tips of the staple legs 10032 can be positioned in the guides 10013 and can not extend above the top surface of the guides 10013 when the staples 10030 are in their unfired positions. In at least such embodiments, the guides 10013 can define a guide height and the staples 10030 can not extend above the guide height when the staples 10030 are in their unfired positions.

In various embodiments, a tissue thickness compensator (such as tissue thickness compensator 10020) can be constructed from a single sheet of material, for example. In at least one embodiment, the tissue thickness compensator can comprise a continuous sheet of material that can cover the entire top deck surface 10011 of the support portion 10010, or less than the entire deck surface 10011. In certain embodiments, the sheet of material can cover the staple cavity openings in the support portion 10010, while in other embodiments, the sheet of material can include openings that can be aligned, or at least partially aligned, with the staple cavity openings. In various embodiments, the tissue thickness compensator can be constructed from multiple layers of material. In some embodiments, the tissue thickness compensator can comprise a compressible core and a wrap surrounding the compressible core.

In various embodiments, the tissue thickness compensator can comprise a wrap for releasably retaining the compressible core to the support portion 10010. In at least one such embodiment, the staple cartridge can further comprise a retainer clip, which can be configured to inhibit the wrap and compressible core from prematurely separating from the support portion 10010. In certain embodiments, as described above, the tissue thickness compensator can be removably attached to the support portion 10010 by staples 10030. More specifically, as also described above, when the staples 10030 are in their unfired positions, the legs of the staples 10030 can extend into the tissue thickness compensator 10020, thereby releasably retaining the tissue thickness compensator 10020 to the support portion 10010. In at least one embodiment, the legs of the staples 10030 can be in contact with the sidewalls of their respective staple cavities 10012 wherein, due to the friction between the staple legs 10032 and the sidewalls, the staples 10030 and the tissue thickness compensator 10020 can be held in place until the staples 10030 are deployed from the staple cartridge 10000. When the staples 10030 are deployed, the tissue thickness compensator 10020 can be captured within the staples 10030 and retained against the stapled tissue T. When the anvil is subsequently moved to the open position to release the tissue T, the support portion 10010 can be moved away from the tissue thickness compensator 10020 which has been secured to the tissue. In certain embodiments, the tissue thickness compensator 10020 can be removably retained to the support portion 10010 using an adhesive. In at least one embodiment, a two-part adhesive may be used. In at least one embodiment, wherein a first portion of the adhesive can be placed on the platform surface 10011 and a second portion of the adhesive can be placed on the tissue thickness compensator 10020 such that when the tissue thickness compensator 10020 is placed against the platform surface 10011, the first portion can contact the second portion to activate the adhesive and detachably bond the tissue thickness compensator 10020 to the support portion 10010. In various embodiments, the tissue thickness compensator can be detachably retained to the support portion of the staple cartridge using any other suitable method.

In various embodiments, in addition to the above, the sled 10050 can be advanced from the proximal end to the distal end to fully deploy all of the staples 10030 contained within the staple cartridge 10000. In at least one embodiment, referring now to fig. 44, the sled 10050 can be advanced distally within a longitudinal cavity within the support portion 10010 by a firing member or knife bar 10052 of a surgical stapler. In use, a staple cartridge 10000 can be inserted into a staple cartridge channel in a jaw of a surgical stapler and the firing member 10052 can be advanced into contact with the sled 10050, as illustrated in fig. 44. As the sled 10050 is advanced distally by the firing member 10052, the sled 10050 can contact the proximal-most staple driver or drivers 10040 and fire (i.e., eject) the staples 10030 from the cartridge body 10010 as described above. As shown in fig. 44, the firing member 10052 can further comprise a cutting edge 10053 that can be advanced distally through a knife slot in the support portion 10010 when the staples 10030 are fired. In various embodiments, the respective knife slot can extend through an anvil positioned opposite the staple cartridge 10000 such that, in at least one embodiment, the cutting edge 10053 can extend between the anvil and the support portion 10010 and incise the tissue and the tissue thickness compensator positioned between the anvil and the support portion 10010. In various circumstances, the sled 10050 can be advanced distally by the firing member 10052 until the sled 10050 reaches the distal end of the staple cartridge 10000. At this point, the firing member 10052 can be retracted proximally. In some embodiments, the sled 10050 can be retracted proximally with the firing member 10052, but in various embodiments, the sled 10050 can remain in the distal end 10002 of the staple cartridge 10000 as the firing member 10052 is retracted. Once the firing member 10052 has been sufficiently retracted, the anvil can be reopened, at which point the tissue thickness compensator 10020 can be separated from the support portion 10010 and the remaining non-implanted portion (including the support portion 10010) of the spent staple cartridge 10000 can be removed from the staple cartridge channel.

After the depleted staple cartridge 10000 is removed from the staple cartridge channel, a new staple cartridge 10000 or any other suitable staple cartridge may be inserted into the staple cartridge channel in addition to the above. In various embodiments, in addition to the above, the staple cartridge channel, the firing member 10052, and/or the staple cartridge 10000 can comprise cooperating features that can prevent the firing member 10052 from being advanced distally again when a new unfired staple cartridge 10000 has not yet been positioned in the staple cartridge channel 10070. More specifically, when the firing member 10052 is advanced into contact with the sled 10050, and when the sled 10050 is in its proximal, unfired position, a support nose of the firing member 10052 can be positioned on and/or over a support ledge on the sled 10050 such that the firing member 10052 is held in a position sufficiently upward to prevent a lock or beam 10054 extending from the firing member 10052 from falling into a lock recess defined within the cartridge channel. Since the lock 10054 will not fall into the lock recess under such circumstances, the lock 10054 may not abut the distal side wall of the lock recess as the firing member 10052 is advanced. As the firing member 10052 pushes the sled 10050 distally, the firing member 10052 can be supported in its upward fired position due to the support nose resting against the support flange. When the firing member 10052 is retracted relative to the sled 10050 as described above, the firing member 10052 can fall from its upward position as the support nose no longer rests against the support ledge of the sled 10050. In at least one such embodiment, the surgical stapler can comprise a spring and/or any other suitable biasing element that can be configured to bias the firing member 10052 to its downward position. Once the firing member 10052 has been fully retracted, it cannot be advanced distally through the spent staple cartridge 10000 again. More specifically, when the sled 10050 is left at the distal end of the staple cartridge 10000 at this point in the operating sequence, the firing member 10052 cannot be held in its upper position by the sled 10050. Thus, as discussed above, if the firing member 10052 is advanced again without replacing the staple cartridge, the lock beam 10054 will contact the side walls 10057 of the lock recess, which will prevent the firing member 10052 from being advanced again distally into the staple cartridge 10000. In other words, once the spent staple cartridge 10000 has been replaced with a new staple cartridge, the firing member 10052 can be retained in its upper position and the firing member 10052 allowed to advance distally again due to the proximally positioned sled 10050 of the new staple cartridge.

As described above, the sled 10050 can be configured to move the staple drivers 10040 between a first, unfired position and a second, fired position in order to eject the staples 10030 from the support portion 10010. In various embodiments, the staple drivers 10040 can be loaded within the staple cavities 10012 after the staples 10030 have been ejected from the support portion 10010. In certain embodiments, the support portion 10010 can comprise one or more retention features that can be configured to prevent the staple drivers 10040 from ejecting or falling out of the staple cavities 10012. In various other embodiments, the sled 10050 can be configured to eject the staple drivers 10040 from the support portion 10010 with the staples 10030. In at least one such embodiment, the staple drivers 10040 can be comprised of a bioabsorbable material and/or a biocompatible material, such as polyetherimide, for example. In certain embodiments, the staple drivers can be attached to the staples 10030. In at least one such embodiment, the staple drivers can be molded over and/or around the base of each staple 10030 such that the staple drivers are integrally formed with the staples. U.S. patent application Ser. No. 11/541,123 entitled "SURGICAL STAPLES HAVING COMPOSITABLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME" filed on 29.9.2006 is hereby incorporated by reference in its entirety.

In various instances, in addition to the above, the compressible tissue thickness compensator can move, twist, and/or deflect relative to the underlying rigid support portion of the staple cartridge. In various embodiments, the support portion and/or any other suitable portion of the staple cartridge can include one or more features configured to limit relative movement between the tissue thickness compensator and the support portion. As described above, at least a portion of the staples 10030 can extend above the deck surface 10011 of the support portion 10010 wherein, in certain instances, lateral forces applied to the tissue thickness compensator can be resisted by, for example, the staples 10030 and/or the cleats 10013 extending from the support portion 10010. In various circumstances, the staples 10030 can tilt and/or bend within the staple cavities 10012 as they resist lateral movement of the tissue thickness compensator, wherein in various embodiments, the staple cavities 10012 and the staples 10030 can be sized and configured to maintain relative alignment between the legs 10032 of the staples 10030 and the forming pockets in the opposing anvil 10060 such that the staples 10000 are properly formed during the staple forming process. In various embodiments, the staples 10030 and/or cleats 10013 can be configured to prevent, or at least limit, lateral distortion within the tissue thickness compensator 10020. In at least one such embodiment, the staples 10030 and/or cleats 10013, for example, can be configured to reinforce or restrict lateral and/or longitudinal movement of a first surface or tissue-contacting surface of the tissue thickness compensator relative to a second, bottom surface. In various embodiments, the staple cartridge and/or the staple cartridge channel in which the staple cartridge is positioned can comprise at least one distortion minimizing member that can extend upwardly to limit lateral and/or longitudinal movement or distortion of the tissue thickness compensator. As described above, the wrap at least partially surrounding the tissue thickness compensator can also prevent, or at least limit, lateral and/or longitudinal movement or twisting of the tissue thickness compensator.

In various embodiments, a staple cartridge can comprise a plurality of staple cavities, each staple cavity containing a staple positioned therein, wherein the staple cavities can be arranged in a plurality of rows, and wherein an anvil positioned opposite the staple cartridge can comprise a plurality of staple forming pockets corresponding to the staple cavities in the staple cartridge. In other words, the anvil can comprise a plurality of rows of forming pockets, wherein each forming pocket can be positioned opposite a staple cavity in the staple cartridge. In various embodiments, each forming pocket can comprise two forming cups configured to receive the staple legs 10032 of a staple 10030, wherein each forming cup is configured to receive a staple leg 10032 and form or crimp the staple leg 10032, e.g., toward the other staple leg 10032. In various circumstances, the staple legs 10032 can fail or not properly enter the forming cups and, as a result, the staple legs 10032 can become deformed during the firing sequence. In various embodiments described herein, the anvil can include an array or grid of forming pockets each configured to receive and form staple legs. In at least one such embodiment, the array of forming pockets can include a number of forming pockets that exceeds the number of staples contained within the staple cartridge. In at least one embodiment, a staple cartridge can comprise, for example, six longitudinal rows of staple cavities, wherein the anvil can comprise six rows of forming pockets aligned with the six rows of staple cavities, and further wherein the forming pockets are positioned intermediate the rows of forming pockets. For example, on one side of the anvil, the anvil can comprise a first row of forming pockets positionable over a first row of staple cavities, a second row of forming pockets positionable over a second row of staple cavities adjacent to the first row of staple cavities, and a row of forming pockets positioned intermediate the first row of forming pockets and the second row of forming pockets.

In various embodiments, as described above, for example, the anvil can be moved from an open position to a closed position in order to compress tissue against a tissue thickness compensator (such as tissue thickness compensator 10020) of the staple cartridge. In various instances, the tissue thickness compensator can be positioned adjacent to the support portion of the staple cartridge prior to positioning the tissue thickness compensator relative to the tissue. In certain embodiments, the tissue thickness compensator 10020 can be in a position that: in this position, the tissue thickness compensator 10020 abuts the support portion 10018 before the anvil is moved to its closed position. In certain other embodiments, the tissue thickness compensator 10020 can be in a position that: in this position, a gap exists between the tissue thickness compensator 10020 and the support portion 10018. In at least one such embodiment, the anvil can displace the tissue and the tissue thickness compensator 10020 downward until the tissue thickness compensator 10020 abuts the support portion 10018, at which point the anvil can be moved to its closed position and create compression within the tissue. If the surgeon does not feel satisfactory with respect to the positioning of the tissue between the anvil and the staple cartridge, the anvil may be opened, the position of the anvil and staple cartridge adjusted, and then the anvil closed again. As the staple cartridge can be so positioned and repositioned relative to the tissue, in various circumstances, for example, the distal end of the tissue thickness compensator 10020 can be separated from the support portion 10010. In some such circumstances, the distal end of the tissue thickness compensator 10020 can contact tissue and peel away from the support portion 10010 or roll up relative to the support portion 10010. In various embodiments, as described in greater detail below, the staple cartridge can include one or more features configured to releasably retain the tissue thickness compensator to an underlying support portion of the staple cartridge.

In various embodiments, referring now to fig. 55, the staple cartridge 10300 can comprise a support portion 10310, a tissue thickness compensator 10320 supported by the support portion 10310, and a distal end 10302 comprising a nose 10303, the nose 10303 configured to releasably retain the distal end 10325 of the tissue thickness compensator 10320 in place. In at least one embodiment, the nose 10303 can include a slot 10305 configured to receive the distal end 10325 of the tissue thickness compensator 10320. In various embodiments, the distal end 10325 can be compressed or wedged within the slot 10305 such that the distal end 10325 can be held in place when the staple cartridge 10300 is positioned relative to tissue. In at least one such embodiment, the slots 10305 can be oriented in a direction parallel, or at least substantially parallel, to the platform surface 10311 of the support portion 10310. In various embodiments, the slot 10305 can be horizontal relative to the platform surface 10311. In various other embodiments, referring now to fig. 56, the staple cartridge 10400 can comprise a support portion, a tissue thickness compensator 10420 supported by the support portion, and a distal end 10402 comprising a nose 10403, the nose 10403 configured to releasably hold a distal end 10425 of the tissue thickness compensator 10420 in place. In at least one embodiment, the distal end 10425 can include a protrusion extending therefrom, and the nose 10403 can include a vertical slot 10405 configured to receive the protrusion of the distal end 10425. In various embodiments, the distal end 10425 and/or the projections extending therefrom can be compressed or wedged within the slot 10405 such that the distal end 10425 can be held in place when the staple cartridge 10400 is positioned relative to the tissue. In certain embodiments, for example, the tissue thickness compensator 10420 can comprise a slot (such as slot 10429) that can be configured to receive at least a portion of the nose 10403 therein. In at least one embodiment, the slots 10405 can be oriented in a direction perpendicular, or at least substantially perpendicular, to the platform surface 10411 of the support portion. In various embodiments, referring now to fig. 57, a staple cartridge 10500 can comprise a support portion, a tissue thickness compensator 10520 supported by the support portion, and a distal end 10502 comprising a nose configured to releasably hold the distal end 10525 of the tissue thickness compensator 10520 in place. In at least one embodiment, the nose can include a vertical slot 10505 configured to receive the distal end 10525 of the tissue thickness compensator 10520. In various embodiments, the distal end 10525 can be compressed or wedged within the slot 10505 such that the distal end 10525 can be held in place when the staple cartridge 10500 is positioned relative to tissue.

In various embodiments, referring again to fig. 55, the tissue thickness compensator 10320 can comprise a top surface 10324, the top surface 10324 can be positioned above the top surface 10304 of the nose 10303. Fig. 44 illustrates another exemplary embodiment in which a top surface of a tissue thickness compensator is positioned over the nose of a staple cartridge, wherein, for example, the top surface 10721 of the tissue thickness compensator 10720 is positioned over the top surface 10004 of the nose 10003. In use, referring again to fig. 55, tissue can slide over the top surface 10304 of the nose 10303 and, in some instances, the tissue can contact the distal end 10325 of the tissue thickness compensator 10320 and a force can be applied to the tissue thickness compensator 10320, thereby facilitating the tissue thickness compensator 10320 to peel away from the support portion 10310. In the embodiments described herein, this peel force can be resisted by the portion of the distal end 10325 wedged within the nose 10303. In any event, once the tissue has been properly positioned relative to the staple cartridge 13000, the anvil can be rotated to a closed position to compress the tissue and the tissue thickness compensator 10320 against the support portion 10310. In at least one such embodiment, the anvil can be rotated to a position that: in this position, the anvil contacts the top surface 10304 of the nose 10303, thus preventing further rotation of the anvil. In various circumstances, because the top surface 10324 of the tissue thickness compensator 10320 is being positioned above the top surface 10304 of the nose 10303, the top surface 10324 can be pushed downward toward the support portion 10310 as the anvil is being closed, and in some cases, for example, the top surface 10324 can be pushed below the top surface 10304 of the nose 10303. As described herein, after the staples contained within the staple cartridge 10300 have been deployed and the tissue thickness compensator 10320 has been incised, the support portion 10310 and the nose 10303 can be moved away from the tissue thickness compensator 10320 such that the distal end 10325 of the tissue thickness compensator 10320 can slide out of the slot 10305.

As described above, an anvil (such as the anvil 10060), for example, can be rotated to a closed position in which the anvil 10060 contacts a top nose surface 10004 of a staple cartridge (such as the staple cartridge 10000). The amount by which the tissue thickness compensator (such as tissue thickness compensator 10020) is compressed once the anvil has reached its closed position will depend on, among other things, the uncompressed thickness or height of the tissue thickness compensator, and the thickness of the tissue. Referring now to fig. 42 and 43, the tissue thickness compensator 10920 can comprise a top surface that is flush, or at least substantially flush, with the top surface 10004 of the nose 10003. In such embodiments, the top surface of the tissue thickness compensator 10920 can be urged below the top surface 10004 of the nose 10003. Referring now to fig. 47 and 48, a tissue thickness compensator (such as tissue thickness compensator 10820) can comprise, for example, a top surface 10821. The top surface 10821 is positioned below the top nose surface 10004 prior to the tissue thickness compensator 10820 being compressed by the tissue T and the anvil 10060. In the case of relatively thin tissue T, as shown in fig. 45 and 46, the tissue thickness compensator 10920 may undergo relatively little compression. Referring now to fig. 47 and 48, when the tissue T is relatively thick, the tissue thickness compensator 10820 can undergo greater compression. In the case of tissue T having both thinner and thicker portions, as shown in fig. 47 and 48, for example, the tissue thickness compensator 10820 may be compressed a greater amount when it is positioned under thicker tissue T and a lesser amount when it is positioned under thinner tissue T. In this manner, the tissue thickness compensator can compensate for different tissue thicknesses, as described above.

In various embodiments, referring now to fig. 58 and 59, the surgical stapling instrument can comprise 1) a cartridge channel 16670 configured to receive a staple cartridge 16600, and 2) an anvil 16660 pivotably coupled to the cartridge channel 16670. The staple cartridge 16600 can include a support portion 16610 and a tissue thickness compensator 16620, wherein a distal end 16625 of the tissue thickness compensator 16620 can be releasably retained to the support portion 16610 by a nose 16603 at the distal end 16602 of the staple cartridge 16600. In at least one embodiment, the nose 16603 can include a slot 16605 and can be constructed from a flexible material. In use, referring primarily to fig. 58, the nose 16603 can be flexed downward to enlarge the opening of the slot 16605. In certain embodiments, the nose 16603 can include a notch or cutout 16606, which can be configured to enable downward deflection of the nose 16603. Regardless, in various circumstances, the enlarged opening of the slot 16605 can facilitate insertion of the distal end 16625 of the tissue thickness compensator 16620 into the slot 16605. Once the tissue thickness compensator 16620 has been properly positioned, the nose 16603 can be released. Because of the resiliency of the material comprising the nose 16603, the nose 16603 can return, or at least substantially return, to its undeflected state and trap the distal end 16625 of the tissue thickness compensator 16620 against the platform surface 16611, as shown in fig. 59. In use, similar to the above, the distal end 16625 can be pulled out of the slot 16605 as the support portion 16610 is moved away from the stapled tissue. In various circumstances, the flexible nose 16603 can be configured to deflect when the tissue thickness compensator 16620 is separated from the support portion 16610. In various embodiments, referring again to fig. 59, the tissue thickness compensator 16620 can comprise a top surface 16621 that is aligned, or at least substantially aligned, with a top surface 16604 of the nose 16603.

In various embodiments, referring now to fig. 60-61, a staple cartridge (such as staple cartridge 11400) can comprise, for example, a tissue thickness compensator 11420 removably attached to a support portion 11410. In at least one embodiment, the staple cartridge 11400 can include one or more retainer bars 11413 configured to retain the longitudinal sides of the tissue thickness compensator 11420 to the deck surface 11411. In at least one such embodiment, each retainer bar 11413 can include opposing arms 11418 that can define a channel 11416 therebetween. In such embodiments, one of the arms 11418 can be configured to extend over the tissue thickness compensator 11420 and the other arm 11418 can be configured to extend under a lip 11419 extending from the support portion 11410. Referring primarily to FIG. 60, the channel 11416 of each retainer rod 11413 may be sized and configured to apply a compressive force to the longitudinal sides of the tissue thickness compensator 11420 prior to use of the staple cartridge 11400. During use, referring primarily to fig. 61, a staple cartridge 11400 can be positioned within the staple cartridge channel, and once the staple cartridge 11400 has been properly positioned, an anvil (such as anvil 11460), for example, can be moved to a position where it can compress the tissue thickness compensator 11420. Similar to the above, when the tissue thickness compensator 11420 is compressed, it may expand laterally or outwardly, thus separating the retainer rod 11413 from the staple cartridge 11400. In certain other embodiments, closing the anvil 11460 may not separate the retainer rod 11413 from the staple cartridge, or may not completely separate the retainer rod 11413 from the staple cartridge. In at least one such embodiment, advancing the firing bar through the staple cartridge 11400 as described above can deploy the staples 10030 from the support portion 11410 while pressing the anvil 11460 and the staple cartridge 11400 closer together to apply a compressive force to the tissue thickness compensator 11420 sufficient to laterally expand the tissue thickness compensator 11420 and separate the retainer bar 11413 from the staple cartridge 11400. Once the retainer rod 11413 has been separated from the staple cartridge 11400, the support portion 11410 can be moved away from the implanted tissue thickness compensator 11420 and removed from the surgical site.

In various embodiments, in addition to the above, the staple cartridge can comprise a plurality of fasteners configured to releasably retain the tissue thickness compensator to the support portion of the staple cartridge. In certain embodiments, for example, the support portion may include a plurality of apertures defined in the platform surface. Wherein the fastener is extendable through the tissue thickness compensator and releasably retainable in the aperture of the support portion. In use, the fastener may be progressively released from the supporting portion as the staples are progressively ejected from the supporting portion. In at least one such embodiment, the fastener can be implanted with the tissue thickness compensator, and in at least one embodiment, for example, the fastener can be constructed of at least one bioabsorbable material. In some embodiments, the fastener can be detached from the support portion after the tissue thickness compensator has been implanted and when the support portion is moved at least partially away from the implanted tissue thickness compensator. In various embodiments, referring now to fig. 130-131, a staple cartridge (such as staple cartridge 11600) can include, for example, a tissue thickness compensator 11620 releasably mounted to a support portion 11610 by a plurality of fasteners 11613. Each fastener 11613 can include a first end portion 11618 embedded within and/or engaged with the tissue thickness compensator 11620, a second end portion 11618 engaged with the support portion 11610, and a connector 11616 connecting the first end portion 11618 to the second end portion 11618. In various embodiments, the fastener 11613 may extend through a knife slot 11615 defined in the support portion 11610. In use, the firing member 10052 can move the knife edge through the knife slot 11615 in the support portion 11610 and incise the fasteners 11613 in order to release the tissue thickness compensator 11620 from the support portion 11610. In at least one such embodiment, the firing bar 10052 can be advanced from a proximal end of the staple cartridge 11600 to a distal end of the staple cartridge 11600 in order to 1) advance the sled 10050 distally and incrementally fire the staples 10030 as described above; 2) progressively incising the fastener 11613 and/or breaking the fastener 11613 to progressively release the tissue thickness compensator 11620 from the support portion 11610. In certain embodiments, similar to the above, the tissue thickness compensator 11620 can include a plurality of separable sections. These multiple separable sections can each be retained to the support portion 11610 by one or more fasteners 11613, for example. If the firing member 10052 comes to rest intermediate the proximal and distal ends of the staple cartridge 11600, as illustrated in fig. 130, the fasteners 11613 can help retain the unimplanted portion of the tissue thickness compensator 11620 to the support portion 11610 after the anvil 11660 is opened and the support portion 11610 is moved away from the tissue T, as illustrated in fig. 131. In various embodiments, in addition to the above, the cutting edge 10053 of the firing member 10052 can be configured to incise the fastener 11613 and/or sever the fastener 11613.

In various embodiments, referring now to fig. 132, a staple cartridge can comprise, for example, a tissue thickness compensator (such as tissue thickness compensator 15120), which can comprise a plurality of portions having different thicknesses. In at least one embodiment, the tissue thickness compensator 15120 can include a first or inner portion 15122a that can have a first thickness, a second or intermediate portion 15122b extending from the first portion 15122a that can each have a second thickness, and a third or outer portion 15122c extending from the second portion 15122b that can each have a third thickness. In at least one such embodiment, for example, the third thickness may be thicker than the second thickness, and the second thickness may be thicker than the first thickness. However, in various other embodiments, any suitable thickness may be used. In various embodiments, the portions 15122 a-15122 c of the tissue thickness compensator 15120 can include steps having different thicknesses. In at least one embodiment, similar to the above, a staple cartridge can comprise a plurality of rows 10030 of staples and a plurality of staple drivers having different heights that can deform the staples 10030 to different formed heights. Also similar to the above, the staple cartridge can comprise a first staple driver 15140a, which first staple driver 15140a can drive the staples 10030 supported thereon to a first formed height; a second staple driver 15140b, the second staple driver 15140b can drive the staples 10030 supported thereon to a second formed height; and a third staple driver 15140c, the third staple driver 15140c can drive the staples 10030 supported thereon to a third formed height. In the staple cartridge, for example, the first forming height can be shorter than the second forming height, which can be shorter than the third forming height. In various embodiments, as shown in fig. 132, each staple 10030 can comprise the same or substantially the same unformed, or unfired, height. In certain other embodiments, referring now to fig. 133, the first driver 15140a, the second driver 15140b, and/or the third driver 15140c can support staples having different unformed heights. In at least one such embodiment, the first staple drivers 15140a can support staples 15130a having a first unformed height, the second staple drivers 15140b can support staples 15130b having a second unformed height, and the third staple drivers 15140c can support staples 15130c having a third unformed height. Wherein, for example, the first unformed height can be shorter than the second unformed height, which can be shorter than the third unformed height. In various embodiments, referring again to fig. 133, the tips of the

pegs

15130a, 15130b, and/or 15130c can lie in, or at least substantially lie in, the same plane, while in other embodiments, the tips of the

pegs

15130a, 15130b, and/or 15130c can not lie in the same plane.

In certain embodiments, referring now to fig. 154, a staple cartridge can comprise a tissue thickness compensator 15220 having a plurality of portions with different thicknesses. The tissue thickness compensator 15220 can be implanted against tissue T by

staples

15130a, 15130b and 15130c as described above. In at least one embodiment, referring now to fig. 155, the

pegs

15130a, 15130b, and/or 15130c can be deformed to different formed heights. Wherein the first staples 15130a can be formed to a first formed height, the second staples 15130b can be formed to a second formed height, and the third staples 15130c can be formed to a third formed height, and wherein, for example, the first formed height can be shorter than the second formed height, and the second formed height can be shorter than the third formed height. Other embodiments are contemplated in which the

staples

15130a, 15130b, 15130c may be formed to any suitable formed height and/or any relative formed height.

As described above and with reference to fig. 134, a staple cartridge (such as staple cartridge 10000), for example, can comprise a support portion 10010 and a tissue thickness compensator 10020. Wherein a plurality of staples 10030 can be at least partially stored in the support portion 10010 and can extend into the tissue thickness compensator 10020 when the staples 10030 are in their unfired positions. In various embodiments, the tips of the staples 10030 do not protrude from the tissue thickness compensator 10020 when the staples 10030 are in their unfired position. As the staple drivers 10040 move the staples 10030 from their unfired positions to their fired positions as described above, the tips of the staples 10030 can penetrate the tissue thickness compensator 10020 and/or penetrate the upper layer or skin 10022. In certain alternative embodiments, the tips of the staples 10030 can protrude through the top surface of the tissue thickness compensator 10020 and/or the skin 10022 when the staples 10030 are in their unfired position. In either case, as the staples 10030 extend upwardly out of the support portion 10010 prior to being deployed, the staples 10030 can also tilt and/or deflect relative to the support portion as described above.

In various embodiments, referring now to fig. 140, a staple cartridge can comprise a tissue thickness compensator 13620, and a skin or top layer 13621, for example. In at least one such embodiment, for example, one or more pledgets or retainers 13622 can be embedded in the skin 13621. In certain embodiments, each retainer 13622 can comprise one or more apertures 13629 defined therein which can be configured to receive the staple legs 13032 of the staples 13030 therein when the staples 13030 are in their unfired positions, as shown in fig. 140. In use, in addition to the above, as the staples 13030 are moved from their unfired positions to their fired positions, the staple legs 10032 can slide through the apertures 13629 until, for example, the bases 13031 of the staples 13030 contact the tissue thickness compensator 13620 and compress at least a portion of the tissue thickness compensator 13620 against a bottom surface of the pledget 13622. In various embodiments, referring now to fig. 135, for example, a staple cartridge can comprise a tissue thickness compensator 13120, and a skin or top layer 13122. In at least one such embodiment, the tissue thickness compensator 13120 can comprise tapered lugs, protrusions, and/or protuberances 13128 that can extend upwardly from a top surface 13121 of the tissue thickness compensator 13120, for example. The projections 13128 can be configured to receive and enclose the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as shown in fig. 135. The top layer 13122 may also include tapered lugs, tabs, and/or protrusions 13129 that may be aligned, or at least substantially aligned, with the tabs 13128. In use, the staple legs 10032 can penetrate the

protrusions

13128 and 13129 and emerge from the tissue thickness compensator 13120. In various embodiments, referring now to fig. 139, a staple cartridge can comprise a tissue thickness compensator 13520, and a skin or top layer 13522, for example. In at least one such embodiment, the skin 13522 can include tapered lugs, protrusions, and/or protrusions 13529 that can extend upwardly from the top surface 13521 of the tissue thickness compensator 13520, for example. Similar to the above, the projections 13529 can be configured to receive and enclose the top ends of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as illustrated in fig. 139. In use, the staple legs 10032 can penetrate the protrusions 13529 and emerge from the skin 13522.

In various embodiments, referring now to fig. 136, a staple cartridge can comprise a tissue thickness compensator 13220, and a skin or top layer 13222, for example. In at least one such embodiment, for example, the tissue thickness compensator 13220 can comprise tapered dimples and/or grooves 13128 that can extend down into the top surface 13221 of the tissue thickness compensator 13220. In various embodiments, the tips of the staple legs 13032 can extend through the flutes 13128 when the staples 13030 are in their unfired positions, as shown in fig. 136. In at least one embodiment, the top layer 13222 can further include tapered dimples and/or recesses 13229 that can be aligned, or at least substantially aligned, with the recesses 13228. In various embodiments, referring now to fig. 137, a staple cartridge can comprise a tissue thickness compensator 13320, and a skin or top layer 13322, for example. In at least one such embodiment, the skin 13320 can include a thick portion 13329 that can extend down into the top surface 13321 of the tissue thickness compensator 13320. In various circumstances, the thick portions 13329 can be configured to receive at least a portion of the staple legs 13032 of the staples 13030 therein when the staples 13030 are in their unfired positions, as illustrated in fig. 137. In such embodiments, the thick portions 13329 can hold the staple legs 13032 in position such that the staple legs 13032 are aligned, or at least substantially aligned, with the staple forming pockets of the anvil positioned opposite the tissue thickness compensator 13320. In various embodiments, referring now to fig. 138, for example, a staple cartridge can include a tissue thickness compensator 13420, and a skin or top layer 13422. In at least one such embodiment, the skin 13422 can include a thick portion 13429 that can extend upwardly from the top surface 13421 of the tissue thickness compensator 13420. In various circumstances, the thick portions 13429 can be configured to receive at least a portion of the staple legs 13032 of the staples 13030 therein when the staples 13030 are in their unfired positions, as illustrated in fig. 138. In such embodiments, the thick portions 13429 can hold the staple legs 13032 in position such that the staple legs 13032 are aligned, or at least substantially aligned, with the staple forming pockets of the anvil positioned opposite the tissue thickness compensator 13420.

In various embodiments, referring now to fig. 141 and 142, for example, a staple cartridge can include tissue thickness compensators 13720 and, and a skin or top layer 13721. In at least one such embodiment, for example, the tissue thickness compensator 13720 can comprise pyramidal and/or stepped lugs, protrusions, and/or protrusions 13728 that can extend upwardly from the top surface 13721 of the tissue thickness compensator 13720. The projections 13728 can be configured to receive and envelop the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as shown in fig. 142. Similarly, top layer 13721 may include pyramid-shaped and/or stepped lugs, protrusions, and/or protrusions 13729 that may be aligned, or at least substantially aligned, with protrusions 13728. In various embodiments, skin 13721 can further include one or more teeth 13727 extending upwardly from tabs 13729, which can be configured to engage tissue positioned against top layer 13721 and prevent, or at least limit, relative lateral and/or longitudinal movement between the tissue, top layer 13721, and/or the tips of staple legs 13032. In use, as the staples 13030 are moved from their unfired positions to their fired positions, the staple legs 13032 can penetrate the

projections

13728 and 13729 and emerge from the tissue thickness compensator 13720. In various embodiments, referring now to fig. 143 and 144, for example, a staple cartridge can comprise a tissue thickness compensator 13820, and a skin or top layer 13821. In at least one such embodiment, for example, the tissue thickness compensator 13820 can comprise pyramidal and/or stepped lugs, projections, and/or protrusions 13828 that can extend upwardly from the top surface 13821 of the tissue thickness compensator 13820. The projections 13828 can be configured to receive and enclose the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as illustrated in fig. 144. Similarly, top layer 13821 may include pyramidal and/or stepped lugs, projections, and/or protrusions 13829 that may be aligned, or at least substantially aligned, with projections 13828. In various embodiments, top layer 13821 may further include one or more teeth 13827 extending downwardly into tissue thickness compensator 13820, for example, which may be configured to prevent or at least limit relative lateral and/or longitudinal movement between top layer 13821 and tissue thickness compensator 13820. In use, as the staples 13030 are moved from their unfired position to their fired position, the staple legs 10032 can penetrate the

projections

13828 and 13829 and emerge from the tissue thickness compensator 13820.

In various embodiments, referring now to fig. 145, for example, a staple cartridge can comprise a tissue thickness compensator (such as tissue thickness compensator 13920) which can comprise ridges 13923 and valleys 13924 defined therein, and in at least one embodiment, valleys 13924 can be defined between the ridges 13923. In various embodiments, each ridge 13923 may have the same height, substantially the same height, or a different height. Similarly, each valley 13924 may include the same depth, substantially the same depth, or a different depth. In various embodiments, a plurality of staples 13030 can be at least partially stored in the tissue thickness compensator 13920 such that the tips of the staples 13030 can be positioned within the ridges 13923. In at least one such embodiment, for example, the staple legs 13032 of the staples 13030 can not protrude from the tissue thickness compensator 13920 and/or a skin or top layer 13921 attached to the tissue thickness compensator 13920 when the staples 13030 are stored in their unfired positions. In various embodiments, the ridges 13923 and/or valleys 13924 may extend laterally across the staple cartridge. In at least one such embodiment, a staple cartridge can comprise a longitudinal knife slot. Wherein the ridges 13923 and valleys 13924 may extend in a direction transverse and/or perpendicular to the knife slot. In various circumstances, the ridges 13923 can be configured to retain the tips of the staple legs 13032 in position until the staples 13030 are moved from their unfired positions to their fired positions. In various embodiments, referring now to fig. 146, the tissue thickness compensator and/or the skin covering the tissue thickness compensator can comprise longitudinal ridges and/or valleys. In at least one such embodiment, for example, the tissue thickness compensator can comprise a top surface defined by ridges 14023 and valleys 14024, wherein the valleys 14024 can be defined between the ridges 14023. In various embodiments, the tissue thickness compensator can comprise a skin 14021, which skin 14021 can comprise a plurality of apertures 14029 defined therein, each of which can be configured to receive a staple leg 13032. In certain embodiments, apertures 14029 can be defined in ridges 14023 wherein the tips of staple legs 13032 can be positioned below apex 14028 of ridge 14029, positioned flush with apex 14028, and/or positioned above apex 14028. In certain embodiments, in addition to or in lieu of the above, an aperture 14029 may be defined in a valley 14024, for example. In certain embodiments, for example, each aperture may be surrounded or at least partially surrounded by embossing, which may enhance the skin and/or tissue thickness compensator surrounding the aperture. In any event, in addition to the above, for example, the skin 14021 can be attached to the tissue thickness compensator in any suitable manner, including using at least one adhesive.

In various embodiments, referring now to fig. 148, for example, a disposable loading unit 15900 can comprise an anvil 15960 and a staple cartridge channel 15970, wherein the staple cartridge channel 15970 can be rotated relative to the anvil 15960. In at least one such embodiment, the anvil 15960 may not be able to rotate. In certain embodiments, tissue can be positioned between the anvil 15960 and the staple cartridge channel 15970, and then the staple cartridge channel 15970 can be rotated toward the tissue to clamp the tissue against the anvil. In at least one such embodiment, the disposable loading unit 15900 can further comprise a tissue thickness compensator 15920 which can be configured to contact tissue.

In various embodiments, referring now to fig. 149-151, the disposable loading unit 12900 can comprise a loading assembly comprising a bottom portion 12922 that can be removably attached to the support portion 12610, a top portion 12990 that can be removably attached to the anvil 12560, and a flexible joint 12991 that connects the bottom portion 12922 and the top portion 12990. Similar to the above, a longitudinal retention rail 12825 can extend downwardly from the bottom portion 12922 into the knife slot 12615 defined in the support portion 12610 such that the bottom portion 12922 can be releasably retained to the support portion 12610. Similarly, a longitudinal retention rail 12995 can extend upwardly from the top portion 12990 into a knife slot defined in the anvil 12560 such that the top portion 12990 can be releasably retained to the anvil 12560. As shown in fig. 150 and 151, the tissue thickness compensator 12620 can be mounted to the bottom portion 12922 of the loading assembly wherein, to position the tissue thickness compensator 12620 relative to the support portion 12610, the clinician can flex the top portion 12990 and the bottom portion 12922 toward one another, position the loading assembly between the anvil 12560 and the support portion 12610, and then release the flexed loading assembly such that the loading assembly can resiliently expand and bias the top portion 12990 against the anvil 12560 and the bottom portion 12922 against the support portion 12610.

In various embodiments, referring now to fig. 152, for example, a staple cartridge (such as staple cartridge 14900) can include a support portion 14910 in addition to a tissue thickness compensator 14920 positioned against the support portion 14910. Similar to the above, for example, the support portion 14910 can include staple drivers that can be lifted upward away by the staple deployment sled in order to lift away a staple (such as staple 10030). The staples are positioned at least partially within the support portion 14910 toward an anvil, such as, for example, the anvil 10060 positioned opposite the staple cartridge 14900. In certain embodiments, for example, the support portion 14910 may include six rows of staple cavities, such as two outer rows of staple cavities, two inner rows of staple cavities, and two intermediate rows of staple cavities positioned intermediate the inner and outer rows. Wherein the anvil 10060 can comprise six rows of forming pockets 10062 that are aligned, or at least substantially aligned, with the staple cavities. In various embodiments, the inside row of staple cavities may include staple drivers 14940a positioned therein, the middle row of staple cavities may include staple drivers 14940b positioned therein, and the outside row of staple cavities may include staple drivers 14940c positioned therein. Wherein each of staple drivers 14940a can comprise a shelf 14949a configured to support a staple 10030, each of staple drivers 14940b can comprise a shelf 14949b configured to support a staple 10030, and each of staple drivers 14940c can comprise a shelf 14949c configured to support a staple 10030. In the unfired position of the staple drivers, i.e., when the staple drivers 14940 a-14940 c are seated on driver supports 14926 that extend below the support portion 14910, the shelf 14949a of the staple drivers 14940a may be positioned closer to the anvil 10060 than the shelf 14949b of the staple drivers 14940b and the shelf 14949c of the staple drivers 14940 c. In such a position, a first forming distance can be defined between bracket 14949a and forming pocket 10062 positioned above bracket 14949 a; a second forming distance can be defined between bracket 14949b and forming pocket 10062 positioned above bracket 14949 b; a third forming distance can be defined between support 14949c and forming pocket 10062 positioned above support 14949 c. Wherein in various embodiments, for example, the first forming distance can be shorter than the second forming distance, and the second forming distance can be shorter than the third forming distance. As the staple drivers 14940 a-14940 c are moved from their unfired position (fig. 152) to their fired position, each staple driver 14940 a-14940 c can be moved upward toward the anvil 10060 an equal, or at least substantially equal, distance by the staple deployment sled such that a first driver 14940a drives its respective staple 10030 to a first forming height, a second driver 14940b drives its respective staple 10030 to a second forming height, and a third driver 14940c drives its respective staple 10030 to a third forming height. Wherein, for example, the first forming height may be shorter than the second forming height, and the second forming height may be shorter than the third forming height. Various other embodiments are contemplated in which first staple driver 14940a is displaced upward a first distance, second staple driver 14940b is displaced upward a second distance, and third staple driver 14940c is displaced upward a third distance. Wherein one or more of the first distance, the second distance, and the third distance may be different.

In various embodiments, referring again to fig. 152, the deck surface 14911 of the support portion 14910 can vary in height relative to the tissue-contacting surface 10061 of the anvil 10060. In certain embodiments, this height variation can occur in the lateral direction, and in at least one embodiment, for example, the height of plateau surface 14911 surrounding the medial row of staple cavities can be higher than the height of plateau surface 14911 surrounding the lateral row of staple cavities. In various embodiments, the bottom surface 14922 of the tissue thickness compensator 14920 is configured to be parallel, or at least substantially parallel, to the deck surface 14911 of the support portion 14910. In addition to the above, the tissue thickness compensator 14920 may also vary in thickness. Wherein in at least one embodiment, the top or tissue contacting surface 14921 of the tissue thickness compensator 14920 can be sloped inwardly from its outer, i.e., lateral, edge. In at least one such embodiment, as a result of the above, for example, the tissue thickness compensator 14920 can be thinner in the areas positioned over the medial row of staple cavities and thicker in the areas positioned over the lateral row of staple cavities. In various embodiments, referring now to fig. 153, the platform surface of the support portion 15010 may comprise a stepped platform surface, for example. Wherein, for example, the highest step of the stepped surface may surround the inside row of staple cavities and the lowest step of the stepped surface may surround the outside row of staple cavities. In at least one such embodiment, a step having an intermediate height can surround the intermediate row of staple cavities. In certain embodiments, for example, a tissue thickness compensator (such as tissue thickness compensator 15020) may include a bottom surface that may be parallel to and contiguous with a deck surface of the support portion 15010. In at least one embodiment, for example, the top surface or tissue contacting surface 15021 of the tissue thickness compensator can comprise an arcuate, parabolic, and/or curved surface, which in at least one such embodiment can extend from a first lateral side of the tissue thickness compensator 15020 to a second lateral side of the tissue thickness compensator 15020, e.g., with the apex aligned with, or at least substantially aligned with, the center of the staple cartridge 15000.

In various embodiments, in addition to the above, the staple firing sled 10050 of the staple cartridge 10000 can be moved from the proximal end of the staple cartridge 10000 toward the distal end 10002 of the staple cartridge by a firing member (as shown elsewhere), as shown in fig. 161 and 162. As the sled 10050 is advanced, the sled 10050 can contact the staple drivers 10040 and lift the staple drivers 10040 upwardly within the staple cavities 10012 defined in the cartridge body 10010 of the staple cartridge 10000. In at least one embodiment, the sled 10050 and the staple drivers 10040 can each comprise one or more ramps or inclined surfaces that can cooperate to move the staple drivers 10040, and the staples supported thereon, upwardly from their unfired positions. The staple cartridge 10000 can further comprise a tray 10027, which can, for example, at least partially surround the bottom of the cartridge body 10010 and at least partially house the staple drivers 10040 disposed within the cartridge body 10010. The cartridge body 10010 can further comprise a longitudinal slot 10016 defined therein, the longitudinal slot 10016 being configured to at least partially receive a firing member as the firing member passes through the staple cartridge 10000.

Turning now to fig. 163, the staples contained within the staple cartridge body 10010 can be fired sequentially between the proximal end 10001 and the distal end 10002 of the staple cartridge 10000. In various embodiments, for example, the staple cartridge 10000 can comprise

staple drivers

10040a, 10040b, and 10040c, which can fire staples in a predetermined manner. For example, the staple cartridge 10000 can comprise a proximal driver 10040c positioned on a first side of the longitudinal slot 10016 and a second proximal driver 10040c positioned on a second, opposite side of the longitudinal slot 10016. Each driver 10040c is configured to fire two staples, i.e., the two most proximal staples, simultaneously. Such staples are positioned in staple cavities labeled 10012 c. In fact, of the two staple cavities labeled 10012c on each side of the longitudinal slot 10016, such staple cavities 10012c can comprise a distal staple cavity labeled 10013c and a proximal staple cavity labeled 10014 c. The reader will appreciate that the staple cavities 10013c are positioned in a different row of staples than the staple cavities 10014 c. In fact, the

staple cavities

10013c and 10014c can be located in two innermost staple rows, with the third outermost staple row having no staples to be fired by the driver 10040 c. In addition, the staple cartridge 10000 can comprise an intermediate driver 10040b positioned on a first side of the longitudinal slot 10016 and a second intermediate driver 10040b positioned on a second, opposite side of the longitudinal slot 10016. Each driver 10040b is configured to fire three staples simultaneously. Such staples are positioned in staple cavities labeled 10012 b. In fact, of the three staple cavities labeled 10012b on each side of the longitudinal slot 10016, such staple cavities 10012b can comprise a distal staple cavity labeled 10013b, an intermediate staple cavity labeled 10014b, and a distal staple cavity labeled 10015 b. The reader will appreciate that the three

staple cavities

10013b, 10014b, and 10015b are all positioned in different rows of staples. In addition, the staple cartridge 10000 can comprise a distal driver 10040a positioned on a first side of the longitudinal slot 10015 and a second distal driver 10040a positioned on a second, opposite side of the longitudinal slot 10015. Each driver 10040a is configured to fire four staples simultaneously. Such staples are positioned in staple cavities labeled 10012 a. In fact, of the four staple cavities labeled 10012a on each side of the longitudinal slot 10016, such staple cavities 10012a can include two distal staple cavities labeled 10013a, an intermediate staple cavity labeled 10014a, and a distal staple cavity labeled 10015 a. The reader will appreciate that the

staple cavities

10013a, 10014a, and 10015a are all positioned in an array that extends across all three rows of staples on one side of the longitudinal slot 10016. In fact, the distal-most staples positioned within the distal-most staple cavities 10013a located within the cartridge body 10010 are positioned in the inner and outer rows of staples and extend distally relative to the distal-most staple cavities 10014a in the intermediate row of staple cavities positioned between the inner and outer rows of staple cavities. While only a few

staple drivers

10040a, 10040b, and 10040c are discussed above, the staple cartridge 10000 can comprise any suitable number of staple drivers for ejecting the staples from the staple cavities. Such staple drivers may eject two, three, four, and/or more staples simultaneously. Referring specifically to fig. 18, a staple cartridge can comprise one or more staple drivers 41040a, e.g., configured to support two staples thereon, one or more staple drivers 41040b, e.g., configured to support three staples thereon, and/or one or more staple drivers 41040c, e.g., configured to support four staples thereon. In various embodiments, the last or distal-most staple driver housed within the staple cartridge can comprise staple drivers 41040c, which drivers 41040c can comprise two distal support legs 41041c configured to retain the last staple in the staple line. For example, drivers 41040 a-41040 c support staples in six staple lines, and driver 41040c supports the last staples in the four staple lines of those staple lines. Such staples can be aligned along an axis perpendicular to the cutting path (which extends along the longitudinal axis), or at least substantially aligned. Because such staples have the above-described arrangement, they can provide a variety of hemostatic benefits. The last of the two other staple lines may be supported by the support 41041 b.

In various embodiments, a staple cartridge for a surgical stapler can include, for example, a layer, such as a tissue thickness compensator and/or a buttress material, disposed on a staple deck of the staple cartridge. In use, the layer and patient tissue can be captured by the staples as they are fired. The layer may then be separated from the surgical stapler, and may remain in the patient when the stapler is removed from the patient. In certain embodiments, the distal end of the layer can be attached to the staple cartridge to stabilize the layer relative to the staple cartridge when the staple cartridge and the layer are being positioned relative to the patient tissue.

In certain embodiments in which the distal end of the layer is attached to the staple cartridge, the staple cartridge can include a distally disposed cutting blade that cuts away the distal end of the layer that is attached to the staple cartridge. Fig. 81A-83 illustrate the staple cartridge assembly 2300, which staple cartridge assembly 2300 includes a staple cartridge 2330 and a distal cutting blade 2324 disposed in a distal chamber 2332 of the staple cartridge 2330. As described in more detail below, the distal cutting blade 2324 may be moved from an undeployed position to a deployed position within the distal chamber 2332. In the deployed position, cutting blade 2324 extends out of distal chamber 2332 to sever distal end 2316 of layer 2306 disposed on the staple cartridge.

Referring to fig. 82 and 83, in various embodiments, distal portion 2316 of layer 2306 can be attached to staple cartridge 2300 by being captured between staple cartridge 2300 and panel 2310, which panel 2310 extends proximally from nose 2308 of staple cartridge assembly 2300. In some embodiments, layer 2306 may be captured by compression between staple cartridge 2330 and panel 2310. In other words, the gap between staple cartridge 2330 and panel 2310 may be less than the thickness of distal portion 2316 of layer 2306 positioned in the gap such that distal portion 2316 is compressed between staple cartridge 2330 and panel 2310. In certain embodiments, referring to fig. 82 and 83, distal portion 2316 of layer 2306 may include one or more apertures 2320. One or more pegs 2318 may extend from panel 2308 and through apertures 2320 to capture distal portions 2316 of layers 2306. In certain embodiments, for example, distal portion 2316 of layer 2306 may be attached to staple cartridge 2330 by adhesive, welding, and/or heat staking.

A distal cutting blade 2324 that severs distal portion 2316 of layer 2306 from the rest of layer 2306 may be disposed in distal chamber 2332 of staple cartridge 2330. The distal cavity 2332 and distal cutting blade 2324 may be positioned such that the distal cutting blade 2324 may sever the distal portion 2316 of layer 2306 at a location that is more proximal relative to the location at which the distal portion 2316 is attached to the staple cartridge 2330. For example, referring to fig. 82 and 83, the distal cutting blade 2324 may sever the distal portion 2316 of the layer 2306 at a more proximal location relative to the pegs 2318 and holes 2320 that attach the distal portion 2316 to the staple cartridge 2330. Thus, when distal cutting blade 2324 severs distal portion 2316 of layer 2306, the remainder of layer 2306 can be released from the staple cartridge.

The distal cutting blade 2324 may include a cam 2322, the cam 2322 being configured to push the distal cutting blade 2324 out of the distal chamber 2332. Cam 2322 may engage a rail and/or channel 2334 in distal chamber 2332, which rail and/or channel 2334 may limit movement of cam 2322 and distal cutting blade 2324 to a particular direction as blade 2324 extends out of distal chamber 2332. The rails and/or channels 2334 are shown in fig. 82 and 83 as being perpendicular to the staple deck 2302 of staple cartridge 2330. In this arrangement, the distal cutting blade 2324 may extend from the distal chamber 2332 in a direction perpendicular to the staple deck 2302 of the staple cartridge 2330 as it moves from the undeployed position (shown in fig. 82) to the deployed position (shown in fig. 83). In various embodiments, the rails and/or channels 2334 can be arranged at any suitable angle relative to the staple deck 2302 of the staple cartridge 2330. For example, the rails and/or channels 2334 can be arranged at a 30 ° angle relative to the staple deck 2302 of the staple cartridge 2330 such that the distal cutting blade 2324 partially extends out of the distal cavity 2322 in a distal direction at a 30 ° angle relative to the staple deck 2302 of the staple cartridge 2330.

To deploy the distal cutting blade, the cam 2322 may be pushed by the firing member 2326. For example, the firing member 2326 may be disposed in a slot (such as knife slot 2304) in the staple cartridge 2330. The firing member 2326 can include

cam surfaces

2328 and 2329 that can be engaged with the cam 2322 to displace the cam 2322 and the distal cutting blade 2324 toward the layer 2306. The firing member 2326 can be moved distally relative to the cam 2322 and the distal cutting blade 2324 from an unactuated position to an actuated position to deploy the cutting blade 2324 and sever the distal portion 2316 of the layer 2306. Fig. 82 illustrates the firing member 2326 in an unactuated position in which the cam surfaces 2328 and 2329 have not yet engaged the cams 2322. In various embodiments, one or both of the cam surfaces 2328 and 2329 of the firing member 2326 may contact the cam when the firing member 2326 is in the unactuated position, so long as the distal cutting blade 2324 is not pushed out of the distal chamber 2332. As the firing member 2326 is moved distally to the actuated position shown in fig. 83, the cam surface 2328 of the firing member 2326 engages the cam 2322 to incrementally push the cam 2322 and the distal cutting blade 2324 to the deployed position such that the distal cutting blade 2324 severs the distal portion 2316 of the layer 2306.

As described above, cam 2322 may engage a rail and/or channel 2334 in distal chamber 2332. In addition, the rails and/or channels 2334 can be disposed at an angle relative to the staple deck 2302 of the staple cartridge 2330. In various embodiments, the rails and/or channels 2334 can be arranged at an angle such that the cams 2322 and blades 2324 move distally when the distal cutting blade 2324 is deployed from the distal chamber 2332. In various circumstances, arranging the rails at such an angle may reduce the amount of force required to actuate the firing member 2326 by: the components of the motion of the cam 2322 and the blade 2324 are aligned along the longitudinal axis along which the firing member 2326 moves. Arranging the rails at such an angle may also reduce the likelihood of adhesions occurring between cam 2322 and firing member 2326 and/or between cam 2322 and rails and/or channel 2324 in distal chamber 2332.

In various embodiments, the firing member 2326 can be moved distally from the unactuated position to the actuated position by the cutting blade 2312 and/or the staple driver 2340. In various embodiments, the firing member 2326 can be integral with the tissue cutting blade 2312 and/or the staple drivers 2340 such that the firing member 2326 travels with the tissue cutting blade 2312 and/or the staple drivers 2340 along the longitudinal axis of the staple cartridge 2330 through the staple cartridge 2330. In various other embodiments, the firing member 2326 can be separate from the tissue cutting blade 2312 and/or the staple driver 2340. In such embodiments, the tissue cutting blade 2312 and/or the staple driver 2340 can push the firing member 2326 through the staple cartridge 2330. Alternatively, in such embodiments where the firing member 2326 is separate from the tissue cutting blade 2312 and/or the staple drivers 2340, the firing member 2326 may be positioned at the distal end of the staple cartridge 2330 with the firing member 2326 in the unactuated position, as shown in fig. 82. When the cutting blade 2312 and/or staple driver 2340 reaches the distal end of the staple cartridge 2330, the cutting blade 2312 and/or staple driver 2340 may travel through the staple cartridge 2330, subsequently pushing the firing member 2326 to the actuated position, as shown in fig. 83. In all of these embodiments, movement of the tissue cutting blade 2312 and/or the staple driver 2340 in a direction along the longitudinal axis of the staple cartridge 2330 can deploy the distal cutting blade 2324 in a different direction than the tissue cutting blade and/or the staple driver 2340.

In various embodiments, the distal cutting blade 2324 is not deployed to sever the distal portion 2316 of the layer 2306 until the firing stroke of the tissue cutting blade 2312 and/or staple driver 2340 has been completed or nearly completed. In such embodiments, distal portion 2316 of layer 2306 can remain attached to staple cartridge 2330, thereby stabilizing layer 2306 relative to staple cartridge 2330 until most or even all of the staples have been fired by staple drivers 2340 and/or until the patient tissue and layer 2306 have been severed by tissue cutting blade 2312. In various other embodiments, the distal cutting blade 2324 can be deployed to sever the distal portion 2316 of the layer 2306 before the tissue cutting blade 2312 and/or staple driver 2340 begin their firing strokes. For example, the firing member 2326 can be moved from the unactuated position shown in fig. 82 to the actuated position shown in fig. 83 by a first actuation of a firing trigger of the surgical stapler. Subsequent actuations of the firing trigger may move the tissue cutting blade 2312 and/or the staple drivers 2340. Thus, distal portion 2316 of layer 2306 can be separated from staple cartridge 2330 before tissue cutting blade 2312 severs patient tissue and/or before staple capture layer 2306 and patient tissue. As another example, the firing member 2326 can be actuated by a first trigger of the surgical instrument, and the tissue cutting blade 2312 and/or the staple driver 2340 can be actuated by a second trigger.

As described above, nose 2308 of staple cartridge assembly 2300 may include panel 2310, which panel 2310 extends proximally from nose 2308 and at least partially covers distal portion 2316 of cartridge 2306. Panel 2310 can include an inwardly facing surface 2309, which inwardly facing surface 2309 can face a distal portion 2316 of layer 2306. In certain embodiments, the inward-facing surface 2309 of the panel 2310 may support the distal portion 2316 of the layer 2306 as the distal cutting blade 2324 severs the distal portion 2316. In various circumstances, as the distal cutting blade 2324 is deployed, the distal cutting blade 2324 may eventually come into contact with the inwardly facing surface 2309, thereby completely severing the distal portion 2316 of the layer 2306 from the remainder of the layer 2306.

The faceplate 2310 may also protect patient tissue from the distal cutting blade 2324. In various circumstances, unaffected patient tissue that is not severed by the tissue cutting blade 2312 and/or stapled by staples from the staple cartridge 2330 may pass over the outward facing surface 2311 of the face plate 2310. In such cases, the faceplate 2310 may protect the unaffected tissue from the distal cutting blade 2324. For example, as shown in fig. 83, the face plate 2310 may be positioned between the distal cutting blade 2324 extending out of the distal chamber 2332 and patient tissue proximate the outward surface 2311 of the face plate 2310 such that these patient tissue is not exposed to the distal cutting blade 2324.

Referring now to fig. 77-79, the staple cartridge 20000 can comprise a cartridge body 20010 and a tissue thickness compensator 20020 releasably attached to the cartridge body 20010. The staple cartridge 20000 can include any suitable arrangement of staples, staple cavities, and/or staple drivers. The staple drivers, after being fired by the sled or firing member, pass distally through the staple cartridge 20000 to capture at least a portion of the tissue thickness compensator 20020 and at least a portion of the patient tissue within the staples, as described elsewhere herein. For the sake of brevity, the reader is not repeated herein with respect to the staples, staple cavities, and staple drivers. Referring now primarily to fig. 77 and 77A, the staple cartridge 20000 can include a sled 20060 that is distally advanced by a firing member 20050. At some point during distal advancement of the firing member 20050 and sled 20060, the sled 20060 can be configured to enable release of the tissue thickness compensator 20020 from the cartridge body 20010, as shown in fig. 78 and 79, for example. For example, the distal end 20022 of the tissue thickness compensator 20020 can be releasably retained to the distal end of the cartridge body 20010 by the flexible jaws 20013 and the retaining pin 20072, wherein the sled 20060 can overcome the retaining action of the retaining pin 20072 or be withdrawn therefrom. The flexible jaws 20013 can be configured to securely hold the tissue thickness compensator 20020 against the deck 20015 of the cartridge body 20010. In such cases, the flexible clamp 20013 can provide sufficient clamping force to the tissue thickness compensator 20020 to hold the tissue thickness compensator 20020 in place. The retaining pins 20072 can also securely retain the tissue thickness compensator 20020 to the cartridge body 20010. For example, referring to fig. 77 and 77A, the distal end 20022 of the tissue thickness compensator 20020 can include an aperture 20023 defined therein, the aperture 20023 can be configured to receive a retaining pin 20072, and the retaining pin 20072 can prevent the tissue thickness compensator 20020 from slipping out from between the clamp 20013 and the cartridge deck 20015 due to the interaction between the retaining pin 20072 and the side wall of the aperture 20023. Further, the retention pin 20072 and the clip 20013 can cooperate to limit movement of the tissue thickness compensator 20020, and in various circumstances, the top of the retention pin 20072 can abut the clip 20013 or can be positioned immediately adjacent to the clip.

In use, in addition to the above, the position of the retaining pin 20072 can be lowered as the slider 20060 is withdrawn, as shown in fig. 78 and 79. More specifically, the retention pin 20072 may extend from the cam 20070. Wherein the cams 20070 can be seated or seated on resilient members, springs 20012, extending from a disc 20011 attached to the cartridge body 20010; and when the slider 20060 engages the cam 20070, the slider 20060 may push the cam 20070 and the retaining pin 20072 downward, thereby compressing the spring 20012. The cartridge body 20010 can include a guide 20018 defined therein which limits the movement of the cams 20070 along a substantially vertical path, i.e., a path perpendicular to the cartridge platform 20015. In various embodiments, sled 20060 can comprise a camming actuator 20062 that extends distally relative to staple driver lift-off surface 20063. Once the position of the pin 20072 has been sufficiently lowered, the tissue thickness compensator 20020 can slide relative to the cartridge deck 20015 and out of the jaws 20013. In each case, the pin 20072 can be lowered a sufficient amount, but still protrude at least partially from the cartridge deck 20015. In other instances, the pin 20072 can be lowered below the cartridge deck 20015. In either case, the cam actuator 20062 and staple driver of sled 20060 being lifted off surface 20063 enables the retention pin 20072 to be lowered sufficiently while the last or most distal staple is fired by sled 20060. In other instances, the cam actuator 20062 and staple driver lift-off surface 20063 of sled 20060 can be configured to enable the retention pin 20072 to descend sufficiently before the last or most distal staple is fired by sled 20060. In still other instances, cam actuator 20062 and staple driver lift-off surface 20063 of sled 20060 can enable retention pin 20072 to descend sufficiently after the last or most distal staple is fired by sled 20060. Although cam 20070 is described herein as having one retention pin 20072, a plurality of retention pins 20072 can extend from cam 20070, each of which can releasably retain a tissue thickness compensator 20020 to cartridge body 20010. Thus, the tissue thickness compensator 20020 can include a suitable number of apertures 20023 that can receive the retaining pins 20072.

Referring now to fig. 80 and 81, for example, the staple cartridge 21000 can comprise a cartridge body 21010, a tissue thickness compensator 21020 releasably secured to the cartridge body 21010, and a sled 21060 configured to release the tissue thickness compensator 21020 from the cartridge body 21010. Similar to that described above, the sled 21060 can include staple driver lift-off surfaces 21063. The staple driver lift-off surface 21063 is configured to lift the staple drivers and staples supported thereon toward an anvil positioned opposite the tissue thickness compensator 21020. Also similar to the above, the slider 21060 may also include a cam actuator 21062. The cam actuators 21062 can act on the jaws 21013 such that the jaws 21013 no longer hold the distal end 21022 of the tissue thickness compensator 21020 to the deck surface 21015 of the cartridge body 21010. More specifically, the jaws 21013 can comprise cams 21072 that extend downwardly into the cartridge body 21010. Wherein the cam 21072 can be engaged by the cam actuator 21062 as the sled 21060 is advanced distally through the staple cartridge 21000. When the cam actuator 21062 engages the cam 21072, the cam actuator 21062 can lift the cam 21072 upward and flex the jaws 21013 away from the distal end 21022 of the tissue thickness compensator 21020, as shown in fig. 81. At this point, the cartridge body 21010 can be moved away from the tissue thickness compensator 21020. In other words, the tissue thickness compensator 21020 has been implanted into the patient's tissue by one or more staples prior to being released from the cartridge body 21010. In such a case, after the tissue thickness compensator 21020 is released, the cartridge body 21010 can be moved away from the implanted tissue thickness compensator 21020 and removed from the surgical site.

In addition to the foregoing, the cam actuators 21062 and staple driver lift-off surfaces 21063 of the sled 21060 can cause the cams 20072 to rise sufficiently to sufficiently reduce the clamping force applied by the jaws 21013 while the last or most distal staple is fired by the sled 20060. In other instances, the cam actuators 21062 and staple driver lift-off surfaces 21063 of the sled 21060 can be configured such that the cams 21072 are sufficiently elevated to reduce the clamping force applied by the jaws 21013 prior to the firing of the last or most distal staple by the sled 21060. In still other instances, the cam actuators 21062 and staple driver lift-off surfaces 21063 of the sled 21060 can cause the cams 20072 to rise sufficiently after the last or distal-most staple is fired by the sled 21060 to sufficiently reduce the clamping force applied by the jaws 21013. While the jaws 21013 are described herein as having one cam 21072 extending therefrom, a plurality of cams 21072 can extend from the jaws 21013 that are each capable of lifting off the jaws 21013 to release the tissue thickness compensator 20020 from the cartridge body 20010.

In addition to the above, a sled or firing member passing through the staple cartridge can release the tissue thickness compensator from the cartridge body at or near the end of the distal movement of the sled, and/or at the end of the firing stroke of the firing member. In other words, the tissue thickness compensator can be released from the cartridge body at the same time as all or substantially all of the staples are fired from the staple cartridge. In various other embodiments, the tissue thickness compensator can be released from the cartridge body at the same time as or prior to the firing of the first, and most proximal, staple from the staple cartridge. One such exemplary embodiment is depicted in fig. 90-92, which illustrate a staple cartridge 22000. Similar to the above, the staple cartridge 22000 can comprise a cartridge body 22010, and a tissue thickness compensator 22020 releasably secured to the cartridge body 22010. While the staple cartridge 22000 can also include a staple firing sled as described above, the sled may not release the tissue thickness compensator 22020; conversely, the staple cartridge 22000 can further comprise an actuator 22011, which actuator 22011 can be advanced distally by the firing member at the beginning of the firing stroke of the firing member. Various other embodiments disclosed herein disclose devices for distally advancing an actuator. For the sake of brevity, however, these other embodiments related to this embodiment will not be described in detail herein. In any case, the actuator 22011 can include a cam support 22012 extending therefrom, the cam support 22012 being configured to support the cam 22070 when the actuator 22011 is in its unactuated position, as shown in fig. 90. In addition, staple cartridge 22000 can further comprise a biasing member, i.e., spring 22074. The biasing member, spring 22074, is capable of holding or biasing the cam 22070 against the cam support 22012, again when the actuator 22011 is in its unactuated position shown in fig. 90. When the cam 22070 is in such a position, a retention pin 22072 extending from the cam 22070 can engage a hole 22023 defined in the distal end 22022 of the tissue thickness compensator 22020 and extend through the hole 22023 such that the retention pin 22072, and/or the retention pin 22072 in cooperation with a jaw 22013 extending from the cartridge body 22010, can retain the tissue thickness compensator 22020 in place similar to that described above.

When the actuator 22011 is advanced distally by the firing member, referring now to fig. 91, the cam support 22012 may be advanced distally such that the cam support 22012 may no longer support the cam 22070. In such instances, the spring 22074 can bias the cam 22070 downward such that the retention pin 22072 is biased out of engagement with the tissue thickness compensator 22020, or at least partially out of engagement with the tissue thickness compensator 22020. In at least one instance, the spring 22074 can bias the cam 22070 downward such that the retention pin 22072 is positioned below the deck 22015 of the staple cartridge 22010. In any event, distal advancement of the actuator 22011 can cause the tissue thickness compensator 22020 to be released from the cartridge body 22010. In other words, the jaws 22013 can provide a clamping force to the tissue thickness compensator 22020 despite the lowering of the position of the retention pin 22072, thereby maintaining the tissue thickness compensator 22020 against the staple deck 22015; however, once a sufficient relative force is applied between the tissue thickness compensator 22020 and the cartridge body 22010, the tissue thickness compensator 22020 can be slid out from under the jaws 22013. In addition to the above, release of the tissue thickness compensator 22020 from the cartridge body 22010 can occur prior to, concurrently with, and/or immediately after the firing of the proximal-most staples from the staple cartridge 22000. In such instances, premature release of the tissue thickness compensator 22020 allows the tissue thickness compensator 22020 to be released from the cartridge body 22010 even if, for example, the staple cartridge 22000 is only partially fired.

Referring now to fig. 84-87, the end effector assembly 5000 can include first and second jaws 5002 shown elsewhere. In various embodiments, the second jaw 5002 can comprise a cartridge assembly. The cartridge assembly includes a fastener cartridge body 5050, and a tissue thickness compensator 5058 releasably secured to the fastener cartridge body 5050. Referring primarily to fig. 84, the fastener cartridge body 5050 can have a cartridge deck 5052 and fastener cavities 5054 defined in the cartridge deck 5052. Additionally, the second jaw 5002 can include fasteners (such as surgical staples), for example, that can be removably positioned in the fastener cavities 5054. For example, such fasteners can be ejectably positioned in each fastener cavity 5054 of the cartridge body 5050. In certain embodiments, the cartridge body 5050 can comprise a slot 5056, which slot 5056 can extend from the proximal portion 5004 of the second jaw 5002 toward the distal portion 5006 of the second jaw 5002. In various embodiments, the firing assembly 5030 can translate along the slot 5056 of the cartridge body 5050. For example, the firing assembly 5030 can translate within the slot 5056 during a firing stroke and can eject fasteners from the fastener cavities 5054 during the firing stroke.

Referring primarily to fig. 84, 86, and 87, the firing assembly 5030 can include a firing bar (fig. 84), a cutting edge 5036, a crossbar 5038, and legs 5044 (fig. 86 and 87). The cutting edge 5036 can cut tissue and/or cut the tissue thickness compensator 5058 as the firing assembly 5030 is fired through the second jaw 5002 during a firing stroke. For example, the crossbar 5038 can hold the first jaw relative to the cartridge body 5050 and the feet 5044 can hold the firing assembly 5030 relative to the cartridge body 5050. In various embodiments, the crossbar 5038 and feet 5044 can, for example, hold the cutting element 5036 perpendicular to the platform 5052 of the fastener cartridge 5050. Referring primarily to fig. 29A and 29B, the firing assembly 5030 can engage the sled 5034 in the cartridge body 5050 during the firing stroke. The firing assembly 5030 can push the sled 5034 distally, e.g., during a firing stroke, thereby ejecting fasteners from the fastener cavities 5054.

Referring primarily to fig. 84, the tissue thickness compensator 5058 can be releasably secured to the cartridge body 5050 by at least one

connector

5080a,5080 b. In certain embodiments, a plurality of

connectors

5080a,5080b can secure the tissue thickness compensator 5058 to the cartridge body 5050. For example, the proximal connector 5080a can secure the tissue thickness compensator 5058 to the cartridge body 5050 at the proximal portion 5004 of the second jaw 5002, and the distal connector 5080b can secure the tissue thickness compensator 5058 to the cartridge body 5050 at the distal portion 5006 of the second jaw 5002. In certain embodiments, additional connectors can secure the tissue thickness compensator 5058 to the cartridge body 5050. In such embodiments, for example, additional connectors can be spaced along at least a portion of the length of the cartridge body 5050 and can be positioned between the proximal connector 5080a and the distal connector 5080 b.

Still referring primarily to fig. 84, the

connectors

5080a and 5080b can retain the tissue thickness compensator 5058 relative to the cartridge body 5050. When the

connectors

5080a and 5080b are cracked, cut, displaced, or otherwise rendered ineffective, the tissue thickness compensator 5058 can be released from the cartridge body 5050. In certain embodiments, the firing assembly 5030 can overcome the

connectors

5080a and 5080b as it translates along the slot 5056 in the fastener cartridge 5050 during the firing stroke. During this firing stroke, the firing assembly 5030 can not only cut tissue clamped between the first jaw and the second jaw 5002, but can also move fasteners from the fastener cavities 5054 into the clamped tissue. In various embodiments, the firing assembly 5030 can push the sled 5034 (fig. 86 and 87) distally during the firing stroke. The slide 5034 can have a camming surface or ramp 5042 that can engage a driver in the fastener cavity 5054. When the ramp 5042 engages the driver, the ramp may push the driver toward the platform 5052 to eject the fastener from the fastener cavity 5054. In addition, the firing assembly 5030 can cut the tissue thickness compensator 5058 and the

connectors

5080a,5080b during the firing stroke.

Referring primarily to FIG. 84, the cutting edge 5036 of the firing assembly 5030 can cut the proximal connector 5080a, such as at or shortly after the beginning of the firing stroke, and can cut the distal connector 5080b, such as at or near the end of the firing stroke. In certain embodiments, the sled 5034 (fig. 86 and 87) can eject the fasteners from the fastener cavities 5054 after the cutting edge 5036 cuts the proximal connector 5080a and before the cutting edge 5036 cuts the distal connector 5080 b. In such embodiments, if the firing assembly 5030 does not complete the firing stroke, the cutting edge 5036 of the firing assembly 5030 can stop before reaching the distal connector 5080b, while the tissue thickness compensator 5058 can remain secured to the cartridge body 5050 at the distal portion 5006 of the second jaw 5002. In certain embodiments, the tissue thickness compensator 5058 can remain secured to the cartridge body 5050 until the operator cuts or otherwise overcomes the distal connector 5080 b. For example, the operator may overcome distal connector 5080b by introducing additional surgical instruments and/or steps during the surgical procedure.

Still referring to fig. 84-87, in various embodiments, the second jaw 5002 can overcome the

connectors

5080a and 5080b at the beginning of or shortly after the firing stroke. In other words, the element of the second jaw 5002 can overcome the proximal connector 5080a, the distal connector 5080b, and any additional connectors between the two connectors at the beginning or shortly after the beginning of the firing stroke. For example, the second jaw 5002 and/or the cartridge assembly can include an actuator 5010 that can overcome the distal connector 5080b prior to ejection of the fastener from the fastener cavity. The actuator 5010 can overcome the distal connector 5080b and the tissue thickness compensator 5358 can be released from the cartridge body 5050 even if the firing stroke ends prematurely, that is, for example, the firing assembly 5030 before reaching the distal portion 5006 of the second jaw 5002. In various embodiments, the actuator 5010 can include a bottom side 5016 (fig. 85A-85C) and sidewalls 5018 (fig. 84 and 85D). The side walls 5018 can extend from the bottom side 5016 and extend around at least a portion of the cartridge body 5050. The bottom side 5016 and/or the side walls 5018 can extend past or around fasteners positioned in the fastener cavities 5054. In addition, the actuator 5010 can be movably retained relative to the cartridge body 5050. For example, the actuator 5010 can be moved from a pre-actuation position (fig. 85A) to an actuation position (fig. 85B and 85D). In certain embodiments, the side walls 5018 of the actuator 5010 can engage slots in the cartridge body 5050 such that the actuator 5010 moves within the slots to slide relative to the cartridge body 5050. As the actuator 5010 moves relative to the cartridge body 5050, the actuator 5010 can slide relative to the fasteners positioned in the fastener cavities 5054 of the cartridge body 5050. For example, the actuator 5010 can slide past and/or around fasteners in the fastener cavities 5054.

Referring primarily to fig. 85A-85C, the actuator 5010 can include a slot 5012, the slot 5012 can extend from the proximal portion 5004 toward the distal portion 5006 of the second jaw 5002. The slots 5012 in the actuator 5010 can correspond to and/or be aligned with the slots 5056 (fig. 84) in the cartridge body 5050, for example. In addition, the firing assembly 5030, when translated along the slot 5056 in the cartridge body 5050 and/or within the slot 5056 during the firing stroke, can also translate along the slot 5012 in the actuator 5010 and/or within the slot 5012. In various embodiments, the firing assembly 5030 can engage the actuator 5010 to move the actuator 5010 distally at or shortly after the beginning of the firing stroke. In such embodiments, the firing assembly 5030 can actuate the actuator 5010 at the proximal portion 5004 of the second jaw 5002. For example, when the actuator 5010 is actuated and moved distally, the distal end of the actuator 5010 can cut or otherwise overcome the distal connector 5080 b. In other words, proximal actuation of the actuator 5010 can effect distal release of the tissue thickness compensator 5058 from the cartridge body 5050. In various embodiments, the actuator 5010 can only be distally displaced to overcome the distal connector 5080 b. In at least one embodiment, the actuator 5010 can be displaced, for example, by about 1mm before overcoming the distal connector 5080 b. In certain embodiments, the actuator 5010 can be displaced, for example, by about 0.5mm to about 5mm before overcoming the distal connector 5080 b.

Referring primarily to fig. 85A and 85B, the actuator 5010 can move from a pre-actuated position (fig. 85A) to an actuated position (fig. 85B) as the firing assembly 5030 moves between the unfired position and the partially fired position during a firing stroke. In various embodiments, the actuator 5010 can include a release stop, such as a detent tab 5022, for example. The travel of the firing element relative to the actuator 5010 can be halted by encountering the detent tab 5022. In other words, the detent tab 5022 can temporarily stop the travel of the firing assembly 5030 relative to the actuator 5010. For example, as the actuator 5010 is moved from the pre-actuated position to the actuated position, the detent tabs 5022 can engage the sled 5034 and/or the firing assembly 5030 to retain the firing assembly 5030 relative to the actuator 5010 such that the actuator 5010 and the firing assembly 5030 move together. For example, referring primarily to fig. 86 and 87, the underside 5016 of the actuator 5010 can include detent tabs 5022 and the sled 5034 can include a groove or channel 5040. In various embodiments, the groove 5040 can receive the tab 5022 when the sled 5034 is positioned in the proximal portion 5004 of the second jaw 5002. For example, the grooves 5040 can be aligned with the tabs 5022 when the firing assembly 5030 is moved from an unfired position to a fired position, such that the actuator is correspondingly pushed from a pre-actuated position (fig. 85A) to an actuated position (fig. 85B). In various embodiments, at least one tab 5022 can be positioned on either side of a slot 5012 (fig. 85A-85C) in the actuator 5010, and each tab 5022 can engage a sled 5034.

Referring primarily to fig. 85A, as the firing assembly 5030 and sled 5034 translate along the slot 5056 (fig. 84) during the firing stroke, the sled 5034 can engage the detent tab 5022. For example, the detent tab 5022 can engage the sled 5034 at the beginning of or shortly after the firing stroke. In certain embodiments, the detent tab 5022 can be located near the proximal end of the actuator 5010, and the sled 4034 can engage the detent tab 5022 at the beginning of the firing stroke. When the firing bar 5032 is moved distally and the detent tab 5022 engages with the groove 5040 in the sled 5034 (fig. 86 and 87), the actuator 5010 can be driven distally and/or displaced distally. In certain embodiments, referring primarily to fig. 85B, the actuator 5010 can be moved distally, for example, until it reaches a hard stop 5060 defined in the cartridge body 5050. A hard stop 5060 can be located, for example, at the distal portion 5006 of the second jaw 5002 and can prevent further distal movement of the actuator 5010. In various embodiments, the actuator 5010 can abut the hard stop 5060 before the firing assembly 5030 ejects fasteners from the fastener cavities 5054 (fig. 84) of the cartridge body 5050. In some embodiments, the actuator 5010 does not abut the hard stop 5060 until the firing assembly 5030 ejects the at least one fastener from the fastener cavity 5054, and/or until the firing assembly 5030 has ejected the at least one fastener from the fastener cavity 5054.

Referring primarily to fig. 85D, as the actuator 5010 is pushed distally by the sled 5034 and/or the firing assembly 5030, the actuator 5010 can cut the distal connector 5080b or otherwise overcome the distal connector 5080b to release the tissue thickness compensation 5058 from the cartridge body 5050 at the distal portion 5006 of the second jaw 5002. In certain embodiments, the actuator 5010 can include a notch 5024 for receiving and securing the distal connector 5080 b. The notch 5024 can secure the distal connector 5080b as the actuator 5010 is displaced distally toward the hard stop 5060. In addition, the actuator 5010 can, for example, include a cutting edge 5020 along the notch 5024. In certain embodiments, the actuator 5010, when moving toward the hard stop 5060, can push the distal connector 5080b between the hard stop 5060 and the cutting edge 5020 of the actuator 5010. In various embodiments, the cutting edge 5020 can cut the distal connector 5080b as the cutting edge 5020 is pushed into and/or towards the hard stop 5060. In such embodiments, at the beginning or shortly after the beginning of the firing stroke, and prior to the firing of fasteners from the fastener cavities 5054 (fig. 84), the distal connector 5080b may be cut by the cutting edge 5020 of the actuator 5010. In some embodiments, the cutting edge 5020 can cut the distal connector 5080b when the firing assembly 5030 ejects the at least one fastener from the fastener cavity 5054 and/or after the firing assembly 5030 has ejected the at least one fastener from the fastener cavity 5054. In various embodiments, the actuator 5010 can overcome the distal connector 5080b without cutting the distal connector 5080 b. For example, the actuator 5010 can separate or stretch the distal connector 5080b such that the distal connector 5080b no longer secures the tissue thickness compensator 5058 relative to the cartridge body 5050.

In various embodiments, the proximal connector 5080a can be cut by a proximal cutting edge of the actuator 5010. Similarly, additional connectors disposed along the length of the cartridge body 5050 can be cut or otherwise overcome by the actuator 5010 at the beginning or shortly after the beginning of the firing stroke. Additionally or alternatively, the cutting edge 5036 of the firing assembly 5030 can cut the proximal connector 5080a and/or additional connector, or can otherwise overcome the proximal connector 5080a and/or additional connector. For example, the cutting edge 5036 of the firing assembly 5030 can cut the proximal connector 5080a and the cutting edge 5020 of the actuator 5010 can cut the distal connector 5080b prior to the ejection of fasteners from the fastener cavities 5054 (fig. 84) of the cartridge body 5050.

Referring primarily to FIG. 87, the sled 5034 and/or firing assembly 5030 can overcome the interference of the detent tab 5022 in the actuator 5010. The firing assembly 5030 and the sled 5034 can move relative to the actuator 5010 when the sled 5034 and/or the firing assembly 5030 overcome the interference of the detent tabs 5022. For example, the firing assembly 5030 can push the sled 5034 distally to move the actuator 5010 distally until the hard stop 5060 prevents further distal movement of the actuator 5010 (fig. 85A, 85C, and 85D). Still referring to fig. 87, when further distal movement of the actuator 5010 is prevented, the firing assembly 5030 can push the sled 5034 with sufficient force to deform, deflect, and/or disengage the detent tabs 5022 from the grooves 5040 in the sled 5034. For example, each tab 5022 can comprise a cantilever arm that can flex downward out of engagement with the channel 5040 upon application of a sufficient longitudinal force to the sled 5034. The firing assembly 5030 and the sled 5034 can move relative to the actuator 5010 as the firing assembly 5030 pushes the sled 5034 out of engagement with the detent tabs 5022. In various embodiments, the detent tab 5022 can be sufficiently rigid to break to withstand the force exerted by the firing assembly 5030 as the actuator 5010 shifts distally toward the hard stop 5060; and when the actuator 5010 reaches the hard stop 5060, the pawl tab 5022 can be flexible enough to deflect without requiring excessive force by the motor and/or the operator. In various circumstances, the detent tabs 5022 can allow the firing bar 5032 to pass through the cartridge body 5050 after the force applied to the detent tabs 5022 has exceeded a predetermined force.

Referring now to fig. 29A and 29B, the end effector assembly 5100 may include a first jaw (as shown elsewhere) and a second jaw 5102. In various embodiments, the second jaw 5102 and/or fastener cartridge assembly positionable therein can include an actuator 5110. The actuator 5110 can slide or displace, for example, relative to a fastener cartridge body of a fastener cartridge assembly, such as the fastener cartridge body 5050 (fig. 84). Additionally, in certain embodiments, the actuator 5110 can comprise a bottom wall 5116 and side walls 5118 which can be positioned at least partially about the cartridge body 5050. When the fixed actuator 5110 is positioned relative to the cartridge body 5050, the bottom wall 5116 and/or the side walls 5118 can extend past or around the fasteners positioned in the fastener cavities 5054 (fig. 84). In various embodiments, the actuator 5110 can include a slot 5112, the slot 5112 extending along at least a portion of the bottom wall 5116. In addition, the side wall 5118 can comprise a lip 5122 and/or a lip 5124 which can be configured to slidably engage the cartridge body 5050. For example, the lip 5122 can extend around the cartridge body 5050 and into a slit in the deck 5052 (fig. 84) of the cartridge body 5050. In addition, the lips 5124 can extend into the slits, for example, along the sides of the cartridge body 5050. In various embodiments, the

lip

5122,5124 can slide within the slot as the actuator 5110 is moved relative to the cartridge body 5050. In such embodiments, the lip can, for example, constrain and/or define relative motion between the actuator 5110 and the cartridge body 5050. As the actuator 5110 moves relative to the cartridge body 5050, the actuator 5110 can slide relative to the fasteners positioned in the fastener cavities 5054 of the cartridge body 5050. For example, the actuator 5110 can slide past or around a fastener in the fastener cavity 5054.

Still referring to fig. 29A and 29B, the actuator 5110 can include a release stop, such as a detent 5114, for example, at the proximal portion 5104 of the second jaw 5102. Referring primarily to fig. 29A, the detent 5114 can comprise a detent arm 5120, the detent arm 5120 can be configured to operably retain the slider 5134 of the cartridge body 5050 (fig. 84). For example, the slider 5134 can include a groove 5144 and the detent arm 5120 can engage the groove 5144 to retain the slider 5134 relative to the actuator 5110. In various embodiments, the detent 5114 can have a plurality of detent arms 5120, the detent arms 5120 can be retained in the groove 5144 of the slider 5134. The detent arm 5120 can extend, for example, from opposite sides of the actuator 5110, and the slider 5134 can be positioned, for example, intermediate the detent arm 5120. In certain embodiments, when the detent arm 5120 is retained in the groove 5144 (fig. 29A) of the sled 5134, the firing assembly 5030 can push against the sled 5134 and can distally displace the actuator 5110. The detent arm 5120 can be sufficiently rigid to retain the sled 5134 relative to the actuator 5110 when the actuator 5110 is pushed distally by the firing assembly 5030. The actuator 5110 can then, for example, abut a hard stop, such as hard stop 5060 (fig. 84-85B, and 85D), which can prevent further distal movement of the actuator 5110.

Referring primarily to fig. 29B, when the actuator 5010 abuts the hard stop 5060 (fig. 84-85B, and 85D), the firing assembly 5030 can push the sled 5134 through the detent 5114. In other words, the firing assembly 5030 can cause the sled 5134 to overcome the detent arm 5120. In such embodiments, the detent arm 5120 can be flexible enough to flex out of engagement with the groove 5144 of the sled 5134 and can allow the firing assembly 5030 to pass between the detent arms 5120 along the slot 5112 in the actuator 5110. Similar to the actuator 5010, the actuator 5110 can include a blade that can cut or otherwise overcome a distal connector, similar to the distal connector 5080b (fig. 84 and 85D), for example, when the actuator 5110 is distally displaced by the firing assembly 5030. The firing assembly 5030 and the sled 5134 can then translate, e.g., along the slot 5112, and can eject the fasteners from the fastener cavities 5054 of the cartridge body. In various embodiments, the actuator 5110 can overcome the distal connector and/or additional connector before the fasteners are fired from the fastener cartridge 5050. In certain embodiments, the actuator 5110 can overcome the distal connector and/or additional connectors before the fasteners are fired from the fastener cartridge 5050.

Referring now to fig. 87A and 87B, end effector assembly 5200 may include a first jaw (as shown elsewhere) and a second jaw 5202. In various embodiments, the second jaw 5202 and/or the fastener cartridge assembly can, for example, comprise an actuator 5210, which actuator 5210 can be slid relative to a fastener cartridge body, such as the fastener cartridge body 5050 (fig. 84). Additionally, in certain embodiments, the actuator 5210 can comprise a bottom wall 5216 and a side wall. The sidewalls can be positioned, for example, at least partially around the cartridge body 5050. The actuator 5210 can comprise a slot 5212, the slot 5212 extending along at least a portion of the bottom wall 5216. Additionally, the actuator 5210 can be movably retained relative to the cartridge body 5050. As the actuator 5210 is moved relative to the cartridge body 5050, the actuator 5210 can be moved relative to the fasteners positioned in the fastener cavities 5054 of the cartridge body 5050. For example, the actuator 5210 can be slid past or around a fastener positioned in the fastener cavity 5054.

In various embodiments, the firing assembly 5030 can translate along the slot 5212 and/or within the slot 5212 during the firing stroke. Similar to the

actuators

5010 and 5110, the actuator 5210 can comprise a release stop 5214. In various embodiments, the release stop 5214 can comprise a frangible portion 5220, which can be, for example, a bridge across the slot 5212. Referring primarily to fig. 87A, the firing assembly 5030 can abut the release stop 5214 to push the actuator 5210 distally. The actuator 5210 can then abut a hard stop, such as hard stop 5060 (fig. 84-85B, and 85D), which can prevent further distal movement of the actuator 5210. Referring primarily to fig. 87B, when the firing assembly 5030 reaches the hard stop 5060, the frangible portion 5220 of the release stop 5214 can be broken and the firing assembly 5030 can continue to move distally along the slot 5212 during the firing stroke. The frangible portion 5220 can be sufficiently rigid to withstand the force exerted by the firing assembly 5030 as the actuator 5210 is displaced distally toward the hard stop 5060 (FIG. 85D); and may be sufficiently frangible to break when the actuator 5210 reaches the hard stop 5060 without requiring excessive force by the motor and/or operator. In various embodiments, the actuator 5210 can overcome the distal connector 5080b and/or additional connectors before the fasteners are fired from the fastener cartridge 5050. In certain embodiments, the actuator 5210 can overcome the distal connector and/or additional connector only after the at least one fastener is fired from the fastener cavity, and/or after the at least one fastener has been fired from the fastener cavity.

Referring now to fig. 88 and 89, the end effector assembly 5300 can include a first jaw (shown elsewhere) and a second jaw 5302. In various embodiments, the second jaw 5302 can comprise a cartridge body 5350, and a tissue thickness compensator 5358 releasably secured to the cartridge body 5350. Similar to the second jaw 5002, the second jaw 5302 can comprise fasteners, such as surgical staples, for example, that can be removably positioned in the fastener cavities of the cartridge body 5350. For example, a fastener can be positioned in each fastener cavity in an ejectable manner. In certain embodiments, the cartridge body 5350 can comprise a slot 5356 (fig. 88), which slot 5356 can extend from the proximal portion 5304 toward the distal portion 5306 of the second jaw 5302. In various embodiments, the firing assembly 5030 can translate along the slot 5356 of the cartridge body 5350. The firing assembly 5030 can translate within the slot of the fastener cartridge 5350, e.g., during a firing stroke, and can eject fasteners from the fastener cavities, e.g., during a firing stroke. The firing assembly 5030 can engage the sled 5334 (fig. 89) in the cartridge body 5350, e.g., during a firing stroke, and can push the sled 5334 distally, e.g., during a firing stroke. In addition, the firing assembly 5030 and/or the actuator 5310 can release the tissue thickness compensator 5358 from the cartridge body 5350 during the firing stroke.

Still referring to fig. 88 and 89, the tissue thickness compensator 5358 can comprise a body 5360, a proximal mount 5362 extending from the body 5360, and a distal mount 5364 extending from the body 5360. Referring primarily to fig. 89, for example, the pin 5366 can extend through the proximal mount 5362 into the opening 5356a in the cartridge body 5350 such that the pin 5366 releasably retains the tissue thickness compensator 5358 relative to the cartridge body 5350 at the proximal portion 5304 of the second jaw 5302. The pin 5366 can be friction fit and/or snap fit into the opening 5356a, for example. In certain embodiments, the pin 5366 can be retained in the opening 5456a, for example, using one or more adhesives. In some embodiments, at least a portion of the cartridge body 5350 and/or the pins 5366 can be welded together, for example. In various embodiments, the tissue thickness compensator 5358 can comprise a plurality of proximal mounts 5362 which can be releasably secured to the cartridge body 5350 on either or both sides of a slot 5356 (fig. 88) in the cartridge body 5350. In certain embodiments, the distal mount 5364 can be fixed to the cartridge body 5350, e.g., at the distal portion 5306 of the second jaw 5302. The distal mounts 5364 can be secured to the cartridge body 5350, for example, via at least one adhesive between the distal mounts 5364 and the cartridge body 5350. Additionally or alternatively, the distal mount 5364 can be secured to the cartridge body 5350, e.g., by at least one pin and/or additional fasteners.

Referring primarily to fig. 89, actuator 5310 can be looped on distal mount 5364 and can extend to slide 5334 in second jaw 5302. In various embodiments, the actuator 5310 can comprise, for example, a cable or cord configured to extend through the cartridge body 5350 and/or through a channel 5346 defined in the second jaw 5302 and/or the slide 5334. In various embodiments, distal movement of the slide 5334 can pull the actuator 5310 to penetrate the distal mount 5364 of the tissue thickness compensator 5358. For example, the actuator 5310 can have a first end 5316 fixed to a slide 5334, a second end 5318 fixed within the cartridge body 5350, and a ring 5320 located between the first and

second ends

5316 and 5318. The ring 5320 can, for example, loop around the distal mount 5364. In various embodiments, the ring 5320 can be wrapped around the distal mount 5364 between the portion of the distal mount 5364 that is fixed to the cartridge body 5350 and the body 5360 of the tissue thickness compensator 5358. In certain embodiments, the second end 5318 can be fixedly secured in the cartridge body 5350 such that the loop 5320 is tightened around the distal mount 5364 as the first end 5316 moves. In various embodiments, the second jaw 5302 and/or the cartridge body 5350 can comprise a button, a pin, and/or a caster, such as the first button 5312 and the second button 5314, for example. The actuator 5310 may, for example, wrap around a first button 5312 and a second button 5314. The position of button 5312,5314 and the orientation of actuator 5310 about button 5312,5314 allows ring 5320 of actuator 5310 to tighten around distal mount 5364 as sled 5334 and firing assembly 5330 move distally during a firing stroke. Additionally, as the ring 5320 is tightened around the distal mount 5364, the ring 5320 can penetrate the distal mount 5364 to release the body 5360 of the tissue thickness compensator 5358 from the cartridge body 5350 at the distal portion 5306 of the second jaw 5302. Thus, in view of the above, the distal mount 5364 can be disengaged from the cartridge body during the beginning of the firing stroke.

In various embodiments, the pins 5366 that secure the proximal mounts 5362 of the tissue thickness compensator 5358 to the cartridge body 5350 can be released from the openings 5356 of the cartridge body 5350 when the distal mounts 5364 of the tissue thickness compensator 5358 are released from the cartridge body 5350. For example, at the beginning of the firing stroke or shortly thereafter, the pin 5366 can be released from the opening 5356. The pin 5366 can be sheared and/or severed by the cutting edge 5036 of the firing assembly 5030, for example, and/or can be pushed out of and/or driven out of the opening 5356 by a component of the firing assembly 5030. In such embodiments, after both the proximal and

distal mounts

5362, 5364 are released from the cartridge body 5350, the tissue thickness compensator 5358 can be released from the cartridge body 5350 at the beginning of the firing stroke or shortly thereafter. In other words, the actuator 5310 can release the tissue thickness compensator 5358 from the cartridge body 5350 before the firing assembly 5030 and/or the sled 5334 eject the fasteners from the fastener cavities in the cartridge body 5350. In some embodiments, the firing assembly 5030 and/or the sled 5334 can eject at least one fastener from the fastener cavity before and/or while the actuator 5310 releases the tissue thickness compensator 5358 from the cartridge body 5350.

The fastener cartridge assembly can comprise a cartridge body comprising a slot and a plurality of fastener cavities. The fastener cartridge assembly may also include a plurality of fasteners, wherein each fastener is removably positioned in a fastener cavity. The fastener cartridge assembly can further comprise a firing element movable along the slot, a tissue thickness compensator releasably secured to the cartridge body, and a mount, wherein the mount secures the tissue thickness compensator to the cartridge body, and wherein the mount is positioned distal to a fastener of the plurality of fasteners. The fastener cartridge assembly can further comprise a cable positioned between the firing element and the mount, wherein the cable is configured to disconnect the mount when the firing element is moved distally along the slot. The tissue thickness compensator can be released from the cartridge body when the cable breaks the mount. The cable breaks the mount prior to removing the fastener from the fastener cavity. The fastener cartridge assembly may also include a channel, wherein the cable extends through the channel.

Referring now to fig. 93A-93D, an end effector assembly 5600 can include a first jaw (as shown elsewhere) and a second jaw 5602. In various embodiments, the second jaw 5602 can include a fastener cartridge body 5650, and a tissue thickness compensator 5658 releasably secured to the second jaw 5602 and/or the fastener cartridge body 5650. In certain embodiments, the fastener cartridge body 5650, as well as a tissue thickness compensator 5658 releasably secured to the fastener cartridge body 5650, can comprise a fastener cartridge assembly. Referring primarily to fig. 93A, the cartridge body 5650 can have a cartridge deck 5652, and fastener cavities 5654 defined in the cartridge deck 5652. Additionally, the second jaw 5602 can include a fastener (such as a surgical staple), for example, that can be removably positioned in the fastener cavity 5654. For example, a single fastener can be ejectably positioned in each fastener cavity 5654 of the cartridge body 5650. Still referring primarily to fig. 93A, the cartridge body 5650 can comprise ridges 5648 extending from a cartridge deck 5652. The ridge 5648 may, for example, extend around at least a portion of the fastener cavity 5654. In various embodiments, when the fastener is positioned in the fastener cavity 5654, the tip of the fastener may protrude from the fastener cavity 5654. In such embodiments, a ridge 5648 positioned at least partially around the fastener cavity 5654 can support and/or guide the tip of the fastener as the fastener is ejected from the fastener cavity 5654. In certain embodiments, still referring to fig. 93A, the cartridge body 5650 can comprise a slot 5656 that can extend from the proximal portion 5604 of the second jaw 5602 toward the distal portion 5606 of the second jaw 5602. In various embodiments, the firing assembly 5630 can be translated along the slot 5656 of the cartridge body 5650. For example, the firing assembly 5630 can translate along the slot 5656 during a firing stroke and can eject fasteners from the fastener cavities 5654 during the firing stroke.

Still referring to fig. 93A-93D, the firing assembly 5630 can include a firing bar 5632, a cutting edge 5636, a cross bar 5638, and legs 5644. The cutting edge 5636 can cut tissue and/or cut the tissue thickness compensator 5658 as the firing assembly 5630 is fired through the second jaw 5602 during a firing stroke. The cross bar 5638 can engage a slot in the first jaw anvil to retain the firing assembly 5630 relative to the first jaw; and the legs 5644 can engage a slot in the second jaw 5602, such as a slot 5656 in the cartridge body 5650, for example, to retain the first jaw relative to the cartridge body 5650. In various embodiments, the cross bar 5638 and/or the legs 5644 can, for example, maintain the cutting edge 5636 of the firing assembly 6530 perpendicular to the deck 5652 of the fastener cartridge 5650. Referring primarily to fig. 93A and 93D, the firing assembly 5630 can engage the sled 5634 in the cartridge body 5650 during a firing stroke. The firing assembly 5630 can push the sled 5634 distally, e.g., during a firing stroke, to eject fasteners from the fastener cavities 5654. In various embodiments, the slider 5634 can have a cam surface or ramp 5642 that can engage a driver and/or fastener in the fastener cavity 5654, for example. When the ramp 5642 engages the driver, the ramp 5642 may push the driver toward the platform 5652 to eject the corresponding fastener from the fastener cavity 5654. Additionally, in various embodiments, the firing assembly 5630 can cut the tissue thickness compensator 5658 during the firing stroke.

Referring primarily to fig. 93A and 93B, the tissue thickness compensator 5658 can comprise a cartridge contact surface 5662 (fig. 93A) and a tissue contact surface 5664 (fig. 93B). The cartridge contact surface 5662 can be positioned against the cartridge deck 5652, such as when the tissue thickness compensator 5658 is secured to the cartridge body 5650 (fig. 93B). Additionally, the tissue contact surface 5664 can be positioned against tissue, for example, when tissue is grasped between the first and second jaws 5602. Referring primarily to fig. 93A, the tissue thickness compensator 5658 can include a mounting member 5660. In various embodiments, the mounting member 5660 can be, for example, a rectangular or triangular tab that can extend from the tissue thickness compensator 5658. Additionally, the mounting member 5660 can be an incised portion of the tissue thickness compensator 5658 that leaves a space 5666 in the tissue thickness compensator 5658 that corresponds to the shape of the mounting member 5660. When the tissue thickness compensator 5658 is positioned relative to the cartridge body 5650, the mounts 5660 can, for example, be aligned with the slots 5656 of the cartridge body 5650. Additionally, the mounts 5660 can extend into the slots 5656 when the cartridge contact surface 5662 of the tissue thickness compensator 5658 is positioned adjacent the deck 5652 of the cartridge body 5650. In various embodiments, the mounts 5660 can be friction fit into the slots 5656 when the tissue thickness compensator 5658 is secured to the cartridge body 5650. The mounting members 5660 can retain at least a portion of the tissue thickness compensator 5658 relative to the cartridge body 5650. For example, when the mount 5660 is friction fit to the slot 5656, the cartridge contact surface 5662 can be positioned against the deck 5652 of the cartridge body 5650.

In various embodiments, the tissue thickness compensator 5658 can comprise a plurality of mounts 5660 that can be aligned with the slots 5656 of the cartridge body 5650. For example, at least one mount 5660 can be positioned in the proximal portion 5604 of the second jaw 5602, and at least one mount 5660 can be positioned in the distal portion 5606 of the second jaw 5602. In various embodiments, the mounting members 5660 can be spaced along at least a portion of the length of the tissue thickness compensator 5658. For example, the slot 5656 can be a longitudinal slot extending from the proximal portion 5604 of the second jaw 5602 to the distal portion 5606 of the second jaw 5602. The mounting members 5660 can, for example, be friction fit into the longitudinal slots 5656 and can secure the tissue thickness compensator 5658 to the cartridge body 5650.

Referring primarily to fig. 93A and 93D, the slider 5634 can include a tongue 5640, which tongue 5640 can project from the slider 5634 toward the distal portion 5606 of the second jaw 5602. As the firing assembly 5630 pushes the sled 5634 during the firing stroke, the tongues 5640 can move along the slots 5656 in the cartridge body 5650. Referring primarily to fig. 93D, the tongue 5640 can be moved along the slot 5656 adjacent the cartridge contact surface 5664 of the tissue thickness compensator 5658. Additionally, the tongue 5640 is movable against a mounting member 5660 positioned in the slot 5656. In various embodiments, the mount 5660 can be deflectable. When the tongue 5640 pushes against the mounting element 5660, the tongue 5640 can deflect the mounting element 5660 into alignment, or at least substantial alignment, with the body of the tissue thickness compensator 5658. For example, as the tongues 5640 move within the cartridge body 5650, the mounts 5660 can sequentially deflect into corresponding spaces 5666 defined in the tissue thickness compensator 5658. As the mounts 5660 deflect away from the slots 5656, the tissue thickness compensator 5658 can no longer be secured to the cartridge body 5650 and/or released from the cartridge body 5650. In various embodiments, the sled 5634 and/or another element of the firing assembly 5630 can deflect the mount 5660 away from the slot 5656 such that the tissue thickness compensator 5658 is no longer secured to the cartridge body 5650 and/or released from the cartridge body 5650.

Referring now to fig. 94, similar to the end effector assembly 5600, the end effector assembly 5700 can include a first jaw (as shown elsewhere) and a second jaw 5702. In various embodiments, the second jaw 5702 can comprise a fastener cartridge body 5750, and a tissue thickness compensator 5758 that is releasably secured to the cartridge body 5750 and/or the second jaw 5702. In certain embodiments, the fastener cartridge body 5750 and the tissue thickness compensator 5758, which is releasably secured to the cartridge body 5750, can comprise, for example, a fastener cartridge assembly. Similar to the cartridge body 5650, the cartridge body 5750 can have a cartridge deck 5752, fastener cavities 5754 defined in the cartridge deck 5752 for retaining fasteners, ridges 5748 at least partially surrounding the fastener cavities 5754, and/or slots 5756 extending from a proximal portion 5704 of the second jaw 5702 toward a distal portion 5706 of the second jaw 5702. In various embodiments, the cartridge body 5750 can comprise bridges 5780 that traverse the slots 5756 or extend across the slots 5756. The bridge 5780 may be, for example, a frangible and/or separable bridge. In certain embodiments, bridge 5780 may be a thin breakable portion, for example, and may be an absorbable material in solid form, such as PGA, PCL, PGA/PCL, PLA/PCL, and/or TMC. The bridge 5780 can have a hole 5782, and the hole 5782 can extend at least partially through the bridge 5780.

Still referring to fig. 94, in various embodiments, the firing assembly 5630 can be translatable along the slot 5756 of the cartridge body 5750. For example, the firing assembly 5630 can translate along the slot 5756 during a firing stroke and can eject fasteners from the fastener cavities 5754 during the firing stroke. The firing assembly 5630 can include a firing bar 5632, a cutting edge 5636, a cross-bar 5638, and a foot 5644. The cutting edge 5636 can cut the tissue and/or the tissue thickness compensator 5758 as the firing assembly 5630 is fired through the second jaw 5702 during a firing stroke. The crossbar 5638 can engage a slot in the first jaw anvil to retain the first jaw relative to the cartridge body 5750, and the legs 5644 can engage a slot in the second jaw 5702 (such as the slot 5756 in the cartridge body 5750), for example, to retain the firing assembly 5630 relative to the second jaw 5702. In various embodiments, the cross-bar 5638 and/or the legs 5644 can, for example, hold the cutting edge 5636 perpendicular to the platform 5752 of the fastener cartridge 5750.

Still referring to fig. 94, the tissue thickness compensator 5758 can comprise a cartridge contacting surface 5762 and a tissue contacting surface. The cartridge contact surface 5762 can be positioned against the cartridge platform 5752, for example, when the tissue thickness compensator 5758 is secured to the cartridge body 5750 and/or the second jaw 5702. Additionally, the tissue contacting surface can be positioned against tissue, for example, when tissue is clamped between the first and second jaws 5702. In various embodiments, the tissue thickness compensator 5758 can comprise a mounting member 5760. The mounting member 5760 can be, for example, a protrusion, pin, tab, and/or post that can extend from the cartridge contacting surface 5762 of the tissue thickness compensator 5758. The mounts 5760 can be aligned, or at least substantially aligned, with the apertures 5782 of the bridges 5780, such as when the tissue thickness compensator 5758 is positioned relative to the cartridge body 5750. Additionally, the mounts 5760 can extend at least partially into the apertures 5782 when the cartridge contact surface 5762 of the tissue thickness compensator 5758 is positioned adjacent the deck 5752 of the cartridge body 5750. In various embodiments, the mounts 5760 can be friction fit into the apertures 5782 when the tissue thickness compensator 5758 is secured to the cartridge body 5750. The mounts 5760 can retain and/or secure the tissue thickness compensator 5758 relative to the cartridge body 5750 and/or the second jaw 5702. For example, the cartridge contact surface 5762 can be positioned against the deck 5752 of the cartridge body 5750 when the mounts 5760 are friction fit into the apertures 5782 of the bridges 5780.

In various embodiments, the fastener cartridge 5750 can comprise a plurality of bridges 5780 that extend across the slots 5756 of the cartridge body 5750. The bridges 5780 can be spaced apart, for example, along at least a portion of the length of the slots 5756. For example, the slot 5756 can be a longitudinal slot extending from a proximal portion 5704 of the second jaw 5702 to a distal portion 5706 of the second jaw 5702. Additionally, in various embodiments, the tissue thickness compensator 5758 can comprise a plurality of mounts 5760 that can be aligned with the bridges 5780 of the cartridge body 5750. For example, when the tissue thickness compensator 5758 is positioned relative to the cartridge body 5750, the at least one mount 5760 can be positioned in the proximal portion 5704 of the second jaw 5702 and the at least one mount 5760 can be positioned in the distal portion 5706 of the second jaw 5702. In various embodiments, the mounts 5760 can be spaced along at least a portion of the length of the tissue thickness compensator 5758. The mounts 5760 can, for example, be friction fit into the slots 5756 and can secure the tissue thickness compensator 5758 to the cartridge body 5750 and/or the second jaw 5702.

Still referring to fig. 94, as the firing assembly 5630 moves along the slot 5756 during the firing stroke, the cutting edge 5636 of the firing assembly 5630 can cut the tissue thickness compensator 5758 and/or the tissue clamped between the first and second jaws 5702 of the end effector assembly 5700. Additionally, the firing assembly 5630 can disengage the bridge 5780 as the firing assembly 5630 moves through the slot 5756. For example, as firing assembly 5630 moves through slot 5756, cutting edge 5636 of firing assembly 5630 can break bridge 5780, or cut the bridge. In various embodiments, the cutting edge 5636 can cut each bridge 5780 in succession as the firing assembly 5630 moves within the slot 5756 during the firing stroke. Once the bridge 5780 has been cut by the cutting edge 5636 or ruptured by the cutting edge 5636, the tissue thickness compensator 5758 can no longer be secured to the cartridge body 5750 and/or released from the cartridge body 5750. In certain embodiments, the cutting edge 5636 can rupture, or cut, the mount 5760 aligned therewith during the firing stroke. In various embodiments, another element of the sled and/or firing assembly 5630 can rupture the bridges 5780 or cut the bridges 5780 to release the tissue thickness compensator 5758 from the cartridge body 5750.

Referring now to fig. 95 and 96, similar to the end effector assembly 5600, the end effector assembly 5800 can include a first jaw (as shown elsewhere) and a second jaw 5802. In various embodiments, the second jaw 5802 can comprise a fastener cartridge body 5850, and a tissue thickness compensator 5858 releasably secured to the cartridge body 5850 and/or the second jaw 5802. In certain embodiments, the fastener cartridge body 5850, as well as a tissue thickness compensator 5858 releasably secured to the fastener cartridge body 5850, can comprise a fastener cartridge assembly. Similar to the cartridge body 5650, the cartridge body 5850 can have a cartridge deck 5852, fastener cavities 5854 defined in the cartridge deck 5852 that are configured to receive fasteners, ridges 5848 positioned about at least a portion of the fastener cavities 5854, and/or slots 5856 that can extend from a proximal portion 5804 of the second jaw 5802 toward a distal portion 5806 of the second jaw 5802. In various embodiments, the cartridge body 5850 can comprise bridges 5880 that traverse the slots 5856 or extend at least partially across the slots 5856. The bridges 5880 may be, for example, frangible and/or separable bridges. In certain embodiments, the bridge 5880 can include a first leg 5884 and a second leg 5886. Referring primarily to fig. 96, a first leg 5884 can extend into the slot 5856, e.g., from a first side of the cartridge body 5850, and a second leg 5886 can extend into the slot 5856, e.g., from a second side of the cartridge body 5850. The first leg 5884 and the second leg 5886 may be oriented at an angle relative to an axis of the slot 5856, and the first leg 5884 may be oriented at approximately 90 degrees relative to the second leg 5886, for example. In certain embodiments, the first leg 5884 and/or the second leg 5886 are capable of deflecting. In various embodiments, the bridge 5880 can include a gap between the first leg 5884 and the second leg 5886, for example.

Still referring to fig. 95 and 96, in various embodiments, the firing assembly 5630 can translate along the slot 5856 of the cartridge body 5850. For example, the firing assembly 5630 can translate along the slot 5856 during a firing stroke and can eject fasteners from the fastener cavities 5854 during the firing stroke. The firing assembly 5630 can include a firing bar 5632, a cutting edge 5636, a cross-bar 5638, and a foot 5644. The cutting edge 5636 can cut tissue and/or the tissue thickness compensator 5858 as the firing assembly 5630 is fired through the second jaw 5802 during a firing stroke. The crossbar 5638 can engage a slot in the first jaw anvil to hold the first jaw relative to the cartridge body 5850, and the legs 5644 can engage a slot in the second jaw 5802 (such as a slot 5856 in the cartridge body 5850), for example, to hold the firing assembly 5630 relative to the second jaw 5802. In various embodiments, the cross-bar 5638 and/or the legs 5644 can, for example, hold the cutting edge 5636 perpendicular to the platform 5852 of the fastener cartridge 5850.

Still referring to fig. 95 and 96, the tissue thickness compensator 5858 can comprise a cartridge contacting surface 5862 and a tissue contacting surface. The cartridge contact surface 5862 can be positioned against the cartridge platform 5852, for example, when the tissue thickness compensator 5858 is secured to the cartridge body 5850 and/or the second jaw 5802. Additionally, the tissue contacting surface can be positioned against tissue, for example, when tissue is clamped between the first and second jaws 5802. In various embodiments, the tissue thickness compensator 5858 can comprise a mount 5860. Similar to the mount 5760, the mount 5860 can be, for example, a protrusion, pin, tab, and/or post that can extend from the cartridge contacting surface 5862 of the tissue thickness compensator 5858. The mounts 5860 can be aligned with the gaps between the

legs

5884 and 5886 of the bridge 5880, such as when the tissue thickness compensator 5858 is positioned relative to the cartridge body 5850. Additionally, when the cartridge-contacting surface 5862 of the tissue thickness compensator 5858 is positioned adjacent to the deck 5852 of the cartridge body 5850, the mounts 5860 can be secured by the

legs

5884 and 5886 of the bridge 5880. In various embodiments, the mounts 5860 can frictionally fit into the gaps between the

legs

5884 and 5886 when the tissue thickness compensator 5858 is secured to the cartridge body 5850. The engagement of the mounts with the bridges in the second jaw 5802 can retain a tissue thickness compensator 5858 relative to the cartridge body 5850. For example, once the mounts 5860 are frictionally engaged between the

legs

5884 and 5886 of the bridges 5880, the cartridge contact surface 5862 can be secured against the deck 5852 of the cartridge body 5850.

In various embodiments, referring primarily to fig. 95, a fastener cartridge 5850 can comprise a plurality of bridges 5880 that extend across slots 5856 of the cartridge body 5850. Bridges 5880 may be spaced apart, for example, along at least a portion of the length of slot 5856. For example, the slot 5856 can be a longitudinal slot extending from a proximal portion 5804 of the second jaw 5802 to a distal portion 5806 of the second jaw 5802. Additionally, in various embodiments, the tissue thickness compensator 5858 can comprise a plurality of mounts 5860 that can be aligned with the bridges 5880 of the cartridge body 5850. For example, when the tissue thickness compensator 5858 is positioned relative to the cartridge body 5850 and/or the second jaw 5802, the at least one mount 5860 can be positioned in a proximal portion 5804 of the second jaw 5802, and the at least one mount 5860 can be positioned in a distal portion 5806 of the second jaw 5802. In various embodiments, the mounts 5860 can be spaced apart along at least a portion of the length of the tissue thickness compensator 5858. The mounts 5860 can, for example, friction fit into the bridges 5880 and can secure the tissue thickness compensator 5858 to the cartridge body 5850.

Still referring to fig. 95 and 96, as the firing assembly 5630 moves along the slot 5856 during the firing stroke, the cutting edge 5636 of the firing assembly 5630 can cut the tissue thickness compensator 5858 and/or the tissue clamped between the first and second jaws 5802 of the end effector assembly 5800. Additionally, as the firing assembly 5630 moves through the slot 5856, the bridge 5880 can be disengaged. For example, as firing assembly 5630 moves through slot 5856, cutting edge 5636 of firing assembly 5630 can deflect

legs

5884 and 5886 of bridge 5880 and/or separate the legs of the bridge. In various embodiments, as firing assembly 5630 moves within slot 5856 during a firing stroke, cutting edge 5636 can successively deflect

legs

5884 and 5886 of each bridge 5880 to separate each bridge 5880. Once the

legs

5884 and 5886 of the bridge 5880 are deflected by the cutting edge 5636, the bridge 5880 can release the corresponding mounts 5860 of the tissue thickness compensator 5858. After each mount 5860 is released from each bridge 5880 along the length of the cartridge body 5850, the tissue thickness compensator 5858 can no longer be secured to and/or released from the cartridge body 5850. In certain embodiments, the cutting edge 5636 can cut, or rupture, the mount 5860 aligned therewith during the firing stroke. In various embodiments, another element of the sled and/or firing assembly 5630 can separate the bridges 5880 to release the tissue thickness compensator 5858 from the cartridge body 5850.

Referring now to fig. 97-100, similar to the end effector assembly 5600, the end effector assembly 5900 can include a first, anvil 5910 (fig. 99 and 100) and a second jaw 5902. In various embodiments, the second jaw 5902 can comprise a fastener cartridge body 5950, and a tissue thickness compensator 5958 releasably secured to the fastener cartridge body 5950 and/or the second jaw 5902. In certain embodiments, the fastener cartridge body 5950, as well as the tissue thickness compensator 5958 releasably secured to the cartridge body 5950, can comprise, for example, a fastener cartridge assembly. Referring primarily to fig. 98, the fastener cartridge body 5950 can have a cartridge deck 5952 and fastener cavities defined in the cartridge deck 5962. The mounting cavity 5948 and/or the fastener cavity 5954 may be defined in the cartridge deck 5952, for example. In various embodiments, the mounting cavity 5948 and the fastener cavity 5954 may have the same or similar structures and/or geometries. The second jaw 5902 may, for example, include a fastener (such as a surgical staple) that is removably positionable in the fastener cavity 5954. In certain embodiments, the cartridge body 5950 can comprise a slot 5956, the slot 5956 can extend from the proximal portion 5904 of the second jaw 5902 toward the distal portion 5906 of the second jaw 5902.

Still referring to fig. 97-100, in various embodiments, the firing assembly 5630 can translate along the slot 5956 of the cartridge body 5950 during a firing stroke and can eject fasteners from the fastener cavities 5954 during the firing stroke. The cutting edge 5636 can cut tissue and/or the tissue thickness compensator 5958 as the firing assembly 5630 is fired through the end effector assembly 5900 during a firing stroke. The cross bar 5638 can engage a slot 5912 (fig. 99 and 100) in the anvil 5910 to maintain the first jaw relative to the cartridge body 5950, and the legs 5644 can engage a slot in the second jaw 5902, such as the slot 5956 in the cartridge body 5950, for example, to maintain the firing assembly 5630 relative to the second jaw 5902. In various embodiments, the cross-bar 5638 and/or the feet 5644 can, for example, hold the cutting edge 5636 perpendicular to the platform 5952 of the fastener cartridge 5950.

Still referring to fig. 97-100, the tissue thickness compensator 5958 can include a cartridge contacting surface 5962 (fig. 97) and a tissue contacting surface 5964 (fig. 98 and 99). The cartridge contact surface 5962 can be positioned against the cartridge deck 5952, such as when the tissue thickness compensator 5958 is secured to the cartridge body 5950 and/or the second jaw 5902. Additionally, the tissue contacting surface 5964 may be positioned against tissue, such as when tissue is clamped between the anvil 5910 and the second jaw 5902. In various embodiments, the tissue thickness compensator 5958 can include a mount 5960. Similar to the mounts 5760 and/or mounts 5860, the mounts 5960 can be, for example, protrusions, pins, tabs, and/or posts that can extend from the cartridge contacting surface 5962 of the tissue thickness compensator 5958. In certain embodiments, the tissue thickness compensator 5958 can, for example, comprise a groove 5970 that can be adjacent to the mounting member 5960. The groove 5970 may be vertically aligned with the mount 5970, for example. Referring primarily to fig. 99, a groove 5970 can be defined in the tissue contacting surface 5964 of the tissue thickness compensator 5958 and can extend toward the mounting member 5960. In various embodiments, a flap of the tissue thickness compensator 5958 can be positioned between the groove 5970 and the mount 5960, for example.

The mounts 5960 can align with the mounting cavities 5948 in the cartridge deck 5952, such as when the tissue thickness compensator 5958 is positioned relative to the cartridge body 5950. Additionally, the mount 5960 can be positioned in the mounting cavity 5948 when the cartridge contact surface 5962 of the tissue thickness compensator 5958 is positioned adjacent the deck 5952 of the cartridge body 5950. In various embodiments, the mounts 5960 can be friction fit into the mounting cavity 5948 when the tissue thickness compensator 5958 is secured to the cartridge body 5950. The mounts 5960 and mounting cavities 5948, which are frictionally engaged together, can retain at least a portion of the tissue thickness compensator 5958 relative to the cartridge body 5950. For example, the cartridge contact surface 5962 can be secured against the platform 5952 of the cartridge body 5950 when the mount 5960 is friction fit into the mounting cavity 5948.

Referring primarily to fig. 97 and 98, the fastener cartridge 5950 can include a plurality of mounting cavities 5948 defined in the cartridge deck 5952. In certain embodiments, corresponding mounting cavities 5948 may be defined in the cartridge platform 5952 on either side of the slot 5956. A first mounting cavity 5948 can, for example, be defined at a first longitudinal side of the cartridge body 5950, and a corresponding second mounting cavity 5948 can, for example, be defined at a second longitudinal side of the cartridge body 5950. For example, a first pair of corresponding mounting cavities 5948 can be positioned in the proximal portion 5904 of the second jaw 5902 and/or a second pair of corresponding mounting cavities 5948 can be positioned in the distal portion 5906 of the second jaw 5902. In various embodiments, fastener cavities 5954 may be positioned between respective pairs of mounting cavities 5948, that is, closer to slot 5956; and can be positioned between the pair of mounting cavities 5948 at the proximal portion 5904 of the second jaw 5902 and the pair of mounting cavities 5948 at the distal portion 5906 of the second jaw 5902, that is, in an intermediate portion of the cartridge body 5950. Additionally, in various embodiments, the tissue thickness compensator 5958 can comprise a plurality of mounts 5960 which can be aligned with the mounting cavity 5948 of the cartridge body 5950. For example, at least one mount 5960 may be positioned in the proximal portion 5904 of the second jaw 5902; and at least one mount 5960 may be positioned in the distal portion 5906 of the second jaw 5902. In various embodiments, a pair of mounts 5960 can be positioned in the proximal portion 5904 of the second jaw 5902; and a pair of mounts 5960 may be positioned in the distal portion 5906 of the second jaw 5902. The mount 5960 can, for example, be friction fit into the mounting cavity 5948, and can secure at least a portion of the tissue thickness compensator 5958 to the cartridge body 5950.

Referring primarily to fig. 99 and 100, the mount 5960 may be removed from the mounting cavity 5948 during the firing stroke. In various embodiments, a driver 5920 movably positioned in the mounting cavity 5948 can eject the mount 5960 from the mounting cavity 5948 during a firing stroke. For example, a driver 5920 may be positioned in each mounting cavity 5948. During the firing stroke, elements of the firing assembly 5630 and/or sled in the second jaw 5902 can be engaged with the driver 5920, for example, to move the driver 5920 toward the cartridge deck 5952 and/or toward the tissue thickness compensator 5958. The driver 5920, when moved, can, for example, urge the mount 5960 positioned in the mounting cavity 5948 toward the platform 5952 and/or the tissue thickness compensator 5958. In various embodiments, a groove 5970 defined in the tissue thickness compensator 5958 corresponding to the pushed out mount 5960 can receive the pushed out mount 5960. For example, the driver 5920 can push the mount 5960 into the groove 5970. The mounting member 5960 may, for example, be squeezed into the groove 5970, deformed into the groove, and/or compressed into the groove 5970. Once the mounts 5960 are removed from the mounting cavity 5960 and pushed into the corresponding grooves 5970 during the firing stroke, the tissue thickness compensator 5958 can no longer be secured to the cartridge body 5950 and/or released from the cartridge body 5950.

In various embodiments, referring now to fig. 62-66, the staple cartridge 13000 can comprise a cartridge body 1310, a tissue thickness compensator 13020, and a plurality of cockable connectors configured to releasably retain the tissue thickness compensator 13020 to the cartridge body 13010, as described in further detail below. The cartridge body 13010 can comprise a proximal end 13011, a distal end 13012, and a deck 13015, the deck 13015 being configured to support a tissue thickness compensator 13020 thereon. The cartridge body 13010 can comprise one or more proximal stops 13013 extending therefrom which can be configured to block, or prevent, the tissue thickness compensator 13020 from moving proximally. Similarly, the cartridge body 13010 can comprise one or more distal stops 13014, which can be configured to block, or prevent, the tissue thickness compensator 13020 from moving distally. Referring primarily to fig. 63, the cartridge body 13010 can further comprise a plurality of staple cavities 13016 defined therein. In various embodiments, the staple cartridge 13000 can comprise a plurality of

connectors

13030 and 13040 that are configured to releasably retain the tissue thickness compensator 13020 to the cartridge body 13010. For example, each connector 13030 can comprise a plurality of lumen plugs 13031 positionable in the staple cavities 13016, and a connecting rod 13032 extending between the lumen plugs 13031 and over the tissue thickness compensator 13020. In at least one embodiment, the cavity plugs 13031 can fit snugly within the staple cavities 13016. In certain embodiments, the lumen plug 13031 can be press-fit and/or snap-fit into the staple lumen 13016. For example, each connector 13040 can comprise a lumen plug 13031 and a head 13042 extending therefrom, wherein the head 13042 can extend at least partially over the tissue thickness compensator 13020. Referring again to fig. 63, the tissue thickness compensator 13020 can comprise, for example: a set of proximal recesses 13023 defined in the proximal end 13021 of the tissue thickness compensator 13020, the proximal recesses configured to receive lumen plugs 13031 extending from the proximal connector 13030; intermediate recesses 13024, each intermediate recess 13024 being configured to receive a lumen plug 13031 extending from an intermediate connector 13040; and a set of distal notches 13025 defined in the distal end 13022 of the tissue thickness compensator 13020 that are configured to receive lumen plugs 13031 extending from the distal connector 13030.

In use, a sled or firing member can be advanced distally through the staple cartridge 13000 to eject the staples positioned within the staple cavities 13016. In various embodiments, the staple cavities 13016 in which the staples are positioned can be unplugged from the cavity plugs 13031. In some embodiments, the staple cavities in which the cavity plugs 13031 are positioned may not have staples positioned therein. Although not shown, in some embodiments, the staple cavities can include fasteners and cavity plugs 13031 positioned therein. Referring again to fig. 65 and 66, the staple cartridge 13000 can, for example, further comprise a plurality of staple drivers 13050, such staple drivers 13050 supporting the staples in their unfired positions. For example, as the firing member is advanced distally through the staple cartridge, the staple drivers 13050 and staples can be lifted upwardly (i.e., toward the deck 13015 of the cartridge body 13010 and toward an anvil positioned opposite the tissue thickness compensator 13020). Similarly, at least some of the staple drivers 13050 can contact the cavity plugs 13031 positioned in some of the staple cavities 13016 and lift those cavity plugs 13031 upwardly toward the anvil. As the staples are lifted upwardly by the staple drivers 13050, the staple legs of the staples can pass through the tissue thickness compensator 13020, through the tissue positioned between the tissue thickness compensator 13020 and the anvil, and contact the anvil positioned on the opposite side of the tissue. The staple drivers 13050 can then drive the staples against the anvil, thereby deforming the staples to capture the tissue thickness compensator 13020 and tissue therein. When the cavity stopper 13031 is lifted upward by the staple drivers 13050, the anvil can prevent the cavity stopper 13031 from moving upward. In such cases, referring primarily to fig. 63, the lumen plug 13031 may deform, deflect, and/or break. In certain embodiments, the cavity plug 13031 can, for example, comprise one or more notches that can cause the cavity plug 13031 to deform, deflect, and/or break at a particular location therein. In various circumstances, the entire cavity plug 13031, or at least substantially the entire cavity plug 13031, can be ejected from the staple cavities 13016 upon actuation of the staple drivers 13050. At this point, the connectors 13030 and/or 13040 can no longer connect the tissue thickness compensator 13020 to the cartridge body 13010, and as a result, the cartridge body 13010 can be moved away from the tissue thickness compensator 13020 that has been implanted against the tissue.

In use, in addition to the above, the firing member can be advanced from the proximal end 13011 of the staple cartridge 13000 toward the distal end 13012 of the staple cartridge 13000. The cartridge body 13010 can comprise a longitudinal slot 13019, the longitudinal slot 13019 being configured to slidably receive at least a portion of a firing member therein. The firing member, when advanced distally, can eject some of the staples 13016 positioned proximally and subsequently fire the proximal-most connector 13030. Firing of the proximal-most connector 13030 can release the proximal end 13021 of the tissue thickness compensator 13020 from the cartridge body 13010. In other embodiments, the firing member may fire the proximal-most connector prior to firing any staples. In any event, the firing member can be advanced further distally to eject the staples from the staple cavities 13016 and then re-fire the intermediate connector 13040. At this point, only the distal-most connector 13030 that holds the tissue thickness compensator 13020 to the cartridge body 13010 can remain. Once the firing member has fired the distal-most connector 13030, the tissue thickness compensator 13020 can no longer be attached to the cartridge body 13010. The firing sequence described above describes the full or complete firing of the staple cartridge. Other situations may also occur in which the staples contained in the staple cartridge are not fully fired. In such instances, some of the connectors that hold the tissue thickness compensator 13020 to the cartridge body 13010 can be unfired. Upon completion of the partial use of the staple cartridge 13000, the anvil can be opened and the cartridge body 13010 pulled away from the partially implanted tissue thickness compensator 13020. In such instances, the unfired connectors are configured to slide out of the staple cavities 13016 even if they have not been fired at all times. In any event, for example, the

connectors

13030 and 13040 can be constructed of any suitable biocompatible and/or bioabsorbable material.

In addition to the above, the firing member can, for example, comprise a cutting portion (such as a knife) that can be configured to transect the tissue thickness compensator 13020 with tissue as the firing member is advanced distally through the staple cartridge 13000. In such a case, the cutting portion is also configured to transect the connecting rod 13032 of the connector 13030.

In various embodiments, referring now to fig. 101 and 102, a staple cartridge 10800 including a support portion 10810 and a tissue thickness compensator 10820 can be loaded into a staple cartridge channel, e.g., using a staple cartridge applicator 10880. Similar to the above, the staple cartridge applicator 10880 can also be configured to position the upper tissue thickness compensator 10890 relative to an anvil (such as the anvil 10060), for example, such that the anvil 10060 can contact and engage the tissue thickness compensator 10890 when the anvil 10060 is closed. In at least one embodiment, the tissue thickness compensator 10890 can comprise a plurality of retention legs 10895 extending from the top surface 10891 of the tissue thickness compensator 10890 configured to engage the anvil 10060 and releasably retain the tissue thickness compensator 10890 thereto. In at least one such embodiment, the legs 10895 can be arranged in a longitudinal row, wherein each leg 10895 can include at least one foot configured to enter and engage the knife slot 10065 defined in the anvil 10060. In some embodiments, some of the legs 10895 may extend in one direction, while other legs may extend in another direction. In at least one embodiment, some of the feet may extend in opposite directions.

In any event, once the anvil 10060 has been engaged with the tissue thickness compensator 10890, referring now to fig. 102 and 103, the anvil 10060 can be reopened and the clinician can then move the cartridge applicator 10880 away from the

tissue thickness compensators

10820 and 10890. Then, referring to fig. 104, an upper tissue thickness compensator 10890 can be positioned on a first side of the target tissue, and a tissue thickness compensator 10820 (which can include a lower tissue thickness compensator) can be positioned on a second side of the tissue. After the

tissue thickness compensators

10820 and 10890 have been properly positioned, referring now to fig. 105, for example, a knife edge (such as knife edge 10053) of a firing member can be advanced through the target tissue and tissue thickness compensator described above.

In various embodiments, referring now to fig. 106, a staple cartridge applicator, such as applicator 12280, for example, can comprise a tissue thickness compensator 12290 detachably mounted thereto, which can be inserted into the staple cartridge channel similar to that described above (as shown in fig. 106A) and engaged with the anvil 10060 when the anvil 10060 is moved to the closed position. The applicator 12280 can include a handle 10084 for positioning the tissue thickness compensator 12290 relative to the staple cartridge. In addition, the applicator 10084 can comprise a plurality of legs 10081 that can secure the tissue thickness compensator 12290 to the staple cartridge. In at least one such embodiment, the tissue thickness compensator 12290 can comprise a plurality of retention members 12295 extending upwardly from a top surface 12291 thereof. Wherein each retention member 12295 can comprise a plurality of flexible legs 12296 configured to be insertable into the knife slots 10065 in the anvil 10060. Referring primarily to fig. 107 and 108, the flexible legs 12296 of each retention member 12295 can be separated by a gap 12298 such that the flexible legs 12296 can flex inwardly when inserted into the knife slot 10065, and the legs 12296 can then spring back outwardly once the enlarged foot of the legs 12296 has passed through the knife slot 10065. In various embodiments, the enlarged feet of the flexible legs 12296 can flex behind opposing retention lips 12297 defined in the anvil 10060, and the tissue thickness compensator 12290 can be retained to the anvil 10060 due to the interaction of the legs 12296 and lips 12297. The staple cartridge applicator 12280 can then be moved away from the tissue thickness compensator 12290, as shown in 106B. In use, once the tissue thickness compensator 12290 has been implanted against tissue, such as by staples deployed from the staple cartridge 10000, the anvil 10060 can be reopened and the legs 12296 of the retention members 12995 can flex inwardly as the anvil 10060 is moved away from the implanted tissue thickness compensator 12290 such that the legs can be pulled out of the knife slot 10065.

As outlined above, the end effector assembly may comprise a staple cartridge, an anvil, and at least one piece of buttress material positioned intermediate the staple cartridge and the anvil. In at least one embodiment, referring now to fig. 109-111, a piece of buttress material, such as buttress material 336, is configured to be snap-fit onto at least one of staple cartridge 322 and/or an anvil (not shown) to releasably retain the piece of buttress material within the end-effector. Referring to fig. 110 and 111, staple cartridge 322 can comprise first sidewall 302 and second sidewall 304, wherein at least one of first sidewall 302 and second sidewall 304 can comprise lip 306 extending outwardly therefrom. In various embodiments, the buttress material 336 can include a first edge or side 308, a second edge or side 310, and at least one lip 312 extending at least partially along the length of the first and

second edges

308, 310. In at least one embodiment, referring to FIG. 111, lip 312 is configured to engage lip 306 in a snap-fit manner to releasably retain buttress material 336 to staple cartridge 322.

In addition to the above, referring to FIG. 111, buttress material 336 can include a surface 316, the surface 316 being configured to be positioned adjacent to the deck 328 of staple cartridge 322 or against the deck 328 of staple cartridge 322. In at least one embodiment, the side edges 308 and 310 can include sidewalls that can extend in a direction perpendicular or transverse to the opposing surface 316. In such embodiments, lip 312 may extend from these sidewalls such that lip 312 may interlock with lip 306 behind lip 306 of staple cartridge 322. In various embodiments, lip 312 of buttress material 336 can disengage from lip 306 of staple cartridge 322 when staples are deployed from staple cartridge 322. More specifically, as the staples are deployed, the staples may come into contact with buttress material 336, apply an upward force to buttress material 336, and separate buttress material 336 from staple cartridge 322. Thus, advantageously, buttress material 336 can be automatically detached from staple cartridge 322 when the staples are deployed from staple cartridge 322 and/or when the end effector is opened, as described above.

In various embodiments, referring to fig. 110 and 111, a piece of buttress material can include at least one member extending therefrom that can be configured to releasably retain the buttress material to one of the staple cartridge and/or the anvil. In at least one embodiment, member 318 can extend from support material 336 in a direction perpendicular or transverse to surface 316. In various embodiments, the member 318 can engage one of the staple cavities 320 and/or anvil pockets in a friction or press fit manner to releasably retain the piece of buttress material to one of the staple cartridge and the anvil. Similar to the above, in various embodiments, staples deployed from staple cavities 320 can apply an upward force to buttress material 336 and separate member 318 from staple cavities 320. In various embodiments, staples can pierce member 318 and/or buttress material 336 to secure the buttress material to tissue, as outlined above.

As shown in fig. 110, a piece of buttress material can include more than one member (i.e., tab) extending therefrom for retaining the piece of buttress material to one of the staple cartridge and the anvil. In various embodiments, referring now to fig. 112 and 113, more than one member 318 'may extend from the sheet of buttress material 336', for example. In at least one embodiment, the member 318 'can be press-fit into the staple cavities 320' of the staple cartridge 322 'and/or the anvil pockets of the anvil (not shown) such that the member 318' frictionally retains the piece of buttress material into the staple cartridge and/or the anvil, as outlined above. As described in greater detail herein, in addition to the staple cavities of the staple cartridge and the anvil pockets of the anvil for receiving projections (or retention members) extending from a piece of buttress material, the staple cartridge and/or anvil can include slots or apertures therein.

In certain embodiments, as described in greater detail below, the support portion can include retention features configured to gradually release the tissue thickness compensator from the support portion as the staples are progressively fired from the staple cartridge. Referring now to fig. 114, a staple cartridge, such as staple cartridge 11200, for example, can comprise a support portion 11210, the support portion 11210 comprising a retention feature 11213 that can be configured to releasably retain a tissue thickness compensator 11220 (fig. 115) thereto. In various embodiments, a retention feature 11213 can be positioned, for example, at a distal end of each staple cavity 11212, wherein each retention feature 11213 can comprise a guide channel 11216 defined therein that is configured to slidably receive the staple legs 10032 of a staple 10030. In such embodiments, both the staple legs 10032 and the retention features 11213 can be configured to releasably retain the tissue thickness compensator 11220 to the support portion 11210.

In use, referring now to fig. 115, the staple drivers 10040 contained within the support portion 11210 can be driven upwardly by the sled 10050 as described above. Wherein the staple drivers 10040 can be configured to contact the retention features 11213, at least partially detach the retention features 11213 from the support portion 11210, and displace the retention features 11213 outwardly and away from the staples 10030 and staple cavities 11212. Upon separation and/or outward displacement of the retention feature 11213 from the support portion 11210, the retention feature 11213 may no longer be able to retain the tissue thickness compensator 11220 to the support portion 11210, and thus, the tissue thickness compensator 11220 may be released from the support portion 11210. Similar to the above, the tissue thickness compensator 11220 can be gradually released from the support portion 11210 as the staples 10030 are gradually ejected from the staple cartridge toward an anvil (such as the anvil 11260), for example. In various embodiments, the staple drivers 10040 can be in contact with the retention features 11213, such as when the top surface of the staple drivers 10040 is coplanar, or at least substantially coplanar, with the deck surface 11211 of the support portion 11210. In such embodiments, the tissue thickness compensator 11220 can be released from the support portion 11210 while and/or before the staples 10030 are being formed into their fully formed or fully fired configuration.

In at least one such embodiment, referring primarily to fig. 116, the drivers 10040 can be overdriven such that they are pushed over the deck surface 11211 to fully form the staples 10030, and the drivers 10040, during the overdriven, can cause the retention features 11213 to break away from the support portion 11210. In various embodiments, referring again to fig. 115, the retention features 11213 can extend over or overhang the staple cavities before separating or displacing outward from the staple cavities 11212 such that the drivers 10040 can come into contact with the retention features 11213 just as they reach the deck surface 11211. In any event, once the tissue thickness compensator 11220 has been released from the support portion 11210, referring now to fig. 116, the support portion 11210 can be moved away from the implanted tissue thickness compensator 11220.

Referring now to fig. 117, a fastener cartridge assembly 6002 for use with an end effector assembly can comprise a cartridge body 6050, and a tissue thickness compensator 6058 releasably secured to the cartridge body 6050. Similar to the cartridge body 5650, for example, the cartridge body 6050 can comprise a slot 6056 configured to guide advancement of the firing assembly and/or fastener cavities 6054 configured to removably retain fasteners in the cartridge body 6050. In various embodiments, the cartridge body 6050 can comprise projections 6048, such as posts, mounts, tabs, and/or ridges, for example. When the tissue thickness compensator 6058 is positioned relative to the cartridge deck, the projections 6048 can extend from the cartridge deck of the cartridge body 6050 and into the tissue thickness compensator 6058. In various embodiments, the cartridge body 6050 can comprise a plurality of projections 6048 extending from the cartridge deck. The projections 6048 can be positioned along the length of the cartridge body 6050, for example, and can be positioned between adjacent fastener cavities 6054, for example.

Still referring to fig. 117, in various embodiments, the tissue thickness compensator 6058 can be thermoformed around the projections 6048 of the tissue thickness compensator 6058. For example, the tissue thickness compensator 6058 can be positioned relative to the cartridge deck of the cartridge body 6050. Once positioned, the tissue thickness compensator 6058 can be heated to a sufficiently high temperature to cause the tissue thickness compensator 6058 to deform to conform to the shape of the cartridge platform including the shape of the projections 6048 extending therefrom. The tissue thickness compensator 6058 can be, for example, locally heated, and can be, for example, heated to approximately and/or near the glass transition temperature of the material comprising the tissue thickness compensator 6058. The tissue thickness compensator can be heated, for example, to about 90 ℃ to about 120 ℃. In certain embodiments, the tissue thickness compensator can be heated, for example, to about 75 ℃ to about 150 ℃. Once the tissue thickness compensator 6058 has deformed and conformed around the protrusion 6048, the heat source can be removed or relieved from providing heat, and the tissue thickness compensator 6058 can cool. The tissue thickness compensator 6058 can be subjected to the elevated temperature for about 2 seconds to about 5 seconds, for example, to sufficiently deform it around the projections 6048. In other cases, the tissue thickness compensator 6058 can be subjected to an elevated temperature, for example, for about 1 second to about 10 seconds, to sufficiently deform it around the projections 6048. The tissue thickness compensator 6058, upon cooling, can, for example, contract closer to the projections 6048 and/or more tightly around the projections 6048. In various embodiments, the thermoformed tissue thickness compensator 6058 can prevent and/or limit lateral displacement and/or buckling of the tissue thickness compensator 6058 along the length of the cartridge body 6050 and between the fastener cavities 6054.

Additionally or alternatively, the tissue thickness compensator 6058 can be thermoformed around at least a portion of a fastener removably positioned in the fastener cavity 6054. For example, the tissue thickness compensator 6058 can be thermoformed around the legs of the staples that extend above the cartridge deck. Still referring to fig. 117, in various embodiments, the fastener cartridge assembly 6002 can comprise a cover or housing 6060 that surrounds at least a portion of the cartridge body 6050. The housing 6060 can extend, for example, around the bottom, sides, and/or deck of the cartridge body 6050. The housing 6060 can be secured to the cartridge body 6050, for example, by pins 6062. Additionally, in various embodiments, the housing 6060 may comprise a metallic material, such as stainless steel 300 series, stainless steel 400 series, titanium, and/or medical grade aluminum, for example. The metal housing 6060 can, for example, facilitate heat transfer in the cartridge body 6050 and/or the projections 6048 to improve the thermoforming effect.

Referring now to fig. 118, a fastener cartridge assembly 6102 for use with the end effector assembly can comprise a cartridge body 6150, and a tissue thickness compensator 6158 releasably secured to the cartridge body 6050. Similar to the cartridge body 5650, the cartridge body 6150 can comprise a slot 6156, e.g., configured to guide advancement of the firing assembly, and fastener cavities 6154, e.g., configured to removably retain fasteners in the cartridge body 6150. The cartridge body 6150 can also include ridges 6146 (similar to the ridges 5648) extending from the cartridge deck 6152. The ridge 6146 can, for example, extend around at least a portion of the fastener cavity 6154. In various embodiments, the tip of the fastener can protrude from the fastener cavity 6148 when the fastener is positioned in the fastener cavity 6154. In such embodiments, the ridge 6146 positioned at least partially around the fastener cavity 6154 can support and/or guide the tip of the fastener as it is ejected from the fastener cavity 6154. In various embodiments, the cartridge body 6150 can comprise a plurality of ridges 6146 at least partially encircling the fastener cavities 6154. For example, the ridge 6146 can extend at least around the proximal end and/or the distal end of each fastener lumen 6154.

Still referring to fig. 118, in various embodiments, the fastener cartridge assembly 6102 can comprise a cover or housing 6160 positioned around at least a portion of the cartridge body 6150 and similar to housing 6060, for example. The housing 6160 can extend, for example, around the bottom and/or sides of the cartridge body 6150 and can be secured to the cartridge body 6150, for example, by pins 6162. In various embodiments, the housing 6160 can include a projection 6148, such as a post, mount, tab, and/or ridge, for example. The projections 6148 can extend beyond the cartridge deck 6152 of the cartridge body 6150. In various embodiments, the projections 6148 can extend into the tissue thickness compensator 6158 when the tissue thickness compensator 6158 is positioned relative to the cartridge deck. In various embodiments, the housing 6160 can include a plurality of projections 6148 extending therefrom. The projections 6148 can be positioned, for example, along the length of the housing 6160 and can be positioned, for example, around the perimeter of the cartridge body 6150.

Similar to the tissue thickness compensator 6058, the tissue thickness compensator 6158 can be thermoformed around the projections 6148 of the housing 6160. In various embodiments, the tissue thickness compensator 6158 can be wider than the housing 6160 such that a portion of the tissue thickness compensator 6158 extends beyond the perimeter of the cartridge body 6150. In such embodiments, the tissue thickness compensator 6158 can be, for example, thermoformed to protrusions 6148 around the perimeter of the cartridge body 6150. Additionally or alternatively, the tissue thickness compensator 6158 can be thermoformed, for example, to the ridge 6146 and/or staple legs extending from the fastener lumen 6154. In various embodiments, the housing 6160 may, for example, comprise a metallic material, such as stainless steel 300 series, stainless steel 400 series, titanium, and/or medical grade aluminum, to facilitate heat transfer and improve thermoforming.

Referring now to fig. 119 and 120, the end effector assembly 6200 can comprise a first or anvil 6210 and a second jaw 6202. The second jaw 6202 can comprise a cartridge body 6250, and a tissue thickness compensator 6258 releasably secured to the cartridge body 6250. Similar to the cartridge body 5650, the cartridge body 6250 can, for example, comprise fastener cavities 6254 and fasteners (such as surgical staples) that can be removably positioned in the fastener cavities 6254. In various embodiments, a surgical staple 6290 can be positioned on the driver 6220 in the fastener cavity 6254. Referring primarily to fig. 119, a portion of the staples 6290 can be positioned in the fastener cavities 6254 when the driver 6220 is in the pre-fired position. In various embodiments, staple 6290 can comprise a base 6292, and

legs

6294a and 6294b extending from base 6292. The first leg 6294a may, for example, extend from a first end of the base 6292 and the second leg 6294b may, for example, extend from a second end of the base 6292. In various embodiments, when the driver 6220 is in a pre-fired position and the staples 6290 are in a preformed configuration, the base portions 6292 of the staples 6290 can be positioned in the fastener cavities 6254 and the

legs

6294a and 6294b of the staples 6290 can extend from the fastener cavities 6254 into the tissue thickness compensator 6258.

In various embodiments, referring still to fig. 119 and 120, each

staple leg

6294a,6294b can comprise a barb between base 6292 and tip 6299a of each

staple leg

6294a,6294 b. The barbs may be, for example, sharp and/or pointed projections, such as spikes. In various embodiments, the wire diameter of the staple may be, for example, about 0.0069 inches, about 0.0079 inches, and/or about 0.0089 inches. The wire diameter of the barbs may be, for example, about 0.001 inches. In some cases, the barbs may be, for example, between about 0.0005 inches and about 0.003 inches. In certain embodiments, first lower barb 6296a may be positioned on first leg 6294a and second lower barb 6296b may be positioned on second leg 6294 b.

Lower barbs

6296a,6296b may be positioned between base 6292 and

tips

6299a,6299b of

legs

6294a,6294 b. In addition, first upper barb 6298a may be positioned on first leg 6294a and second upper barb 6298b may be positioned on second leg 6294 b.

Upper barbs

6298a,6298b may be positioned on

respective legs

6294a,6294b between

lower barbs

6296a,6296b and

tips

6299a,6299 b. At least one

barb

6296a,6296b,6298a,6298b of a staple 6290 can be positioned in a tissue thickness compensator 6258 when the driver 6220 is in the pre-fired position and the staples 6290 are in the pre-formed configuration. In such embodiments, the

barbs

6296a,6296b,6298a,6298b can, for example, grasp and/or hold the tissue thickness compensator 6258 relative to the cartridge body 6250.

Barbs

6296a,6296b,6298a,6298b embedded in tissue thickness compensator 6258 can, for example, prevent and/or limit lateral movement of the tissue thickness compensator 6258 relative to the cartridge deck, and/or can, for example, prevent lifting of the tissue thickness compensator 6258 away from the cartridge deck. Additionally or alternatively, in various embodiments, barbs may be positioned at

tips

6299a,6299b of

legs

6294a, 6294b.

Referring primarily to fig. 120, as the driver 6220 moves to the fired position, the staples 6290 can be removed and/or ejected from the fastener cavities 6254. Additionally, the tissue thickness compensator 6258 and the tissue T can be clamped between the anvil 6210 and the cartridge body 6250 of the end effector assembly 6200. The staple forming pockets 6214 in the anvil 6210 can, for example, form the staples 6290 into a B-shape. Additionally, at least one

barb

6296a,6296b,6298a,6298b of staple 6290 can, for example, engage tissue grasped in staple 6290.

Barbs

6296a,6296b,6298a,6298b can grasp and/or hold tissue T captured within staples 6290.

Referring now to fig. 121-124, a fastener 6390 may be releasably retained in a fastener cavity 6350 by a lock driver 6320 (fig. 123 and 124) used with an end effector assembly. In various embodiments, fastener 6390 may include a base 6392, and

legs

6394a and 6294b extending from base 6392. The first leg 6394a may extend from a first end of the base 6392, for example, and the second leg 6394b may extend from a second end of the base 6392, for example. In certain embodiments, the lock driver 6320 may be configured to releasably retain the base 6392 of the fastener 6390. In various embodiments, the lock driver 6320 may include a latch 6340, where the latch 6340 may be configured to releasably hook and/or retain the base 6392. The latch 6340 may be flexible, for example, and may flex, for example, to release the base 6392 of the fastener 6390. In various embodiments, the lock driver 6320 and/or the lock 6340 may be constructed of a plastic, such as polyetherimide, with or without a glass filler, for example, such that the lock 6340 is sufficiently elastically and/or plastically deformable.

Referring primarily to fig. 123 and 124, the lock drivers 6320 are movably positioned in fastener cavities 6354 defined in the cartridge deck 6352 of the cartridge body 6350. The lock driver 6320 is movable in the fastener cavity from a locked position (fig. 123) to an unlocked position (fig. 124). A sled and/or driver in the cartridge body 6350 can engage the lock driver 6320 during the firing stroke to move the lock driver 6320 from the locked position to the unlocked position. In various embodiments, the fastener 6390 may be secured to the lock driver 6320 when the lock driver 6320 is in the locked position and may be released from the lock driver 6320 when the lock driver 6320 is moved to the unlocked position. When the lock driver 6320 is moved from the locked position to the unlocked position, the fastener 6390 may be ejected from the fastener cavity 6354. A key 6353 adjacent to the fastener cavity 6354 may, for example, allow the fastener 6390 to be released from the lock driver 6320. The key 6353 may be, for example, a lip extending inward from at least a portion of the edge of the fastener cavity 6354. In various embodiments, the keys 6353 may have cam surfaces 6355. After the lock driver 6320 is moved from the locked position to the unlocked position, the lip 6344 of the latch 6340 may abut the cam surface 6355 of the key 6353. In such embodiments, when the catch 6340 moves against the cam surface 6355, the cam surface 6355 may flex the catch 6340, causing the hook 6342 to release the base 6392 of the fastener 6390. In various embodiments, the hook 6342 may be rotated upward to release the base 6392. For example, the hook 6342 may be rotated upward such that its opening is directed upward toward the tissue thickness compensator 6358, and such that the base 6392 may be moved upward through this opening and ultimately away from the lock driver 6320.

Still referring to fig. 123 and 124, the tissue thickness compensator 6358 can be releasably secured to the cartridge deck 6352 of the cartridge body 6350. When the lock driver 6320 is in the locked position (fig. 123), the

staple legs

6394a and 6394b may extend from the fastener cavity 6354 into the tissue thickness compensator 6358. The

staple legs

6394a and 6394b can retain the tissue thickness compensator 6358 relative to the cartridge platform 6352, for example, and can prevent and/or limit lateral movement of the tissue thickness compensator 6358 relative to the cartridge platform 6352, for example. Additionally, when the lock drivers 6320 are moved to the unlocked position and the fasteners 6390 are ejected from the fastener cavities 6354 (fig. 124), the latches 6340 can release the bases 6392 of the fasteners 6390 such that the fasteners 6390 can be disengaged from the lock drivers 6320 and the cartridge body 6350. When the fasteners 6390 removably positioned in the fastener cavities 6354 are ejected from their respective fastener cavities 6354 and out of engagement with the cartridge body 6350, the tissue thickness compensator 6858 can no longer be secured to the cartridge body 6350 and/or released from the cartridge body 6350.

Referring now to fig. 125-129, the end effector assembly 6400 may include a first jaw and/or anvil 6410 (fig. 127-129), and a second jaw 6402. The second jaw 6402 can comprise a fastener cartridge body 6450, and a tissue thickness compensator 6458 releasably secured to the second jaw 6402 and/or the tissue thickness compensator 6458. In certain embodiments, the fastener cartridge body 6450 and the tissue thickness compensator 6458, which is releasably secured to the cartridge body 6450, can comprise, for example, a fastener cartridge assembly. In various embodiments, the cartridge body 6450 can comprise a cartridge platform 6452 and a slot 6456 extending through at least a portion of the cartridge body 6450. The cavity may be defined in the cartridge deck 6452 and into the cartridge body 6450. For example, fastener cavities 6454 can be defined in the cartridge platform 6452 and can receive fasteners 6490 therein (fig. 126A-129). The fastener 6490 may be removably positioned in the fastener cavity 6454. For example, a single fastener 6490 may be removably positioned in each fastener cavity 6454 and may be ejected from the fastener cavity 6454 during the firing stroke. Additionally, a lock cavity 6448 can be defined in the cartridge platform 6452 and can receive the lock 6440 therein. For example, a single lock 6440 may be movably positioned in each lock cavity 6448 and may move from a locked position (fig. 127 and 128) to an unlocked position (fig. 129) during the firing stroke.

Referring primarily to fig. 126, the lock 6440 may include a base 6444 and a hook 6442, which may be movably positioned relative to the base 6444. For example, the hook 6442 may move within a hole formed through at least a portion of the base 6444. The hook 6442 may, for example, receive and/or retain the connector 6480. The hooks 6442 may be constructed of, for example, Liquid Crystal Polymer (LCP), nylon, polyetherimide, polycarbonate, and/or ABS. The connector 6480 may be a suture, for example. In certain embodiments, the connector may be comprised of, for example, a PDS, PGA/PCL, PLLA/PCL, TMC/PCL, PGA, and/or PCL. In various embodiments, the hook 6442 may constrain the connector 6480 after being embedded or partially embedded in the base 6444. The connector 6480 may be held between the hook 6442 and the base 6444, for example. When the hook 6442 is lifted off or partially lifted off of the base 6444, the connector 6480 may, for example, no longer be bound by the hook 6442 and may, for example, move out of engagement with the lock 6440. In various embodiments, the connector 6480 can slide out of engagement with the lock 6440 after the hook 6442 is at least partially lifted off the base 6444.

Referring primarily to fig. 126A, a connector 6480 may extend from the tissue thickness compensator 6458. The tissue thickness compensator 6458 can be, for example, friction fit with the connector 6480, and/or thermoformed with the connector 6480. In various embodiments, the connector 6480 may be passed through the hook 6442 of the lock 6440 when the lock 6440 is in the unlocked position. The tissue thickness compensator 6458 can be moved into position relative to the cartridge body 6450 as the connector 6480 is passed through the hooks 6442. For example, the tissue thickness compensator 6458 can be positioned on the cartridge deck 6452 of the cartridge body 6450. Referring primarily to fig. 127, once the tissue thickness compensator 6458 is positioned relative to the cartridge body 6450, the lock 6440 can be moved from the unlocked position to the locked position. For example, the hooks 6442 of the lock 6440 may be embedded or partially embedded in the base 6444 such that the lock 6440 encloses the connector 6480 and/or constrains the connector 6480. In various embodiments, the lock 6440 and/or driver 6420 may, for example, comprise a spring that may bias the lock 6440 to an unlocked position. When the lock 6440 is in the locked position, the tissue thickness compensator 6458 can be secured to the cartridge body 6450, for example, by engagement of a connector with the lock.

Referring primarily to fig. 128 and 129, the keys can move along at least a portion of the cartridge body 6450 during the firing stroke. The key may be, for example, a component of the sled 6434 and/or firing assembly. In various embodiments, the sled 6434 can engage with drivers in cavities in the cartridge body 6450 during the firing stroke. The slide 6434 can push the driver toward the cartridge deck 6452 and/or toward the tissue thickness compensator 6458 to eject the fastener from the fastener cavity 6454 and/or move the lock 6440 from the locked position to the unlocked position. Referring primarily to fig. 128, the sled 6434 may engage with the driver 6420 in the lock cavity 6448 during the firing stroke. The slide 6434 can move the driver 6420 toward the cartridge platform 6452 and/or toward the tissue thickness compensator 6458. Additionally, referring primarily to fig. 129, the driver 6420 may move the lock 6440 from a locked position to an unlocked position. For example, the driver 6420 may push the hook 6442 out of the base 6444. When the hook 6442 is lifted off the base 6444, the connector can no longer be bound by the lock 6440. In such embodiments, the tissue thickness compensator 6458 can be unsecured to the cartridge body 6450 and/or released from the cartridge body 6450, for example.

Referring now to fig. 67, the tissue thickness compensator 17050 can comprise, for example, a first portion 17052, and a second portion 17054 extending opposite the first portion 17052. The tissue thickness compensator 17050 may form part of a staple cartridge assembly. In some cases, a tissue thickness compensator 17050 can be attached to a cartridge body on the staple cartridge assembly. In some instances, the tissue thickness compensator 17050 can be assembled to an anvil of a surgical stapling instrument. In any case, the first portion 17052 of the tissue thickness compensator 17050 can be compressible. In use, the first portion 17052 can be captured within a staple ejected from a staple cartridge and can apply a compressive force to tissue also captured within the staple. The second portion 17054 of the tissue thickness compensator 17050 can extend through the first portion 17052, wherein the second portion 17054 can include a proximal end 17053 and a distal end 17055 extending from the first portion 17052. As described in more detail below, the second portion 17054 may be less flexible than the first portion 17052 and/or more rigid than the first portion 17052. Referring now to fig. 68, a staple cartridge assembly 17000 can comprise a cartridge body 17010 comprising a plurality of staple cavities defined therein and a plurality of staples at least partially stored within the staple cavities. As shown in fig. 68, a tissue thickness compensator 17050 can be mounted to the cartridge body 17010.

The staple cartridge assembly 17000 can comprise a proximal mount 17060 configured to releasably retain a proximal end 17053 of the second portion 17054 to the cartridge body 17010 and a distal mount 17070 configured to releasably retain a distal end 17055 of the second portion 17054 to the second portion 17054. The proximal mount 17060 can comprise a single component, or more than one component. As shown in fig. 68, the proximal mount 17060 can comprise a first mount portion 17060a and a second mount portion 17060b configured to at least partially capture the second portion 17054 and retain the second portion 17054 against the cartridge body 17010. Turning now to fig. 69, each

mount portion

17060a and 17060b can comprise a key 17062, which key 17062 can be releasably secured within a keyway 17012 defined in the cartridge body 17010. Each key 17062 and each keyway 17012 may be sized such that the sidewalls of the keyways 17012 apply a retaining force to the keys 17062, thereby resisting removal of the keys 17062 from the keyways 17012. In various instances, the key 17062 can be releasably press-fit and/or snap-fit within the keyway 17012. In at least one instance, the key 17062 can, for example, include an enlarged end 17063 that can be releasably clamped between the sidewalls of the keyway 17012. As shown in fig. 68 and 69, each

mount portion

17060a and 17060b can include a window 17064 configured to at least partially receive the proximal end 17053 of the second portion 17054. In such instances, the sidewalls of the window 17064 can be configured to engage the tissue thickness compensator 17030 and press the tissue thickness compensator 17030 against the deck 17014 of the cartridge body 17010. Further, at least a portion of the second portion 17054 can be housed within the

mount portions

17060a and 17060 b.

Referring again to fig. 68 and 69, similar to the above, the distal mount 17070 can include a window 17074, which window 17074 can be sized and configured to receive at least a portion of the distal end 17055 of the second portion 17054. Also similar to the above, the sidewalls of the window 17074 can be configured to engage the tissue thickness compensator 17030 and press the tissue thickness compensator 17030 against the deck 17014 of the cartridge body 17010. Further, at least a portion of the second portion 17054 can be housed within the mount portion 17070. The distal mount portion 17070 can comprise one or more pins 17072 extending therefrom that can be releasably secured within one or more pin holes 17011 defined in the cartridge body 17010. Each pin 17070 and each pin aperture 17011 may be sized and configured such that the sidewalls of the pin apertures 17011 apply a retaining force to the pins 17072, thereby resisting removal of the pins 17072 from the pin apertures 17011. In various circumstances, each pin 17072 can be releasably press-fit and/or snap-fit within the pin aperture 17011.

To assemble the staple cartridge 17000, in at least one instance, the tissue thickness compensator 17030 can first be positioned against the deck 17014 of the cartridge body 17010, and the proximal and distal mounts 17060, 17070 can be assembled to the cartridge body 17010. The proximal and distal mounts 17060, 17070 are assembled to the cartridge body 17010 to capture or trap the tissue thickness compensator 17050 against the cartridge body 17010 as described above. The proximal and distal mounts 17060, 17070 can be configured to capture and releasably retain an end of the second portion 17074 to the cartridge body 17010, as also described above. In certain instances, the proximal mount 17060 and/or the distal mount 17070 can be configured to capture at least a portion of the first portion 17052 therein. While fig. 67-69 depict a tissue thickness compensator 17050 comprising only two portions, various alternative forms of tissue thickness compensators comprising more than two portions are also contemplated. For example, the tissue thickness compensator can include a compressible first portion 17052, and two or more rigid second portions 17054 extending therethrough. Further, for example, the tissue thickness compensator can comprise two or more compressible portions arranged in any suitable arrangement, such as in two or more layers.

Once the staple cartridge 17000 is assembled, it can be assembled to a surgical stapler. In at least one instance, staple cartridge 17000 can be removably retained using a channel defined in an end effector of a surgical stapler, and staple cartridge 17000 can subsequently be inserted into a surgical site within a patient. The proximal mount 17060 and/or the distal mount 17070 can be configured to retain the tissue thickness compensator 17050 to the cartridge body 17010 as the staple cartridge 17000 is inserted into and/or manipulated within a surgical site. The second portion 17054 of the tissue thickness compensator 17050 can make the tissue thickness compensator 17050 sufficiently rigid such that the tissue thickness compensator 17050 does not become separated from the cartridge body 17010 until one or more of the proximal mounts 17060 and/or the distal mounts 17070 are severed and/or separated from the cartridge body 17010, as described in more detail below. Since the second portion 17054 is rigid, in each case, the properties of the first portion 17052 of the tissue thickness compensator 17050 are selected primarily or exclusively to provide the tissue thickness compensator 17050 with desired tissue compensation characteristics. In use, the second portion 17054 of the tissue thickness compensator 17050 can resist relative movement between the proximal end 17053 and the distal end 17055, and in various instances, resist movement of the proximal end 17053 and the distal end 17055 toward each other.

In various circumstances, once the staple cartridge 17000 has been properly positioned, the firing member 17030 can be advanced through the staple cartridge 17000 to deploy staples removably positioned in the staple cartridge 17000. The staple cartridge 17000 can include a moveable member 17034, which moveable member 17034 can be advanced from a proximal end of the staple cartridge 17000 toward a distal end of the staple cartridge 17000 by a firing member 17030. In addition to the above, the movable member 17034 can be configured to lift staples removably stored within the cartridge body 17010 between an unfired position and a fired position. The firing member 17030 can, for example, further comprise a cutting portion (such as a knife 17032) that can be configured to transect tissue being stapled as the firing member 17030 is advanced distally through the staple cartridge 17000. The knife 17032 can also be configured to transect the tissue thickness compensator 17050 as the firing member 17030 is advanced distally through the staple cartridge 17000. Referring primarily to fig. 67 and 68, the proximal end 17053 of the second portion 17054 may be severed by a knife 17032. In at least one such embodiment, the tissue thickness compensator 17050 can be at least partially severed, or completely severed, along a longitudinal axis defined at least in part by the notch 17057 defined in the second portion 17054. As shown in fig. 68, the notches 17057 can be aligned, or at least substantially aligned, with the longitudinal knife slot 17015 extending through the cartridge body 17010. Once the knife 17032 at least partially transects the proximal end 17053 of the second portion 17054, the second portion 17054 can be at least partially released, or released, from the

proximal mounts

17060a,17060 b. In such instances, the tissue thickness compensator 17050 can become separated from the cartridge body 17010. For example, the firing member 17030 can be advanced at least partially or fully through the staple cartridge 17000 to at least partially or fully implant the tissue thickness compensator 17050 into tissue, and as the tissue thickness compensator 17050, and particularly the second portion 17054, is at least partially transected, the tissue thickness compensator 17050 can be flexible enough to slide out of the

proximal mount portions

17060a,17060b and the distal mount 17070. In use, in various circumstances, after the firing member 17030 has been at least partially fired and the tissue thickness compensator 17050 has been at least partially implanted, the firing member 17030 can be retracted to its proximal or starting position wherein the cartridge body 17010 can then be pulled away from the implanted tissue thickness compensator 17050. For example, if the cartridge body 17010 is pulled away from the tissue thickness compensator 17050 along a longitudinal axis, the tissue thickness compensator 17050, e.g., at least partially transected, can be longitudinally flexed and the proximal and distal ends of the tissue thickness compensator 17050 can be moved toward one another.

70-72, the tissue thickness compensator 17150 can include a compressible portion 17152, and a mount portion 17154 extending through the compressible portion 17152 and/or from the compressible portion 17152. The compressible portion 17152 can include a proximal end 17153, the proximal end 17153 can have a thickness that is less than a thickness of the body portion 17156 of the tissue thickness compensator 17150. In at least one such embodiment, the proximal end 17153 may, for example, include a tapered portion. Referring again to fig. 70-72, a staple cartridge assembly (such as staple cartridge 17100), for example, can comprise a proximal mount 17160 that is configured to releasably secure a mount portion 17154 of the tissue thickness compensator 17150 to the cartridge body 17010. The proximal mount 17160 can comprise one or more locks 17162 extending therefrom which locks 17162 can be received within one or more keyholes 10112 defined in the cartridge body 17110. In at least one such embodiment, each lock 17162 can include a leg and a foot extending from the leg, wherein the leg can be configured to flex laterally when lock 17162 is inserted into keyhole 17112 and then spring back, or at least substantially spring back, to its unflexed configuration, thereby enabling the foot to releasably engage or move behind the keyhole 17112 side wall. Similar to the above, the proximal mount 17160 can further include a lumen 17164, the lumen 17164 being configured to receive the proximal mount portion 17154 of the tissue thickness compensator 17150. The lumen 17164 can be configured to press the proximal mount portion 17154 toward the deck of the cartridge body 17110 and hold the proximal end of the tissue thickness compensator 17150 in place. In various circumstances, a firing member, such as the firing member 17030, for example, can be configured to incise the proximal mount 17160 as the firing member 17030 advances to incise the tissue thickness compensator 17150. In at least one such instance, cutting into the proximal mount 17160 can release the tissue thickness compensator 17150 from the cartridge body 17110. Referring again to the embodiment depicted in fig. 68, for example, the firing member 17030 can be configured to pass through a slot defined between the

proximal mount portions

17060a and 17060b, and in at least some instances, to pass through the

proximal mount portions

17060a,17060b without cutting therein.

In addition to the above, referring now to fig. 73-76, a proximal mount for releasably retaining a tissue thickness compensator to the cartridge body can comprise a first portion 17260a and a second portion 17260b which, upon assembly to the cartridge body, can define a longitudinal gap or slot 17267 which can be sized to allow the firing member 17030 to pass between the first portion 17260a and the second portion 17260 b. Similar to the above, each of the first and second portions 17260a, 17260b can include a cavity 17264 configured to at least partially receive and hold in place a tissue thickness compensator. Also similar to the above, each of the first and second portions 17260a, 17260b can comprise a lock 17262 extending therefrom, the lock 17262 can be configured to be engaged with the cartridge body.

As described above, the staple cartridge assembly can comprise a proximal mount or attachment portion and a distal mount or attachment portion, wherein the proximal mount or attachment portion is configured to retain a proximal end of the tissue thickness compensator to a proximal end of the cartridge body and the distal mount or attachment portion is configured to retain a distal end of the tissue thickness compensator to a distal end of the cartridge body. In certain other embodiments, the cartridge assembly may employ only at least one proximal mount or at least one distal mount for retaining the tissue thickness compensator to the cartridge body. Turning now to fig. 147, the cartridge assembly 17300 can comprise a cartridge body 17310 and a tissue thickness compensator 17350, wherein a distal end of the tissue thickness compensator 17350 can comprise a distal end 17355 configured to be releasably mountable to the cartridge body 17310. In at least one such embodiment, the distal end of the cartridge body 17310 can comprise a lock aperture 17011, the lock aperture 17011 being configured to receive and attach at least one distal mount to the cartridge body 17310. The reader will appreciate that, at least with respect to this embodiment, the cartridge assembly 17300 does not additionally include a proximal mount for mounting the proximal end of the tissue thickness compensator 17350 to the cartridge body 17310. In various instances, the distal end 17355 can be integrally formed with the body portion 17356 of the tissue thickness compensator 17350, or alternatively, can be attached to the body portion 17356.

In various embodiments, referring now to fig. 156 and 157, a staple cartridge assembly, such as a staple cartridge 10400, for example, can comprise a cartridge body 10410 comprising a distal end or nose 10419 which can be configured to releasably hold a tissue thickness compensator 10450 in place. Similar to the above, the tissue thickness compensator 10450 can comprise a first portion 10452 mounted to a second portion 10454, wherein the second portion 10454 can comprise a distal end 10455 configured to be releasably retained by the nose 10419. In various circumstances, the nose 10419 and the platform 10414 of the cartridge body 10410 can define a slot 10418 therebetween, the slot 10418 being configured to receive the distal end 10455. Nose 10419 may be constructed of an elastic material that may be sized and configured to bias nose 10419 into engagement with distal end 10455. In use, referring to fig. 157, after the tissue thickness compensator 10450 has been at least partially implanted, the nose 10419 can be sufficiently flexible to allow the tissue thickness compensator 10450 to slide out from under the nose 10419 as the cartridge body 10410 is moved away from the tissue thickness compensator 10450. Turning now to fig. 158, in addition to the above, first layer 10452 may be constructed of a compressible foam and may be mounted to second layer 10454. In various instances, the first layer 10452 can be mounted to the second layer 10454 with one or more adhesives. The first layer 10452 is mounted to the second layer 10454 such that the distal end 10455 and the notch 10457 defined in the distal end 10455 remain exposed. Additionally, the first layer 10452 is mounted to the second layer 10454 such that the first layer 10452 is laterally centered with respect to a longitudinal central axis 10459 defined by the second layer 10454.

As described above, the cartridge module can include a movable firing member at least partially stored therein, which can be configured to lift staples stored within the cartridge module between an unfired position and a fired position. Turning now to fig. 159 and 160, the staple cartridge assembly 10500 can comprise a cartridge body 10510, a tissue thickness compensator 10550, and a movable firing member or sled 10034 slidably stored therein. The sled 10034 can comprise one or more ramps 10035 defined thereon that can be configured, in use, to lift staples upwardly from their unfired position to a fired position. Prior to use, the sled 10034 can be releasably locked in place. In at least one such embodiment, the tissue thickness compensator 10550 can be configured to releasably retain the sled 10034 in a proximal position prior to distal advancement of the sled 10034 to eject staples from the staple cartridge assembly 10500 and cut into the tissue thickness compensator 10550. The tissue thickness compensator 10550 can include one or more tabs or detent devices 10557 extending therefrom, the tabs or detent devices 10557 can be configured to releasably engage the sled 10034. For example, the sled 10034 can comprise one or more grooves 10037 in which the detent devices 10557 can be positioned 10037 until the sled 10034 is exerted with sufficient force to cause the sled 10034 to overcome the retention force exerted thereon by the detent devices 10557. In use, the detent 10557 can be configured to hold the sled 10034 in place until a longitudinal firing force applied to the sled 10034 in a distal direction exceeds a threshold force, wherein when the firing force exceeds the threshold force, the sled 10034 can slide distally and the detent 10557 can flex or deform sufficiently to enable the sled 10034 to slide therethrough. In at least one embodiment, the detent 10557 can be positioned proximal of the staple cavities defined in the cartridge body 10510 and/or proximal of the staples stored within the cartridge body 10510 such that the sled 10034 can be releasably retained in an unfired position proximal of the staples. Once the sled 10034 has been advanced distally, the sled 10034 can be advanced toward the staples.

In addition to the above, referring again to fig. 159 and 160, the cartridge body 10510 can comprise one or more retention slots 10517, which retention slots 10517 can be configured to receive at least a portion of the detent 10557. More specifically, at least in the illustrated embodiment, when the sled 10034 is in its proximal, unfired position, a retention slot 10517 defined on one side of the cartridge body 10510 can be aligned with a recess 10037 defined on a corresponding side of the sled 10034 such that the detent 10557 can be synchronously positioned within the aligned retention slot 10517 and recess 10037. In at least one such embodiment, the side walls of the retention slots 10517 defined in the cartridge body 10510 can support the detent devices 10557 and at least inhibit the detent devices 10557 from prematurely disengaging from the recesses 10037. As described above, the sled 10034 can be advanced distally such that the groove 10037 is no longer aligned with the detent 10557; however, at least in the illustrated embodiment, the pawl 10557 can remain aligned with the retention slot 10517 and/or positioned within the retention slot 10517 after the slider 10034 has been at least partially advanced. Referring primarily to fig. 159, a first arrangement comprising the detent device 10557, the sled groove 10037, and the cartridge retention slot 10517 can be disposed on a first side of the sled 10034, comprising a second detent device 10557, and a second arrangement of the second sled groove 10037 and the second cartridge retention slot 10517 can be disposed on a second or opposite side of the sled 10034.

Certain embodiments of staple cartridges may, for example, comprise a pliable layer (such as a tissue thickness compensator and/or buttress material) on a staple deck, wherein the staples may be arranged such that the tips of the unfired staples extend into the layer. In certain other embodiments, the pliable layer may constitute a compressible and/or squeezable staple cartridge that is implantable in the patient and deforms and/or compresses when captured in the staple. The flexible layer and/or the implantable staple cartridge can also, for example, deform and/or compress if a surgeon, nurse, technician, or other user(s) inadvertently presses a thumb or other finger against the flexible layer or the implantable staple cartridge. Such deformation and/or compression renders the staple cartridge unusable.

A retainer is typically fitted in the staple cartridge, which may assist the user in smoothly loading the staple cartridge into the surgical stapler. The retainer may also cover the staple deck and any pliable layer, thereby preventing a user from inadvertently compressing, squeezing, and/or deforming the pliable layer. However, users sometimes prematurely remove the staple cartridge holder before the staple cartridge is not fully installed into the end effector of the surgical stapler. In the event of premature removal of the cartridge holder, the flexible layer may be damaged by the user.

Fig. 164-167 illustrate an embodiment of a retainer 10000 that is attachable to the staple cartridge 10010. Referring to fig. 166 and 167, the staple cartridge 10010 can comprise a pliable layer 10020 (such as a tissue thickness compensator and/or buttress material) disposed on a cartridge deck 10011 thereof. As shown in fig. 167, the staples 10030 can extend from the staple cartridge 10010 into the exposed flexible layer 10020. If the retainer 10000 is removed prematurely, a user can inadvertently press the pliable layer 10020 while pushing the staple cartridge 10010 into the staple cartridge channel of the end effector, thereby compressing the layer 10020 and/or deforming the layer 10020.

168-173 illustrate an embodiment of a retainer 2600 that may be locked to the staple cartridge 2650 and cannot be unlocked and removed from the staple cartridge 2650 until the staple cartridge 2650 is fully inserted into the staple cartridge channel 2670 of the end effector. As best shown in fig. 168, the proximal end portion 2604 of the retainer 2600 can include movable cam portions 2616, the movable cam portions 2616 having locking tabs 2626 extending therefrom. The locking tabs 2626 extend into slots 2652 (such as knife slots) of the staple cartridge 2650 and engage the slots 2652. The locking tabs 2626 are engaged within the slots 2652 to releasably hold the retainer 2600 and the staple cartridge 2650 together. As described in greater detail below, after the cam portions 2616 of the retainer 2616 engage the keys in the staple cartridge channel 2670, causing the cam portions 2616 to flex inwardly toward one another, the locking tabs are only disengaged from the slots 2652, thereby allowing the retainer 2600 to be released and removed from the staple cartridge 2650. Further, in various embodiments, the cam portions 2616 may only engage the keys if the staple cartridge 2650 is properly seated in the staple cartridge channel 2670.

As described above, in certain embodiments, the proximal end portion 2604 of the holder 2600 can include cam portions 2616, each cam portion 2616 being attached to the body 2606 of the holder 2600 by a neck 2624. The cam portions 2616 may be separated from each other by a gap 2622. The cam portion 2616 may flex inwardly in the direction of arrow I (shown in fig. 172) when subjected to an inward compressive force and, in addition, may flex resiliently outwardly about the neck 2624 in the direction of arrow O (shown in fig. 170). A locking tab 2626 may extend from each cam portion 2618. As described in greater detail below, when the locking tabs 2626 are disposed on the staple cartridge 2650, they can extend into slots 2652 (such as knife slots) of the staple cartridge 2650 and releasably engage the slots 2652. Referring primarily to fig. 170 and 171, the cam portions can be biased in an outwardly flexed position such that lips 2628 extending from the locking tabs 2626 can engage ridges 2654 in slots 2652 of the staple cartridge 2650. The cam portions 2616, when biased in the outwardly flexed position, can push the lips 2628 of the locking tabs 2626 into engagement with the ridges 2654 in the slots 2652 such that the retainer 2600 is locked onto the staple cartridge 2650 in the absence of an inward compressive force from the keys of the staple cartridge channel 2670.

Referring primarily to fig. 170-173, in various embodiments, the splines of the staple cartridge channel 2670 can comprise interior walls of the staple cartridge channel 2670 that provide an increasing inward compressive force to the cam portions 2616, thereby enabling the cam portions 2616 to flex inward in the direction of arrow I (shown in fig. 172) as the retainer 2600 and staple cartridge 2650 are inserted into the staple cartridge channel 2670. For example, the staple cartridge channel 2670 can include a first inner wall 2672 defining a first width that can accommodate the cam portions 2616 in the outwardly flexed, biased position. The staple cartridge channel 2670 can include a second inner wall 2676 defining a second width that can accommodate the cam portions 2616 in the inwardly flexed position as shown in FIG. 172. The staple cartridge channel 2670 can include an intermediate inner wall 2674 positioned intermediate the first inner wall 2672 and the second inner wall 2676, the intermediate inner wall 2674 can transition from a first width to a second width. In use, the staple cartridge 2650 and retainer 2600 are moved in a proximal direction relative to and toward the staple cartridge channel 2670 for insertion into the staple cartridge channel 2670 as indicated by arrow P in fig. 170 and 172. Referring primarily to fig. 170 and 171, as the staple cartridge 2650 and retainer 2600 are moved toward the staple cartridge channel 2670, the rounded ends 2620 and outward surfaces 2618 of the cam portions 2616 may engage the first wall 2672 of the staple cartridge channel 2670. As described above, in certain embodiments, the first wall 2672 defines a width that accommodates the cam portion 2616 in the outwardly deflected biased position. In various other embodiments, the first wall 2672 defines a width that accommodates the cam portion 2616 in an inwardly deflected position, wherein the inwardly deflected position is sufficient enough that the lips 2628 of the locking tabs 2626 do not disengage from the ridges 2654 of the staple cartridge 2650 and unlock the retainer 2600 from the staple cartridge 2650. Referring now to fig. 172 and 173, as the staple cartridge 2650 and retainer 2600 continue to move proximally in the direction of arrow P toward the staple cartridge channel 2670, the rounded end 2620 and outward surface 2618 engage the intermediate wall 2674 and then the second wall 2676. Intermediate wall 2674 and second wall 2676 may provide an incremental force that gradually flexes cam portion 2616 inward. Eventually, the cam portions 2616 will flex inward an amount such that the lips 2628 of the locking tabs 2626 can disengage from the ridges 2654 in the slots 2652 of the staple cartridge 2650. Once the locking tabs 2626 are disengaged from the ridges 2654, the retainer 2600 is unlocked from the staple cartridge 2650 such that the retainer 2600 can be removed from the staple cartridge 2650. In various embodiments, the cam portions 2616 flex inwardly such that the locking tabs 2626 only disengage from the ridges 2654 when the staple cartridge 2650 is fully inserted into the staple cartridge channel 2670.

In certain embodiments, a lockable retainer, such as retainer 2600 described above in connection with fig. 168-173, can also prevent a particular sized staple cartridge from being inserted into an end effector intended for use with a different particular sized staple cartridge. For example, the staple cartridge 2650 can comprise a datum surface 2632, and the datum surface 2632 can engage a datum surface 2674 of the staple cartridge channel 2670. The first predetermined distance from the datum surface 2632 of the staple cartridge 2650 to the cam portion 2616 may correspond to a second predetermined distance between the datum surface 2674 of the staple cartridge channel 2670 and the

walls

2672,2674 and 2676 of the staple cartridge channel 2670 that include the keys. The first and second predetermined distances for a particular sized retainer, staple cartridge, and staple cartridge channel intended for use with a particular sized staple cartridge may be different than the first and second predetermined distances for another differently sized retainer, staple cartridge, and staple cartridge channel. In other words, the first and second predetermined distances for each size of staple cartridge, retainer, and staple cartridge channel may be different than the first and second predetermined distances for other sizes of staple cartridges, retainers, and staple cartridge channels. Thus, attempts to insert the staple cartridge and retainer into an improperly sized staple cartridge channel may result in the cam portions of the retainer failing to engage the walls of the staple cartridge channel and/or the datum surface of the staple cartridge failing to engage the datum surface of the staple cartridge channel. For example, the staple cartridge 2650 and retainer 2600 can be arranged such that the cam portions 2616 can only engage the second wall 2676 of the staple cartridge channel 2670 when inserted into a correspondingly sized staple cartridge channel such that the locking tabs 2626 disengage from the slots 2652 in the staple cartridge 2650 when the

datum surfaces

2632 and 2674 engage one another. For example, if the staple cartridge 2650 and retainer 2600 are too short relative to the staple cartridge channel 2670, the cam portions 2616 may not reach the second wall 2676, thereby causing the locking tabs 2626 to disengage from the slots 2552 in the staple cartridge 2650 when the

reference surfaces

2632 and 2674 are engaged. Thus, the retainer 2600 will not unlock and cannot be removed from the staple cartridge 2650. Conversely, if the staple cartridge 2650 and retainer 2600 are too long relative to the staple cartridge channel 2670, for example, the cam portions 2616 engaging the second wall 2676 of the staple cartridge channel 2670 may interfere with the engagement of the reference surfaces 2632 of the staple cartridge 2650 with the reference surfaces 2674 of the staple cartridge channel 2670, respectively. Thus, the staple cartridge 2650 will not be fully seated in the staple cartridge channel 2670.

The retainer 2600 includes not only locking tabs 2626 extending from the cam portion 2616, but also a pair of proximal tabs 2612 disposed near the proximal end 2602 of the retainer 2600 and a pair of distal tabs 2610 disposed near the distal end 2604 of the retainer 2600. The proximal and

distal tabs

2608, 2610 can extend from the body 2606 and can engage the staple cartridge 2650 and releasably retain the staple cartridge 2650. In certain embodiments, the proximal and

distal tabs

2612, 2610 can engage the staple cartridge 2650 and hold the staple cartridge 2650 until the staple cartridge 2650 is fully seated in the staple cartridge channel 2670. In other words, the proximal and/or

distal tabs

2612, 2610 can act as another type of lock that prevents the retainer 2600 from being removed from the staple cartridge 2650 before the staple cartridge 2650 is fully seated in the staple cartridge channel 2670.

Referring primarily to fig. 168, each proximal tab 2612 can include a proximal lip 2614, and each distal tab 2610 can include a distal lip 2610. Each proximal lip 2614 can include an inwardly facing angled surface 2615, and each distal lip 2610 can include an inwardly facing angled surface 2611. The proximal and

distal lips

2614, 2610 can engage lateral sides of the staple cartridge 2650 and releasably retain the lateral sides of the staple cartridge 2650. Upon insertion of the staple cartridge 2650 and retainer 2600 into the staple cartridge channel 2670, the inwardly facing

angled surfaces

2611 and 2615 may engage edges 2672 and 2678 of the staple cartridge channel 2670. The edges 2672 and 2678 of the staple cartridge channel 2670 can flex the proximal and/or

distal tabs

2612 and 2610 outward, thereby disengaging the proximal and

distal lips

2614 and 2610 from the lateral sides of the staple cartridge 2650. When the proximal and

distal lips

2614, 2610 are disengaged from the lateral sides of the staple cartridge 2650, the retainer 2600 can be released and removed from the staple cartridge 2650.

Referring to fig. 174-180, for example, the end effector 12 of the surgical instrument can be configured to receive an end effector insert 28010. In various embodiments, the end effector insert 28010 may comprise a compensator body 28012 and at least one

clamp

28014a,28014 b. In various embodiments, the end effector insert 28010 may, for example, comprise a proximal clamp 28014b at a proximal end of the compensator body 28012, and a distal clamp 28014a at a distal end of the compensator body 28012. Referring primarily to fig. 177, a distal clamp 28014a can be secured to the anvil 25060 of the end effector 12 at or near the distal end of the anvil 25060. For example, the distal clamp 28014a can be substantially aligned with the longitudinal slot 25062 of the anvil 25060 and/or can be partially positioned within the longitudinal slot 25062 of the anvil 25060. Referring primarily to fig. 178, the proximal clamp 28014b can be secured to a staple cartridge 25000 (fig. 179) in the lower jaw 25070 of the end effector 12. The proximal clamp 28014b can be secured to the staple cartridge 25000 at or near the proximal end of the staple cartridge 25000. For example, the proximal clamp 28014b can be substantially aligned with the longitudinal slot 25004 in the staple cartridge 25000 and/or can be positioned within the longitudinal slot 25004 in the staple cartridge 25000.

Referring now to fig. 179 and 180, the end effector insert 28010 may be inserted into the end effector 12 of the surgical instrument. In various embodiments, at least a portion of the end effector insert 28010 (e.g., the compensator body 28012, the distal clamp 28014a, and/or the proximal clamp 28014b) can be, for example, deformable and/or resilient. When the end effector insert 28010 is inserted into the end effector 12, the distal clamp 28014a and/or the proximal clamp 28014b can bend or flex. Once

clamps

28014a and 28014b are flexed, for example, clamps 28014a and 28014b may, for example, have a tendency to return to their original, undeformed configuration and may develop a spring back or restoring force. In various embodiments, the end effector insert 28010 may apply a spring load to the end effector 12 when the end effector insert 28010 is positioned within the end effector 12. In some embodiments, the end effector insert 28010 may be solid or substantially solid such that an operator can grasp the insert 28010 when inserting the end effector insert 28010 and staple cartridge 25000 into the end effector 12.

In some embodiments, the end effector insert 28010 may be removed from the end effector 12 after a cutting and/or fastening operation of the end effector 12. In other embodiments, the end effector insert 28010 may remain positioned in the end effector 12 during the cutting and/or firing operation. For example, the end effector insert 28010 can be transected by the cutting element 25052 as staples are fired from staple cavities 25002 (fig. 178) in the staple cartridge 25000. In various embodiments, the end effector insert 28010 can comprise a tissue thickness compensating material similar to at least one of the tissue thickness compensators described herein. For example, the end effector insert 28010 may comprise a polymeric composition, such as a bioabsorbable, biocompatible elastomeric polymer. The end effector insert 28010 may also comprise a bioabsorbable polymer, such as lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and/or Oxidized Regenerated Cellulose (ORC). In some embodiments, end effector insert 28010 may contain at least one therapeutic agent, such as a pharmaceutically active agent or drug.

Still referring to fig. 174-180, the end effector insert 28010 can be releasably attached to the end effector 12 and/or to the anvil 25060 and/or to the staple cartridge 25000 of the end effector 12. The proximal clamp 28014b can be releasably secured to the staple cartridge 25000 (fig. 178), for example, and the distal clamp 28014a can be releasably secured to the anvil 25060 (fig. 177), for example. In various embodiments, the proximal clamp 28014b can be aligned with the slot 25004 of the staple cartridge 25000 and/or can be retained within the slot 25004. Additionally, in certain embodiments, the distal clamp 28014a can be aligned with the slot 25062 of the anvil 25060 and/or can be retained within the slot 25062. Referring primarily to FIG. 179, in certain embodiments, the proximal clamp 28014b can be releasably secured to the staple cartridge 25000 prior to positioning the staple cartridge 25000 in the lower jaw 25070 (FIG. 179). For example, as the staple cartridge 25000 and attached end effector insert 28010 are moved toward and/or into the end effector 12 and/or lower jaw 25070, the distal clamp 28014a can be moved into alignment with the slot 25062 in the anvil 25060. In various embodiments, the distal clamp 28014a can be configured to releasably engage the anvil 25060 when the staple cartridge 25000 and end effector insert 28010 are positioned in the end effector 12 (fig. 180). The distal clamp 28014a can, for example, be slid into the slot 25062 of the anvil 25060. In various embodiments, the proximal clamp 28014b is positioned relative to the staple cartridge 25000 prior to or simultaneously with positioning the distal clamp 28014a relative to the anvil 25060.

When the end effector insert 28010 is releasably secured within the end effector 12, e.g., by the proximal and

distal clamps

28014b and 28014a as described herein, the end effector insert 28010 may remain taut in the end effector 12. In other words, a proximal clamp 28014b that is fixed relative to a staple cartridge 25000 in the lower jaw 25070 can apply a pulling force to a distal clamp 28014a that is fixed relative to the anvil 25060, e.g., along the end effector insert 28010. In various embodiments, tension between the proximal clamp 28014b and the distal clamp 28014a can help retain the end effector insert 28010 in the end effector 12.

In various embodiments, when the staple cartridge 25000 and end effector insert 28010 are positioned in the end effector 12, the proximal clamp 28014b can be positioned intermediate the unfired sled 25056 (fig. 178) and the staple cartridge 25000. For example, an unfired sled 25056 can be proximal to the proximal clamp 28013 b. In certain embodiments, the sled 25056 can move distally past the proximal clip 28014b, e.g., during a firing stroke, and can deflect the proximal clip 28014 b. In various embodiments, upon deflection of the proximal clamp 28014b by sled 25056 during a firing stroke, the proximal clamp 28014b can be released from the slot 25004 in the staple cartridge 25000. In certain embodiments, elements of the sled 25056 and/or firing bar 25050 (as shown elsewhere) can release the proximal clamp 28014b from the staple cartridge 25000. Additionally, upon release of the proximal clamp 28014b from the staple cartridge 25000, the tension in the end effector insert 28010 can be at least partially relieved. In the absence of a pulling force applied to the distal clamp 28014a, the distal clamp 28014a can be released from the anvil 25060. Thus, the end effector insert 28010 may be released from the end effector 12 and may, for example, remain in the tissue of the patient after the end effector 12 is removed from the patient.

In certain embodiments, an anvil-attachable layer, such as a tissue thickness compensator and/or a proximal end of a buttress material, for example, can be releasably attached to the proximal end of the staple cartridge for alignment with and attachment to an anvil of an end effector insertable into the staple cartridge. Generally, the anvil-attachable layer can be disposed relative to a side of the staple cartridge facing the anvil. For example, an anvil-attachable layer can be disposed on a staple deck of a staple cartridge and/or can be disposed on a staple deck layer. The proximal end of the anvil-attachable layer may be attached to the proximal end of the staple cartridge, or to the proximal end of the staple platform layer. Upon insertion of the staple cartridge into the end effector of the surgical stapler, the anvil of the surgical stapler can be closed against the anvil-attachable layer, thereby attaching the anvil-attachable layer to the anvil. When the anvil is reopened, the anvil-attachable layer, which is currently attached to the anvil, may be moved away from the staple cartridge with the anvil. In various instances, the attachment layer, when moved with the anvil, may pivot about a proximal end attached to the staple cartridge and/or staple cartridge layer. In various other instances, the attachment layer, when moved with the anvil, may have its proximal end detached from the staple cartridge. At this point, the surgical stapler with the anvil-attachable layer attached to the anvil can cut and staple patient tissue. An anvil-attachable layer may also be cut by the surgical stapler and captured by the staples. After the anvil-attachable layer and the patient tissue are captured by the staples, the surgical stapler can be removed from the patient. In various embodiments in which the anvil-attachable layer remains attached to the staple cartridge, the surgical stapler can be pulled away from the layer, thereby breaking the attachment between the layer and the staple cartridge.

Fig. 181 and 182 illustrate an embodiment of a staple cartridge assembly 2400 that includes an anvil-attachable layer 2414. The anvil-attachable layer 2414 may, for example, comprise a tissue thickness compensator and/or a buttress material. The proximal end 2416 of the anvil-attachable layer 2414 can be attached to the proximal end 2418 of the cartridge body 2402. In various embodiments, the staple cartridge assembly 2400 may include a staple cartridge layer 2412, such as a tissue thickness compensator and/or buttress material, for example, disposed on a staple deck of the staple cartridge body 2402. The cartridge pan 2404 can, for example, at least partially surround the staple cartridge body 2402 and can be constructed of a metallic material. The cartridge body 2402 may include a surface 2406 at a proximal end 2418 thereof and a groove 2408 defined in the surface 2406. Referring to fig. 181, to attach the anvil-attachable layer 2414 to the staple cartridge body 2402, the proximal end portion 2416 of the anvil-attachable layer 2414 can be positioned over the channel 2408. Next, as shown in fig. 182, for example, the tabs 2410 extending from the cartridge tray 2404 can be deformed such that they extend into the channels 2408, and the proximal end portions 2416 of the anvil-attachable layer 2414 are captured in the channels 2408 between the side walls of the channels and the tabs 2410. The tab 2410 may also capture the anvil-attachable layer 2414, for example, between the bottom of the groove 2408 and the tab 2410.

In use, the cartridge assembly 2400 shown in FIG. 182 can be inserted into a cartridge channel of an end effector of a surgical stapler. Next, the anvil of the end effector may be closed against the anvil-attachable layer 2414. The anvil-attachable layer 2414 is disposed within the cartridge body 2402 such that when the cartridge assembly 2400 is inserted into the cartridge channel 2400 and the anvil is subsequently closed, the anvil-attachable layer 2414 is properly aligned with the anvil. In various embodiments, the anvil-facing surface 2415 of the anvil-attachable layer 2414 can comprise an adhesive configured to adhere to the anvil surface and/or one or more attachment features that engage the anvil to attach the anvil-attachable layer 2414 to the anvil. For example, the anvil-facing surface 2415 can include one or more protrusions extending therefrom that can engage the knife slots of the anvil. After the anvil-attachable layer 2414 has been attached to the anvil, the anvil can be returned to the open position with the anvil-attachable layer 2414 attached thereto. The portion of the anvil-attachable layer 2414 attached to the anvil can pivot about the proximal end 2416 of the layer 2414 attached to the cartridge body 2402 to enable the layer 2414 to move with the anvil. At this point, the surgical stapler can include a cartridge layer 2412 aligned over the cartridge body 2402, and an anvil-attachable layer 2414 attached to and aligned with the anvil.

When the staple cartridge layer 2412 is aligned with the staple cartridge body 2402 and the anvil-attachable layer 2414 has been attached to and aligned with the anvil, the surgical stapler can be ready to cut and staple patient tissue. The staple cartridge body 2402 and staple cartridge layer 2412 may be positioned on one side of the patient tissue, and the anvil and anvil attachable layer 2414 may be positioned on the opposite side of the patient tissue. The attachment of the anvil-attachable layer 2414 to the anvil and cartridge body 2402 may stabilize the anvil-attachable layer 2414 relative to the anvil when positioning the stapler against the patient tissue. When the surgical stapler is properly positioned relative to the patient's tissue, the anvil can be closed, capturing the tissue between the cartridge body 2402 and cartridge layer 2412 on one side of the tissue and the anvil and anvil attachable layer 2414 on a second, opposite side of the tissue.

After the anvil is closed, the surgical stapler can be fired with the patient tissue captured between the cartridge body 2402 and cartridge layer 2412 on one side of the tissue and the anvil and anvil attachable layer 2414 on the other side of the tissue. For example, staple drivers can be advanced in a distal direction through staple driver slots 2422 in the staple cartridge body 2402 to fire and form the staples stored in the staple cartridge. The fired and formed staples can capture the staple cartridge layer 2412, the anvil-attachable layer 2414, and patient tissue therebetween. Additionally, a cutting blade can be advanced in a distal direction through the knife slot 2420 in the cartridge body 2402 and the knife slot in the anvil. The cutting blade, when advanced, can sever the cartridge layer 2412, the anvil-attachable layer 2414, and patient tissue therebetween. In various embodiments, the staple drivers and cutting blades can be advanced simultaneously. In various circumstances, the staple drivers can direct the cutting blade such that the staples are fired and formed prior to severing the patient tissue, the staple cartridge layer 2412, and the anvil attachable layer 2414.

After the cartridge layer, the anvil-attachable layer 2414, and the patient tissue therebetween are captured by the staples and cut by the cutting blade, the anvil can be opened again. When the anvil is reopened, the anvil-attachable layer 2414, now attached to the staple cartridge layer 2412 and the patient's tissue by the staples, can be separated from the anvil. For example, upon opening the anvil and/or upon removal of the surgical stapler from the patient, the layer 2414, which may be attached due to the anvil, may be held in place by the staples and the patient tissue such that the layer 2414 may be pulled away from, for example, the adhesive and/or attachment features that hold it to the anvil. Further, the proximal end 2416 of the anvil-attachable layer 2414 may be pulled away from the cartridge body 2402, thereby separating from the proximal end 2416 of the cartridge body 2402. For example, in various circumstances, the portion of the proximal end 2416 of the anvil-attachable layer 2414 captured between the channel 2408 in the cartridge body 2402 and the tab 2410 of the cartridge tray 2404 can be pulled out from between the tab 2410 and the channel 2408. In various other instances, the anvil-attachable layer 2414 can be torn from the portion thereof captured between the groove 2408 and the tab 2410 of the cartridge tray 2404. For example, the portion of the anvil-attachable layer 2414 captured between the groove 2408 and the tab 2410 can be trapped by the tab 2410 pressing in that portion of the layer 2414, which can reduce the force required to tear the remainder of the layer 2414 and/or define a location where the layer 2414 is torn. For example, the tabs 2410 that extend into the anvil-attachable layer 2414 may, for example, be partially scored, cut, and/or perforated into the layer 2414. After the cartridge layer 2412 is separated from the cartridge body 2402 and the anvil-attachable layer 2414 is separated from the cartridge body 2402 and the anvil, the surgical stapler is removed from the patient, but the implanted

layers

2412 and 2414 remain in the patient. For example, layers 2412 and 2414 may be stapled with rows of staples and/or may be compressed by different staples to different thicknesses in order to apply at least a minimum amount of compression to the patient tissue captured by the staples.

Still referring to fig. 181 and 182, in various embodiments, the anvil-attachable layer 2414 can be detached from the staple cartridge body 2402 after being attached to the anvil and the anvil reopened. As described above, after the cartridge assembly 2400 is inserted into the cartridge channel and the anvil is pressed closed against the anvil-attachable layer 2414, the layer 2414 may be attached to the anvil using an adhesive and/or attachment features on its anvil-facing surface 2415. Upon reopening the anvil, the anvil-attachable layer 2414 can move with the anvil away from the staple cartridge body 2402. In various circumstances, moving the anvil-attachable layer 2414 and the anvil together away from the staple cartridge body 2402 can pull the portion of the layer 2414 captured between the tabs 2410 of the cartridge tray 2404 and the grooves 2408 in the cartridge body 2402 out from between the tabs 2410 and the grooves 2408, such that the proximal end 2416 of the layer 2414 will also move with the anvil.

Fig. 183 and 184 illustrate another embodiment 2450 of a staple cartridge assembly, which staple cartridge assembly 2450 comprises an anvil-attachable layer 2464 that is attachable to a cartridge body 2452. In this embodiment, the proximal end 2466 of the anvil-attachable layer 2464 is attached to the surface 2472 on an attachment portion 2470 that can extend from the surface 2456 of the cartridge body 2452. The proximal end 2466 of the anvil-attachable layer 2464 can be attached to the surface 2472, for example, with an adhesive, ultrasonic welding, thermal welding, and/or thermal riveting. In various embodiments, staple cartridge assembly 2450 can comprise a staple cartridge layer 2462 disposed on a staple cartridge body 2462. In such embodiments, the attachment portion 2470 can extend from the surface 2456 of the cartridge body 2452 such that the surface 2472 is substantially flush with the anvil-facing surface 2467 of the staple cartridge layer 2462. Thus, the anvil-attachable layer 2464 can be substantially flat on the anvil-facing surface 2467 and surface 2472 of the cartridge layer 2462. In various instances, similar to the embodiment described above in connection with fig. 181 and 182, after insertion of the staple cartridge assembly 2450 into the staple cartridge channel of the end effector, the anvil of the end effector can be closed such that the anvil is in contact with the anvil-facing side 2465 of the anvil-attachable layer 2464. Adhesive and/or attachment features on the anvil-facing side 2465 of anvil-attachable layer 2464 can attach anvil-attachable layer 2464 to the anvil. Next, the anvil is opened again, at which point the anvil-attachable layer 2464 can be pivoted about proximal end 2466 attached to surface 2472. Similar to the embodiment described above in connection with fig. 181 and 182, the staple cartridge layer 2462, the anvil-attachable layer 2464, and the patient's tissue therebetween can be cut and stapled together. Next, the anvil of the surgical stapler is reopened and/or removed from the patient, anvil-attachable layer 2464 can be separated from the anvil, and cartridge layer 2462 can be separated from cartridge body 2452. Additionally, proximal end 2466 of anvil-attachable layer 2464 can be separated from the adhesive and/or other attachment features attached to surface 2472, such that anvil-attachable layer 2464 can be implanted within a patient.

Still referring to fig. 183 and 184, in various embodiments, when the anvil is opened again after the anvil-attachable layer 2464 is attached to the anvil, the proximal portion 2466 of the anvil-attachable layer 2464 can be separated from the surface 2472. For example, the proximal end 2466 of the anvil-attachable layer 2464 can also be attached to the anvil. As the anvil and attached anvil-attachable layer 2464 move in a direction away from cartridge body 2452 and/or cartridge layer 2462, proximal end 2466 of layer 2464 can be pulled up from surface 2472 and separated from surface 2472. In such embodiments, the anvil-attachable layer 2464 can be separated from the staple cartridge prior to the staple cartridge layer 2462, the anvil-attachable layer 2464, and patient tissue therebetween being cut and stapled.

Fig. 185 and 186 illustrate another embodiment of a staple cartridge assembly 2500, which staple cartridge assembly 2500 comprises a staple cartridge layer 2506 and an anvil-attachable layer 2510. In the embodiment illustrated in fig. 185 and 186, the anvil-attachable layer 2510 is attached to the cartridge layer 2506 rather than the cartridge body 2502. For example, the staple cartridge layer 2506 and the anvil-attachable layer 2510 can each comprise a tissue thickness compensator and/or a buttress material. The anvil-attachable layer 2510 can include a first proximal tab portion 2512 that extends from a proximal end 2508 of the layer 2510. The first proximal tab portion 2512 can be attached to a proximal end surface 2516 of the cartridge layer 2506. For example, the first proximal tab portion 2512 can be glued, welded, and/or overmolded onto the proximal end surface 2516 of the cartridge layer 2506. In certain embodiments, the anvil-attachable layer 2510 can include a second proximal tab portion 2514 extending from the first proximal tab portion 2512. The second proximal tab portion 2514 can be attached to the bottom surface 2518 of the cartridge layer 2506, for example, using glue, welding, and/or overmolding.

Similar to the embodiment described above in connection with fig. 181-184, upon insertion of the staple cartridge assembly 2500 into the staple cartridge channel of the surgical stapler end effector, an anvil-facing surface 2511 of the anvil-attachable layer 2510 may be attached to the anvil by adhesive and/or attachment features as the anvil of the end effector is closed upon the anvil-attachable layer 2510. Upon reopening the anvil, the anvil-attachable layer 2510 can move with the anvil away from the cartridge layer 2506 and the cartridge body 2502. In various circumstances, the anvil-attachable layer 2510 can pivot about the first tab portion 2512 when the anvil is reopened. After the anvil-attachable layer 2510 is attached to the anvil, the end effector can be closed on the patient's tissue such that the cartridge body 2502 and cartridge layer 2506 are positioned on a first side of the patient's tissue and the anvil and anvil-attachable layer 2510 is positioned on a second, opposite side of the patient's tissue. As described above in connection with fig. 181 and 182, the cutting blade can be advanced through the knife slots 2520 in the cartridge body 2502 and the staple drivers can be advanced through the staple driver slots 2422 in the cartridge body 2502. Referring primarily to fig. 185, in certain embodiments, the first and

second tab portions

2512, 2514 of the anvil-attachable layer may be aligned with the knife slot 2512. The cutting blade may cut the first and

second tab portions

2512 and 2514 as the cutting blade advances through the blade slot 2520. In various circumstances, first and

second tab portions

2512 and 2514 can be separated from the cartridge layer 2506 by severing the first and

second tab portions

2512 and 2514 with a cutting blade. After the cutting blade and staple drivers have been advanced, the cartridge layer 2506, the anvil-attachable layer 2510, and the patient tissue therebetween have been cut and stapled, the anvil can be reopened such that the anvil-attachable layer 2510 separates from the anvil and the cartridge layer 2506 separates from the cartridge body 2502. As described above, the anvil-attachable layer 2510 in the embodiment of fig. 185 and 186 is attached to the staple cartridge layer 2506 and not to the staple cartridge body 2502. Accordingly, no action needs to be taken to separate the anvil-attachable layer 2510 from the cartridge body 2502. Further, the first and/or

second tab portions

2512, 2514 of the anvil-attachable layer 2510 can remain attached to the cartridge layer 2506 because both layers are captured by the staples and implantable within the patient. For example, if the cutting blade does not separate the first and

second tab portions

2512 and 2514 from the cartridge layer 2506, the cartridge layer 2506 and anvil-attachable layer 2510 will be attached to each other within the patient's body by the first and

second tab portions

2512 and 2514, as well as the formed staples.

Still referring to fig. 185 and 186, in various embodiments, after the staple cartridge assembly 2500 has been inserted into the staple cartridge channel and the anvil-attachable layer 2510 has been attached to the anvil, the first and

second tab portions

2512 and 2514 can be separated from the staple cartridge layer 2506 when the anvil is reopened and the anvil and anvil-attachable layer 2510 are moved away from the staple cartridge layer 2506. For example, the anvil and anvil-attachable layer 2510 attached thereto can pull first and

second tab portions

2512 and 2514 away from the cartridge layer 2506, thereby separating first and

second tab portions

2512 and 2514 from the cartridge layer 2506.

Fig. 187 and 188 illustrate another embodiment 2550 of an anvil-attachable layer for use with a surgical stapler. As explained below, the proximal end portion 2554 of the anvil-attachable layer 2550 can be attached to a proximal end portion of a staple cartridge for insertion into and alignment with and attachment to an anvil of a surgical stapler. At the beginning of the stroke of the cutting blade, the body 2552 of the anvil-attachable layer 2550 can be separated from the staple cartridge by the cutting blade of the surgical stapler. For example, the cutting blade 2570 shown in fig. 188 can separate the anvil-attachable layer 2550 from the staple cartridge prior to cutting any patient tissue and prior to any portion of the body 2552 of the anvil-attachable layer 2550 being captured by the staples.

Referring primarily to fig. 187, the anvil-attachable layer 2550 can comprise a body 2552 and a proximal end portion 2554. The proximal end portion 2554 includes an attachment feature 2556 that is attachable to the proximal end portion of the staple cartridge. For example, the attachment features 2556 may include adhesives, welds, and/or heat staking points. The attachment features 2556 can also, for example, include portions that are captured between the slots of the staple cartridge and the tabs of the cartridge tray, as described above in connection with fig. 181 and 182. An anvil-attachable layer 2550 can be attached to and aligned with the staple cartridge, the staple cavities of such staple cartridge being aligned with the body 2552 of layer 2550. In other words, as the staples are fired from the staple cartridge, the staples will capture the body 2552 of the anvil-attachable layer 2550. Similar to the embodiment described above in connection with fig. 181-186, a staple cartridge assembly comprising an anvil-attachable layer 2550 attached to a staple cartridge can be inserted into a staple cartridge channel of a surgical stapler end effector. The anvil of the end effector can then be closed on the anvil-facing surface 2553 of the anvil-attachable layer 2550. The anvil-facing surface 2553 can comprise an adhesive and/or attachment features that releasably attach the anvil-attachable layer 2550 to the anvil when the anvil is pressed closed against the anvil-facing surface 2553. Next, the anvil is opened again, at which point the anvil-attachable layer 2550 can be pivoted with the anvil about the attachment features 2556. Similar to the embodiments described above in connection with fig. 181-186, a staple cartridge can, for example, comprise a layer of staple cartridges, such as a tissue thickness compensator and/or a buttress material.

The anvil-attachable layer 2550 can comprise a first lateral side 2566 and a second lateral side 2568. The first lateral side 2566 and the second lateral side 2568 can define a midline 2564 therebetween. In certain embodiments, the anvil-attachable layer 2550 can be attached to and aligned with the anvil of the end effector such that the midline 2564 is aligned with the knife slot in the anvil and the knife slot in the staple cartridge. The body 2552 of the anvil-attachable layer 2550 can comprise a first lateral slit 2558 positioned near the proximal end and extending from a first lateral side 2566 and through the midline 2564. The body 2552 of the anvil-attachable layer 2550 can further comprise a second lateral slit 2560, the second lateral slit 2560 being positioned proximally relative to the first lateral slit 2558 and extending from the second lateral side 2568 and through the midline 2564. The first lateral slit 2558 and the second lateral slit 2560 can define a connecting portion 2562 therebetween, which connecting portion 2562 can connect the body 2552 of the anvil-attachable layer 2550 to the proximal end portion 2554 of the layer 2550.

Referring primarily to fig. 188, after the anvil-attachable layer 2550 is releasably attached to the anvil of the end effector, the end effector can be closed on the patient tissue with the anvil and anvil-attachable layer 2550 on one side of the tissue and the staple cartridge and/or staple cartridge layer on the opposite side of the tissue. Next, the cutting blade 2570 can be advanced through a knife slot in the staple cartridge (such as knife slot 2418 shown in fig. 181-185) and a knife slot in the anvil, for example. A midline 2564 of the anvil-attachable layer 2550 can be aligned with the knife slot such that the cutting blade 2570 progressively cuts the anvil-attachable layer 2550 along the midline. As the cutting blade 2570 is advanced through the anvil-attachable layer 2550 in the distal direction indicated by arrow D, its cutting edge 2572 first cuts the proximal end portion 2554 of that layer 2550 and then severs the connecting portion 2562, thereby separating the body 2552 of the layer 2550 from the proximal end portion 2554 of the layer 2550. The cutting blade 2570 eventually severs the body 2552 of the anvil-attachable layer 2550. After the cutting blade 2570 is advanced through the anvil-attachable layer 2550, the layer 2550 is divided into four pieces. The body 2552 of the anvil-attachable layer 2550 is separated from the proximal portion 2554 of the layer 2550. Further, the body 2552 of the anvil-attachable layer 2550 is divided into two pieces, 2580 and 2582; the proximal portion 2554 of the anvil-attachable layer 2550 is divided into two pieces, 2586 and 2588.

In various circumstances, a surgeon using a surgical stapler may not fully fire the stapler. For example, referring to FIG. 188, the surgeon may only advance the cutting blade 2570 and staple driver to a position half of the body 2552 of the anvil-attachable layer 2550. Continuing with the example, at the beginning of the cutting stroke of the cutting blade 2570, the body 2552 of the anvil-attachable layer 2550 is released from the staple cartridge as the blade 2570 severs the connecting portion 2560 of the layer 2550. The cutting blade 2570 then continues to advance along the centerline 2564 to a position where the body 2552 of the anvil-attachable layer 2550 is about half way along the length. During the above process, the staple drivers will also advance, firing and forming the staples in half of the body 2552 of the layer 2550 and the patient tissue that are severed by the cutting blade 2570. The other half of the body 2552 of the anvil-attachable layer 2550 is uncut and not captured by the staples. The cutting blade 2570 and staple driver can then be retracted and the anvil reopened. When the anvil is reopened, the portion of the body 2552 of the anvil-attachable layer 2550 that was captured by the staples and attached to the patient tissue can be separated from the anvil. As described above, the connecting portion 2560 connecting the body 2552 of the anvil-attachable layer 2550 to the proximal end portion 2554 can be severed before any staples are fired and the cutting blade 2570 severs any patient tissue or any portion of the body 2552 of the layer 2550. Thus, the body 2552 of layer 2550 has been released from the staple cartridge. As the surgical stapler is removed from the patient, the portion of the body 2552 of the anvil-attachable layer 2550 that is captured by the patient's tissue can pull the remainder of the body 2552 away from the anvil. As described in this example, the anvil-attachable layer 2550 can accommodate incomplete firing of the surgical stapler because the connecting portion 2560 of the anvil-attachable layer 2550 can be cut by the cutting blade 2570 before any staples from the staple cartridge are fired and formed in the body 2552 of the layer 2550.

The embodiments described in connection with fig. 181-186 can also accommodate incomplete firing of the surgical stapler. In each case, the anvil-attachable layer need not be separated from the staple cartridge with the cutting blade of the surgical stapler. In the embodiments described in connection with fig. 181-184, after partial firing of the surgical instrument, the anvil-attachable layer can be pulled away from attachment with the staple cartridge body. In the embodiments described in connection with fig. 185 and 186, the anvil-attachable layer is attached to the cartridge deck and not to the staple cartridge. As described above, the cartridge layer and the anvil-attachable layer are implanted simultaneously within the patient. Thus, whether the surgical instrument is fully fired is not relevant to separating the layers to which the anvil may be attached in the embodiment described in connection with fig. 181-186.

In various circumstances, the surgeon can use a second surgical instrument to separate the anvil-attachable layers described above in connection with fig. 181-184. For example, in various circumstances, if a surgeon is using the surgical stapler on delicate tissue (such as lung tissue), he may wish to avoid pulling the tissue hard to pull the surgical stapler away from the anvil-attachable layer. In such cases, the surgeon may introduce another surgical instrument, such as a grasping tool, to hold the stapled patient tissue and the anvil-attachable layer stationary while removing the surgical stapler from the patient. In the various embodiments of anvil-attachable layers described above in connection with fig. 185-188, the surgeon may no longer need to introduce a second surgical tool to separate the anvil-attachable layers from the surgical stapler. Referring again to the embodiment described in connection with fig. 185 and 186, an anvil-attachable layer 2510 is attached to a cartridge layer 2506, which is also implanted in the patient. The anvil-attachable layer is not attached to a staple cartridge in the surgical stapler. Thus, when the stapler is removed from the patient, there is no need to pull or pull the patient tissue hard to separate the anvil-attachable layer from the staple cartridge. Referring again to the embodiment described in connection with fig. 187 and 188, at the beginning of the stroke of the cutting blade 2570, the body 2552 of the anvil-attachable layer 2550 is mechanically separated from the surgical stapler by the cutting blade. Likewise, there is also no attachment between the body 2552 of the anvil-attachable layer 2550 and the staple cartridge of the surgical stapler in preparation for removal of the surgical stapler from the patient after the patient tissue has been cut and stapled with the surgical stapler. Thus, the body 2552 of the anvil-attachable layer 2550 can be separated from the staple cartridge without having to pull or pull on the patient's tissue when the stapler is removed from the patient.

Referring primarily to fig. 189-190, a compensator 27120 for a sleeve 27110 can include a main body 27122 with a longitudinal protrusion 27124 extending along at least a portion of the main body 27122. The longitudinal protrusion 27124 can, for example, define a longitudinal path along the midline of the body 27122. In various embodiments, when the sleeve 27110 is positioned on the anvil, the longitudinal protrusion 27124 may be received by a longitudinal slot in the anvil. Referring primarily to fig. 191, the longitudinal protrusion 27124 may include rounded protrusions. For example, the cross-section of the longitudinal protrusion 27124 may form an arc and/or a partial circle. In other embodiments, the longitudinal protrusion 27124 may include angled and/or stepped protrusions. The compensator 27120 can also, for example, include an edge 27126, which edge 27126 can be straight, curved, fluted, undulating, and/or zigzagged. In various embodiments, the edges 27126 may include gaps 27128, which gaps 27128 are configured to receive latch extensions extending from the anvil when the assembled sleeve 27110 is positioned on the anvil.

As outlined herein, a layer such as a tissue thickness compensator, for example, can be implanted in tissue by one or more fasteners ejected by the staple cartridge. In addition, as outlined herein, in various instances, the entire staple line can capture at least a portion of the layer into tissue. For example, the proximal-most staple in the staple line may capture at least a portion of the layer therein, while the distal-most staple in the staple line may also capture at least a portion of the layer therein. In some cases, a proximal portion of the layer can extend proximally relative to a proximal-most staple in the staple line, and/or a distal portion of the layer can extend distally relative to a distal-most staple in the staple line. In use, a series of layers may be implanted. In at least one such case, the layers may be implanted sequentially along the cut line. In some cases, layers may be implanted such that one layer partially overlaps another layer. For example, the distal end of the first implant layer may overlap the proximal end of the second implant layer. Likewise, the distal end of the second implant layer may overlap the proximal end of the third implant layer, and so on. Thus, some fasteners may capture a portion of two or more layers therein. Capturing two or more layers within a staple can increase the pressure applied to the captured tissue within the staple and/or increase tissue stiffness, particularly when several adjacent staples have captured more than one layer. Referring now to fig. 192-194, as described in greater detail below, the tissue thickness compensator 11050 can include a proximal end 11053 and a distal end 11055, wherein the proximal end 11053 and/or the distal end 11055 can include one or more strain relief portions that can reduce the rigidity of the tissue thickness compensator 11050 and the rigidity of the tissue being stapled.

Referring again to fig. 192-194, the distal end 11055 of the tissue thickness compensator 11050 can include one or more slots 11058 defined therein. The slots 11058 may, for example, include cuts and/or notches defined in the tissue thickness compensator 11050. The slots 11058 may define projections or tabs 11056, which projections or tabs 11056 may be configured to be at least partially movable and/or deflectable relative to each other and/or a body portion of the tissue thickness compensator 11050. In other words, the slots 11058 may locally relieve strain in the tissue thickness compensator 11050 and the tissue below it. In some instances, the tabs 11056 of the first tissue thickness compensator 11050 can overlap the proximal end 11053 of the second tissue thickness compensator 11050. In various circumstances, slots 11058 can allow first and second

tissue thickness compensators

11050, 11050 to pivot relative to one another. In some cases, referring primarily to fig. 194, the tabs 11056 of the first tissue thickness compensator 11050 can overlap the tabs 11056 of the second tissue thickness compensator 11050. In various circumstances, the slots 11058 in the overlapping two distal ends 11055 can also reduce rigidity within the underlying tissue. While the illustrated embodiment of the tissue thickness compensator 11050 includes an arrangement of tabs 11057 and slots 11058 on only one end thereof, the tissue thickness compensator can include an arrangement of tabs 11057 and slots 11058 on both ends thereof, for example.

In certain embodiments, in addition to the above, each tab 11056 may include a tapered profile. For example, each tab 11056 may include a base attached to the body of the tissue thickness compensator 11050 and having a base width and a free end opposite thereto having an end width, wherein the base width may be wider than the end width. In certain embodiments, the end width may be wider than the base width. Referring primarily to fig. 194, the end 11055 may include a plurality of tabs 11056 having different configurations. For example, the tabs 11056 may have different lengths. As shown in fig. 194, for example, the endmost tab 10056a can have a first length, the second tab 10056b can have a second length that is longer than the first length, the third tab 10056c can have a third length that is longer than the second length, the fourth tab 10056d can have a fourth length that is longer than the third length, the fifth tab 10056e can have a fifth length that is longer than the fourth length, and the sixth tab 10056f can have a sixth length that is longer than the fifth length. In such embodiments, the tab 10056 can become shorter closer to the distal end of the tissue thickness compensator 10050. In other embodiments, the tab 10056 lengths can be arranged in any other suitable arrangement.

In various instances, in addition to the above, the layer can include an edge defining a perimeter of the layer. In some cases, the edges may be straight, substantially straight, linear, and/or substantially linear. In some such cases, the layer edges may be in intimate contact and/or otherwise affect the surrounding tissue. Additionally, in some such cases, the edges may be rigid and may rigidly support tissue. In fact, some portions of the tissue adjacent to other portions of the tissue rigidly supported by the layer may be unsupported by the layer without a transition therebetween. Referring again to fig. 192-194, the perimeter of the tissue thickness compensator 11050 can include a contoured configuration that can provide an area of graduated stiffness to underlying tissue. The perimeter of the tissue thickness compensator 11050 can include a plurality of notches or grooves 11059 defined therein, which notches or grooves 11059 can define tabs 11057. Similar to the above, the tabs 11057 may extend from the body of the tissue thickness compensator 11050 and may be movable relative to the body. Also similar to the above, each tab 11057 may include a base end attached to the body of the tissue thickness compensator 11050 and a free end that is movable relative to the base end. In some cases, the free end of the tab 11057 can have a width that is narrower than the width of the base end of the tab 11057, while in other cases, the free end of the tab 11057 can have a width that is wider than the width of the base end of the tab 11057. The tabs 11057 may include any suitable configuration, such as a semi-circular configuration, or an at least partially arcuate configuration, for example. In view of the above, tissue underlying the body portion of the tissue thickness compensator 11050 and/or tissue secured to the body portion of the tissue thickness compensator can be rigidly supported by the body portion, tissue underlying the tabs 11057 and/or tissue secured to the tabs are less rigidly supported by the tabs 11057, and tissue adjacent to but not underlying the tabs 11057 can be unsupported by the tissue thickness compensator 11050.

Referring now to fig. 195 and 196, the staple cartridge assembly 11100 can comprise a cartridge body 11110 and a tissue thickness compensator 11150 attached to the cartridge body 11110. The staple cartridge assembly 11100 can further comprise one or more attachment members 11160, the attachment members 11160 can be configured to releasably retain the tissue thickness compensator 11150 on the cartridge body 11110. In at least one instance, each attachment member can comprise a strap that extends around the cartridge body 11110 and the tissue thickness compensator 11150. In use, in addition to the above, the firing member 10030 can be advanced through the staple cartridge 11100 to incise the tissue thickness compensator 11150, subsequently fire the staples at least partially stored within the cartridge body 11110, and sever the attachment member 11160. The tissue thickness compensator 11150 can comprise a first or proximal end 11157, and a second or distal end 11155. The distal end 11155 can include an elongated protrusion 11156, the protrusion 11156 extending from a body portion 11153 of the tissue thickness compensator 11150. As shown in fig. 195, the elongated projection 11156 can extend distally relative to the distal-most attachment member 11160. In at least the illustrated embodiment, the cartridge body 11110 can comprise a deck 11113 within which the staple cavities of the cartridge body 11110 can be defined. In various circumstances, the body 11153 of the tissue thickness compensator 11150 can be configured and arranged such that it covers the deck 11113 and staple cavities defined in the cartridge body 11110. In at least some instances, as also shown in fig. 195, the elongated projections 11156 can extend distally from the deck 11113 and distally relative to a staple cavity defined within the deck 11113.

In use, in addition to the above, the tissue thickness compensator 11150 can be secured to tissue as described herein and can provide tissue thickness compensating properties. Similar to the above, the tissue underlying the tissue thickness compensator 11150 can be rigidly supported by the tissue thickness compensator 11150 and the staples securing the tissue, while the tissue surrounding the tissue thickness compensator 11150 can be unsupported by the tissue thickness compensator 11150 and can be flexible. In such cases, an undesirable degree of strain may occur in the tissue between the unsupported, flexible tissue and the rigidly supported tissue below the tissue thickness compensator 11150 (i.e., the transitional tissue). Such strain may negatively impact the transitional tissue. For example, when securing a tissue thickness compensator to, for example, lung tissue, the tissue immediately surrounding the tissue thickness compensator (i.e., the peripheral tissue) may in some cases tear, particularly the peripheral tissue adjacent to and/or surrounding the distal end of the tissue thickness compensator (i.e., the end peripheral tissue). However, the distal protrusion 11156 of the tissue thickness compensator 11150 can support end periphery tissue. In other words, the distal protrusion 11156 can provide transitional support to the end periphery tissue. Such transitional support may be less than that provided by the body of the tissue thickness compensator 11150 and may mitigate strain changes between unsupported tissue and sufficiently supported tissue beneath the tissue thickness compensator 11150. In various circumstances, the distal protrusion 11156 can provide an enlarged region in which force can be transferred between unstitched tissue and stapled tissue. The distal projection 11156 can be configured to flex and move with the unsupported tissue and the tissue thickness compensator 11150. In various circumstances, the distal projection 11156 can move relative to the body portion of the tissue thickness compensator 11150 and/or the unsupported tissue.

Referring again to fig. 195 and 196, the tissue thickness compensator 11150 can further comprise a notch 11157 defined in a proximal end 11153 thereof. The notch 11157 may be defined between two distally extending projections 11158. The recess 11157 may have any suitable shape, such as a parabolic shape, for example. Similar to the above, the distally extending protrusion 11158 may provide transitional support to the proximal end perimeter tissue. Such transitional support may be less than the support provided by the body of the tissue thickness compensator 11150 and may mitigate strain changes between unsupported tissue and sufficiently supported tissue below the tissue thickness compensator 11150. In various instances, the proximal tab 11158 can provide an enlarged area in which force can be transferred between unstitched tissue and sutured tissue. The proximal tab 11158 can be configured to flex and move with the unsupported tissue and the tissue thickness compensator 11150. In various circumstances, the two proximal tabs 11158 can move relative to the body portion of the tissue thickness compensator 11150, each other, and/or the unsupported tissue. Various alternative embodiments of more than two projections extending from the proximal end and/or the distal end of the tissue thickness compensator are also contemplated.

As shown in fig. 196, two or more tissue thickness compensators 11150 may be implanted in an end-to-end fashion along a path. In such cases, the distal end 11155 of the first tissue thickness compensator 11150 can overlap the proximal end 11153 of the second tissue thickness compensator 11150. Similarly, the distal end 11155 of the second tissue thickness compensator 11150 can overlap the proximal end 11153 of the third tissue thickness compensator 11150. In various circumstances, the distal protrusion 11156 of the first tissue thickness compensator 11150 can be aligned, or at least substantially aligned, with the recess 11157 of the second tissue thickness compensator 11150. Additionally, in various embodiments, the distal protrusion 11156 and the proximal recess 11158 may be sized and configured such that they have substantially the same size and/or shape. In various instances, the distal protrusion 11156 can be configured to be positioned within the proximal recess 11157 of an adjacent tissue thickness compensator 11150.

Turning now to fig. 293 and 294, an end effector of a surgical stapling instrument can comprise a first jaw comprising a cartridge channel 11390 configured to receive a staple cartridge 11300 therein and a second jaw comprising an anvil 11391. Similar to the above, the staple cartridge 11300 can comprise a cartridge body 11310 and a tissue thickness compensator 11350. The staple cartridge 11300 can further comprise a tissue abutment member 11355 attached thereto. In various circumstances, the tissue abutment member 13555 can be removably attached to the cartridge body 11310. In addition to, or in the alternative to, being removably attached to the cartridge body 11310, the tissue abutment member 11355 can also be attached to the tissue thickness compensator 11350. In at least one such embodiment, the tissue abutment member 11355 can be releasably secured to the tissue thickness compensator 11350. In use, similar to the above, fasteners can be deployed from the cartridge body 11310 to secure the tissue thickness compensator 11350 to tissue T captured between the tissue thickness compensator 11350 and the anvil 11391. In various circumstances, the fastener may not penetrate the tissue abutment member 11355. In certain other instances, the fastener can penetrate the tissue abutment member 11355 and capture at least a portion of the tissue abutment member 11355 therein and secure the tissue abutment member 11355 to the tissue T. In either case, similar to the above, at least a portion of the tissue abutment member 11355 can be configured to provide transitional support between unsupported tissue and tissue rigidly supported by the fastener below the tissue thickness compensator 11350. The tissue abutment member 11355 may, for example, have any suitable shape, such as a tongue. In at least one embodiment, the tissue abutment member 11355 can include one or more notches 11358 that can define a tab 11356 therebetween. Once the tissue thickness compensator 11350 is positioned against and secured to the tissue T, the tissue abutment member 11355 can be configured to flex relative to the tissue thickness compensator 11350 and provide support to the tissue adjacent the distal end of the tissue thickness compensator 11350. In various instances, for example, the tissue abutment member 11355 can flex relative to the tissue thickness compensator 11350, and in addition, the tabs 11356 can flex relative to each other, the body of the tissue abutment member 11355, and/or the tissue thickness compensator 11350.

Referring again to fig. 293 and 294, at least a portion of the tissue abutment member 11355 can overlap the tissue thickness compensator 11350. In various instances, the portion of the tissue abutment member 11355 can be attached to the tissue thickness compensator 11350, for example, by one or more adhesives. In certain instances, at least a portion of the tissue abutment member 11355 can overlap one or more staple cavities defined in the cartridge body 11310 such that staples ejected from these staple cavities can capture at least a portion of the tissue abutment member 11355 therein and secure the tissue abutment member 11355 to tissue. At least a portion of the tissue abutment member 11355 can overlap the nose portion 11311 of the cartridge body 11310. In various instances, this portion of the tissue abutment member 11355 can be attached to the nose 11311, for example, by one or more adhesives. In other cases, this portion of the tissue abutment member 11355 may not be attached to the nose 11311. Referring primarily to fig. 294, at least a portion of the tissue abutment member 11355 can overlap a distal portion 11312 of the nose 11311. In various circumstances, this portion of the tissue abutment member 11355 can be unattached to the distal portion 11312 of the nose 11311. In at least some instances, a gap may be defined between the tissue abutment members 11355. At least a portion of the tissue abutment member 11355 can extend freely from the nose portion 11311 of the cartridge body 11310. In such embodiments, the tissue abutment member 11355 can comprise a cantilever.

In use, in addition to the above, the staple cartridge 11300 can be positioned on a first side of the tissue T and the anvil 11391 can be positioned on a second side. The anvil 11391 can then be pivoted toward the staple cartridge 11300 about a pivot axis 11392 defined in the shaft 11393 of the surgical stapling instrument. Once the anvil 11391 and staple cartridge 11300 have been properly positioned, the staples contained within the cartridge body 11310 can be ejected therefrom, penetrate the tissue thickness compensator 11350, and secure the tissue thickness compensator 11350 to the tissue T. Thereafter, the anvil 11391 can be opened and the end effector can be moved away from the tissue T. In such instances, the cartridge body 11310 can be pulled away from the tissue thickness compensator 11350, thereby leaving the tissue thickness compensator 11350 behind in the tissue T. At the same time, the tissue abutment member 11355 can be detached from the staple cartridge 11300 along with the tissue thickness compensator 11350. The significance of attaching the tissue abutment member 11355 to the tissue thickness compensator 11350 is that the tissue thickness compensator 11350 can hold the tissue abutment member 11355 against the tissue. In various instances, the tissue abutment member 11355 can be biased against the tissue T by the tissue thickness compensator 11350. For example, the tissue abutment member 11355 can flexibly support underlying tissue T and distribute pressure, stress, and/or strain of the tissue over a larger area as the tissue moves, stretches, and/or flexes.

Referring again to fig. 293 and 294, the end effector of the surgical instrument can comprise a tissue abutment member, such as, for example, tissue abutment member 11395 attached to anvil 11391. In various instances, tissue abutment member 11395 may be identical, or at least substantially identical, to tissue abutment member 11355. In at least one instance, the tissue abutment member 11395 can include notches 11398 defined between tabs 11396. In use, the tissue abutment member 11395 can be attached to the anvil 11391, such as with one or more adhesives, wherein the tissue abutment member 11395 can be positioned against the tissue T when the anvil 11391 is positioned relative to the tissue T and subsequently closed. Upon reopening the anvil 11391 after the staples are fired from the staple cartridge, the tissue abutment member 11395 may separate from the anvil 11391 and remain attached to the tissue T. In various circumstances, at least a portion of the tissue abutment member 11395 can be captured within the staples ejected from the cartridge body 11310, for example. In at least some such instances, the tissue abutment member 11395 can at least partially overlap with, or extend over, the staple cavities defined in the anvil 11391. In some cases, one or more adhesives (such as activatable adhesives) may be located on the tissue contacting surface of tissue abutment member 11395, for example, such that tissue abutment member 11395 adheres to tissue T. In any event, referring primarily to fig. 294, tissue abutment member 11355 and/or tissue abutment member 11395 can be used to flexibly support tissue T. In embodiments utilizing both tissue abutment member 11355 and tissue abutment member 11395,

tissue abutment members

11355 and 11395 can be comprised of the same material, or different materials.

Tissue abutment members

11355 and 11395 may have the same shape and configuration, or different shapes and configurations.

Tissue abutment members

11355 and 11395 may also have the same thickness or different thicknesses. Such characteristics of the

tissue abutment members

11355 and 11395 may be selected so as to provide a desired support profile (profile) for tissue positioned therebetween. For example, such characteristics can be selected such that one of the

tissue thickness compensators

11355 and 11395 is more rigid than the other. At the same time, these characteristics can be selected such that one of the

tissue thickness compensators

11355 and 11395 is more flexible than the other.

In various instances, the tissue thickness compensator can comprise a plurality of layers. For example, the tissue thickness compensator can comprise a first layer and a second layer. Such layers may be composed of the same material or different materials. Some layers may be configured to provide different characteristics to the tissue thickness compensator. For example, the tissue thickness compensator can comprise a compressible first layer that provides tissue thickness compensation properties, and a more rigid second layer that can support the first layer. Referring primarily to fig. 197 and 198, a tissue thickness compensator 11250 can comprise a first layer 11251 and a second layer 11252. The second layer 11252 is compressible and can provide tissue thickness compensation properties. The first layer 11251 can be rigid and can support the second layer 11252. The second layer 11252 can be positioned against the cartridge body 11210 and/or attached to the cartridge body 11210, for example. In certain instances, the first layer 11251 can comprise a longitudinal channel 11253 extending along its length, which longitudinal channel 11253 can be sized and configured to be releasably retained in a longitudinal knife slot 11215 defined in the cartridge body 11210. In various instances, the second layer 11252 can be secured to the first layer 11251 and held in place by the first layer 11251.

Referring again to fig. 197 and 198, the compensator 11250 can comprise a plurality of layers. Additionally, the outer perimeter 11218 of the second layer 11252 can extend at least partially beyond the outer perimeter 11220 of the first layer 11251. Further, the first layer 11251 and the second layer 11252 can include different degrees of stiffness. For example, the second layer 11252 may be softer than the first layer 11251. Such an arrangement may provide tissue thickness compensator 11250 with a sufficiently rigid inner region comprised of first layer 11251 and second layer 11252 that may be adapted to provide sufficient support to staples 11260 and a sufficiently flexible outer region comprised of second layer 11252 that may be adapted to provide sufficient flexibility to alleviate the burden placed on tissue T, for example, during and/or after tissue T and tissue thickness compensator 11250 are captured by staples 11260. The first layer 11251 and the second layer 11252 can be joined together, for example, by an adhesive. Other attachment means for attaching the first layer 11251 to the second layer 11252 are also contemplated within the scope of the present disclosure.

In addition to the above, first layer 11251 can include an interior portion 11254 and an exterior portion 11256 at least partially surrounding interior portion 11254, wherein exterior portion 11256 can be more flexible than interior portion 11254. For example, the outer portion 11254 may include a plurality of slits 11210, the slits 11210 may increase the flexibility of the outer portion 11254. Further, as described above, the second layer 11252 may be configured to be more flexible than the first layer 11251. This arrangement can provide the tissue thickness compensator 11250 with three regions of different stiffness, including a first inner region, a middle region, and a third, outer region. The first interior region, which is comprised of the interior portion 11254 of the first layer 11251, has the greatest rigidity; an intermediate region having an intermediate level of rigidity, the intermediate region being formed by an outer portion 11256 of the first layer 11251 and the second layer 11252; the third region has the least rigidity and is composed of only the second layer 11252.

The second layer 11252 of the tissue thickness compensator 11250 can have a fabric structure that can include a plurality of fibers that can be woven into the fabric structure. The fabric structure may provide the second layer 11252 with sufficient flexibility to reduce the burden imposed on the tissue T, for example, during and/or after the tissue T and tissue thickness compensator 11250 are captured by staples 11260. Further, outer periphery 11218 may be comprised of fibers that may provide an atraumatic tissue contacting surface to minimize the burden placed on tissue T as described above. The fabric structure and fibers may be constructed of biocompatible materials. Furthermore, the above-described textile structures and/or fibers may be constructed, for example, from bioabsorbable materials such as PLLA, PGA, PCL, and/or combinations thereof.

Referring to fig. 199-201, the staple cartridge channel can be configured to receive a staple cartridge 1060, wherein the staple cartridge 1060 can comprise a cartridge body 1062, a cartridge deck 1064, and supports 1065. In addition, a tissue thickness compensator (e.g., tissue thickness compensator 1100) can be removably positioned against the cartridge deck 1064 or adjacent the cartridge deck 1064, as shown in fig. 199.

Referring again to fig. 199-201, the tissue thickness compensator can be absorbed by tissue after implantation in a patient. This absorption process may initially break down the tissue thickness compensator into smaller pieces that include rough edges that can adversely affect the surrounding tissue T. To mitigate these adverse effects, the tissue thickness compensator 1100 can be at least partially assembled from a plurality of pieces 1140, each of which has an atraumatic outer periphery and can be bonded together to form a single structure, as shown in fig. 201. The manner in which the tabs 1140 are joined to form the tissue thickness compensator 1100 is such that the absorption process first breaks the tissue thickness compensator 1100 into several tabs 1140, thereby minimizing the possibility of rough edges. For example, the panels 1140 may have a circular profile and may be thermally bonded together to form the tissue thickness compensator 1100. Other contours of the tabs 1140 and other ways of joining the tabs 1140 together are also contemplated within the scope of the present disclosure. In one example, the sheets 1140 are joined together by an adhesive 1143 (see fig. 200). The adhesive 1143 is absorbed by the tissue more quickly than the sheets 1140, so that the sheets 1140 can be separated from each other at an initial stage of the absorption process. As shown in fig. 200, the plurality of sheets 1140 may be arranged in a stacked array wherein an end portion of one sheet 1140 may overlap an end portion of another sheet 1140 such that the two end portions of the plurality of sheets 1140 may be releasably attached to one another, such as by an adhesive. In some cases, the plurality of sheets 1140 may be arranged in another stacked array, wherein one of the sheets 1140 may be positioned over the plurality of sheets 1140 and releasably attached to the several sheets 1140, as shown in fig. 201.

Referring to fig. 202-204, as described above, the tissue thickness compensator is capable of being absorbed by tissue after implantation in a patient, and the absorption process may initially break the tissue thickness compensator up into random small pieces. As mentioned above, by starting with a patch having an atraumatic outer edge, guidance of the absorption process may be achieved to produce a patch having an atraumatic outer edge. Another method may include modifying the tissue thickness compensator in the following manner: it can be split into smaller pieces with an atraumatic periphery at the initial stage of the absorption process. For example, as shown in fig. 202, the tissue thickness compensator 1200 can, for example, comprise a pattern, such as pattern 1212, which can be molded or engraved into the tissue thickness compensator 1200 to create, for example, a plurality of rounded portions 1210. The portion 1210 can be defined by reducing the thickness of the tissue thickness compensator 1200 along the perimeter 1214 of the circular portion 1210, as shown in the cross-sectional view 202A. Thus, those portions of the tissue thickness compensator 1200 along the perimeter 1214 of the circular portion 1210 may be more quickly absorbed by tissue, which may cause the circular portions 1210 to separate from each other during the initial stages of the absorption process. Other patterns including portions having other geometries and atraumatic outer perimeters are also contemplated within the scope of the present disclosure. For example, as shown in fig. 203, the tissue thickness compensator 1200 'can have a pattern 1216, the pattern 1216 including a plurality of portions 1218, the contours of which can extend longitudinally in an undulating curve along the length of the tissue thickness compensator 1200'. In another example, as shown in fig. 204, the tissue thickness compensator 1200 "can comprise a pattern 1220, and the pattern 1220 can comprise a plurality of hexagonal shaped portions 1222.

Referring to fig. 205, as described above, a tissue thickness compensator, such as tissue thickness compensator 1250, can be captured, for example, along tissue T by staples, such as staples 1002, and can be configured to break down into several atraumatic pieces, such as pieces 1226, at an initial stage of the absorption process, for example, after being implanted in a patient. Once separated, the pieces 1226 may move and/or slide relative to each other, which may affect the surrounding tissue T. To minimize relative movement between the pieces 1226, the fired staples 1002 can be spatially arranged onto the tissue thickness compensator 1250 such that the staples 1002 can capture multiple pieces 1226, as shown in fig. 205. Such an arrangement may also help the tissue thickness compensator 1250 to remain a substantially unitary structure even if the plurality of sheets 1226 are separated from one another during the initial stages of the absorption process. Thus, tissue thickness compensator 1250 can continue to provide support to tissue T captured by staples 1002 after pieces 1226 are separated from one another during the initial stages of the absorption process.

In addition to the above, referring now to fig. 206, yet another method may be employed to guide the absorption process of the tissue thickness compensator to produce a sheet having an atraumatic outer edge. For example, as shown in fig. 206, a tissue thickness compensator, such as tissue thickness compensator 1300, can include a plurality of slits 1310, the slits 1310 being strategically positioned to enhance the flexibility of the tissue thickness compensator 1300 as described above. In addition, the slits 1310 may partially divide the tissue thickness compensator 1300 into a plurality of portions 1312 that may be separated from each other at an initial stage of the absorption process. The slits 1312 can reduce the width of the tissue thickness compensator 1300 along the outer perimeter 1314 of the portion 1312, as shown in fig. 206. The reduction in width may result in portions 1312 being absorbed faster along outer perimeter 1314, which may cause tissue thickness compensator 1300 to break down into separate portions 1312 at an initial stage of the absorption process.

Referring to fig. 207A and 207B, an end effector of a surgical stapling instrument can comprise a first jaw and a second jaw, wherein at least one of the first jaw and the second jaw can be configured to move relative to the other jaw. In certain embodiments, the end effector can comprise a first jaw with a staple cartridge channel 1010, and a second jaw with an anvil 1012 (fig. 207B), wherein the anvil 1012 can pivot toward the staple cartridge channel 1010 and/or away from the staple cartridge channel 1010, for example. The staple cartridge channel 1010 can be configured to receive a staple cartridge 1020, the staple cartridge 1020, for example, can be removably retained within the staple cartridge channel 1010. Other embodiments may include staple cartridges that are not easily removable from the staple cartridge channel 1010. The staple cartridge 1020 can comprise a cartridge body 1022, a cartridge deck 1024, and a layer 1000, wherein the layer 1000 can be removably positioned against or adjacent to the cartridge deck 1024, as shown in fig. 207A.

Similar to the other embodiments described herein, referring again to fig. 207A and 207B, the cartridge body 1022 can comprise a plurality of staple cavities 1026 and staples 1002 positioned within each staple cavity 1026. Also similar to the other embodiments described herein, the staples 1002 can be supported by staple drivers 1028 positioned within the cartridge body 1022. Wherein the sled and/or firing member can be advanced through the staple cartridge 1020, for example, to lift the staple drivers 1028 upwardly within the staple cavities 1026 and eject the staples 1002 from the staple cavities 1026, as illustrated in fig. 207B. As staples 1002 are ejected from staple cavities 1026, tissue T and/or layer 1000 can be captured by staples 1002, as shown in fig. 207B.

Layer 1000 may be constructed of a biocompatible material. Additionally, layer 1000 can be constructed of, for example, a bioabsorbable material such as PLLA, PGA, PCL, and/or combinations thereof. In at least one embodiment, the layer 1000 can include a tissue thickness compensator that can include internal compression features designed to compensate for the thickness of the tissue T as the layer 1000 and the tissue T are captured by the staples 1002 as described above.

Referring again to fig. 207B, the layer 1000 can include a tissue contacting surface 1003, and the tissue contacting surface 1003 can be configured to reduce slippage between the layer 1000 and tissue T positioned against the layer 1000. The pressure applied against the tissue T in contact with the tissue contacting surface 1003 may depend in part on the contact area between the tissue T and the tissue contacting surface 1003. Since this pressure is inversely proportional to the area, reducing the contact area may result in higher pressure against the tissue T and, in turn, may result in better slip protection. The tissue contacting surface 1003 may include a plurality of cleats 1030, the cleats 1030 comprising a smaller contact area, wherein the cleats 1030 may reduce slippage between the layer 1000 and tissue T positioned against the layer 1000. Layer 1000 with cleats 1030 may be formed, for example, by compression molding techniques. Alternatively, the layer 1000 can be fabricated and the cleats 1030 formed on the tissue contacting surface 1003, for example, by laser and/or chemical etching techniques that can create a plurality of protruding structures. In addition, cleats 1030 may include micro-scale and/or nano-scale structures formed on tissue contacting surface 1003 using, for example, photolithographic techniques. Photolithography techniques can generally use a pre-fabricated photomask as a master from which the final pattern of micro-and/or nano-scale cleats can be obtained. Other techniques for forming micro-scale and/or nano-scale cleats 1030 are also contemplated within the scope of the present disclosure, and these techniques may be employed to produce the desired cleats 1030. In one example, the cleats 1030 can be fabricated using electron beam lithography.

Referring now to fig. 207C-224, cleats 1030 may include a plurality of shapes. For example, as shown in fig. 207C, the tissue contacting surface 1003 can include cylindrical cleats 1038, and these cylindrical cleats 1038 can include square and/or rectangular bases and generally perpendicular sides that extend generally away from the tissue contacting surface 1003. Additionally, the cylindrical cleats 1038 may terminate in a generally narrower top portion or tip 1040, as shown in cross-section 208. In addition, tissue contacting surface 1003 can include conical cleats 1032 (as shown in fig. 218), pyramidal cleats 1034 (as shown in fig. 219), and/or dome-shaped cleats 1042 (as shown in fig. 211). Pyramid-shaped cleats 1034 may include square and/or triangular bases, as well as sloped sides that may extend generally away from tissue-contacting surface 1003 and terminate at a top portion 1036, as shown in cross-section in fig. 220.

The cleats 1030 may be spatially arranged in a predetermined pattern or array on the tissue contacting surface 1003. For example, cleats 1030 may be arranged on tissue contacting surface 1003 in a plurality of rows that extend longitudinally along the length of surface 1003 in space and parallel to one another. The cleats 1030 may also be arranged in a spatial loop. For example, cleats 1030 may be arranged in concentric circles. Alternatively, cleats 1030 may be randomly positioned on tissue contacting surface 1003.

In addition to the above, the tissue contacting surface 1003 can have cleats 1030 that include multiple shapes, multiple heights, and/or multiple spatial arrangements to avoid the aforementioned slippage to varying degrees along various regions of the tissue contacting surface 1003. For example, a greater degree of slippage avoidance may be desired at and/or around the region of the tissue contacting surface 1003 where the staples 1002 are configured to penetrate and capture the tissue T.

Referring to fig. 209, 210, and 215-217, layer 1000 can include linear protrusions 1044, which can be disposed on tissue contacting surface 1003. Linear protrusions 1044 may extend longitudinally. For example, linear protrusions 1044 may extend parallel to each other along the length of layer 1000, as shown in fig. 209. Alternatively, linear protrusions 1044 may extend along the width of layer 1000, as shown in fig. 215. In addition, longitudinal and transverse linear protrusions 1044 may form a cross-shaped path. For example, as shown in fig. 217, a first pattern 1046 of linear protrusions 1044 may extend parallel to a first direction on tissue contacting surface 1003, and a second pattern 1048 of linear protrusions 1044 may extend parallel to a second direction on tissue contacting surface 1003, wherein the first direction may be perpendicular or substantially perpendicular to the second direction. Further, linear protrusions 1044 may have substantially uniform cross-sectional areas as shown in section area 210. Alternatively, linear protrusions 1044 may have different cross-sectional areas (not shown). In some cases, the first pattern 1046 and the second pattern 1048 may be continuous or discontinuous.

In addition to the above, layer 1000 may include non-linear protrusions, which may be provided on tissue contacting surface 1003 alone or in combination with linear protrusions 1044. In addition, in combination with cleats 1030, linear protrusions 1044 and/or non-linear protrusions may be provided on tissue contacting surface 1003 to avoid slippage within desired limits.

Referring to fig. 213 and 214, layer 1000 can include a plurality of recesses 1050 that can be etched into tissue contacting surface 1003, as shown in fig. 223. The depression 1050 may comprise a substantially uniform socket shape, as shown in fig. 224. Alternatively, the recesses 1050 may include different depths, which may avoid slippage to varying degrees along various regions of the tissue contacting surface 1003. In general, deeper individual depressions can make the regions in which they are located softer and make such regions more susceptible to disintegration. Further, as described above in connection with cleats 1030, recesses 1050 may comprise a variety of shapes and/or spatial arrangements. Additionally, layer 1000 may include a combination of indentations 1050 and cleats 1030 spatially disposed on tissue contacting surface 1003. In some cases, cleats 1030 and recesses 1050 may be arranged in an alternating pattern.

Referring again to fig. 223 and 244, layer 1000 may include linear depressions 1052 similar to linear protrusions 1044 (described above), which may, for example, extend longitudinally along the length of layer 1000 and parallel to one another as shown in fig. 223. Furthermore, layer 1000 may comprise a combination of linear depressions 1052 and linear protrusions 1044 spatially arranged on tissue contacting surface 1003, e.g., in an alternating pattern. Further, referring now to fig. 221 and 222, the combinations of linear depressions 1052 and linear protrusions 1044 may be arranged in a corrugated pattern 1054, as shown in fig. 221.

Referring now to fig. 244-246, a tissue thickness compensator, such as compensator 22320, for example, can comprise a plurality of first cavities 22322a and a plurality of second cavities 22322b, the first cavities 22322a and the second cavities 22322b can be aligned with

staple forming pockets

22062a and 22062b, respectively. Referring primarily to fig. 245,

staple forming pockets

22062a and 22062b can be defined in separate stepped surfaces on the anvil 22060. More specifically, for example, staple forming pockets 22062a can be defined in a first surface 22069a of the anvil 22060 and staple forming pockets 22062b can be defined in a second surface 22069b of the anvil 22060, wherein the first surface 22069a can be positioned offset, or higher, relative to the second surface 22069 b. The first cavity 22322a of the tissue thickness compensator 22320 can be larger than the second cavity 22322b, wherein in at least one such embodiment, the first cavity 22322a can extend higher than the second cavity 22322 b. In view of the above, the first cavities 22322a can extend upwardly into the first staple forming pockets 22062a while the second cavities 22322b can extend upwardly into the second staple forming pockets 22062 b. The first cavity 22322a and/or the second cavity 22322b can be configured to contain a drug.

In addition to the above, the first cavities 22322a can be arranged in certain rows and the second cavities 22322b can be arranged in different rows. The first cavities 22322a and/or the second cavities 22322b can be configured to fit snugly within the staple forming pockets 22062a and/or 22062b, respectively. Further, the tissue thickness compensator 22320 can be assembled to the anvil 22060 such that the second layer 22327 of the compensator 22320 is positioned against the second surface 22069b of the anvil 22060. Referring now to fig. 247 and 248, the compensator 22320 can be positioned adjacent to the anvil 22060 such that the compensator 22320 can abut the anvil 22060 when the anvil 22060 is displaced toward the staple cartridge 22000 compressing the tissue T therebetween.

Referring now to fig. 224A and 224B, similar to the above, the layer 1000 can also be positioned adjacent to the anvil 1012 such that the layer 1000 can abut the anvil 1012 when the anvil 1012 is displaced toward the staple cartridge 1020 compressing the tissue T therebetween. Also similar to the above, the layer 1000 can be captured by the staples 1002 after the staples 1002 are ejected from the staple cavities 1026 by the staple drivers 1028. Specifically, as shown in fig. 224A and 224B, the staple 1002 can include a base 1060, a first deformable member 1062, and a second deformable member 1064. The first deformable member 1062 includes a first apex 1063 and the second deformable member 1064 includes a second apex 1065, the second apex 1065 together with the first apex 1063 can penetrate the layer 1000 to their corresponding

staple forming pockets

1066 and 1068 as the staple 1002 is driven out of the staple cavity 1026 by the staple driver 1028. In addition, the

tips

1063 and 1065 can each re-penetrate the layer 1000 as the

tips

1063 and 1065 are directed in a return path away from the

staple forming pockets

1066 and 1068, respectively.

Referring again to fig. 224A, layer 1000 may include a plurality of portions 1070 that may include a reduced thickness relative to the remainder of layer 1000. For example, as shown in fig. 224A, layer 1000 may include a substantially uniform thickness "a" and portion 1070 may include a thickness that is less than thickness "a". In addition, the layer 1000 can be aligned with the staple cartridge 1020 such that, once the staples 1002 are fired, the

tips

1063 and 1065 of the staples 1002 can penetrate the tissue T and the entire thickness "a" of the layer 1000 as the

tips

1063 and 1065 of the

deformable members

1062 and 1064 travel toward the

respective pockets

1066 and 1068, and can penetrate this reduced thickness of the portion 1070 as it is directed out of the

staple forming pockets

1066 and 1068, respectively. The reduced thickness of portion 1070 may facilitate re-penetration of

tips

1063 and 1065 from

pockets

1066 and 1068, respectively, into tissue T on the return path of

tips

1063 and 1065.

Referring now to fig. 224B, layer 1000 can include a plurality of protrusions 1080, which can include an increased thickness relative to the remainder of layer 1000. For example, as shown in fig. 224B, layer 1000 can include a substantially uniform thickness "a" and protrusions 1080 can include a thickness "a + B" that is greater than thickness "a". The layer 1000 can be aligned with the staple cartridge 1020 such that once the staples 1002 are fired, the

tips

1063 and 1065 of the staples 1002 can penetrate the tissue T and the thickness "a" of the layer 1000 as the

tips

1063 and 1065 of the

deformable members

1062 and 1064 travel toward the

respective pockets

1066 and 1068. Additionally,

tips

1063 and 1065 of staples 1002 may penetrate through thickness "a" of layer 1000 as they are directed out of

recesses

1066 and 1068, respectively, thereby wrapping or substantially wrapping

deformable members

1062 and 1064 at least partially around protrusions 1080. In other words, tissue T and protrusions 1080 can be captured between each of

deformable members

1062 and 1064 and base 1060 of staple 1002. In addition to the above, the protrusions 1080 can be arranged in rows and can be configured to fit snugly within the staple forming pockets of the anvil 1020. For example, as shown in fig. 224B, the protrusions 1080 can have a curved profile configured to matingly engage

staple forming pockets

1066 and 1068.

As described above, certain embodiments of the surgical stapler can include a layer disposed on an anvil surface of the end effector, such as a buttress material and/or a tissue thickness compensator. The layer may be susceptible to movement and/or misalignment. For example, if the surgeon drags the layer across the tissue as the surgical stapler is positioned prior to stapling the tissue, the layer will move relative to the anvil. In certain embodiments, the layer can include releasable retention features for attaching it to the anvil such that the layer is retained in alignment with the anvil until the surgical stapler is fired. In certain embodiments, the releasable retention feature may be implanted in the patient.

In certain embodiments, referring now to fig. 225-227, an anvil-attachable layer 33420 (such as a buttress material and/or a tissue thickness compensator) may comprise a housing 33426, a cavity 33424 defined in the housing 33426, and a core 33425 positioned within the cavity 33424. In at least one such embodiment, for example, the housing 33426 can comprise a film body formed from a continuous extrusion, and the core 33425 can comprise a fibrous drug core (such as an ORC). In at least one embodiment, the housing 33426 can comprise one or more flexible legs 33423 that can be configured to extend into a knife slot 22063 defined in the anvil 22060 and releasably retain the anvil-attachable layer 33420 to the anvil 22060.

In certain other embodiments, referring to fig. 244-248, an anvil-attachable layer 22320 (such as a buttress material and/or a tissue thickness compensator) can be attached to the anvil 22060. In at least one embodiment, the anvil-attachable layer 22320 can comprise cavities 22322a and/or cavities 22322b that can be configured to fit snugly within the staple forming pockets 22062a and/or 22062b, respectively. The snug fit may releasably retain the anvil-attachable layer 22320 relative to the anvil 22060. In certain embodiments, the anvil-attachable layer 22320 can be assembled to the anvil 22060 such that the second layer 22327 of the anvil-attachable layer 22320 is positioned against the second surface 22069b of the anvil 22060. In certain other embodiments, referring now to fig. 247 and 248, the anvil-attachable layer 22320 can be positioned adjacent to the anvil 22060 such that the anvil-attachable layer 22320 can abut the anvil 22060 when the anvil 22060 is displaced toward the staple cartridge 22000 compressing the tissue T therebetween.

Referring to fig. 228-234, the retainer can be used to align and attach the anvil-attachable layer to the anvil of the end effector. Referring primarily to fig. 229 and 230, the anvil-attachable layer 2030 can include a body 2034 and a protrusion 2036 extending from the body 2034. Referring to fig. 231-234, the protrusion 2036 can be engaged with a slot 2048, such as a knife slot, in the end effector anvil 2042. In some embodiments, protrusions 2036 may be wider than slots 2048, such that protrusions 2036 are compressed when inserted into slots 2048. In certain embodiments, the protrusion 2036 can be deformed such that it bulges outward and presses against a surface of the slot 2048. The compressive force between the protrusions 2036 and the slots 2048 can provide a retention force that secures the anvil-attachable layer 2030 relative to the anvil 2042.

Anvil-attachable layer 2030 is releasably attachable to holder 2000. The retainer 2000 can align the anvil-attachable layer 2030 with the anvil 2042 and attach the anvil-attachable layer 2030 to the anvil 2042. Embodiments of the retainer 2000 may include a cover 2006 and

tabs

2008 and 2010 extending from the cover 2006 (tabs 2010 are shown in fig. 228-230). As shown in fig. 229 and 230, the tabs are configured to engage the staple cartridge 2020 and releasably retain the staple cartridge 2020 to the retainer 2000. The retainer can further include a grip portion 2002 extending from the cover 2006, and a user can insert the retainer 2000, the staple cartridge 2020, and the anvil-attachable layer 2030 into the staple cartridge channel 2040 of the end effector by gripping the grip portion 2002.

Holder 2000 may also include tabs 2014 extending from cover 2006. In certain embodiments, the retainer 2000 can include two tabs 2014, one tab 2014 extending from each lateral side of the cover 2006. As best seen in fig. 228, each tab 2014 may include an inwardly facing groove 2016 and an inwardly facing angled surface 2018. Referring to fig. 229 and 230, lateral edges of the anvil-attachable layer 2030 can engage with grooves 2016 in tabs 2014. In various embodiments, the anvil-attachable layer 2030 and the cover 2006 of the retainer 2000 can define a gap therebetween when the anvil-attachable layer 2030 is engaged in the slot 2016 of the retainer 2000. The anvil-attachable layer 2030 may be arranged on the holder 2000 such that the protrusions 2036 of the layer 2030 extend away from the holder 2000. As best seen in fig. 228 and 231, retainer 2000 may further include a raised ridge 2022 extending from cover 2006. As can be clearly seen in fig. 231, raised ridges 2022 of retainer 2000 may be aligned with protrusions 2036 of anvil-attachable layer 2030.

In use, a surgeon, nurse, clinician or other user may insert the staple cartridge 2020 into the staple cartridge channel 2040 of the end effector, close the anvil onto the retainer to release and attach the anvil-attachable layer to the anvil, and then remove the retainer from the end effector. Referring primarily to fig. 231-234, a user may grasp the retainer 2000 (by grasping the grasping portion 2002) and insert the staple cartridge 2020 into the staple cartridge channel 2040 of the end effector. Upon insertion of the staple cartridge 2020 into the staple cartridge channel 2040 of the end effector, the tabs 2008 of the retainer 2000 may be engaged with the staple cartridge channel 2040. Fig. 231 shows the staple cartridge 2020 loaded into the staple cartridge channel 2040 with the retainer 2000 and anvil attachable layer 2030 positioned on top of the staple cartridge 2020. Fig. 231 also shows that the anvil 2042 of the end effector is positioned over the anvil-attachable layer 2030 and the retainer 2000. Referring now to fig. 232, the anvil 2042 may be moved toward the retainer 2000 and the anvil-attachable layer 2030. As the anvil 2042 is moved, a surface 2044 of the anvil 2042 may come into contact with the body 2034 of the anvil-attachable layer 2030. Further, a slot 2046 (such as a knife slot) of the anvil 2042 may engage with a ridge 2036 of the anvil-attachable layer 2030. Additionally, as the anvil 2042 is moved toward the staple cartridge 2020, lateral edges 2050 of the anvil 2042 may engage the inwardly facing angled surfaces 2018 of the film retention tabs 2014, pushing the tabs 2014 outwardly such that the inwardly facing channels 2016 may move away from the lateral edges of the anvil-attachable layer 2030.

Continued movement of the anvil 2042 toward the anvil-attachable layer 2030 may push the anvil-attachable layer 2030 toward the cover 2006 of the holder 2000. Additionally, as the anvil 2042 continues to move toward the staple cartridge 2020, the raised ridges 2022 of the retainer 2000 will support the protrusions 2036 of the anvil attachable layer 2034 as the protrusions 2036 engage the slots 2046 of the anvil 2042. As described above, the raised ridge 2022 of the retainer 2000 can deform the protrusions 2036 of the anvil-attachable layer 2030 such that the outer dimensions of the protrusions 2036 of the anvil-attachable layer 2030 extend outward. In other words, as the protrusions 2036 of the anvil-attachable layer 2030 enter the slots 2046 of the anvil 2042, the raised ridges 2022 of the retainer 2000 can press into the anvil-attachable layer 2030 under the protrusions 2036, causing the protrusions 2036 to bulge and/or expand into the slots 2046 of the anvil 2042. The expanded protrusions 2036 in contact with the slots 2046 can retain the ridges 2036 of the anvil-attachable layer 2030 within the slots 2046. The slot 2046 can include a lip 2048, and the lip 2048 can capture at least a portion of the protrusion 2036, more securely retaining the protrusion 2036 within the slot 2046 of the anvil 2042.

Referring now to fig. 233, as the anvil 2042 is moved away from the retainer 2000, the anvil 2042 carries the anvil-attachable layer 2030 therewith away from the retainer 2000. As shown in fig. 234, after the anvil 2042 and anvil-attachable layer 2030 are moved away from the retainer 2000, the retainer 2000 can be removed from the end effector leaving the anvil-attachable layer 2030 and staple cartridge 2020 in place.

Referring again to fig. 229 and 230, in certain embodiments, the proximal end 2032 of the anvil-attachable layer 2030 may be attached to the staple cartridge 2020. For example, the anvil-attachable layer 2030 may be attached to the staple cartridge 2020 using an adhesive, spot welding, and/or heat staking. In various embodiments, the anvil-attachable layer 2030 is attached to the anvil 2042 and, upon reopening the anvil 2042, the anvil-attachable layer 2030 may be separated from the staple cartridge 2020. In various other embodiments, the anvil-attachable layer 2030 may remain attached to the staple cartridge 2020 until the staples in the staple cartridge are fired and the attendant anvil-attachable layer 2030 is captured within the fired staples.

Fig. 235 shows an anvil-attachable layer 2030 separate from retainer 2000. Fig. 236 and 237 illustrate other embodiments of anvil attachable layers. Fig. 236 illustrates an anvil-attachable layer embodiment 2060 comprising a main body 2064 and discrete protrusions 2062 extending therefrom. Fig. 237 illustrates another anvil-attachable layer embodiment 2070 comprising a body 2074 and discrete protrusions 2072 extending therefrom. For example, each discrete protrusion 2072 can comprise a peg 2073 extending from the body of the anvil-attachable layer 2070 and a cap 2075 extending from the peg 2073. In certain embodiments, the cap 2075 may have a larger dimension than the peg 2073 such that when the projection 2072 is inserted into the slot 2046, the cap may extend over the lateral edge 2048 in the slot 2046 of the anvil 2042.

Referring now to fig. 238-243, various embodiments of the anvil-attachable layer can include one or more deployable attachment features that can be formed in the body of the anvil-attachable layer. Fig. 238-240 illustrate an anvil-attachable layer 2080 embodiment, such anvil-attachable layer 2080 including a body 2082 and a series of deployable attachment features 2084 formed in the body 2082. Each deployable attachment feature 2084 can be formed in the body 2082 by forming a hole 2085 in the body 2082. Each deployable attachment feature 2084 can include a longitudinal portion 2086 attached to the body 2082, and a transverse portion 2088 attached to the longitudinal portion 2086. In various embodiments, longitudinal portion 2086 may be attached to body 2082 by a hinge 2087. Apertures 2085 and hinges 2087 surrounding each deployable attachment feature 2084 may allow deployable attachment features 2084 to move between an undeployed configuration and a deployed configuration, as described in more detail below. In various other embodiments, hinge 2087 may not be present. In such embodiments, the deployable attachment features 2084 can be bent, for example, about the longitudinal portion 2086, to move between an undeployed configuration and a deployed configuration.

Fig. 238 shows deployable attachment features 2084 in an undeployed configuration, wherein each deployable attachment feature 2084 lies substantially in the plane of a body 2082 of a layer 2084 attachable by a defined anvil. Fig. 239 shows deployable attachment features 2084 in a deployed configuration, where each deployable attachment feature 2084 extends out of a plane defined by a body 2082 of an anvil-attachable layer 2080. For example, deployable attachment feature 2084 may rotate about hinge 2087 to extend out of the plane defined by body 2082. As shown in fig. 240, the deployable attachment features 2084 can be deployed into the slots 2046 of the anvil 2042. The deployable attachment features 2084, when deployed, can extend with longitudinal portions 2086 into slots 2046 of the anvil 2042 and lateral portions 2088 can extend further into the slots 2046. In various circumstances, a lateral portion 2088 of the deployable attachment feature 2084 can engage with a lip 2048 in the slot 2046 to provide a stronger retention force between the anvil-attachable layer 2080 and the anvil 2042. Further, engagement of a lateral portion 2088 of the deployable attachment feature 2084 with a lip 2048 in a slot 2046 may prevent the deployable attachment feature 2084 from returning to an undeployed position. In certain embodiments, the longitudinal portion 2086 of each deployable attachment feature 2084 may be shorter than the narrow portion 2047 of the slot 2046. In such embodiments, tension may be applied to longitudinal portion 2086 as transverse portion 2088 engages lip 2048 in slot 2046. Tension in the lateral portion 2088 may hold the body 2082 of the anvil-attachable layer 2080 tight against the anvil 2042.

The body 2082 and the deployable attachment features 2084 can be formed from a single body. An aperture 2085 may then be formed in the body 2082, for example, by cutting an aperture 2085 in the body 2082. The holes 2085 may be cut with a punch tool, a cutting blade, a laser, or any other suitable device. In various other embodiments, the anvil-attachable layer 2080 and the aperture 2085 can be formed in a mold. In certain embodiments, the aperture 2085 can include a gap between the body 2082 and the deployable attachment features 2084. In certain other embodiments, the aperture 2085 does not provide clearance between the body 2082 and the deployable attachment features 2084. In various embodiments, for example, anvil-attachable layer 2080 interposed between body 2082 and longitudinal portion 2086 may be thinned or scored, thereby forming hinge 2087. In various other embodiments, the hinge can be formed without changing the thickness between the body 2082 and the longitudinal portion 2086 of the deployable attachment feature 2084.

Fig. 238-240, which have been described above, illustrate an anvil-attachable layer 2080 embodiment in which deployable attachment features 2084 all include a rounded lateral portion 2088. The transverse portion 2088 may have other suitable shapes including, but not limited to, triangular, elliptical, and polygonal. For example, fig. 241-243 illustrate an anvil-attachable layer 2090 embodiment, where deployable attachment features 2094 each include a transverse portion 2098 having a rectangular cross-section. Each deployable attachment feature 2094 may be attached to the main body 2092 by a hinge 2097.

In certain embodiments, the body of the anvil-attachable layer and the deployable attachment features may comprise flexible and/or resilient materials. For example, referring again to fig. 238-240, the body 2082 and deployable attachment features 2084 of the anvil-attachable layer 2080 can comprise a flexible and/or elastic material. As another example, referring to fig. 241-243, the body 2092 of the anvil-attachable layer 2090 and the deployable attachment feature 2094 may comprise a flexible and/or elastic material. Referring to the anvil-attachable layer 2080 of fig. 238-240, as each deployable attachment feature 2084 is deployed into a slot 2046 (such as a knife slot) of the anvil 2042, the lateral portion 2088 can flex and/or deform to pass through the narrow portion 2047 of the slot 2046. Then, as lateral portion 2088 extends past lip 2048 of slot 2046 and into wide portion 2049 of slot 2046, lateral portion 2088 may resume an undeflected and/or undeformed shape. During the return of lateral portion 2088 to the undeflected and/or undeformed shape, lateral portion 2088 may extend laterally into wide portion 2049 of slot 2046. After the lateral portion 2088 extends laterally into the wide portion 2049 of the slot 2046, the narrow portion 2047 of the slot 2046 can provide an interference fit that inhibits the lateral portion 2088 from being easily pulled out of the slot 2046. In other words, to pull the transverse portion 2088 out of the slot 2046, the transverse portion 2088 must again flex and/or deform appropriately to pass through the narrow portion 2047 of the slot 2046. In various embodiments, transverse portion 2088 and/or narrow portion 2047 of slot 2046 may be sized such that: the pulling force required to pull the deployable attachment feature 2084 out of the slot may be large enough so that the anvil-attachable layer 2080 is not displaced from the anvil 2042 when the anvil 2042 is positioned relative to the patient tissue. However, after anvil-attachable layer 2080 is captured by the staples, the pulling force may be small enough such that anvil-attachable layer 2080 may be pulled away from the anvil.

In various embodiments, a cutting blade of a surgical stapler can sever a deployable attachment feature of an anvil-attachable layer. Referring to fig. 240, the cutting blade may travel through the slot 2046 of the anvil 2042. The cutting blade may generally cut each deployable attachment feature 2084 in half. Upon removal of the anvil-attachable layer 2080 from the anvil 2042 after firing of the staples, it is easy to pull half of each deployable attachment feature 2084 out of the slot 2046.

For anvil-attachable layers that include deployable attachment features, such as the anvil-attachable layers disclosed in fig. 238-243, a retainer may be used to align the anvil-attachable layer with the anvil and deploy the deployable attachment features into the slots of the anvil. Fig. 251-254 illustrate a retainer 19700 that can first mount the staple cartridge 19690 into the staple cartridge channel 19740 and then squeeze the anvil-attachable layer 2056 toward the anvil 19720. The retainer 19700 includes a first portion 2052 and a second portion 2054, wherein the first portion 2052 is movable relative to the second portion 2054 in the directions indicated by arrows Q and S (shown in fig. 253 and 254, respectively). First portion 2052 may include a cam that includes anti-lobes 19646 and 19647, and

lobes

19642 and 19643. The second portion can include

cam protrusions

19614 and 19616 that engage the cam of the first portion 2052. As seen in fig. 251 and 252, when the retainer 19700 is inserted into the end effector, the

cam protrusions

19614 and 19616 engage the reverse lobes 16646 and 16647 of the cams of the first portion 2052. Referring now to fig. 253 and 254, after a staple cartridge is seated in the staple cartridge channel 19740 of the end effector, the first portion 2052 can be moved in the direction of arrow Q relative to the second portion 2054. Movement of the first portion 2052 in the direction of arrow Q causes the

cam protrusions

19614 and 19616 to engage the

cam lobes

19642 and 19643 of the first portion 2052. The

lobes

19642 and 19643 push the

cam protrusions

19614 and 19616 apart, pushing the anvil-attachable layer 2056 into contact with the anvil 19720.

Referring now to fig. 255-258, in certain embodiments, the retainer can mount a staple cartridge into the staple cartridge channel, dispose the anvil-attachable layer on the anvil, and deploy the deployable attachment features of the anvil-attachable layer into an engaged configuration with the anvil. Referring to fig. 256 and 257, retainer 2110 embodiments may include a grip portion 2112, a cartridge facing portion 2114, and an anvil facing portion 2118. The cartridge-facing portion 2114 and the anvil-facing portion 2118 may be spaced apart by a buttress 2116 and may be disposed at an angle relative to one another. As can be best seen in fig. 258, the cartridge facing portion 2114 and the anvil facing portion 2118 can be disposed at an angle similar to the angle between the cartridge channel 2160 and the anvil 2150 when the anvil 2150 is in the fully open position. Cartridge-facing portion 2114 can include a first clamp 2124 and a second clamp 2126 extending from cartridge-facing portion 2114. The first clamp 2114 can be engaged with the staple cartridge 2140 to releasably retain the staple cartridge 2140 to the holder 2110, as shown in FIG. 255. The second clamp 2126 can engage the staple cartridge channel 2160 of the end effector such that the retainer 2110 can be releasably retained to the staple cartridge channel 2160. Anvil-facing portion 2118 may include a clamp 2120 that holds an anvil-attachable layer, such as anvil-attachable layer 2080 shown in fig. 238-240, relative to anvil surface 2118. The anvil-facing portion 2118 can further include discrete protrusions 2122 that are positioned relative to the location of the deployable attachment features 2084 on the anvil-attachable layer 2080. As shown in fig. 255, when the anvil-attachable layer 2080 is loaded onto the anvil-facing portion 2118 of the retainer 2110, the anvil-attachable layer 2080 may first rest on top of the discrete protrusions 2122.

Referring to fig. 258, in certain embodiments, the anvil-attachable layer 2080 can be in contact with the anvil 2150 upon insertion of the retainer 2110 into the end effector and upon seating of the staple cartridge 2140 in the staple cartridge channel 2160. Once the anvil-attachable layer 2080 is in contact with the anvil 2150, the retainer 2110 and staple cartridge 2140 may continue to move relative to the anvil 2150 until the staple cartridge 2140 is fully seated within the staple cartridge channel 2160. In such embodiments, the anvil-facing portion 2118 of retainer 2110 can be moved toward anvil-attachable layer 2080 and pushed against anvil-attachable layer 2080 such that discrete protrusions 2122 extending from the anvil-facing portion 2118 of retainer 2110 can push deployable attachment features 2084 in layer 2080 upward to a deployed configuration as described above in connection with fig. 238-243. In various embodiments, each discrete protrusion 2122 of the retainer 2110 facing the anvil portion 2118 can include an angled face 2123, which angled face 2123 can engage with the deployable attachment feature 2084. As the retainer 2110 continues to move relative to the anvil 2150 and the anvil-attachable layer 2080, the inclined surface 2123 may progressively engage with the deployable attachment feature 2084 until the deployable attachment feature 2084 is rotating about the hinge 2087 and is deployed into the slot 2152 of the anvil 2150. As shown in fig. 258, the inclined surface 2123 of the discrete protrusions 2122 can simultaneously support the longitudinal portion 2086 and the lateral portion 2088 of each deployable attachment feature such that both the longitudinal portion 2086 and the lateral portion 2088 are deployed into the slot 2152 of the anvil 2150.

In certain other embodiments, the staple cartridge 2140 may be fully seated in the staple cartridge channel 2160 using the retainer 2110 without contacting the anvil attachable layer 2080 with the anvil 2150. In such embodiments, after the staple cartridge 2140 is fully seated in the staple cartridge channel 2160, the anvil 2150 can be moved from the fully open position toward the closed position such that the anvil 2150 is in contact with the anvil-attachable layer 2080 and the discrete protrusions 2122 deploy the deployable attachment features 2084 into the slots 2052 of the anvil 2050.

Fig. 259-262 illustrate another retainer embodiment 2170. Retainer 2170 can include a staple cartridge facing portion 2174 and an anvil facing portion 2178 that are spaced apart by supports 2190 and arranged at an angle relative to each other. The staple cartridge facing portion 2174 can engage the staple cartridge 2140 and releasably retain the staple cartridge 2140. The staple cartridge facing portion 2174 may also engage and releasably retain the staple cartridge channel 2160 of the end effector. Anvil-facing portion 2178 may have an anvil-attachable layer disposed thereon, such as anvil-attachable layer 2080 described above in connection with fig. 238-240. As shown in more detail in fig. 261 and 262, anvil-facing portion 2178 may include an aperture 2182 that may be aligned with a deployable attachment feature 2084 of an anvil-attachable layer 2080 disposed on anvil-facing portion 2178. Each aperture 2182 may include a cam 2202 disposed therein. Each cam 2202 may be attached by a flexible member 2204 to an anvil-facing portion 2178 such that the cam 2202 may be rotated about the flexible member 2204 out of the hole 2182 and into contact with a deployable attachment feature 2084. Each cam 2202 can include a curved surface 2203 that can progressively deploy a deployable attachment feature 2084 into a slot 2152 in an anvil 2150. Referring to fig. 261, as the cam 2202 begins to move out of the aperture 2182 and into contact with the deployable attachment feature 2084, the curved surface 2203 of the cam 2202 first comes into contact with the lateral portion 2088 of the deployable attachment feature 2084, causing the lateral portion 2088 to deploy into the slot 2152 of the anvil 2150. Referring now to fig. 262, as the cam 2202 continues to move out of the aperture 2182, the curved surface 2203 of the cam 2202 may come into contact with the longitudinal portion 2086 of the deployable attachment feature 2086, causing the longitudinal portion 2086 to deploy into the slot 2152 of the anvil 2150.

The support 2190 between the staple cartridge facing portion 2174 and the anvil facing portion 2178 may include a fixed portion 2194 and a movable portion 2196. The movable portion 2196 can be operably coupled to the button 2192, and a user depressing the button 2192 moves the movable portion 2196 relative to the fixed portion 2194. The movable portion 2196 of the support 2190 may include a series of cam surfaces 2206 that may engage the cam portion 2202 to push the cam portion 2202 out of the hole 2182. As the movable portion 2196 moves proximally relative to the fixed portion 2194, the cam surface 2206 may allow the cam 2202 to move out of the hole 2182 as described above and into contact with the deployable attachment features 2084 of the anvil-attachable layer 2080.

In certain embodiments, the movable portion 2196 of the support 2190 can be biased in a distal position relative to the fixed portion 2194, as shown in fig. 259. For example, a spring or the like may be disposed between the fixed portion 2194 and the movable portion 2196. The spring may bias the movable portion 2196 of the support 2190 in a distal position relative to the fixed portion 2194. In various embodiments, the biasing force may be sufficiently large such that the force required to seat the staple cartridge 2140 in the staple cartridge channel 2160 will not overcome the biasing force. Thus, the deployable attachment features 2084 are less likely to be deployed by the cams 2202 in the event that the button 2192 is inadvertently applied with the force required to fully seat the staple cartridge 2140 in the staple cartridge channel 2160.

In various embodiments in which the anvil-attachable layer is releasably retained to the surgical stapler anvil, the anvil-attachable layer can include additional features that stabilize patient tissue relative to the anvil-attachable layer and the anvil. Referring now to fig. 249 and 250, anvil-

attachable layers

22320a and 22320b are shown positioned between the anvil 22060 and the patient tissue T. Embodiments of anvil-

attachable layers

22320a and 22320b may include protrusions 2078 extending from the body on a side facing the patient tissue T. The protrusions 2078 can push or pierce the tissue T, thereby providing a grip between the tissue T and the anvil-

attachable layers

22320a and 22320 b. This grip may prevent tissue from sliding relative to the anvil-

attachable layers

22320a and 22320 b.

In various embodiments, the retention feature can be separable from the anvil-attachable layer after the surgical stapler mounted with the anvil-attachable layer has been fired. In such embodiments, the retention features described above may be attached to one or more tethers. The tether may be attached to the surgical stapler, or another object outside the patient's body, such that after firing of the stapler, the retention features can be removed from the patient by pulling on the tether.

In various embodiments, the tissue thickness compensator can comprise a polymer composition. The polymer composition may comprise one or more synthetic polymers and/or one or more non-synthetic polymers. The synthetic polymer may comprise a synthetic absorbable polymer and/or a synthetic non-absorbable polymer. In various embodiments, the polymer composition can comprise, for example, a biocompatible foam. Such biocompatible foam may include, for example, porous open cell foam and/or porous closed cell foam. This biocompatible foam may have a uniform pore morphology, or may have a gradient pore morphology (i.e., small pores gradually increasing in size to large pores throughout the foam thickness in one direction). In various embodiments, the polymeric composition can comprise one or more of a porous scaffold, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a filamentous matrix, a tubular matrix, a composite matrix, a membrane matrix, a biostable polymer, and a biodegradable polymer, and combinations thereof. For example, the tissue thickness compensator may comprise a foam reinforced by a filamentous matrix, or may comprise a foam with an additional hydrogel layer that stretches in the presence of bodily fluids to provide further compression on the tissue. In various embodiments, the tissue thickness compensator can also be comprised of a material and/or a coating on the second or third layer that stretches in the presence of bodily fluids to provide further compression on the tissue. Such layers may be hydrogels, for example, which may be synthetic and/or naturally derived materials, and may be biodurable and/or biodegradable materials. In certain embodiments, the tissue thickness compensator may be reinforced with, for example, a fibrous nonwoven or a fibrous mesh type element that can provide additional flexibility, stiffness, and/or strength. In various embodiments, the tissue thickness compensator has a porous morphology that exhibits a gradient structure, such as, for example, small pores on one surface and larger pores on the other surface. Such a morphology may be more desirable for tissue in-growth or hemostatic behavior. Furthermore, the gradient may also be combined with a varying bio-absorption profile. A short-term absorption profile may be more suitable for achieving hemostasis, while a long-term absorption profile may achieve better tissue healing without leakage.

Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharides, glycoproteins, elastin, proteoglycans, gelatin, collagen, and Oxidized Regenerated Cellulose (ORC). Examples of synthetic absorbable polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), Polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), polyethylene terephthalate (PET), Polyhydroxyalkanoate (PHA), copolymers of glycolide and epsilon-caprolactone (PGCL), copolymers of glycolide and trimethylene carbonate, poly (glycerol sebacate) (PGS), polydioxanone, poly (orthoesters), polyanhydrides, polysaccharides, poly (ester-amides), tyrosine-based polyarylates, tyrosine-based polyiminocarbonates, tyrosine-based polycarbonates, poly (D, L-lactide-urethanes), poly (B-hydroxybutyric acid), poly (E-caprolactone), polyethylene glycol (PEG), poly [ di (carboxyphenoxy) phosphazene ], (N-methyl-co-phosphazene), Poly (amino acids), pseudo-poly (amino acids), absorbable polyurethanes, and combinations thereof.

In various embodiments, the polymeric composition can comprise, for example, from about 50% to about 90% by weight of the polymeric composition of PLLA, and from about 50% to about 10% by weight of the polymeric composition of PCL. In at least one embodiment, the polymeric composition may comprise, for example, about 70% by weight PLLA, and about 30% by weight PCL. In various embodiments, the polymeric composition can comprise, for example, from about 55% to about 85% by weight of the polymeric composition of PGA, and from 15% to 45% by weight of the polymeric composition of PCL. In at least one embodiment, the polymer composition can comprise, for example, about 65% by weight PGA, and about 35% by weight PCL. In various embodiments, the polymer composition can comprise, for example, from about 90% to about 95% by weight of the polymer composition of PGA, and from about 5% to about 10% by weight of the polymer composition of PLA.

In various embodiments, the synthetic absorbable polymer may comprise a bioabsorbable biocompatible elastomeric copolymer. Suitable bioabsorbable biocompatible elastomeric copolymers include, but are not limited to, copolymers of epsilon-caprolactone and glycolide (the mole ratio of epsilon-caprolactone to glycolide is preferably from about 30:70 to about 70:30, preferably from 35:65 to about 65:35, and more preferably from 45:55 to 35: 65); elastomeric copolymers of epsilon-caprolactone and lactide (including L-lactide, D-lactide, blends thereof or lactic acid copolymers) (the mole ratio of epsilon-caprolactone to lactide is preferably from about 35:65 to about 65:35, and more preferably from 45:55 to 30: 70); elastomeric copolymers of p-dioxanone (1, 4-dioxan-2-one) and lactide (including L-lactide, D-lactide, and lactic acid) (the molar ratio of p-dioxanone to lactide is preferably from about 40:60 to about 60: 40); elastomeric copolymers of epsilon-caprolactone and p-dioxanone (the mole ratio of epsilon-caprolactone to p-dioxanone is preferably from about 30:70 to about 70: 30); an elastomeric copolymer of p-dioxanone and trimethylene carbonate (the molar ratio of p-dioxanone to trimethylene carbonate is preferably from about 30:70 to about 70: 30); elastomeric copolymers of trimethylene carbonate and glycolide (preferably in a mole ratio of trimethylene carbonate to glycolide of from about 30:70 to about 70: 30); elastomeric copolymers of trimethylene carbonate and lactide (including L-lactide, D-lactide, blends thereof or lactic acid copolymers) (the molar ratio of trimethylene carbonate to lactide is preferably from about 30:70 to about 70: 30); and blends thereof. In one embodiment, the elastomeric copolymer is a copolymer of glycolide and epsilon-caprolactone. In another embodiment, the elastomeric copolymer is a copolymer of lactide and epsilon-caprolactone.

The disclosures of U.S. Pat. No. 5,468,253, entitled "ELASTOMERIC MEDICAL DEVICE", published at 21.11.1995 and U.S. Pat. No. 6,325,810, entitled "FOAM BUTTRESS FOR STAPLING APPATUS", published at 4.12.2001, are hereby incorporated by reference in their entireties.

In various embodiments, the synthetic absorbable polymer may include, for example, one or more of 90/10 poly (glycolide-L-lactide) copolymer commercially available from Ethicon, inc. under the trade name VICRYL 910, polyglycolide commercially available from American Cyanamid co. under the trade name DEXON, polydioxanone commercially available from Ethicon, inc. under the trade name PDS, poly (glycolide-trimethylene carbonate) random block copolymer commercially available from American Cyanamid co. under the trade name MAXON, 75/25 poly (glycolide-epsilon-caprolactone) copolymer commercially available from Ethicon under the trade name MONOCRYL 25.

Examples of synthetic non-absorbable polymers include, but are not limited to, polyurethane foams, polypropylene (PP), Polyethylene (PE), polycarbonate, polyamides such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), Polystyrene (PS), polyester, Polyetheretherketone (PEEK), Polytetrafluoroethylene (PTFE), Polychlorotrifluoroethylene (PTFCE), polyvinyl fluoride (PVF), Fluorinated Ethylene Propylene (FEP), polyacetal, polysulfone, and combinations thereof. Synthetic non-absorbable polymers may include, but are not limited to, elastomeric foams and porous elastomers such as silicone, polyisoprene, and rubber. In various embodiments, the synthetic polymer may comprise expanded polytetrafluoroethylene (ePTFE) commercially available from W.L.Gore & Associates, Inc. under the trade name GORE-TEX Soft Tissue Patch, and copolyether ester polyurethane foam commercially available from Polyganics under the trade name NASPORE.

The polymer composition of the tissue thickness compensator can be characterized by, for example, percent porosity, pore size, and/or hardness. In various embodiments, the polymer composition can have a percent porosity of, for example, from about 30% to about 99% by volume. In certain embodiments, the polymer composition can have a percent porosity of, for example, about 60% to about 98% by volume. In various embodiments, the polymer composition can have a percent porosity of, for example, about 85% to about 97% by volume. In at least one embodiment, the polymeric composition may comprise, for example, about 70% by weight PLLA and about 30% by weight PCL, and may have, for example, about 90% porosity by volume. In at least one such embodiment, therefore, the polymer composition will comprise about 10% copolymer by volume. In at least one embodiment, the polymer composition may comprise, for example, about 65% by weight PGA and about 35% by weight PCL, and may have, for example, a percent porosity of about 93% to about 95% by volume. In various embodiments, the polymer composition can have a porosity of greater than 85% by volume. The polymer composition can have a pore size of, for example, about 5 microns to about 2000 microns. In various embodiments, the polymer composition can have a pore size of, for example, between about 10 microns to about 100 microns. In at least one such embodiment, the polymeric composition can comprise, for example, a copolymer of PGA and PCL. In certain embodiments, the polymer composition can have a pore size of, for example, between about 100 microns to about 1000 microns. In at least one such embodiment, the polymeric composition can comprise, for example, a copolymer of PLLA and PCL. According to certain aspects, the hardness of a polymer composition may be expressed in terms of shore hardness, which may be defined as the resistance of a material to permanent indentation as measured by a durometer (such as shore durometer). To evaluate the Durometer value of a given material, the material was pressed with a Durometer pin according to ASTM procedure D2240-00, entitled "Standard Test Method for Rubber Property-Durometer Hardness" (which is incorporated herein by reference in its entirety). The durometer indenter foot may be pressed into the material for a sufficient period of time (e.g., 15 seconds), with the reading then being taken on a suitable scale. Depending on the type of scale used, when the indenter foot has fully penetrated the material, a reading of 0 can be obtained; and when the indenter foot did not penetrate the material, a reading of 100 was obtained. The readings are dimensionless. In various embodiments, hardness can be determined according to ASTM D2240-00 using any suitable scale, such as a class A and/or OO class scale. In various embodiments, the polymer composition of the tissue thickness compensator can have a shore a hardness value of, for example, about 4A to about 16A, which is about 45OO to about 65OO in the shore OO range. In at least one such embodiment, the polymeric composition can comprise, for example, a PLLA/PCL copolymer or a PGA/PCL copolymer. In various embodiments, the polymer composition of the tissue thickness compensator can have a shore a hardness value of less than 15A. In various embodiments, the polymer composition of the tissue thickness compensator can have a shore a hardness value of less than 10A. In various embodiments, the polymer composition of the tissue thickness compensator can have a shore a hardness value of less than 5A. In certain embodiments, the polymeric material may have a shore OO composition value of, for example, about 35OO to about 75 OO.

In various embodiments, the polymer composition can have at least two of the above identified properties. In various embodiments, the polymer composition can have at least three of the above identified properties. The polymer composition can have, for example, a porosity of 85% to 97% by volume, a pore size of 5 microns to 2000 microns, and a shore a hardness value of 4A to 16A, and a shore OO hardness value of 45OO to 65 OO. In at least one embodiment, for example, the polymeric composition can comprise 70% by weight of the polymeric composition of PLLA and 30% by weight of the polymeric composition of PCL, and have a porosity of 90% by volume, a pore size of 100 microns to 1000 microns, and a shore a hardness value of 4A to 16A, and a shore OO hardness value of 45OO to 65 OO. In at least one embodiment, for example, the polymeric composition can comprise 65% by weight of the polymeric composition of PGA and 35% by weight of the polymeric composition of PCL, and have a porosity of 93% to 95% by volume, a pore size of 10 microns to 100 microns, and a shore a hardness value of 4A to 16A, and a shore OO hardness value of 45OO to 65 OO.

In various embodiments, the tissue thickness compensator can be releasably attached to the staple cartridge and/or anvil using a flowable attachment portion. Such flowable attachment portions can be operably associated with a staple cartridge and/or an anvil. In various embodiments, a flowable attachment portion can be disposed between the tissue thickness compensator and the staple cartridge and/or anvil. In various embodiments, at least a portion of the outer surface of the tissue thickness compensator can comprise a flowable attachment portion. In various embodiments, the adhesive laminate may include a tissue thickness compensator and a flowable attachment portion. The adhesive laminate can include a base layer including a tissue thickness compensator and an adhesive layer on at least a portion of a surface of the base layer, the adhesive layer including a flowable attachment portion. The adhesive laminate can include a tissue contacting surface including a tissue thickness compensator and an opposing surface including a flowable attachment portion. The adhesive laminate can be releasably attachable to the staple cartridge and/or anvil.

In various embodiments, the flowable attachment portion can comprise a flowable polymeric composition, such as a pressure sensitive adhesive ("PSA"), for example. An effective amount of a pressure sensitive adhesive capable of providing sufficient cohesive strength to produce the desired adhesive characteristics to adhere to the staple cartridge and/or anvil may be applied to the tissue thickness compensator. The pressure sensitive adhesive may have one or more of the following properties: (1) strong and durable tack; (2) the adhesive can be adhered by slightly pressing the fingers; (3) sufficient ability to remain on an adherend; (4) sufficient cohesive strength to be removed thoroughly from the adherend. In various embodiments, the flowable attachment portion can flow when pressure, heat, and/or stress is applied to the flowable attachment portion. Such pressure and/or stress may be applied directly, for example by hand and/or by a device (such as a mechanical device), and accordingly may be a manual process and/or an automated process.

In various embodiments, the flowable attachment portion may respond to temperature changes and/or pressure changes. In various embodiments, the flowable attachment portion can flow from the first position to the second position when heat and/or pressure is applied to the flowable attachment portion. In various embodiments, the flowable attachment portion is flowable at body temperature (37 ℃) and/or room temperature (25 ℃). In various embodiments, the flowable attachment portion is flowable at body temperature (37 ℃) but not at room temperature (25 ℃). In various embodiments, the flowable attachment portion can be responsive to temperature changes such that the flowable attachment portion is in a first position when the tissue thickness compensator is at a first temperature and the flowable attachment portion is in a second position when the tissue thickness compensator is at a second temperature. In various embodiments, the second temperature may be higher than the first temperature. In various embodiments, the first temperature may be room temperature and the second temperature is body temperature. In various embodiments, the flowable attachment portion can be responsive to pressure changes such that the flowable attachment portion is in a first position when the tissue thickness compensator is subjected to a first pressure and the flowable attachment portion is in a second position when the tissue thickness compensator is subjected to a second pressure. In various embodiments, the second pressure may be greater than the first pressure. In various embodiments, the first pressure may be atmospheric pressure and the second pressure may be finger pressure. In various embodiments, the flowable attachment portion can flow from a first position when at room temperature and/or atmospheric pressure to a second position when at body temperature and/or finger pressure. In various embodiments, the flowable attachment portion may flow from a first (unstressed) position to a second position when pressure and/or stress is applied to the flowable attachment portion.

In various embodiments, the flowable attachment portion can flow into a void in the staple cartridge and/or anvil. In various embodiments, when heat and/or pressure is applied to the flowable attachment portion, the flowable attachment portion can flow and extend over at least a portion of a surface of the staple cartridge and/or anvil that is free of the flowable attachment portion and/or fill at least a portion of a void (such as, for example, a slot and/or staple cavity) in the staple cartridge and/or anvil. In various embodiments, the flowable attachment portion can flow in vivo to fill at least a portion of a void in the staple cartridge and/or anvil. In various embodiments, the flowable attachment portion is flowable such that the flowable attachment portion comprises a shape complementary to at least a portion of a void in the staple cartridge and/or anvil. In various embodiments, the flowable polymeric composition can flow to fill at least a portion of the slots and/or staple cavities in the anvil. In various embodiments, the flowable attachment portion can flow into the void and take the shape of the void when pressure is applied to the flowable attachment portion. Without wishing to be bound by any particular theory, it is believed that filling at least a portion of the void in the staple cartridge and/or anvil with a flowable attachment portion may increase the strength of attachment of the tissue thickness compensator to the staple cartridge and/or anvil.

In various embodiments, a flowable attachment portion, such as a pressure sensitive adhesive, may respond to temperature changes and/or pressure changes to move between a first position and/or first profile and a second position and/or second profile. In various embodiments, the flowable attachment portion can have a first position spaced from the staple cartridge and/or the anvil. In various embodiments, the flowable attachment portion can be configured to infiltrate and/or fill at least a portion of a void in the staple cartridge and/or anvil when the flowable attachment portion is in the second position. As described herein, the flowable attachment portion can be in the shape of the void such that when the flowable attachment portion is specified to be in the second profile, the flowable attachment portion includes a profile that is complementary to the void. In various embodiments, the first position and/or first profile can be spaced from the staple cartridge and/or anvil and the second position and/or second profile can be in contact with the staple cartridge and/or anvil. In various embodiments, the first position and/or first profile may comprise a neutral (original) profile when at room temperature and/or atmospheric pressure, and the second position and/or second profile may comprise a profile that is complementary to a void in the staple cartridge and/or anvil when at body temperature and/or finger pressure. The flowable attachment portion can be contoured to achieve a shape and/or size complementary to a void in the staple cartridge and/or anvil.

In various embodiments, methods of bonding a tissue thickness compensator to a substrate (e.g., a staple cartridge and/or an anvil) can generally comprise: providing a tissue thickness compensator, applying a flowable attachment portion (such as a pressure sensitive adhesive), for example, to at least a portion of a surface of the tissue thickness compensator, and contacting the flowable attachment portion with a substrate. In various embodiments, a method of bonding a tissue thickness compensator to a substrate can comprise applying pressure to at least one of the tissue thickness compensator and the substrate. The flowable attachment portion can flow from a first location on the outer surface of the tissue thickness compensator to a second location that also includes the outer surface and/or the inner surface of the base. The flowable attachment portion can be in contact with the substrate, adhering the tissue thickness compensator to the substrate. In various embodiments, the flowable attachment portion can adhere the tissue thickness compensator to the substrate. In various embodiments, the flowable attachment portion can flow into at least one void in the substrate, such as a slot and/or staple cavity. In various embodiments, the flowable attachment portion can fill at least a portion of at least one void in the substrate when in the second position.

In various embodiments, methods of attaching a tissue thickness compensator to a substrate (e.g., a staple cartridge and/or an anvil) can generally comprise: the method includes applying at least one discrete bead and/or discrete strip of a flowable polymeric composition (such as a pressure sensitive adhesive) to a surface of a tissue thickness compensator, contacting the substrate with the at least one discrete bead and/or discrete strip of the flowable polymeric composition, and pressing the substrate and the at least one discrete bead and/or discrete strip of the flowable polymeric composition against the at least one discrete bead and/or discrete strip of another flowable polymeric composition to releasably attach the tissue thickness compensator to the substrate. In various embodiments, the method of attaching the tissue thickness compensator to the substrate can comprise applying at least one discrete bead and/or discrete strip of the flowable polymeric composition to the substrate at a desired location of the substrate on the tissue thickness compensator perimeter and/or central axis. In various embodiments, a method of attaching a tissue thickness compensator to a substrate can comprise applying at least one discrete bead and/or discrete strip of a flowable polymeric composition to the tissue thickness compensator in a longitudinal direction and/or a transverse direction.

In various embodiments, the method of attaching the tissue thickness compensator to the substrate can comprise applying at least one discrete bead and/or discrete strip of the flowable polymeric composition in a pattern and/or amount pre-selected based at least in part on the desired coating amount on the tissue thickness compensator. The pattern and amount of flowable polymer composition applied can be selected to withstand the stresses (e.g., shear stresses) associated with manipulation of the medical device by a clinician. The pattern and amount of application of the flowable polymer composition is preferably selected to balance the amounts on the flowable polymer composition in view of the clinician's ease of handling and/or preservation of the flowable polymer composition. Additionally, the composition of the flowable polymer composition can be considered in selecting the pattern and amount of application of the flowable polymer composition.

In various embodiments, the flowable attachment portion can partially affix the tissue thickness compensator to the staple cartridge and/or the anvil, and/or can fully affix the tissue thickness compensator to the staple cartridge and/or the anvil. A fully attached tissue thickness compensator can comprise a complete layer of a flowable polymer composition (such as, for example, a pressure sensitive adhesive) between the tissue thickness compensator and the substrate. In other words, a fully attached tissue thickness compensator can be a tissue thickness compensator without any portion of the tissue thickness compensator being uncoated with the flowable polymer composition. The partially attached tissue thickness compensator can comprise an effective amount of a flowable polymer composition between the tissue thickness compensator and the substrate, including at least a portion of the tissue thickness compensator being free of the flowable polymer composition. A partially attached tissue thickness compensator can impart a greater shear stress to the flowable polymer composition than a fully attached tissue thickness compensator. Thus, the shear properties of the flowable polymeric composition and/or the pattern and amount of the flowable polymeric composition can be selected to withstand manipulation of the medical device by a clinician in a desired manner.

In various embodiments, the flowable polymeric composition can be applied to the tissue thickness compensator in one of a continuous pattern and a discontinuous pattern. In various embodiments, the continuous pattern of flowable polymeric composition can comprise discrete bands of flowable polymeric composition applied to at least a portion of the tissue thickness compensator. In various embodiments, the continuous pattern of flowable polymer composition can comprise continuous beads of flowable polymer composition disposed longitudinally along at least a portion of a central axis of the tissue thickness compensator and/or disposed along at least a portion of a perimeter of the tissue thickness compensator. The flowable polymeric composition may be applied to the substrate in a variety of other patterns and configurations, such as a cruciform pattern or other diagonal pattern, in a continuous sheet or layer, or in any other design that achieves the desired adhesive properties. In various embodiments, a continuous pattern of flowable polymer composition can be applied along the inner and/or outer perimeter of the tissue thickness compensator. In various embodiments, a continuous pattern of the flowable polymeric composition can be applied along the inner perimeter of the tissue thickness compensator such that upon attachment of the tissue thickness compensator to the substrate, the flowable polymeric composition is positioned along the central longitudinal axis of the substrate. In various embodiments, a continuous pattern of the flowable polymer composition can be applied along the inner perimeter of the tissue thickness compensator such that upon attachment of the tissue thickness compensator to the substrate, the flowable polymer composition aligns with at least one void (such as a slot and/or staple cavity) in the substrate. In various embodiments, a continuous pattern of the flowable polymer composition can be applied along the outer periphery of the tissue thickness compensator such that upon attaching the tissue thickness compensator to the substrate, the flowable polymer composition is positioned along the outer periphery of the substrate. In various embodiments, the flowable polymer composition is applied to the tissue thickness compensator such that the inner portion and/or the peripheral boundary of the substrate is free of the flowable polymer composition.

In various embodiments, the discontinuous pattern of flowable polymeric composition may comprise a plurality of discrete beads and/or discrete stripes of flowable polymeric composition spaced apart from each other on the substrate. In various embodiments, at least a portion of the plurality of beads and/or ribbons of flowable polymeric composition may be pressed together when pressure and/or stress is applied. In various embodiments, a plurality of beads and/or ribbons of the flowable polymer composition that are pressed together can form a continuous pattern of the flowable polymer composition. In various embodiments, the partially attached tissue thickness compensator can comprise a plurality of discrete beads and/or discrete strips of the flowable polymeric composition spaced apart from one another on a surface thereof such that at least a portion of the surface of the tissue thickness compensator is free space free of the flowable polymeric composition when subjected to pressure. Such free space may include portions of the tissue thickness compensator where no beads and/or strips of the flowable polymer composition contact each other, and/or portions of the tissue thickness compensator where no beads and/or strips of the flowable polymer composition are applied. In various embodiments, the free space may be an interior portion and/or a perimeter boundary of the substrate.

In various embodiments, a method of attaching a tissue thickness compensator to a substrate can comprise applying at least one discrete strip of a flowable polymeric composition onto the tissue thickness compensator. In various embodiments, the discrete strips of flowable polymeric composition can extend along a portion of the central longitudinal axis of the tissue thickness compensator. In at least one embodiment, discrete bands of flowable polymeric composition can be applied along a portion of the tissue thickness compensator that is aligned with at least one void (such as a slot and/or staple cavity) in the substrate. In various embodiments, a method of attaching a tissue thickness compensator to a substrate can comprise applying a plurality of parallel discrete strips of a flowable polymeric composition onto the tissue thickness compensator. In various embodiments, two discrete strips of flowable polymeric composition can extend longitudinally along opposite side edges of the tissue thickness compensator. In at least one embodiment, for example, each of two discrete strips of flowable polymeric composition can be applied along a portion of the tissue thickness compensator that is aligned with at least one void (such as a slot and/or staple cavity) in the substrate. In various embodiments, the distance between the strips and/or between the side edges can be preselected such that upon attachment of the tissue thickness compensator to the substrate, the flowable polymeric composition can flow into at least one void in the substrate (such as at least one staple cavity of an anvil).

In various embodiments, the distance between the plurality of parallel discrete strips of flowable polymeric composition and/or the distance between the side edges can be preselected to enable the tissue thickness compensator to be fully adhered to the substrate, or partially adhered to the substrate. In various embodiments, the width of the strip may be at least 1mm, for example. In various embodiments, the width of the strip may be, for example, between about 0.5mm and about 1.5 mm. In various embodiments, the width of the strip may be, for example, between about 1.0mm and about 1.25 mm. In various embodiments, the gap width between the adhesive stripes and/or between the side edges may be, for example, at least 1 mm. In various embodiments, the distance between the strips and/or between the side edges can be preselected to partially adhere the tissue thickness compensator to the substrate, with the ratio of adhesive to adhesive-free space being preselected based on the intended application amount on the tissue thickness compensator. In various embodiments, the ratio of adhesive to adhesive-free space may be 1:10 to 10:1, such as 1:1, 1:2, 1:3, 1:4, 1:5, and 2: 3.

In various embodiments, for example, it may be desirable to: the minimum value at which the pressure sensitive adhesive can flow is 0.25 mm. In various embodiments, for example, the pressure sensitive adhesive substrate can comprise a thickness between about 1.25mm and about 1.50 mm. In certain embodiments, for example, the pressure sensitive adhesive substrate may comprise a thickness between about 0.5mm and about 0.75 mm.

As described herein, in various embodiments, the flowable attachment portion can comprise a flowable polymeric composition. The flowable polymer composition may include a pressure sensitive adhesive. The flowable attachment portion may comprise a pressure sensitive adhesive laminate. In various embodiments, the flowable attachment portion can include an adhesive laminate including a tissue thickness compensator and a flowable polymer composition. The polymer composition may comprise one or more synthetic polymers and/or one or more natural polymers. The polymer composition may be bioabsorbable, biocompatible, and/or biodegradable. Examples of natural polymers include, but are not limited to, lyophilized polysaccharides, glycoproteins, elastin, proteoglycans, gelatin, collagen, fibrin, fibronectin, fibrinogen, elastin, serum albumin, hemoglobin, ovalbumin, Oxidized Regenerated Cellulose (ORC), and combinations thereof. Examples of polysaccharides include, but are not limited to, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, hydroxypropyl cellulose, carboxymethyl cellulose, chitin/chitosan, agarose, alginate, and combinations thereof. Examples of synthetic polymers include, but are not limited to, poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), Polycaprolactone (PCL), polyglycolic acid (PGA), poly (glycolic acid), poly (hydroxybutyric acid), poly (phosphazene), polyester, poly (trimethylene carbonate) (TMC), polyethylene terephthalate (PET), Polyhydroxyalkanoates (PHA), copolymers of glycolide and epsilon-caprolactone (PGCL), copolymers of glycolide and trimethylene carbonate, poly (glycerol sebacate) (PGS), polydioxanone, poly (orthoesters), polyanhydrides, polyacrylamides, polysaccharides, poly (ester-amides), tyrosine-based polyarylates, tyrosine-based polyiminocarbonates, tyrosine-based polycarbonates, poly (D, L-lactide-urethane), poly (B-hydroxybutyric acid), Poly (E-caprolactone), polyethylene glycol (PEG), polyethylene oxide, poly [ di (carboxyphenoxy) phosphazene ], poly (amino acids), pseudo poly (amino acids), absorbable polyurethanes, polyhydroxyethylmethacrylate, polyvinylpyrrolidone, polyvinyl alcohol, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, nylon, and combinations thereof.

In various embodiments, the flowable polymer composition can comprise a copolymer of epsilon-caprolactone and glycolide (PCL/PGA). In various embodiments, the flowable polymeric composition can comprise, for example, from about 50% to about 90% by weight of the polymeric composition of PGA, and from about 50% to about 10% by weight of the polymeric composition of PCL. In various embodiments, the flowable polymeric composition can comprise, for example, from about 50% to about 75% by weight of the polymeric composition of PGA, and from about 50% to about 25% by weight of the polymeric composition of PCL. In various embodiments, the flowable polymeric composition can comprise, for example, from about 50% to about 60% by weight of the polymeric composition of PGA, and from about 50% to about 40% by weight of the polymeric composition of PCL. In at least one embodiment, the flowable polymeric composition can comprise, for example, about 70% by weight of the polymeric composition of PGA, and about 30% by weight of the polymeric composition of PCL. In at least one embodiment, the flowable polymeric composition can comprise, for example, about 64% by weight of the polymeric composition of PGA, and about 36% by weight of the polymeric composition of PCL.

In various embodiments, the flowable polymer composition can comprise a copolymer of epsilon-caprolactone and lactide (including L-lactide, D-lactide, blends thereof, and lactic acid copolymers). In various embodiments, the flowable polymer composition can include a molar ratio of PCL to PGA of from 30:70 to 70:30 (such as, for example, 35:65 to 65:35, 45:55 to 35:65, and 50: 50). In various embodiments, the amount of epsilon-caprolactone may be 30 to 45 mole percent with the balance being glycolide, such as, for example, an amount of epsilon-caprolactone of 35 to 40 mole percent with the balance being glycolide. In various embodiments, the pressure sensitive adhesive may comprise 36:64 (moles/mole) of the poly (e-caprolactone-co-glycolide) copolymer. In various embodiments, the flowable polymer composition can comprise a copolymer of dioxanone (1, 4-dioxan-2-one) and lactide (including L-lactide, D-lactide, and lactic acid). In various embodiments, the flowable polymer composition can comprise p-dioxanone and lactide in a molar ratio of 40:60 to 60: 40. In various embodiments, the flowable polymer composition can comprise a copolymer of epsilon-caprolactone and para-dioxanone. In various embodiments, the flowable polymer composition can comprise epsilon-caprolactone and para-dioxanone in a molar ratio of 30:70 to 70: 30.

In various embodiments, the tissue thickness compensator and the flowable attachment portion can comprise the same polymeric composition, or different polymeric compositions. In various embodiments, the tissue thickness compensator and the flowable attachment portion can comprise the same bioabsorbable material, such as a copolymer of epsilon-caprolactone and glycolide (PCL/PGA). In various embodiments, the tissue thickness compensator and the flowable attachment portion can differ in at least one feature selected from the group consisting of: material composition, modulus, elongation, intrinsic viscosity, crystallinity, and bioabsorbability. In various embodiments, the tissue thickness compensator and the flowable attachment portion can comprise the same copolymer that differs in at least one characteristic selected from the group consisting of: material composition, modulus, elongation, intrinsic viscosity, crystallinity, and bioabsorbability. For example, both the tissue thickness compensator and the flowable attachment portion can comprise a PCL/PGA copolymer that differs in the weight percent of epsilon-caprolactone to glycolide and/or the molar ratio of epsilon-caprolactone to glycolide. In at least one embodiment, the tissue thickness compensator can comprise about 50% by weight of the polymeric composition of PGA and about 50% by weight of the polymeric composition of PCL, and the flowable attachment portion can comprise about 64% by weight of the polymeric composition of PGA and about 36% by weight of the polymeric composition of PCL. In at least one embodiment, the tissue thickness compensator can comprise a PCL/PGA copolymer having a mole ratio of epsilon-caprolactone to glycolide of 50:50, and the flowable attachment portion can comprise a PCL/PGA copolymer having a mole ratio of epsilon-caprolactone to glycolide of 36: 64.

In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator (each by weight of the polymer composition) may differ by at least 1 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 5 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 10 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 15 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 1 to 15 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 10 to 15 weight percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 14 weight percent. In various embodiments, as described above, the concentration of epsilon-caprolactone in the pressure sensitive adhesive may be different than the concentration of epsilon-caprolactone in the tissue thickness compensator such that the concentration of epsilon-caprolactone in the pressure sensitive adhesive may be greater or less than the concentration of epsilon-caprolactone in the tissue thickness compensator.

In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 1 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 5 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 10 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 15 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 20 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by 1 to 20 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator by 15 to 20 weight percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator by 16 weight percent. In various embodiments, as described above, the concentration of polyglycolic acid in the pressure sensitive adhesive may be different than the concentration of polyglycolic acid in the tissue thickness compensator such that the concentration of polyglycolic acid in the pressure sensitive adhesive may be greater than or less than the concentration of polyglycolic acid in the tissue thickness compensator.

In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 1 mole percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 5 mole percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 10 mole percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by at least 15 mole percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 1 to 15 mole percent. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 10 mole% to 15 mole%. In various embodiments, the concentration of epsilon-caprolactone in the pressure sensitive adhesive and the concentration of epsilon-caprolactone in the tissue thickness compensator can differ by 14 mole percent. In various embodiments, as described above, the concentration of epsilon-caprolactone in the pressure sensitive adhesive may be different than the concentration of epsilon-caprolactone in the tissue thickness compensator such that the concentration of epsilon-caprolactone in the pressure sensitive adhesive may be greater or less than the concentration of epsilon-caprolactone in the tissue thickness compensator.

In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 1 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 5 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 10 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 15 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive and the concentration of polyglycolic acid in the tissue thickness compensator can differ by at least 20 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive can differ from the concentration of polyglycolic acid in the tissue thickness compensator by 1 to 20 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator by 15 to 20 mole percent. In various embodiments, the concentration of polyglycolic acid in the pressure sensitive adhesive may differ from the concentration of polyglycolic acid in the tissue thickness compensator by 16 mole percent. In various embodiments, as described above, the concentration of polyglycolic acid in the pressure sensitive adhesive may be different than the concentration of polyglycolic acid in the tissue thickness compensator such that the concentration of polyglycolic acid in the pressure sensitive adhesive may be greater than or less than the concentration of polyglycolic acid in the tissue thickness compensator.

In various embodiments, the flowable polymeric composition may include additional optional components to further improve the processability and/or mechanical properties of the composition, as well as other properties such as tack, light aging resistance, oxygen aging resistance, heat aging resistance, and visual appearance. Such optional components may include other copolymers that the flowable polymer composition may include to achieve desired properties, such as enhanced adhesion or compatibility with the substrate. In various embodiments, such additional optional components may include, but are not limited to, other polymers or copolymers, fillers, crosslinkers, tackifiers, plasticizers, pigments, dyes, antioxidants, colorants, and stabilizers. In various embodiments, the flowable polymeric composition may comprise an amount of tackifier in an amount of at least 0.1 weight percent, at least 2 weight percent, or at least 5 weight percent and up to 10 weight percent, 25 weight percent, or 50 weight percent, based on the total weight of the polymeric composition. In various embodiments, the flowable polymer composition can include an amount of plasticizer of at least 0.1 weight percent, at least 2 weight percent, or at least 5 weight percent and up to 10 weight percent, 25 weight percent, or 50 weight percent, based on the total weight of the polymer composition.

In various embodiments, the flowable attachment portion can include a flowable (plastically deformable) polymer composition. In various embodiments, the flowable polymeric composition is generally tacky at room temperature (e.g., 20 ℃ to 25 ℃) and can be releasably adhered to a variety of substrates by application of only moderate pressure thereto (e.g., finger pressure) to form a bond attached to the substrate. In various embodiments, the flowable polymer composition is a solid at up to 40 ℃, up to 45 ℃, up to 50 ℃, up to 55 ℃, and/or up to 60 ℃. In various embodiments, the flowable polymer composition melts, but does not degrade, above 40 ℃, above 45 ℃, above 50 ℃, above 55 ℃, above 60 ℃, and/or above 120 ℃. In various embodiments, the flowable polymer composition can be melted without degradation up to 600 ℃, up to 500 ℃, up to 400 ℃, up to 300 ℃, up to 240 ℃, and/or up to 180 ℃. In various embodiments, the flowable polymer composition can melt without degradation at a temperature in the range of 40.1 ℃ to 600 ℃, in the range of 120 ℃ to 240 ℃, and/or at a temperature of 180 ℃.

In various embodiments, the flowable polymer composition can be characterized by: a0.1 g/dL solution of the composition in hexafluoroisopropanol has an intrinsic viscosity at 25 ℃ of 0.6 to 4.0g/dL, 0.8 to 3.2g/dL, 1.0 to 2.4g/dL, and/or 1.6 g/dL. In various embodiments, the flowable polymer composition may not contain a gel.

In various embodiments, the flowable polymer composition can have one or more of the following characteristics: a percent crystallinity of less than about 25%, less than about 15%, and from 15% to 25%; a percent elongation of greater than about 200, greater than about 500, and from about 200 to about 500; the modulus is less than about 40,000psi, less than about 20,000, and from about 20,000psi to about 40,000 psi.

In various embodiments, the flowable attachment portion can comprise one of a strip, a ribbon, a roll of tape, a sheet, and a membrane attached to a surface and/or edge of the tissue thickness compensator. In various embodiments, the flowable attachment portion can comprise a pressure sensitive tape comprising an adhesive and a backing. In various embodiments, the backing may comprise one of a flexible backing material and a non-flexible backing material. Examples of flexible backing materials include, but are not limited to, plastic films such as polypropylene, polyethylene, polyvinyl chloride, polyester (polyethylene terephthalate), polycarbonate, polymethyl methacrylate (PMMA), cellulose acetate, cellulose triacetate, and ethyl cellulose. A foam backing may be used. Examples of non-flexible backing materials include, but are not limited to, metals, metallized polymer films, indium tin oxide coated glass and polyester, PMMA plates, polycarbonate plates, glass or ceramic sheets. In various embodiments, the pressure sensitive adhesive tape may include a release liner. In various embodiments, the pressure sensitive adhesive tape may be applied by removing the release liner to expose the adhesive.

In various embodiments, the flowable attachment portion can be applied to the tissue thickness compensator using conventional coating techniques such as roll coating, flow coating, dip coating, spin coating, spray coating, knife coating, and extrusion coating. In various embodiments, the flowable attachment portion can have an initial thickness of about 1.25mm to about 1.50mm, for example. In some embodiments, the flowable attachment portion can have an initial thickness of about 0.5mm to about 0.75mm, for example. In various embodiments, the flowable attachment portion can have a final thickness of, for example, at least 0.25mm when pressure is applied thereto.

In various embodiments, referring to fig. 263, the flowable attachment portion 30000 can comprise a continuous strip longitudinally centered along a portion of the central axis of the tissue thickness compensator 30010. The width of the strip may be, for example, at least 1 mm. The width of the strip may be, for example, between about 0.5mm and about 1.5 mm. The width of the strip may be, for example, between about 1.0mm and about 1.25 mm. The first position of the flowable attachment portion 30000 can be spaced apart from the anvil 30020, and the first profile of the flowable attachment portion 30000 can comprise a neutral (original) profile. As shown in fig. 264, the flowable attachment portion 30000 can be aligned with a void 30025 (e.g., such as a centrally disposed slot) in the anvil 30020. As shown in fig. 265, when pressure is applied to the flowable attachment portion 30000 up to a threshold level, the flowable attachment portion 30000 can flow into the slot 30025 to securely engage the anvil 30020. The flowable attachment portion 30000 can fill at least a portion of the slot 30025 such that the flowable attachment portion 30000 can assume the shape of the slot 30025. The second position of the flowable attachment portion 30000 can be in contact with the anvil 30020, and the second profile of the flowable attachment portion 30000 can include a profile complementary to the slot 30025. The flowable attachment portion 30000 can releasably attach the tissue thickness compensator 30010 to the anvil 30020.

In various embodiments, referring to fig. 266, the flowable attachment portion 30000 can comprise two continuous strips disposed longitudinally along a portion of the tissue thickness compensator 30010 and parallel to each other. The width of the strip may be, for example, at least 1 mm. The width of the strip may be, for example, between about 0.5mm and about 1.5 mm. The width of the strip may be, for example, between about 1.0mm and about 1.25 mm. Two separate strips may be spaced apart from the central axis and the side edges of the tissue thickness compensator 30010. The width of the gap between each strip may for example be at least 1mm and the width of the gap between each strip and the side edges may for example be at least 1 mm. The ratio of adhesive to adhesive free space may be, for example, between about 1:4 and about 1: 2. The ratio of adhesive to adhesive-free space may be, for example, at least 1: 10. In each case, the ratio of adhesive to adhesive-free space may be 0. In some cases, a constant layer may be desired across the entire surface. The first position of the flowable attachment portion 30000 can be spaced apart from the anvil 30020, and the first profile of the flowable attachment portion 30000 can comprise a neutral (original) profile. As shown in fig. 267, the flowable attachment portion 30000 can be aligned with the staple cavity 30030, for example. As shown in fig. 268, when pressure (such as finger pressure) is applied to the flowable attachment portion 30000 up to a threshold level, the flowable attachment portion 30000 can flow into the staple cavity 30030, which in turn forms a secure engagement with the anvil 30020. The flowable attachment portion 30000 can fill at least a portion of the staple cavity 30030 such that the flowable attachment portion 30000 can take the shape of the staple cavity 30030. At least a portion of the staple cavity 30030 can be free of the flowable attachment portion 30000. The second position of the flowable attachment portion 30000 can be in contact with the anvil 30020, and the second profile of the flowable attachment portion 30000 can comprise a profile complementary to the staple cavity 30030. The flowable attachment portion 30000 can releasably attach the tissue thickness compensator 30000 to the anvil 30020.

In various embodiments, referring now to fig. 269-273, a staple cartridge 30100 including a support portion 30102 and a tissue thickness compensator 30110 can be loaded into a staple cartridge channel, for example, using a staple cartridge applicator 30140. In various embodiments, the staple cartridge applicator 30140, in addition to being capable of positioning the staple cartridge 30100 within a staple cartridge channel, can be further configured to position the upper tissue thickness compensator 30110 relative to the anvil 30120. The staple cartridge applicator 30140 can include lock arms 30141 that can be releasably engaged with lock tabs that extend from the support portion 30102 of the staple cartridge 30100 such that the staple cartridge applicator 30140 can be held in place over the tissue thickness compensator 30110 of the staple cartridge 30100. In various embodiments, the upper tissue thickness compensator 30110 is removably attachable to the cartridge applicator 30140 such that the anvil 30120 of the surgical instrument can be closed on the applicator 30140, engaged with the tissue thickness compensator 30110, and the tissue thickness compensator 30110 separated from the cartridge applicator 30140. In various embodiments, the tissue thickness compensator 30110 and/or the anvil 30120 can comprise one or more retention features that can be configured to releasably retain the tissue thickness compensator 30110 to the anvil. In various embodiments, the retention features may include adhesive patches and/or adhesive tabs 30112.

In various embodiments, the adhesive sheet and/or adhesive tab may be integrally formed with a portion of the tissue thickness compensator 30110. In various embodiments, the tissue thickness compensator 30110 can include at least one adhesive tab 30112 along its edges. The adhesive tab 30112 may include a release liner 30113. Referring to fig. 271, the anvil 30120 can be moved to a closed position to engage the tissue thickness compensator 30110. The release liner 30113 can then be removed to expose the adhesive surface of the adhesive tab 30112. Next, referring to fig. 272 and 273, a first end of the adhesive tab 30112 can be secured to the anvil and a second end of the adhesive tab 30112 can be secured to the anvil to releasably attach the tissue thickness compensator 30110 to the anvil. The adhesive tab 30112 can be pulled distally to separate the tissue thickness compensator 30110 from the staple cartridge applicator 30140. Upon completion of the above-described operations, the anvil and staple cartridge 30100 can be positioned relative to the tissue to be stapled and/or incised. Next, the clinician can pull on the adhesive tab 30112 to separate the tissue thickness compensator 30110 from the anvil.

Referring to fig. 284-288, in various embodiments, the tissue thickness compensator 30210 can include at least one adhesive tab 30212 along its distal edge. The adhesive tab 30212 may include a release liner 30213. As described herein, the staple cartridge applicator 30240 can be configured to position the upper tissue thickness compensator 30210 relative to the anvil 30220. The release liner 30213 may be removed to expose the adhesive surface of the adhesive tab 30212. The adhesive tab 30212 may be flipped over and secured to the anvil 30220 such that the tissue thickness compensator 30210 is releasably attached to the anvil 30220. The adhesive tab 30212 may then be pulled distally to separate the tissue thickness compensator 30210 from the staple cartridge applicator 30240. The anvil 30220 and the staple cartridge 30200 can then be positioned relative to the tissue to be stapled and/or incised. Referring to fig. 289-290, in use, a staple deployment sled can be advanced distally through the staple cartridge by the firing member, which in turn can advance a knife edge 30211 through the tissue thickness compensator 30210 to cut into at least a portion of the adhesive tab 30212 and gradually separate the tissue thickness compensator 30210 from the anvil 30220. The clinician may pull the remainder of the adhesive tab 30212 away from the anvil 30220 prior to reloading a new staple cartridge 30200.

In various embodiments, the adhesive sheet and/or adhesive tab may be separate from the tissue thickness compensator. Referring to fig. 274-276, in at least one embodiment, an adhesive tab 30312 (see also fig. 288 and 292) can be disposed between the staple cartridge 30300 and the tissue thickness compensator 30310. The tissue thickness compensator 30310 can include a notch 30311 that is sized and configured to cooperate with the adhesive tab 30312 to releasably retain the tissue thickness compensator 30310 to the anvil 30320. A first end of the adhesive tab 30312 may be secured to the tissue thickness compensator 30310 adjacent to the notch 30311, and a second end of the adhesive tab 30312 may be secured to the anvil 30320. As shown in fig. 277, the adhesive tab 30312 does not engage the notch 30311. Thereafter, the anvil 30320 and staple cartridge 30300 can be positioned relative to the tissue T to be stapled and/or incised.

As noted above, in use, a staple deployment sled can be advanced distally through the staple cartridge by the firing member to eject the staples from the staple cartridge as outlined above. As the staples deform, each staple can capture a portion of the tissue thickness compensator against the tissue top surface. At the same time, the firing member can advance the knife blade through the tissue thickness compensator 30310, wherein in at least one embodiment the knife blade can advance through the tissue thickness compensator 30310 to move the tissue thickness compensator 30310 distally and align the adhesive tab 30312 with the notch 30311 as shown in fig. 277-279 so that the knife blade cuts into the tissue thickness compensator 30310 and separates the tissue thickness compensator 30310 from the anvil 30320. In various embodiments, the non-notched tissue thickness compensator 30310 can move downward, as shown in fig. 280 and 281, to disengage the adhesive tabs 30312 and separate the tissue thickness compensator 30310 from the anvil 30320 as the staples are moved from their unfired positions to their fired positions by the staple drivers as described above. After the staples have been deployed, the anvil 30320 can be opened again and moved away from the implanted tissue thickness compensator 30310, as shown in fig. 283. By comparing fig. 282 and 283, the reader will appreciate that the tissue thickness compensator 30310 may be secured to the tissue T and incised by the cutting member as described above.

In various embodiments, the flowable attachment portion can be applied by removing the first release liner from the first adhesive tab, thereby exposing the flowable attachment portion (e.g., comprising a pressure sensitive adhesive). The first adhesive tab may then be rolled or otherwise pressed onto the outer surface of the substrate. The second release liner can then be removed from the second adhesive tab, exposing the pressure sensitive adhesive. The second adhesive tab may be pressed onto the outer surface of the substrate and/or the first adhesive tab at this time. Once the pressure sensitive adhesive is applied to the tissue thickness compensator, it is placed in contact with the staple cartridge and/or anvil. The pressure sensitive adhesive may secure the tissue thickness compensator to the substrate.

The various embodiments described herein are described in the context of staples that are removably stored within a staple cartridge for use with a surgical stapling instrument. In some cases, a staple may include a wire that deforms when it contacts an anvil of a surgical stapler. Such wires may be constructed, for example, from metal (such as stainless steel) and/or any other suitable material. Such embodiments and the teachings thereof are applicable to embodiments that include fasteners that are removably stored within a fastener cartridge for use with any suitable fastening instrument.

Various embodiments described herein are described in the context of a tissue thickness compensator attached to and/or used with a staple cartridge and/or a fastener cartridge. Such tissue thickness compensators may be used to compensate for variations in tissue thickness from one end of the staple cartridge to the other, or to compensate for variations in tissue thickness captured within one staple or fastener as compared to the thickness of tissue captured within another staple or fastener. Such tissue thickness compensators may also be used to compensate for variations in tissue thickness from one side of the staple cartridge to the other. Such embodiments and their teachings are applicable to embodiments that include one or more layers of material attached to and/or used with a staple cartridge and/or fastener cartridge. Such a layer of material may comprise a buttress material.

The various embodiments described herein are described in the context of a linear end effector and/or linear fastener cartridge. Such embodiments and their teachings can be applied to non-linear end effectors and/or non-linear fastener cartridges, such as rounded and/or contoured end effectors. For example, various end effectors, including non-linear end effectors, are disclosed in U.S. patent application serial No. 13/036,647 (now U.S. patent application publication 2011/0226837), entitled "SURGICAL STAPLING INSTRUMENT," filed 28/2.2011, which is hereby incorporated by reference in its entirety. Additionally, U.S. patent application serial No. 12/893,461 (now U.S. patent application publication 2012/0074198), entitled "STAPLE CARTRIDGE," filed 9, 29, 2012, is hereby incorporated by reference in its entirety. U.S. patent application Ser. No. 12/031,873 (now U.S. Pat. No. 7,980,443), entitled "END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT", filed on 15.2.2008, is also hereby incorporated by reference in its entirety.

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. Thus, where necessary, the disclosure explicitly set forth herein may supersede any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein is only incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

While this invention has been described as having an exemplary design, the present invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains.

Claims

1. A staple cartridge, comprising:

a cartridge body comprising a deck;

a plurality of staples removably stored within the cartridge body; and

An implantable layer assembly positioned over the platform, wherein the implantable layer assembly comprises:

a compensation layer configured to be at least partially captured within the staples as the staples are moved from an unfired position to a fired position, wherein the compensation layer comprises a first length; and

an overlapping layer extending from the compensation layer, wherein the overlapping layer comprises a second length, wherein the second length is longer than the first length, and wherein the overlapping layer is configured to overlap an adjacently implanted implantable layer,

wherein the overlapping layer is configured to be softer than the compensation layer.

2. The staple cartridge of claim 1, wherein said compensation layer is comprised of a compressible foam.

3. The staple cartridge of claim 1, wherein said deck comprises a distal deck end, wherein said compensation layer comprises a distal compensation end, wherein said overlapping layer comprises a distal overlapping end, and wherein said distal overlapping end extends beyond said distal deck end and said distal compensation end.

4. The staple cartridge of claim 1, wherein said overlapping layer and said compensating layer comprise a laminate.

5. The staple cartridge of claim 1, wherein said overlapping layers comprise flexible end members extending from said compensation layer.