JP2015513965A - Movable member for use with tissue thickness compensator - Google Patents

Abstract

Disclosed herein is a cutting blade for surgical cutting and stapling instruments. The cutting blade can have one or more structures for guiding or moving material released from the interior of the tissue thickness compensator used with the surgical instrument. The cutting blade can have a non-smoothed surface that allows material from the tissue thickness compensator to spread across the entire surface of the blade.

Description

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

The following is a non-exhaustive list of embodiments of the invention that are claimed or have the potential to be claimed.
1. A disposable loading unit for a surgical stapler having an anvil,
A housing assembly;
A staple cartridge assembly having a staple cartridge body defining a staple deck and a slot, and further comprising a tissue thickness compensator disposed adjacent to the staple deck, wherein the tissue thickness compensator includes a substance therein. A staple cartridge assembly;
A knife assembly disposed within the housing assembly and disposed to move relative to the staple cartridge assembly along the slot;
A cutting surface configured to cut the tissue thickness compensator captured between the staple cartridge assembly and an anvil of the surgical stapler as the knife assembly moves relative to the cartridge assembly;
An interaction surface disposed relative to the cutting surface and configured to guide at least a portion of the material in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. A disposable loading unit having a knife assembly having an interaction surface.
2. The knife assembly further includes a blade, the cutting surface is defined on the blade, the blade defines a first surface and a second surface opposite the first surface, the first The disposable loading unit of embodiment 1, wherein the surface of said comprises the interacting surface.
3. The disposable loading unit of embodiment 2, wherein the interacting surface has a raised portion raised on the first surface of the blade.
4). The disposable loading unit of embodiment 2 or embodiment 3, wherein the interaction surface has a groove in the first surface of the blade.
5). The interaction surface is a first interaction surface, and the second surface of the knife assembly further comprises a second interaction surface disposed relative to the cutting surface, the second interaction The disposable loading of any one of embodiments 2-4, wherein a surface is configured to guide at least a portion of the substance in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. unit.
6). 6. The disposable loading unit of embodiment 5, wherein the second interactive surface includes a raised portion that is raised on the second surface of the blade.
7). The disposable loading unit of embodiment 5 or embodiment 6, wherein the second interactive surface comprises a groove in the second surface of the blade.
8). The tissue thickness compensator is a first tissue thickness compensator, the material is a first material, the interaction surface is a first interaction surface, and the disposable loading unit further comprises:
A second tissue thickness compensator configured to be disposed adjacent to the anvil of the surgical stapler, the second tissue thickness compensator including a second substance therein;
A second interactive surface disposed relative to the cutting surface, wherein at least one of the second materials in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. Embodiment 1. The disposable loading unit of any one of embodiments 1-4 having a second interaction surface configured to guide the part.
9. The knife assembly further comprises a blade, the blade has the cutting surface, the blade defines a first surface and a second surface opposite the first surface, the first and A second interaction surface is disposed on the first surface of the blade, and the second surface is
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. 3 interaction surfaces;
A second one disposed against the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly; 9. The disposable loading unit of embodiment 8, comprising 4 interaction surfaces.
10. The disposable loading unit of embodiment 8 or embodiment 9, wherein the first material is different from the second material.
11. 11. The disposable loading unit of any one of embodiments 1-10, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a non-smoothed surface.
12 A surgical stapler,
A handle,
A trigger configured to move between a non-actuated position and an actuated position;
A staple cartridge operably coupled to the trigger, the staple cartridge defining a staple deck and a slot;
An anvil operatively coupled to the handle, the anvil having at least one staple forming surface;
A tissue thickness compensator disposed with respect to the staple deck and the anvil, the tissue thickness compensator including a substance therein;
A knife assembly arranged to move relative to the staple cartridge along the slot, the cutting surface configured to cut the tissue thickness compensator arranged relative to the staple cartridge and the anvil. A knife assembly further comprising a guide disposed with respect to the cutting surface, the guide in the tissue thickness compensator as the knife assembly moves relative to the staple cartridge. A surgical stapler configured to guide at least a portion of a substance.
13. The knife assembly further includes a blade, the cutting surface is defined on the blade, the blade defines a first surface and a second surface opposite the first surface, the first The surgical stapler of embodiment 12, wherein the surface of the guide comprises the guide.
14 The surgical stapler of embodiment 13, wherein the guide includes a raised portion raised on the first surface of the blade.
15. The surgical stapler of embodiment 13 or embodiment 14, wherein the guide includes a groove in the first surface of the blade.
16. The guide is a first guide, and the second surface of the knife assembly further comprises:
A second guide disposed relative to the cutting surface and configured to guide at least a portion of the substance in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. The surgical stapler of any one of embodiments 13-15, having a second guide.
17. The surgical stapler of embodiment 16, wherein the second guide includes a ridge raised on the second surface of the blade.
18. The surgical stapler of embodiment 16 or embodiment 17, wherein the second guide includes a groove in the second surface of the blade.
19. The tissue thickness compensator is a first tissue thickness compensator disposed with respect to the staple deck, the material is a first material, the guide is a first guide, and the surgical stapler Further includes a second tissue thickness compensator disposed with respect to the anvil, the second tissue thickness compensator including a second material therein, and the knife assembly is against the cutting surface. Embodiment 12 further comprising: a second guide disposed in position, wherein the second guide is configured to guide at least a portion of the second material in the second tissue thickness compensator. The surgical stapler of any one of -15.
20. The knife assembly further comprises:
A blade defining a cutting surface and defining a first surface and a second surface opposite the first surface, wherein the first surface is the first guide and the second guide; The second surface comprising:
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the staple cartridge. 3 guides,
A second one disposed with respect to the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the staple cartridge. The surgical stapler of embodiment 19 comprising: 4 guides.
21. The surgical stapler of embodiment 19 or embodiment 20, wherein the first material is different from the second material.
22. The surgical stapler according to any one of embodiments 12-21, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a non-smoothed surface.

The features and advantages of the present invention, as well as the manner in which they are realized, will become more apparent from the following description of embodiments of the invention, taken in conjunction with the accompanying drawings, to provide a deeper understanding of the invention itself. I will.
1 is a cross-sectional view of one embodiment of a surgical instrument. 1 is a perspective view of one embodiment of an implantable staple cartridge. FIG. FIG. 6 shows a portion of an end effector that clamps and staples tissue with an implantable staple cartridge. FIG. 6 shows a portion of an end effector that clamps and staples tissue with an implantable staple cartridge. FIG. 6 shows a portion of an end effector that clamps and staples tissue with an implantable staple cartridge. FIG. 6 shows a portion of an end effector that clamps and staples tissue with an implantable staple cartridge. FIG. 9 is a partial cross-sectional view of another end effector coupled to a portion of a surgical instrument with an end effector supporting a surgical staple cartridge and an anvil thereof in an open position. FIG. 3 is another partial cross-sectional view of the end effector of FIG. 2 in a closed position. FIG. 4 is another partial cross-sectional view of the end effector of FIGS. 2 and 3 as the knife bar begins to advance through the end effector. FIG. 5 is another partial cross-sectional side view of the end effector of FIGS. 2-4 with the knife bar partially advanced through the interior. FIG. 6 is a perspective view of another staple cartridge embodiment installed in a surgical cutting and stapling apparatus. FIG. 7 is a plan view of the surgical staple cartridge and elongated groove member of the apparatus shown in FIG. 6. FIG. 10 is a plan view of another surgical staple cartridge embodiment installed in an elongated groove member of an end effector. It is a bottom view of an anvil. It is a fragmentary perspective view of the some staple which shape | molds a part of staple row | line | column. FIG. 11 is another partial perspective view of the staple row of FIG. 10 after the staple has been formed by contact with the anvil of the surgical cutting and stapling apparatus. FIG. 5 is a partial perspective view of another staple forming a portion of another staple row. FIG. 5 is a partial perspective view of another staple forming a portion of another staple row. FIG. 6 is a partial perspective view of another staple forming a portion of another staple row embodiment. It is sectional drawing of the end effector which supports a staple cartridge. FIG. 16 is a cross-sectional view of the implantable staple cartridge body portion and the elongated groove portion of the end effector of FIG. 15 after the staples have been removed. FIG. 6 is a cross-sectional view of an end effector that supports another staple cartridge. FIG. 10 illustrates a deformation of a surgical staple disposed within a collapsible staple cartridge body in accordance with at least one embodiment. FIG. 10 illustrates a deformation of a surgical staple disposed within a collapsible staple cartridge body in accordance with at least one embodiment. FIG. 10 illustrates a deformation of a surgical staple disposed within a collapsible staple cartridge body in accordance with at least one embodiment. FIG. 10 illustrates a deformation of a surgical staple disposed within a collapsible staple cartridge body in accordance with at least one embodiment. It is a figure which shows the staple arrange | positioned in the staple cartridge main body which can be crushed. FIG. 19B shows the collapsible staple cartridge body of FIG. 19A crushed by an anvil. FIG. 19B shows the collapsible staple cartridge of FIG. 19A further crushed by an anvil. FIG. 19B illustrates the staple of FIG. 19A in a fully formed state and the collapsible staple cartridge of FIG. 19A in a fully collapsed state. FIG. 6 shows staples placed against a staple cartridge support surface and showing the relative motion possible between them. FIG. 21 is a cross-sectional view of a staple cartridge support surface including slots or troughs configured to stabilize the base of the staple of FIG. FIG. 6 is a cross-sectional view of a staple that includes an overmolded crown and a slot or trough configured to receive a portion of the crown, according to at least one other embodiment. FIG. 3 is a plan view of a staple cartridge according to at least one embodiment including staples embedded within a collapsible staple cartridge body. FIG. 24 is an elevational view of the staple cartridge of FIG. 23. 1 is an elevational view of a staple cartridge according to at least one embodiment, including a protective layer surrounding a staple, disposed within a collapsible staple cartridge body. FIG. FIG. 26 is a cross-sectional view of the staple cartridge of FIG. 25 taken along line 26-26 of FIG. FIG. 3 is an elevational view of a staple cartridge according to at least one embodiment including staples extending at least partially outside the collapsible staple cartridge body and a protective layer surrounding the staple cartridge body. FIG. 28 is a cross-sectional view of the staple cartridge of FIG. 27 taken along line 28-28 of FIG. The staple cartridge according to at least one embodiment, wherein the staple comprises a staple that is at least partially disposed within a staple cavity space of the staple cartridge body and at least partially embedded within the collapsible staple cartridge body. FIG. FIG. 30 is a cross-sectional view of the staple cartridge of FIG. 29 taken along line 30-30 of FIG. 29. FIG. 6 is a partial cutaway view of a staple cartridge, according to at least one embodiment. Partial cutaway view of a staple cartridge, according to at least one embodiment, comprising a staple embedded within at least a collapsible staple cartridge body and an alignment matrix that couples the staples and aligns the staples relative to each other. It is. FIG. 33 is a cross-sectional view of the staple cartridge of FIG. 32 taken along line 33-33 of FIG. It is a partial cutaway view of the inner layer of the compressible cartridge body. FIG. 35 shows the inner layer of FIG. 34 compressed between a transfer plate and a support plate. FIG. 36 shows staples inserted into the compressed inner layer of FIG. 35. FIG. 36 is a view of the support plate of FIG. 35 removed from the inner layer. FIG. 35 is a view of a subassembly including the inner layer of FIG. 34 and the staple of FIG. 36 inserted into the outer layer. FIG. 39 illustrates the outer layer of FIG. 38 sealed to form a sealed staple cartridge. FIG. 40 is a cross-sectional view of the sealed staple cartridge of FIG. 39. FIG. 6 is a cross-sectional view of a staple cartridge and a staple cartridge groove member, according to at least one embodiment. FIG. 42 is a view showing a part of the staple cartridge of FIG. 41 in a deformed state. FIG. 3 is an elevation view of an end effector of a surgical stapler including an anvil in an open position and a staple cartridge disposed within a staple cartridge groove member. FIG. 44 is an elevational view of the end effector of FIG. 43 illustrating the anvil in the closed position and the staple cartridge compressed between the anvil and the staple cartridge groove member. FIG. 44 is an elevational view of the end effector of FIG. 43 illustrating the staple cartridge of FIG. 43 disposed in the staple cartridge groove member in another manner. 1 is a cross-sectional view of a surgical stapler end effector including a compressible staple cartridge disposed within a staple cartridge groove member and a piece of buttress material attached to an anvil. FIG. FIG. 47 is a cross-sectional view of the end effector of FIG. 46 illustrating the anvil in the closed position. FIG. 10 is a cross-sectional view of another embodiment of an end effector of a surgical stapler including a staple cartridge that includes a water impermeable layer. FIG. 6 is a cross-sectional view of another embodiment of an end effector of a surgical stapler. FIG. 9 is a cross-sectional view of another embodiment of a staple cartridge including an end effector of a surgical stapler including a stepped anvil and a cartridge body formed with a step. FIG. 6 is a cross-sectional view of another embodiment of an end effector of a surgical stapler. FIG. 9 is a cross-sectional view of another embodiment of an end effector of a surgical stapler that includes an angled tissue contacting surface. FIG. 9 is a cross-sectional view of another embodiment of an end effector of a surgical stapler that includes an angled tissue contacting surface. FIG. 10 is a cross-sectional view of another embodiment of an end effector of a surgical stapler including a support insert configured to support a staple cartridge. FIG. 9 is a cross-sectional view of another embodiment of an end effector of a surgical stapler including a staple cartridge that includes a plurality of compressible layers. FIG. 10 is a cross-sectional view of another embodiment of an end effector of a surgical stapler including a staple cartridge including a stepped compressible cartridge body. FIG. 10 is a cross-sectional view of another embodiment of an end effector of a surgical stapler that includes a staple cartridge that includes a compressible cartridge body with a step formed therein. FIG. 9 is a cross-sectional view of another embodiment of an end effector of a surgical stapler that includes a staple cartridge that includes a curved tissue contacting surface. FIG. 6 is a cross-sectional view of another embodiment of an end effector of a surgical stapler including a staple cartridge having a tilted tissue contacting surface. 1 is a cross-sectional view of a compressible staple including a staple and at least one drug stored therein. FIG. FIG. 61 shows the compressible staple cartridge of FIG. 60 after the compressed and contained staples are deformed. FIG. 6 is a partial cutaway view of a staple cartridge, according to at least one embodiment. FIG. 63 is a cross-sectional view of the staple cartridge of FIG. 62. FIG. 6 is a perspective view of an implanted staple cartridge according to at least one alternative embodiment. FIG. 65 is a cross-sectional view of the implanted staple cartridge of FIG. 64. FIG. 10 is a perspective view of an alternative embodiment of a staple cartridge including a deformable member extending from the outer layer of the staple cartridge. FIG. 7 is a perspective view of an alternative embodiment of a staple cartridge that includes an outer layer of staple cartridges combined with an inner layer. FIG. 6 is a cross-sectional view of an alternative embodiment of a staple cartridge that includes a plurality of staples, a compressible layer, and a pledget layer. FIG. 69 is a perspective view of the pledget layer of FIG. 68. FIG. 69 is a perspective view of a pledget separated from the pledget layer of FIG. 68 and staples aligned with pledget grooves. FIG. 69 is a perspective view of two connected pledgets from the pledget layer of FIG. 68. FIG. 69 is a perspective view of the pledget support frame of the pledget layer of FIG. 68, removed from the separated pledget. FIG. 6 is an exploded perspective view of an alternative embodiment of a compressible staple cartridge containing staples therein and a system for driving the staples against the anvil. FIG. 74 is a partial cutaway view of an alternative embodiment of the staple cartridge of FIG. 73. FIG. 74 is a cross-sectional view of the staple cartridge of FIG. 73. FIG. 74 is an elevational view of a sled configured to traverse the staple cartridge of FIG. 73 and move the staples toward the anvil. FIG. 76 is a view of a staple driver that can be lifted toward the anvil by the sled of FIG. 75; FIG. 7 is a cutaway view of a staple cartridge according to at least one alternative embodiment including staples disposed within a staple driver. FIG. 78 is a cross-sectional view of the staple cartridge of FIG. 77 disposed within a staple cartridge groove member. FIG. 78 is a cross-sectional view of the staple cartridge of FIG. 77 illustrating the anvil moved to the closed position and staples contained within the staple cartridge deformed by the anvil. FIG. 78 is a cross-sectional view of the staple cartridge of FIG. 77 illustrating staples moved upward from the anvil. FIG. 10 is a perspective view of an alternative embodiment of a staple cartridge including a strap connecting the flexible sides of the staple cartridge. FIG. 6 is a perspective view of a thread and cutting member assembly. FIG. 89 is a view of the sled and cutting member assembly of FIG. 82 used to lift the staples of the staple cartridge of FIG. 77. FIG. 5 illustrates a sled configured to engage and lift a staple toward an anvil and a lockout system configured to selectively allow the sled to move distally. . A to C illustrate the advancement of the staple inserted into the staple crown. FIG. 3 is a cross-sectional view of a staple cartridge including a support pan or retainer. FIG. 6 is a partial cross-sectional view of a compressible staple cartridge according to at least one alternative embodiment. FIG. 88 is a diagram showing the staple cartridge of FIG. 87 in an implanted state. FIG. 6 is a partial cutaway view of a compressible staple cartridge in accordance with at least one alternative embodiment. FIG. 90 is a partial cross-sectional view of the staple cartridge of FIG. 89. FIG. 90 shows the staple cartridge of FIG. 89 in an implanted state. FIG. 5 is a partial cross-sectional view of a collapsible staple cartridge according to at least one alternative embodiment. 1 is a partial cutaway view of a collapsible staple cartridge according to at least one embodiment including a plurality of collapsible elements. FIG. FIG. 94 is a perspective view of the collapsible element of FIG. 93 in an uncollapsed state. FIG. 95 is a perspective view of the collapsible element of FIG. 94 in a collapsed state. An end effector of a surgical stapling instrument comprising: a jaw including a retaining matrix with a jaw attached thereto; a staple cartridge groove member disposed opposite the jaw; and a staple cartridge disposed within the staple cartridge groove member. It is a fragmentary sectional view. The end of FIG. 96A illustrating a staple cartridge compressed by a jaw, anvil and retention matrix moved in the direction of the staple cartridge groove member, and a staple extending at least partially through tissue disposed intermediate the retention matrix and staple cartridge. It is a fragmentary sectional view of an effector. FIG. 96B is a partial cross-sectional view of the end effector of FIG. 96A showing the jaws in the final position and the retention matrix engaging the staples of FIG. 96B. FIG. 96B is a partial cross-sectional view of the end effector of FIG. 96A illustrating that the jaws and staple cartridge groove members have been removed from the implanted staple cartridge and retention matrix. FIG. 7 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including a plurality of retention members configured to engage fastener legs extending therethrough. FIG. 7 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including six retention members. FIG. 6 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including eight retention members. FIG. 7 is a perspective view of a retention opening in a retention matrix, according to at least one alternative embodiment, including a plurality of retention members configured to engage fastener legs extending therethrough. FIG. 7 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including six retention members. FIG. 6 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including eight retention members. FIG. 6 is a perspective view of a retention opening of a retention matrix according to at least one other embodiment that includes a plurality of retention members stamped from a metal sheet. FIG. 6 is a perspective view of a retention opening of a retention matrix, according to at least one alternative embodiment, including a plurality of openings extending around an outer periphery of the retention opening. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one other embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one other embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one other embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one other embodiment. FIG. 6 is a plan view of a retention opening of a retention matrix according to at least one other embodiment. FIG. 6 is a plan view of a retention opening in a retention matrix including retention tabs extending into the retention opening according to at least one embodiment. FIG. 6 is a plan view of a retention opening in a retention matrix including retention tabs extending into the retention opening according to at least one alternative embodiment. 1 is a perspective view of a fastening system that includes a plurality of staples, a retention matrix that engages the staples, and an alignment matrix configured to align the staples. FIG. FIG. 113 is a perspective view of the retention matrix of FIG. 112. FIG. 113 is a perspective view of the alignment matrix of FIG. 112. FIG. 113 is a partial plan view of the retention matrix of FIG. 112 engaging the staples of FIG. 112; FIG. 113 is a partial bottom view of the retention matrix of FIG. 112 engaged with the staple of FIG. 112; FIG. 113 is a partial elevation view of the fastening system of FIG. 112. FIG. 113 is a partial perspective view of the fastening system of FIG. 112. FIG. 113 is a partial plan view of the retention matrix of FIG. 112 engaging the staples of FIG. 112; FIG. 113 is a partial cross-sectional view of the fastening system of FIG. 112. FIG. 113 is a perspective view of the fastening system of FIG. 112 further including a protective cap associated with the staple legs. FIG. 122 is a bottom perspective view of the fastening system configuration of FIG. 121. It is a fragmentary perspective view of the fastening system structure of FIG. It is a fragmentary sectional view of the fastening system structure of FIG. FIG. 10 is an elevational view of an end effector according to at least one embodiment including a jaw in an open position, a retention matrix and a plurality of protective caps disposed within the jaws, and a staple cartridge disposed within a staple cartridge groove member. . FIG. 126 is an elevational view of the end effector of FIG. 125 in a closed position. FIG. 126 is an elevational view of the end effector of FIG. 125 in a fired position. FIG. 126 is an elevational view of the retention matrix and protective cap of FIG. 125 combined with the staple cartridge of FIG. 125; FIG. 129 is a detailed view of the configuration of FIG. 128. FIG. 126 is an elevational view of the end effector of FIG. 125 illustrating the jaws in the open position and thinner tissue disposed between the retention matrix and the staple cartridge. FIG. 126 is an elevation view of the end effector of FIG. 125 illustrating the jaws in a closed position relative to the thinner tissue of FIG. 125 is an elevation view of the end effector of FIG. 125 illustrating the jaws in a fired position to capture the thinner tissue of FIG. 130 between the retention matrix and the staple cartridge. 125 is an elevation view of the retention matrix and protective cap of FIG. 125 combined with the staple cartridge of FIG. 125 with the thin tissue of FIG. 130 disposed therebetween. FIG. 134 is a detailed view of the configuration of FIG. 133. FIG. 6 is a cross-sectional view of a protective cap disposed at the tip of a staple leg according to at least one other embodiment. It is a perspective view of a plurality of protective caps embedded in a material sheet. FIG. 5 is a perspective view of a jaw including a plurality of recesses configured to receive a plurality of protective caps therein. 138 is a detailed view of a portion of a jaw including a sheet covering a protective cap disposed within the jaw of FIG. FIG. 7 is a cross-sectional view of a protective cap disposed on a staple leg tip according to at least one alternative embodiment, wherein the protective cap includes an internal molded surface. FIG. 140 is another cross-sectional view of the protective cap of FIG. 139 illustrating the staple legs deformed relative to the molding surface. FIG. 6 is a plan view of another embodiment of a retention matrix that includes a plurality of linked matrix elements. FIG. 6 is a plan view of another embodiment of a retention matrix that includes a plurality of linked matrix elements. FIG. 6 is a plan view of another embodiment of a retention matrix that includes a plurality of linked matrix elements. FIG. 6 is a plan view of another embodiment of a retention matrix that includes a plurality of linked matrix elements. FIG. 6 is a plan view of another embodiment of a retention matrix that includes a plurality of linked matrix elements. FIG. 3 is a partially exploded view of a jaw including a retention matrix that includes a compressible cover. FIG. 147 is a detailed view of the retention matrix of FIG. 1 is a partial cross-sectional view of a fastening system that includes a compressible layer and a retention matrix that includes a plurality of cells that enclose one or more drugs. FIG. FIG. 149 shows the staple legs passing through the cells of FIG. 148 when engaged with the retention matrix. 1 is a partial cross-sectional view of a fastening system including a retention matrix that includes a compressible layer. FIG. 3 is an elevational view of a fastening cartridge insertion assembly including a holder, a first fastening cartridge, and a second fastening cartridge. 1 is an elevational view of an end effector of a surgical stapler including a first jaw and a second jaw, the second jaw being illustrated in an open configuration. FIG. Exemplifying that the second jaw is in a closed configuration and the fastening cartridge insertion assembly of FIG. 151 is used to fill the first jaw into the first cartridge and the second jaw into the second cartridge; FIG. 157 is an elevational view of the end effector of FIG. 152. The filled end of FIG. 153 illustrating the cartridge insertion assembly removed from the end effector, the second jaw again in the open configuration, and the tissue positioned between the first jaw and the second jaw. It is an elevation view of an effector. 156 is an elevation view of the filled end effector of FIG. 154 in a firing configuration. FIG. FIG. 6 is an elevational view of the first cartridge and the second cartridge in an implanted state. 157 is an elevational view of the end effector of FIG. 152 illustrating a portion of the first cartridge still engaging the first jaw in accordance with at least one embodiment. FIG. 10 is an elevational view of another embodiment of a fastening cartridge insertion assembly including a holder, a first fastening cartridge, and a second fastening cartridge. 159 is an elevational view of the fastener cartridge insertion assembly of FIG. 158 used to fill the first jaw of the end effector with the first cartridge and the second jaw with the second cartridge. FIG. FIG. 159 is a cross-sectional view of the filled end effector of FIG. 159; 1 is a perspective view of a surgical stapler including a lower jaw and an upper jaw, according to at least one embodiment, with a portion of the surgical stapler removed. FIG. 164 is a perspective view of the surgical stapler of FIG. 161 with the upper jaw removed. FIG. 164 is a perspective view of the slidable anvil system of the upper jaw of the surgical stapler of FIG. 161 including a first slidable anvil and a second slidable anvil. FIG. FIG. 164 is an end view of the slidable anvil system of FIG. 163; FIG. 164 is a plan view of the slidable anvil system of FIG. 163; FIG. 167 shows the slidable anvil system of FIG. 163 in an unfired state. FIG. 167 shows the first slidable anvil of the slidable anvil system of FIG. 163 in the unfired position and the staples disposed in the lower jaw in the undeployed position. 167 is a diagram of the first slidable anvil of FIG. 167 pulled proximally to deform the staples in the lower jaw and the staple legs of the first group of staples in a deployed configuration. FIG. . 169 is a diagram of the first group of staples of FIG. 168 deformed into a fully deformed state. FIG. FIG. 167 shows the second slidable anvil of the slidable anvil system of FIG. 163 pushed distally to deform the second group of staple legs. FIG. 5 is a partial perspective view of an anvil that forms a plurality of molded pockets in at least one embodiment. 171 is a cross-sectional end view of the anvil of FIG. FIG. 172 is a diagram showing a first step for manufacturing the molding pocket of FIG. 171. It is a figure which shows the 2nd process of manufacturing the shaping | molding pocket of FIG. FIG. 172 is a plan view of a molding pocket configuration of the anvil of FIG. 171; It is a figure which shows the 1st process of the manufacturing process for manufacturing an anvil. FIG. 176 is a diagram showing a second step of the manufacturing process in FIG. 176. FIG. 176 is a diagram showing a third step of the manufacturing process in FIG. 176. FIG. 6 is a left front perspective view of a surgical stapling and cutting instrument with a handle portion that includes an automatic retraction by link trigger and a ratchet manual retraction mechanism. A portion of the elongate shaft of the surgical stapling and cutting instrument of FIG. 179 was cut away to remove the right half shell of the handle housing to expose an automatic end-of-fire movement retraction mechanism and a manual firing retraction mechanism. FIG. 179 is a right rear perspective exploded view of the handle portion and elongate shaft of the surgical stapling and cutting instrument of FIG. 179; FIG. 179 is a right rear perspective view of the surgical stapling and cutting instrument of FIG. 179 with the right half shell and outer portion of the implementation portion removed to expose the initial closure and firing mechanism. FIG. 183 is a right side elevational view of the partially exploded surgical stapling and cutting instrument of FIG. 182; With the closure mechanism closed and clamped, the side pawl firing mechanism has completed the first stroke, the manual retraction mechanism is removed, and the distal link of the linkage rack triggering automatic retraction of the firing mechanism 187 is a right rear perspective view of the partially exploded surgical stapling and cutting instrument of FIG. 182 exposed. FIG. 186 is a right rear perspective view of the partially exploded surgical stapling and cutting instrument of FIG. 183 with the side pawl firing mechanism released and the distal link approaching automatic retraction. FIG. 184 is a left side elevational view of the partially exploded surgical stapling and cutting instrument of FIG. 183 in an initial state with the end effector opened and the anti-retraction mechanism engaged; 186 is a detailed left side view of the right half shell of the handle portion of FIG. 186 and a reverse prevention release lever. FIG. The left side detail elevation of the surgical stapling and cutting instrument of FIG. 179 with the closure trigger clamped, the firing trigger performing the final stroke, and the distal link positioned to disengage the automatic retraction FIG. 188 is a left side detail elevation view of the exploded surgical stapling and cutting instrument of FIG. 188 with the linkage rack retracted immediately after the distal link has actuated and locked the anti-retraction release lever. 179 is a right exploded perspective view of the idler and posterior gear, manual retract lever and ratchet pawl of the manual retract mechanism of the surgical stapling and cutting instrument of FIG. 179; 190 is a right perspective view of the manual retraction mechanism of FIG. 190 with the manual retraction lever partially cut away to expose a small diameter ratchet gear on the rear gear that engages the ratchet pawl. FIG. The surgical staple of FIG. 179 has an anti-retraction mechanism engaged with a fully fired linkage rack that has been removed from the combined tension / compression spring prior to actuation of the manual retract lever of FIG. FIG. 3 is a left side elevational view with parts of the fastening and cutting instrument partially disassembled. 192 is a partially exploded left side elevational view of the surgical stapling and cutting instrument of FIG. 192, with hidden portions of the anti-retraction release lever, rear gear, and manual firing release lever shown in dotted lines. FIG. 194 is a partially exploded left side elevational view of the surgical stapling and cutting instrument of FIG. 193 after manually retracting the linkage rack by actuation of a manual firing release lever. 195 is a partially exploded left side elevational view of the surgical stapling and cutting instrument of FIG. 194 with the linkage rack omitted and the manual firing release lever removing the anti-retraction mechanism. 179 is a left side detail view of another anti-retraction release lever and handle housing of the surgical stapling and cutting instrument of FIG. 179; 196 is an exploded left side perspective view of another reverse prevention release lever, rear gear shaft, and automatic reverse cam wheel of FIG. 196. FIG. 196 is a right side elevational view of the alternate anti-retraction release mechanism of FIG. 196, with the linkage rack in the retracted position, the anti-retraction release lever positioned proximally, and the anti-retraction plate engaging the firing rod. . FIG. 198 is a right detailed side elevational view of the rear gear, automatic retracting cam wheel, and most distal link of FIG. 198; FIG. 198 is a right side elevation view of the anti-retraction release mechanism of FIG. 198 after the initial firing stroke. FIG. 199 is a right detailed side elevational view of the rear gear, the automatically retracting cam wheel and the second link of FIG. 199; FIG. 200 is a right side elevation view of the anti-retraction release mechanism of FIG. 199 after a second firing stroke. FIG. 200 is a right detailed side elevational view of the rear gear, the automatically retracting cam wheel and the third link of FIG. FIG. 212 is a right side elevational view of the anti-retraction release mechanism of FIG. 200 after the third launch and final stroke. FIG. 201 is a right detail side elevational view of the rear gear, the automatically retracting cam wheel and the most proximal fourth link of FIG. A right side elevational view of the automatic release mechanism of FIG. 201, after the automatic retraction cam wheel slides distally with a further firing stroke to lock the anti-retraction release lever and the anti-retraction mechanism disengages. It is. FIG. 7 is a left front perspective view of the staple application assembly in an open state with the right half of a replaceable staple cartridge included in the staple groove member. FIG. 204 is an exploded perspective view of the staple application assembly of FIG. 203 with a fully replaceable staple cartridge and a non-articulated shaft configuration. FIG. 204 is a perspective view of a two-piece knife and firing bar (E-beam) of the staple application assembly of FIG. 203. FIG. 3 is a perspective view of a wedge thread of a staple cartridge of a staple application assembly. FIG. 204 is a left side elevational view in longitudinal section along the centerline 207-207 of the staple application assembly of FIG. 203; The open staple application assembly of FIG. 203 without the replaceable staple cartridge, with a portion of the staple groove member adjacent to the two-piece knife and the intermediate pin of the firing bar and no distal portion of the staple groove member. It is a perspective view. FIG. 220 is a front elevational view in cross-section along line 209-209 of the staple application assembly of FIG. 203 showing the internal staple driver of the staple cartridge and a portion of the two-piece knife and firing bar. 203 of the closed staple application assembly of FIG. 203 that includes a central contact point between the two-piece knife and the wedge thread and is laterally offset to show the staples and staple drivers in the staple cartridge. 207 is a left side elevation view generally along the longitudinal axis of 207; FIG. A two piece knife, which is typical for staple cartridge replacement, is slightly retracted. FIG. 222 is a detailed elevation view of the left side of the staple application assembly of FIG. 210; FIG. 222 is a left side detail elevation view of the staple application assembly of FIG. 211, corresponding to the structure shown in FIG. 210, with a two piece knife beginning to fire. FIG. 222 is a left cross-sectional elevation view of the closed staple application assembly of FIG. 210 after a two-piece knife and firing bar have been fired distally. 224 is a left cross-sectional elevation view of the closed staple application assembly of FIG. 213 after firing the staple cartridge and retracting the two-piece knife. FIG. 227 is a left side cross-sectional detail elevation view of the staple application assembly of FIG. 214, wherein the two-piece knife is allowed to fall into the lockout position; 1 is a perspective view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator for use with a surgical stapling instrument, according to at least one embodiment of the present invention. FIG. FIG. 227 is a partial exploded view of the staple cartridge of FIG. 216; FIG. 227 is a fully exploded view of the staple cartridge of FIG. 216; 226 is another exploded view of the staple cartridge of FIG. 216 without a wrap covering the tissue thickness compensator. 227 is a perspective view of the cartridge main body (or supporting portion) of the staple cartridge of FIG. 216; FIG. 226 is a top perspective view of a sled that can be moved within the staple cartridge of FIG. 216 for deploying staples from the staple cartridge; FIG. 223 is a bottom perspective view of the sled of FIG. 221. FIG. 223 is an elevational view of the thread of FIG. 223 is a top perspective view of a driver configured to support one or more staples and to be raised up by the sled of FIG. 221 for firing staples from a staple cartridge. FIG. 224 is a bottom perspective view of the driver of FIG. 224; FIG. A wrap configured to at least partially surround a compressible tissue thickness compensator of a staple cartridge. FIG. 6 is a partial cutaway view of a staple cartridge including a rigid support portion and a compressible tissue thickness compensator showing the staples moving from an unfired position to a fired position during a first sequence. 228 is an elevational view of the staple cartridge of FIG. 227; FIG. 228 is a detailed elevation view of the staple cartridge of FIG. 227; FIG. 227 is a cross-sectional view of the staple cartridge of FIG. 227. FIG. 227 is a bottom view of the staple cartridge of FIG. 227; FIG. 227 is a detailed bottom view of the staple cartridge of FIG. 227; FIG. Longitudinal direction of a staple cartridge including a closed position anvil and a rigid support portion and a compressible tissue thickness compensator showing the staple moved from an unfired position to a fired position during the first sequence It is sectional drawing. 234 is another cross-sectional view of the anvil and staple cartridge of FIG. 233 showing the anvil in an open position after the firing sequence is complete. 234 is a partial detail view of the staple cartridge of FIG. 233 showing the staple in an unfired position. FIG. 1 is a cross-sectional elevation view of a staple cartridge with a rigid support portion and a compressible tissue thickness compensator showing the staple in an unfired position. FIG. 237 is a detailed view of the staple cartridge of FIG. 236. FIG. 1 is an elevational view of a staple cartridge including an anvil in an open position, a rigid support portion and a compressible tissue thickness compensator showing the staple in an unfired position. FIG. A staple cartridge comprising a staple in an unfired position and an anvil in a closed position showing tissue captured between the anvil and the tissue thickness compensator, a rigid support portion and a compressible tissue thickness compensator. FIG. 239 is a detailed view of the anvil and staple cartridge of FIG. 239; Standing staple cartridge comprising a staple in an unfired position, an anvil in a closed position, showing thicker tissue captured between the anvil and staple cartridge, a rigid support portion and a compressible tissue thickness compensator FIG. FIG. 242 is a detailed view of the anvil and staple cartridge of FIG. 241; 242 is an elevational view of the anvil and staple cartridge of FIG. 241 showing tissue having different thicknesses disposed between the anvil and the staple cartridge. FIG. 242 is a detailed view of the anvil and staple cartridge of FIG. 241 shown in FIG. 243; FIG. 5 shows a tissue thickness compensator that compensates for different tissue thicknesses captured in different staples. FIG. 5 shows a tissue thickness compensator applying compression pressure to one or more vessels cut by a staple row. It is a figure which shows the condition where one or more staples are malformed. FIG. 6 shows a tissue thickness compensator that can compensate for imperfectly formed staples. It is a figure which shows the tissue thickness compensator arrange | positioned in the tissue area | region where several staple rows cross | intersect. FIG. 3 shows tissue captured within a staple. FIG. 6 shows tissue and tissue thickness compensator captured within a staple. FIG. 3 shows tissue captured within a staple. FIG. 3 shows a thick tissue and tissue thickness compensator captured within a staple. FIG. 5 shows a thin tissue and tissue thickness compensator captured within a staple. FIG. 5 shows a tissue having an intermediate thickness captured in a staple and a tissue thickness compensator. FIG. 6 shows a tissue having another intermediate thickness captured within a staple and a tissue thickness compensator. FIG. 3 shows a thick tissue and tissue thickness compensator captured within a staple. FIG. 6 is a partial cross-sectional view of an end effector of a surgical stapling instrument showing the firing bar and staple firing thread in a retracted unfired position. 259 is another partial cross-sectional view of the end effector of FIG. 258 showing the firing bar and staple firing sled in a partially advanced position. 259 is a cross-sectional view of the end effector of FIG. 258 showing the firing bar in a fully advanced (fired) position. 259 is a cross-sectional view of the end effector of FIG. 258 showing the firing bar in the retracted position after firing and the staple firing thread remaining in the fully fired position. 261 is a detailed view of the firing bar in the retracted position of FIG. 1 is a partial cross-sectional view of an end effector of a surgical stapling instrument with a staple cartridge including a tissue thickness compensator and staples at least partially disposed therein. FIG. 264 is another partial cross-sectional view of the end effector of FIG. 263 showing that the staples are at least partially moved and / or rotated relative to the anvil disposed opposite the staple cartridge. FIG. 6 is a partial cross-sectional view of an end effector of a surgical stapling instrument according to at least one embodiment. FIG. 6 is a partial cross-sectional view of an end effector according to at least one other embodiment. FIG. 10 is another partial cross-sectional view of an end effector according to another alternative embodiment. FIG. 3 is a perspective view of an end effector of a surgical stapling instrument according to at least one embodiment. FIG. 273 is a partial cross-sectional view of the end effector of FIG. 268 in a bent state. FIG. 269 is a partial cross-sectional view of the end effector of FIG. 269 in a released state; FIG. 6 is a perspective view of an end effector including a tissue thickness compensator sock. 281 is a rear perspective view of the tissue thickness compensator socks of FIG. 271; FIG. FIG. 6 is a perspective view of an end effector including a plurality of rails extending from a support portion and a tissue thickness compensator having a longitudinal cavity defined therein. FIG. 273 is a perspective view of the tissue thickness compensator of FIG. 273; FIG. 6 is a perspective view of an end effector including a plurality of teeth extending from a support portion and a tissue thickness compensator engaging therewith. FIG. 3 is a perspective view of an anvil including a pocket arrangement, according to at least one embodiment. 276 is a partial detail view of the anvil of FIG. 276; 276 is a longitudinal cross-sectional view of the anvil of FIG. 276; 276 is a cross-sectional view of the anvil of FIG. FIG. 3 is an elevation view of a fired staple that includes a generally B-shaped shape. FIG. 4 is an elevational view of a fired staple including one leg deformed inward and one leg deformed outward. FIG. 3 is an elevation view of a fired staple including both legs deformed outward. FIG. 6 is a partial perspective view of a support portion of a staple cartridge including a removable and / or replaceable staple leg guide. FIG. 283 is a partial cross-sectional view of the staple cartridge of FIG. 283 illustrating staples being deployed from the staple cartridge; FIG. 283 is a cross-sectional detail view of FIG. 284 after the staple cartridge has been fired; FIG. 3 is an exploded view of a staple cartridge with a tissue thickness compensator that includes a space defined therein. FIG. 287 shows the tissue thickness compensator of FIG. FIG. 290 is another view of the tissue thickness compensator of FIG. 286 implanted against tissue. FIG. 3 is a cross-sectional perspective view of a staple cartridge including a lateral retention member extending from a support portion configured to hold a tissue thickness compensator in place. FIG. 290 is a cross-sectional view of the staple cartridge of FIG. 289 applying staples to tissue. FIG. 290 is another cross-sectional view of the staple cartridge of FIG. 289 showing the support portion moving away from the implanted tissue thickness compensator. FIG. 5 is a cross-sectional perspective view of a staple cartridge including a transverse retention member configured to retain a tissue thickness compensator against a support portion. FIG. 293 is a cross-sectional view of the staple cartridge of FIG. 292 applying staples to tissue. FIG. 292 is another cross-sectional view of the staple cartridge of FIG. 292 showing the support portion moving away from the implanted tissue thickness compensator. FIG. 4 is a cross-sectional detail view of a retainer holding a tissue thickness compensator against a support portion of a staple cartridge, according to at least one embodiment. FIG. 6 is a partial cutaway view of a staple cartridge including staple drivers having different heights according to at least one embodiment. 296 illustrates the staple driver of FIG. 296 and staples having different unfired heights supported thereon. FIG. FIG. 5 shows a tissue thickness compensator with varying thickness, a staple driver with different heights, and a staple with different green heights. FIG. 209 shows the staple and tissue thickness compensator of FIG. 297 implanted in tissue. FIG. 3 is a partial cross-sectional view of a staple cartridge including a tissue thickness compensator with varying thickness according to at least one embodiment. FIG. 6 is a cross-sectional view of an end effector of a surgical stapling instrument in an open position. FIG. 330 is a cross-sectional view of the end effector of FIG. 300 in a partially fired state. FIG. 330 is a cross-sectional view of the end effector of FIG. 300 shown reopened. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple driver having deck surfaces with different heights and irregularities according to at least one embodiment. FIG. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple driver having different heights and stepped deck surfaces according to at least one embodiment. FIG. FIG. 3 is a perspective view of a staple cartridge loaded into an effector of a surgical stapling instrument that utilizes a staple cartridge applicator. 306 is a bottom perspective view of the staple cartridge applicator of FIG. 305; FIG. 306 is a side view of the staple cartridge applicator of FIG. 305 assembled into a staple cartridge. FIG. 307 is a cross-sectional view of the assembly of FIG. FIG. 6 is a perspective view of a staple cartridge applicator assembly further comprising an upper tissue thickness compensator disposed on the upper surface of the staple cartridge applicator, according to at least one embodiment. FIG. 309 is an exploded view of the upper tissue thickness compensator and staple cartridge applicator of FIG. 309; FIG. 3 is an exploded view of a staple cartridge applicator assembly including a pull member configured to remove an upper tissue thickness compensator adhered to the staple cartridge applicator. FIG. 6 is a partially exploded view of a staple cartridge applicator assembly according to at least one other embodiment. FIG. 10 is a perspective view of a staple cartridge applicator assembly including an upper tissue thickness compensator with a plurality of retention features extending from itself and a staple cartridge including a lower tissue thickness compensator. FIG. 322 is an elevational view of the staple cartridge applicator assembly of FIG. 312 disposed in a staple cartridge groove member with the anvil closed on the staple cartridge applicator assembly. 334 is an elevational view of the anvil of FIG. 313 in the open position again, with the staple cartridge applicator of FIG. 312 being removed from the end effector. FIG. 4B is a cross-sectional view of the tissue disposed between the upper tissue thickness compensator and the lower tissue thickness compensator of FIG. 312. FIG. 3 is a cross-sectional view showing an upper tissue thickness compensator and a lower tissue thickness compensator stapled to tissue and cut by a cutting member. FIG. 6 illustrates a tissue thickness compensator being inserted into an anvil according to at least one embodiment. FIG. 315 is a cross-sectional view of the tissue thickness compensator of FIG. 315. FIG. 4 is an exploded view of a tissue thickness compensator and anvil, according to at least one alternative embodiment. FIG. 10 is a perspective view of a staple cartridge applicator assembly including an upper tissue thickness compensator configured to be attached to an anvil according to at least one embodiment. 318 is an elevational view of the staple cartridge applicator assembly of FIG. 318 disposed within the staple cartridge groove member with the anvil moving toward the upper tissue thickness compensator. 318 shows the staple cartridge applicator of FIG. 318 removed from the end effector after the upper tissue thickness compensator has engaged the anvil. FIG. 318 is a cross-sectional end view of the anvil being moved toward the upper tissue thickness compensator of FIG. 318. FIG. 7 is a cross-sectional end view of an anvil engaged with an upper tissue thickness compensator. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple cartridge with a separable tissue thickness compensator attached to a support portion of the staple cartridge by a plurality of fasteners. FIG. 324 is a cross-sectional view of the end effector of FIG. 323 showing the firing member in a partially fired position. FIG. 323 is a cross-sectional view of the end effector of FIG. 323 showing the support portion moving away from the partially implanted tissue thickness compensator. FIG. 323 is a partial perspective view of the support portion in FIG. 323. FIG. 3 is a perspective view of a staple deployment thread according to at least one embodiment of the invention. FIG. 327 is an elevation view of the thread of FIG. 327; 1 is a perspective view of an end effector of a surgical stapling instrument including a staple cartridge with a tissue thickness compensator and a plurality of staple guides disposed on the tissue thickness compensator. FIG. FIG. 329 is a partial cross-sectional view of the tissue thickness compensator and staple guide of FIG. 329 in an unfired state. FIG. 329 is a partial cross-sectional view of the tissue thickness compensator and staple guide of FIG. 329 in a fired state. FIG. 4 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. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 339 is a detailed view of a region surrounding the staple front end of FIG. 339. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 341 is a detailed view of a region surrounding the staple front end of FIG. 341; FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position, according to at least one other embodiment. FIG. 6 is a perspective view of a staple guide layer and a plurality of staples in an unfired position, according to at least one other embodiment. 1 is an end view of a tissue thickness compensator configured for use with a surgical circular stapler. FIG. 346 is a perspective view of the tissue thickness compensator and the surgical circular stapler of FIG. FIG. 6 is an end view of a tissue thickness compensator configured for use with a surgical circular stapler according to at least one alternative embodiment. FIG. 347 is a perspective view of the tissue thickness compensator and the surgical circular stapler of FIG. 347; 1 is an end view of a tissue thickness compensator configured for use with a surgical circular stapler. FIG. FIG. 349 is an end view of the partially expanded configuration of the tissue thickness compensator of FIG. 349. 1 is an elevational view of a surgical stapling instrument including a staple cartridge, according to at least one embodiment. FIG. 356 is an end view of the surgical stapling instrument of FIG. 351 positioned against tissue. 356 is an end view of the surgical stapling instrument of FIG. 351 further including a tissue thickness compensator disposed between the staple cartridge and the tissue. 356 is a partial perspective view of a staple deployed in tissue from the surgical stapling instrument of FIG. 351 without a tissue thickness compensator; 356 is a partial perspective view of a staple deployed into tissue from the surgical stapling instrument of FIG. 351 with a tissue thickness compensator; FIG. 356 is a partial cross-sectional view of the end effector of the surgical stapling instrument of FIG. 351 including the anvil plate in a first configuration; 356 is a partial cross-sectional view of the end effector of the surgical stapling instrument of FIG. 351 showing the anvil plate of FIG. 356 in a second configuration. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple cartridge with a gap setting element. FIG. 359 is a perspective view showing the firing member cutting the gap setting element of FIG. 358 at the end of the firing stroke of the firing member. FIG. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple cartridge with a flexible nose. FIG. FIG. 360 is a cross-sectional view of the end effector of FIG. 360 showing the nose in a bent state. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a staple cartridge with a slidable portion. FIG. FIG. 367 is a cross-sectional view of the end effector of FIG. 362 showing the slidable portion slid distally; 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a support portion that includes an upwardly inclined deck surface and a tissue thickness compensator that includes a thickness change. FIG. 1 is a cross-sectional view of an end effector of a surgical stapling instrument including a support portion that includes an up-sloped deck surface and a tissue thickness compensator that includes a uniform thickness. FIG. FIG. 6 is a perspective view of a staple cartridge including a tissue thickness compensator having a thickness change. 366 is an end view of the staple cartridge of FIG. 366; FIG. FIG. 6 is a cross-sectional perspective view of a tissue thickness compensator including a longitudinal layer. FIG. 6 is a cross-sectional perspective view of a tissue thickness compensator comprising a plurality of layers according to at least one other embodiment. FIG. 6 is a perspective view of a disposable loading unit that includes a retaining member configured to releasably retain a tissue thickness compensator on itself. FIG. 10 is a perspective view of a tissue thickness compensator including a retaining member configured to releasably hold the tissue thickness compensator to a disposable loading unit. 372 is a perspective view of the tissue thickness compensator of FIG. 371 attached to a disposable loading unit. FIG. FIG. 372 is an end view of the disposable loading unit of FIG. 372; FIG. 10 is a perspective view of a tissue thickness compensator including a retaining member configured to releasably hold the tissue thickness compensator to a disposable loading unit. FIG. 375 is a perspective view of the tissue thickness compensator of FIG. 374 attached to a disposable loading unit. FIG. 376 is an end view of the disposable loading unit of FIG. 375; FIG. 10 is a perspective view of a tissue thickness compensator including a retaining member configured to releasably hold the tissue thickness compensator to a disposable loading unit. FIG. 377 is a perspective view of the tissue thickness compensator of FIG. 377 attached to a disposable loading unit; FIG. 6 is a perspective view of a tissue thickness compensator applicator disposed within an effector of a disposable loading unit. 379 is a top perspective view of the tissue thickness compensator applicator of FIG. 379. FIG. 379 is a bottom perspective view of the tissue thickness compensator applicator of FIG. 379. FIG. FIG. 6 is a perspective view of a tissue thickness compensator applicator disposed within an effector of a disposable loading unit, according to at least one other embodiment. FIG. 382 is a top perspective view of the tissue thickness compensator applicator of FIG. 382; FIG. 382 is a bottom perspective view of the tissue thickness compensator applicator of FIG. 382; FIG. 6 is an elevational view of a disposable loading unit with a pivotable jaw configured to support a staple cartridge. 2 is a cross-sectional view of a staple cartridge including a tissue thickness compensator attached to a support portion of the staple cartridge, according to at least one embodiment. FIG. 2 is a cross-sectional view of a staple cartridge including a tissue thickness compensator attached to a support portion of the staple cartridge, according to at least one embodiment. FIG. FIG. 4 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator attached to a support portion of the staple cartridge, according to at least one embodiment. 387 is a perspective view of the tissue thickness compensator of FIG. 387. FIG. 1 is a cross-sectional perspective view of one embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue. FIG. FIG. 390 is a cross-sectional side view illustrating the structure on the cutting blade of FIG. 390 configured to guide material within the tissue thickness compensator in the direction of the tissue. FIG. 6 is a cross-sectional perspective view of an alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue. FIG. 9 is a cross-sectional perspective view of another alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue. FIG. 394 is a cross-sectional side view illustrating the structure on the cutting blade of FIG. 393 configured to mix the material within the first tissue thickness compensator with the material from the second tissue thickness compensator. FIG. 394 is a front view of the structure on the cutting blade of FIG. 393 configured to mix the material within the first tissue thickness compensator with the material from the second tissue thickness compensator. FIG. 394 is a cross-sectional top view of the structure on the cutting blade of FIG. 393 configured to mix the material within the first tissue thickness compensator with the material from the second tissue thickness compensator. FIG. 9 is a cross-sectional perspective view of another alternative embodiment of a cutting blade being advanced distally within an end effector of a surgical instrument to incise tissue. FIG. 40 is a cross-sectional side view illustrating the structure on the cutting blade of FIG. 397 configured to expand the material contained within the tissue thickness compensator. FIG. 397 is a cross-sectional side view of the cutting blade of FIG. 397 with expanding material. FIG. 5 is a partially cutaway perspective view of a tissue thickness compensator, according to at least one embodiment. Fig. 4 shows the drug being loaded into the tissue thickness compensator. FIG. 43 is a cross-sectional end view of a tube disposed within the tissue thickness compensator of FIG. 400 with a drug contained therein. FIG. 43 shows the tissue thickness compensator of FIG. 400 placed and compressed against the patient's tissue. FIG. 43 is a cross-sectional end view of an end effector of a surgical stapling instrument showing a staple being fired through the tissue thickness compensator of FIG. 400; FIG. 6 is a graph showing dissolution of capsules contained within a tissue thickness compensator having multiple drug layers. 405 shows the first (or outer) layer of the capsule of FIG. 405 being dissolved. 405 shows the second layer of the capsule of FIG. 405 being dissolved. 403 shows the third layer of the capsule of FIG. 405 being dissolved. FIG. 405 shows the fourth (or inner) layer of the capsule of FIG. 405 being dissolved; FIG. 5 is a partial cutaway view of a staple cartridge according to at least one embodiment including a tissue thickness compensator having a plurality of vertical capsules. FIG. 43 is a perspective view of the vertical capsule of FIG. 410. FIG. 43 is a partial cutaway view of the staple cartridge of FIG. 410 showing the staples contained therein in an unfired position. 4 is a cross-sectional side view of the staple cartridge of FIG. 410 showing the staple of FIG. 412 being moved from an unfired position to a fired position. FIG. 4 is a partial cutaway view of a tissue thickness compensator with a vertical capsule disposed therein, according to at least one embodiment. FIG. 5 is a partial cutaway view of a tissue thickness compensator having a plurality of capsules with openings defined therein. A cross-sectional end face of a surgical stapling instrument having a plurality of staples in an unfired position and a plurality of penetrating members configured to rupture a capsule or tube contained within a tissue thickness compensator according to at least one embodiment FIG. FIG. 431 is an elevation view of the staple of FIG. 416 in an unfired configuration; FIG. 417 is an elevational view of the staple of FIG. 417 in a fired configuration; 416 is an elevation view of the penetrating member of FIG. 416; FIG. FIG. 431 is a cross-sectional end view of the end effector of FIG. 416 showing the staple and penetrating member in a fired position; 431 is a cross-sectional side view of the end effector of FIG. 416 showing the staple and penetrating member being moved from an unfired position to a fired position; FIG. 6 is a top cutaway view of a staple cartridge according to at least one embodiment including a tissue thickness compensator with a plurality of capsules disposed therein. FIG. 422 is a detailed view of the staple cartridge of FIG. 422; FIG. 434 is a cross-sectional end view of the staple cartridge of FIG. 422 disposed within the end effector showing the staples contained within the staple cartridge in a fired position; FIG. 423 is a cross-sectional end view of the staple cartridge of FIG. 422 within the end effector of FIG. 424 showing the cutting member being advanced through the capsule in the tissue thickness compensator; FIG. 6 is a perspective view of a tissue thickness compensator having a longitudinal member according to at least one embodiment. 427 is a cross-sectional view of a mold configured to produce the tissue thickness compensator of FIG. 426; FIG. 427 is a cross-sectional end view of the mold of FIG. 427 showing the longitudinal member of FIG. 426 disposed therein; FIG. 427 is a cross-sectional end view of the mold of FIG. 427 showing the material of the tissue thickness compensator poured into the mold of FIG. 427; FIG. 5 is a cutaway perspective view of a tissue thickness compensator, according to at least one embodiment. FIG. 5 is a perspective view of a support member configured to be implanted within a tissue thickness compensator according to at least one embodiment. 2 is a cutaway perspective view of a tissue thickness compensator according to at least one embodiment. FIG. FIG. 433 is a sectional end view showing a mold for manufacturing the tissue thickness compensator of FIG. 432; FIG. 432 is a cross-sectional view of the tissue thickness compensator of FIG. 432; 433 is a cross-sectional side view of the mold of FIG. 433; FIG. FIG. 6 is a cross-sectional end view of a tissue thickness compensator according to at least one embodiment. FIG. 6 is a cross-sectional end view of another tissue thickness compensator according to at least one embodiment. 2 is a detailed view of a scaffold material of a tissue thickness compensator according to at least one embodiment. FIG. FIG. 3 is a detailed view of a tissue thickness compensator according to at least one embodiment. FIG. 439 is a detail view of the tissue thickness compensator of FIG. 439 in an expanded state. 2 is a cutaway perspective view of a tissue thickness compensator according to at least one embodiment. FIG. FIG. 3 is a partially cutaway perspective view of a tissue thickness compensator being manufactured in a mold according to at least one embodiment. FIG. 5 is a cross-sectional perspective view of a tissue thickness compensator according to at least one other embodiment. 6 is a cross-sectional end view of a tissue thickness compensator according to at least one other embodiment. FIG. FIG. 6 is a partial perspective view of a tissue thickness compensator according to at least one other embodiment. 1 is an elevational view of an end effector of a surgical stapling instrument having a tissue thickness compensator according to at least one embodiment. FIG. FIG. 446 is an exploded view of the tissue thickness compensator of FIG. 446 having multiple layers. FIG. 6 is a cross-sectional view of a layer of tissue thickness compensator. FIG. 6 is a cross-sectional view of another layer of tissue thickness compensator. FIG. 446 is a partial cross-sectional elevation view of the tissue thickness compensator of FIG. 446 positioned between the anvil of the surgical stapling instrument and the staple cartridge; FIG. 446 is another partial cross-sectional elevation view of the tissue thickness compensator of FIG. 446 captured in a staple ejected from a staple cartridge and deformed by an anvil of a surgical stapling instrument. FIG. 456 is another partial cross-sectional elevation view of the tissue thickness compensator of FIG. 446 attached to the tissue by the staple of FIG. 451; FIG. 6 is a perspective view of a layer of tissue thickness compensator according to at least one other embodiment. FIG. 457 is a perspective view of an end effector of a surgical stapling instrument including a tissue thickness compensator having the layer of FIG. 453; FIG. 6 is a partial perspective view of a tissue thickness compensator according to at least one other embodiment. 456 is a perspective view of an end effector of a surgical stapling instrument including the tissue thickness compensator of FIG. 455; FIG. FIG. 3 is a perspective view of a plurality of coated fibers. 1 is a perspective view illustrating an extrusion process for producing coated fibers and / or coated yarns that can be cut into coated fibers. FIG. 1 is a cross-sectional perspective view of a coated fiber. FIG. 5 is a perspective view illustrating a coating process using a carrier liquid configured to deposit material on and / or within a fiber. 457 is a perspective view of a staple cartridge having a tissue thickness compensator comprising the fibers of FIG. 457; FIG. 6 is a partially cutaway perspective view of a tissue thickness compensator according to at least one embodiment. 1 is a perspective view of a drug encapsulated by a hydrophilic material according to at least one embodiment. FIG. FIG. 464 is a perspective view of the tissue thickness compensator of FIG. 462 disposed within an end effector of a surgical instrument; 462 is a partially cutaway perspective view of the drug of FIG. 463 being exposed to fluid so that the drug can bleed out of the tissue thickness compensator of FIG. 462; FIG. 6 is a partial perspective view of a tissue thickness compensator according to at least one embodiment. FIG. 473 is a partial perspective view of the tissue thickness compensator of FIG. 466 after being exposed to liquid; FIG. 473 is a perspective view of an end effector having the tissue thickness compensator of FIG. 466 attached to an anvil; FIG. 457 is a partially cutaway perspective view of a tissue thickness compensator comprising the agent of FIG. 463 and the fiber of FIG. 457; FIG. 6 is a partial perspective view of a staple cartridge having a tissue thickness compensator including a plurality of capsules. FIG. 470 is a side view of the staple cartridge of FIG. 470; 470 shows the capsule of FIG. 470 placed in a mold. 472 shows the capsule of FIG. 470 sinking to the bottom of the mold of FIG. 472; 470 shows the compensator body material poured over the capsule of FIG. 470 illustrates an embodiment in which the capsule of FIG. 470 has a higher density than the material of the compensator body and remains at the bottom of the mold of FIG. 470 shows an embodiment in which the capsule of FIG. 470 has a lower density than the material of the compensator body and can float on top of the mold of FIG. 472. FIG. 470 illustrates another embodiment of a mold having a plurality of recesses or recesses configured to receive the capsule of FIG. 470; FIG. 6 is a cross-sectional end view of an end effector of a surgical stapling instrument having a tissue thickness compensator disposed on a staple cartridge according to at least one embodiment. 473 is a cross-sectional end view of the end effector of FIG. 478 showing the staples fired from the staple cartridge and extending through the tissue thickness compensator of FIG. 478; 2 shows a mold and a plurality of drug capsules disposed within the mold. FIG. 3 is a cross-sectional end view of a mold showing the material of the compensator body that is poured into the mold to form a tissue thickness compensator. FIG. 481 is a perspective view of the tissue thickness compensator of FIG. 481 attached to an anvil of a surgical stapling instrument. FIG. 487 is a cross-sectional view of a mold configured to form the tissue thickness compensator of FIG. 486, showing the first layer being poured into the mold; FIG. 484 is a cross-sectional view of the mold of FIG. 483 showing the capsules disposed on the first layer. FIG. 484 is a cross-sectional view of the mold of FIG. 483 showing a second layer poured over the capsule. FIG. 6 is a perspective view of a tissue thickness compensator according to at least one embodiment. FIG. 487 is a perspective view of the tissue thickness compensator of FIG. 486 positioned within an end effector of a surgical stapling instrument. FIG. 492 is a perspective view of a compensator body of the tissue thickness compensator of FIG. 491; FIG. 488 is a perspective view of a longitudinal opening defined within the compensator body of FIG. 488; FIG. 410 shows a capsule disposed within the longitudinal opening of FIG. 489. 1 is a perspective view of an end effector of a surgical stapling instrument including a tissue thickness compensator according to at least one embodiment. FIG. 495 is a perspective view of a compensator body of the tissue thickness compensator of FIG. 495; FIG. 492 is a perspective view of a plurality of lateral openings defined in the compensator body of FIG. 492; FIG. 494 shows the capsule placed in the lateral opening of FIG. 493; 1 is a perspective view of an end effector of a surgical stapling instrument including a tissue thickness compensator according to at least one embodiment. FIG. 1 is a perspective view of a vertical mold configured to produce a tissue thickness compensator. FIG. FIG. 100 is a perspective view of a capsule being placed in the mold of FIG. 496; 496 is a perspective view of the capsule of FIG. 497 positioned within the mold of FIG. 496. FIG. FIG. 100 is a perspective view of the cover disposed in contact with the mold of FIG. 496 and the material of the compensator body being placed into the mold. FIG. 499 is a perspective view of the mold of FIG. 496 shown with the cover of FIG. 499 removed; 1 illustrates a staple cartridge having a tissue thickness compensator and a tissue thickness compensator mat according to at least one embodiment. FIG. 504 is a partial bottom perspective view of the tissue thickness compensator mat of FIG. 501; FIG. 501 is a partial top perspective view of the tissue thickness compensator mat of FIG. 501; 504 is a partial perspective view of the staple cartridge of FIG. 501 being fired by a firing member, the staple cartridge being shown without a tissue thickness compensator disposed thereon; FIG. 504 is a top view of the tissue thickness compensator mat of FIG. 501 being cut by a cutting member engaged with the firing member of FIG. 504, with the staple cartridge shown without a tissue thickness compensator disposed thereon; Yes. 504 is a top view of the tissue thickness compensator mat of FIG. 501 being cut by a cutting member engaged with the firing member of FIG. 504, with the staple cartridge shown with the tissue thickness compensator disposed thereon; . FIG. 6 is a plan view of a circular staple cartridge according to at least one alternative embodiment having a circular tissue thickness compensator mat. FIG. 6 illustrates a mold having a plurality of cavities configured to simultaneously form a tissue thickness compensator on a plurality of staple cartridge bodies. FIG. FIG. 509 illustrates the staple cartridge body disposed within the cavity of FIG. 508 and one or more sheets being disposed over the cartridge body. 509 shows the sheet of FIG. 509 secured in place within the mold of FIG. 508 shows an elongated tube member wrapped around a plurality of post supports within the mold of FIG. FIG. 509 shows the sheet of FIG. 509 secured over a staple cartridge body of FIG. 508 in place. 509 shows the tube member of FIG. 511 disposed on the sheet of FIG. FIG. 509 shows the compensator body material being poured into the mold of FIG. 509 shows a cutting die placed on the mold of FIG. 514 shows the compensator body material of FIG. 514 and the cutting die moved down to cut the sheet of FIG. 509; 509 shows the cutting die moved upward in a direction away from the mold of FIG. 516 is a cross-sectional end view of a tissue thickness compensator manufactured by the manufacturing process outlined in FIGS. 508-517 according to at least one embodiment. FIG. FIG. 3 is a top view of a staple cartridge having a tissue thickness compensator according to at least one embodiment. 519 is a perspective view of the staple cartridge of FIG. 519; FIG. 519 illustrates the manufacture of the tissue thickness compensator of the staple cartridge of FIG. 519; FIG. 3 is a view of a roller that flattenes and collapses a tube of material to form a tissue thickness compensator according to at least one embodiment. FIG. 6 is an illustration of a roller forming a tissue thickness compensator according to at least one other embodiment. 524 is a perspective view of a staple cartridge having a tissue thickness compensator manufactured by the process shown in FIG. 523; FIG. 524 is a cross-sectional elevation view of a staple being deployed from the staple cartridge of FIG. 524; 525 is a cross-sectional end view of a staple being deployed from the staple cartridge of FIG. 524; FIG.

  Corresponding reference characters indicate corresponding parts throughout the several views. The illustrations set forth in this specification are intended to illustrate specific embodiments of the invention in one form, and such illustrations should be construed as limiting the scope of the invention in any way. is not.

The applicant of this application also owns the following US patent applications, each of which is incorporated herein by reference in its entirety: That is,
US patent application Ser. No. 12 / 894,311 (Attorney Docket No. END6734USNP / 100058) whose title is “SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFFT SEGMENTS”;
The title of the invention is “SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORM 35” US Patent No.
US patent application Ser. No. 12 / 894,327 (Attorney Docket No. END6736USNP / 100060) whose title is “JAW CLOSEURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS”;
US Patent Application No. 12/894, 351D (Attorney) No. 12/894, 351D, US Patent Application No. 12 / 894,351D, US Patent Application No. 12/894, N
US patent application Ser. No. 12 / 894,338 (Attorney Docket No. END6840USNP / 100525) whose title is “IMPLANTABLE FASTNER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT”;
US patent application Ser. No. 12 / 894,369 (Attorney Docket No. END6841USNP / 100526) whose title is “IMPLANTABLE FASTNER CARTRIDGE COMPRISING A SUPPORT RETAINER”;
US patent application Ser. No. 12 / 894,312 (Attorney Docket No. END6842USNP / 100527) whose title is “IMPLANTABLE FASTNER CARTRIDGE COMPRISING MULTIPLE LAYERS”;
US patent application Ser. No. 12 / 894,377 (Attorney Docket No. END6843USNP / 100528), whose title is “SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE”;
US patent application Ser. No. 12 / 894,339 (Attorney Docket No. END6847USNP / 100532) whose title is “SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT”;
US patent application Ser. No. 12 / 894,360 (Attorney Docket No. END6848USNP / 100533) whose title is “SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM”;
US patent application Ser. No. 12 / 894,322 (Attorney Docket No. END6849USNP / 100534) whose title is “SURGICAL STAPLING INSTRUMENT WITH INTERCHANGABLE STAPLE CARTRIDGE ARRANGEMENTS”;
Entitled "SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT" is a U.S. Patent Application No. 12 / 894,350 (Attorney Docket No. END6855USNP / 100540) ;
US patent application Ser. No. 12 / 894,383 (Attorney Docket No. END6856USNP / 100541) whose title is “IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS”;
US patent application Ser. No. 12 / 894,389 (Attorney Docket No. END6857USNP / 100542) whose title is “COMPRESSABLE FASTNER CARTRIDGE”;
US patent application Ser. No. 12 / 894,345 (Attorney Docket No. END6858USNP / 100543), whose title is “FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT”;
US patent application Ser. No. 12 / 894,306 (Attorney Docket No. END6859USNP / 100544), whose title is “COLLAPSIBLE FASTENER CARTRIDGE”;
US patent application Ser. No. 12 / 894,318 (Attorney Docket No. END6860USNP / 100546) whose title is “FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS”;
US patent application Ser. No. 12 / 894,330 (Attorney Docket No. END6861USNP / 100547) whose title is “FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX”;
US patent application Ser. No. 12 / 894,361 (Attorney Docket No. END 6862 USNP / 100548), whose title is “FASTENER SYSTEM COMPRISING A RETENTION MATRIX”;
US Patent Application No. 12 / 894,367 (Attorney Docket No. END 6863USNP / 100549) whose title is “FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX”;
US patent application Ser. No. 12 / 894,388 (Attorney Docket No. END 6864 USNP / 100550) whose title is “FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER”;
US patent application Ser. No. 12 / 894,376 (Attorney Docket No. END6865USNP / 100551) whose title is “FASTENER SYSTEM COMPRISING A PLULARITY OF FASTENER CARTRIDGES”;
US Patent Application No. 13 / 097,865 (Attorney Docket No. END6735USCIP1 / 100059CIP1) whose title is “SURGICAL STAPLLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS”;
US Patent Application No. 13 / 097,936 (Attorney Docket No. END6736USCIP1 / 100060CIP1) whose title is “TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLE”;
US Patent Application No. 13 / 097,954 (Attorney Docket No. END6840USCIP1 / 100525CIP1) whose title is “STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESIBLE POTION”;
US Patent Application No. 13 / 097,856 (Attorney Docket No. END6841USCIP1 / 100526CIP1) whose title is "STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESIBLE PORTION THEREOF";
US Patent Application No. 13 / 097,928 (Attorney Docket No. END6842USCIP1 / 100527CIP1) whose title is “TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS”;
US Patent Application No. 13 / 097,891 (Attorney Docket No. END6843USCIP1 / 100528CIP1) whose title is “TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLLER COMPRISING AN ADJUSTABLE ANVIL”;
US Patent Application No. 13 / 097,948 (Attorney Docket No. END6847 USCIP1 / 10032 CIP1) whose title is “STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISPORTION”;
US Patent Application No. 13 / 097,907 (Attorney Docket No. END6848USCIP1 / 1003353CIP1) having the name of the invention “COMPRESSLESS STAPLE CARTRIDGE ASSEMBLY”;
US Patent Application No. 13 / 097,861 (Attorney Docket No. END6849USCIP1 / 10000534CIP1) whose title is “TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERITES”;
US Patent Application No. 13 / 097,869 (Attorney Docket No. END6855 USCIP1 / 100540CIP1) with the title of the invention “STAPLE CARTRIDGE LOADING ASSEMBLY”;
US Patent Application No. 13 / 097,917 (Attorney Docket No. END6856USCIP1 / 1001541CIP1) whose title is “COMPRESSLESS STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS”;
U.S. Patent Application No. 13 / 097,873 (Attorney Docket No. END6857USCIP1 / 100542CIP1) whose title is "STAPLE CARTRIDGE COMPRISING A RELEASABLE POTION";
US Patent Application No. 13 / 097,938 (Attorney Docket No. END6858 USCIP1 / 1003153CIP1) whose title is "STAPLE CARTRIDING COMPRISING COMPRESSITE DISTORTION REISTANT COMPONENTS";
US Patent Application No. 13 / 097,924 (Attorney Docket No. END6859USCIP1 / 100544CIP1) whose title is “STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR”;
US patent application Ser. No. 13 / 242,029 (Attorney Docket No. END6841USCIP2 / 100526CIP2), whose title is “SURGICAL STAPLER WITH FLOATING ANVIL”;
US Patent Application No. 13 / 242,066 (Attorney Docket No. END6841USCIP3 / 100526CIP3) having the title of the invention "CURVED END EFFECTOR FOR A STAPLING INSTRUMENT";
US Patent Application No. 13 / 242,086 (Attorney Docket No. END7020USNP / 110374), whose title is "STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK";
US Patent Application No. 13 / 241,912 (Attorney Docket No. END7019USNP / 110375), whose title is “STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT”;
US patent application Ser. No. 13 / 241,922 (Attorney Docket No. END7013USNP / 110377), whose title is “SURGICAL STALPLE WITH STATIONARY STAPLE DRIVERS”;
US Patent Application No. 13 / 241,637 USNP3ITRUS3, ITUITLE TIMER, SUMITAL ACTUAL, MOTIONS, and US Patent Application No. 13 / 241,637 (Certificate No. END6888USNP3S US patent application Ser. No. 13 / 241,629, “EFFECTOR” (Attorney Docket No. END6888 USNP2 / 110379).

Applicants also own the following US patent applications filed on the same filing date as the present application, each of which is incorporated herein by reference in its entirety: That is,
US Patent Application No. _____________ (Attorney Docket No. END6864USCIP1 / 100550CIP1) whose title is "TISSUE THICKNESS COMPENSATOR COMPRISING A PLULARITY OF CAPSULES";
US Patent Application No. ______________ (Attorney Docket No. END 6864USCIP2 / 100550CIP2) whose title is “TISSUE THICKNESS COMPENSATOR COMPRISING A PLULARITY OF LAYERS”;
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP2 / 100528CIP2) whose title is "EXPANDABLE TISSUE THICKNESS COMPENSATOR".
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP3 / 100528CIP3) whose title is "TISSUE TICHKNESS COMPENSATOR COMPRISING A RESERVOIR";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP4 / 100528CIP4), whose title is "RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP5 / 100528CIP5) whose title is "TISSUE THICKNESS COMPENSATOR COMPRISING AT Least ONE MEDIACAMENT";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP6 / 100528CIP6) whose title is "TISSUE TICHKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP7 / 100528) whose title is “TISSUE TICHKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD”;
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP8 / 10028) whose title is “TISSUE TICHKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD”
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP9 / 100528CIP9), whose title is “TISSUE THICKNESS COMPENSATOR COMPRISING COMPLISING MEMBERS”;
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP10) with the title of the invention "METHODS FOR FORMING TISSUE TICHKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS"
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP11 / 100528CP11) whose title is "TISSUE THICKNESS COMPENSATORS";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP12 / 100528CP12), whose title is "LAYERED TISSUE THICKNESS COMPENSATOR";
US Patent Application No. ______________ (Attorney Docket No. END6843USCIP13 / 100528CP13), whose title is "TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS";
United States Patent Application No. ______________ (Attorney Docket No. END7100USNP / 1101001 USNP / 1101001 USNP / 1101101NP)
US Patent Application No. ______________ (Attorney Docket No. END7101USNP / 110602) whose title is "TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLULARITY OF MATERIALS";
US Patent Application No. ______________ (Attorney Docket No. END7107USNP / 110603) whose title is "MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR";
US Patent Application No. ______________ (Attorney Docket No. END7102USNP / 110604) whose title is "TISSUE THICKNESS COMPENSATOR COMPRISING A PLULARITY OF MEDICAMENTS";
US Patent Application No. ______________ (Attorney Docket No. END7103USNP / 110605) whose title is "TISSUE TICHKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME";
Entitled is "TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS" U.S. Patent Application No. _______________ No. (Attorney Docket No. END7104USNP / 110606); and entitled "TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES" a is U.S. Patent Application No. _______________ No. (Agent reference number END7105USNP / 110607);
Entitled is "DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS" a is U.S. Patent Application No. _______________ No. (Attorney Docket No. END7106USNP / 110608).

  Certain exemplary embodiments are described below to provide a general understanding of the principles of structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the devices and methods described in detail herein and shown in the accompanying drawings are non-limiting and exemplary embodiments. Features illustrated or described in the context of one exemplary embodiment can be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

  By using any of the methods disclosed or claimed herein to make, produce, or manufacture some article or product in some other form, all or part of the article or product of interest Can be made, produced, or manufactured in some other form, and using such methods, when the article or product part of interest is made, produced, or manufactured in some other manner, The remaining part of the article or product is by any method, including using any of the other methods disclosed or claimed to make, produce, or manufacture in any other manner the subject article or product. It is possible to manufacture and the different parts thus manufactured can be combined in any way. Similarly, all articles or products disclosed or claimed herein may be combined alone or in combination with any other article or product disclosed herein with which it is compatible. Can exist as a part of Thus, a particular function, structure, or feature illustrated or described in the context of an article, product, or method may, in whole or in part, be a function, structure of one or more other suitable articles, products, or methods. Or can be combined with features without limitation. Such modifications and variations are intended to be included within the scope of the present invention.

  It is disclosed herein that a particular embodiment of the present invention or a particular article, product, or method may have a particular structure, feature, or function, with or without reference to a particular drawing. If so, this will be understood by the reader that these structures, features, or functions may be implemented in any suitable combination in the subject article, product, or method. In particular, such disclosure of a number of arbitrary structures, features or functions is intended to cover all combinations of these structures, features or functions in the case of structures, features or functions disclosed as alternatives to each other It should be understood that this is also for disclosure purposes. Where such structures, features, or functions are disclosed as alternatives to each other, it should be understood that these alternatives are disclosed as being alternatives to each other.

  The terms “proximal” and “distal” are used herein with reference to the physician operating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the physician and the term “distal” refers to the portion that is remote from the clinician. For convenience and clarity, it is further understood that spatial terms such as “vertical”, “horizontal”, “top”, “bottom” may be used herein with respect to the drawings. It will be. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

  Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgery. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in many surgical procedures and applications, including those associated with open surgery. By reading the “Mode for Carrying Out the Invention” herein, the reader will be able to see that the various instruments disclosed herein can be incised or punctured into tissue, eg, through natural openings. It will further be appreciated that it can be inserted into the body in any way, such as through a hole. The working or end effector portions of these instruments can be inserted directly into the patient's body or like a trocar having a working channel through which the surgical instrument end effector and elongate shaft can be advanced. It can also be inserted through any access device.

  Returning to the drawings, wherein like reference numerals indicate like components throughout the several views, FIG. 1 shows a surgical instrument 10 capable of performing some inherent effects. Surgical stapling instrument 10 is designed to manipulate and / or actuate end effectors 12 of various shapes and sizes operably attached thereto. 1E, the end effector 12 has a long groove member 14 that forms a lower jaw 13 of the end effector 12. The elongate groove member 14 is configured to support an “implantable” stapling cartridge 30 and operatively supports an anvil 20 that functions as the upper jaw 15 of the end effector 12.

  The elongate groove member 14 may be made of 300 & 400 series, 17-4 & 17-7 stainless steel, titanium, or the like, and may be formed with spaced side walls 16. Anvil 20 may be made of, for example, 300 & 400 series, 17-4 & 17-7 stainless steel, titanium, etc., and has a plurality of staple forming pockets 23 formed therein, generally indicated as 22. And may have a staple-formed lower surface. See Figures 1B-1E. In addition, the anvil 20 has a bifurcated ramp assembly 24 that projects proximally. An anvil pin 26 projects from each side wall of the ramp assembly 24 and is received in a corresponding slot or opening 18 in the side wall 16 of the elongate groove member 14 and is movable or pivotable relative to the elongate groove member 14. Mounting is easy.

  Various forms of implantable staple cartridges can be used with the surgical instruments disclosed herein. Specific staple cartridge configurations and structures are described in further detail below. However, in FIG. 1A, an implantable staple cartridge 30 is shown. The staple cartridge 30 includes a body portion 31 formed of a compressible hemostatic material, such as oxidized regenerated cellulose (“ORC”) or bioabsorbable foam, with an unformed metal staple 32 supported therein. Have. In order to prevent staples from being affected and activation of the hemostatic material during the introduction and placement process, the entire cartridge may be biodegradable film 38, such as polydioxanone film sold under the trade name PDS®. Or polyglycerol sebacate (PGS) film, or PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL ( Polygrecapron sold under the trade name Monocryl 25) or other biodegradable film made of PGA, PCL, PLA, PDS composites that are impervious until rupture may be coated or coated it can. The main body 31 of the staple cartridge 30 is sized to be removably supported within the elongated groove member 14 as shown, so that the anvil 20 is in molding contact with the staple cartridge 30. Each internal staple 32 is aligned with a corresponding staple forming pocket 23 in the anvil.

  In use, once the end effector 12 is positioned adjacent to the target tissue, the end effector 12 is manipulated to capture the target tissue between the top surface 36 of the staple cartridge 30 and the staple forming surface 22 of the anvil 20. Or clamp it. Staples 32 move anvil 20 in a path substantially parallel to elongate groove member 14 to bring staple forming surface 22, and more particularly staple forming pocket 23 therein, into contact with top surface 36 of staple cartridge 30 at substantially the same time. It is formed by. As the anvil 20 continues to move into the staple cartridge 30, the legs 34 of the staples 32 contact the corresponding staple forming pockets 23 of the anvil 20, and the staple forming pockets 23 fold the staple legs 34 to make the staples 32 “B-shaped”. ”To function. The movement of the anvil 20 closer to the elongated groove member 14 further compresses the staple 32 and forms it to the desired final formed height “FF”.

  The above staple forming process is generally illustrated in FIGS. For example, FIG. 1B shows the end effector 12 with the target tissue “T” positioned between the anvil 20 and the top surface 36 of the implantable staple cartridge 30. FIG. 1C illustrates the initial clamping position of the anvil 20, where the anvil 20 is closed over the target tissue “T” to clamp the target tissue “T” between the anvil 20 and the top surface 36 of the staple cartridge 30. It is tightened. FIG. 1D shows an initial staple forming state where the anvil 20 begins to compress the staple cartridge 30 such that the legs 34 of the staples 32 are being formed by the staple forming pockets 23 in the anvil 20. FIG. 1E shows the staple 32 in its final molded state through the target tissue “T” with the anvil 20 removed for clarity. Once the staple 32 is formed and fastened to the target tissue “T”, the cartridge body 31 and the staple 32 are secured to the target tissue while the end effector 12 is withdrawn from the patient when the surgeon moves the anvil 20 to the open position. Will remain. The end effector 12 forms all the staples simultaneously when the two jaws 13, 15 are clamped together. The remaining “crushed” body material 31 functions as both a hemostatic agent (ORC) and staple row reinforcement (PGA, PDS or any other film composition 38 described above). Furthermore, since the staple 32 does not leave the cartridge body 31 during molding, the possibility that the staple 32 is improperly molded during molding is minimized. As used herein, the term “implantable” means that in addition to staples, the material of the cartridge body that supports the staples can also remain in the patient's body and eventually be absorbed by the patient's body. Such implantable staple cartridges are distinct from conventional cartridge configurations that remain entirely within the end effector after firing.

  In various implementations, the end effector 12 is configured to be coupled to an elongate shaft assembly 40 that protrudes from the handle assembly 100. End effector 12 (when closed) and elongate shaft assembly 40 may have similar cross-sectional shapes and are sized to operably pass through a working channel in a trocar tube or other shaped access device. can do. As used herein, the term “operably passing” means that at least a portion of the end effector and elongate shaft assembly can be inserted or passed through a passage or conduit opening, This means that it can be manipulated internally as needed to complete the stapling operation. The jaws 13 and 15 of the end effector 12 can provide the end effector with a generally circular cross-sectional shape when in the closed position, which facilitates the end effector through the circular passage / opening. It becomes. However, it is also conceivable to provide the end effector and elongate shaft assembly of the present invention with other cross-sectional shapes that can pass through access passages and openings having a non-circular cross-sectional shape. Thus, the overall size of the cross-section of the closed end effector is related to the size of the passage or opening for passing the end effector. Thus, an end effector may be referred to as, for example, a “5 mm” end effector, which means that the end effector can operatively pass through an opening that is at least about 5 mm in diameter.

  The elongate shaft assembly 40 can have an outer diameter that is substantially the same as the outer diameter of the end effector 12 in the closed position. For example, a 5 mm end effector can be coupled with an elongate shaft assembly 40 having a 5 mm cross-sectional diameter. However, as the detailed description of the present invention proceeds, it will become apparent that the present invention can be effectively used with different sized end effectors. For example, a 10 mm end effector can be coupled to an elongate shaft having a 5 mm cross-sectional diameter. Conversely, in applications where an access opening or path of 10 mm or more is provided, the elongate shaft assembly 40 may have a cross-sectional diameter of 10 mm (or more), but actuates a 5 mm or 10 mm end effector. It is also possible. Thus, the outer shaft 40 can have an outer diameter that is the same as or different from the outer diameter of the closed end effector 12 attached thereto.

  As shown, the elongate shaft assembly 40 extends generally straight distally from the handle assembly 100 to define a longitudinal axis AA. For example, the elongate shaft assembly 40 may be approximately 229 to 406 millimeters (9 to 16 inches) long. However, the elongate shaft assembly 40 may be provided in other lengths, or may have a joint therein, or relative to other portions of the shaft or handle assembly as described in detail below. The end effector 12 can be configured to facilitate articulation. The elongate shaft assembly 40 includes a spinal member 50 that extends from the handle assembly 100 to the end effector 12. The proximal end of the elongated groove member 14 of the end effector 12 has a pair of retaining trunnions 17 projecting therefrom, the retaining trunnions 17 allowing the end effector 12 to be removed from the elongated shaft assembly 40. It is sized to be received in a corresponding trunnion opening or cradle 52 provided at the distal end of the spinal column member 50 to allow connection. The spinal member 50 can be made from, for example, 6061 or 7075 aluminum, stainless steel, titanium, or the like.

  The handle assembly 100 has a pistol grip type housing that can be made of two or more parts for assembly purposes. For example, the illustrated handle assembly 100 has a right case member 102 and a left case member designed to fit together, molded or otherwise made from a polymer or plastic member (not shown). ) Such case members may be attached to each other by snap mechanisms, pegs and sockets molded or otherwise formed therein and / or by adhesives, screws, and the like. The spinal member 50 has a proximal end 54 with a flange 56 formed thereon. The flange 56 is configured to be rotatably supported in a groove 106 formed by a fitting rib 108 protruding inward from each case member 102, 104. Such a configuration facilitates attachment of the spine member 50 to the handle assembly 100 while allowing the spine member 50 to rotate in a 360 ° path about the longitudinal axis AA relative to the handle assembly 100. To do.

  As further seen in FIG. 1, the spinal member 50 passes through and is supported by a mounting bushing 60 that is rotatably mounted to the handle assembly 100. The mounting bushing 60 has a proximal flange 62 and a distal flange 64 that form a rotational groove 65 configured to rotatably receive the nose portion 101 of the handle assembly 100 therebetween. Such a configuration allows the mounting bushing 60 to rotate relative to the handle assembly 100 about the longitudinal axis A-A. Spinal member 50 is non-rotatably pinned to mounting bushing 60 by spinal pin 66. Further, a rotation knob 70 is attached to the attachment bushing 60. For example, the rotary knob 70 has a hollow mounting flange portion 72 sized to receive a portion of the mounting bushing 60 therein. The rotary knob 70 may be made of, for example, glass or carbon-filled nylon, polycarbonate, Ultem®, etc., and is similarly attached to the mounting bushing 60 by a spinal pin 66. Further, an inwardly projecting retaining flange 74 is formed in the mounting flange portion 72 and is configured to extend into a radial groove 68 formed in the mounting bushing 60. Accordingly, the physician grasps the rotation knob 70 and rotates it relative to the handle assembly 100 to cause the spine member 50 (and the end effector 12 attached thereto) to 360 about the longitudinal axis AA. It can be rotated by a path of °.

  The anvil 20 is maintained in the open position by an anvil spring 21 and / or other biasing mechanism. Anvil 20 can be selectively moved from an open position to a different closed or clamping position and firing position by a firing system, generally designated 109. Firing system 109 includes a “firing member” 110, which in a different embodiment includes a hollow firing tube 110. The hollow firing tube 110 is axially movable on the spine member 50 and thus forms the exterior of the elongate shaft assembly 40. The firing tube 110 may be made from a polymer or other suitable material and may have a proximal end attached to the firing yoke 114 of the firing system 109. For example, the firing yoke 114 can be overmolded to the proximal end of the firing tube 110. However, other fastener mechanisms can be used.

  As can be seen in FIG. 1, the firing yoke 114 can be rotatably supported within a support collar 120 that is configured to move axially within the handle assembly 100. Each of the support collars 120 has a pair of laterally extending fins sized to be slidably received within fin slots formed in the right and left case members. Thus, the support collar 120 is slidable axially within the handle housing 100 while allowing the firing yoke 114 and the firing tube 110 to rotate about the longitudinal axis AA. To do. In accordance with the present invention, a longitudinal slot is provided through the firing tube 110 to allow the spinal pin 66 to extend through the interior into the spinal member 50 while firing on the spinal member 50. The axial movement of the tube 110 is urged.

  The firing system 109 further includes a firing trigger 130 that functions to control the axial movement of the firing tube 110 on the spine member 50. Please refer to FIG. This movement of the firing tube 110 in the distal direction in the axial direction and interacting with the anvil 20 for firing is referred to herein as “firing motion”. As can be seen in FIG. 1, the firing trigger 130 is movably or pivotally coupled to the handle assembly 100 by a pivot pin 132. A torsion spring 135 is utilized to bias the firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 to an inoperative “open” or starting position. As seen in FIG. 1, the firing trigger 130 has an upper portion 134 movably attached (pinned) to a firing link 136 movably attached (pinned) to the support collar 120. Yes. Accordingly, movement of the firing trigger 130 from the starting position (FIG. 1) toward the ending position adjacent to the pistol grip portion 107 of the handle assembly 100 causes the firing yoke 114 and the firing tube 110 to move in the distal direction “DD”. Movement of the firing trigger 130 away from the pistol grip portion 107 of the handle assembly 100 (by biasing the torsion spring 135) causes the firing yoke 114 and the firing tube 110 to move in a proximal direction “PD” on the spinal member 50. It moves to.

  The present invention can be used with implantable staple cartridges of different sizes and configurations. For example, the surgical instrument 10 when used with the first firing adapter 140 can be used with a 5 mm end effector 12 about 20 mm (or other length) that supports the implantable staple cartridge 30. . Such a size of the end effector is particularly suitable for performing a relatively fine incision and blood vessel cutting, for example. However, as will be described in more detail below, the surgical instrument 10 may be used with other sizes of end effectors and staple cartridges, for example, by replacing the first firing adapter 140 with a second firing adapter. it can. As a further alternative, the elongate shaft assembly 40 can be configured to attach to an end effector of at least one shape or size.

  Next, one method for detachably connecting the end effector 12 to the spine member 50 will be described. This coupling process is initiated by inserting the retaining trunnion 17 on the elongated groove member 14 into the trunnion cradle 52 of the spine member 50. Thereafter, the surgeon advances the firing trigger 130 in the direction of the pistol grip 107 of the housing assembly 100, and moves the firing tube 110 and the first firing adapter 140 far over the proximal end portion 47 of the elongated groove member 14. The trunnions 17 are held in the respective cradles 52 when advanced in the lateral direction. This position of the first firing adapter 140 on the trunnion 17 is referred to herein as a “coupled position”. The present invention may have an end effector lock assembly to lock the firing trigger 130 in place after the end effector 12 is attached to the spinal member 50.

  More particularly, one embodiment of the end effector lock assembly 160 has a retaining pin 162 that is movably supported within the upper portion 134 of the firing trigger 130. As described above, the firing tube 110 is initially advanced distally to a coupling position where the first firing adapter 140 retains the retaining trunnion 17 of the end effector 12 within the trunnion cradle 52 of the spinal member 50. It must be done. The surgeon advances the firing adapter 140 distally to the coupled position by pulling the firing trigger 130 from the starting position toward the pistol grip 107. When the firing trigger 130 is initially activated, the retaining pin 162 moves distally until the firing tube 110 advances the first firing adapter 140 to the coupled position, at which point the retaining pin 162 is within the case member. Is urged into a lock cavity 164 formed in Optionally, when the retaining pin 162 enters the lock cavity 164, the pin 162 may produce an audible “click” or other sound, and the end effector 12 “locks” to the spinal member 50. A tactile indication that “done” has been given. In addition, unless the surgeon intentionally biases the retaining pin 162 away from the lock cavity 164, the surgeon may inadvertently actuate the firing trigger 130 and begin forming the staple 32 within the end effector 12. Absent. Similarly, if the surgeon releases the firing trigger 130 when the firing trigger 130 is in the coupled position, the firing trigger 130 is held in that position by the retaining pin 162 so that the firing trigger 130 returns to the starting position and ends. The effector 12 is prevented from being released from the spinal column member 50.

  The present invention may further include a firing system lock button 137 pivotally attached to the handle assembly 100. In one form, the firing system lock button 137 has a latch 138 formed at its distal end, the latch 138 being oriented to engage the firing yoke 114 when the firing release button is in the first latched position. It becomes. As seen in FIG. 1, the latch spring 139 functions to bias the firing system lock button 137 to the first latched position. In different circumstances, the latch 138 corresponds to the position of the firing yoke 114 on the spine member 50 where the first firing adapter 140 begins to advance distally through the clamping ramp 28 on the anvil 20. In that respect, it functions to engage the firing yoke 114. As the first firing adapter 140 moves axially forward up the clamping ramp 28, the anvil 20 moves in a path such that its staple forming surface portion 22 is substantially parallel to the top surface 36 of the staple cartridge 30. Will be understood.

  After the end effector 12 is coupled with the spine member 50, the stapling process is initiated by first pushing the firing system lock button 137, and the firing yoke 114 is further moved distally over the spine member 50 and finally. The anvil 20 is pressed against the staple cartridge 30. After depressing the firing system lock button 137, the surgeon continues to actuate the firing trigger 130 toward the pistol grip 107 to drive the first staple collar 140 to climb the corresponding staple forming ramp 29 and the anvil. 20 is brought into molding contact with the staples 32 in the staple cartridge 30. The firing system lock button 137 prevents inadvertent shaping of the staple 32 until the surgeon is ready to begin the process. In this embodiment, the surgeon must press the firing system lock button 137 before the firing trigger 130 is further actuated to initiate the stapling process.

  The surgical instrument 10 can simply be used as a tissue stapling device if it is desired. However, the present invention may also include a tissue cutting system, generally designated as 170. In at least one form, the tissue cutting system 170 includes a knife member 172 that can be selectively advanced from a non-actuated position adjacent the proximal end of the end effector 12 to an activated position by actuating the knife advance trigger 200. . Knife member 172 is movably supported and mounted within spinal column member 50 or otherwise protrudes from knife rod 180. The knife member 172 may be made, for example, from 420 or 440 stainless steel having a hardness of more than 38 HRC (Rockwell hardness C scale), formed at its distal end 174, and the slot of the anvil 20 and the center of the staple cartridge 30 And a tissue cutting edge 176 configured to slidably extend through the slot 33 disposed in the end effector 12 and to cut tissue clamped in the end effector 12. The knife rod 180 extends through the spine member 50 and has a proximal end portion that operably interfaces with a knife transmission operably attached to the knife advance trigger 200. Knife advance trigger 200 is attached to pivot pin 132 so that it can be pivoted or otherwise actuated without firing trigger 130 being actuated. According to the present invention, since the first knife gear 192 is also attached to the pivot pin 132, the first knife gear 192 is also pivoted by the operation of the knife advance trigger 200. The firing return spring 202 is mounted between the first knife gear 192 and the handle housing 100 to urge the knife advance trigger 200 to the starting position or non-actuated position.

  The knife transmission further includes a second knife gear 194 rotatably supported on the second gear spindle and meshed with the first knife gear 192. The second knife gear 194 meshes with a third knife gear 196 supported on the third gear spindle. A fourth knife gear 198 is also supported on the third gear spindle 195. The fourth knife gear 198 is configured to driveably engage a series of annular gear teeth or rings at the proximal end of the knife rod 180. Thus, such a configuration allows the fourth knife gear 198 to drive the knife rod 180 axially in the distal direction “DD” or the proximal direction “PD” while the firing rod 180 is It is possible to rotate about the longitudinal axis AA with respect to the four knife gears 198. Thus, the surgeon can advance the firing rod 180 axially and ultimately advance the knife member 172 distally by pulling the knife advance trigger 200 in the direction of the pistol grip 107 of the handle assembly 100. .

  The present invention further includes a knife lockout system 210 that prevents the advancement of the knife member 172 unless the firing trigger 130 is pulled to the full firing position. Such a mechanism thus prevents operation of the knife advancement system 170 unless the staple is first fired or molded into tissue. As seen in FIG. 1, a different implementation of the knife lockout system 210 includes a knife lockout bar 211 pivotally supported within the pistol grip portion 107 of the handle assembly 100. Knife lockout bar 211 has an actuating end 212 configured to engage firing trigger 130 when firing trigger 130 is fully in the firing position. In addition, the knife lockout bar 211 has a holding hook 214 at its other end configured to engage the latch rod 216 of the first cutting gear 192. A knife lock spring 218 is used to bias the knife lockout bar 211 to the “locked” position, and the retaining hook 214 is kept engaged with the latch rod 216 so that the firing trigger 130 is fully engaged. The knife advance trigger 200 is prevented from operating except in the firing position.

  After the staple is “fired” (molded) into the target tissue, the surgeon presses the firing trigger release button 167 to allow the firing trigger 130 to return to the starting position due to the biasing force of the torsion spring 135, thereby enabling the anvil. 20 is urged to the open position by the urging force of the spring 21. When in the open position, the surgeon can pull the end effector 12 leaving behind the implantable staple cartridge 30 and staples 32. In applications where the end effector is inserted from a passage, working passage, etc., the surgeon can pull the end effector 12 out of the passage or working passage by actuating the firing trigger 130 to return the anvil 20 to the closed position. However, if the surgeon wishes to cut the target tissue after staple firing, the surgeon operates the knife advance trigger 200 as described above to push the knife bar 172 through the target tissue to the end effector end. Thereafter, the surgeon can release the knife advance trigger 200 so that the firing return spring 202 allows the firing transmission to return the knife bar 172 to its starting (non-actuated) position. When the knife bar 172 returns to the starting position, the surgeon opens the end effector jaws 13, 15 to release the implantable cartridge 30 within the patient's body and then withdraws the end effector 12 from the patient. Thus, such a surgical instrument facilitates the use of a relatively small working channel and a small implantable staple cartridge that can be inserted through the channel while firing the staples without cutting tissue. Or, if necessary, provides an option to cut tissue after the staples have been fired.

  Various unique and novel embodiments of the present invention use a compressible staple cartridge that supports staples in a substantially fixed position for contact molding with an anvil. Although the anvil is pushed into the green staple, for example, the degree of staple forming achieved depends on how far the anvil is pushed into the staple. Such a configuration allows the surgeon to change the height of the final formed staple by adjusting the magnitude of the forming pressure or firing pressure acting on the staple. In the present invention, the surgical stapling mechanism can use a staple driving element that can lift the staples in the direction of the anvil. This is described in further detail below.

  In some cases, the amount of firing motion applied to the movable anvil in relation to the above depends on the degree of actuation of the firing trigger. For example, if the surgeon wishes to obtain a partially molded staple, the firing trigger is only partially pushed inward toward the pistol grip 107. To perform further staple forming, the surgeon simply pushes the firing trigger further, thereby further driving the anvil into contact forming with the staple. As used herein, the term “contact forming” means that the staple forming surface or staple forming pocket is in contact with the end of the staple leg and the leg is beginning to be molded or bent into the formed position. The degree of staple forming refers to how much the staple leg is folded, and thus relates to the above-described staple forming height. Those skilled in the art will further understand that, as the firing motion is applied, the anvil 20 moves in a generally parallel relationship with the staple cartridge so that each staple is formed at approximately the same forming height at approximately the same time. I will.

  2 and 3 show another end effector 12 "similar to the end effector 12 'described above, except for the following differences configured to accommodate the knife bar 172'. Knife bar 172 ′ is coupled to or protrudes from knife rod 180 and is otherwise operated in the manner described above with respect to knife bar 172. However, in this embodiment, the knife bar 172 'is long enough to traverse the entire length of the end effector 12 "and therefore no separate distal knife member is used with the end effector 12". The knife bar 172 'has an upper transverse member 173' and a lower transverse member 175 'formed thereon. The upper transverse member 173 ′ is oriented in a direction that slidably traverses the corresponding elongated slot 250 of the anvil 20 ″, and the lower transverse member 175 ′ is the elongated groove member of the end effector 12 ″. Oriented across the 14 ″ elongated slot 252. A release slot (not shown) is also provided in the anvil 20 ″ so that when the knife bar 172 ′ is driven to the end position with the thin end effector 12 ″, the upper cross member 173 ′ has a corresponding slot. Down through, the anvil 20 '' moves to the open position and disengages from the stapled and cut tissue. The anvil 20 '' may be otherwise the same as the anvil 20 described above, and the elongated groove member 14 '' may be otherwise the same as the elongated groove member 14 described above. .

  In these embodiments, the anvil 20 '' is biased to the fully open position (FIG. 2) by a spring or other release mechanism (not shown). Anvil 20 "is moved between an open position and a fully clamped position by axial movement of firing adapter 150 in the manner described above. Once the firing adapter 150 has been advanced to the fully clamped position (FIG. 3), the surgeon can further advance the knife bar 172 "in the distal direction as described above. When the surgeon uses the end effector as a grasping device for manipulating tissue, the firing adapter may be moved proximally to move the anvil 20 '' away from the elongate groove member 14 ''. This is possible (represented by broken lines in FIG. 4). In this embodiment, when the knife bar 172 ″ moves distally, the upper cross member 173 ′ and the lower cross member 175 ′ pull the anvil 20 ″ and the elongated groove member 14 ″ together, As the knife bar 172 ″ is advanced distally through the end effector 12 ″, the desired stapling takes place. Please refer to FIG. Thus, in this embodiment, staple forming is performed simultaneously with tissue cutting, but the staples themselves may be sequentially formed as the knife bar 172 "is driven in the distal direction.

  The unique and novel features of the various surgical staple cartridges and surgical instruments of the present invention allow each staple of these cartridges to be arranged in one or more linear or non-linear rows. . A plurality of such staple rows can be provided on either side of an elongated slot centrally disposed within the staple cartridge for receiving a tissue cutting member therethrough. In one configuration, for example, each staple in one row may be substantially parallel to each staple in an adjacent staple row, but may be offset from each staple. As a further alternative, the row of one or more staples may be non-linear. That is, the base of at least one staple in a row of staples may extend along an axis that is generally transverse to the base of other staples in the same staple row. For example, as discussed in more detail below, as an alternative, the staple rows on either side of the elongated slot may have a zigzag appearance. Such non-linear staple arrays can provide better tissue fastening results with fewer staples than the various linear staple arrays used in conventional staple cartridges.

  FIG. 6 illustrates the use of a surgical staple cartridge embodiment 900 in an end effector embodiment 612 '. As seen in FIGS. 6 and 7, an embodiment of the surgical staple cartridge 900 has a centrally located elongated slot 904 that extends through the proximal end 903 to a region adjacent to the distal end 905. A main body 902 is provided. The elongated slot 904 is configured such that the knife body can move axially therethrough in the tissue cutting operation as described above. The cartridge body 902 is, for example, oxidized regenerated cellulose (“ORC”), or, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PDS (polydioxanone). ), PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25 sold under the trade name Monocryl), or a bioabsorbable foam made from a composite of PGA, PCL, PLA and PDS Constructed of hemostatic material, in which rows 920, 930 of unformed staples 922 are supported. However, the cartridge body 902 may be made from other materials that function to support the green staple 922 in the desired orientation so that these materials are compressed as the anvil 910 ′ contacts the material. Can be done. The staple cartridge 900 is implantable and is left attached to the stapled tissue after the stapling operation is complete. To prevent staples 922 from being affected and the hemostatic material from being activated during the introduction and placement process, the entire cartridge 900 is a biodegradable film 906, such as polydioxax sold under the trade name PDS®. Non-film, or polyglycerol sebacate (PGS) film, or, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA, or PLLA (polylactic acid), PHA (poly Hydroxyalkanoates), PGCL (Polygrecapron 25 sold under the trade name Monocryl), or other biodegradation made from PGA, PCL, PLA, PDS composites (impervious until rupture) It can be coated or coated with an adhesive film. The cartridge main body 902 of the staple cartridge 900 is configured to be detachably supported in the long groove member of the end effector 612 '.

  In FIGS. 6, 10 and 11, the surgical staple cartridge 900 is shown in a first row 920 of staples 922 on one lateral side 907 of the elongated slot 904 and the other lateral side of the elongated slot 904. A second row 930 of staples 922 in section 909 is operably supported. The staple 922 can be made of a metallic material such as titanium, a titanium alloy (e.g., 6AI-4V titanium, 3al-2.5V titanium), stainless steel, and the like, and has a staple base 924 and two uprights protruding therefrom. The staple legs 926 have been prepared. Each staple leg 926 can have a tissue penetrating tip 928 formed thereon. In the first row 920 of staples 922, the staple base 924 of at least one staple 922 overlaps the staple base of another staple 922. The staple base 924 of each staple 922 preferably overlaps the staple base 924 of two adjacent staples 922 except for the base 924 of the last staple 922 at each end of the first staple row 920. Please refer to FIG. Accordingly, the first staple row 920 has a substantially non-linear shape. More specifically, when viewed from above, the first staple row 920 has a substantially zigzag appearance.

  As seen in FIG. 9, the anvil 90 has two continuous longitudinal staple forming pockets 912, each of which has a generally zigzag shape that corresponds to the shape of the first row 920 of staples 922. , When the anvil 910 is brought into molding contact with each staple 922, its legs 926 are molded as shown in FIG. Thus, the distal leg of one staple shares the same pocket as the proximal leg of the next longitudinal staple. Such a configuration allows for a more dense pocket pattern to the point where staples interact (eg, fold over each other). In conventional staple pocket configurations, there should generally be between 0.13-0.38 mm (0.005-0.015 inches) of metal / spacing from one pocket group to the next. . However, in this embodiment of the invention, for example, one staple fits with the next, so, for example, 0-0.5 mm (0-0.02 inch) interference / overlap (approximately -0. 5 mm (−0.020 ″)). In such a configuration, 15 to 30% more staples can be arranged in the same space. Further, when the staples are connected to each other, the necessity for providing a plurality of lateral staple rows is reduced. In the conventional configuration, generally, three rows are used on both sides of the tissue cutting line to prevent an open path through which blood can pass. With connected rows of staples, there is less chance of leaving a path through which blood can pass. Another obvious advantage provided by the various interlocking staple mechanisms of the present invention relates to an increase in “burst strength” with respect to the amount of force required to tear open the staple row.

  Another staple forming pocket configuration may include a common staple forming pocket. As used herein, the term “common staple forming pocket” refers to a single forming pocket, unlike conventional anvil designs in which a separate forming pocket is provided for each leg of each staple being formed. It means that it is possible to mold all the staples in a single staple row.

  FIG. 12 shows yet another staple embodiment 922 ', where the bases 924' have an offset portion 929 that facilitates closer overlap between the bases 924 '. As described above, the staple cartridge 900 has a second row 930 of staples 922 supported on the second lateral side 909 of the elongated slot 904. The second row 930 of staples 922 is substantially similar to the first row 920 of staples 922. Accordingly, the anvil 910 has a second common staple forming pocket 912 corresponding to the second row of staples 930 for forming contact with the second row of staples 930. However, in the alternative, the second row 930 of staples 922 may differ from the first row of staples 920 in shape and possibly the number of staples.

  FIG. 8 shows a surgical staple cartridge 900 'that is substantially similar to the staple cartridge 900 described above, except for the rows 920', 930 'of staples 922 supported therein. For example, in this embodiment, the row 920 ′ of staples 922 is such that the base axis SS of at least one staple base 924 is relative to the base axis SS of the staple base 924 of at least one other adjacent staple 922. Are arranged in a substantially transverse direction. Such a predetermined pattern of staples has a substantially zigzag arrangement when viewed from above. In FIG. 13, each base 924 of staple 922 further includes a base support member 927 overmolded over base 924 as shown. The base support member 927 is, for example, a non-absorbable plastic such as polyether ether ketone “PEEK”, or polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA”, polydioxanone “PDS”, PCL (polycaprolactone) Made from absorbent plastics such as PHA (polyhydroxyalkanoate), PGCL (polygrecapron 25, sold under the trade name Monocryl), or various composite mixtures of PGS, PDS, PLA, PGA and PCL Can do. The base support member 927 facilitates the connection between the staples without overlapping the staples themselves. Therefore, according to such a configuration, the “B” shape or the inverted “W” shape can be formed without overlapping the legs of the staples. However, since each crown is connected by a base support member, it functions like an overlapping staple. With such a configuration, the combined pocket can have two separate paths for each leg.

  FIG. 14 uses a staple row 920 ″, where the legs 926 of adjacent staples 922 are connected to each other by a coupler portion 929 that is molded or otherwise attached thereto. . Each coupler portion 929 includes, for example, polyetheretherketone “PEEK”, or polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA”, polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkano). 8), PGCL (sold under the trade name Monocryl 25), or various synthetic blends of PGS, PDS, PLA, PGA and PCL. Such a staple row 920 ″ has a substantially zigzag appearance when viewed from above. While different surgical staple cartridge embodiments 900, 900 ′ have been described above in connection with use with the end effector 612 ′, the stapling cartridges 900, 900 ′ may be other than those described hereinabove. It can be used effectively with a variety of end effectors and surgical instruments and is suitable for the anvils of these instruments to achieve the desired amount of staple forming as the anvil moves into forming contact with the staples. It will be appreciated that a staple forming pocket mechanism is provided.

  FIGS. 15 and 16 illustrate another surgical staple cartridge 940 embodiment supported within the elongate groove member 14 of the surgical instrument 10. Surgical staple cartridge 940 has a cartridge body 942 having a centrally located elongated slot 944 extending at least partially therethrough. The elongated slot 944 is configured to allow the knife body of the surgical instrument 10 to move axially therethrough during a tissue cutting operation as described above. The cartridge body 942 is compressible, such as oxidized regenerated cellulose ("ORC") or bioabsorbable foam of the type described above or below, with rows 946, 948, 950, 952 of unformed staples 922 supported therein. Made of hemostatic material. To prevent staples 922 from being affected and the hemostatic material from being activated during the introduction and placement process, the entire cartridge 940 may be replaced with a biodegradable film 954, such as polydioxax sold under the trade name PDS®. Non-film, or polyglycerol sebacate (PGS) film or, for example, PGA (polyglycolic acid sold under the trade name Vicryl), PCL (polycaprolactone), PLA, or PLLA (polylactic acid), PHA ( Polyhydroxyalkanoate), PGCL (Polygrecapron 25 sold under the trade name Monocryl), or other raw materials made from PGA, PCL, PLA, PDS composites that are impervious until rupture It can be coated or coated with a degradable film.

  In FIG. 15, the cartridge 940 further includes a cartridge support member 960 connected to the cartridge main body 942. The cartridge support member 960 may be made from a rigid material such as, for example, titanium, stainless steel, aluminum, alloys thereof, and may be partially embedded within the cartridge body 942. The cartridge support member 960 may be held in place by a film 954, for example. Also, if limited bonding is desired, cyanoacrylate can be used sporadically to “glue” the two components together. As a further alternative, the cartridge body 942 can be heated and “welded” or “fused” to the cartridge support member 960. The cartridge support member 960 forms at least a part of the bottom surface of the cartridge main body 942 so as to be fitted to the elongated groove member 14. The cartridge support member 960 has one or more snap mechanisms 962 projecting therefrom to releasably connect the cartridge support member 960 to the elongated groove member 14. Other forms of snap / fastening mechanisms may be used to releasably connect the cartridge support member 960 to the elongated groove member 14.

  Since the cartridge support member 960 is formed with a series of support ridges 964, 966, 968, 970, 972, 974, 976, as shown in FIG. A constant lateral support is provided to the base 924 of the staple 922. For this reason, the support bulge extends to substantially the same range as the staple row. FIG. 17 shows the raised fin portions 978, 979, 980, 981, 982, 983 protruding from each support ridge 964, 966, 968, 970, 972, 976 to provide further lateral support to the staple 922. Another staple cartridge embodiment 940 ′ is shown that is substantially similar to the cartridge 940 except that it includes. The fin portion may be integrally formed with the cartridge support member 960 and may have a height that is about ½ or less of the height of the cartridge. Therefore, for example, the standing mechanism that supports the foam material does not extend above the maximum compression height of the foam material. Thus, for example, if the cartridge is designed to compress to 1/3 of its original height when fired, the fins will be 66% of the uncompressed height to 10% of the uncompressed height. Range.

  In use, when the staple 922 is formed by contact with the anvil 20 in the manner described above, the anvil 20 is opened and the end effector 12 is withdrawn from the stapled tissue. As the end effector 12 is withdrawn from the stapled tissue, the cartridge body 942 remains fastened to the stapled tissue and is then detached from the cartridge support member 960, which is in the elongated groove. It remains connected to the member 14. The cartridge support member 960 has a color different from the color of the material constituting the cartridge main body 942 and the color of the elongated groove member 14. Such a configuration provides the surgeon with an easily recognizable indication that no staple cartridge is present in the end effector. Thus, the surgeon will not accidentally reinsert / use the end effector without first placing a new staple cartridge in the end effector. To that end, the surgeon can place the cartridge support member 960 of the new staple cartridge 940 inside by simply removing the snap mechanism of the cartridge support member 960 from the elongated groove member 14. While the staple cartridges 940, 940 ′ have been described in the context of the surgical instrument 10, these cartridges may be used with other surgical instruments disclosed in the present invention without departing from the spirit and scope of the present invention. It will be appreciated that it can be used effectively with many of the above.

  According to the present invention, the staple cartridge can include a cartridge body and a plurality of staples stored in the cartridge body. In use, a staple cartridge can be introduced into the surgical site and placed on one side of the tissue to be treated. In addition, a staple forming anvil can be placed on the opposite side of the tissue. The anvil may be held by the first jaw, the staple cartridge may be held by the second jaw, and the first jaw and / or the second jaw may move in the other direction. Once the staple cartridge and anvil are positioned against the tissue, the staple can be fired from the staple cartridge body and the staple can penetrate the tissue and contact the staple forming anvil. When the staple is deployed from the staple cartridge body, the staple cartridge body can be withdrawn from the surgical site. The staple cartridge or at least a portion of the staple cartridge can be implanted with staples. For example, as described in more detail below, the staple cartridge can have a cartridge body that can be compressed, crushed, and / or crushed by the anvil as the anvil moves from the open position to the closed position. As the cartridge body is compressed, crushed and / or crushed, staples disposed within the cartridge body are deformed by the anvil. Alternatively, the jaws that support the staple cartridge may move to the closed position in the direction of the anvil. In either case, the staple can be deformed while at least partially disposed within the cartridge body. In certain cases, the staples may not be ejected from the staple cartridge, and in other cases, the staples may be ejected from the staple cartridge along with a portion of the cartridge body.

  Referring now to FIGS. 18A-18D, a compressible staple cartridge, such as, for example, a staple cartridge 1000, includes a compressible implantable cartridge body 1010 and a plurality of cartridges disposed within the compressible cartridge body 1010. Although staples 1020 may be included, only one staple 1020 is shown in FIGS. FIG. 18A shows a staple cartridge 1000 supported by a staple cartridge support or staple cartridge groove member 1030, the staple cartridge 1000 being shown in an uncompressed state. In such an uncompressed state, the anvil 1040 may or may not be in contact with the tissue T. In use, the anvil 1040 can be moved from the open position to contact the tissue T as shown in FIG. 18B and press the tissue T against the cartridge body 1010 for placement. Referring again to FIG. 18B, the anvil 1040 can be placed by pressing the tissue T against the tissue contacting surface 1019 of the staple cartridge body 1010, but the staple cartridge body 1010 is now subjected to a compressive force or pressure (received). The staple 1020 can remain in an unformed or unfired state. As shown in FIGS. 18A and 18B, the staple cartridge body 1010 may include one or more layers, and the staple legs 1021 of the staples 1020 can extend upwardly through these layers. The cartridge body 1010 may include a first layer 1011, a second layer 1012, and a third layer 1013. The second layer 1012 includes the first layer 1011, the third layer 1013, and the fourth layer. The third layer 1013 can be disposed between the second layer 1012 and the fourth layer 1014. The base 1022 of the staple 1020 is disposed within the cavity 1015 of the fourth layer 1014, and the staple legs 1021 pass upward from the base 1022 through the fourth layer 1014, the third layer 1013, and the second layer 1012. Can extend. If desired, each deformable leg 1021 may have a tip, such as a sharp tip 1023, for example, the second layer 1012 when the staple cartridge 1000 is in an uncompressed state. Can be located within. For example, the tip 1023 may not extend into and / or through the first layer 1011, and the tip 1023 may be tissue when the staple cartridge 1000 is in an uncompressed state. It does not have to protrude through the contact surface 1019. When the staple cartridge is in an uncompressed state, the sharp tip 1023 may be located in the third layer 1013 and / or any other suitable layer. Alternatively, the cartridge body of the staple cartridge may have any suitable number of layers, for example, fewer than four layers, or more than four layers.

  If desired, the first layer 1011 can be composed of a buttress material and / or a plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA), as described in more detail below. The second layer 1012 can be composed of a bioabsorbable foam material and / or a compressible hemostatic material, such as oxidized regenerated cellulose (ORC). If desired, one or more of the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 can hold the staple 1020 within the staple cartridge body 1010. In addition, the staples 1020 can be kept aligned with each other. The third layer 1013 can be composed of a buttress material or a relatively incompressible or inelastic material that can be configured to hold the staple legs 1021 of the staples 1020 in place relative to each other. Further, the second layer 1012 and the fourth layer 1014 disposed on both sides of the third layer 1013 may be composed of a compressible foam or elastic material, but may stabilize the staple 1020 or The movement can be reduced. A part of the staple leading end portion 1023 of the staple leg 1021 may be embedded in the first layer 1011. For example, the first layer 1011 and the third layer 1013 can be configured to cooperate to securely hold the staple legs 1021 in place. Each of the first layer 1011 and the third layer 1013 is a sheet of bioabsorbable plastic, such as polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS) sold under the trade name Vicryl, Consists of polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl Each of the second layer 1012 and the fourth layer 1014 can be composed of at least one hemostatic material or drug.

  The first layer 1011 may have compressibility, and the second layer 1012 may have significantly higher compressibility than the first layer 1011. For example, the second layer 1012 may be about twice as compressible, about three times compressible, about four times compressible, about five times compressible, and / or about ten times greater than the first layer 1011. Can have compressibility. In other words, the second layer 1012 is compressed by a predetermined force in an amount about 2 times, about 3 times, about 4 times, about 5 times, and / or about 10 times that of the first layer 1011. sell. The second layer 1012 may have a compressibility that is between about 2 times and about 10 times that of the first layer 1011. The second layer 1012 may have a plurality of air spaces defined therein, and the amount and / or size of the air space in the second layer 1012 provides the desired compressibility of the second layer 1012. Can be adjusted to. Similar to the above, the third layer 1013 may have compressibility, but the fourth layer 1014 may have significantly higher compressibility than the third layer 1013. For example, the fourth layer 1014 may be about twice as compressible, about three times compressible, about four times compressible, about five times compressible, and / or about ten times the third layer 1013. Can have compressibility. In other words, the fourth layer 1014 is compressed by a predetermined force in an amount of about 2 times, about 3 times, about 4 times, about 5 times, and / or about 10 times that of the third layer 1013. sell. The fourth layer 1014 may have a compressibility that is between about 2 times and about 10 times that of the third layer 1013. The fourth layer 1014 may have a plurality of air spaces defined therein, and the amount and / or size of the air space of the fourth layer 1014 provides the desired compressibility of the fourth layer 1014. Can be adjusted to. In various situations, the compressibility of a cartridge body, or cartridge body layer, can be represented by the compressibility (ie, the distance that the layer is compressed by a predetermined amount of force). For example, a layer with a high compressibility compresses a greater distance than a layer with a lower compressibility by a predetermined amount of compressive force acting on that layer. That is, the second layer 1012 can have a higher compression ratio than the first layer 1011, and similarly the fourth layer 1014 can have a higher compression ratio than the third layer 1013. . The second layer 1012 and the fourth layer 1014 may be made of the same material and may have the same compressibility. The second layer 1012 and the fourth layer 1014 can also be made of materials having different compression ratios. Similarly, the first layer 1011 and the third layer 1013 may be made of the same material and may have the same compression rate. The first layer 1011 and the third layer 1013 can also be formed using materials having different compression ratios.

  As shown in FIG. 18C, when the anvil 1040 is moved to the closed position, the anvil 1040 can contact the tissue T and apply a compressive force to the tissue T and the staple cartridge 1000. In such a situation, the anvil 1040 can push the top surface or tissue contacting surface 1019 of the cartridge body 1010 downward toward the staple cartridge support 1030. Staple cartridge support 1030 may have a cartridge support surface 1031 that is stapled when staple cartridge 1000 is compressed between cartridge support surface 1031 and tissue contacting surface 1041 of anvil 1040. The cartridge 1000 can be configured to be supported. The pressure applied by the anvil 1040 compresses the cartridge body 1010 and allows the anvil 1040 to contact the staple 1020. More specifically, the compression of the cartridge body 1010 and the downward movement of the tissue contacting surface 1019 causes the tips 1023 of the staple legs 1021 to penetrate the first layer 1011 of the cartridge body 1010 and the tissue T, The anvil 1040 can enter the molding pocket 1042. As the cartridge body 1010 is further compressed by the anvil 1040, the tip 1023 contacts the wall defining the molding pocket 1042, so that the legs 1021 are deformed or inward as shown, for example, in FIG. 18C. Can be curved. As can also be seen in FIG. 18C, when the staple legs 1021 are deformed, the base 1022 of the staple 1020 can contact or be supported by the staple cartridge support 1030. If desired, the staple cartridge support 1030 can be configured to support the staple 1020 or at least the base 1022 of the staple 1020 as the staple 1020 is deformed, eg, staples, as described in more detail below. There can be multiple support mechanisms such as support grooves, slots or troughs 1032. As also shown in FIG. 18C, the cavities 1015 of the fourth layer 1014 can collapse as a result of the compressive force applied to the staple cartridge body 1010. In addition to the cavity 1015, the staple cartridge body 1010 may further include one or more spaces, such as a space 1016, which may or may not have a portion of staples disposed therein. Alternatively, the cartridge body 1010 may be configured to be crushed. The cavity 1015 and / or space 1016 is a layer of the cartridge body 1010 in which the walls defining the cavity and / or wall deflect downwardly into contact with the cartridge support surface 1031 and / or are located below the cavity and / or space. It can comprise so that it may collide so that it may contact.

  Comparing FIG. 18B and FIG. 18C clearly shows that the second layer 1012 and the fourth layer 1014 are greatly compressed by the compression pressure applied by the anvil 1040. It will be appreciated that the first layer 1011 and the third layer 1013 are similarly compressed. As the anvil 1040 is moved to its closed position, the anvil 1040 can continue to compress the cartridge body 1010 further by pushing the tissue contacting surface 1019 downward toward the staple cartridge support 1030. As shown in FIG. 18D, when the cartridge body 1010 is further compressed, the anvil 1040 can deform the staple 1020 to its fully molded shape. Referring to FIG. 18D, the legs 1021 of each staple 1020 are deformed downward in the direction of the base 1022 of each staple 1020 so that at least a portion of the tissue T is between the deformable legs 1021 and the base 1022. The first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 can be captured. Comparing FIG. 18C and FIG. 18D, it can be seen more clearly that the second layer 1012 and the fourth layer 1014 are more greatly compressed by the compression pressure applied by the anvil 1040. Comparing FIG. 18C and FIG. 18D, it will be appreciated that the first layer 1011 and the third layer 1013 are further compressed as well. When the anvil 1040 is lifted away from the tissue T after the staple 1020 is fully or at least fully formed, the staple cartridge 1030 moves away from the staple cartridge 1000 and / or separates from the staple cartridge 1000. sell. As shown in FIG. 18D, as a result of the above, the cartridge body 1010 can be implanted with staples 1020. In various situations, the implanted cartridge body 1010 can support tissue along a staple row. In certain circumstances, the hemostatic agent and / or any other suitable therapeutic agent contained within the implanted cartridge body 1010 can treat the tissue over time. As described above, a hemostatic agent reduces bleeding in stapled and / or incised tissue, while a binder or tissue adhesive can impart strength to the tissue over time. The transplanted cartridge body 1010 is composed of, for example, ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkano sold under the trade name Vircyl. Consists of materials such as ATE (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or composites of PGA, PLA, PDS, PHA, PGCL and / or PCL sold under the trade name Monocryl can do. In certain circumstances, the cartridge body 1010 can include antibiotics and / or antibacterials such as colloidal silver and / or triclosan that can reduce the likelihood of infection at the surgical site.

  The layers of the cartridge body 1010 may be coupled together. For example, the second layer 1012 is adhered to the first layer 1011 and the third layer 1013 is adhered to the second layer 1012 using at least one adhesive such as fibrin and / or protein hydrogel. The fourth layer 1014 can be bonded to the third layer 1013. Although not shown, the layers of the cartridge body 1010 may be coupled to each other by a connecting mechanical mechanism. For example, the first layer 1011 and the second layer 1012 can each have a corresponding coupling mechanism, such as, for example, a tongue and groove mechanism and / or a dovetail mechanism. Similarly, the second layer 1012 and the third layer 1013 may each have a corresponding coupling mechanism, and the third layer 1013 and the fourth layer 1014 each have a corresponding coupling mechanism. Also good. Although not shown, the staple cartridge 1000 may include one or more rivets that may extend through one or more layers of the cartridge body 1010, for example. For example, each rivet may be assembled or formed by a first end or head disposed adjacent to the first layer 1011 and a second end of the rivet. There may be a second head disposed adjacent to the fourth layer 1014. Due to the compressible nature of the cartridge body 1010, the rivet can compress the cartridge body 1010 so that the head of the rivet is recessed relative to the tissue contacting surface 1019 and / or the bottom surface 1018 of the cartridge body 1010, for example. can do. For example, rivets are polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) sold under the trade name Vircyl, polygrecapron sold under the trade name Monocryl. 25 (PGCL), polycaprolactone (PCL), and / or bioabsorbable materials such as PGA, PLA, PDS, PHA, PGCL and / or PCL composites. The layers of the cartridge body 1010 may not be coupled to each other except by the staple 1020 included therein. For example, the layers of the cartridge body 1010 can be held together by a friction fit between the staple legs 1021 and the cartridge body 1010, and each layer can be captured within the staple 1020 when the staple is formed. At least a portion of the staple legs 1021 may have a non-planarized surface or non-planarized coating that can increase the frictional force between the staple 1020 and the cartridge body 1010.

  As described above, the surgical instrument can have a first jaw that includes a staple cartridge 1030 and a second jaw that includes an anvil 1040. If desired, the staple cartridge 1000 can be configured to releasably hold the staple cartridge 1000 to the staple cartridge support 1030 as a result of engaging the staple cartridge support 1030, as described in more detail below. One or more retaining mechanisms may be included. The staple cartridge 1000 can be adhered to the staple cartridge support 1030 by at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In use, in at least one situation, particularly in laparoscopic and / or endoscopic surgery, for example, the second jaw can be inserted so that the first and second jaws can be inserted through the trocar and into the surgical site. It can be moved to a closed position opposite the first jaw. For example, the trocar may define an opening or cannula of about 5 mm through which the first and second jaws can be inserted. The second jaw is an intermediate portion between the open and closed positions that allows the first and second jaws to be inserted through the trocar without deforming the staple 1020 contained within the staple cartridge body 1010. Can be moved to a closed position. For example, when the second jaw is in its partially closed intermediate position, the anvil 1040 may exert a compressive force on the staple cartridge body 1010, but the second jaw is in its partially closed intermediate position. In some cases, the anvil 1040 may compress the staple cartridge body 1010. While the anvil 1040 may compress the staple cartridge body 1010 when in such an intermediate position, the anvil 1040 may cause the anvil 1040 to contact the staple 1020 and / or the staple 1020 may be deformed by the anvil 1040. The staple cartridge main body 1010 may not be sufficiently compressed. Once the first and second jaws are inserted through the trocar into the surgical site, the second jaw can be reopened and the anvil 1040 and staple cartridge 1000 are positioned relative to the target tissue as described above. be able to.

  Referring now to FIGS. 19A-19D, the surgical stapler end effector may include an implantable staple cartridge 1100 disposed between the anvil 1140 and the staple cartridge support 1130. As above, the anvil 1140 may have a tissue contacting surface 1141, the staple cartridge 1100 may have a tissue contacting surface 1119, and the staple cartridge support 1130 is configured to support the staple cartridge 1100. It may have a support surface 1131 capable of. Referring to FIG. 19A, the anvil 1140 is used to position the tissue T against the tissue contacting surface 1119 of the staple cartridge 1100 without deforming the staple cartridge 1100, with the anvil 1140 in such a position. The tissue contacting surface 1141 can be located at a distance 1101a from the staple cartridge support surface 1131 and the tissue contacting surface 1119 can be located at a distance 1102a from the staple cartridge support surface 1131. After this, the anvil 1140 is moved in the direction of the staple cartridge support 1130, and referring now to FIG. 19B, the anvil 1140 pushes down on the upper surface or tissue contacting surface 1119 of the staple cartridge 1100, and the first of the cartridge body 1110. The first layer 1111 and the second layer 1112 can be compressed. Referring again to FIG. 19B, as the layers 1111 and 1112 are compressed, the second layer 1112 is crushed and the legs 1121 of the staple 1120 enter the tissue T through the first layer 1111. sell. For example, the staple 1120 may be at least partially disposed within the staple cavity or space 1115 of the second layer 1112 such that when the second layer 1112 is compressed, the staple cavity 1115 collapses, resulting in a second Layer 1112 can be collapsed around the staple 1120. The second layer 1112 may include a cover portion 1116 that extends over the staple cavity 1115 and may surround or at least partially surround the staple cavity 1115. FIG. 19B shows a cover portion 1116 that is crushed down into the staple cavity 1115. Second layer 1112 may include one or more weakened portions that may facilitate crushing of second layer 1112. If desired, such weakened portions can have, for example, notches, perforations, and / or thin cross-sections that can facilitate controlled crushing of the cartridge body 1110. The first layer 1111 may include one or more weakened portions that facilitate penetrating the staple legs 1121 in the first layer 1111. If desired, such weakened portions may include, for example, notches, perforations, and / or thin cross-sections, which can be aligned or at least approximately aligned with the staple legs 1121.

  Referring again to FIG. 19A, when the anvil 1140 is in a partially closed unfired position, the anvil 1140 is positioned at a distance 1101a from the cartridge support surface 1131 to define a gap therebetween. . This gap may be filled with staple cartridge 1100 having a staple cartridge height 1102a and tissue T. Referring again to FIG. 19B, when the anvil 1140 is moved downward to compress the staple cartridge 1100, the distance between the tissue contacting surface 1141 and the cartridge support surface 1131 may be defined by a distance 1101b that is shorter than the distance 1101a. In various situations, the gap between the tissue contacting surface 1141 of the anvil 1140 and the cartridge support surface 1131 defined by the distance 1101b can be larger than the original undeformed staple cartridge height 1102a. Referring now to FIG. 19C, as the anvil 1140 is moved toward the cartridge support surface 1131, the second layer 1112 continues to collapse and the distance between the staple legs 1121 and the forming pocket 1142 can approach. . Similarly, the distance between the tissue contacting surface 1141 and the cartridge support surface 1131 can approach up to a distance 1101c, but the distance 1101c is greater than or equal to the original undeformed cartridge height 1102a, or It can be smaller than this. Referring to FIG. 19D, the anvil 1140 can be moved to a final fired position in which the staple 1120 is fully formed or at least formed to the desired height. In this position, the tissue contacting surface 1141 of the anvil 1140 may be a distance 1101d from the cartridge support surface 1131, in which case the distance 1101d may be shorter than the original undeformed cartridge height 1102a. As also shown in FIG. 19D, the staple cavities 1115 may be completely or at least substantially crushed, and the staple 1120 may be completely or at least substantially surrounded by the crushed second layer 1112. In various situations, the anvil 1140 can then be moved away from the staple cartridge 1100. After the anvil 1140 is disengaged from the staple cartridge 1100, the cartridge body 1110 can be at least partially re-expanded at various positions (ie, for example, positions between adjacent staples 1120). The crushed cartridge body 1110 may not elastically re-expand. The shaped staple 1120 and the cartridge body 1110 located between adjacent staples 1120 may exert pressure or compressive force on the tissue T, which may provide various therapeutic effects.

  Referring again to FIG. 19A, a staple leg 1121 can extend from each staple 1120 as described above. Staple 1120 is shown as having two staple legs 1121, but has one staple leg, or more than two staple legs, such as three staple legs, or four staple legs. A variety of staples can be used. As shown in FIG. 19A, each staple leg 1121 may be embedded within the second layer 1112 of the cartridge body 1110, thereby securing the staple 1120 within the second layer 1112. The staple 1120 can be inserted into the staple cavity 1115 of the cartridge body 1110 such that the leading end 1123 of the staple leg 1121 enters the cavity 1115 before the base 1122. The tip 1123 is inserted into the cavity 1115 and then pushed into the cover portion 1116 to cut through the second layer 1112. The staple 1120 can be placed at a sufficient depth within the second layer 1112 such that the staple 1120 does not move or at least substantially does not move relative to the second layer 1112. The staple 1120 can be placed deep enough within the second layer 1112 such that the base 1122 is located or embedded within the staple cavity 1115. Alternatively, the base 1122 may not be located in the second layer 1112 or may not be embedded. Referring again to FIG. 19A, the base 1122 may extend below the bottom surface 1118 of the cartridge body 1110. The base 1122 can be placed on the cartridge support surface 1130 or placed directly in contact with the cartridge support surface 1130. The cartridge support surface 1130 may have a support mechanism extending therethrough and / or defined therein, in which case, for example, the base 1122 of the staple 1120 is a staple, as described in more detail below. The cartridge support 1130 may be disposed in or supported by one or more support grooves, slots, or troughs 1132 of the cartridge support 1130.

  Referring now to FIG. 20, in addition to the above, the base 1122 of the staple 1120 can be placed directly against the support surface 1131 of the staple cartridge support 1130. If desired, the staple base 1122 can move or slide along the staple cartridge support surface 1131, for example, where the staple base 1122 includes a circular or arcuate bottom surface 1124. Such sliding can occur when the anvil 1140 is pressed against the tip 1123 of the staple leg 1121 during the staple forming process. As described above, and referring now to FIG. 21, the staple cartridge support 1130 may be provided with one or more support slots 1132, which support slots 1132 include the staple base 1122 and the cartridge. Relative movement with the support surface 1131 can be prevented or at least reduced. For example, each support slot 1132 may be defined by a surface profile that matches, or at least approximately matches, the profile of the bottom surface of the staples disposed therein. For example, the bottom surface 1124 of the base 1122 shown in FIG. 21 may have a circular or at least approximately circular surface, and the support slot 1132 may also have a circular or at least approximately circular surface. For example, the surface that defines slot 1132 may be defined by a radius of curvature that is greater than or equal to the radius of curvature that defines bottom surface 1124. The slot 1132 can help prevent or reduce relative sliding movement between the staple 1120 and the staple cartridge support 1130, while the slot 1132 provides rotational movement between the staple 1120 and the staple cartridge support 1130. It can also be configured to prevent or reduce. More particularly, the slot 1132 can be configured to tightly receive the base 1122 to prevent or reduce the rotation of the staple 1120 about the shaft 1129, which causes the staple 1120 to deform. It will not rotate or twist when it is done.

  In addition to the above, each staple 1120 can be formed of round or at least substantially round wire. The legs and base of each staple can also be formed of a wire having a non-circular cross section, for example, a rectangular cross section. For example, the staple cartridge 1130 may have a corresponding non-circular slot such as, for example, a rectangular slot configured to receive a base of such staples. Referring now to FIG. 22, each staple 1120 may have a crown, such as a crown 1125 overmolded to the base 1122, in which case each crown 1125 supports a staple cartridge support 1130. It can be placed in a slot. For example, each crown 1125 may have a square and / or rectangular cross-section that can be configured to be received within a square and / or rectangular slot 1134 of the staple cartridge support 1130, for example. it can. The crown 1125 is polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), which is commercially available under the trade name Vicryl, and polygrecapron 25, which is commercially available under the trade name Monocryl. (PGCL), polycaprolactone (PCL), and / or bioabsorbable plastics such as PGA, PLA, PDS, PHA, PGCL and / or PCL composites, for example, by an injection molding process, 1120 can be formed around the base 1122. Various crowns and methods for forming various crowns are named “SURGICAL STAPLES HAVING COMPRESIBLE OR CRUSSHABLE MEMBERS FOR SECURING TUSSUE THEREIN AND STAPLING INSTRUMENTY IN 29 DAY 9” No. 11 / 541,123, the entire disclosure of which is incorporated herein by reference. Referring again to FIG. 22, the slot 1134 can further include an introducer or bevel 1135 that can be configured to facilitate insertion of the crown 1125 into the slot 1134. The base and / or crown of the staple 1120 can be placed in the slot 1134 when the staple cartridge 1100 is assembled to the staple cartridge support 1130. The crown 1125 of the staple 1120 may be aligned with the slot 1134 when the staple cartridge 1100 is assembled to the staple cartridge support 1130. For example, the crown 1125 can be prevented from entering the slot 1134 until a compressive force is applied to the staple legs 1121 and the base and / or crown of the staple 1120 is pushed down into the slot 1134.

  Referring now to FIGS. 23 and 24, for example, a staple cartridge such as staple cartridge 1200 may have a compressible implantable cartridge body 1210 having an outer layer 1211 and an inner layer 1212. Similar to the above, the staple cartridge 1200 may have a plurality of staples 1220 disposed within the cartridge body 1210. Each staple 1220 can have a base 1222 and one or more staple legs 1221 extending from the base 1222 as desired. For example, the staple legs 1221 are inserted into the inner layer 1212 and, for example, to a depth such that the base 1222 of the staple 1220 abuts and / or is disposed adjacent to the bottom surface 1218 of the inner layer 1212. Can be placed. In FIGS. 23 and 24, the inner layer 1212 does not have a staple cavity configured to receive a portion of the staple 1220, but alternatively, the inner layer 1212 may have such a staple cavity. Good. In addition to the above, the inner layer 1212 can be configured to collapse the cartridge body 1210 when a compressive load is applied, such as a bioabsorbable foam and / or oxidized regenerated cellulose (ORC) compressible Can be made of any material. The inner layer 1212 can be made of, for example, a freeze-dried foam material containing polylactic acid (PLA) and / or polyglycolic acid (PGA). The ORC is marketed under the trade name Surgicel and may include loosely knitted fabrics (such as surgical sponges), loose fibers (such as cotton balls), and / or foam. The inner layer 1212 can be activated with water and / or activated by a patient's body fluid, for example, and / or lyophilized thrombin and / or fibrin contained in and / or coated on the inner layer 1212 It can be comprised with the material containing pharmaceuticals like. For example, lyophilized thrombin and / or fibrin can be retained on a Vicryl (PGA) matrix. However, in certain circumstances, when the staple cartridge 1200 is inserted into, for example, a surgical site in a patient's body, an activatable medicament may be activated unintentionally. Referring again to FIGS. 23 and 24, the outer layer 1211 can be constructed of a water impermeable, or at least substantially water impermeable material, which compresses the cartridge body 1210 and causes the staple legs to be outward. The liquid does not contact or at least substantially does not contact the inner layer 1212 after penetrating the layer 1211 and / or until after the outer layer 1211 is cut in some way. The outer layer 1211 can be composed of a buttress material and / or a plastic material such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). The outer layer 1211 can include a wrap surrounding the inner layer 1212 and the staples 1220. More particularly, the staple 1220 can be inserted into the inner layer 1212 and the outer layer 1211 can be wrapped around the subassembly including the inner layer 1212 and the staple 1220 and then sealed.

  Referring now to FIGS. 25 and 26, for example, a staple cartridge such as staple cartridge 1300 may have a compressible implantable cartridge body 1310 that includes an outer layer 1311 and an inner layer 1312. Similar to the above, the staple cartridge 1300 may further include staples 1320 disposed within the cartridge body 1310, each staple 1320 having a base 1322 and one or more legs 1321 extending from the base 1322. sell. Similar to the staple cartridge 1200, the base 1322 of the staple 1320 may extend below the bottom surface 1318 of the inner layer 1312, and the outer layer 1311 may surround the base 1322. For example, the outer layer 1311 may be flexible enough to wrap each staple base 1322, so that the outer layer 1311 matches the outer shape of the base 1322. Alternatively, referring again to FIG. 24, the outer layer 1211 may have sufficient rigidity to extend around the base 1222 without conforming to each base 1222. In either case, the outer layer 1311 can be disposed between the base 1322 of the staple 1320 and a staple cartridge support surface, such as a support surface 1031 or 1131 that supports the staple cartridge 1300, for example. For example, the outer layer 1311 can be disposed between the base 1322 and a support slot, such as slot 1032 or 1132 defined in the staple cartridge support surface, for example. For example, in addition to the above, the outer layer 1311 may limit the movement of the base 1322 and / or increase the coefficient of friction between them by increasing the coefficient of friction between the base 1322 and the staple cartridge support surface and / or the support slot. It can be configured to reduce relative motion. Alternatively, referring now to FIGS. 27 and 28, an outer layer of a staple cartridge, such as staple cartridge 1400, may not completely enclose the staples disposed therein. For example, the outer layer 1411 of the compressible implantable cartridge body 1410 can be assembled to the inner layer 1412 prior to inserting the staple legs 1421 of the staples 1420 into the cartridge body 1410. As a result of the above, the base 1422 of the staple 1420 may extend outside the outer layer 1411 and the base 1422 may be placed directly into the support slot 1032 or 1132 within the cartridge support surface 1031 or 1131, for example. The staple legs 1421 may cut through the outer layer 1411 as the staple legs 1421 are inserted through the outer layer 1411. In various situations, the holes formed by the staple legs 1421 can tightly surround the staple legs 1421 such that little fluid (even if leaked) leaks between the staple legs 1421 and the outer layer 1411. This can reduce or prevent the possibility that the medicament contained within the staple cartridge body 1410 is activated early and / or leaks from the cartridge body 1410.

  Referring again to FIGS. 23 and 24, as described above, the legs 1221 of the staples 1220 may be embedded within the cartridge body 1210 and the base 1222 of the staples 1220 is external to the bottom surface 1218 of the inner layer 1212. May extend. In addition to the above, the inner layer 1212 may not have staple cavities configured to receive the staples 1220. Alternatively, referring now to FIGS. 29 and 30, a staple cartridge, such as a staple cartridge 1500, for example, has a staple cavity 1515 that can be configured to receive at least a portion of the staple 1520 therein. A possible implantable cartridge body 1510 may be included. For example, the top of staple legs 1521 of staples 1520 can be embedded within inner layer 1512, while the bottom and base 1522 of staple legs 1521 can be disposed within staple cavities 1515. The base 1522 may be disposed entirely within the staple cavity 1515, or at least a portion thereof may extend below the bottom surface 1518 of the inner layer 1512. Similar to the above, the outer layer 1511 can surround the inner layer 1512 and the staples 1520 disposed therein. Alternatively, referring now to FIG. 31, the staple cartridge 1600 may have staples 1620 disposed within staple cavities 1615 within the compressible implantable cartridge body 1610, in which case at least one of the staples 1620. The part is not surrounded by the outer layer 1611. For example, the staple 1620 can have staple legs 1621 at least partially embedded within the inner layer 1612 and a base 1622 that extends outwardly around the outer layer 1611.

  Referring now to FIGS. 32 and 33, for example, a staple cartridge such as staple cartridge 1700 includes a compressible implantable cartridge body 1710 and a plurality of staples 1720 at least partially disposed within the cartridge body 1710. Can have. The cartridge body 1710 can include an outer layer 1711, an inner layer 1712, and an alignment matrix 1740 that can be configured to align and / or hold the staples 1720 in place within the cartridge body 1710. Inner layer 1712 can have a recess 1741 that can be configured to receive alignment matrix 1740 therein. The alignment matrix 1140 may be press fit into the recess 1741 and / or otherwise secured to the inner layer 1712 using at least one adhesive such as, for example, fibrin and / or protein hydrogel. Can do. The recesses 1741 can be configured such that the bottom surface 1742 of the alignment matrix 1740 is aligned or at least substantially aligned with the bottom surface 1718 of the inner layer 1712. The alignment matrix bottom surface 1742 may be recessed with respect to and / or extend from the bottom surface 1718 of the second layer 1712. As desired, each staple 1720 may have a base 1722 and one or more legs 1721 extending from the base 1722, and at least a portion of the staple legs 1721 may extend through the alignment matrix 1740. The alignment matrix 1740 may further include, for example, a plurality of openings and / or slots extending therethrough, and the plurality of openings and / or slots can be configured to receive the staple legs 1721 therein. . For example, each opening can be configured to closely receive the staple legs 1721 such that there is little (if any) relative movement between the staple legs 1721 and the sidewalls of the openings. The alignment matrix opening may not extend through the alignment matrix 1740 and the staple legs 1721 may need to incise the alignment matrix 1740 as the staple legs 1721 are pushed through the alignment matrix 1740.

  The alignment matrix 1740 can be comprised of a molded plastic body that is, for example, stiffer or less compressible than the inner layer 1712 and / or the outer layer 1711. For example, the alignment matrix 1740 can be composed of a plastic material and / or any other suitable material, such as polydioxanone (PDS) and / or polyglycolic acid (PGA). The alignment matrix 1740 can be assembled to the inner layer 1712 and then the staple legs 1721 can be inserted through the alignment matrix 1740 and embedded within the inner layer 1712. The bottom surface 1742 of the alignment matrix 1740 may include, for example, one or more grooves, slots, or troughs that are configured to receive at least a portion of the base 1722 of the staple 1720. it can. As above, the outer layer 1711 can then be placed around a subassembly that includes the inner layer 1712, the alignment matrix 1740 and the staples 1720. Alternatively, outer layer 1711 may be placed around a subassembly that includes inner layer 1712 and alignment matrix 1740, after which staples 1720 may be inserted through outer layer 1711, alignment matrix 1740, and inner layer 1712. . In any case, as a result of the above, inner layer 1712, alignment matrix 1740, and / or outer layer 1711 hold staples 1720 in place until and / or thereafter as they are deformed by the anvil. Can be configured to. For example, the alignment matrix 1740 functions to hold the staples 1720 in place before the staple cartridge 1700 is implanted in the patient, and further along the row of staples after the staple cartridge 1700 is implanted. Can function to fix. For example, the staple 1720 can be secured within the alignment matrix 1740 without being embedded within the inner layer 1712 and / or the outer layer 1711.

  Referring now to FIGS. 34-40, for example, a staple cartridge, such as staple cartridge 1800, compresses inner layer 1812 and inserts staples, such as staple 1820, into inner layer 1812, with inner layer 1812 on the outer side. Can be assembled by wrapping with layer 1811. Referring primarily to FIG. 34, the compressible inner layer 1812 is shown as having a plurality of staple cavities 1815 defined therein, but the inner layer 1812 includes staple cavities as described above. There are no alternatives possible. Referring to FIG. 35, a compressible inner layer 1812 may be disposed between the transfer plate 1850 and the support plate 1860 and compressed between their respective compression surfaces 1852 and 1862. As shown in FIG. 35, the top and bottom surfaces of the inner layer 1812 are compressed in the direction of each other, and the inner layer 1812 can bulge outward in the lateral direction accordingly. The inner layer 1812 can be compressed, for example, to a height of about 1/3 of its original height, for example, about 1.5 mm (0.06 ″) to about 2.0 mm (0. May have a height or thickness of 08 ″). As also shown in FIG. 35, the transfer plate 1850 can further include a plurality of staples, such as staples 1820, disposed within the plurality of staple wells 1853. In addition, the transfer plate 1850 can further include a plurality of drivers 1851 that can be configured to push the staples 1820 upward and out of the staple well 1853. Referring now to FIG. 36, a driver 1851 can be used to push the staple legs 1821 of the staples 1820 through the inner layer 1812 and into the compressed inner layer 1812. The driver 1851 is configured such that when the staple 1820 is fully deployed from the staple well 1853 of the transfer plate 1850, its top surface is flush with, or at least close to, the compression surface 1852 of the transfer plate 1850. can do. As also shown in FIG. 36, the support plate 1860 includes a plurality of receiving openings that can be configured to receive the tips after the staple legs 1821 or at least the tips of the staple legs 1821 are pushed through the inner layer 1812. A portion 1861 may be included. A receiving opening 1861 or similar configuration is required when the inner layer 1812 is compressed to a height that is lower than the height of the staple 1820, and thus when the staple 1820 is fully ejected from the staple well 1853. The staple legs 1821 can protrude from the top surface of the compressed inner layer 1812. The inner layer 1812 may be compressed to a height that is higher than the height of the staples 1820 so that the receiving openings 1861 in the support plate 1860 may not be required.

  After the staples 1820 are inserted into the inner layer 1812, referring now to FIG. 37, the inner layer 1812 can be uncompressed by moving the support plate 1860 away from the transfer plate 1850. In such a situation, the inner layer 1812 can elastically re-expand elastically to its original height, or at least an uncompressed height close to the original height. As the inner layer 1812 re-expands, the height of the inner layer 1812 can increase so that it exceeds the height of the staple 1820, which causes the staple legs 1821 of the staple 1820 to protrude from the top surface of the inner layer 1812. Disappear. In various embodiments, the receiving opening 1861 is configured to hold the staple legs 1821 in place until the support plate 1860 has moved far enough so that at least the legs 1821 are not located within the receiving openings 1861. can do. In such situations, the receiving opening 1861 can help maintain the relative alignment of the staples 1820 within the inner layer 1812 as the inner layer 1812 re-expands. In various situations, the inner layer 1812 and the staples 1820 disposed therein may form a subassembly 1801, which can then be inserted into the outer layer 1811, for example with reference to FIG. it can. For example, the outer layer 1811 may have a cavity 1802 defined therein that may be configured to receive the subassembly 1801 therein. In various situations, the outer layer 1811 can be pulled over the subassembly 1801 using a tool such as a pliers 1855, for example. Referring now to FIG. 39, the outer layer 1811 can be sealed when the subassembly 1801 is positioned sufficiently inside the outer layer 1811. The outer layer 1811 can be sealed by applying thermal energy to a portion thereof. More specifically, the outer layer 1811 can be composed of a plastic material, and the open end of the outer layer 1811 is opened by heat caulking with one or more thermal elements or irons 1856. The outer peripheries of the ends can be bonded and / or sealed together. For example, referring now to FIG. 40, the excess portion 1857 of the outer layer 1811 can be removed, and then the staple cartridge 1800 can be used as described herein.

  As described above, the staple cartridge may be disposed within and / or secured to the staple cartridge mounting portion. 41 and 42, the staple cartridge mounting portion can be configured to receive at least a portion of a staple cartridge such as a staple cartridge 1900 therein, such as a staple cartridge groove member 1930. It may have a staple cartridge groove member. Staple cartridge groove member 1930 can have a bottom support surface 1931, a first side support wall 1940, and a second side support wall 1941. In use, the staple cartridge 1900 is disposed in contact with and / or adjacent to the bottom support surface 1931 and between the first side support wall 1940 and the second side support wall 1941. In the staple cartridge groove member 1930. The first side support wall 1940 and the second side support wall 1941 can define a lateral gap therebetween. For example, the staple cartridge 1900 may have a lateral width 1903 that is the same and / or wider than the lateral gap defined between the support walls 1940 and 1941 so that the staple cartridge 1900 can be compressed. The implantable cartridge body 1910 can fit securely between the walls 1940 and 1941. The lateral width 1903 of the staple cartridge 1900 may be shorter than the gap defined between the first side wall 1940 and the second side wall 1941. Optionally, walls 1940 and 1941 and at least a portion of bottom support surface 1931 are formed by stamped metal groove members, or alternatively, at least one of side support wall 1940 and / or side support wall 1941. The portion can be made of a flexible material such as an elastomer material. Referring primarily to FIG. 41, the first side wall 1940 and the second side wall 1941 of the staple cartridge groove member 1930 are respectively a rigid portion 1933 extending upwardly from the bottom support surface 1931 and a flexible portion extending upwardly from the rigid portion 1933. Sex portion 1934 may be configured.

  In addition to the above, the cartridge body 1910 of the staple cartridge 1900 can include one or more compressible layers, such as a first layer 1911 and a second layer 1912, for example. When the cartridge body 1910 is compressed against the bottom support surface 1931 by the anvil as described above, the sides of the cartridge body 1910 can expand laterally. When the staple cartridge 1930 has rigid side walls, such lateral expansion of the cartridge body 1910 is prevented or at least limited by the rigid side walls so that a substantial amount of internal pressure or stress is generated within the cartridge body 1910. Can occur. If at least a portion of the staple cartridge 1930 is comprised of flexible side walls, the flexible side walls flex laterally and allow the sides of the cartridge body 1910 to expand laterally, thereby allowing the cartridge The internal pressure or stress generated in the main body 1910 is reduced. If the cartridge groove member does not have side walls or has side walls that are relatively shorter than the staple cartridge, the side of the staple cartridge is not obstructed laterally or at least substantially unobstructed. Can expand. In any case, referring now to FIG. 42, the staple cartridge groove member 2030 can have side sidewalls 2040 and 2041 that can be entirely comprised of a flexible material, such as, for example, an elastomeric material. The staple cartridge 2030 is a side extending along the side of the bottom support surface 2031 of the staple cartridge groove member 2030 that can be configured to receive and secure at least a portion of the side sidewalls 2040 and 2041 therein. A part slot 2033 may be further provided. Side sidewalls 2040 and 2041 can be secured within slot 2033 by a snap-fit and / or press-fit mechanism, but can also be secured within slot 2033 by one or more adhesives. Sidewalls 2040 and 2041 can be separated from bottom support surface 2031 in use. In either case, the compressible implantable cartridge body 2010 can be separated and / or detached from the side walls 2040 and 2041 when the cartridge body 2010 is implanted with the staples 2020.

  Referring now to FIG. 43, the surgical instrument can have a shaft 2150 and an end effector extending from the distal end of the shaft 2150. The end effector is similar to the above, the staple cartridge groove member 2130, the anvil 2140 that can move between the open position and the closed position, and the staple cartridge 2100 that can be disposed between the staple cartridge groove member 2130 and the anvil 2140. Can be included. Again, as described above, the staple cartridge 2100 can have a compressible implantable cartridge body 2110 and a plurality of staples 2120 disposed within the cartridge body 2110. The staple cartridge groove member 2130 can have 1) a bottom support surface 2131, 2) a distal end 2135, and 3) a proximal end 2136 on which the staple cartridge 2100 can be placed. As shown in FIG. 43, the staple cartridge 2100 can be disposed within a first end 2105 that can be disposed within the distal end 2135 of the staple cartridge groove member 2130 and a proximal end 2136 of the staple cartridge groove member 2130. Second end 2106. The distal end 2135 of the staple cartridge groove member 2130 may have at least one distal retention mechanism, such as a retention wall 2137, and similarly the proximal end 2136 is at least, for example, a retention wall 2138. One proximal retention mechanism may be included. For example, the distal retaining wall 2137 and the proximal retaining wall 2138 may define a gap therebetween that is equal to or shorter than the length of the staple cartridge 2100 so that the staple cartridge 2100 has a staple cartridge groove member. When inserted into the staple cartridge groove member 2130, the staple cartridge groove member 2130 can be tightly fitted.

  Referring again to FIGS. 23 and 24, for example, a staple cartridge such as staple cartridge 1200 may have a flat or at least substantially flat tissue contacting surface 1219. For example, the staple cartridge body 1210 of the staple cartridge 1200 has a first end 1205 that can be defined by a first height or thickness 1207 and a second end that can be defined by a second height or thickness 1208. A portion 1206 may be included, and the first height 1207 may be equal to or at least approximately equal to the second height 1208. The height or thickness of the cartridge body 1210 may be constant or at least substantially constant between the first end 1205 and the second end 1206. For example, the tissue contacting surface 1219 can be parallel or at least substantially parallel to the bottom surface 1218 of the cartridge body 1210. Referring again to FIG. 43, the first end 2105 of the cartridge body 2110 of the staple cartridge 2100 can be defined by a first height 2107 that is different from the second height 2108 of the second end 2106. As shown, the first height 2107 is greater than the second height 2108, but instead the second height 2108 may be greater than the first height 2107. The height of the cartridge body 2110 can decrease linearly and / or geometrically between the first end 2105 and the second end 2106. For example, the tissue contacting surface 2119 extending between the first end 2105 and the second end 2106 can have an orientation along a predetermined angle defined therebetween. For example, the tissue contacting surface 2119 may not be parallel to the bottom surface 2118 of the cartridge body 2110 and / or the support surface 2131 of the staple cartridge groove member 2130.

  Referring again to FIGS. 43 and 44, the anvil 2140 may have a tissue contacting surface 2141 that is staple cartridge groove member when the anvil 2140 is in the closed position as shown in FIG. It can be parallel or at least substantially parallel to the support surface 2131 of 2130. When the anvil 2140 is in the closed position, the anvil 2140 has a first end of the staple cartridge 2100 due to the higher height of the first end 2105 and the lower height of the second end 2106. 2105 can be configured to compress more than the second end 2106. In certain situations, including situations where the tissue T disposed between the tissue contacting surfaces 2119 and 2141 has a constant or at least approximately constant thickness, the pressure generated in the tissue T and the cartridge 2100 may cause the distal effector to At the distal end, it can be larger than at the proximal end of the end effector. More particularly, when the tissue T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness, it is disposed between the distal end 2145 of the anvil 2140 and the first end 2105 of the staple cartridge 2100. The tissue T to be applied can be compressed more than the tissue T disposed between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100. In accordance with the present invention, a pressure gradient can be created in the tissue T between the proximal and distal ends of the end effector. More specifically, the tissue T between the anvil 2140 and the staple cartridge 2100 has a substantially constant thickness, and the height of the staple cartridge 2100 decreases linearly from the distal end to the proximal end of the end effector. If so, the pressure in the tissue T may decrease linearly from the distal end effector end to the end effector proximal end. Similarly, tissue T between anvil 2140 and staple cartridge 2100 has a substantially constant thickness, and the height of staple cartridge 2100 decreases geometrically from the distal end to the proximal end of the end effector. In doing so, the pressure in the tissue T may decrease geometrically from the distal end effector end to the end effector proximal end.

  Referring again to FIG. 43, the tissue T disposed between the staple cartridge 2100 and the anvil 2140 may not have a constant thickness throughout. In at least one such situation, the tissue T disposed between the proximal end 2146 of the anvil 2140 and the second end 2106 of the staple cartridge 2100 can be removed from the distal end 2145 of the anvil 2140 and the staple cartridge 2100. It may be thicker than the tissue T disposed between the first end 2105 and the first end 2105. In such a situation, the result is that the thicker tissue T is typically placed on the shorter proximal end 2106 of the staple cartridge 2100 and the thinner tissue T is typically placed on the higher distal end 2105. Can be arranged. As shown in FIG. 44, in use, the firing collar 2152 of the shaft 2150 is advanced distally along the shaft spine 2151 so that the firing collar 2152 engages the cam portion 2143 of the anvil 2140, and the anvil 2140. Is rotated in the direction of the staple cartridge 2100. When the anvil 2140 is rotated to the fully closed position, the tissue T is compressed between the tissue contacting surfaces 2119 and 2141 and the height of the staple cartridge 2100 is increased between the proximal and distal ends of the end effector. The pressure or compressive force acting on the tissue T may be constant throughout the tissue, or at least approximately constant, although it may not be constant between. More particularly, the thinner tissue T can be associated with a higher height of the staple cartridge 2100 and the thicker tissue T can be associated with a shorter height of the staple cartridge 2100 so that the accumulation of tissue T and staple cartridge 2100 Or, the total height can be constant or at least approximately constant between the proximal and distal ends of the end effector so that the compression of this cumulative height by the anvil 2140 is constant or at least constant throughout the tissue. Can be almost constant.

  Referring again to FIGS. 43 and 44, the staple cartridge 2100 may have an asymmetric configuration. For example, the height at the first end 2105 of the staple cartridge 2100 may be higher than the height at the second end 2106 of the cartridge 2100. The staple cartridge 2100 and / or the staple cartridge groove member 2130 may be disposed in one orientation within the staple cartridge groove member 2130 (ie, the first end 2105 is disposed within the distal end 2135 of the staple cartridge 2130; There may be one or more alignment and / or retention mechanisms that may be configured to be securely positioned (in the orientation in which the second end 2106 is positioned within the proximal end 2136). . Alternatively, the staple cartridge 2100 and / or the staple cartridge groove member 2130 can be configured 1 to allow the staple cartridge 2100 to be disposed in more than one orientation within the staple cartridge groove member 2130 1. There may be one or more alignment and / or retention mechanisms. Referring now to FIG. 45, for example, the staple cartridge 2100 includes a first end 2105 of the staple cartridge 2100 disposed within the proximal end 2136 of the staple cartridge groove member 2130 and a second end 2106 distally. The staple cartridge groove member 2130 may be disposed so as to be disposed in the end 2135. As a result, as a result, the lower height of staple cartridge 2100 is positioned adjacent to distal retention wall 2137 and the higher height of staple cartridge 2100 is positioned adjacent to proximal retention wall 2138. sell. For example, the staple cartridge 2100 exerts a constant or at least substantially constant clamping pressure on tissue T having a thicker portion within the distal end of the end effector and a thinner portion within the proximal end of the end effector. It can be configured as appropriate. The staple cartridge 2100 can be selectively oriented, for example, within the staple cartridge groove member 2130. For example, the alignment and / or retention mechanism of the staple cartridge 2100 may be symmetric and the surgeon selectively moves the staple cartridge 2100 in the staple cartridge groove member 2130, for example, in the orientation shown in FIGS. Can be arranged.

  In addition to the above, the implantable cartridge body 2110 has a longitudinal axis 2109 that extends between the proximal and distal ends of the end effector when the staple cartridge 2100 is disposed within the staple cartridge groove member 2130. sell. The thickness of the cartridge body 2110 can generally decrease and / or generally increase along the longitudinal axis 2109 between the first end 2105 and the second end 2106. . For example, the distance or height between the bottom surface 2118 and the tissue contacting surface 2119 generally decreases and / or generally increases between the first end 2105 and the second end 2106. sell. The thickness of the cartridge body 2110 can increase and decrease along the longitudinal axis 2109. For example, the thickness of the cartridge body 2110 can include one or more portions where the thickness increases and one or more portions where the thickness can decrease. A plurality of staples 2120 can be disposed inside the staple cartridge 2100. In use, as described above, the staple 2120 can be deformed when the anvil 2140 is moved to the closed position. Each staple 2120 may have the same or at least approximately the same height. For example, staple height can be measured, for example, from the bottom of the staple base to the top or tip of the highest leg of the staple.

  The staples in the staple cartridge may have different staple heights. For example, the staple cartridge is disposed within a first staple group having a first staple height disposed within a first portion of the compressible cartridge body and a second portion of the compressible cartridge body. And a second group of staples having a second staple height. The first staple height may be higher than the second staple height, and the first staple group may be disposed at the first end 2105 of the staple cartridge 2100 while the second staple group is the second staple group. Can be disposed at the end 2106 of the. Alternatively, a higher first staple group may be disposed at the second end 2106 of the staple cartridge 2100 and a shorter second staple group may be disposed at the first end 2105. Multiple staple groups, each group having a different staple height, can be used. For example, a third group having an intermediate staple height can be disposed between the first staple group and the second staple group in the cartridge body 2110. If desired, each staple in the staple row in the staple cartridge may have a different staple height. The tallest staple in a staple row can be placed at the first end of the staple row and the shortest staple can be placed at the opposite end of the staple row. For example, staples disposed between the highest and shortest staples can be configured, for example, such that the staple height is lowered between the highest and shortest staples.

  Referring now to FIG. 46, the end effector of the surgical stapler may have an anvil 2240, a staple cartridge groove member 2230, and a staple cartridge 2200 supported by the staple cartridge groove member 2230. The staple cartridge 2200 can include a compressible implantable cartridge body 2210 and a plurality of staples, such as staples 2220a and 2220b, disposed within the staple cartridge 2200, for example. Staple cartridge groove member 2230 may have a cartridge support surface 2231 and a plurality of staple support slots defined in staple cartridge groove member 2230, such as support slots 2232a and 2232b, for example. For example, the staple cartridge 2200 may include two rows of outer staple rows 2220a and two rows of inner staple rows 2220b, where the support slot 2232a is configured to support the staples 2220a, and the support slots 2232b are staples 2220b. Can be configured to support. 46 and 47, the anvil 2240 includes a plurality of staples that can be configured to receive and deform the staples 2220a and 2220b as the anvil 2240 is moved toward the staple cartridge 2200. A molding pocket 2242 may be defined. For example, the bottom surface of the support slot 2232a may be separated from the top surface of the staple forming pocket 2242 by a first distance 2201a, and the bottom surface of the support slot 2232b is separated from the top surface of the staple forming pocket 2242 by a second distance 2201b. Good. For example, the support slot 2232b is positioned closer to the anvil 2240 due to a raised step in the support surface 2231 in which the support slot 2232b is defined. Due to the different distances 2201a and 2201b, the outer rows of staples 2220a and the inner rows of staples 2220b can be deformed to different formed heights. In various situations, staples deformed to different forming heights can apply different clamping pressures or forces to the stapled tissue T. In addition to the above, the staples can also start from different green staple heights. For example, referring again to FIG. 46, the outer staple 2220a may have an initial unformed height that is higher than the initial unformed height of the inner staple 2220b. As shown in FIGS. 46 and 47, the inner staple 2220b having a shorter unformed height than the outer staple 2220a may also have a lower formed height than the outer staple 2220b. Alternatively, the inner staple 2220b may have a higher unformed height than the outer staple 2220a and a deformed staple height lower than the outer staple 2220a.

  In addition to the above, by moving the anvil 2240 to the closed position as shown in FIG. 47, the cartridge body 2210 can be compressed to deform the staples 2220a and 2220b. For example, the surgical stapler having the end effector shown in FIGS. 46 and 47 further includes a cutting member that can be configured to cut tissue T disposed between the anvil 2240 and the staple cartridge 2200. May be. For example, anvil 2240, staple cartridge groove member 2230, and / or staple cartridge 2200 may define a slot configured to slidably receive a cutting member therein. More particularly, the anvil 2240 may have a slot portion 2249 and the staple cartridge groove member 2230 may have a slot portion 2239 when the staple cartridge 2200 is in a closed or at least substantially closed position. Can have slot portions 2203 that can be aligned or at least substantially aligned with each other. The cutting member can be moved from the proximal end of the end effector to the distal end of the end effector after the anvil 2240 is closed and the staples 2220a, 2220b are deformed. The cutting member can be moved independently of the staple deformation process. The cutting member can also be advanced simultaneously with the staple being deformed. In either case, the cutting member can be configured to incise the tissue along a path disposed between the inner rows of staples 2220b.

  If desired, as shown in FIG. 47, the inner staple 2220b may be formed to a lower height than the outer staple 2220a, in which case the inner staple 2220b is adjacent to the cutting line formed by the cutting member. A greater clamping pressure or force can be applied to the tissue being applied. For example, a larger clamping pressure or force generated by the inner staple 2220b can provide various therapeutic effects such as reduced bleeding from the incised tissue T, while a smaller clamp generated by the outer staple 2220a. The clamping pressure can provide flexibility within the stapled tissue. 46 and 47, the anvil 2240 may further be attached with at least one buttress material, such as buttress material 2260, for example. For example, the legs of the staples 2220a, 2220b cut through the buttress material 2260 and / or pass through the opening in the buttress material 2260 as the staple cartridge 2200 is compressed by the anvil 2240, after which the staple forming pocket of the anvil 2240 2242 can be configured to contact. As the legs of staples 2220a, 2220b are deformed, each leg can re-contact and / or incise buttress material 2260. Buttress material 2260 can increase hemostasis and / or provide strength to the tissue being stapled.

  46 and 47, the bottom surface of the cartridge body 2210 may have an outer shape formed with a step that matches or at least substantially matches the outer shape of the cartridge support surface 2231 where the step is formed. The bottom surface of the cartridge body 2210 can be deformed to match or at least approximately match the outer shape of the cartridge support surface 2231. Referring now to FIG. 48, for example, an end effector similar to the end effector shown in FIG. 46 may have a staple cartridge 2300 disposed therein. The staple cartridge 2300 may have a compressible and implantable body 2310 having an inner layer 2312 and an outer layer 2311, and in addition to the above, the outer layer 2311 can be constructed of a water impermeable material. The outer layer 2311 may extend around the staples 2220a, 2220b and may be disposed between the staples 2220a, 2220b and the support slots 2232a, 2232b, respectively. Referring now to FIG. 49, for example, an end effector similar to the end effector shown in FIG. 46 may have a staple cartridge 2400 disposed therein. Similar to the staple cartridge 2300, the compressible implantable cartridge body 2410 of the staple cartridge 2400 can have an inner layer 2412 and an outer layer 2411, although the cartridge body 2410 need not have a cutting member slot therein. For example, the cutting member may be required to incise, for example, the inner layer 2412 and / or the outer layer 2411 as it is advanced through the staple cartridge.

  Referring now to FIG. 50, the surgical stapler end effector may include an anvil 2540, a staple cartridge groove member 2530, and a staple cartridge 2500 disposed within the staple cartridge groove member 2530. Similar to the above, the staple cartridge 2500 can include a compressible implantable cartridge body 2510, an outer staple row 2220a, and an inner staple row 2220b. The staple cartridge groove member 2530 can have a flat or at least substantially flat cartridge support surface 2531 and a staple support slot 2532 defined in the groove member 2530. The anvil 2540 can have a step forming surface 2541 and a plurality of staple forming pockets defined in the anvil 2540, such as forming pockets 2542a and 2542b. Similar to the above, a distance greater than the distance between the molding pocket 2452b and the support slot 2532 can be defined between the molding pocket 2542a and the support slot 2532. Anvil 2540 can further include a buttress material 2560 attached to the stepped surface 2541 of the anvil 2540. For example, the buttress material 2560 can match or at least approximately match the shape of the step forming surface 2541. Buttress material 2560 can be removably attached to surface 2541 by at least one adhesive, such as fibrin and / or protein hydrogel. The cartridge body 2510 may also have an outer shape formed with a step that is parallel or at least substantially parallel to the step forming surface 2541 of the anvil 2540, for example. More specifically, the anvil 2540 may have a step 2548 extending in the direction of the staple cartridge 2500, in which case the step 2548 is equal to or at least approximately equal to the step height of the step 2508 extending from the cartridge body 2510. It may have a step height. For example, as a result of the above, the amount of compressible cartridge body 2510 that can be captured within the first staple 2220a can differ from the amount of compressible cartridge body 2510 that can be captured within the second staple 2220b, for example.

  Referring now to FIG. 51, the end effector can have an anvil 2640, a staple cartridge groove member 2530, and a staple cartridge 2600 disposed therebetween. Staple cartridge 2600 can have a compressible implantable cartridge body 2610 that includes an inner layer 2612, an outer layer 2611, and a plurality of staples such as staples 2220a and 2200b disposed therein. The anvil 2640 may have a plurality of staple forming pockets 2642 on the surface 2641, and the staple cartridge groove member 2530 may have a plurality of staple forming slots 2532 defined in the support surface 2531. As shown in FIG. 51, the anvil surface 2641 may be parallel or substantially parallel to the cartridge support surface 2531 and each molding pocket 2642 is equidistant or at least approximately equidistant from the opposing corresponding staple support slot 2532. Can be arranged. Staple cartridge 2600 may include staples having the same or at least about the same initial unformed staple height and the same or at least about the same post-formed staple height. The outer staple row may include staples 2220a, the inner staple row may include staples 2220b, and may have an unformed staple height different from staples 2220a and 2220b, as described above. As the anvil 2640 is moved toward the closed position in the direction of the staple cartridge 2600, the staples 2220a and 2220b can be molded so that they have the same or at least approximately the same staple height after molding. For example, as a result of the above, the outer staple 2220a and the inner staple 2220b after molding may have the same or at least approximately the same amount of compressible cartridge body 2610 housed therein, for example, the outer staple 2220a. Has a higher unformed staple height than the inner staple 2220b but has the same post-molded staple height, the outer staple 2220a can have a higher clamping pressure than the inner staple 2220b.

  Referring now to FIG. 52, the end effector of the surgical stapler can have an anvil 2740, a staple cartridge groove member 2530, and a staple cartridge 2700 disposed within the staple cartridge groove member 2530. As above, the staple cartridge 2700 has a compressible implantable staple cartridge body 2710 that includes an inner layer 2712, an outer layer 2711, and a plurality of staples, eg, staples 2220a and 2220b disposed therein. sell. The thickness of the cartridge body 2710 can vary across its width. For example, the cartridge body 2710 may include a central portion 2708 and side portions 2709, and the central portion 2708 can have a greater thickness than the side portions 2709. The thickest portion of the cartridge body 2710 can be located at the central portion 2708 and the thinnest portion of the cartridge body 2710 can be located at the side 2709. For example, the thickness of the cartridge body 2710 can gradually decrease between the central portion 2708 and the side portion 2709. The thickness of the cartridge body 2710 may decrease linearly and / or geometrically between the central portion 2708 and the side 2709. For example, the tissue contacting surface 2719 of the cartridge body 2710 can include two inclined or angled surfaces that are inclined downwardly from the central portion 2708 toward the side 2709. Anvil 2740 may include two inclined or angled surfaces that are parallel or at least approximately parallel to inclined tissue contacting surface 2719. Anvil 2740 can further include at least one buttress material 2760 attached to the inclined surface of anvil 2740.

  In addition to the above, the inner staple row in staple cartridge 2700 may include higher staples 2220a and the outer staple row may include shorter staples 2220b. The higher staple 2220a can be placed in and / or adjacent to the thicker central portion 2708, while the staple 2220b can be placed in and / or adjacent to the side 2709. it can. For example, as a result of the above, the higher staple 2220a may capture more material of the implantable cartridge body 2710 than the shorter staple 2220b. In such a situation, the staple 2220a applies a greater clamping pressure to the tissue T than the staple 2220b. The higher staples 2220a can capture more cartridge body 2710 material therein than the shorter staples 2220b, but because of the slanted configuration of staple forming pockets 2742a and 2742b, the staples 2220a are shorter staples 2220b. May have a higher post-mold staple height. By taking such considerations, a desired clamping pressure is achieved in the tissue captured by the staples 2220a and 2220b so that, for example, the clamping pressure in the staple 2220a is applied to the tissue by the staple 2220b. It can be greater than, less than or equal to the clamping pressure. As an alternative to the end effector shown in FIG. 52, the shorter staple 2220b is positioned within and / or adjacent to the thicker central portion 2708 of the cartridge body 2710, with the higher staple 2220a being thinner. It can be arranged inside the side portion 2709 and / or adjacent thereto. Further, although the staple cartridge 2700 is shown as including an inner row and an outer row of staples, the staple cartridge 2700 may be a staple row such as, for example, a staple row disposed between an inner row and an outer row of staples. A staple row can be included. For example, the intermediate staple row may include staples having an unformed staple height of staples 2220a and 2220b and an unformed staple height that is intermediate to the staple height after forming of staples 2220a and 2220b, for example. .

  Referring now to FIG. 53, the end effector of the surgical stapler can include an anvil 2840, a staple cartridge groove member 2530, and a staple cartridge 2800 disposed within the staple cartridge groove member 2530. Similar to the above, the staple cartridge 2800 can include a compressible implantable staple cartridge body 2810 that includes an inner layer 2812, an outer layer 2811, and a plurality of staples, eg, staples 2220a and 2220b disposed therein. . The thickness of the cartridge body 2810 can vary across its width. For example, the cartridge body 2810 can include a central portion 2808 and side portions 2809, and the central portion 2808 can have a thickness that is less than the thickness of the side portions 2809. The thinnest portion of the cartridge body 2810 may be located in the central portion 2808 and the thickest portion of the cartridge body 2810 may be located in the side 2809. For example, the thickness of the cartridge body 2810 can gradually decrease between the central portion 2808 and the side 2809. The thickness of the cartridge body 2810 can increase linearly and / or geometrically between the central portion 2808 and the side 2809. For example, the tissue contacting surface 2819 of the cartridge body 2810 can include two inclined or angled surfaces that are inclined upwardly from the central portion 2808 toward the side 2809. Anvil 2840 can include two inclined or angled surfaces that are parallel or at least approximately parallel to inclined tissue contacting surface 2819. Anvil 2840 can further include at least one buttress material 2860 attached to the inclined surface of anvil 2840. In addition to the above, the outer staple row in staple cartridge 2800 may include higher staples 2220a and the inner staple row may include shorter staples 2220b. Staples 2220b can be positioned in and / or adjacent to central portion 2808, while higher staples 2220a can be positioned in and / or adjacent to thicker sides 2809. For example, as a result of the above, the higher staple 2220a may capture more material of the implantable cartridge body 2810 than the shorter staple 2220b.

  For example, as described above with respect to FIG. 46, staple cartridge groove member 2230 has a stepped support surface 2231 that can be configured to support staples 2220a and 2220b at different heights relative to anvil 2240. Yes. The staple cartridge groove member 2230 can be made of metal, and the step of the support surface 2231 can be formed on the support surface 2231 by, for example, a grinder operation. Referring to FIG. 54, the end effector of a surgical instrument can include a staple cartridge groove member 2930 with a support insert 2935 disposed therein. More specifically, the staple cartridge groove member 2930 can be configured to support an insert 2935 having a stepped surface for supporting the staples 2220a and 2220b of the staple cartridge 2200 at different heights, for example flat or It can be formed to have at least a substantially flat support surface 2931. For example, the insert 2935 can have a flat or at least substantially flat bottom surface that can be disposed against the support surface 2931. The insert 2935 may further include support slots, grooves or troughs 2932a and 2932b, which may be configured to support the staples 2220a and 2220b, respectively, at different heights. As above, the insert 2935 may have a knife slot 2939 defined therein that can be configured to allow a cutting member to pass therethrough. The staple cartridge groove member 2930 can be constructed of the same material as the support insert 2935 or a different material. Both staple cartridge groove member 2930 and support insert 2935 may be comprised of, for example, metal, but alternatively staple cartridge groove member 2930 may be comprised of, for example, metal, and support insert 2935 may be comprised of, for example, plastic. The support insert 2935 can be fastened into and / or welded to the staple cartridge groove member 2930. Support insert 2935 may be snapped and / or press fit into staple cartridge groove member 2930. Support insert 2935 can also be secured to staple cartridge groove member 2930 using an adhesive.

  Referring now to FIG. 55, the surgical stapler end effector can include an anvil 3040, a staple cartridge groove member 3030, and a compressible implantable staple cartridge 3000 disposed within the staple cartridge groove member 3030. As above, the anvil 3040 can have a plurality of staple forming pockets 3042 defined therein and a knife slot 3049 that can be configured to slidably receive a cutting member therein. Similar to the above, the staple cartridge groove member 3030 can have a plurality of staple support slots 3032 defined therein and a knife slot 3039 that can also be configured to slidably receive a cutting member therein. . Staple cartridge 3000 may include a first layer 3011, a second layer 3012, and a plurality of staples, such as staples 3020a and 3020b disposed therein, for example. Staples 3020a can have an unformed staple height that is higher than the unformed staple height of staples 3020b. The first layer 3011 can be composed of a first compressible material, and the second layer 3012 can be composed of a second compressible material. The first compressible material may be compressed at a higher rate than the second compressible material, but the first compressible material may be compressed at a lower rate than the second compressible material. The first compressible material can be composed of an elastic material that can have a first spring constant, and the second compressible material has a second spring constant that is different from the first spring constant. It can be made of an elastic material. The first compressible material may have a spring constant that is higher than the spring constant of the second compressible material. The first compressible material may have a spring constant that is lower than the spring constant of the second compressible material. The first compressible layer may have a first stiffness, the second compressible layer may have a second stiffness, and the first stiffness is different from the second stiffness. The first compressible layer can have a stiffness that is higher than the stiffness of the second compressible layer. The first compressible layer may have a stiffness that is lower than that of the second compressible layer.

  Referring again to FIG. 55, the second layer 3012 of the staple cartridge 3000 can have a constant or at least approximately constant thickness across its width. The first layer 3011 can have a thickness that varies across its width. For example, the first layer 3011 can have one or more steps 3008 that can increase the thickness of the cartridge 3010 in a central portion of the cartridge body 3010, such as the central portion. Referring again to FIG. 55, the shorter staple 3020b may be placed in or aligned with the step 3008 (ie, the thicker portion of the cartridge body 3010), while the higher staple 3020a It can be placed in a thin section or aligned with it. If desired, as a result of the thicker and thinner portions of the cartridge body 3010, the stiffness of the cartridge body 3010 can be higher along the inner staple row 3020b than the outer staple row 3020a. The first layer 3011 can be combined with the second layer 3012. For example, the first layer 3011 and the second layer 3012 can include a coupling mechanism that can hold the layers 3011 and 3012 together. The first layer 3011 may include a first stack, the second layer 3012 may include a second stack, and the first stack may be a second stack with one or more adhesives. Can be glued to the body. The staple cartridge 3000 can have a knife slot 3003 that can be configured to slidably receive a cutting member therein.

  Referring now to FIG. 56, a staple cartridge 3100 includes a compressible implantable cartridge body 3110 that includes a single layer of compressible material and a plurality of staples, eg, staples 3020b disposed therein. sell. The thickness of the cartridge body 3110 can vary across its width. For example, the cartridge body 3110 can include a step 3108 extending along its side. Referring now to FIG. 57, a staple cartridge 3200 includes a compressible implantable cartridge body 3210 that includes a single layer of compressible material and a plurality of staples, eg, staples 3020b disposed therein. sell. The thickness of the cartridge body 3210 can vary across its width. For example, the cartridge body 3210 can include a step 3208 extending along its central portion. Referring now to FIG. 58, the staple cartridge 3300 may have a compressible implantable cartridge body 3310, and the thickness of the cartridge body 3310 may vary across its width, as described above. The thickness of the cartridge body 3310 can increase geometrically between the side and center portions of the cartridge body 3310. For example, the thickness of the cartridge body 3310 may be defined by an arcuate or curved profile and may form an arcuate or curved tissue contacting surface 3319. The thickness of the body 3310 and the outer shape of the tissue contacting surface 3319 can be defined, for example, by a single radius of curvature or multiple radii of curvature. Referring now to FIG. 59, the staple cartridge 3400 may have a compressible implantable cartridge body 3410 where the thickness of the cartridge body 3410 is between the side and center portions of the cartridge body 3410. It can increase linearly or at least approximately linearly between.

  Referring now to FIG. 60, a staple cartridge 3500 can include a compressible implantable cartridge body 3510 and a plurality of staples 3520 disposed therein. The implantable cartridge body 3510 can include a first inner layer 3512, a second inner layer 3513, and an outer layer 3511. The first inner layer 3512 may have a first thickness, the second inner layer 3513 may have a second thickness, and the second inner layer 3513 is more than the first layer 3512. It can be thick. Alternatively, the first inner layer 3512 may be thicker than the second inner layer 3513. As a further alternative, the first inner layer 3512 may have the same or substantially the same thickness as the second inner layer 3513. Each staple 3520 can have a base 3522 and one or more deformable legs 3521 extending from the base 3522. If desired, each leg 3521 may have a tip 3523 embedded within the first inner layer 3511, and each base 3522 of the staple 3520 may be encased within the second inner layer 3512. Can be buried. The first inner layer 3512 and / or the second layer 3513 may include at least one drug stored therein, and the outer layer 3511 includes the first inner layer 3512 and the second inner layer 3513. It can be encapsulated and sealed so that the drug does not flow out of the staple cartridge body 3510 until after the outer layer 3511 has been perforated by the staple 3520. More specifically, in addition to the above, the anvil is pushed downward against tissue disposed against the tissue contacting surface 3519 of the staple cartridge 3500, thereby compressing the cartridge body 3510 and lowering the surface 3519 downward. , At least partially below the staple tip 3523, causing the tip 3523 to rupture or perforate the outer layer 3511. After the outer layer 3511 is cleaved by the staple legs 3521, at least one drug M can flow out of the cartridge body 3510 around the staple legs 3521. In various situations, further compression of the cartridge body 3510 squeezes additional drug M from the cartridge body 3510, as shown in FIG.

  Referring again to FIG. 60, the outer layer 3511 may include a wrap that is impermeable or at least substantially impermeable to water, which wraps 1) that the drug flows out of the staple cartridge 3500 early. 2) it can be configured to prevent liquid in the surgical site from flowing into the staple cartridge 3500 early. The first inner layer 3512 can store or absorb a first drug therein, the second inner layer 3513 can store or absorb a second drug therein, and the second drug May be different from the first agent. Initial compression of the cartridge body 3510 that results in the rupture of the outer layer 3511 can generally squeeze the first drug from the first inner layer 3512, and subsequent compression of the cartridge body 3510 is generally second. Can be squeezed out of the second inner layer 3513. However, in such a case, the first drug and a part of the second drug can be squeezed at the same time. However, most of the drug squeezed first consists of the first drug, and then the squeezed drug The majority can consist of a second drug. In addition to the above, the first inner layer 3512 may be composed of a material that is more compressible than the second inner layer 3513, so that the initial compressive force may be lower than the subsequent compressive force or pressure. Or, the initial deflection can be greater in the first inner layer 3512 than in the second inner layer 3513. Such a larger initial deflection in the first inner layer 3512 causes a greater percentage of the first drug to squeeze out of the first inner layer 3512 than the second drug squeezed out of the second inner layer 3513. Is issued. The first inner layer 3512 can be more porous and / or flexible than the second inner layer 3513. For example, the first inner layer 3512 may have a plurality of holes or spaces 3508 defined therein, and the second inner layer 3513 has a plurality of holes or spaces 3509 defined therein. The hole 3508 may be configured to store a first drug in the first inner layer 3512 and the hole 3509 may be configured to store a second drug in the second inner layer 3513. can do. The size and density of the holes 3508 in the first inner layer 3512 and the holes 3509 in the second inner layer 3513 can be selected to provide the desired results described herein.

  60 and 61, the outer layer 3511, the first inner layer 3512, and / or the second inner layer 3513 can be composed of a bioabsorbable material. The first inner layer 3512 is made of a first bioabsorbable material, the second inner layer 3513 is made of a second bioabsorbable material, and the outer layer 3511 is made of a third bioabsorbable material. The first bioabsorbable material, the second bioabsorbable material, and / or the third bioabsorbable material can be made of different materials. The first bioabsorbable material may be bioabsorbed at a first rate, the second bioabsorbable material may be bioabsorbed at a second rate, and the third bioabsorbable material may be a third May be bioabsorbed at a rate, and the first rate, the second rate and / or the third rate may be different. For example, if the material is bioabsorbed at a specific rate, such rate can be defined as the mass of material absorbed into the patient's body per unit time. As is known, different patient bodies can absorb different materials at different rates, so such rates can be expressed as average rates to account for such variability. In any case, the faster speed is the speed at which more mass can be bioabsorbed per unit time than the slower speed. Referring to FIGS. 60 and 61, the first inner layer 3512 and / or the second inner layer 3513 can be made of a material that is bioabsorbed at a higher rate than the material that makes up the outer layer 3511. For example, the first inner layer 3512 and / or the second inner layer 3513 can be comprised of a bioabsorbable foam material, tissue sealant, and / or a hemostatic material such as, for example, oxidized regenerated cellulose (ORC). , Outer layer 3511 may be made of buttress material and / or polyglycolic acid (PGA) (commercially available under the trade name Vicryl), polylactic acid (PLA or PLLA), polydioxane (PDS), polyhydroxyalkanoate (PHA), Polygrecapron 25 (PGCL) (commercially available under the trade name Monocryl), polycaprolactone (PCL), and / or plastic materials such as PGA, PLA, PDS, PHA, PGCL and / or PCL composites. Can do. In such cases, the first inner layer 3512 and / or the second inner layer 3513 can quickly treat the tissue and reduce bleeding from the tissue, for example, the outer layer 3514 can be a long-term Structural support and can be bioabsorbed at a slower rate.

  In addition to the above, because of the slower rate of bioabsorbability of the outer layer 3511, the outer layer 3511 can strengthen or structurally strengthen the tissue as the tissue in the staple row heals. One of the first inner layer 3512 and the second inner layer 3513 can be composed of a material that can be bioabsorbed faster than the other, so that one of the layers can provide an initial release of the therapeutic substance, The other layer can provide sustained release of the same therapeutic agent and / or different therapeutic agents. For example, the rate at which the therapeutic agent is released from the layers 3512, 3513 can be a function of the bioabsorbability of the substrate layer where the drug is absorbed or dispersed. For example, the substrate that makes up the first inner layer 3512 may be bioabsorbed earlier than the substrate that makes up the second inner layer 3513 so that the drug is faster than, for example, the second layer 3513 It can be released from the first inner layer 3512. Optionally, as described herein, one or more of the layers 3511, 3512 and 3513 of the cartridge body 3510 may be attached by at least one adhesive, such as fibrin and / or protein hydrogels, for example. Can be glued together. The adhesive can be water soluble and can be configured to release the bond between the layers when and / or shortly after the staple cartridge 3500 is implanted. For example, the adhesive can be configured to bioabsorb faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

  Referring now to FIGS. 62 and 63, a staple cartridge, such as, for example, a staple cartridge 3600, includes a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a second layer. The cartridge body 3610 may include a peelable compressible layer 3613 attached to the layer 3612 of the cartridge. For example, the first layer 3611 can be composed of a compressible foam material, and the second layer 3612 is adhered to the first layer 3611 using one or more adhesives. The third layer 3613 may comprise a laminate material and may be composed of a compressible foam material that is releasably attached to the second layer 3612 using, for example, one or more adhesives. it can. Staple cartridge 3600 can further include a plurality of staples, such as, for example, staple 3620, disposed within cartridge body 3610. For example, each staple 3620 includes a base 3622 disposed in the third layer 3613 and one or more extending upward from the base 3622 through the second layer 3612 and into the first layer 3611. Of deformable legs 3621. In addition to the above, in use, the top surface 3619 of the staple cartridge body 3610 can be pushed downward by the anvil until the staple legs 3621 penetrate the top surface 3619 and the target tissue and contact the anvil. After the staple legs 3621 are fully deformed, each compressible layer can be at least partially re-inflated by moving the anvil away from the staple cartridge 3600. In various situations, insertion of staples through tissue can cause tissue bleeding. The third layer 3613 can be composed of an absorbent material, such as a protein hydrogel, that can absorb blood from the stapled tissue. In addition to or in lieu of the above, the third layer 3613 is made of a hemostatic material and / or tissue sealant that can be configured to reduce bleeding from the tissue, such as lyophilized thrombin and / or fibrin. Can be configured. The third layer 3613 can provide structural support to the first layer 3611 and the second layer 3612, in which case the third layer 3613 is a bioabsorbable material and / or a non-bioabsorbable material. Can be configured. In either case, the third layer 3613 can be separated from the second layer 3612 after the staple cartridge 3610 has been implanted. If the third layer 3613 comprises an implantable quality material, the surgeon can choose whether to peel the third layer 3613 of the cartridge body 3610. The third layer 3613 can be configured to be peeled from the second layer 3612 as a unit.

  The first layer 3611 can be composed of a first foam material, and the third layer 3613 can be composed of a second foam material that can be different from the first foam material. The first foam material may have a first density, the second foam material may have a second density, and the first density may be different from the second density. For example, the second density may be higher than the first density, so that the third layer 3613 may be less compressible or have a lower compression rate than the first layer 3611. Alternatively, the first density may be higher than the second density, so that the first layer 3611 may be less compressible or have a lower compression rate than the third layer 3613. 64 and 65, similar to the staple cartridge 3600, the staple cartridge 3700 includes a first compressible foam material layer 3711, a second layer 3712 attached to the first layer 3711, and a second layer. A cartridge body 3710 that includes a detachable third layer of compressible foam material 3713 releasably attached to the layer 3712 of the cartridge. For example, the third layer 3713 can have a plurality of staple receiving slots or cutouts 3709 that can each be configured to receive at least a portion of a staple 3620, such as a staple base 3622, for example. Staple 3620 can be configured to slide within staple receiving slot 3709, in other words, third layer 3713 is stapled when staple cartridge 3700 is placed against the target tissue and compressed by the anvil. It can be configured to slide relative to 3620. The receiving slot 3709 can be configured such that there is a gap between the staple 3620 and the side wall of the receiving slot 3709. For example, as shown in FIGS. 64 and 65, as a result of the above, the staple 3620 may not capture a portion of the third layer 3713 therein when the staple 3620 is deformed. Both ends of the staple receiving slot 3709 adjacent to the second layer 3712 can be closed by a portion of the third layer 3713 so that at least a portion of the third layer 3713 is deformed when the staple 3620 is deformed. Can be captured within the staple 3620. In any case, the third layer 3713 can be configured such that the third layer 3713 can be peeled from the second layer 3712 as two or more portions, for example, as shown in FIG. Or it may have two or more perforations and / or indents 3708. In FIG. 64, one of the portions of the third layer 3713 is shown being peeled from the tool 3755. The perforation 3708 can be disposed along a line located between the first staple row and the second staple row.

  Referring again to FIGS. 64 and 65, the base 3622 of the staple 3620 can be placed in the receiving slot 3709 and the side wall of the receiving slot 3709 contacts the staple leg 3621 to releasably place the staple leg 3621 in place. It can be configured to hold. Although not shown in the figure, the third layer 3713 may have an elongated slot that surrounds all of the staples in a single staple row. For example, a staple cartridge that includes four staple rows may include an elongated slot that is aligned with each staple row in the bottom layer of the staple cartridge. In addition to the above, at least a portion of the staple cartridge 3600 and / or the staple cartridge 3700 can be implanted in the patient's body and at least a portion of the staple cartridge can be removed from the patient. Referring again to FIGS. 64 and 65, the first layer 3711 and the second layer 3712 can be captured within the staple 3620 and can be implanted with the staple 3620, and the third layer 3713 can be If desired, the staple cartridge 3700 can be peeled off or separated. In various situations, removal of a portion of the implanted staple cartridge can reduce the amount of material that can have various therapeutic effects that the patient's body must reabsorb. For example, if a portion of the staple cartridge is separated and removed by a laparoscope 3755, the separated staple cartridge portion can be removed from the surgical site through a trocar, such as a trocar having a 5 mm opening, for example. The cartridge body can have two or more layers that can be removed. For example, the cartridge body 3710 may include a fourth layer, the third layer 3713 of the cartridge body 3710 may be composed of a hemostatic material, and the fourth layer may be composed of a support layer. For example, the surgeon can choose to remove the support layer and then remove the hemostatic layer, for example.

  Referring now to FIG. 66, for example, a staple cartridge such as staple cartridge 3800 can include a cartridge body 3810 having an outer layer 3811 and an inner layer 3812. Inner layer 3812 can be comprised of a compressible foam material and outer layer 3811 can be at least partially wrapped around inner layer 3812. The outer layer 3811 has a first portion 3811a configured to be disposed on the first side of the inner layer 3812 and a second configured to be disposed on the second side of the inner layer 3812. The first portion 3811a and the second portion 3811b can be connected by a flexible hinge such as a hinge 3809, for example. For example, at least one adhesive, such as fibrin and / or protein hydrogel, can be applied to secure a portion of the outer layer 3811 to the first side and / or the second side of the inner layer 3812. The outer layer 3811 can have one or more fastening members extending from the outer layer 3811. For example, the outer layer 3811 can have a plurality of deformable legs 3821 extending from one side of the outer layer 3811 that can be disposed within the compressible inner layer 3812. For example, the legs 3821 may not protrude from the second side of the inner layer 3812, or alternatively, the legs 3821 may protrude at least partially from the inner layer 3812. When the compressible cartridge body 3810 is compressed in use, the legs 3821 can be configured to penetrate the inner layer 3812 and the second portion 3811b of the outer layer 3811. The second portion 3811b of the outer layer 3811 can be defined with an opening, such as an opening 3808, that can be configured to receive the staple legs 3821. At least a portion of the staple cartridge 3800 can have a knife slot 3803 that can be configured to slidably receive a cutting member therein. For example, the knife slot 3803 may extend completely through the thickness of the cartridge body 3810 so that the cartridge body 3810 can be incised as the cutting member is moved relative to the cartridge body 3810. it can.

  Referring now to FIG. 67, the staple cartridge 3900 can include a cartridge body 3910 having an inner layer 3812 and an outer layer 3811, similar to the staple cartridge 3800, where the outer layer 3811 is a first of the inner layer 3812. A first portion 3811a disposed adjacent to the side surface and a second portion 3811b disposed adjacent to the second side surface of the inner layer 3812 may be included. As above, the outer layer 3811 can have one or more fastening members extending from the outer layer 3811. For example, the outer layer 3811 can have a plurality of deformable legs 3921 extending from one side of the outer layer 3811 that can be disposed within the compressible inner layer 3812. From each deformable leg 3921, at least one hook or barb that can be configured to hold the outer layer 3811 against the inner layer 3812 as a result of engaging the second portion 3811b of the outer layer 3811. 3923 may protrude. For example, the barb 3923 can be configured to protrude from the second side of the inner layer 3812 and extend through the opening 3808 of the second portion 3811b of the outer layer 3811, thereby providing the barb 3923. Can engage the outer surface of the outer layer 3811 to secure the outer layer 3811 to the inner layer 3812. The staple cartridge 3900 can be constructed by at least partially compressing the inner layer 3812 so that the barbs protrude from the inner layer 3812 into the opening 3808. For example, the staple cartridge 3900 can be pre-compressed at least partially when inserted into the staple cartridge, for example. In addition to the above, at least a portion of the leg 3921 can be embedded within the first portion 3811a of the outer layer 3811, in which case the outer layer 3811 can be, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), etc. The plastic material can be overmolded around at least a portion of the leg 3921.

  68-72, for example, a staple cartridge, such as staple cartridge 4000, includes a compressible first layer 4011 and a second layer 4012, a cartridge body 4010, and further within the cartridge body 4010. There may be a plurality of staples 4020 arranged. Referring to FIG. 70, each staple 4020 can include a base 4022 and at least one deformable leg 4023 extending from the base 4022. Referring to FIG. 68, the staple cartridge 4000 is disposed between the staple cartridge groove member 4030 and the end effector anvil 4040 of the surgical stapler and the second layer 4012 of the cartridge body 4010 and / or the base of the staple 4020. 4022 can be disposed in contact with the staple cartridge groove member 4030. Referring now to FIG. 69, the second layer 4012 can include a layer of pledgets 4060 that are connected together by a pledget support frame 4061. For example, pledget 4060 and pledget support frame 4061 can be constructed of a molded plastic material, such as, for example, polyglycolic acid (PGA). Each pledget 4060 can have one or more openings or slots 4062 that can be configured to receive staple legs 4021 extending therethrough, as shown in FIGS. 70 and 71. Each pledget 4060 can further include a receiving slot 4063 defined therein that can be configured to receive the base 4022 of the staple 4020. Referring again to FIG. 69, the pledget 4060 and / or pledget support frame 4061 can have a plurality of indentations, perforations, etc. that can be configured to allow the pledget 4060 to be separated from the pledget support frame 4061 at a desired location. . Similarly, referring to FIG. 71, one or more pledgets 4060 may be coupled together, for example, along a line that includes perforations and / or notches 4064. In use, the compressible foam layer 4011 can be placed against the target tissue T, and the anvil 4040 can deform the staple 4020 as the cartridge body 4010 is compressed by the anvil 4040. As the staples 4020 are deformed, the staple legs 4021 of each staple 4020 can capture the tissue T, a portion of the first layer 4011, and the pledget 4060 within the deformed staples. For example, when the staple cartridge groove member 4030 is moved away from the implanted staple cartridge 4060, the pledget support frame 4061 can be separated from the pledget 4060 and / or the pledgets 4060 can be separated from each other. In certain circumstances, the pledgets 4060 may be separated from the frame 4061 and / or from each other when the staples 4020 are deformed by the anvil 4040 as described above.

  As described herein, the staples of the staple cartridge can be completely formed by the anvil when the anvil is moved to the closed position. Alternatively, referring now to FIGS. 73-76, staples of a staple cartridge, such as staple cartridge 4100, for example, are staple drivers that move the staple further toward the closed anvil as the anvil moves to the closed position. It can be modified by the system. Staple cartridge 4100 can include, for example, a compressible cartridge body 4110 that can be comprised of a foam material and a plurality of staples 4120 disposed at least partially within compressible cartridge body 4110. The staple driver system can include a driver holder 4160, a plurality of staple drivers 4162 disposed in the driver holder 4160, and a staple cartridge pan 4180 that can be configured to hold the staple drivers 4162 in the driver holder 4160. For example, the staple driver 4162 can be placed in one or more slots 4163 of the driver holder 4160, where the side walls of the slot 4163 help guide the staple driver 4162 upward toward the anvil. sell. Staple 4120 is supported in slot 4163 by staple driver 4162, and staple 4120 can be fully disposed in slot 4163 when staple 4120 and staple driver 4162 are in their unfired positions. Alternatively, at least a portion of the staple 4120 may extend upward through the open end 4161 of the slot 4163 when the staple 4120 and staple driver 4162 are in their unfired positions. For example, referring now primarily to FIG. 74, the base of the staple 4120 can be disposed within the driver holder 4160 and the distal end of the staple 4120 can be embedded within the compressible cartridge body 4110. About one third of the height of the staple 4120 may be disposed within the driver holder 4160 and about two thirds of the height of the staple 4120 may be disposed within the cartridge body 4110. Referring to FIG. 73A, the staple cartridge 4100 may further include a water impermeable wrap or membrane 4111 that surrounds the cartridge body 4110 and the driver holder 4160, for example.

  In use, the staple cartridge 4100 can be placed, for example, in a staple cartridge groove member and the anvil can be moved toward the staple cartridge 4100 to a closed position. When the anvil is moved to its closed position, it can contact and compress the compressible cartridge body 4110. The anvil may not contact the staple 4120 when in the closed position. When the anvil is moved to its closed position, it can contact the legs of the staple 4120 and cause the staple 4120 to deform at least partially. In any case, the staple cartridge 4100 may further include one or more threads 4170 that can be advanced longitudinally within the staple cartridge 4100 such that the threads 4170 are in sequential engagement with the staple driver 4162. The staple driver 4162 and the staple 4120 can be moved in the direction of the anvil. The sled 4170 can slide between the staple cartridge pan 4180 and the staple driver 4162. If the forming process of the staple 4120 is initiated by closing the anvil, the upward movement of the staple 4120 toward the anvil completes the forming process, and the staple 4120 is fully formed, or at least to the desired height. And can be transformed. If the staple 4120 is not deformed by closing the anvil, the upward movement of the staple 4120 toward the anvil initiates and completes the forming process, causing the staple 4120 to be fully formed, or at least deformed to the desired height. be able to. By allowing the sled 4170 to advance from the proximal end of the staple cartridge 4100 to the distal end of the staple cartridge 4100, the staple 4120 disposed at the proximal end of the staple cartridge 4100 is disposed at the distal end of the staple cartridge 4100. The formed staple 4120 is fully formed before it is fully formed. Referring to FIG. 75, the threads 4170 can each include at least one angled or inclined surface 4711 that slides under the staple driver 4162 as shown in FIG. The staple driver 4162 can be configured to lift.

  In addition to the above, forming the staple 4120 allows at least a portion of the tissue T and at least a portion of the compressible cartridge body 4110 of the staple cartridge 4100 to be captured therein. After the staple 4120 is formed, the surgical stapler anvil and staple cartridge groove member 4130 can be moved away from the implanted staple cartridge 4100. In various situations, the cartridge pan 4180 is securely fitted with the staple cartridge groove member 4130 so that the cartridge pan 4180 is compressible when the staple cartridge groove member 4130 is pulled away from the implanted cartridge body 4110. The cartridge body 4110 can be separated. Referring again to FIG. 73, the cartridge pan 4180 can have opposing sidewalls 4181 between which the cartridge body 4110 can be removably mounted. For example, the compressible cartridge body 4110 is compressed between the side walls 4181 so that the cartridge body 4110 is removably retained between the side walls 4181 during use, and is removed from the cartridge pan 4180 when the cartridge pan 4180 is pulled apart. Can be releasably released. For example, the driver holder 4160 can be coupled to the cartridge pan 4180 such that the driver holder 4160, driver 4162, and / or sled 4170 remain within the cartridge pan 4180 when the cartridge pan 4180 is removed from the surgical site. The driver 4162 may be ejected from the driver holder 4160 and left at the surgical site. For example, the driver 4162 includes polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) sold under the trade name Vircyl, and polygregal sold under the trade name Monocryl. It can be composed of a bioabsorbable material such as capron 25 (PGCL), polycaprolactone (PCL), and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL. Driver 4162 can be attached to staple 4120 for deployment with staple 4120. For example, each driver 4162 may have a trough configured to receive a base of staples 4120, for example, where each trough is configured to receive a staple base by press fit and / or snap fit. can do.

  In addition to the above, driver holder 4160 and / or sled 4170 can be ejected from cartridge pan 4180. For example, the sled 4170 can slide between the cartridge pan 4180 and the driver holder 4160 so that when the sled 4170 is advanced and pushes the staple driver 4162 and staple 4120 upward, the sled 4170 is in the driver holder 4160. Can be moved upward to the outside of the cartridge pan 4180 in the same manner. For example, the driver holder 4160 and / or the thread 4170 may be polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name Monocryl sold under the trade name Vircyl. Can be composed of a bioabsorbable material such as polygrecapron 25 (PGCL), polycaprolactone (PCL), and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL sold on the market. The sled 4170 can be integrally formed and / or attached to a driver bar or cutting member that pushes the sled 4170 through the staple cartridge 4100. In such a case, the sled 4170 may not be ejected from the cartridge pan 4180 and may stay with the surgical stapler, but in other cases where the sled 4170 is not attached to the driver bar, the sled 4170 is left behind at the surgical site. Also good. In any case, in addition to the above, because of the compressibility of the cartridge body 4110, the cartridge body 4110 can be compressed or contracted when the stapler anvil is closed, so that a thicker staple cartridge is attached to the end of the surgical stapler. Can be used in effectors. As a result of the at least partial deformation of the staples as the anvil closes, it is possible to use higher staples such as, for example, staples having a staple height of about 4.6 mm (0.18 "); In that case, a staple height of about 3.0 mm (0.12 ″) can be placed in the compressible layer 4110, and the compressible layer 4110 can be, for example, about 3.6 mm (0.14 ″) non- Can have a compressed height.

  77-80, a staple cartridge, such as a staple cartridge 4200, for example, includes a compressible cartridge body 4210, a plurality of staples 4220 disposed therein, and a plurality of flexible side support members 4234. Can be included. Referring now to FIG. 78, the staple cartridge 4200 can be positioned between the anvil 4240 and the staple cartridge groove member 4230 and the side support member 4234 can be attached to the staple cartridge groove member 4230. As shown in FIG. 79, when the anvil 4240 is moved downward to compress the cartridge body 4210 and at least partially deform the staple 4220, the side of the cartridge body 4210 bulges laterally to support the side. The member 4234 can be pushed outward. For example, the side support member 4234 may be attached to the cartridge body 4210, and when the cartridge body 4210 bulges in the lateral direction as described above, the side support member 4234 is separated from the cartridge body 4210 as shown in FIG. Yes. Side support member 4234 can be adhered to cartridge body 4210 using at least one adhesive such as fibrin and / or protein hydrogel. As above, closing the anvil 4240 may cause the staple 4220 to be only partially deformed, in which case the formation of the staple 4220 is one or two through the staple cartridge 4200 as shown in FIG. The above-described advancement of the thread 4270 can be completed. 82 and 83, the sled 4270 can be advanced by the cutting member 4280 from the proximal end of the staple cartridge 4200 to the distal end of the staple cartridge 4200. For example, cutting member 4280 can include a cutting element or knife 4283 that can be advanced through tissue T and / or compressible cartridge body 4210. The cutting member 4280 can have a cam member 4282 that can move along the outer surfaces of the jaws 4230 and 4240 to move the jaws or hold them in place. If desired, as a result of the above, staples 4220 can be formed into their final shape at the same time or at least about the same time as tissue T is incised. For example, the thread 4270 can be placed distal to the knife 4283 so that the tissue T is incised only when, for example, the treated portion of tissue is fully stapled.

  Referring again to FIGS. 82 and 83, the sled 4270 can include separate slidable members that are advanced together by the cutting member 4280. For example, the sled 4270 can be contained within the staple cartridge 4200 and the cutting member 4280 can be advanced into the staple cartridge 4200 by the firing bar 4281 so that the cutting member 4280 engages the sled 4270 and disengages the sled 4270. Advance forward. The threads 4270 may be coupled together. In any case, each thread 4270 can have an angled surface or cam 4271 that can be configured to lift the staples 4220 aligned within the staple row. The angled surface 4271 can be formed integrally with the cutting member 4280. Referring again to FIGS. 82 and 83, each staple 4200 is overmolded around a base, at least one deformable member extending from the base, and / or at least a portion of the deformable member of the staple and / or staple 4200. And / or have a crown 4229 arranged. If desired, such a crown 4229 can be configured to be pushed directly by, for example, a thread 4270. More particularly, the crown 4229 of the staple 4220 is configured such that the angled surface 4271 of the sled 4270 slides downward and is in direct contact with the crown 4229 without a staple driver disposed therebetween. can do. In such a case, each crown 4229 may have at least one cooperating angled or inclined surface that can engage the angled surface 4271 of the sled 4270, thereby As the sled 4270 slides under the staple 4220, cooperating angled surfaces can push the staple 4220 upward.

  Referring now to FIG. 81, a staple cartridge, such as staple cartridge 4300, for example, can have a compressible body 4310 and a plurality of staples 4320 disposed within the compressible body 4310. Similar to the above, the staple cartridge 4300 can have a flexible side support 4334 that can be attached to a staple cartridge groove member and / or adhered to a compressible body 4310. In addition to the above, the flexible side supports 4334 are connected to each other by one or more struts or connecting members 4335 that can be configured to hold the side supports 4334 together. sell. In use, the connecting member 4335 can be configured to prevent or at least inhibit the side support 4334 from separating early from the cartridge body 4310. The connecting member 4335 can be configured to hold the side support 4334 together after the staple cartridge 4300 is compressed by the anvil. In such a case, the side support 4334 can resist lateral bulging or displacement of the side of the cartridge body 4310. For example, a cutting member, such as cutting member 4280, can be configured to cut coupling member 4335 as cutting member 4280 moves distally within cartridge body 4310. For example, the cutting member 4280 can be configured to press and staple the staple 4320 against the anvil, eg, by pushing one or more threads, such as the thread 4270, distally. The thread 4270 may guide the cutting edge 4283 so that the cutting member 4280 does not cut the connecting member 4335 until the staple 4320 adjacent to the connecting member 4335 is fully formed or at least formed to a desired height. it can. In various situations, the coupling member 4335 can cooperate with the side support 4334 to prevent or at least reduce lateral movement of the compressible cartridge body 4310 while at the same time within the cartridge body 4310. Lateral movement of the disposed staple 4320 can be prevented or at least reduced. In certain circumstances, the connecting member 4335 can hold the staple 4320 in place until the staple 4320 is deformed, and the connecting member 4335 can then be cut to release the side of the cartridge body 4310. As described above, the side support 4334 can also be coupled to the staple cartridge groove member so that the side support 4334 together with the staple cartridge groove member can be removed from the surgical site after the staple cartridge 4300 has been implanted. It can be taken out. The side support 4334 can be composed of an implantable material and can be left at the surgical site. The connecting member 4335 is disposed between the cartridge body 4310 and the tissue T, and the connecting member 4335 can remain implanted in the patient's body after the connecting member 4335 is separated from the side support 4334. For example, the connecting member 4335 can be made of an implantable material, and the connecting member 4335 can be made of the same material as the side support 4334, for example. The connecting member 4335 and / or the side support 4334 is made of polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), trade name sold under the trade name Vircyl. Consists of flexible bioabsorbable materials such as polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or composites of PGA, PLA, PDS, PHA, PGCL and / or PCL sold by Monocryl be able to. According to the present invention, the connecting member can have a sheet of material connecting the side supports 4334. The staple cartridge may include a connecting member that extends over the top surface of the cartridge body 4310 and a connecting member that extends around the bottom surface of the cartridge body 4310.

  Referring now to FIG. 84, the staple cartridge can have staples such as staple 4420 that can include a wire portion inserted into the crown portion. The wire portion can be composed of metals such as titanium and / or stainless steel and / or plastics such as polydioxanone (PDS) and / or polyglycolic acid. The crown portion can be composed of metals such as titanium and / or stainless steel and / or plastics such as polydioxanone (PDS) and / or polyglycolic acid (PGA). The wire portion of each staple 4420 may have a base 4422 and a deformable leg 4421 extending from the base 4422, and the crown portion of each staple 4420 is configured to receive at least a portion of the base 4422 therein. A crown 4429 that can be included. Referring now to FIGS. 85A-85C, to assemble the portions of each staple 4420, the wire portion legs 4421 may be inserted into the openings 4426 of the crown 4429, in which case the openings 4426 may be connected to the legs 4421. Can be configured to guide the base chamber 4427. By further inserting the wire portion into the crown 4429, the legs 4421 exit the base chamber 4427 and the wire portion base 4422 enters the base chamber 4427. For example, the base chamber 4427 can be configured such that the wire portion rotates within the crown 4429 as the base 4422 enters the base chamber 4427 so that the staple legs 4421 are directed upward or at least substantially upward. It is done. Referring again to FIG. 84, the crown 4429 can have an exit hole 4425 that can be configured to receive the staple legs 4421 therein.

  In addition to the above, the surgical stapler includes a sled 4470 configured to move the staple 4420 contained within the cartridge body 4410 in the direction of the anvil across the staple cartridge 4400 and the staple cartridge groove member 4430. sell. In various situations, the sled 4470 can be implanted from the proximal end of the staple cartridge groove member 4430 to the distal end of the cartridge groove member 4430 to implant the cartridge body 4410 and the staple 4420. In certain circumstances, the sled 4470 can be retracted or returned to the proximal end of the cartridge groove member 4430 and another staple cartridge 4400 can be inserted into the cartridge groove member 4430. When a new staple cartridge 4400 is placed in the cartridge groove member 4430, the sled 4470 can be advanced distally again. The surgical stapler has one or more lockout mechanisms that can prevent the sled 4470 from being advanced again distally while the new cartridge 4400 is not disposed within the cartridge groove member 4430. sell. For example, referring again to FIG. 84, the staple cartridge groove member 4430 can include a lockout shoulder 4439 that can be configured to prevent or at least limit such distal movement of the sled 4470. . More specifically, the sled 4470 is not lifted up at least partially over the shoulder 4439 by a lifting mechanism 4428 extending between, for example, the most proximal staples 4420 in the staple cartridge 4400. , And can be configured to contact the shoulder 4439. In other words, the staple 4470 cannot be advanced without the most proximal staple 4420 in the new staple cartridge 4400. Accordingly, the sled 4470 cannot be advanced within the cartridge groove member 4430 if there is a used staple cartridge 4400 in the cartridge groove member 4430 or if there is no staple cartridge 4400 in the cartridge groove member 4430.

  Referring to FIG. 86, in addition to the above, a staple cartridge such as a staple cartridge 4500 can be disposed in the staple cartridge groove member 4530, and the staple cartridge 4500 can be compressed in the cartridge body 4510 and the cartridge body 4510. Can include a plurality of staples 4520 and a cartridge pan or retainer 4580. The compressible cartridge body 4510 may include an outer layer 4511 and an inner layer 4512 that can encapsulate the inner layer 4512 in a sealed state. For example, the outer layer 4511 may extend between the inner layer 4512 and the cartridge pan 4580. The outer layer 4511 need only partially surround the inner layer 4512. For example, the outer layer 4511 and the cartridge pan 4580 can cooperate to surround or at least substantially surround the inner layer 4512. In addition to the above, the staple 4520 may be supported by the cartridge pan 4580, and the cartridge pan 4580 may include one or more staple support groove members configured to support the staple 4520. The cartridge pan 4580 may be attached to the cartridge body 4510, in which case, for example, the cartridge body 4510 may be compressed laterally between opposing sidewalls of the cartridge pan 4580. The side wall of the cartridge pan 4580 can support the cartridge body 4510 laterally, for example, the cartridge pan 4580 has one or more walls or fins extending upwardly from the lower support 4583 to the cartridge body 4510. 4582 may be included. For example, the cartridge body 4510 may have one or more slots or groove members therein that can be configured to receive and / or mate with the wall 4582. The wall 4582 can extend through a portion or substantially the entire cartridge body 4510. For example, the wall 4582 may extend longitudinally through the staple cartridge 4500 between the first staple row 4520 and the second staple row 4520.

  The cartridge body 4510 and / or the cartridge pan 4580 may have cooperating retention mechanisms that provide a snap fit between the cartridge pan 4580 and the cartridge body 4510. The staple cartridge 4500 may be disposed within the cartridge groove member 4530 such that the cartridge pan 4580 is disposed against and / or attached to the cartridge groove member 4530. The cartridge pan 4580 may be detachably coupled to the cartridge groove member 4530 such that the cartridge pan 4580 is separated from the cartridge groove member 4530 after the staple cartridge 4500 is compressed by the anvil 4540 and the staple 4520 is deformed. Can be implanted with the cartridge body 4510. For example, the cartridge pan 4580 is made of polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) sold under the trade name Vircyl, and poly sold under the trade name Monocryl. It can be composed of a bioabsorbable material such as Grecapron 25 (PGCL), polycaprolactone (PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL. The surgical stapler can be configured to lift or eject the cartridge pan 4580 from the cartridge groove member 4530 and can be slid between the staple cartridge groove member 4530 and the bottom drive surface of the cartridge pan 4580. And / or further drivers. The cartridge body 4510 can be detachably coupled to the cartridge pan 4580 so that the cartridge body 4510 is separated from the cartridge pan 4580 after the staple cartridge 4500 is compressed by the anvil 4540 and the staple 4520 is deformed. Can do. For example, the cartridge pan 4580 may be maintained in a fixedly engaged state with the cartridge groove member 4530, whereby the cartridge pan 4580 can be removed from the surgical site together with the cartridge groove member 4530. The surgical stapler can be configured to lift or eject the cartridge body 4510 from the cartridge pan 4580 and can be slid between the staple cartridge pan 4580 and the bottom drive surface of the cartridge pan 4510 and / or Or it may further include a driver. For example, the staple cartridge 4500 may further include a staple driver disposed between the cartridge pan 4580 and the staple 4520 so that when the firing mechanism is slid in the distal direction, the staple driver and the staple 4520 can be pushed upward in the direction of the anvil. For example, at least a portion of the staple driver can be embedded in the compressible cartridge body 4510.

  Optionally, as described above, the staple cartridge 4500 may prevent or at least limit distal movement of the cutting member unless the unfired staple cartridge 4500 is disposed within the staple cartridge groove member 4530. A lockout mechanism can be included that can be configured. The staple cartridge pan 4580 can have a surface that lifts the cutting member upward and onto a fixed surface within the staple cartridge groove member 4530, for example. If the staple cartridge 4500 including the cartridge pan 4580 is not present in the cartridge groove member 4530, the cutting member cannot be advanced. The most proximal staple in staple cartridge 4500, and / or any other suitable staple, can include a lifting surface that can sufficiently lift the cutting member over the stationary surface. In addition to or in lieu of the above, different portions of the staple cartridge 4500 can be constructed of materials having different colors. In such a case, the surgeon can visually identify when an unfired and / or fired staple cartridge is present in the staple cartridge groove member 4530. For example, the outer layer 4511 of the cartridge body 4510 may have a first color, the cartridge pan 4580 may have a second color, and the staple cartridge groove member 4530 may have a third color. If the first color is visible, the surgeon can know that an unfired cartridge 4500 is present in the staple cartridge groove member 4530, and if the second color is visible, the surgeon can see that the fired cartridge 4500 is stapled. If the third color is visible, and the surgeon can see that any portion of the staple cartridge 4500 is present in the cartridge groove member 4530 and the remaining cartridge pan 4580 needs to be removed, the cartridge groove member It can be seen that it does not remain in 4530.

  Referring now to FIG. 87, a staple cartridge, such as staple cartridge 4600, for example, can have a compressible implantable cartridge body 4610 and a plurality of staples 4620 disposed therein. The cartridge body 4610 can have an outer layer 4611 and an inner layer 4612. Inner layer 4612 can include a plurality of pockets, such as pockets defined therein or cavities 4615 that can facilitate crushing of cartridge body 4610. For example, the inner layer 4612 may have a corrugated or honeycomb lattice that can be configured to withstand the compressive force or pressure to the extent that the compressive force or pressure does not exceed a certain threshold. If the threshold is not exceeded, the inner layer 4612 may deform at a linear or at least approximately linear velocity with respect to the applied compressive force or pressure. After the compressive force or pressure exceeds a threshold, the inner layer 4612 may suddenly yield and collapse or buckle for large flexures as a result of the compressive load. The lattice of the inner layer 4612 can include a plurality of sublayers 4612a that can be coupled together. Each sublayer 4612a may have a plurality of alternating valleys and peaks, i.e., corrugations, which are alternately arranged valleys of adjacent sublayers 4612a. And can be aligned with the peaks. For example, the valleys of the first sublayer 4612a can be placed adjacent to the peaks of the second sublayer 4612a, and similarly, the peaks of the first sublayer 4612a can be placed in the second sublayer 4612a. It can arrange | position adjacent to the trough part. Adjacent sublayers 4612a can be adhered to each other and / or to outer layer 4611 by at least one adhesive, such as fibrin and / or protein hydrogels. 88 shows the staple cartridge 4600 after the cartridge body 4610 is crushed and the staple 4620 is deformed to capture the tissue T and hold it against the cartridge body 4610. FIG.

  Referring to FIGS. 89-91, for example, a staple cartridge, such as staple cartridge 4700, can have a compressible implantable cartridge body 4710 and a plurality of staples 4720 disposed within the cartridge body 4710. Similar to the above, the cartridge body 4710 may include an outer layer 4711 and an inner layer 4712, in which case the inner layer 4712 may include a plurality of sub-layers 4712a. Similar to the above, each sublayer 4712a may include alternating valleys 4717 and peaks 4718, which are aligned with each other so that there are pockets or cavities between them. 4715 may be defined. For example, the valleys 4717 and / or peaks 4718 may extend along an axis that is parallel to each other and / or parallel to the longitudinal axis 4709. The staples 4720 can be aligned within a plurality of staple rows that can be parallel to each other and / or extend along an axis parallel to the longitudinal axis 4709. Alternatively, referring again to FIGS. 87 and 88, the staples 4620 received within the cartridge body 4600 are along an axis that is transverse or perpendicular to the axis defined by the valleys and peaks of the sublayer 4612a. Can extend. Referring again to FIGS. 89-91, the staple 4720 may extend through the trough 4717 and the crest 4718, and the frictional force between the staple 4720 and the sublayer 4712 a may hold the staple 4720 within the cartridge body 4710. it can. The plurality of sub-layers 4712a may be configured to hold staples 4720 in an upright direction and / or align staples 4720 relative to each other, for example as shown in FIGS. 89 and 90, and / or Alternatively, it can be made of a plastic material such as polydioxanone (PDS) and / or polyglycolic acid (PGA). FIG. 91 shows the staple cartridge 4710 after the cartridge body 4710 is crushed and the staple 4720 is deformed to capture the tissue T and hold it against the cartridge body 4700.

  Referring again to FIGS. 89-91, the cartridge body 4710 may be crushed elastically or elastically when compressed. For example, the corrugations formed in each sublayer 4712a by valleys 4717 and peaks 4718 are flattened or at least substantially flattened when the cartridge body 4710 is compressed, thereby providing a The cavity 4715 defined in FIG. 1 may be crushed or at least substantially crushed. In various situations, after the compressive force or pressure is removed from the cartridge body 4710, the cartridge body 4710 or at least a portion of the cartridge body 4710 can be re-expanded elastically or elastically. For example, when the cartridge body 4710 is compressed, the connection between the valleys 4717 and the peaks 4718 of the adjacent sublayer 4712a can be maintained in a complete or almost complete state, so that the compression force is removed from the cartridge body 4710. After being removed, the sublayer 4712a can bias them away from each other so that the cartridge body 4710 can be at least partially re-inflated. When the cartridge body 4710 is compressed, it may plastically deform or collapse, and as a result, the cartridge body 4710 may not re-expand after the compression force or pressure is removed from the cartridge body 4710. Referring to FIG. 92, for example, a staple cartridge, such as staple cartridge 4800, may have a collapsible cartridge body 4810 having an outer layer 4811 and an inner layer 4812, where the inner layer 4812 includes a plurality of layers. Pockets or cavities 4815 can have a corrugated honeycomb lattice defined therein. The walls defining the lattice of the inner layer 4812 can be configured to allow the walls defining the lattice to break when the cartridge body 4810 is compressed. Or have a thin cross-section 4819. Under such circumstances, the cartridge body 4810 can collapse when the staple cartridge 4800 is implanted.

  93-95, a staple cartridge, such as a staple cartridge 4900, for example, includes an outer layer 4911 and a plurality of collapsible elements 4912 disposed between the upper and lower portions of the outer layer 4911. 4910 may be included. Referring primarily to FIGS. 93 and 94, the staple cartridge 4900 may further include a plurality of staples 4920, in which case each staple 4920 may be disposed within a collapsible element 4912. More particularly, each collapsible element 4912 may include a first portion 4912a, a second portion 4012b, and a third portion 4012c that are configured to cooperate to receive the staple 4920. A defined cavity 4915 may be defined therein. In addition to the above, in use, the staple cartridge 4900 can be disposed within the staple cartridge groove member and the cartridge body 4910 can be compressed by applying a compressive force to the tissue contacting surface 4919. As the tissue contacting surface 4919 is moved downward, the collapsible element 4912 can collapse. In such a situation, the second portion 4912b of the collapsible element 4912 can be collapsed into the corresponding first portion 4912a, and similarly, the third portion 4912c of each collapsible element 4912 is corresponding. Can be crushed into the second portion 4912b. When the cartridge body 4910 is compressed and the collapsible element 4912 is collapsed, the staples 4920 disposed within the collapsible element 4912 can be deformed as shown in FIG. The second portion 4912b of each collapsible element 4912 is frictionally fitted and / or pressed into the corresponding first portion 4912a, so that the compressive force applied to the collapsible element 4912 is first. When the holding force that holds the portion 4912a and the second portion 4912b in the extended position (FIG. 94) is exceeded, the first portion 4912a and the second portion 4912b begin to slide relative to each other. Similarly, the third portion 4912c of each collapsible element 4912 is fitted and / or press-fit into the corresponding second portion 4912b via friction, thereby providing a compressive force applied to the collapsible element 4912. When the holding force holding the second portion 4912b and the third portion 4912c in their extended position (FIG. 94) is exceeded, the second portion 4912b and the third portion 4912c begin to slide relative to each other.

  As described herein, a staple cartridge can have a plurality of staples therein. If desired, such staples can be comprised of a metal wire that is deformed into a generally U-shaped configuration having two staple legs. Alternatives are contemplated where the staples have different forms, such as two or more wires connected to each other having three or more staple legs. The wires used to form the staples can be round or at least have a substantially round cross section. The staple wire may have any other suitable cross section, such as a square and / or rectangular cross section. Staples can be constructed of plastic wire. Staples can be composed of plastic-coated metal wires. According to the present invention, the cartridge may include any suitable type of fastener in addition to or instead of staples. For example, such a fastener may include a pivotable arm that is folded when engaged with an anvil. A two-part fastener can be used. For example, the staple cartridge may include a plurality of first fastening portions, and the anvil may have a plurality of second fastening portions that are coupled to the first fastening portions when compressed against the staple cartridge. . As described above, the staple forming process can be completed by advancing a thread or driver within the staple cartridge. By advancing the sled or driver within the anvil, one or more forming members can be moved downwardly into engagement with opposing staple cartridges and staples or fasteners disposed therein.

  As described herein, a staple cartridge can have four rows of staples stored therein. The four staple rows can be arranged as two inner staple rows and two outer staple rows. For example, one inner staple row and one outer staple row can be disposed on a first side of a cutting member or knife slot in a staple cartridge, and similarly one inner staple row and one outer staple row can be It can be located on the second side of the cutting member or knife slot. The staple cartridge may not have a cutting member slot, but such a staple cartridge may have a designated portion configured to be incised by the cutting member instead of the staple cartridge slot. Each inner staple row may be positioned within the staple cartridge so as to be evenly or at least approximately equally spaced from the cutting member slot. Similarly, each outer staple row may be positioned within the staple cartridge so that it is equally or at least substantially equally spaced from the cutting member slot. In accordance with the present invention, the staple cartridge can include more or fewer staples than four rows stored in the staple cartridge. The staple cartridge can have six rows of staples. For example, a staple cartridge can have three rows of staples on a first side of a cutting member slot and three rows of staples on a second side of the cutting member slot. The staple cartridge may have an odd number of staple rows. For example, the staple cartridge can have two rows of staples on the first side of the cutting member slot and three rows of staples on the second side of the cutting member slot. The staple rows can have the same or at least about the same unformed staple height. Alternatively, one or more rows of staples may include staples having an unformed staple height that is different from other staples. For example, the staples on the first side of the cutting member slot may have a first unformed height, and the staples on the second side of the cutting member slot are different from the first height. It may have a molding height.

  Referring to FIGS. 96A-96D, the end effector of a surgical stapler includes a cartridge mounting portion, such as a staple cartridge 5030, a fastener removably disposed within a staple cartridge groove member 5030, such as a staple cartridge 5000, for example. The cartridge may include a jaw 5040 disposed opposite the staple cartridge 5000 and the staple cartridge groove member 5030. Staple cartridge 5000 may include a compressible body 5010 and a plurality of staples 5020 and / or any other suitable fastener at least partially disposed within compressible body 5010. For example, each staple 5020 can include a base 5022 and further a leg 5021 extending upward from the base 5022, in which case at least a portion of the leg 5021 can be embedded within the cartridge body 5010. The compressible body 5010 may have an upper or tissue contacting surface 5019 and a lower surface 5018 that can be disposed against and supported by the support surface 5031 of the staple cartridge groove member 5030. As above, the support surface 5031 can have a plurality of support slots 5032 (FIG. 96D) defined therein that can be configured to receive and support the base 5022 of the staple 5020, for example. The end effector of the surgical stapler can further include a retention matrix, such as a retention matrix 5050, that can be configured to engage and capture tissue between the staples 5020, for example. For example, the retention matrix 5050 can be removably attached to the jaw 5040. In use, when the cartridge 5000 is positioned within the staple cartridge groove member 5030, the jaws 5040 and the retaining matrix 5050 attached thereto can be moved toward the staple cartridge 5000 and staple cartridge groove member 5030. The jaw 5040 can be moved downward along the axis 5099 so that when the jaw 5040 is closed, the jaw 5040 and the staple cartridge groove member 5030 are maintained in parallel or at least substantially parallel to each other. More specifically, the jaw 5040 is arranged such that the tissue contacting surface 5051 of the retention matrix 5050 is parallel or at least substantially parallel to the tissue contacting surface 5019 of the staple cartridge 5000 when the jaw 5040 is moved in the direction of the staple cartridge 5000. Can be closed.

  Referring now to FIG. 96A, the retention matrix 5050 is releasably secured to the jaw 5040 so that there is little (if any) relative movement between the retention matrix 5050 and the jaw 5040 when attached to the jaw 5040. sell. The jaw 5040 can include one or more holding mechanisms that can be configured to hold the holding matrix 5050 in place. For example, the retention matrix 5050 can be snapped and / or press fit into the jaw 5040. The retention matrix 5050 can be adhered to the jaws 5040 using at least one adhesive. In either case, the jaws 5040 can be moved to a position such that the retention matrix 5050 is in contact with the tissue T and the tissue T is positioned against the tissue contacting surface 5019 of the staple cartridge 5000. When the tissue T is placed against the staple cartridge 5000 by the jaws 5040, the compressible body 5010 of the staple cartridge 5000 may or may not be compressed by the jaws 5040. In either case, the legs 5021 of the staple 5200 may not protrude through the tissue contacting surface 5019 of the staple cartridge 5000, as shown in FIG. 96A. Further, as also shown in FIG. 96A, the jaws 5040 can hold the tissue T against the compressible body 5010 without engaging the holding matrix 5050 with the staples 5020. These configurations allow the surgeon to obtain the desired position of the end effector within the surgical site by opening and closing the jaws 5040 multiple times without damaging the tissue T, for example. However, alternatives are contemplated where the staple tip 5023 can protrude from the tissue contacting surface 5019 before the cartridge body 5010 is compressed by the anvil 5040. Referring now to FIG. 96B, when the end effector is properly positioned, the jaw 5040 can be moved downward toward the staple cartridge groove member 5030 so that the compressible body 5010 is compressed by the anvil 5040. The tissue contacting surface 5019 is pushed downward against the staple 5020. When the tissue contacting surface 5019 is pushed downward, the tip 5023 of the staple leg 5021 can penetrate the tissue contacting surface 5019 and further penetrate at least a portion of the tissue T. In such circumstances, the retention matrix 5050 can be positioned over the staples 5020 such that the retention openings 5052 of the retention matrix 5050 are aligned or at least substantially aligned with the tips 5023 of the staple legs 5021.

  Referring now to FIG. 96C, the staple legs 5021 of the staples 5020 can enter into the retention openings 5052 as the retention matrix 5050 is pushed down along the axis 5099. Staple legs 5021 can engage the sidewalls of retention openings 5052. As described in more detail below, the retention matrix 5050 can include one or more retention members that extend into and / or around the retention openings 5052 that can engage the staple legs 5021. In either case, the staple leg 5021 can be held in the holding opening 5052. In various situations, the tip 5023 of the staple leg 5021 can enter the retaining opening 5052 and can frictionally engage the retaining member and / or the sidewall of the opening 5052. As the retention matrix 5050 is pushed in the direction of the base 5022 of the staple 5020, the staple legs 5021 can slide relative to the sidewalls and / or retention members. As a result, a sliding frictional force can be generated between the staple legs 5021 and the holding matrix 5050. Such a sliding frictional force can resist the insertion of the holding matrix 5050 onto the staple 5020. The sliding frictional force between the retention matrix 5050 and the staple 5020 can be constant or at least approximately constant as the retention matrix 5050 slides downward along the staple legs 5021 of the staple 5020. For example, the retention matrix 5050 slides downward along the staple legs 5021 due to variations in the shape of the staple members 5021, the retention openings 5052, and / or the retention members extending into and / or around the retention openings 5052. In this case, the sliding frictional force can be increased and / or decreased. Insertion of the retention matrix 5050 onto the staples 5020 can also be resisted by the compressible body 5010 of the staple cartridge 5000. More particularly, the compressible body 5010 may be comprised of, for example, an elastic material that can apply a resistance force to the retention matrix 5050 that increases as the distance to which the compressible body 5010 is compressed increases. it can. For example, the increase in resistance generated by the cartridge body 5010 may be linearly proportional, or at least approximately linearly proportional to the distance to which the cartridge body 5010 is compressed. The increase in resistance generated by the cartridge body 5010 may be geometrically proportional to the distance to which the cartridge body 5010 is compressed.

  In addition to the above, the above resistance and frictional forces can be overcome by applying sufficient firing force to the jaws 5040 and the retaining matrix 5050. In use, the retention matrix 5050 can be disposed at any suitable depth relative to the staple 5020. By placing the retention matrix 5050 at a predetermined depth relative to the base 5022 of the staple 5020, two or more layers of tissue can be secured together, creating a compressive force or pressure within the tissue. In various situations, a system that includes a retention matrix 5050 and staples 5020 allows a surgeon to select the amount of compressive force or pressure applied to the tissue by selecting the depth at which the retention matrix 5050 is disposed. To do. The retention matrix 5050 may be pushed downward from the bottom of the support slot 5032 toward the staple base 5022 of the staple 5020 until the retention matrix 5050 is positioned at a constant depth 5011, in which case, at a shorter depth 5011, A higher compression force or pressure will act on the tissue T as compared to the higher depth 5011 where the compression force or pressure applied to the tissue T may be lower. The compressive force or pressure acting on the tissue T can be linearly proportional or at least approximately linearly proportional to the depth 5011 at which the retention matrix 5050 is disposed. In various situations, the compressive force or pressure acting on the tissue T may depend on the thickness of the tissue T disposed between the retention matrix 5050 and the staple cartridge 5020. More specifically, at a given distance 5011, the presence of thicker tissue T may cause a higher compressive force or pressure than thinner tissue T.

  In addition to the above, in various situations, the surgeon may adjust the depth at which the retention matrix 5050 is disposed to adapt to the thicker and / or thinner tissue disposed within the end effector. Regardless of the thickness, a constant or predetermined pressure can be applied to the tissue T. For example, the surgeon may place the retention matrix 5050 at a shorter depth 5011 when fastening thinner tissue T or at a higher depth 5011 when fastening thicker tissue T. The same or nearly the same compression pressure can be obtained. In addition to the above, the surgeon can also selectively determine the amount of compression pressure that acts on the tissue T disposed between the retention matrix 5050 and the staple cartridge 5010. In various situations, the surgeon engages the retention matrix 5050 with the staple 5020 and places the retention matrix 5050 at a first distance from the base 5022 of the staple 5020 to apply a first compression pressure to the tissue. Can act. Alternatively, the surgeon places a second compression pressure higher than the first pressure on the tissue by placing the retention matrix 5050 at a location that is separated from the base 5022 by a second distance that is less than the first distance. be able to. Alternatively, the surgeon places a third compression pressure higher than the second pressure on the tissue by placing the retention matrix 5050 at a position that is separated from the base 5022 by a third distance that is shorter than the second distance. be able to. The fastening system that includes the retention matrix 5050 and the staples 5020 can be configured to allow the surgeon to apply a wide range of compression pressures to the target tissue.

  Referring now to FIG. 96D, the staple legs 5021 can be inserted through the retention matrix 5050 such that the staple leg tips 5023 extend above the upper surface of the retention matrix 5050. Referring again to FIG. 96C, the jaw 5040 further has a gap opening 5042 that can be configured to receive the staple leg tip 5023 as the staple tip 5023 passes through the holding opening 5052 in the holding matrix 5050. It may be defined within it. For example, the gap opening 5042 can be aligned with the retention opening 5052 so that the legs 5021 do not contact the jaws 5040. The gap opening 5042 can have sufficient depth such that the staple legs 5021 do not contact the jaws 5040 regardless of the distance at which the retention matrix 5050 is disposed. Referring now to FIG. 96D, after the retention matrix 5050 engages the staple 5020 and is positioned in the desired position, the staple cartridge groove member 5030 and the jaw 5040 can be moved away from the tissue T. More particularly, the staple cartridge groove member 5030 can be separated from the implanted staple cartridge 5000 and the anvil 5040 can be separated from the implanted retention matrix 5050. When the jaw 5040 is moved away from the retention matrix 5050 and the staple support 5032 is moved away from the staple base 5022, the distance 5011 between the retention matrix 5050 and the bottom of the base 5022 is determined by the jaw 5040 and the staple cartridge. The groove member 5030 can be maintained despite no longer providing support thereto. The static friction force between the staple legs 5021 and the retention matrix 5050 defines the retention matrix 5050 despite the biasing force acting on the retention matrix 5050 by the compressed cartridge body 5010 and / or the compressed tissue T. It may be sufficient to maintain the position. For example, the cartridge body 5010 may be made of an elastic material that applies an elastic biasing force to the holding matrix 5050 and the staple 5020 so as to push the holding matrix 5050 and the staple 5020 away from each other when compressed. Although possible, such movement is hindered by frictional engagement between the staple legs 5021 and the retention matrix 5050.

  Optionally, as described above, the retention matrix may have a plurality of retention openings, in which case each retention opening can be configured to receive a fastener leg therein. Referring now to FIG. 97, a portion of a retention matrix 5150 that can have a retention opening 5152 defined by an outer periphery 5156 is shown. The outer periphery 5156 of the opening 5152 can have a circular or at least substantially circular profile and / or any other suitable profile. The retention matrix 5150 extends into the opening 5152 and can be configured to engage the fastener legs as the fastener legs are inserted, such as one or more of the retention members 5153, for example. A holding member may be included. For example, each holding member 5153 can include a cantilever that extends inward toward the central axis 5159, that is, toward the center of the opening 5152. If desired, each cantilever can have a first end that is attached to the retention matrix body 5158 and a second end that forms an outer perimeter 5156 of the retention opening 5152. The outer perimeter 5156 of the retention opening 5152 can be defined by a first diameter or width, the fastener leg can be defined by a second diameter or width, and the second diameter is the first diameter. Larger than that. For example, the fastener legs can be configured to contact and bend one or more of the holding members 5153 so that the diameter of the holding opening 5152 increases when the fastener legs are inserted. Can be. In addition to the above, the fastener legs may define an outer periphery that is larger than the outer periphery 5156 of the retaining opening 5152 so that when the fastener leg is inserted through the retaining opening 5152, the outer periphery 5156 Can be extended.

  Referring to FIG. 97, the openings 5152 may be defined by deformable members 5153, each deformable member 5153 configured to flex with respect to other deformable members 5153 or independently. be able to. For example, adjacent deformable members 5153 can be separated by slots 5154 that can be configured such that each deformable member 5153 can flex with respect to other deformable members 5153. Each slot 5154 includes a first end 5155 in the retention matrix body 5158, a second end opening that opens into the retention opening 5152, and between the first end 5155 and the second end. It may have a constant or at least approximately constant width extending. Alternatively, the width of each slot 5154 may not be constant, and each slot 5154 may increase and / or decrease in width between its first end and second end. The first end 5155 of the slot 5154 is for 1) providing strain relief to the base of the deformable member 5153 attached to the holding matrix body 5158, and 2) increasing the flexibility of the deformable member 5153. It can have an enlarged portion such as a circular portion that can provide a means. The shape of the deformable member 5153 and / or the slot 5154 can be selected to give the deformable member 5153 the desired flexibility. For example, elongating the slot 5154 provides a longer deformable member 5153 that may have greater flexibility than a deformable member 5153 having a shorter length. The width of each deformable member 5153 can be selected to provide its desired flexibility. More particularly, a deformable member having a thinner width may have greater flexibility than a deformable member having a thicker width. 97, the first end of the cantilever of the deformable member 5153 attached to the holding matrix body 5158 can be wider than the second end of the cantilever. For example, the cantilever can be linearly or at least substantially linearly tapered between its first end and second end.

  Referring again to FIG. 97, the retention matrix body 5158 may include a flat or at least substantially flat sheet of material having a tissue contacting surface 5151 and an upper surface 5157. For example, the tissue contacting surface 5151 and the top surface 5157 can be parallel to each other or at least approximately parallel. If desired, each deformable member 5153 may have a first portion 5153a and a second portion 5153b, in which case the first portion 5153a may extend in the first direction and the second portion 5153a. Portion 5253b may extend in a different direction or a second direction. For example, the retention matrix body 5158 may define a plane and the first portion 5253a of the deformable member 5153 may be located in that plane. The second portion 5153b of the deformable member 5153 can extend at a predetermined angle with respect to the first portion 5153a. For example, the second portion 5153 b may extend in a direction away from the upper surface 5157 of the holding matrix body 5158, and the second portion 5153 b can converge toward the central axis 5159 of the holding opening 5152. . In any case, the second portion 5153b can be configured to bend in a direction away from the central axis 5159 when the fastener leg is inserted. When the staple leg 5021 of the staple 5020 is inserted into the holding opening 5152, the deformable member 5153 can be deformed in a direction generally away from the base 5122 of the staple 5120. As a result, the deformable member 5153 may bend in the same general direction or at least about the same general direction as the staple legs 5021 are being inserted.

  Referring to FIG. BD, each of the second portions 5153b of the deformable member 5153 can be configured to slide against the staple legs 5021 when the staple legs 5021 are inserted, for example, sharp edges. You may have. The sharp tip of the second portion 5153b can also be configured to bite into the staple legs 5021 when the staple legs 5021 are pulled in the opposite direction (ie, the direction in which the staple legs 5021 are pulled out of the retaining openings 5052). . In certain circumstances, the second portion 5153b may be inclined relative to the side of the staple leg 5021 at a predetermined angle greater than 90 °, resulting in the staple leg 5021 being held from the retaining opening 5052 to the staple leg 5021. When a force for pulling is applied, the second portion 5153 b can bite into or enter the side surface of the staple leg 5021. The staple legs 5021 can have recesses and / or recesses on the surface thereof, such as, for example, micro-recesses that can be configured to receive the tip of the deformable member 5053 therein. For example, when the force to be pulled out acts on the staple leg 5021, the distal end portion of the deformable member 5053 can be caught in the recess of the staple leg 5021. If necessary, the second portion 5153b bites into the staple leg 5021 so that the force acting to pull the staple leg 5021 out of the retaining opening 5022 only causes the second portion 5153b to be placed deeper within the staple leg 5021. The force required to pull out the staple legs 5021 can be increased. Further, since the second portion 5153b is inclined upward, the second portion 5153b makes it easier to insert the staple leg 5021 into the holding opening 5152 and at the same time against the withdrawal of the staple leg 5021. Can give greater resistance. As a result, the force required to insert the staple leg 5021 into the holding opening 5022 can be less than the force required to pull the staple leg 5021 out of the holding opening 5022. For example, the force required to pull the staple leg 5021 from the holding opening 5022 may be approximately 50% greater than the force required to insert the staple leg 5021 into the holding opening 5022. Alternatively, for example, the force required to pull out the staple legs 5021 may be about 10% to 100% greater than the force required to insert the staple legs 5021. For example, the force required to pull the staple legs 5021 may be greater than about 100%, about 150%, about 200%, and / or greater than about 200% than the force required to insert the staple legs 5021.

  Referring again to FIG. 97, the second portion 5153b can be circumferentially disposed around the opening 5152 and define a pocket therebetween. More particularly, the second portion 5153b can define a pocket 5160 that can be configured to receive the tip of the fastener leg as the fastener leg is inserted into the retention opening 5152. . For example, the second portion 5153b of the deformable member 5153 can have an annular or at least substantially annular profile that can cooperate to define an annular or at least approximately annular profile of the pocket 1560. For example, the second portion 5153b may define a conical or frustoconical pocket. The pocket may be defined by a suitable number of deformable members, for example, four deformable members 5153 (FIG. 97), six deformable members 5153 (FIG. 98), or eight deformable members 5153 (FIG. 99). Referring now to FIG. 100, a deformable member of the retention matrix, such as retention matrix 5250, may form a pyramid shape or at least approximately a pyramid shape. In accordance with the present invention, the retention matrix 5250 can have a plurality of retention openings, such as retention openings 5252, that can be defined by the outer periphery 5256. The outer periphery 5256 may have a polygonal or at least approximately polygonal outline and / or any other suitable outline. The retention matrix 5250 extends into the opening 5252 and can be configured to engage the fastener legs as the fastener legs are inserted, such as one or more of the retention members 5253. A holding member may be included. For example, each holding member 5253 can include a cantilever that extends inward toward the central axis 5259, that is, toward the center of the opening 5252. If desired, each cantilever can have a first end that is attached to the retention matrix body 5258 and a second end that forms the outer periphery 5256 of the retention opening 5252. The outer periphery 5256 of the retaining opening 5252 can be defined by a first diameter or width, the fastener legs can be defined by a second diameter or width, and the second diameter is the first diameter. Larger than that. For example, the fastener legs can be configured to contact and bend one or more of the holding members 5253 so that the diameter of the holding opening 5252 increases when the fastener legs are inserted. Can be. In addition to the above, the fastener legs may define an outer periphery that is larger than the outer periphery 5256 of the retaining opening 5252 so that when the fastener leg is inserted through the retaining opening 5252 the outer periphery 5256 Can be extended.

  Referring to FIG. 100, the opening 5252 may be defined by a deformable member 5253, each deformable member 5253 configured to flex with respect to other deformable members 5253 or independently. be able to. For example, adjacent deformable members 5253 can be separated by slots 5254 that can be configured such that each deformable member 5253 can flex with respect to other deformable members 5253. The retention matrix body 5258 may include a flat or at least substantially flat sheet of material having a tissue contacting surface 5251 and an upper surface 5257. For example, the tissue contacting surface 5251 and the upper surface 5257 can be parallel or at least substantially parallel to each other. If desired, each deformable member 5253 may have a first portion 5253a and a second portion 5253b, in which case the first portion 5253a may extend in the first direction and the second portion 5253a. Portion 5253b may extend in a different direction or a second direction. For example, the retention matrix 5258 may define a plane and the first portion 5253a of the deformable member 5253 may be located in that plane. The second portion 5253b of the deformable member 5253 can extend at a predetermined angle with respect to the first portion 5253a. For example, the second portion 5253b may extend away from the top surface 5257 of the retention matrix body 5258, and the second portion 5253b may converge toward the central axis 5259 of the retention opening 5252. . In any case, the second portion 5253b can be configured to bend in a direction away from the central axis 5259 when the fastener leg is inserted. Referring to FIG. 100, the second portion 5253b can be circumferentially disposed around the opening 5252 and define a pocket therebetween. More particularly, the second portion 5253b can define a pocket that can be configured to receive the tip of the fastener leg as the fastener leg is inserted into the retention opening 5252. For example, the second portion 5253b of the deformable member 5253 can define a polygon or at least a substantially polygonal pocket. The pocket may be, for example, four deformable members 5253 (FIG. 100) that may define a square, six deformable members 5253 (FIG. 101) that may define a hexagon, or eight deformable members 5253 that may define an octagon. It can be defined by any number of deformable members, such as (FIG. 102).

  Referring now to FIG. 103, for example, a retention matrix, such as retention matrix 5350, can be formed from a sheet of flat or at least substantially flat material, such as, for example, a titanium and / or stainless steel sheet. For example, the plurality of openings 5352 can be formed in the body 5358 of the retention matrix 5350 by one or more stamping processes. A sheet of material can be placed in a stamping die, and when such a stamping die is actuated, by punching out a specific portion of the material, slot 5354, slot 5354 opening 5355, and / or retaining opening 5352. An outer peripheral portion 5356 can be formed. The stamping die can also be configured to bend the deformable member 5353 into a suitable form. For example, the stamping die can deform the second portion 5353b upward with respect to the first portion 5353a along the crease line 5353c. Referring now to FIG. 104, a retention matrix, such as retention matrix 5450, can have a plurality of retention openings 5252, for example. Similar to the above, the outer perimeter 5456 of each retaining opening 5452 can be defined by a plurality of deformable members 5453 separated by slots or slits 5454. For example, the entire deformable member 5453 may be bent upward, in which case the free end of the cantilever constituting the deformable member 5453 may define the outer periphery 5456. The retention matrix 5450 may have a plurality of openings 5455 that surround or at least approximately surround the retention openings 5252. For example, the openings 5455 can be arranged in a circular array that surrounds or surrounds the outer periphery defined by the fixed end of the cantilever of the deformable member 5453. Each opening 5455 may have a circular or at least substantially circular periphery and / or any other suitable periphery. In use, the opening 5455 provides 1) a strain relief to the base of the deformable member 5453 attached to the retention matrix body 5458, and 2) a means for increasing the flexibility of the deformable member 5453. be able to. If desired, the larger opening 5455 can provide the deformable member 5453 with greater flexibility compared to the smaller opening 5455. Furthermore, the opening 5455 closer to the deformable member 5453 can provide greater flexibility compared to the farther opening 5455.

  Referring now to FIG. 105, a retention matrix, such as retention matrix 5550, can have a plurality of retention openings 5552, for example. Each retention opening 5552 can have an elongated slot 5554 having an enlarged circular or at least substantially circular end 5555. For example, end 5555 can be defined by a wider diameter than slot 5554. Elongated slot 5554 and end 5555 are disposed along longitudinal axis 5559 and / or centered along longitudinal axis 5559. Slot 5554 and end 5555 can define two opposing tabs 5553 that can be configured to engage and flex the fastener legs as the fastener legs are inserted. An end 5555 having a larger perimeter or diameter can define a longer tab 5553 that may have greater flexibility than a tab 5553 defined by the end 5555 having a smaller perimeter or diameter. The ends 5555 may have the same circumference and diameter, for example, each tab 5553 may be symmetric about an axis that is perpendicular or at least substantially perpendicular to the longitudinal axis 5559. Alternatively, the ends 5555 may have different perimeters and / or diameters, in which case each end 5553 may not be symmetric about its axis. For example, the tabs 5553 may be twisted about their axes when the fastener legs are inserted through the retaining openings 5552. Referring now to FIG. 106, a retention matrix, such as retention matrix 5650, can have a plurality of retention openings 5562, for example. Each retention opening 5562 can have an elongated slot 5654 having a circular or at least substantially circular end 5655. For example, the elongated slot 5654 and the end 5655 are disposed along the longitudinal axis 5659 and / or centered along the longitudinal axis 5659. If desired, each end 5655 can be defined by a diameter that is the same or at least approximately the same as the width of the slot 5654.

  Referring now to FIG. 107, a retention matrix, such as retention matrix 5750, may have a plurality of retention openings 5752, for example. Each retention opening 5752 may include a plurality of slots, such as slot 5754, having enlarged ends 5755. For example, the elongated slot 5754 and the end 5755 are disposed along the longitudinal axis 5759 and / or centered along the longitudinal axis 5759. Each axis 5759 may extend in a direction perpendicular or transverse to each other. The slot 5754 and end 5755 may define, for example, four tabs 5753 that may be configured to engage and flex with the fastener legs as the fastener legs are inserted through the retention openings 5752. it can. Each tab 5753 can have the form of a triangle, such as an equilateral triangle, or at least approximately triangular. Alternatively, referring now to FIG. 108, a retention matrix, such as retention matrix 5850, can have a plurality of retention openings 5852. Each retention opening 5852 may include a plurality of slots, such as slot 5854, having ends 5855, in which case the slots 5854 and ends 5855 are disposed along the longitudinal axis 5859, and And / or centered along longitudinal axis 5859. The shafts 5859 can extend in directions perpendicular or transverse to each other. For example, the slot 5854 and the end 5855 can define a tab 5853 that can be configured to engage and flex with the fastener leg as the fastener leg is inserted through the retention opening 5852. Each tab 5853 may have an arcuate cross section. More particularly, each tab 5853 may include a curved end that may be configured to contact a fastener leg, unlike the pointed end shown in FIG.

  Referring now to FIG. 109, a retention matrix, such as retention matrix 5950, can have a plurality of retention openings 5952, for example. Each retention opening 5952 may include a plurality of slots, such as slots 5954, in which case each slot 5954 extends along axis 5959 and / or is centered along axis 5959. Each shaft 5959 is transverse to each other, for example, the shafts 5959 can be arranged such that all the shafts 5959 pass through the center of the retaining opening 5952 and are spaced equidistantly or at least approximately equidistant from each other. Each slot 5954 can have an open end facing the center of the retention opening 5952 and a second closed end 5955 at the opposite end of the slot 5954. Similar to the above, the slot 5954 and end 5955 can be configured to engage and flex with the fastener leg when the fastener leg is inserted into the retention opening 5952, eg, three tabs 5953. Can be defined. If desired, each end 5953 may form an arcuate shape extending between adjacent ends 5955 of the slot 5954. Referring now to FIG. 110, a retention matrix, such as retention matrix 6050, can have a plurality of retention openings 6052, for example. Each retention opening 6052 can have a tab 6053 that can be configured to engage and flex with the fastener leg as the fastener leg is inserted into the retention opening 6052. For example, the tab 6053 can have a base secured to the retention matrix body 6058 and a free end having an arcuate or curved profile 6056 that can be configured to contact the fastener legs. The fastener legs may be staple legs composed of round wire, in which case the curved profile 6056 may be configured to match or at least approximately match the curved outer surface of the round wire. .

  Referring again to FIG. 110, the retention matrix body 6058 can have a plurality of slots 6054 and openings 6055 that can be configured to define tabs 6053 and different portions of the retention openings 6052. The tab 6053 can have a rectangular configuration with parallel or at least substantially parallel sides. Referring now to FIG. 111, a retention matrix, such as retention matrix 6150, can have a plurality of retention openings 6152, for example. Each retention opening 6152 can have a tab 6153 that can be configured to engage and flex with the fastener leg as the fastener leg is inserted into the retention opening 6152. For example, the tab 6153 can have a base secured to the retention matrix body 6158 and a free end having an arcuate or curved profile 6156 that can be configured to contact the fastener legs. The retention matrix body 6158 can include a plurality of slots 6154 and openings 6155 that can be configured to define tabs 6153 and different portions of the retention openings 6152. Tab 6153 may have a tapered configuration with arcuate sides. For example, the tab 6153 can be a geometrically tapered shape, for example with a base wider than the free end.

  Optionally, as described above, the fastening system can include a plurality of staples having staple legs inserted through a plurality of retention openings in the retention matrix. As described in more detail below, the staples may be held on the first jaw and the holding matrix may be held on the second jaw, moving at least one of the first and second jaws relative to each other. be able to. In various situations, staples disposed within the first jaw can be secured therein such that the staple legs are aligned with the retention openings when the retention matrix engages the staple legs. 112 and 113, the fastening system includes a staple cartridge 6200 disposed, for example, in a first jaw of a surgical stapler, and a retention matrix 6250 disposed, for example, in a second jaw of the surgical stapler. Can be included. In addition to the above, referring to FIGS. 119 and 120, the retention matrix 6250 may include a plurality of retention openings 6252, each retention opening 6252 defined by one or more deflectable members 6253. The outer peripheral portion 6256 may be included. For example, in addition to the above, the bendable member 6253 that defines each opening 6252 can define a pocket 6201. If desired, each pocket 6201 can be configured so that, for example, the staple leg is offset from the retention opening 6252 and the distal end of the staple leg is brought into contact with the bendable member 6253 and / or the tissue contacting surface 6251 for the first time. For example, it may have a curved and / or concave surface that can be configured to guide into the opening 6252.

  In addition to the above, the fastening system can further include a plurality of staples 6220 having staple legs 6221 that can be inserted through the retention openings 6252 of the retention matrix 6250. For example, each staple 6220 can have a generally U-shaped configuration, including a base 6222 from which staple legs 6221 can extend upward. Referring now to FIGS. 115 and 116, the retention openings 6252 of the retention matrix 6250 can extend along, or parallel to, the longitudinal axis of the retention matrix, for example, two rows that are parallel or at least substantially parallel. Can be arranged. The first row of retention openings 6252 are offset or staggered relative to the second row of retention openings 6252. For example, each staple 6220 may have a first staple leg 6221 disposed within a first row of retention openings 6252 and a second staple leg 6221 disposed within a second row of retention openings 6252. As a result, the base 6222 may extend in a direction transverse to the longitudinal axis of the retention matrix 6250. For example, the staples 6220 can be parallel or at least substantially parallel to each other. More specifically, for example, the base 6222a of the staple 6220a may be parallel or at least substantially parallel to the base 6222b of the staple 6220b, and the base 6222b may be parallel or at least substantially parallel to the base 6222c of the staple 6220c. The staple legs 6221a of the staple 6220a may define a plane that is parallel or at least substantially parallel to the plane defined by the staple legs 6221b of the staple 6220b, which is defined by the staple legs 6221 of the staple 6220c, for example. Parallel to, or at least approximately parallel to, the plane.

  112 and 114, the staple cartridge 6200 includes a plurality of staples 6220 and a plurality of alignment guides such as slots, grooves and / or openings that can be further configured to align the staples 6220, for example. An alignment matrix 6260 may be included. In various situations, the alignment matrix 6260 is configured such that the staple legs 6221 of the staples 6220 are aligned with the retention openings 6252 of the retention matrix 6250 before the retention matrix 6250 engages the staple legs 6221. Can do. Referring now to FIGS. 117 and 118, the alignment matrix 6260 can have a plurality of alignment openings 6262 that can be configured to closely receive the staple legs 6221 of the staples 6220. FIG. For example, each staple 6220 may have a base 6222 and two staple legs 6221 extending from the base 6222, in which case the base 6222 of the staple 6220 may extend around the bottom surface 6264 of the retention matrix 6260, The staple legs 6221 can extend upward through the alignment openings 6262. Each alignment opening 6262 is circular or at least approximately circular and may be defined by a diameter that is equal to or slightly larger than the diameter of the staple legs 6221 passed therethrough. The alignment matrix 6260 may further include a plurality of raised members 6263 that extend upward from the top surface 6261 of the alignment matrix 6260 and may surround or at least partially surround the alignment opening 6262. The raised member 6263 can provide a longer alignment opening 6262, and in various situations, the longer opening 6262 provides greater control over the alignment of the staple legs 6221 than the shorter opening 6262. be able to.

  In use, the first jaw supporting the staple cartridge 6200 may be placed on one side of the tissue to be stapled and the second jaw supporting the retention matrix 6250 may be placed on the other side of the tissue. it can. Once the jaws are properly positioned relative to the tissue, the second jaw and retention matrix 6250 can be moved toward the staple cartridge 6200. When the staple legs 6221 are inserted through the retention openings 6252 of the retention matrix 6250a, the tissue contacting surface or bottom surface 6251 of the retention matrix 6250 contacts the tissue and the tissue against the tissue contacting surface or upper surface 6261 of the alignment matrix 6260. Press. Alternatively, as will be described in more detail below, the staple cartridge 6200 may further include a compressible cartridge body disposed on the top surface 6261 of the alignment matrix 6260, which may contact tissue, for example. 114 and 118, the alignment matrix 6260 includes one or two that can be configured to receive a portion of tissue therein when the alignment matrix 6260 is placed against the tissue. The above opening 6203 may be further defined. If the compressible cartridge body is positioned on and / or in contact with the alignment matrix 6260, a portion of the compressible cartridge body may enter the opening 6203 when the cartridge body is compressed. it can. Similarly, the retention matrix 6250 can have a plurality of openings 6202 that can be configured to receive at least a portion of the tissue therein when the retention matrix 6250 is placed against the tissue.

  In addition to the above, when the staple legs 6221 of the staple 6220 are inserted through the holding openings 6252 of the holding matrix 6250, the leading ends of the staple legs 6221 can protrude upward from the upper surface 6257 of the holding matrix 6250. As described above, in various situations, the tip of the staple leg 6221 may remain unbent after being inserted through the retention opening 6252. 121-124, a fastening system including a staple cartridge 6200 and a retention matrix 6250 can be assembled to staple legs 6221 protruding above the retention matrix 6250, such as a plurality of protective caps, such as caps 6270, or the like. You may further have a cover. If desired, each cap 6270 can cover, in whole or at least, the sharp ends of the staple legs 6221 so that the sharp ends can be placed on tissue disposed adjacent thereto. Do not touch. Referring now to FIG. 124, each cap 6270 may be defined with an opening 6271 that may be configured to closely receive the tip of the staple leg 6221 therein. The cap 6270 can be made of an elastic material such as silicone, polyisoprene, sanoprene, and / or natural rubber, for example. The opening 6271 can have an outer periphery or diameter that is smaller than the outer periphery or diameter of the staple legs 6221 inserted therein. For example, the opening 6271 in the protective cap 6270 can be expanded to receive the staple leg 6221 therein. Alternatively, the cap 6270 may not have an opening, and the tip of the staple leg 6221 can be configured to incise the cap 6270 when the leg 6221 is inserted into the cap 6270. In any case, each cap 6270 is fitted over the staple legs 6221 until the base 6272 of the cap 6270 is in contact with or located adjacent to the upper surface 6257 of the retention matrix 6250. In various situations, the cap 6270 can be configured to fit snugly on the tips of the staple legs 6221 so that the cap 6270 does not easily dislodge. Each cap 6270 may include, for example, a conical or at least substantially conical outer surface. The cap 6270 can have any suitable shape, for example, a parabolic shape or a shape that includes at least a substantially parabolic outer surface.

  For example, the fastening system described above can be operated using, for example, a surgical stapler shown in FIGS. The end effector may be configured to support a first jaw or staple cartridge groove member 6230 that may be configured to support a staple cartridge 6200 therein, a retention matrix 6250, and a plurality of protective caps 6270. A second jaw 6240 that can be made. Referring primarily to FIG. 125 showing the second jaw 6240 in an open configuration, the jaws 6230 and 6240 are positioned against the tissue T such that the tissue T is disposed between the retention matrix 6250 and the staple cartridge 6200. Can be arranged. If desired, as described above, the staple cartridge 6200 can further include a compressible cartridge body, such as the cartridge body 6210, within which the staples 6220 and the alignment matrix 6260 are disposed. The tissue T can be disposed in contact with the upper surface of the cartridge body 6210, for example. The second jaw 6240 may be configured to hold a plurality of recesses or openings 6245 configured to receive a plurality of protective caps 6270, and further to hold the retention matrix 6250 in place on the cap 6270. One or more possible holding mechanisms or holding parts may be included. For example, the retention matrix 6250 can be configured to retain the cap 6270 within the opening 6245. Referring to FIG. 137, each opening 6245 can be configured to receive a portion or all of the cap 6270 therein. The opening 6245 can be sufficiently sized and configured, for example, such that the cap 6270 can be secured therein by at least one of a press-fit and / or snap-fit mechanism. At least one type of adhesive can be used to secure cap 6270 within opening 6245. For example, such an adhesive may be selected to disengage the cap 6270 from the second jaw 6240 after the cap 6270 engages the staple leg 6221 and the second jaw 6240 is separated from the implanted fastening assembly. can do. Referring now to FIG. 138, the second jaw 6240 is assembled to the second jaw 6240 and extends over the cap 6270 to hold the cap 6270 within the opening 6245. 6246 may be included. For example, at least a portion of cover sheet 6246 can be secured to jaw 6240 using, for example, at least one adhesive. In use, cover sheet 6246 can be at least partially removed from jaw 6240 before the end effector is inserted into the surgical site. The cover sheet 6246 can be constructed of an implantable material such as PDS and / or PGA that can be incised by the staple legs 6221 as the staple legs 6221 protrude from the retention matrix 6250. Cover sheet 6246 may be secured to the fastening system between cover 6270 and retention matrix 6250, for example.

  In addition to the above, referring now to FIG. 126, the jaw 6240 can be moved from an open position to a closed position where the tissue T is placed against the retention matrix 6250 and the cartridge body 6210. In this position, the retention matrix 6250 may not yet engage the staple 6220. Jaw 6240 is moved between its open and closed positions by actuator 6235. For example, the jaw 6240 may have a distal pin 6243 and a proximal pin 6244 extending therefrom, the distal pin 6243 sliding vertically or at least substantially vertically within the distal slot 6233 defined in the cartridge groove member 6230. The proximal pin 6244 can also slide vertically or at least approximately vertically within the proximal slot 6234 defined in the staple cartridge groove member 6230. As shown in FIG. 126, in use, pins 6243 and 6244 are moved to the upper end of each slot 6233 and 6234 by retracting actuator 6235 proximally. For example, the actuator 6235 may have a distal drive slot 6236 and a proximal drive slot 6237, in which case the distal pins 6243 and 6237 and the 6237 sidewalls move in the proximal direction as the actuator 6235 moves proximally. Pins 6243 and 6244 can be configured to move upwardly in contact with proximal pin 6244, respectively. More specifically, as the actuator 6235 moves in the proximal direction, the distal pin 6243 slides up the slanted first portion 6236a of the distal drive slot 6236 and enters the intermediate or second portion 6236b. Similarly, the proximal pin 6244 can slide up the inclined first portion 6237a of the distal drive slot 6237 and enter the middle or second portion 6237b. As both pins 6243 and 6244 move upward, jaw 6240 may rotate downward toward tissue T to a closed position.

  In addition to the above, referring now to FIG. 127, pulling actuator 6235 further proximally pushes second jaw 6240 downward toward first jaw 6230, compressing cartridge body 6210. A retention matrix 6250 and a plurality of protective caps 6270 can engage the staple legs of the staple 6220. For example, further proximal movement of actuator 6235 causes the sidewalls of drive slots 6236 and 6237 to contact pins 6243 and 6244, causing pins 6243 and 6244 to move downward toward the lower ends of slots 6233 and 6234, respectively. In such a situation, the actuator 6235 can be pulled proximally so that 1) the distal pin 6243 exits the second portion 6236b of the drive slot 6236 and enters the inclined third portion 6236c. Similarly, the proximal pin 6244 exits the second portion 6237b of the drive slot 6237 and enters the inclined third portion 6237c. As both pins 6243 and 6244 move downward, the second jaw 6240 can move downward toward the first jaw 6230 to the post-fired position. For example, the second jaw 6240 can be moved downwards while the retention matrix 6250 is held parallel or at least approximately parallel to the top surface of the cartridge body 6210 and / or parallel or at least approximately parallel to the alignment matrix 6260. In any case, as shown in FIG. 129, when the retention matrix 6250 and protective cap 6270 engage the staple legs 6221 of the staple 6220, the second jaw 6240 is returned to the open position or at least approximately the open position. be able to. For example, when the pins 6243 and 6244 are moved to the upper ends of the slots 6233 and 6234, respectively, by pushing the actuator 6235 in the distal direction, and then each pin passes through the intermediate portions 6236b and 6237b of the drive slots 6236 and 6237. Thus, it can be moved downward toward the lower ends of the slots 6233 and 6234. As shown in FIG. 128, when the second jaw 6240 is opened, the first jaw 6230 can be separated from the implanted staple cartridge 6200, and the first jaw 6230 and the second jaw 6240 can be removed from the implanted fastening assembly.

  Referring again to FIG. 127, the pins 6243 and 6244 are shown at the lowest end of their respective slots 6233 and 6234, despite the retention matrix 6250 and cap 6270 engaging the staple legs 6221. The reader will notice that this is not done. Such a situation can occur when a thick tissue T is placed between the retention matrix 6250 and the cartridge body 6210. Referring now to FIG. 130, in a situation where a thinner tissue T is disposed between the retention matrix 6250 and the cartridge body 6210, the pins 6243 and 6244 have their respective slots 6233 and 6234 as shown in FIG. It can be moved further down inwards. In general, for example, by pulling the actuator 6235 proximally, the pins 6243 and 6244 are moved up and down by the process described above and shown in FIGS. The retention matrix 6250 and protective cap 6270 can be pushed further onto the staple legs 6221 of the staple 6220 as shown in FIGS. 133 and 134. Optionally, as a result of the adjustability provided by the retention matrix 6250, the same or at least about the same compression pressure is obtained in the fastened tissue, regardless of whether the tissue captured in the end effector is thick or thin. It is done. The adjustability provided by the retention matrix 6250 allows the surgeon to apply a greater or lesser compression pressure to the tissue by selecting the depth at which the retention matrix 6250 is placed. It is possible to select. For example, the extent to which the retention matrix 6250 is fitted to the staple legs 6221 can be determined by the length or extent of the slots 6233 and 6234, for example.

  If desired, as noted above, the protective cap 6270 can be configured to grip the end of the staple leg 6221, eg, a soft or flexible material. The protective cap 6270 is a bioabsorbable plastic, commercially available under the trade name Vicryl, polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), available under the trade name Monocryl. Polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or PGA, PLA, PDS, PHA, PGCL and / or PCL composites and / or biocompatible such as titanium and / or stainless steel It can be made of a conductive metal. As shown in FIG. 124, each cap 6270 may not be connected to the other cap 6270. Alternatively, one or more caps 6270 can be attached to the retention matrix 6250. For example, the cap 6270 can be attached to the retention matrix 6250 by, for example, at least one adhesive, in which case the openings 6271 of the cap 6270 are aligned with the retention openings 6252 in the retention matrix 6270 or It can be at least approximately aligned. Referring to FIG. 135, a protective cap, such as cap 6370, can define an inner cavity or dome 6374 that can be configured to receive the tip of staple leg 6221 therein, for example. For example, the cap 6370 can have a bottom 6372 and an opening 6371 extending through the bottom 6372. The opening 6371 can be defined by one or more bendable members 6373 that can be configured to bend as the staple legs 6221 are inserted. For example, two or more caps 6370 can be coupled together to form an array of caps 6370. For example, referring to FIG. 136, a plurality of caps 6370 can be coupled together by a sheet of material 6375. The seat 6375 has sufficient rigidity so that the desired placement and / or alignment of the cap 6370 can be maintained. The cap 6370 may comprise a biocompatible metal such as titanium and / or stainless steel, and the sheet 6375 is a bioabsorbable plastic, polyglycolic acid (PGA), polylactic acid (PLA or PLLA, commercially available under the trade name Vicryl. ), Polydioxanone (PDS), polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL), polycaprolactone (PCL) and / or PGA, PLA, PDS, PHA, PGCL and / or commercially available under the trade name Monocryl. Alternatively, it can be composed of a PCL composite. In accordance with the present invention, the sheet 6375 may comprise a bioabsorbable material comprising an antibacterial agent such as colloidal silver and / or triclosan stored and / or dispersed therein, for example, the sheet 6375 It can be released when absorbed by the body.

  In addition to the above, the sheet 6375 can be injection molded around the cap 6370 using, for example, an injection molding process, whereby the cap 6370 is embedded within the sheet 6375. Sheet 6375 can be formed using, for example, an injection molding process, and openings 6376 are formed in sheet 6375 using a stamping process during and / or after the injection molding process. be able to. In any case, the cap 6370 can be inserted and secured into the opening 6376 using a press-fit and / or snap-fit connection and / or at least one adhesive. Each cap 6370 may have an annular groove that surrounds or at least partially surrounds the outer periphery of the cap 6370 that may be configured to receive the outer periphery of the opening 6376 therein. The sheet 6375 can be composed of a flexible and / or soft material that can allow relative movement within the cap 6370. For example, the flexible sheet 6375 can be made of, for example, rubber, plastic, and / or silicone material, and the cap 6370 can be made of, for example, a rigid material such as metal. For example, a flexible material can be molded around the cap 6370 as described above. The cap 6370 can be pushed into a pre-formed sheet 6375, for example. The durometer of the flexible material can be selected to provide a sheet 6375 of the desired hardness. The sheet 6375 can be configured to include a flexible band. In any case, the sheet 6375 may facilitate assembly of the cap 6370 to the end effector when the plurality of caps 6370 are simultaneously placed and / or aligned within the end effector. Further, the sheet 6375 connecting the cap 6370 can reinforce or reinforce tissue along the staple row, for example, when implanted. Cap 6370 may be added to the connecting sheet or alternatively, cap 6370 may be connected to each other by a plurality of connecting portions. For example, such a connection may be flexible, allowing relative movement between the caps 6370.

  Referring now to FIGS. 139 and 140, for example, a protective cap, such as cap 6470, may include a molded surface that can be configured to deform the tips of the staple legs. For example, the cap 6470 can have a base 6472 that can include an opening 6471 extending therethrough. The opening 6471 can be configured to closely receive, for example, a staple leg such as the staple leg 6221 therein. Opening 6471 may be defined by a diameter or circumference that may be equal to or greater than the diameter or circumference of staple leg 6221. The cap 6470 can further include a cavity or dome 6474 that can be configured to receive the tip of the staple leg 6221 as it is inserted into the cap 6470. Referring primarily to FIG. 140, the cap 6470 may further include an anvil or molded surface 6473 that can be configured to flex and deform the staple legs 6221. In various situations, the molding surface 6473 may be curved and / or concave, for example, and may be configured to bend the staple legs 6221 as they are inserted into the cap 6470. The staple leg 6221 may be sufficiently deformed so that it cannot be withdrawn from the opening 6471 so that the cap 6470 can be secured to the staple leg 6221. For example, the base 6472 of the cap 6470 can define a lip extending around the opening 6471 that can prevent the deformed staple leg 6221 from detaching from the cavity 6474. In various situations, as a result of the above, one or more caps 6470 may prevent or limit a retention matrix, such as retention matrix 6250, from retracting or detaching from staple 6220, for example. it can. Optionally, although not shown in the figure, the cap 6470 can be formed symmetrically or at least approximately symmetrically and the opening 6471 can be disposed along a central axis 6479 extending through the cap 6470. it can. Alternatively, referring again to FIG. 139, the opening 6471 may be offset with respect to the central axis 6479. For example, the offset opening 6471 contacts the side of the molding surface 6473 instead of contacting the center of the molding surface 6473 as may occur in embodiments including the centered opening 6471 described above. And may be able to curve toward the other side of the molding surface 6473.

  If desired, as described above, a retention matrix, such as retention matrix 6250, can be comprised of, for example, a sheet of material and a plurality of retention openings 6252 extending through the sheet of material. The sheet of material comprising the retention matrix 6250 can be rigid or nearly inflexible. Alternatively, the retention matrix can be comprised of an array of retention matrix elements, a plurality of flexible connectors or connections that connect the retention matrix elements. Referring to FIG. 141, the retention matrix 6550 or a portion of the retention matrix can include a plurality of element bodies 6505 that can be coupled together by one or more coupling connections 6507. Each element body 6505 can have a plurality of deformable members 6553 in which retention openings 6552 are defined. The element main body 6505 and the connection connection portion 6507 of the holding matrix 6550 can be integrally formed, and can be formed of an integrally formed material. The retention matrix 6550 can be stamped or cast, for example, from a metallic material such as titanium and / or stainless steel. Retaining matrix 6550 is a plastic, for example, polyetheretherketone (PEEK), polypropylene, polyester, commercially available under the trade name Proline, polyethylene terephthalate, polyvinylidene fluoride, polyvinylidene fluoride-co-, commercially available under the trade names Ethibond and Mersilene. Hexafluoropropylene, commercially available under the trade name Pronova, polyhexafluoropropylene-VDF, and / or long chain fatty acid polymer nylon 6 and nylon 6,6, etc. marketed by Ethilon & Neuron, etc. It can be formed by an injection molding process. The element main body 6505 can be formed integrally with the connection connecting portion 6507. In accordance with the present invention, a plurality of single element bodies 6505 can be made and then connected together and embedded in a retention matrix. For example, the element body 6505 is stamped from a metallic material such as, for example, titanium and / or stainless steel, placed in a plastic injection mold, and the plastic material is injected into the mold, thereby 1) the element body 6505 A rim 6506 of material that surrounds or at least substantially surrounds 2) and a connecting connection 6507 extending from the rim 6506. Alternatively, one or more connector grids may be formed that include openings defined in the plurality of rims 6506, in which case such openings each receive an element body 6505 therein. Can be configured. Each element body 6505 may have a circular or at least approximately circular perimeter, and similarly each rim 6506 may be defined with a circular or at least approximately circular opening, the diameter of the opening being the size of the element body 6505. It may be equal to or smaller than the diameter. For example, the element body 6505 can be press fit or embedded in the opening of the rim 6505. Element body 6505 can be secured within the opening using at least one adhesive.

  In addition to the above, for example, as shown in FIGS. 142-145, the retention matrix has a plurality of element bodies 6505 and a plurality of connection connections 6507 that can connect the element bodies 6505 in any suitable arrangement. sell. Regardless of the arrangement pattern, the coupling connection 6507 can be configured to allow the element body 6505 and the retention opening 6552 to move relative to each other. For example, the lattice and connecting connections 6507 of the element body 6505 that make up the retention matrix 6550 may expand, twist, contract, and / or bend in other forms when engaged with tissue. It can be configured to allow at least some movement within, while at the same time resisting large movements. As required, each linking connection 6507 allows the retention matrix 6550 to bend between each matrix retention element 6505 by stretching, twisting, contracting, and / or bending in another form. A flexible member configured to do so. Referring again to FIG. 141, each connection 6507 extending from the rim 6506 may be defined by a width that is narrower than the width of the element body 6505 and / or the rim 6506. With reference to FIGS. 142-145, one or more of the connections 6507 can have, for example, straight portions that extend along a straight line between adjacent element bodies 6506. For example, each connection 6507 can have a first end attached to the first rim 6506 and a second end attached to the second rim 6506. Referring again to FIG. 141, two or more connections 6507 can be coupled together. For example, the two or more connection parts 6507 may be connected by an intermediate hinge 6509, for example. The hinge 6509 may have a reduced cross-sectional thickness in one or more directions compared to the cross-sectional thickness of the connection 6507, such that, for example, the connected connections 6507 move relative to each other. Is possible. The retention matrix 6550 may further include a hinge 6508 that couples the connection 6507 to the rim 6506 to allow relative movement between the connection 6507 and the rim 6506. Similar to hinge 6509, hinge 6508 may have a reduced cross-sectional thickness in one or more directions, for example, compared to the cross-sectional thickness of connection 6507.

  In addition to the above, the connecting connection 6507 may extend in different directions. For example, the first connection portion 6507 may extend in a first direction, the second connection portion 6507 may extend in a second direction, and the first direction may be different from the second direction. The first connection portion 6507 may extend along the first line, the second connection portion 6507 may extend along the second line, and the first line and the second line are: For example, they may intersect each other at an angle of about 30 °, about 45 °, about 60 °, and / or about 90 °. The hinge 6508 and / or the hinge 6509 may include a living hinge that allows the connection 6507 to move multiple times relative to each other without breaking. Hinge 6508 and / or hinge 6509 may have portions that are too fragile and / or fragile or easily ruptured when bent excessively. For example, such a weakened portion may allow one or more portions of the retention matrix 6550 to break and separate from another portion of the retention matrix 6550. For example, hinge 6508 and / or hinge 6509 may have a section of retention matrix 6550 that is easier to cut than other portions of retention matrix 6550. More particularly, the implanted retention matrix and the tissue fastened by the implanted retention matrix can often be incised by a cutting member for a variety of reasons, but to facilitate such a cut, hinges 6508 and The hinge 6509 can provide, for example, a passage or thin section through which the cutting member can more easily pass through the retention matrix 6550. In addition to the above, the coupling connection 6507 may be defined with, for example, one or more coinings or material upsets that may facilitate bending, breaking, and / or incision of the coupling connection 6507. .

  In accordance with the present invention, the retention matrix may have a plurality of retention matrix elements, such as matrix element body 6505, that can be embedded within a flexible sheet or band of material. The flexible sheet of material can be formed of a bioabsorbable, elastomeric material, such as silicone, and the flexible sheet can be made with a plurality of openings defined therein. For example, a solid flexible sheet can be formed and a plurality of openings can be punched into the flexible sheet. Alternatively, the flexible sheet can be molded to form openings defined therein during the molding process. In either case, the retention matrix element 6505 can be inserted and retained, for example, in a flexible sheet. Alternatively, similar to the above, the flexible sheet can be formed around the matrix element 6505. The flexible sheet can be composed of, for example, a woven mesh, and / or any other suitable material. In addition to the above, such a woven mesh can be easily cut.

  146 and 147, a fastening system that includes a retention matrix, such as retention matrix 6250, for example, covers the tip of the staple legs 6221 as they extend beyond the upper surface 6257 of the retention matrix 6250. A cover such as cover 6670 can be included. Cover 6670 can be attached to retention matrix 6250. Cover 6670 and / or retention matrix 6250 can include a retention mechanism that can be configured to retain cover 6670 against retention matrix 6250. At least one adhesive can be used to adhere the cover 6670 to the retention matrix 6250. As described in more detail below, the cover 6670 is shown as including two layers, but the cover 6670 can also be composed of a single layer. Referring primarily to FIG. 147, the tip of staple leg 6221 may extend through bottom surface 6673 of cover 6670, but cover 6670 is sufficient to prevent the staple tip from penetrating top surface 6675 of cover 6670. It can have a thickness. For example, as a result, the tip of the staple leg 6221 may not protrude from the cover 6670. Cover 6670 can have multiple layers. For example, the cover 6670 can include a first layer 6671 and a second layer 6672. The first layer 6671 and the second layer 6672 may be attached to each other, and the second layer 6672 may have a bottom surface 6676 bonded to the first layer 6671. The first layer 6671 and the second layer 6672 may have different thicknesses, but may have the same thickness. The first layer 6671 and the second layer 6672 can have substantially the same width and / or length. Alternatively, layers 6671 and 6672 may have different widths and / or lengths.

  In addition to the above, the first layer 6671 can be composed of, for example, a compressible foam material, a mesh material, and / or a hydrogel that can be incised by the staple legs 6211. The second layer 6672 can be comprised of a harder material or skin such as, for example, PGA and / or PDS, and / or any suitable buttress material. For example, the staple legs 6221 can be configured to penetrate the first layer 6671, but the staple legs 6221 need not be able to penetrate the second layer 6672. The second layer 6672 allows the second layer 6672 to be displaced by the staple legs 6221 in contact with the staple legs 6221, but is not incised or slightly incised by the staple tips of the staple legs 6221. It can be made of a material having sufficient elasticity and / or toughness. Although not shown in the figure, the cover may include more than two layers, and one or more of such layers may be non-penetrating. In use, for example, the retention matrix 6250 is placed against the tissue to be fastened and pushed downward, thereby pushing the staple legs 6221 of the staple 6220 through the retention openings 6252 of the tissue T and the retention matrix 6250, Enters first layer 6271 of cover 6270. The tips of the staple legs 6221 may or may not enter at least the second layer 6272 of the cover 6270. As shown in FIG. 146, after the retention matrix 6250 is properly positioned, the jaws 6240 can be opened and the cover 6670 and the retention matrix 6250 can be separated from the jaws 6240. As shown in FIG. 146, the jaw 6640 can be configured to hold more than one holding matrix 6250 and cover 6670. For example, jaw 6640 can include two groove members 6679, each of which can be configured to receive an inner cover 6670 and a retention matrix 6250 disposed thereon, with each retention matrix 6250 Tissue contact surface 6251 is located below the bottom of jaw 6240. For example, retention matrix 6250 and cover 6270 are housed within jaw 6640 on each side of knife slot 6678. In use, the retention matrix 6250 and cover 6670 may be deployed at the same depth with respect to opposing staple cartridges, such as cartridge 6200, disposed at the same time and / or, for example, across it. The fastened tissue is then incised along the cutting line by a cutting member that traverses the knife slot 6678 and the jaw 6640 is reopened. Cover 6670 may not be attached to retention matrix 6250. For example, the cover 6670 may be disposed on the groove member 6679 and may be retained on the groove member 6679 by a retention matrix 6250 that may be secured to the jaw 6640. Each retention matrix 6250 may be wider and / or longer than each of these covers 6670 so that the retention matrix 6250 can hold the entire cover 6670 in place. Each retention matrix 6250 may have the same width and / or length as each of these covers 6670, for example.

  Optionally, as described above, the fastening system may include a material layer, which can be attached to a retention matrix, such as retention matrix 6250, for example. Referring now to FIG. 150, a layer of material 6870 can be attached to the bottom surface 6251 of the retention matrix 6250. Layer 6870 and / or retention matrix 6250 may include a retention mechanism, which may be configured to retain layer 6870 in retention matrix 6250. At least one adhesive may be used to adhere the layer 6870 to the retention matrix 6250. In any case, the layer 6870 may include a bottom surface or tissue contacting surface 6873 when the retention matrix 6250 is moved downward toward the staple 6220 to engage the retention openings 6252 with the staple legs 6221. Further, it can be configured to come into contact with the tissue T. For example, the layer 6870 can be composed of a compressible material, such as a bioabsorbable foam material, which can be compressed between the bottom surface 6251 of the retention matrix 6250 and the tissue T. Layer 6870 can further include at least one drug stored and / or absorbed therein, and the drug is squeezed out of layer 6870 when layer 6870 is compressed. The agent can include at least one tissue sealant, hemostatic agent, and / or antimicrobial agent, such as ionized silver and / or triclosan. The compression of layer 6870 can squeeze the drug from layer 6870 so that the entire surface of tissue T, or at least many portions, is covered by the drug. Further, as the layer 6870 is compressed and the staple legs 6221 penetrate the tissue T and the layer 6870, the drug can flow down from the staple legs 6221 and treat, for example, the tissue just incised by the staple legs 6221. The body of the retention matrix 6250 may include a first layer that includes a biocompatible material, such as, for example, titanium and / or stainless steel, and the bottom surface 6870 includes, for example, oxidized regenerated cellulose (ORC), fibrin, and / or Biologically active agents such as thrombin (either liquid or dry frozen), glycerin, absorbable porcine gelatin (in the form of smoke or foam), and / or antibacterials such as ionized silver and / or triclosan A second layer comprising a compatible material may be included. Additional biocompatible materials are Surgicel Nu-Knit, Surgicel Fibrilla, Collagen / ORC (composite with an embedded collagen matrix, marketed under the trade name Promogran), polyglycolic acid (PGA) (commercial product) Polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polygrecapron 25 (PGCL) (commercially available under the trade name Monocryl), polycaprolactone (commercially available under the name Vicryl) PCL) and / or a composite of PGA, PLA, PDS, PHA, PGCL and / or PCL. Although only one layer 6870 is illustrated in FIG. 150, any suitable number of layers can be used. A first layer containing a first agent can be attached to the retention matrix 6250, and a second layer containing a second and different agent can be attached to the first layer. For example, multiple layers may be used, and each layer may contain different drugs and / or different combinations of drugs contained within.

  Referring now to FIG. 148, the fastening system can have a layer of material 6770 attached to the bottom surface 6251 of the retention matrix 6250. Layer 6770 and / or retention matrix 6250 may include a retention mechanism, which may be configured to retain layer 6770 in retention matrix 6250. At least one adhesive may be used to adhere the layer 6770 to the retention matrix 6250. In any case, the layer 6770 may include a bottom surface or tissue contacting surface 6773 that is moved when the retention matrix 6250 is moved downward toward the staple 6220 to engage the retention openings 6252 with the staple legs 6221. Further, it can be configured to come into contact with the tissue T. For example, the layer 6770 can be comprised of a compressible material, such as a bioabsorbable foam material, which can be compressed between the face 6251 of the retention matrix 6250 and the tissue T. Layer 6770 may further include one or more enclosures or cells 6774, which can be configured to store at least one drug therein. Referring to FIG. 149, the encapsulant 6774 is aligned with, or at least substantially aligned with, the retention opening 6252 so that when the staple leg 6221 is pushed through the tissue T and the layer 6770, the staple leg 6221 is 6774 can be punctured and / or otherwise ruptured. After the encapsulating part 6774 ruptures, at least one kind of medicine M stored in the enclosing part 6774 can flow out to the tissue T. For example, the drug M includes liquid that flows down or travels down the staple legs 6221 to treat the tissue T that has just been incised by the staple legs. As a result of the above, the drug stored in the enclosure 6774 provides a local treatment for the tissue. The encapsulant 6774 of the sheet 6770 can include different drugs stored therein. For example, a first group of enclosures 6774 may include a first drug or a first combination of drugs stored therein, and a second group of enclosures may include different drugs stored therein. Or a combination of different agents. Layer 6770 may include a flexible silicone sheet and encapsulant 6774 may provide space for the silicone sheet. For example, the silicone sheet may include two layers that can be attached to each other, and an encapsulant 6774 can be defined between the two layers. Layer 6770 may have one or more thin sections or weakened portions, for example, partial perforations, which facilitate incision of layer 6770 and rupture of encapsulant 6774 by legs 6221. There is a case. At least a portion of the enclosure 6774 can be disposed within the dome 6777, and the dome 6777 can extend upward from the seat 6770. For example, at least a portion of the dome 6777 and / or the enclosure 6774 can be disposed in a pocket 6201 formed in the retention matrix 6250. The enclosure 6774 may have separate cells that are not connected to each other. Alternatively, one or more of the enclosures 6774 can be in fluid communication with each other, eg, through one or more pathways, conduits, and / or groove members that extend through the layer 6770. The entire contents of US Pat. No. 7,780,685, entitled “ADHESIVE AND MECHANICAL FASTENER”, issued August 24, 2010, is hereby incorporated by reference.

  In addition to the above, a staple cartridge containing a cartridge body, staples, and / or alignment matrix therein is filled into the first jaw of the end effector, as well as the retention matrix and / or one or more covers. Can be filled into the second jaw of the end effector. Referring now to FIG. 151, an instrument such as, for example, a cartridge filler 6990 can be used to simultaneously insert two or more fastener cartridges into the end effector. The cartridge filler 6990 can include a handle 6991 and a cartridge carrier 6992, the cartridge carrier 6992 having a first holding portion configured to hold the cartridge body 6210 of the staple cartridge 6200, and the cartridge body 6980. A second holding portion configured to hold a first holding portion 6) a plurality of protective caps 6270 therein and 2) a holding matrix 6250 along its bottom surface. To do. The first holding portion and the second holding portion may include one or more holding members configured to releasably engage the cartridge bodies 6210 and 6980, respectively. Referring now to FIGS. 152 and 153, the end effector may include a first or lower jaw 6230 and a second or upper jaw 6940, and the staple cartridge 6200 is attached to the first jaw 6230. Filled, the cartridge body 6980 can fill the second jaw 6940. In various situations, the upper jaw 6940 can be rotated from the open position (FIG. 152) to the closed position (FIG. 153) by the actuator 6235, but the operation of the actuator 6235 has been described above for the sake of brevity. I won't repeat here. Referring now to FIG. 153, when the upper jaw 6940 is in its closed position, the distal end 6993 of the cartridge carrier 6992 may be inserted into the end effector so that the staple cartridge 6200 is in the first position. Slides through the distal end 6938 of the jaw 6930 to the first attachment portion or groove member 6939 in the first jaw 6230. Similarly, the distal end 6993 of the cartridge carrier 6992 may be inserted into the end effector such that the cartridge body 6980 passes through the distal end 6948 of the second jaw 6940 and within the second jaw 6940. Slide into the second attachment portion or groove member 6949. The surgeon or other clinician holding the handle 6991 of the cartridge filler 6990 places the staple cartridge 6200 and the cartridge body 6980 completely inside the staple cartridge 6200 and the cartridge body 6980 through the groove members 6939 and 6949, respectively. You can press up.

  Once the staple cartridge 6200 and staple body 6980 are in place, the staple cartridge 6200 and cartridge body 6980 are each associated with one or more holding positions within their respective jaws 6230 and 6940, as described in more detail below. Can be combined. In any case, referring now to FIG. 154, when the staple cartridge 6200 and cartridge body 6980 are placed, the cartridge filler 6990 is separated from the staple cartridge 6200 and the cartridge body 6980 is removed from the end effector. . For example, the holding force that holds the staple cartridge 6200 within the first jaw 6230 is greater than the holding force that holds the staple cartridge 6200 to the cartridge carrier 6992, thereby pulling the cartridge carrier 6992 distally from the end effector. In doing so, the staple cartridge 6200 may remain behind the first jaw 6230. Similarly, the holding force that holds the cartridge body 6980 in the second jaw 6940 may be higher than the holding force that holds the cartridge body 6940 on the cartridge carrier 6992 so that the cartridge carrier 6992 moves distally from the end effector. When pulled out, the cartridge body 6940 may remain behind the second jaw 6940. When the cartridge filler 6990 is removed from the end effector, the filled first jaw 6230 and the filled second jaw 6940 can be placed against the tissue T to be stapled. Referring now to FIG. 155, the second jaw 6940 is opened to engage the retention matrix 6250 and the plurality of protective caps 6270 held by the cartridge body 6980 with the staples 6220 disposed within the staple cartridge 6200. Moved from position (FIG. 154) to fired position (FIG. 155).

  Referring now to FIGS. 156 and 157, the second jaw 6940 is reopened and the plurality of protective caps 6270 and retention matrix 6250 are separated from the cartridge body 6980 so that the cap 6270 and retention matrix 6250 are It can remain engaged with tissue T and staple cartridge 6200. The cartridge body 6980 includes a plurality of pockets in which a plurality of caps 6270 can be removably disposed and one or more retaining slots configured to removably retain the retaining matrix 6250 therein. The holding member of the second jaw 6940 engaged with the cartridge body 6980 can hold the cartridge body 6980 in the second jaw 6940 after the second jaw 6940 is opened. The cartridge body 6980 can be configured to break when the second jaw 6940 is opened so that a portion of the cartridge body 6980 is embedded with the cap 6270 and the retention matrix 6250 so that the cartridge body 6980 A portion remains in the second jaw 6940. Similarly, referring again to FIGS. 156 and 157, the retaining member of the first jaw 6230 engaged with the cartridge body 6210 is moved into the cartridge body 6210 within the first jaw 6230 after the second jaw 6940 is opened. Can be retained. The cartridge body 6210 is configured to break when the first jaw 6230 is pulled away from the implanted cartridge 6200 so that a portion of the cartridge body 6210 is embedded with the staples 6220 and the alignment matrix 6260 so that the cartridge body 6210 A portion remains in the first jaw 6230. Referring now to FIGS. 158-160, for example, a staple cartridge, such as staple cartridge 6900, may include one or more elongated retention slots 6913 that extend along the length of the cartridge body 6910, which is For example, when the staple cartridge 6900 is inserted into the jaw 6930, it can be configured to receive one or more longitudinal retaining rails 6916 extending from the jaw 6930 therein. In use, the end of the retention slot 6913 can be aligned with the distal end of the retention rail 6916 before the staple cartridge 6900 slides through the distal end 6938 of the retention groove member 6939, for example.

  Referring again to FIG. 160, the jaw 6940 may include two retention groove members 6949, each retention groove member 6949 configured to receive a cartridge body 6980 that includes a plurality of caps 6270 and a retention matrix 6250 therein. can do. Each cartridge body 6980 may include one or more longitudinal retaining shoulders 6917 that are inserted when the cartridge body 6980 is inserted into their corresponding retaining groove member 6949 in the jaw 6940. In addition, the second jaw 6940 can be configured to slide along one or more longitudinal retaining rails 6918. The retention rail 6918 and retention shoulder 6917 cooperate to retain the cartridge body 6980 in the second jaw 6940 when the cartridge body 6980 is separated from the cap 6270 and retention matrix 6250 stored therein. sell. Referring now to FIG. 159, the second jaw 6940 further includes one or more distal protrusions, or retention members 6915 extending therefrom, that cause the cartridge body 6980 to have their corresponding retention grooves. It can be configured to be removably secured within the member. For example, the second jaw 6940 can be bent with respect to each holding groove member 6949 so that each cartridge body 6980 can be bent around the protrusion 6915 when the cartridge body 6980 is inserted into the groove member 6949. The distal end of the cartridge body 6980 may extend beyond the protrusion 6915 when the cartridge body 6915 is fully disposed within the groove member 6949. Fit on it. As described above, in order to remove the cartridge body 6980 after they are used, the cartridge body 6980 can be pulled back over the protrusion 6915 and removed from the retaining groove member 6949. Similar to the above, the first jaw 6930 may include one or more distal retention protrusions 6914 extending therefrom, which when the staple cartridge 6900 is fully deployed, the cartridge body 6910. Can be configured to be received in one or more retaining grooves or slots 6912 (FIG. 158).

  In addition to the above, a first fastening cartridge that includes a plurality of first fasteners disposed therein can be disposed within the first jaw of the surgical fastening device, wherein the plurality of second fasteners disposed therein. A second fastening cartridge containing two fasteners may be disposed in the second jaw of the surgical fastening device. In use, the first jaw and / or the second jaw can be moved relative to each other to engage the first fastener and the second fastener and secure the tissue therebetween. The first fastening cartridge and the second fastening cartridge can be engaged with each other when the first fastener is engaged with the second fastener. The body of the first fastening cartridge may include a first compressible material and the body of the second fastening cartridge may include a second compressible material, the first body and / or the second The body may be compressed against the tissue to be fastened. After the tissue is fastened, the first jaw may be moved from the implanted first fastening cartridge and the second jaw may be moved from the implanted fastening cartridge. Thereafter, the first jaw may be refilled with another first fastening cartridge or the like, the second jaw may be refilled with another second fastening cartridge or the like, and the surgical Fasteners can be reused. Staples can be used, but alternatives are envisioned that include other types of fasteners, such as, for example, two-part fasteners that are secured together when engaged with each other. For example, a first storage portion can be included for storing the first fastener portion, and a second fastening cartridge can include a second storage portion for storing the second fastener portion. . The fastening system described in the present invention may use fasteners that include any suitable type of material and / or shape. The fastener can have a penetrating member. Such a penetrating member can be composed of, for example, a polymer, a composite, and / or a multilayer substrate. An example of a multi-layer substrate can be a wire or sheet substrate with an elastomer or polymer coating. The penetrating member can be a thin sheet formed to be oriented perpendicularly or at least substantially perpendicular to the connecting member. The penetrating member may have a rectangular profile, a semi-circular profile, and / or any beam profile. The fasteners described herein can be manufactured using any suitable process, such as, for example, a wire extrusion process. Another possibility is the use of microfibrosis to produce a hollow penetrating member. These penetrating members may be made by a process different from the wire extrusion process and may use a combination of materials.

  As noted above, the tips of the staple legs that protrude through the retention matrix can be covered by one or more caps and / or covers. The tips of the staple legs can be deformed after they are inserted through the retaining matrix. The jaws holding the retention matrix may further have an anvil pocket disposed over and / or aligned with the retention opening, as these staple legs protrude above the retention matrix. These can be configured to be deformed. The staple legs of each staple may be distorted inwardly toward each other and / or toward the center of the staple, for example. Alternatively, one or more staple legs of the staple can be distorted outwardly from other staples and / or away from the center of the staple. If desired, regardless of the direction in which the staple legs are distorted, the tips of the staple legs can contact the body of the retention matrix and may not reenter the tissue fastened by the staples. Deformation of the staple legs after passing through the retention matrix can secure the retention matrix in place.

  Referring now to FIGS. 161 and 162, for example, a surgical stapling instrument, such as surgical stapler 7000, may have a first jaw 7030 and a second jaw 7040, where The movement of the actuator 6235 can move toward and away from the first jaw 7030. The operation of actuator 6235 is as described above and will not be repeated here for the sake of brevity. The first jaw 7030 can include a distal end 7031 and a proximal end 7032, and the first jaw 7030 can define a groove member extending between the distal end 7031 and the proximal end 7032. This can be configured to receive a staple cartridge. For purposes of illustration, the cartridge body of such a staple cartridge is not shown in FIG. A staple driver 7012 may be included. Although not shown in FIG. 161 for clarity, the second jaw 7040 holds a retention matrix, such as retention matrix 6250, on staple 6220 and / or as described above. The retention matrix can be configured to move into engagement with the legs of the staple 6220. The surgical staple 7000 can further include a thread 7010 disposed within the first jaw 7030, which slides from the distal end 7031 of the first jaw 7030 toward the proximal end 7032, for example. The staple driver 7012 and the upper supported staple 6220 can be lifted in the direction of the retention matrix and second jaw 7040. Alternatively, the sled 7010 can be moved from the proximal end 7032 toward the distal end 7031 to deploy the staple 6020, for example. The sled 7010 may include one or more inclined ramps or cams 7011 that can be configured to slide under the staple driver 7012 and lift the staple driver 7012 to information. . Surgical staple 7000 may further include a rod for pulling or pushing operatively connected to sled 7010, which includes an actuator located on the handle and / or a shaft of surgical staple 7000. Can be moved proximally and / or distally.

  Referring again to FIG. 161, the second jaw 7040 of the surgical stapler 7000 can include a frame 7041, a distal end 7048, and a proximal end 7049 disposed opposite the distal end 7048. The second jaw 7040 may further include a guide system that includes one or more guide rails, such as guide rails 7045 and 7046, extending along the longitudinal axis of the frame 7041. This includes one or more anvils or cams that engage and deform the staple legs of the staple 6220 after the staple legs 6221 of the staple 6220 have passed through the retention matrix, as described in more detail below. It can be configured to guide. For example, guide rails 7045 and 7046 may include guide wires or cables that extend along the top or top surface of frame 7041, for example, along the top or surface of frame 7041, back from the periphery of distal post 7047. Optionally, as described above and now mainly referring to FIGS. 163 and 165, the second jaw 7040 may further include one such as, for example, a first anvil 7050 and a second anvil 7060. Or may further include two or more anvils or cams, which are longitudinally along the second jaw 7040 to deform the legs of the staple 6220 after passing the retention matrix. It may move. Surgical stapler 7000 may further include a first anvil driver or actuator 7051 coupled to and / or operably coupled to the first anvil 7050, which includes the first anvil 7050. It can be configured to pull 7050 proximally and / or push the first anvil 7050 distally. Similarly, the surgical staple 7000 may further comprise a second anvil driver or actuator coupled to and / or operably coupled to the second anvil 7060, which includes a second One anvil 7060 can be pushed distally and / or the second anvil 7060 can be pulled proximally. The first anvil 7050 can include a guide slot 7052 and the second anvil 7060 can include a guide slot 7062, each of which slidably receives a guide rail 7045 or a guide rail 7046 therein. It can be constituted as follows. For example, guide rails 7045 and 7046 are tightly received in guide slots 7052 and 7062, thereby preventing or at least limited relative lateral or side-to-side movement therebetween. .

  In addition to the above, the first anvil 7050 can be pulled proximally and the second anvil 7060 can be pulled distally. Referring to FIG. 161, guide rails 7045 and 7046 and distal post 7047 are configured to pull second anvil 7060 distally and / or pull second anvil 7060 proximally. A pulley system may be included. For example, guide rail 7045 and guide rail 7046 may have a continuous wire or cable extending around distal post 7047, and a portion of the continuous wire wraps around the wire at distal post 7047. Can be pulled as For example, the guide rail 7046 may be attached to the second anvil 7060 so that the second anvil 7060 is moved to the distal end of the jaw 7040 when a continuous cable is routed in the first direction. 7048 can be pulled distally toward 7048 and the second anvil 7060 can be pulled proximally toward the proximal end 7049 as the continuous cable wraps around in the second or opposite direction. . Referring now to FIG. 163, the guide rail 7046 can be secured within the guide slot 7062 so that traction can be transmitted therebetween. For example, the guide rail 7045 can be configured to slide within the other guide slot 8062. The first anvil 7050 may operate separately from the second anvil 7060, such that the pulley system and the guide slot 7052 defined in the first anvil 7050 are allowed relative movement therebetween. Guide rails 7045 and 7046 can be slidably received. The continuous cable including guide rails 7045 and 7046 can be sufficiently flexible to accommodate the opening and closing of the upper jaw 7040. The continuous cable may also be sufficiently flexible to accommodate vertical movement toward and away from the lower jaw 7030 of the second anvil 7060, which is described in more detail below.

  Referring again to FIGS. 163 and 165, the first anvil 7050 can include a cam follower 7055 extending therefrom, which is defined within the frame 7041 of the second jaw 7040, eg, a cam slot 7070. (FIG. 166) can be configured to be located within one or more cam slots or guide slots. More specifically, frame 7041 extends longitudinally along a first cam slot 7070 that extends longitudinally along a first side of frame 7041 and a second opposite side of frame 7041. A cam follower 7055 that may include a second cam 7070 and extends from the first side of the first anvil 7050 may be located in the first cam slot 7070 and the second of the first anvil 7050 The cam follower 7055 extending from the second side may be located in the second cam slot 7070. For example, the outer shape of each cam slot 7070 may be the same or at least approximately the same and aligned with each other or at least approximately aligned. Similarly, the second anvil 7060 may have a cam follower 7065 extending therefrom, which is located in a cam slot 7070 (FIG. 166) defined in the frame 7041 of the second jaw 7040. It can be constituted as follows. More specifically, a cam follower 7065 that extends from the first side of the second anvil 7060 may be located within the first cam slot 7070 and from the second side of the second anvil 7060. An extended cam follower 7065 can be located in the second cam slot 7070. In use, the cam follower 7055 of the first anvil 7050 and the cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 so that the first anvil 7050 and the second anvil 7050 As the anvil 7060 is pulled proximally and / or pushed distally, the first anvil 7050 and the second anvil 7060 follow the profile of the cam slot 7070. Optionally, as described in more detail below, each cam slot 7070 can include a plurality of parallel portions or upper portions 7071 and a plurality of drivers or lower portions 7072, such that the anvils 7050 and 7060 are longitudinal. At the same time (between the distal end 7048 and the proximal end 7049 of the frame 7041), the anvils 7050 and 7060 can be configured to move vertically (ie towards the lower jaw 7030). , And away from this).

  166, when the surgical stapler 7000 is in an unfired state, the first anvil 7050 may be placed at the distal end 7048 of the frame 7041 and the second anvil 7060 may be Referring now to FIG. 167, which may be disposed at the proximal end 7049, the staple 6220 disposed within the first jaw 7030 is still in the tissue T when the surgical stapler 7000 is in an unfired state. It may not be inserted and / or the retention matrix is disposed thereon. In use, referring now to FIG. 168, the staple 6220 may be driven upward within the staple cavity 7033 of the staple cartridge by the staple driver 7012, and the first anvil 7050 may be the staple leg of the staple 6220. To engage 6221, it may be moved proximally from the distal end 7048 of the frame 7041 to the distal end 7049. The staple 6220 can be driven upward before the first anvil 7050 engages its staple leg 6221. If desired, all staples 6220 may be deployed upward by sled 7010 before first anvil 7050 is advanced into contact with staple legs 6221, or sled 7010 may be While the anvil 7050 may be moved proximally at the same time as the anvil 7050 is moved proximally, the sled 7010 causes the first anvil 7050 to be deployed in front of the first anvil 7050. There is enough guidance. Optionally, as shown in FIG. 168, the cam slot 7070 can be formed on the first cam 7050, for example, molding surfaces or cam surfaces 7053 and 7054 as the first cam 7050 passes through the parallel portion or top. Can be configured and arranged such that the molding surface can contact at least a portion of the staple legs 6221. In various situations, the cam followers 7055 of the first anvil 7050 are each disposed within the parallel portion 7071 of the cam slot 7070 so that the molding surfaces 7053 and 7054 are in the raised portion and the staple legs 6221 are in the anvil. 7050 is only partially deformed as it passes through it in the parallel section. As shown in FIG. 169, when the first cam 7050 is moved further along the cam slot 7070, the cam follower 7055 of the first anvil 7050 is driven or lower part of the cam slot 7070. 7072 may cause the molding surfaces 7053 and 7054 to move vertically downward toward the staple legs 6021 to drive the staple legs 6021 to their final molded configuration. . Thereafter, as the first anvil 7050 is further advanced along the cam slot 7070, the first anvil 7050 can be driven vertically upward to another set of parallel portions 7071 of the cam slot 7070. As shown in FIGS. 168 and 169, the reader will appreciate that the first anvil 7050 may only engage some of the staple legs and not others. For example, the first anvil 7050 can be configured to deform only a group of staple legs including, for example, the distal staple legs 6221 of the staple 6220. For example, the first anvil 7050 can be configured to deform the distal staple leg 6221 toward the center of the staple 6220. Optionally, each proximal staple leg 6221 has a second anvil 7050 and twice (ie, a first molding surface 7053 and a second molding surface 7054 aligned with the first molding surface 7053). ) Can touch. For example, the first molding surface 7053 can cause the distal staple legs 6221 to deform into a partially deformed configuration when the first anvil 7050 is in the parallel portion or at the top, and the second The molding surface 7054 can transform the distal staple leg 6221 into a fully molded configuration as the first anvil 7050 is moved to the drive or lower portion. Referring now to FIGS. 163 and 164, the first anvil 7050 can be used to deform the distal staple legs 6221 of the staples 6220 when the staple legs 6221 are configured in more than one row or line. There may be a plurality of first molding surfaces 7053 and a plurality of second molding surfaces 7054. If desired, the proximal staple leg 6221 of the staple 6020 can be deformed, for example, by the second anvil 7060, as described in more detail below.

  In addition to the above, the first anvil 7050 may be moved from the distal end 7048 of the frame 7041 to the proximal end 7049 to deform all of the distal staple legs 6221 of the staple 6220. As the reader will notice, the first anvil 7050 can be moved up and down relative to the undeformed proximal staple leg 6221, and in order to accommodate such movement, the first anvil 7050 is 1 One or more gap slots 7057 (FIG. 165) may be included so that the first anvil 7050 receives the unbent proximal staple legs 6221 as the distal staple legs 6221 are bent. Can be configured. Similarly, referring again to FIG. 163, the second anvil 7060 moves up and down as described above when the anvil 7050 is moved between its parallel portion and the drive portion. There may be a gap slot 7067 that may be configured to accommodate 7051 vertical movement. After all distal staple legs 6221 have been bent, the second anvil 7060 can be moved from the proximal end 7049 of the frame 7041 to the distal end 7048 by the anvil actuator 7061. Referring now to FIG. 170, similar to the above, the cam follower 7065 of the second anvil 7060 can slide within the cam slot 7070 and the proximal staple leg 6221 can be positioned, for example, in the middle of the staple 6220. The second anvil 7060 can be moved between a parallel part or upper part and a drive part or lower part in order to deform inwardly towards it. As above, the second anvil 7060 may include a plurality of first molding or cam surfaces 7063 and a plurality of second molding or cam surfaces 7064, each of which is one of the proximal staple legs 6021. One or more can be configured to be at least partially deformed and / or fully deformed. Referring again to FIG. 164, the second anvil 7060 may include a plurality of first shaping surfaces 7063 and a plurality of second shaping surfaces 7064, which are arranged, for example, in a plurality of rows or lines. Also, the proximal staple leg 6221 of the staple 6220 can be configured to deform. Also as shown in FIG. 164, the first molding surface 7063 and the second molding surface 7064 of the second anvil 7060 are connected to the first molding surface 7053 and the second molding surface 7054 of the first anvil 7050. As a result, the proximal legs 6221 of the staples 6220 may be arranged in a different row or line than the distal legs 6221 of the staples 6220. As the reader will notice, the second anvil 7060 may push the first anvil 7050 as the second anvil 7060 is moved distally. For example, the second anvil 7060 can push the first anvil 7050 back into the distal end 7048 of the frame 7041 so that the first anvil 7050 can be returned to its pre-launch position. After all of the proximal staple legs 6221 of the staple 6220 have been deformed, the second anvil 7060 can be retracted proximally back to its initial or unfired position. In this manner, the surgical stapler 7000 can be used again so that a new staple cartridge can be placed in the first jaw 7030 and a new retention matrix can be placed in the second jaw 7040. 7000 can be reset.

  If desired, as described above, a surgical staple can have two or more anvils that can move longitudinally to engage a plurality of staple legs in the lateral direction. The surgical stapler can include an anvil that is moved proximally to deform the first group of staple legs and moved distally to deform the second group of staple legs. For example, such an anvil can include, for example, a molding surface facing proximally and a molding surface facing distally.

  Referring now to FIG. 171, for example, an anvil such as anvil 7140 may have a bottom surface or tissue contacting surface 7141 and a plurality of molded pockets 7142 defined therein. Anvil 7140 may have two or more plates, such as, for example, pocket plate 7143, which can be welded to frame 7144. For example, each pocket plate 7143 may be welded to the frame 7144 through a weld slot 7146 disposed within the plate groove member 7145 in the frame 7144 and extending through the frame 7144 to form a longitudinal weld 7147. In various circumstances, the longitudinal weld 7147 can have a continuous weld extending along the entire length of the weld slot 7146 and a series of spaced spot welds extending along the length. If desired, each pocket plate 7143 can include two or more plate portions welded together. For example, each pocket plate 7143 may have a first plate 7143a and a second plate portion 7143b, which may be welded together along a seam 7148. In each plate 7143, the first plate portion 7143 a and the second plate portion 7143 b can be welded together before the plate 7143 is welded to the plate groove member 7145 in the frame 7144. For example, the first plate portion 7143a and the second plate portion 7143b can include cooperating contours, such as, for example, the toothed contour shown in FIG. 171 which fit together to form a tight seam 7148. . Each plate 7143 may include a height of about 0.5 mm (0.02 "), which may be, for example, higher than the depth of the plate groove member 7145 so that its tissue contacting surface 7141 is the frame of the anvil 7040. 7044. Referring now to Fig. 172, the plates 7143 can be coupled together, for example, by at least one weld 7149 at the distal end of the plate 7143.

  As shown in FIGS. 171 and 172, each pocket plate 7143 can include a plurality of molded pockets 7142 defined therein. The molding pocket 7142 can be formed in the plate 7143 by any suitable manufacturing process, such as, for example, a grinding process and / or an electrode combustion process. For example, referring now to FIGS. 173 and 174, each molded pocket 7142 first forms a deep well 7150, and then forms an arcuate or curved surface 7151 that encloses the deep well 7150, and thereafter It can be manufactured by forming staple leg guide grooves 7152 in the curved surface 7151. Alternatively, these steps can be performed in any suitable order. Referring now to FIG. 175, the staple forming pocket 7142 can be formed such that the inner edge 7153 of the forming pocket is separated by a constant or at least approximately constant gap 7154. For example, the gap 7154 can be, for example, about 0.2 mm (.008 "). Further, the molding pocket 7142 can be disposed along two or more rows or lines, the centerline of which is constant or at least approximately The spacing 7155 may be separated by a constant spacing 7155. For example, the spacing 7155 between the centerlines may be, for example, about 0.89 mm (0.035 "). Referring again to FIG. 175, each molding pocket 7142 may taper between a narrow width 7156 and a wide width 7157. For example, the narrow width 7156 can be about 1.1 mm (0.045 ″) and the wide width 7157 can be about 1.9 mm (0.075 ″). The plate 7143 can be made of the same material as the frame 7144. For example, both the plate 7143 and the frame 7144 can be comprised of stainless steel, such as, for example, 300 series or 400 series stainless steel, and / or titanium. Alternatively, the plate 7143 and the frame 7144 can be composed of different materials. For example, the plate 7143 can be made of, for example, a ceramic material, and the frame 7144 can be made of stainless steel and / or titanium. Depending on the material used, in various situations, for example, in addition to or instead of the welding process described above, at least one fastening process may be used to secure the plate 7143 in the frame 7144.

  Referring now to FIGS. 176-178, the anvil 7240 can have a frame 7244 and a plurality of pocket plates 7243 that can be inserted into the frame 7244. As above, each pocket plate 7243 can have a plurality of molded pockets 7242 defined therein. Anvil frame 7244 can include retention slots 7246 defined therein, each of which can be configured to receive retention rails 7247 extending from pocket plate 7243. In order to assemble the pocket plate 7243 to the anvil frame 7244, to expand the retention slot 7246 so that each retention slot 7246 can receive the retention rail 7247 of the interior pocket plate 7243, as shown in FIG. The side wall 7245 may be refracted or widened outward. When the retention rail 7247 is placed in the retention slot 7246, the sidewall 7245 may be released, as shown in FIG. 178, so that the frame 7244 elastically contracts to its unbent state. Allows to do and / or return. Under such circumstances, the retention slot 7246 can contract and thereby capture the retention rail 7247 therein. Retention rail 7247 and / or retention slot 7246 may include one or more cooperating tapered surfaces such that after the refracted retention slot 7246 is released, the cam is within retention slot 7246. A tapered locking engagement can be formed that can hold the retaining rail 7247. Similar to the above, the pocket plate 7243 can be made of the same material as the frame 7244 or a different material. For example, the plate 7243 can be made of, for example, a ceramic material, and the frame 7244 can be made of stainless steel and / or titanium. Depending on the materials used, at least one gluing process and / or at least one welding process may be used to secure the plate 7243 in the frame 7244 in various situations.

  In FIGS. 179 and 180, the surgical stapling and cutting instrument 8010 may include an anvil 8014 that can be repeatedly opened and closed around a pivotable attachment to the elongate staple groove member 8016. Staple application assembly 8012 may include an anvil 8014 and a groove member 8016, with the proximal side of assembly 8012 attached proximally to elongate shaft 8018 to form an implementation portion 8022. When the staple application assembly 8012 is closed, or at least substantially closed, the implementation portion 8022 may exhibit a sufficiently small cross section suitable for inserting the staple application assembly 8012 into the trocar. The assembly 8012 can be operated by a handle 8020 coupled to the shaft 8018. The handle 8020 can include user controls, such as, for example, a rotary knob 8030 that rotates the elongate shaft 8018 and staple application assembly 8012 about the longitudinal axis of the shaft 8018. The closure trigger 8026 can pivot about a closure trigger pin 8152 (FIG. 181) that engages laterally across the handle housing 8154, in front of the pistol grip 8036, and pressing it causes the staple application. The assembly 8012 can be closed. According to the present invention, as will be described in detail below, when the closure trigger 8026 is clamped, the closure release button 8038 may be on the outside of the handle 8020, thereby pressing the release button 8038 to close the closure trigger. The 8026 clamp can be released to open the staple application assembly 8012. The firing trigger 8034 can pivot in front of the closure trigger 8026 so that the staple application assembly 8012 can simultaneously cut and staple the tissue clamped therein. In various situations, as will be described in detail below, a firing trigger 8034 can be used to utilize multiple firing strokes to reduce the amount of force required by the surgeon's hand per stroke. The handle 8020 may include rotatable right and / or left indicator wheels 8040, 8041 (FIG. 181), which may indicate the progress of firing. For example, the full firing stroke may require three full firing strokes of the firing trigger 8034, and thus the indicator wheels 8040, 8041 may rotate up to one third of a revolution for each stroke of the firing trigger 8034. As will be described in detail below, the manual firing release lever 8042 can retract the firing system before the entire firing stroke is completed, if desired, and in addition, the firing release lever 8042 can be secured to the firing system. And / or allows the surgeon or other physician to retract the firing system in case of failure.

  With reference to FIGS. 179 and 181, the elongate shaft 8018 may include an outer structure that includes a longitudinally returning closure tube 8024, which is responsive to a proximal press of the closure trigger 8026 of the handle 8020, Anvil 8014 may be pivoted toward the closed position. The elongated groove member 8018 can be coupled to the handle 8020 by a frame 8028 (FIG. 181) inside the closure tube 8024. Frame 8028 may be rotatably engaged to handle 8020 so that rotation of rotation knob 8030 (FIG. 179) can cause implementation portion 8022 to rotate. With particular reference to FIG. 181, the rotation knob 8030 may be comprised of two half-shells, which may have one or more inward projections 8031, which may be one or more lengths within the closure tube 8024. It can extend through the scaled side opening 8070 and engage the frame 8028. As a result of the above, the rotary knob 8030 and the frame 8028 can rotate together or synchronously so that the rotational position of the knob 8030 determines the rotational position of the implementation portion 8022. The longitudinal length of the long opening 8070 is long enough to allow longitudinal closing and opening movements of the closure tube 8024. With respect to generating the closing movement of the closing tube 8024, mainly referring to FIGS. 181 and 183, the upper portion 8160 of the closing trigger 8026 can be pushed toward the closing yoke 8162 via the closing link 8164. The closure link 8164 is pivotally attached to the closure yoke 8162 at its distal side by a closure yoke pin 8166 and is pivotally attached at its proximal side by a closure link pin 8168. The closure trigger 8026 is biased to the open position by a closure trigger tension spring 8246 which is proximally formed by a top portion 8160 of the closure trigger 8026 and right and left half shells 8156, 8158. And connected to The tension applied by the tension spring 8246 can be overcome by the closure force applied to the closure trigger 8026 to advance the yoke 8162, the closure link 8164, and the closure tube 8024 in the distal direction.

  When the closure trigger 8026 is actuated or pressed as described above, the closure release button 8038 causes the surgeon or other physician to depress the closure release button 8038, if desired, to close the closure trigger 8026 and other surgical instruments. It can be possible to return to the operating state. The closure release button 8038 is connected to a locking arm 8172 that is pivoted by a central outer pivot shaft 8173 so that movement can be transmitted between the release button 8038 and the locking arm 8172. Referring again to FIG. 181, compression spring 8174 can bias closure release button 8038 proximally (ie, clockwise about central outer pivot axis 8173 when viewed from the right) The upper portion 8160 of the closure trigger 8026 can include a proximal ridge 8170 with a rear notch 8171. When the closure trigger 8026 is depressed, the pivoting locking arm 8172 rides on the proximal ridge 8170 and when the closure trigger 8026 reaches the fully depressed position, the rear notch 8171 is below the pivoting locking arm 8172. It falls into the rear notch 8171 and is locked to the rear notch 8171 under the biasing force of the compression spring 8174. At this point, manually pressing the closure release button 8038 will cause the pivoting locking arm 8172 to rotate upward and disengage from the rear notch 8171, thereby unlocking the closure trigger 8026 and closing the trigger 8026 to be clamped. Can return to no position.

  Once the closure trigger 8026 is clamped proximally, the firing trigger 8034 can be pulled toward the pistol grip 8036 to advance the firing rod 8032 distally from the handle 8020 as described above. The firing trigger 8034 can pivot about a firing trigger pin 8202 traversing laterally and is engaged with the right and left half shells 8156, 8158 of the handle 8020. Firing trigger 8034, when activated, may advance linked transmission firing mechanism 8150. The linked transmission firing mechanism 8150 is biased to the unfired position retracted by a spring 8184, which is first attached to the pistol grip 8036 of the handle 8020, as will be described in detail below. Second, it is attached to one of the links of the linked transmission firing mechanism 8150. Spring 8184 may include a stationary end 8186 coupled to housing 8154 and a moving end 8188 coupled to proximal end 8190 of steel band 8192. The distal end 8194 of the steel band 8192 can be attached to an attachment mechanism 8195 on the front link 8196a of the plurality of links 8196a-8196d. The linkage rack 8200 may be flexible, which allows it to be easily retracted toward the pistol grip 8036 to minimize the length of the handle 8020, while forming a straight and rigid rack assembly that is fired. A significant firing force can be transmitted to and / or through the rod 8032. As described in more detail below, firing trigger 8034 engages first link 8196a during a first actuation of firing trigger 8034 and engages with second link 8196b during a second actuation of firing trigger 8034. The third link 8196c during the third actuation of the firing trigger 8034, and the fourth link 8196d during the fourth actuation of the firing trigger 8034. Each of these actuations allows the linkage rack 8200 to be advanced distally by an incremental amount. Further to the above, multiple strokes of the firing trigger 1034 can cause the left and right indicator gauge wheels 1040, 1041 to rotate, thereby indicating the distance that the linked rack 8200 has advanced.

  Referring now to FIGS. 181 and 183, the anti-retraction mechanism 8250 can prevent the combined tension / compression spring 8184 from retracting the interlocking rack 8200 between firing strokes. According to the present invention, the connecting slide tube 8131 supports the first link 8196a and is connected to the firing rod 8032 to transmit the firing motion. Firing rod 8032 exits proximally from the proximal end of frame 8028 and extends through through hole 8408 in anti-retraction plate 8266. The through-hole 8408 is dimensioned to slidably receive the firing rod 8032 when vertically aligned but to restrain when tilted. The lower tab attachment 8271 extends proximally from the lower lip at the proximal end of the frame 8028 and extends through the opening 8296 in the lower edge of the anti-retraction plate 8266. The lower tab attachment 8271 pulls close to the lower partial frame 8028 of the anti-retraction plate 8266 so that the anti-retraction plate 8266 becomes vertical when the firing rod 8032 is advanced distally and fires. If the rod 8032 attempts to retreat, the upper rear side can be tilted into a restrained state. The anti-retraction compression spring 8264 is restrained in the distal direction by the proximal end of the frame 8028 and supports the upper portion of the anti-retraction plate 8266 in the proximal direction to urge the anti-retraction plate 8266 in a locked state. The reverse movement prevention cam tube 8268 slidably surrounds the connecting slide tube 8131 and supports the backward movement prevention plate 8266 against the spring bias. A proximally protruding anti-retraction yoke 8256 attached to the anti-retraction cam tube 8268 extends over the closure yoke 8162.

  Referring to FIG. 181, a link trigger automatic retractor 8289 is incorporated into the surgical stapling and cutting instrument 8010 to retract the knife at the end of the entire firing stroke. Thus, the distal link 8196d includes a tongue 8290 that protrudes upward as the distal link 8196d advances into the rack groove member 8291 (FIG. 181) formed in the closure yoke 8162. The tongue 8290 is aligned to actuate the lower proximal cam 8292 on the anti-retraction release lever 8248 (FIG. 186). With particular reference to FIGS. 186 and 187, the structure formed in the right and left half shells 8156, 8158 restrains the movement of the anti-retraction release lever 8248. A pin receiving portion 8296 and a circular pin 8293 formed between the right and left half shells 8156 and 8158, respectively, pass through a longitudinally long opening 8294 formed in the anti-retraction release lever 8248. Received on the distal side of the side proximal cam 8292, which allows for rotation about the circular pin 8293 with longitudinal translation. In the right half shell 8156, the proximal open groove member 8295 includes a proximal horizontal portion 8295a, which is a right-facing rear pin 8297 near the proximal end of the anti-retraction release lever 8248 (FIG. 187). In communication with an upwardly and distally angled portion 8295b that provides upward rotation when the anti-retraction release lever 8248 reaches the most distal portion of translational motion. To do. The block structure formed in the right half shell 8156 on the proximal side of the anti-retraction release lever 8248, when assembled to maintain the right-facing rear pin 8297 in the proximal open groove member 8295, Block side movements.

  Further to the above, as shown in FIGS. 187 and 188, the distal end 8254 of the anti-retraction release lever 8248 is thereby biased distally and downward, thereby causing the right front pin 8298 to thereby move within the right half shell 8156. Is dropped into a distal open step structure 8299 formed on the left hook 8301 on the anti-retraction release lever 8248 between the right-facing front pin 8298 and the longitudinally long opening 8294. The compression spring 8300 (FIG. 188) biases this engagement state. The other end of the compression spring 8300 attaches to a hook 8302 (FIGS. 186, 188, 189) formed in the right half shell 8156, just above the closure yoke 8266, in a more proximal and lower position. It has been. The compression spring 8300 thus pulls the distal end 8254 of the anti-retraction release lever 8248 downward and rearward, thereby causing the right-facing front pin 8298 to move to the distal open step structure when advanced distally. It is fixed in 8299. Thus, referring to FIG. 189, once removed, the anti-retraction release lever 8248 is held forward to hold the anti-retraction plate 8266 vertically, and thus the connecting rack 8200 can be retracted. When the end effector 8012 is unclamped and thereby the closure yoke 8266 is retracted, the upwardly projecting reset tongue 8303 on the closure yoke 8266 contacts the lower distal cam 8305 of the anti-retraction release lever 8248; The right forward pin 8298 is lifted out of the distal open step structure 8299 so that the anti-retraction compression spring 8264 pushes the anti-retraction cam tube 8268 and the anti-retraction release lever 8248 proximally into their retracted positions. (FIG. 186).

  Referring to FIGS. 179 and 189, the firing trigger 8034 can be operably engaged with the linkage rack 8200 in any suitable manner. With particular reference to FIGS. 180 and 185, firing trigger 8034 pivots about firing trigger pin 8202 coupled to housing 8154. The upper portion 8204 of the firing trigger 8034 moves distally about the firing trigger pin 8202 when the firing trigger 8034 is pressed toward the pistol grip 8036 and between the upper portion 8204 of the firing trigger 8034 and the housing 8154. The proximally placed firing trigger tension spring 8206 (FIG. 181) is extended proximally. The upper portion 8204 of the firing trigger 8034 engages the linkage rack 8200 during each firing trigger press via a spring biased side pawl mechanism 8210. When the firing trigger is released, the side pawl mechanism can be disengaged from the linkage rack 8200 and the firing trigger can return to the non-pressed (unfired) position. In use, an inclined right track, formed by a proximal and right-facing ramp 8284, is engaged by a side pawl assembly 8285 in each of the links 8196a-8196d. In particular, pawl slide 8270 (FIGS. 181 and 183) has a lower right and lower left guide 8272, each of which has a left track 8274 (FIG. 181) formed in a closing yoke 8266 below rack groove member 8291. , Respectively, to slide to the right track 8275 in the closing yoke 8276 that is parallel to the rack groove member 8291 and attached to the rack groove member cover 8277, where the rack groove member cover 8277 is relative to the stroke of the pawl slide 8270. Close the right-hand open portion of the rack groove member 8291 within the distal closing yoke 8266. 181, 182, and 185, compression spring 8278 is mounted between hook 8279 in the upper proximal position above closure yoke rail 8276 and hook 8280 on the distal right side of pawl slide 8270. This pulls pawl slide 8270 proximally into contact with upper portion 8204 of firing trigger 8034.

  With particular reference to FIG. 181, pawl block 8318 rides on pawl slide 8270 pivoting about vertical rear pin 8320, which passes through the left proximal corner of pawl block 8318 and pawl slide 8230. Yes. A kickout block recess 8322 is formed in the distal portion of the top surface of block 8318 to receive a kickout block 8324 pivotally pinned by a vertical pin 8236, the lower tip of this pin being , Extending into the pawl spring recess 8328 on the upper surface of the pawl slide 8270. A pawl spring 8330 in pawl spring recess 8328 extends to the right side of vertical front pin 8326 and urges pawl block 8318 to rotate clockwise as viewed from above to engage inclined right track 8282. A small coil spring 8322 in the kickout block recess 8322 urges the kickout block 8324 to rotate clockwise as viewed from above, with its proximal end within the closure yoke 8266 above the rack groove member 8291. It is urged | biased to contact the uneven | corrugated lip 8334 formed in this. This is because the pawl spring 8330 has a stronger mechanical advantage than the small coil spring 8332, as shown in FIG. Means tending to engage. In FIG. 185, when the firing trigger 8034 is fully pressed and begins to be released, when the pawl slide 8270 is retracted, the kickout block 8324 hits the raised portion 8336 in the uneven lip 8334 and the kickout block 8324 is When viewed from above, the pawl block 8318 is rotated from the engagement with the connecting rack 8200 by rotating clockwise. Due to the shape of the kickout block recess 8322, the clockwise rotation of the kickout block 8324 stops and is oriented perpendicular to the uneven lip 8334, maintaining this disengaged state during complete retraction, This eliminates ratchet noise.

  In FIGS. 181, 183, 190, and 195, the surgical stapling and cutting instrument 8010 provides manual release of the firing mechanism, manual retraction, and in one version (FIGS. 196-202) further of the full firing stroke. A manual retraction mechanism 8500 may be included that finally performs automatic retraction. Referring now to FIGS. 181, 190, and 191, in particular, the front idler gear 8220 engages the toothed upper left surface 8222 of the connecting rack 8200, where the front idler gear 8220 is a small right ratchet gear 8231. The rear idler gear 8230 having The front idler gear 8220 and the rear idler gear 8230 are rotatably connected to the handle housing 8154 on the front idler shaft 8232 and the rear idler shaft 8234, respectively. Both ends of the rear shaft 8232 extend through the housing right half shell and the left half shell 8156, 8158, respectively, and are attached to the left and right indicator gauge wheels 8040, 8041. The indicator gauge wheels 8040 and 8041 rotate together with the rear gear 8230 by freely spinning inside and having key engagement with the rear gear 8230. The gear relationship between the linkage rack 8200, idler gear 8220, and rear gear 8230 is such that the toothed upper surface 8222 has a tooth size of suitable strength and during complete firing movement of the connected transmission firing mechanism 8150. The rear gear 8230 can be advantageously selected such that it rotates less than one revolution. In addition to the gear mechanism 8502 that visually indicates the firing stroke or progression, the gear mechanism 8502 can also be used to manually retract the knife. A small ratchet gear 8231 on the right side of the rear idler gear 8230 extends into the hub 8506 of the manual retraction lever 8042, particularly in a vertically aligned longitudinally aligned slot 8508 (FIG. 190) that bisects the hub 8506. Aligned. The lateral through hole 8510 of the hub 8506 communicates with the upper recess 8512. The front portion 8514 is shaped to receive a proximally guided locking pawl 8516 that pivots about a rightward lateral pin 8518 formed at the distal end of the upper recess 8512. The rear portion 8520 is shaped to receive an L-shaped spring tab 8522 that biases the locking pawl 8516 downward and engages a small ratchet gear 8231 on the right side. The retaining structure 8524 (FIGS. 186 and 193) protrudes from the right half shell 8156 into the upper recess 8512 and lock pawl 8516 so that it does not engage the small ratchet gear 8231 on the right when the manual retract lever 8042 is lowered. Is held up (FIG. 193). A coil spring 8525 (FIG. 181) biases the manual retraction lever 8042 downward.

  In use, as shown in FIGS. 192 and 193, the combined tension / compression spring 8184 can be disconnected from the distally disposed linkage rack. In FIGS. 194 and 195, when the manual retraction lever 8042 is raised, the lock pawl 8516 rotates in the clockwise direction and is not held by the holding structure 8524, engages the small right ratchet gear 8231, and the rear idler gear 8230 is moved from the left. Rotate clockwise to see. Therefore, the front idler gear 8220 moves counterclockwise, and moves the connecting rack 8200 backward. In addition, a ridge 8510 curved to the right protrudes from the hub 8506 and is dimensioned to move distally in contact with the anti-retraction release lever 8248 so that when the manual retraction lever 8042 rotates, The prevention mechanism 8250 is released.

  In FIGS. 196-202, the automatic retraction mechanism 8600 for the surgical stapling and cutting instrument 8010a enters the front idler gear 8220a with the teeth 8602 at the end of the full firing stroke, which teeth have three firing strokes. An automatic retraction may be incorporated that moves within a circular groove 8604 in the cam wheel 8606 after making a nearly complete one turn corresponding to. In such a situation, the right ridge 8610 is rotated upward to contact the lower cam recess 8612 and move the anti-retraction release lever 8248a in the distal direction. With particular reference to FIG. 197, anti-retraction release lever 8248a includes a distal end 8254 that operates as described above. Circular pins 8293 and pin receptacles 8296 formed in the right and left half shells 8156, 8158 have a generally rectangular opening 8294a formed in the back-release prevention release lever 8248a on the rear side of the lower cam 8192. Received through, thereby allowing longitudinal translation and downward locking movement of the distal end 8254 of the anti-retraction release lever 8248a. In the right half shell 8156, a horizontal proximal open groove member 8295a receives a right-facing rear pin 8297 near the proximal end of the anti-retraction release lever 8248a.

  In operation, prior to firing, in FIGS. 198 and 198A, the linkage rack 8200 and anti-retraction cam tube 8268 are in the retracted position and the anti-retraction compression spring 8264 contacts the anti-retraction plate 8266 proximally to prevent the anti-retraction mechanism. 8250 is fixed. The automatic reverse mechanism 8600 is an initial state in which the reverse prevention release lever 8248a is retracted by the link 8196a that contacts the front idler gear 8220a. The tooth 8602 is at the 6 o'clock position, with the right-hand ridge 8610 just proximal to the tooth 8602 in the entire stroke of the circular groove 8604 traveling in the counterclockwise direction. In FIG. 199, 199A, a single firing stroke advances one distal link 8196b and contacts the front idler gear 8220a. The teeth 8602 travel one third of a turn through the circular groove 8604 of the stationary cam wheel 8606. In FIGS. 200 and 200A, the second firing stroke causes the other link 8196c to advance and contact the front idler gear 8220a. The teeth 8602 travel two thirds through the circular groove 8604 of the stationary cam wheel 8606. In FIGS. 201 and 201A, the third firing stroke causes one distal link 8196d to advance and contact the front idler gear 8220a. The tooth 8602 makes a complete rotation of the circular groove 8604 to contact the block 8608, starts the counterclockwise rotation of the cam wheel 8606 (when viewed from the right), and contacts the rightward ridge 8608 to the anti-retraction release lever 8248a. Let In FIG. 202, the anti-retraction release lever 8248a moves distally in response thereto, fixing the right forward pin 8298 to the distal open step structure 8299 and releasing the anti-retraction mechanism 8250. A similar surgical stapling instrument is disclosed in US Pat. No. 7,083,075 (issued August 1, 2006), the entire disclosure of which is incorporated herein by reference.

  Referring to FIG. 203, the staple application assembly 9012 of the surgical stapling instrument 9010 clamps the staples on the tissue by two different movements transmitted to the shaft frame 9070 to longitudinally lower the shaft 9016. Drives and achieves the function of cutting tissue. The shaft frame 9070 is attached proximally to the handle of the surgical stapling instrument and is connected to rotate about the longitudinal axis. An exemplary multi-stroke handle for a surgical stapling and cutting instrument is described in co-pending and co-pending U.S. patent application "SURGICAL STAPLING INSTRUMENTING A MULTISTROKING FIRING POSITION", the entire disclosure of which is incorporated herein by reference. Details are described in "INDICATOR AND RETRACTION MECHANISM" 10 / 374,026. Other applications in common with the present invention include, for example, co-pending and co-pending US patent application Ser. No. 10 / 441,632 “SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT, which is hereby incorporated by reference in its entirety. A single firing stroke can be incorporated as described in “CLOSING AND FIRING SYSTEMS”.

  With particular reference to FIG. 204, the distal end of shaft frame 9070 is attached to staple groove member 9018. Anvil 9022 has a proximal pivot end 9072 that is pivotally received within proximal end 9074 of staple groove member 9018, which is just distal to engagement with shaft frame 9070. As the anvil 9022 pivots downward, the anvil 9022 moves the tissue contacting surface 9028 to form a pocket 9026 toward the opposing staple cartridge, as described in detail below. The pivot end 9072 of the anvil 9022 includes a closure mechanism 9076 that is proximal but distal to the pivotable attachment with the staple channel member 9018. Thus, the closure tube 9078 includes a horseshoe-shaped opening 9080 at its distal end that engages the closure mechanism 9076 and, as described above, slides over the shaft frame 9070 in response to a closure trigger. Tube 907 is selectively imparted with an opening movement relative to anvil 9022 during proximal longitudinal movement and a closing movement relative to anvil 9022 during distal longitudinal movement. The shaft frame 9070 includes and guides the firing movement from the handle via a two piece knife and firing bar 9090 reciprocating in the longitudinal direction. In particular, the shaft frame 9070 includes a longitudinally reciprocating two-piece knife and a longitudinal firing bar slot 9092 that receives a proximal portion of the firing bar 9090, specifically a laminated tapered firing bar 9094. . It will be appreciated that the laminated tapered firing bar 9094 can be replaced with a solid firing bar and / or other suitable material.

  E-beam 9102 is the distal part of a two-piece knife and firing bar 9090 that facilitates separate closure and firing and also spaced anvil 9022 from elongate staple channel member 9018 during firing. Facilitate. With particular reference to FIGS. 204 and 205, in addition to any attachment process such as brazing or adhesive, the knife and firing bar 9090 is a female vertical attachment opening formed proximally within the E-beam 9102. 9104, which receives a corresponding male attachment member 9106 that is placed distally by a laminated tapered firing bar 9094 so that each portion is selected with a selected material suitable for a different function and Formed in the process (eg strength, flexibility, friction). The E-beam 9102 has material properties suitable for forming a pair of upper pins 9110, a pair of intermediate pins 9112, and lower pins or legs 9114, and a material that can provide a sharp cutting edge 9116 And can be formed in an advantageous manner. In addition, the integrally formed proximally projecting upper guide 9118 and intermediate guide 9120 that support and hold each vertical end of the cutting edge 9116 further provides a sharper cutting edge 9116 toward the cutting edge 9116 prior to cutting. A tissue preparation area 9122 is defined that assists in guiding the patient. The intermediate guide 9120 is further used to engage and fire the staple applicator 9012 by supporting the stepped central member 9124 of the wedge thread 9126 (FIG. 206), as will be described in more detail below. Staple forming is performed. These shapes (for example, the upper pin 9110, the intermediate pin 9112, and the lower leg 9114) are integrally formed with the E-beam 9102, so that the tolerance with respect to each other is made smaller than when a plurality of parts are assembled. This facilitates the effective operation of the staple application assembly 9012 with the desired operation during firing and / or various lockout functions.

  In FIGS. 207 and 208, the staple application assembly 9012 is shown open and the E-beam 9102 is shown fully retracted. During assembly, the lower leg 9114 of the E-beam 9102 falls into this through the widened hole 9130 in the staple groove member 9018, and then the E-beam 9102 is advanced so that the E-beam 9102 is moved into the staple groove member. Slide distally along lower track 9132 formed in 9018. In particular, the lower track 9132 includes a narrow slot 9133 that opens as a widened slot 9134 on the lower surface of the staple groove member 9018, which is a widened hole 9130, as shown particularly in FIGS. 208 and 209. Inverted T-shaped in cross section, communicating with the. Once assembled, the component connected proximally to the laminated tapered firing bar 9094 does not allow the lower leg 9114 to move proximally again into the widened hole 9130 and disengage. Referring to FIG. 210, a laminated tapered firing bar 9094 facilitates insertion of the staple application assembly 9012 through the trocar. In particular, the more distal and lower projection 9136 lifts the E-beam 9102 when fully retracted. This is accomplished by the placement of the downward projection 9136 at the point where the cam engages upwardly at the proximal edge of the widened hole 9130 in the staple groove member 9018. Referring now to FIG. 211, the laminated taper firing bar 9094 further enhances the operation of certain lockout mechanisms that are biased downward by the shaft frame 9070 during the initial portion of the firing stroke. Can be incorporated into staple groove member 9018 by including a more proximal upward projection 9138. In particular, the transverse bar 9140 is defined between a pair of rectangular openings 9142 in the shaft frame 9070 (FIG. 204). A clip spring 9144 wrapping the transverse bar 9140 biases downward a portion of the laminated tapered firing bar 9094 that projects distally from the longitudinal firing bar slot 9092, thereby providing certain advantages when appropriate. A secure lockout mechanism is securely engaged. This bias is more prominent or more limited to only a portion of the firing stroke when the upward projection 9138 contacts the clip spring 9144.

  In FIGS. 207 and 208, E-beam 9102 is retracted by upper pin 9110 of E-beam 9102 within anvil pocket 9150 near the pivoting proximal end of anvil 9022. A downward open vertical anvil slot 9152 (FIG. 203) expands laterally within anvil 9022 to an anvil internal track 9154, as it is advanced distally during firing, as shown in FIGS. 210 and 211. The anvil 9022 is actively spaced from the groove member 9018 to capture the upper pin 9110 of the E-beam 9102. Thus, with the E-beam 9102 retracted, the surgeon can repeatedly open and close the staple application assembly 9012 until satisfied with the placement and orientation of the tissue captured therein for stapling and cutting, E-beam 9102 assists in proper tissue placement, even in staple application assemblies 9012 that have a small diameter and correspondingly reduced stiffness. In FIGS. 203, 204, 206, 207, 209, and 215, a staple application assembly 9012 is shown with a replaceable staple cartridge 9020 that includes a wedge thread 9126. A plurality of longitudinally aligned parallel downward open wedge slots 9202 (FIG. 209) receive respective wedges 9204 integrated into the wedge thread 9126. In FIGS. 209-211, wedge thread 9126 cams upwardly into a plurality of staple drivers 9206, which can slide vertically within staple driver recess 9208. In this exemplary version, each staple driver 9206 has two vertical pointed projections that each move upward into a respective staple hole 9210 or cavity 9024 to push the staple 9023 upward. It is deformed to fit against the staple forming surface 9214 (FIG. 211) of the anvil 9022. A central firing recess 9216 (FIG. 204) is defined in the staple cartridge 9020 proximate to the staple groove member 9018 so that the lower horizontal portion 9218 (FIG. 206) of the wedge thread 9126 and the intermediate pin 9112 of the E-beam 9102. Can be passed. In particular, a staple cartridge tray 9220 (FIGS. 204, 209) is attached to and underneath the polymer staple cartridge body 9222, which has a staple driver recess 9208, staple holes formed therein. 9210 and a central firing recess 9216. When the staple 9023 is thereby formed on either side, the sharp cutting edge 9116 enters vertically through the slot 9230 that passes through the longitudinal axis of the staple cartridge 9020 except for the most distal end.

  As shown in FIG. 211, firing of the staple application assembly 9012 is performed proximally until the two-piece knife and firing bar 9090 cam down the middle guide 9120 above and below the E-beam on the E-beam. Pulling sideways causes a new staple cartridge 9020 to be inserted into the staple groove member 9018 when the anvil 9022 is open, as shown in FIGS. In FIG. 212, the two-piece knife and firing bar 9090 has been advanced distally by a small distance, thereby causing the clip tape 9144 to move downward under the biasing force of the clip spring 9144 against the upward projection 9138 of the laminate taper firing bar 9094. The protrusion 9136 falls into the widened hole 9130 of the lower track 9132. The intermediate guide 9120 rides on the stepped central member 9124 of the wedge thread 9126 to prevent further downward rotation, thereby retaining the E-beam intermediate pin 9112 in the central firing recess 9216. In FIG. 213, a staple cartridge having an anvil 9022 and a sharp cutting edge 9116 while a two piece knife and firing bar 9090 has been fired distally and the wedge thread 9126 has advanced to form the staple 9023. The tissue 9242 sandwiched between 9020 is cut. Thereafter, in FIG. 214, the two-piece knife and firing bar 9090 are retracted, leaving the wedge thread 9126 disposed distally. In FIG. 215, the intermediate pin 9112 can be translated and lowered into a lockout recess 9240 formed in the staple groove member 9018 (see also FIGS. 208 and 211). Thus, when the wedge thread 9126 (not shown in FIG. 215) is not disposed proximally (ie, without the staple cartridge 9020 or the used staple cartridge 9020), the intermediate pin 9112 is Upon hitting the distal edge of lockout recess 9240, the operator can receive a tactile indication. Similar surgical stapling instruments are disclosed in US Pat. No. 7,380,696 (issued June 3, 2008), the entire disclosure of which is hereby incorporated by reference.

  Optionally, as described above, the staple cartridge can include a cartridge body having a plurality of staple cavities defined therein. The cartridge body may have a deck and a deck upper surface, and each staple cavity may define an opening in the deck surface. As described above, staples can be placed in each staple cavity so that they are stored in the cartridge body until fired therefrom. The staples can be received within the cartridge body before firing from the cartridge body so that the staples do not protrude above the deck surface. Since the staples are located below the deck surface, in such cases, the damage to the staples and / or the possibility of premature contact with the target tissue can be reduced. In various situations, the staple is between an unfired position that does not protrude from the cartridge body and a fired position that emerges from the cartridge body and can contact an anvil disposed opposite the staple cartridge. Can move. The anvil, and / or the molding pocket defined within the anvil, can be placed at a predetermined distance above the deck surface so that the staple can be positioned at a predetermined molding height when the staple is deployed from the cartridge body. It will be transformed. In certain situations, the thickness of the tissue captured between the anvil and the staple cartridge can vary so that thicker tissue may be captured within a particular staple while being thinner Tissue can be captured within other specific staples. In any case, the clamping pressure or clamping force exerted on the tissue by the staples can vary with the staples, or, for example, at one end of a staple row and the other end of the staple row. There is a possibility of changing between certain staples. In certain circumstances, the gap between the anvil and the staple cartridge deck can be controlled such that the staples apply a predetermined minimum clamping pressure within each staple. However, in some such situations, there may still be significant fluctuations in clamping pressure within different staples.

  As described herein, a staple cartridge can include means for compensating for the thickness of tissue captured in staples deployed from the staple cartridge. Referring to FIG. 216, a staple cartridge (eg, staple cartridge 10000) includes a rigid first portion (eg, support portion 10010) and a compressible second portion (eg, tissue thickness compensator 10020). sell. Referring primarily to FIG. 218, the support portion 10010 may include a cartridge body, a deck upper surface 10011, and a plurality of staple cavities 10012, similar to the above, each staple cavity 10012 defining an opening in the deck surface 10011. Yes. For example, staples 10030 can be removably disposed within each staple cavity 10012. For example, each staple 10030 can include a bottom surface 10031 and one or more legs 10032 extending from the bottom surface 10031, as primarily described with reference to FIG. 245 and described in detail below. Before the staple 10030 is deployed, the bottom surface 10031 of the staple 10030 can be supported by a staple driver disposed within the support portion 10010 and, at the same time, the legs of the staple 10030, as will also be described in detail below. 10032 can be at least partially housed within the staple cavity 10012. The staple 10030 moves such that the legs 10032 move through the tissue thickness compensator 10020, penetrate the upper surface of the tissue thickness compensator 10020, enter the tissue T, and contact an anvil disposed opposite the staple cartridge 10000. , Can be deployed between an unfired position and a fired position. As the legs 10032 are deformed against the anvil, the legs 10032 of each staple 10030 capture a portion of the tissue thickness compensator 10020 and a portion of the tissue T within each staple 10030 and apply a compressive force to the tissue. be able to. Further to the above, the leg 10032 of each staple 10030 can be deformed downward toward the bottom surface 10031 of the staple to form a staple capture region 10039, and the tissue T and tissue thickness compensator 10020 can be captured. . In various situations, the staple capture region 1000039 can be defined between the inner surface of the deformed leg 10032 and the inner surface of the bottom surface 10031. The size of the staple capture area may depend on several factors, such as, for example, leg length, leg diameter, bottom width, and / or degree of leg deformation.

  In the past, surgeons often have to select appropriate staples having the appropriate staple height for the tissue to which they are applied. For example, a surgeon could select long staples for use with thick tissue and short staples for use with thin tissue. However, in certain circumstances, the tissue to which the staples are applied does not have a uniform thickness and some staples have not been able to achieve the desired firing shape. For example, FIG. 250 shows a long staple used for thin tissue. Referring now to FIG. 251, when a tissue thickness compensator (eg, tissue thickness compensator 10020) is used with thin tissue, even large staples can be formed into the desired firing shape.

  Thanks to the compressibility of the tissue thickness compensator, the tissue thickness compensator can compensate for the thickness of the tissue captured within each staple. More particularly, referring now to FIGS. 245 and 246, a tissue thickness compensator (eg, tissue thickness compensator 10020) depends on the thickness and / or type of tissue captured in the staple capture region 10039. , Each staple 10030 may occupy a larger portion and / or a smaller portion of the staple capture area 10030. For example, when thinner tissue T is captured in the staple 10030, the tissue thickness compensator 10020 occupies a larger portion of the staple capture region 10030 than when thicker tissue T is captured in the staple 10030. be able to. Correspondingly, when a thicker tissue T is captured in the staple 10030, the tissue thickness compensator 10020 is within the staple capture region 10030 compared to when a thinner tissue T is captured in the staple 10030. It can occupy a smaller part. In this way, the tissue thickness compensator can compensate for thinner and / or thicker tissue, and compresses the tissue pressure regardless of, or at least substantially, the tissue thickness captured within the staple. Can be applied to. In addition to the above, the tissue thickness compensator 10020 can compensate for various types or compressibility of tissue captured in different staples 10030. Referring now to FIG. 246, the tissue thickness compensator 10020 can apply a compressive force against the vascular tissue T that can include the tube V, resulting in blood passing through the less compressible tube V. While restricting flow, the desired compression pressure can be applied to the surrounding tissue T. In various situations, in addition to the above, the tissue thickness compensator 10020 can also compensate for malformed staples. Referring to FIG. 247, misforming of various staples 10030 may result in a larger staple capture region 1000039 defined within such staples. Thanks to the elasticity of the tissue thickness compensator 10020, referring now to FIG. Even when region 10039 is increasing, sufficient compression pressure can still be applied to tissue T. In various situations, for example, the tissue thickness compensator 10020 in the middle of adjacent staples 10030 can be biased against the tissue T by the properly formed staples 10030 surrounding the malformed staples 10030, so that the surroundings Compressive pressure can be applied to the tissue and / or tissue captured in the malformed staple 10030. In various situations, the tissue thickness compensator can compensate for different tissue densities that can be caused by, for example, calcification, fibrotic regions, and / or previously stapled or treated tissue.

  According to the present specification, a fixed (non-changeable) tissue spacing can be defined between the support portion and the anvil so that the staples are at the thickness of the tissue captured within the staples. Regardless, it can be deformed to a predetermined height. When a tissue thickness compensator is used in these cases, the tissue thickness compensator can be adapted to the tissue captured between the anvil and the support portion staple cartridge, thanks to this tissue thickness compensator, A tissue thickness compensator can apply additional compression pressure to the tissue. Next, referring to FIGS. 252 to 257, the staple 10030 is formed to a predetermined height H. With respect to FIG. 252, the tissue thickness compensator is not used and the tissue T occupies the entire staple capture area 10039. Referring to FIG. 259, a portion of the tissue thickness compensator 10020 is captured within the staple 10030, compresses the tissue T, and occupies at least a portion of the staple capture region 10037. Referring now to FIG. 254, thin tissue T has been captured within staple 10030. In this embodiment, for example, the compressed tissue T has a height of about 2 / 9H and the compressed tissue thickness compensator 10020 has a height of about 7 / 9H. Referring now to FIG. 255, tissue T having an intermediate thickness is captured within staple 10030. In this embodiment, for example, the compressed tissue T has a height of about 4 / 9H and the compressed tissue thickness compensator 10020 has a height of about 5 / 9H. Referring now to FIG. 256, tissue T having an intermediate thickness has been captured within staple 10030. In this embodiment, for example, the compressed tissue T has a height of about 2 / 3H and the compressed tissue thickness compensator 10020 has a height of about 1 / 3H. Referring now to FIG. 255, thick tissue T has been captured within the staple 10030. In this embodiment, for example, the compressed tissue T has a height of about 8 / 9H and the compressed tissue thickness compensator 10020 has a height of about 1 / 9H. In various situations, the tissue thickness compensator can be, for example, about 10% of staple capture height, about 20% of staple capture height, about 30% of staple capture height, about 40% of staple capture height, Compression comprising about 50% of staple capture height, about 60% of staple capture height, about 70% of staple capture height, about 80% of staple capture height, and / or about 90% of staple capture height Can have a height.

  Staple 10030 may include any suitable green height. The staple 10030 can have an unformed height of, for example, about 2 mm to 4.8 mm. The staple 10030 may be, for example, about 2.0 mm, about 2.5 mm, about 3.0 mm, about 3.4 mm, about 3.5 mm, about 3.8 mm, about 4.0 mm, about 4.1 mm, and / or about 4 May have an unformed height of 8 mm. The height H at which the staple can be deformed can be defined by the distance between the deck surface 10011 of the support portion 10010 and the anvil relative to it. The distance between the deck surface 10011 and the tissue contacting surface of the anvil can be, for example, about 2.5 mm (0.097 ″). The height H is also defined by the depth of the molding pocket defined in the anvil. The molding pocket can have a depth measured, for example, from the tissue contacting surface, and optionally, the staple cartridge 10000 can further include a staple driver, as described in detail below. Can lift the staple 10030 toward the anvil and can lift (or “overdrive”) the staple onto the deck surface 10011. In such a case, the height H at which the staple 10030 is formed can also be defined by the distance over which the staple 10030 is overdriven. For example, the staple 10030 may be overdriven, for example, about 0.71 mm (.028 "), so that the staple 10030 may be formed to a height of, for example, about 4.80 mm (0.189"). Staple 10030 can be formed to a height of, for example, about 0.8 mm, about 1.0 mm, about 1.5 mm, about 1.8 mm, about 2.0 mm, and / or about 2.25 mm. The staple can be formed to a height of about 2.25 mm to about 3.0 mm, for example. Further to the above, the height of the staple capturing area of the staple can be determined by the forming height of the staple and the width (or diameter) of the wire constituting the staple. The height of the staple capturing region 10030 of the staple 10030 can be obtained by subtracting twice the diameter width of the wire from the forming height H of the staple. The staple wire can include, for example, a diameter of about 0.23 mm (0.0089 ″). The staple wire can be, for example, about 0.18 mm (0.0069 ″) to about 0.30 mm (0.0119 ″). For example, the formed height H of the staple 10030 may be about 4.8 mm (0.189 ") and the staple wire diameter is about 0.23 mm (0.0089"). This may result in a staple capture height of about 4.31 mm (0.171 ").

  Further to the above, the tissue thickness compensator can be configured to have an uncompressed (or pre-deployment) height and be deformed to one of a plurality of compressed heights. The tissue thickness compensator can include, for example, an uncompressed height of about 3.18 mm (0.125 ″). The tissue thickness compensator can, for example, have an uncompressed height of about 2.0 mm (0.080 ″) or greater. May be included. The tissue thickness compensator can include an uncompressed (or pre-deployment) height that is higher than the unfired height of the staples. The uncompressed (or pre-deployment) height of the tissue thickness compensator is, for example, about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, than the unfired staple height. About 70%, about 80%, about 90%, and / or about 100% higher. The uncompressed (or pre-deployment) height of the tissue thickness compensator may be, for example, up to about 100% higher than the unfired staple height. The uncompressed (or pre-deployment) height of the tissue thickness compensator may be, for example, 100% higher than the unfired staple height. The tissue thickness compensator can include an uncompressed height equal to the unfired height of the staples. The tissue thickness compensator can include an uncompressed height that is less than the unfired height of the staples. The uncompressed (or pre-deployment) height of the thickness compensator is, for example, about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about It may be 70%, about 80%, and / or about 90% smaller. The compressible second portion may have an uncompressed height that is higher than the uncompressed height of the tissue T to be stapled. The tissue thickness compensator may have an uncompressed height that is equal to the uncompressed height of the tissue T to be stapled. The tissue thickness compensator may have an uncompressed height that is lower than the uncompressed height of the tissue T to be stapled.

  As described above, the tissue thickness compensator can be compressed into a plurality of shaped staples regardless of whether the tissue captured in the staples is thick or thin. For example, the staples in the staple line (row) are deformed such that the staple capture area of each staple includes a height of, for example, about 2.0 mm, and the tissue T and tissue thickness compensator are compressed within this height Can be done. In certain circumstances, for example, tissue T may include a compressed height of about 1.75 mm in the staple capture region, while a tissue thickness compensator has a compressed height of about 0.25 mm in the staple capture region. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 1.50 mm in the staple capture region, while tissue thickness compensator has a compressed height of about 0.50 mm in the staple capture region. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 1.25 mm within the staple capture area, while a tissue thickness compensator has a compressed height of about 0.75 mm within the staple capture area. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 1.0 mm in the staple capture area, while tissue thickness compensator has a compressed height of about 1.0 mm in the staple capture area. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 0.75 mm in the staple capture region, while a tissue thickness compensator has a compressed height of about 1.25 mm in the staple capture region. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 1.50 mm in the staple capture region, while tissue thickness compensator has a compressed height of about 0.50 mm in the staple capture region. This may result in a total staple capture area height of about 2.0 mm. In certain circumstances, for example, tissue T may include a compressed height of about 0.25 mm in the staple capture area, while tissue thickness compensator has a compressed height of about 1.75 mm in the staple capture area. This may result in a total staple capture area height of about 2.0 mm.

  Further to the above, the tissue thickness compensator can have an uncompressed height that is less than the fired height of the staples. The tissue thickness compensator can have an uncompressed height equal to the fired height of the staples. The tissue thickness compensator can have an uncompressed height that is higher than the fired height of the staples. For example, the uncompressed height of the tissue thickness compensator may be, for example, about 110% of the formed staple height, about 120% of the formed staple height, about 130% of the formed staple height, of the formed staple height. About 140%, about 150% of the formed staple height, about 160% of the formed staple height, about 170% of the formed staple height, about 180% of the formed staple height, of the formed staple height It may include a thickness of about 190% and / or about 200% of the formed staple height. The tissue thickness compensator can have an uncompressed height that is more than twice as high as the fired height of the staples. The tissue thickness compensator can have, for example, a compressed height of about 85% to about 150% of the formed staple height. If desired, the tissue thickness compensator can be compressed to between an uncompressed thickness and a compressed thickness, as described above. The compressed thickness of the tissue thickness compensator is, for example, about 10% of uncompressed thickness, about 20% of uncompressed thickness, about 30% of uncompressed thickness, about 40% of uncompressed thickness, uncompressed It can be about 50% of thickness, about 60% of uncompressed thickness, about 70% of uncompressed thickness, about 80% of uncompressed thickness, and / or about 90% of uncompressed thickness. The uncompressed thickness of the tissue thickness compensator can be, for example, about 2 times, about 10 times, about 50 times, and / or about 100 times the compressed thickness. The compressed thickness of the tissue thickness compensator can be about 60% to about 99% of the uncompressed thickness. The compressed thickness of the tissue thickness compensator may be at least 50% thicker than the compressed thickness. The compressed thickness of the tissue thickness compensator may be up to 100 times thicker than the compressed thickness. The compressible second portion may be elastic or at least partially elastic and may bias the tissue T against the deformed leg of the staple. For example, the compressible second portion can elastically expand between the tissue T and the bottom surface of the staple to press the tissue T against the staple legs. As will be described in detail below, the tissue thickness compensator can be placed between the tissue T and the deformed staple leg. In various situations, as a result of the above, the tissue thickness compensator can be configured to fill any gaps in the staple capture region.

  The tissue thickness compensator can include a polymer composition. The polymer composition can include one or more synthetic polymers and / or one or more non-synthetic polymers. The synthetic polymer can include an absorbent synthetic polymer and / or a non-absorbable synthetic polymer. The polymer composition can include, for example, a biocompatible foam material. The biocompatible foam material may include, for example, a porous open-cell foam material and / or a porous closed-cell foam material. The biocompatible foam may have a uniform pore morphology, or it may have a gradient pore morphology (ie, gradually increase from small to large pores in one direction across the thickness of the foam). You may do it. Polymer compositions include porous scaffolds, porous matrices, gel matrices, hydrogel solutions, solution matrices, fibrous matrices, tubular matrices, composite matrices, membranous matrices, biostable polymers, and biodegradable polymers, and these One or more of the combinations may be included. For example, a tissue thickness compensator may include a foam reinforced with a fibrous matrix, or may include a foam with an additional hydrogel layer that expands in the presence of body fluid to provide more pressure to the tissue. Good. According to the present invention, the tissue thickness compensator may further comprise a coating on the material and / or a second or third layer that expands in the presence of body fluid to provide more pressure to the tissue. May be included. Such a layer may be, for example, a hydrogel that may be a synthetic and / or naturally derived material, and may be biodurable and / or biodegradable. The tissue thickness compensator can be reinforced with, for example, a fibrous nonwoven material or a fibrous mesh type component, which can provide additional flexibility, synthesis, and / or strength. According to the present invention, the tissue thickness compensator has a porous morphology, which exhibits, for example, a gradient structure with small pores on one surface and larger pores on the other surface. Such a form may be more optimal for growing tissue or hemostasis treatment. Furthermore, this gradient can be configured with various bioabsorbable profiles. A short-term absorption profile is preferred for hemostasis management, while a long-term absorption profile can provide better tissue healing without leaks.

  Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharides, glycoproteins, elastin, proteoglycans, gelatin, collagen, and oxidized regenerated cellulose. Examples of synthetic absorbent polymers include poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), Polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), copolymer of glycolide and ε-caprolactone (PGCL), copolymer of glycolide and trimethylene carbonate, poly (glycerol sebacate) (PGS), polydioxanone, poly (orthoester) , Polyanhydrides, polysaccharides, poly (ester-amides), tyrosine-based polyarylate, tyrosine-based polyiminocarbonate, tyrosine-based polycarbonate, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), Poly (E- Caprolactone), polyethylene glycol (PEG), poly [bis (carboxymethyl Lato phenoxy) phosphazene], poly (amino acids), pseudo-poly (amino acids), absorbent polyurethane, and combinations thereof without limitation. The polymer composition can include, for example, about 50% to about 90% by weight of the PLLA polymer composition and about 50% to about 10% by weight of the PCL polymer composition. The polymer composition may include, for example, about 70% PLLA and about 30% PCL. The polymer composition can include, for example, about 55 wt% to about 85 wt% PGA polymer composition and 15 wt% to 45 wt% PCL polymer composition. The polymer composition may include, for example, about 65% by weight of PGA and about 35% by weight of PCL. The polymer composition can include, for example, about 90% to about 95% by weight of the PGA polymer composition and about 5% to about 10% by weight of the PLA polymer composition.

  Synthetic absorbable polymers can include bioabsorbable and biocompatible elastomeric copolymers. Suitable bioabsorbable, biocompatible elastomer copolymers are copolymers of epsilon-caprolactone and glycolide (preferably having a molar ratio of epsilon-caprolactone to glycolide of from about 30:70 to about 70:30, preferably 35: 65 to about 65:35, more preferably 45:55 to 35:65); elastomeric copolymers of epsilon-caprolactone and lactide (including L-lactide, D-lactide, blends thereof, or lactic acid copolymers) (preferably Is a molar ratio of epsilon-caprolactone to lactide of about 35:65 to about 65:35, more preferably 45:55 to 30:70); p-dioxanone (1,4-dioxane-2-one) and lactide Elastomer copoly with L-lactide, D-lactide, and lactic acid -(Preferably a molar ratio of p-dioxanone to lactide of about 40:60 to about 60:40); an elastomeric copolymer of epsilon-caprolactone and p-dioxanone (preferably a mole of epsilon-caprolactone to p-dioxanone. A ratio of about 30:70 to about 70:30); an elastomeric copolymer of p-dioxanone and trimethylene carbonate (preferably a molar ratio of p-dioxanone to trimethylene carbonate of about 30:70 to about 70:30); An elastomeric copolymer of trimethylene carbonate and glycolide (preferably the molar ratio of trimethylene carbonate to glycolide is about 30:70 to about 70:30); trimethylene carbonate and lactide (L-lactide, D-lactide, blends thereof) Or elastomeric copolymer with lactic acid copolymer) (Preferably, the molar ratio of trimethylene carbonate to-lactide is from about 30:70 to about 70:30) and although these formulations include, but are not limited to. The elastomeric copolymer may be a copolymer of glycolide and epsilon-caprolactone. Alternatively, the elastomeric copolymer is a copolymer of lactide and epsilon-caprolactone.

  Disclosure in US Pat. No. 5,468,253 “ELASTOMERIC MEDICAL DEVICE” (issued November 21, 1995) and US Pat. No. 6,325,810 “FOAM BUTTRESS FOR STAPLING APPARATUS” (December 4, 2001) Each of which is hereby incorporated by reference in its entirety.

  Synthetic absorbent polymers are, for example, 90/10 poly (glycolide-L-lactide) copolymer (commercially available from Ethicon, Inc. under the trade name VICRYL (polyglactic 910)), polyglycolide (trade name DEXON from American Cyanamid Co.). , Polydioxanone (commercially available from Ethicon, Inc. under the trade name PDS), poly (glycolide-trimethylene carbonate) random block copolymer (commercially available from American Cyanamid Co. as trade name MAXON), 75/25 poly (glycolide-E -Caprolactone-polygrecaprolactone 25) may comprise one or more of the copolymers (commercially available from Ethicon under the trade name MONOCRYL).

  Examples of synthetic non-absorbable polymers include foamed polyurethane, polypropylene (PP), polyethylene (PE), polycarbonate, polyamide (eg nylon), polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), Polyester, polyetheretherketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone, and combinations thereof However, it is not limited to these. Synthetic non-absorbable polymers may include, but are not limited to, foamed elastomers and porous elastomers such as silicone, polyisoprene, and rubber. Synthetic polymers are described in W.W. L. Gore & Associates, Inc. Expanded polytetrafluoroethylene (ePTFE) commercially available under the trade name GORE-TEX Soft Tissue Patch from the company, and co-polyether ester urethane foams available under the trade name NASOPORE from Polyganics.

  The tissue composition of the tissue thickness compensator can be characterized, for example, by percent porosity, pore size, and / or hardness. The polymer composition can have, for example, a percent porosity of about 30% to about 99% by volume. The polymer composition can have, for example, a percent porosity of about 60% to about 98% by volume. The polymer composition can have, for example, a percent porosity of about 85% to about 97% by volume. The polymer composition may have, for example, about 70% by weight PLLA and about 30% by weight PCL, for example, may have a porosity of about 90% by volume. For example, as a result, the polymer composition may comprise about 10% by volume copolymer. The polymer composition may have, for example, about 65% by weight PGA and about 35% by weight PCL, for example, may have a porosity of about 93% to about 95% by volume. The polymer composition may have a porosity greater than 85%. The polymer composition can have a pore size of, for example, from about 5 micrometers to about 2000 micrometers. The polymer composition can have a pore size of, for example, from about 10 micrometers to about 100 micrometers. For example, the polymer composition can include, for example, a copolymer of PGA and PCl. The polymer composition can have, for example, a pore size of about 100 micrometers to about 1000 micrometers. For example, the polymer composition can include, for example, a copolymer of PLLA and PCl. According to a particular embodiment, the hardness of the polymer composition can be expressed in terms of Shore hardness, which can be defined as the resistance to permanent depression of the material, as measured, for example, by a durometer such as a Shore durometer. In order to evaluate the durometer value of a given material, pressure is applied to the material at the durometer indenter foot according to ASTM procedure D2240-00 “Standard Test Method for Rubber Property-Durometer Hardness”. The durometer indenter foot may be applied to the material for a sufficient amount of time, for example 15 seconds, and this measurement is taken on an appropriate scale. Depending on the type of scale used, a reading of 0 is obtained when the indenter foot is fully penetrated into the material and a reading of 100 is obtained when no penetration into the material has occurred. This reading is dimensionless. The durometer can be measured according to any suitable scale, for example type A and / or type OO, according to ASTM D2240-00. The polymer composition of the tissue thickness compensator may have, for example, a Shore A hardness value of about 4A to about 16A, which is about 45 OO to about 65 OO in the Shore OO range. For example, the polymer composition can include, for example, a PLLA / PCL copolymer or a PGA / PCL copolymer. The polymer composition of the tissue thickness compensator can have a Shore A hardness value of less than 15A. The polymer composition of the tissue thickness compensator can have a Shore A hardness value of less than 10A. The polymer composition of the tissue thickness compensator can have a Shore A hardness value of less than 5A. The remer composition can have, for example, a Shore OO composition value of about 35 OO to about 75 OO.

  The polymer composition may have at least two of the properties described above. The polymer composition can have at least three of the properties described above. The polymer composition has a porosity of 85% to 97% by volume, a pore size of 5 micrometers to 2000 micrometers, and a Shore A hardness of 4A to 16A, and a Shore OO hardness value of 45 OO to 65 OO. Yes. The polymer composition includes, for example, 70% by weight PLLA polymer composition and 30% by weight PCL polymer composition, 90% by volume porosity, 100 micrometer to 1000 micrometer pore size, and 4A to 16A. It may have a Shore A hardness and a Shore OO hardness value of 45 OO to 65 OO. The polymer composition includes, for example, 65% by weight PGA polymer composition and 35% by weight PCL polymer composition, 93 volume% to 95 volume% porosity, 10 micrometer to 100 micrometer pore size, and It can have a Shore A hardness value of 4A-16A and a Shore OO hardness value of 45OO-65OO.

  The polymer composition can include a pharmaceutically active agent. The polymer composition can release a therapeutically effective amount of the pharmaceutically active agent. The pharmaceutically active agent can be released as the polymer composition is desorbed / adsorbed. The pharmaceutically active agent can be released into a liquid (eg, blood) that passes over or through the polymer composition. Examples of pharmaceutically active agents include hemostatic agents and agents (eg, fibrin, thrombin, and oxidized regenerated cellulose (ORC)), anti-inflammatory agents (eg, diclofenac, aspirin, naproxen, sulindac, and hydrocortisone), antibiotics and antibacterial agents Or drugs (eg, triclosan, silver ion, ampicillin, gentamicin, polymyxin B, chloramphenicol), as well as anti-cancer agents (eg, cisplatin, mitomycin, adriamycin).

  Referring now to FIG. 216, a staple cartridge (eg, staple cartridge 10000) can include a support portion 10010 and a compressible tissue thickness compensator 10020. Referring now to FIGS. 218-220, the support portion 10010 can include a deck surface 10011 and a plurality of staple cavities 10012 defined within the support portion 10010. Each staple cavity 10012 may be sized, for example, to removably store a staple (eg, staple 10030) therein. The staple cartridge 10000 may further include a plurality of staple drivers 10040 that each support one or more staples 10030 within the staple cavity 10012 when the staples 10030 and 10040 are in an unfired position. It can be constituted as follows. For example, referring primarily to FIGS. 224 and 225, each staple driver 10040 may include, for example, one or more cradle (or trough) 10040 that supports staples and staples 10030. And the staple driver 10040 can be configured to limit relative movement. Referring again to FIG. 218, the staple cartridge 10000 may further include a staple firing thread 10050, which positions the staple driver 10040 and the staple 10030 from their unfired positions opposite the staple cartridge 10000. The staple cartridge can be moved from the proximal end 10001 to the distal end 10002 for continuous lifting toward the anvil that is being operated. Referring primarily to FIGS. 218 and 220, each staple 10030 includes a bottom surface 10031 and one or more legs 10032 extending from the bottom surface 10031, each staple being, for example, generally U-shaped and generally V-shaped. There can be at least one. The staple 10030 can be configured such that the tips of the staple legs 10032 are retracted against the deck surface 10011 of the support portion 10010 when the staple 10030 is in the unfired position. The staple 10030 can be configured such that the tips of the staple legs 10032 are flush with the deck surface 10011 of the support portion 10010 when the staple 10030 is in the unfired position. Staple 10030 may be configured such that the tip of staple leg 10032 or at least a portion of staple leg 10032 extends above deck surface 10011 of support portion 10010 when staple 10030 is in the unfired position. it can. In such a case, the staple legs 10032 can extend into and be embedded within the tissue thickness compensator 10020 when the staple 10030 is in the unfired position. For example, the staple legs 10032 may, for example, extend approximately 1.9 mm (0.075 ") above the deck surface 10011. The staple legs 10032, for example, approximately 0.64 mm (0.025") above the deck surface 10011. The tissue thickness compensator 10020 can be, for example, about 2.0 mm (0.08 ") to about 3.18 mm (0.125"). ”) Uncompressed thickness.

  In use, and with reference primarily to FIG. 233, the anvil (eg, anvil 10060) can move to a closed position relative to the staple cartridge 10000 in addition to the above. As will be described in detail below, the anvil 10060 can place tissue as opposed to the tissue thickness compensator 10020 and, for example, compress the tissue thickness compensator 10020 against the deck surface 10011 of the support portion 10010. can do. Once the anvil 10060 is properly positioned, staples 10030 can be deployed, as also shown in FIG. If desired, the staple firing sled 10050 can move from the proximal end 10001 of the staple cartridge 10000 toward the distal end 10002, as shown in FIG. As the thread 10050 advances, the thread 10050 contacts the staple driver 10040 and lifts the staple driver 10040 upward within the staple cavity 10012. Each of the sled 10050 and the staple driver 10040 may have one or more inclined surfaces (oblique surfaces), which can cooperate to move the staple driver 10040 upward from the unfired position. For example, referring to FIGS. 221-225, each staple driver 10040 may have at least one inclined surface 10042, and the thread 10050 may have at least one or more inclined surfaces 10052, which The sloping surface 10052 can be configured to slide under the sloping surface 10042 as the sled 10050 is advanced distally within the staple cartridge. As the staple driver 10040 is lifted upward within the respective staple cavity 10012, the staple driver 10040 lifts the staple 10030 upward so that the staple 10030 emerges from the staple cavity 10012 through the opening in the staple deck 10011. Can do. During a typical firing sequence, primarily referring to FIGS. 227-229, the sled 10050 can first contact the staple 10030a and begin to lift the staple 10030a up. As the sled 10050 is advanced further in the distal direction, the sled 10050 may in turn begin to further lift the staples 10030b, 10030c, 10030d, 10030e, and 10030f, and other subsequent staples. As shown in FIG. 229, the sled 10050 can drive the staple 10030 upward so that the staple leg 10032 contacts the opposing anvil, deforms to the desired shape, and is fired from the support portion 10010. In various situations, the sled 10030 can move several staples upward simultaneously as part of the firing sequence. With respect to the firing sequence shown in FIG. 229, the staples 10030a and 10030b have been moved to the fully fired position and fired from the support portion 10010, and the staples 10030c and 10030d are at least partially supported by firing. Housed in 10010, staples 10030e and 10030f are still in the unfired position.

  As described above, referring to FIG. 235, the staple legs 10032 of the staple 10030 can extend over the deck surface 10011 of the support portion 10010 when the staple 10030 is in the unfired position. Further, with respect to this firing sequence shown in FIG. 229, staples 10030e and 10030f are shown in an unfired position, and their staple legs 10032 exit above deck surface 10011 and extend into tissue thickness compensator 10020. ing. When the staple 10030 is in the unfired position, the tip of the staple leg 10032 or any portion of the staple leg 10032 cannot protrude through the tissue contacting upper surface 10021 of the tissue thickness compensator 10020. As the staple 10030 moves from the unfired position to the fired position, the tip of the staple leg may protrude through the tissue contacting surface 10032 as shown in FIG. The tip of the staple leg 10032 may have a sharp tip, which can incise and penetrate the tissue thickness compensator 10020. The tissue thickness compensator 10020 may have a plurality of openings that are configured to receive the staple legs 10032 and allow the staple legs 10032 to slide relative to the tissue thickness compensator 10020. can do. Support portion 10010 can further include a plurality of guides 10013 extending from deck surface 10011. The guide 10013 can be positioned adjacent the staple cavity opening in the deck surface 10011 such that the staple legs 10032 can be at least partially supported by the guide 10013. Guide 10013 may be disposed at the proximal and / or distal end of the staple cavity opening. In accordance with the present invention, a first guide 10013 can be disposed at the first end of each staple cavity opening and a second guide 10013 is disposed at the second end of each staple cavity opening. 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. Can do. Referring to FIG. 235, each guide 10013 may have a groove or slot (eg, groove 10016) in which staple legs 10032 may be slidably received. If desired, each guide 10013 may include a non-slip, protrusion, and / or spike that can extend from the deck surface 10011, which can extend into the tissue thickness compensator 10020. As described in detail below, anti-slip, protrusions, and / or spikes can reduce relative movement between the tissue thickness compensator 10020 and the support portion 10010. The tips of the staple legs 10032 can be disposed within the guide 10013 and cannot extend over the upper surface of the guide 10013 when the staple 10030 is in the unfired position. For example, the guide 10013 defines a guide height, and the staple 10030 cannot extend beyond this guide height when in the unfired position.

  According to the present invention, a tissue thickness compensator (eg, tissue thickness compensator 10020) can be constructed of a single sheet material. The tissue thickness compensator can include a single continuous sheet material that can cover the entire deck upper surface 10011 of the support portion 10010 or can cover a smaller area than the entire deck surface 10011. While the sheet material can cover the staple cavity opening of the support portion 10010, as an alternative, the sheet material may have an opening that is aligned with, or at least partially aligned with, the staple cavity opening. be able to. According to the present invention, the tissue thickness compensator can be composed of multiple layers of material. Referring now to FIG. 217, the tissue thickness compensator can include a compressible core and a wrap that encloses the compressible core. The wrap 10022 can be configured to releasably hold the compressible core relative to the support portion 10010. For example, the support portion 10010 includes one or more protrusions (eg, protrusion 10014 (FIG. 220)) extending therefrom, which can include one or more protrusions defined within the wrap 10022. An opening and / or slot (eg, opening 10024) may be received. The protrusion 10014 and the opening 10024 can be configured such that the protrusion 10014 can secure the wrap 10022 to the support portion 10010. The ends of the protrusions 10014 can be deformed, for example, by a thermal caulking process, etc., thereby increasing the ends of the protrusions 10014 and consequently limiting the relative movement between the wrap 10022 and the support portion 10010. . As shown in FIG. 217, the wrap 10022 may include one or more perforations 10025, which may facilitate peeling the wrap 10022 from the support portion 10010. Referring now to FIG. 226, the tissue thickness compensator may have a wrap 10222 that includes a plurality of openings 10223 that are aligned, or at least partially, with staple cavity openings in the support portion 10010. Can be aligned. The core of the tissue thickness compensator may also have openings, which may be aligned or at least partially aligned with the openings 10223 of the wrap 10222. Alternatively, the tissue thickness compensator core may have a continuum that may extend below the opening 10223 such that the continuum covers the staple cavity opening in the deck surface 10011.

  Optionally, as described above, the tissue thickness compensator can include a wrap that releasably holds the compressible core relative to the support portion 10010. For example, referring to FIG. 218, the staple cartridge may further include a retaining clip 10026, which can be configured to prevent the wrap and compressible core from prematurely disengaging from the support portion 10010. If desired, each retaining clip 10026 may have an opening 1000028 that is configured to receive a protrusion 10014 extending from the support portion 10010 so that the retaining clip 10026 can be secured to the support portion 10010. be able to. Each retaining clip 10026 may have at least one dished portion 10027 that extends below the support portion 10010 and can hold the staple driver 10040 within the support portion 10010. As described above, the tissue thickness compensator can be removably attached to the support portion 10010 by staples 10030. More particularly, as also described above, when the staple 10030 is in the unfired position, the legs of the staple 10030 can extend into the tissue thickness compensator 10020, thereby supporting the tissue thickness compensator 10020. The portion 10010 can be releasably held. The staple 10030 legs may be in contact with the side walls of each staple cavity 10012, and the staple 10030 until the staple 10030 is deployed from the staple cartridge 10000, thanks to friction between the staple legs 10032 and the side walls. And the tissue thickness compensator 10020 can be held in place. When the staple 10030 is deployed, the tissue thickness compensator 10020 can be captured within the staple 10030 and held against the stapled tissue T. When the anvil is then moved to the open position to release the tissue T, the support portion 10010 secured to the tissue can move away from the tissue thickness compensator 10020. An adhesive can be used to removably hold the tissue thickness compensator 10020 to the support portion 10010. A two-component adhesive can be used, a first component of the adhesive can be placed on the deck surface 10011, and a second component of the adhesive can be placed on the tissue thickness compensator 10020, thereby When the tissue thickness compensator 10020 is positioned opposite the deck surface 10011, the first component contacts the second component to activate the adhesive, and the tissue thickness compensator 10020 is attached to the support portion 10010. It can be detachably coupled to it. If desired, any other suitable means can be used to removably hold the tissue thickness compensator to the support portion of the staple cartridge.

  Further to the above, the sled 10050 can be advanced from the proximal end 10001 to the distal end 10002 to fully deploy all the staples 10030 received within the staple cartridge 10000. Referring now to FIGS. 258-262, the sled 10050 can be advanced distally within the longitudinal cavity 10016 in the support portion 10010 by the firing member (or knife bar) 10052 of the surgical stapler. In use, the staple cartridge 10000 is inserted into a staple cartridge groove member (eg, staple cartridge groove member 10070) in the jaws of the surgical stapler, which causes the firing member 10052 to advance and thread 10050 as shown in FIG. Can contact. As sled 10050 is advanced distally by firing member 10052, sled 10050 can contact the most proximal staple driver (or driver 10040) to fire or eject staple 10030 from cartridge body 10010 as described above. Can do. As shown in FIG. 258, the firing member 10052 can further have a cutting edge 10053 that can be advanced distally through the knife slot in the support portion 10010 when the staple 10030 is fired. In accordance with the present invention, a corresponding knife slot can extend through an anvil disposed opposite the staple cartridge 10000 so that the cutting edge 10053 extends between the anvil and the support portion 10010. The tissue and tissue thickness compensator in between can be cut. In various situations, the sled 10050 can be advanced distally by the firing member 10052 until the sled 10050 reaches the distal end 10002 of the staple cartridge 10000, as shown in FIG. At that point, the firing member 10052 can be retracted proximally. The sled 10050 can be retracted proximally at the firing member 10052, but referring now to FIG. 261, the sled 10050 can be moved to the distal end 10002 side of the staple cartridge 10000 when the firing member 10052 is retracted. Can be left behind. When the firing member 10052 is fully retracted, the anvil reopens, the tissue thickness compensator 10020 moves away from the support portion 10010, and the remaining non-implanted portion of the spent staple cartridge 10000 (including the support portion 10010) becomes staple cartridge. The groove member 10070 can be removed.

  After the consumed staple cartridge 10000 is removed from the staple cartridge groove member, a new staple cartridge 10000, or any other suitable staple cartridge, can be further inserted into the staple cartridge groove member 10070 relative to the above. . Further to the above, the staple cartridge groove member 10070, the firing member 10052, and / or the staple cartridge 10000 can constitute a cooperating function, which is a new (or new) disposed within the staple cartridge groove member 10070. Without the (unfired) staple cartridge 10000, the firing member 10052 can be prevented from advancing distally a second time (or subsequent). More specifically, referring again to FIG. 258, when the firing member 10052 is advanced to contact the sled 10050 and the sled 10050 is in the proximal unfired position, the support nose 10055 of the firing member 10052 is A 10050 support shelf 10056 may be positioned above and / or above so that the firing member 10052 is held in a sufficiently upper position and a lock (or beam) 10054 extending from the firing member 10052 is a staple cartridge. It can prevent falling into the lock recess defined in the groove member. If the lock 10054 does not fall into the lock recess, in such a situation, the lock 10054 does not contact the distal sidewall 10057 of the lock recess as the firing member 10052 is advanced. When the firing member 10052 pushes the sled 10050 distally, the firing member 10052 can be supported in the upper firing position thanks to the support nose 10055 riding on the support shelf 10056. When the firing member 10052 is retracted with respect to the sled 10050, as described above and as shown in FIG. 261, the support nose 10055 is no longer on the support shelf 10056 of the sled 10050, and the firing member 10052 is removed. Can fall from its upper position downward. For example, the surgical staple may have a spring 10058 and / or any other suitable biasing component, which can be configured to bias the firing member 10052 to a lower position. . Once the firing member 10052 is fully retracted, the firing member 10052 cannot be advanced again distally through the used staple cartridge 10000, as shown in FIG. More specifically, the firing member 10052 cannot be held in the up position by the sled 10050 because the sled 10050 is left at the distal end 10002 of the staple cartridge 10000 at this point in the sequence of operations. Thus, as described above, when the firing member 10052 is advanced again without replacement of the staple cartridge, the lock beam 10054 contacts the side wall 10057 of the locking recess, thereby causing the firing member 10052 to again move relative to the staple cartridge 10000. Prevents advancement in the distal direction. In other words, if the used staple cartridge 10000 is replaced with a new staple cartridge, the new staple cartridge has a sled 10050 disposed proximally, which can hold the firing member 10052 in the upper position, The firing member 10052 can again be advanced in the distal direction.

  As described above, the sled 10050 is configured to move the staple driver 10040 between a first unfired position and a second fired position to fire the staple 10030 from the support portion 10010. Can do. After the staple 10030 is fired from the support portion 10010, the staple driver 10040 can be received within the staple cavity 10012. Support portion 10010 can constitute one or more retention mechanisms, which can be configured to prevent staple driver 10040 from being fired or dropped from staple cavity 10012. Alternatively, the thread 10050 can be configured to fire the staple driver 10040 from the support portion 10010 within the staple 10030. For example, the staple driver 10040 can be constructed of a bioabsorbable and / or biocompatible material (eg, Ultem). A staple driver can be attached to the staple 10030. For example, a staple driver can be molded on and / or around the bottom surface of each staple 10030 such that the driver is molded integrally with the staple. US Patent Application No. 11 / 541,123 "SURGICAL STAPLES HAVING COMPRESIBLE OR CRUSSHABLE MEMBERS FOR SECURING TISSUE THEHERE AND STAPLING INSTRUMENTS FOR DEPLOYING 9 Incorporated into.

  In various situations, in addition to the above, the compressible tissue thickness compensator can move, twist, and / or flex with respect to the rigid support portion under the staple cartridge. The support portion, and / or any other suitable staple cartridge portion, is one or more mechanisms configured to limit relative movement between the tissue thickness compensator and the support portion. Can be included. As described above, at least a portion of the staple 10030 may extend above the deck surface 10011 of the support portion 10010, and in certain circumstances, referring now to FIGS. 263 and 264, for example, the tissue thickness compensator 10120. The lateral force applied to the sheet is resisted by the anti-slip 10013 extending from the staple 10030 and / or the support portion 10010. In various situations, the staple 10030 can tilt and / or bend within the staple cavity 10012 while resisting lateral movement of the tissue thickness compensator 10120, and the staple cavity 10012 and the staple 10030 can be It can be sized and configured to maintain relative alignment between the legs 10032 and the forming pocket 10062 in the opposing anvil 10060 so that the staple 10000 is properly formed during the staple forming process. The Staple 10030 and / or anti-slip 10013 may be configured to prevent or at least limit lateral strain within tissue thickness compensator 10020, as shown in FIG. For example, the staple 10030 and / or the anti-slip 10013 may be cured or, for example, laterally and / or laterally of the first (tissue contacting side) surface 10021 relative to the second (lower) surface 1000029 of the tissue thickness compensator. Or it can be configured to limit longitudinal movement. In accordance with the present invention, the staple cartridge and / or the staple cartridge groove member in which the staple cartridge is disposed may include at least one strain minimizing member that extends upwardly and is a tissue thickness compensator. Lateral and / or longitudinal movement, or strain, can be limited. As described above, the wrap that at least partially wraps the tissue thickness compensator can also prevent or at least limit lateral and / or longitudinal movement or distortion of the tissue thickness compensator.

  Referring again to FIGS. 263 and 264, a tissue thickness compensator (eg, tissue thickness compensator 10120) can include a core 10128 and a coating 10122. The covering 10122 and the compressible core 10128 can be composed of different materials, or alternatively, can be composed of the same material. In any case, the coating 10122 can have a higher density than the core 10128. In situations where the covering 10122 constitutes the top surface of the tissue thickness compensator 10120, the tips of the staple legs 10032 may be embedded within the covering 10122. If the coating includes the underside of the tissue thickness compensator 10120, the staple legs 10032 can extend through the coating and enter the core. In any case, the coating of the tissue thickness compensator can help keep the staple legs 10032 aligned with the forming pocket 10062 of the anvil 10060. The coating 10122 may be, for example, a density about 10% higher than the density of the core 10128, a density about 20% higher than the density of the core 10128, a density about 30% higher than the density of the core 10128, a density about 40% higher than the density of the core 10128, About 50% higher density than the core 10128, about 60% higher than the core 10128, about 70% higher than the core 10128, about 80% higher than the core 10128, about 10% higher than the core 10128 The density may be 90% higher and / or about 100% higher than the density of the core 10128. The coating 10122 can have, for example, a density that is higher than the density of the core 10128 and lower than twice the density of the core 10128. The coating 10122 may have a density that is greater than twice the density of the core 10128, for example. Further to the above, the coating 10122 and the core 10128 can be formed or manufactured simultaneously. For example, a liquid containing any suitable material disclosed herein can be poured into a dish or mold, and when the liquid solidifies, it can form a film or layer, It can have a higher density than the part. If desired, multiple layers within the material can be formed by utilizing a process in which one or more subsequent material layers are cast over the already solidified layer. Two or more layers can be bonded together, for example, with an adhesive. Two or more layers can be attached to each other, for example, by one or more fasteners and / or one or more mechanical engagement mechanisms. For example, adjacent layers can be joined together, for example, with one or more dovetail joints. The coating can include a sealing surface that can prevent or at least restrict the flow of liquid. The coating can include, for example, an open cell open cell structure.

  Further to the above, the coating can be cut from the tissue thickness compensator. The tissue thickness compensator can be cut from a larger block of material so that the tissue thickness compensator does not contain a coating. For example, the tissue thickness compensator can be composed of, for example, a homogeneous or at least nearly homogeneous material that includes large pores.

  In accordance with the present invention, a staple cartridge may have a plurality of staple cavities, each containing staples disposed therein, the staple cavities being arranged in a plurality of rows and facing the staple cartridge. The disposed anvil can include a plurality of molding pockets corresponding to staple cavities in the staple cartridge. In other words, the anvil may have a plurality of rows of forming pockets, and each forming pocket may be disposed opposite a staple cavity in the staple cartridge. If desired, each molding pocket may have two molding cups configured to receive staple legs 10032 of staples 10030, each molding cup receiving, for example, staple legs 10032 and other The staple legs 10032 are configured to be shaped or curved toward the staple legs 10032. In various situations, the leg 10032 may come off the molding cup or may not fit properly, so that the staple leg 10032 may become malformed during the firing sequence. As described herein, the anvil may have an array or grid of molding pockets, each configured to receive and mold staple legs. For example, the array of molding pockets can include a certain amount of molding pockets that exceeds the number of staples contained within the staple cartridge. The staple cartridge may, for example, have six rows of staple cavities in the longitudinal direction, the anvil may have six rows of molding pockets aligned with the six rows of staple cavities, and between the rows of molding pockets. May also include a molded pocket disposed on the surface. For example, on one side of the anvil, the anvil includes a first row of molding pockets that can be positioned over the first row of staple cavities and a second row adjacent to the first row of staple cavities. A second row of molding pockets that can be disposed over the staple cavities of the first row and further disposed between the first row of molding pockets and the second row of molding pockets. May include a pocket. Referring now to FIGS. 276-279, the anvil 10260 may have six rows of forming pockets 10261 that are configured to be positioned over corresponding six rows of staple cavities within the staple cartridge 10200. be able to. For example, the middle row of molding pockets 10262 can be disposed between and / or adjacent to the rows of molding pockets 10261. Referring now to FIGS. 277, 278, and 280, each molding pocket 10261 and 10262 may have two molding cups such that each molding cup molds or curves the staple legs 10032 proximally. A distal portion 10263 that can be configured and a proximal portion 10264 that can be configured to shape or curve the staple leg 10032 distally. In various other situations, the staple 10030 can be formed in various other ways. For example, the staple 10030 can be shaped so that one leg 10032 is shaped outward and the other leg 10032 is shaped inward (FIG. 281), or both legs 10032 are shaped outward. (FIG. 282), which may be, for example, (1) which forming cup the staple leg 10032 enters and / or (2) the distal part 10263 or the distal portion of the leg 10032 that enters each forming cup. Depending on whether you enter 10064 or not.

  Further to the above, each molding pocket 10261 and / or molding pocket 10262 may have, for example, a triangular or diamond shape. Each distal portion 10263 and / or each proximal portion 10264 of the molding pocket may have a triangular shape, for example, the triangular shape of the distal portion 10263 and the proximal portion 10264 is such that the apexes are opposite to each other. Can be arranged. An anvil can include, for example, an array of generally square shaped pockets. For example, the forming surface of each square forming pocket may include an arcuate surface extending between the sides of the square. An anvil can include, for example, an array of circular or spherical indentations. Further to the above, the molding pocket 10261 can be disposed along one or more lines, and similarly, the molding pocket 10262 can be disposed along one or more lines. Alternatively, the molding pockets 10261 and / or the molding pockets 10262 can be arranged in one or more circular rows. For example, the molding pockets 10261 can be arranged along the main circumference and the molding pockets 10262 can be arranged along another circumference. The main circumference and another circumference may be concentric, or at least approximately concentric. For example, the molding pocket 10262 can be disposed along an inner circumference disposed radially inward with respect to the main circumference and / or disposed radially outward with respect to the main circumference. Can be arranged along the outer circumference. The main circumference can be defined by the main diameter, the inner circumference can be defined by the inner diameter, and the outer circumference can be defined by the outer diameter. For example, the inner diameter may be shorter than the main diameter and the outer diameter may be longer than the main diameter.

  If desired, as described above, the anvil can move from an open position to a closed position, thereby compressing the tissue against the tissue thickness compensator (eg, tissue thickness compensator 10020) of the staple cartridge. can do. In various situations, the tissue thickness compensator can be positioned adjacent to the support portion of the staple cartridge prior to the tissue thickness compensator being positioned against the tissue. The tissue thickness compensator 10020 can be in a position that contacts the support portion 10018 before the anvil moves to the closed position. The tissue thickness compensator 10020 can be positioned such that there is a gap between the compensator 10020 and the support portion 10018. For example, the anvil can move the tissue and tissue thickness compensator 10020 down until the tissue thickness compensator 10020 contacts the support portion 10018, at which point the anvil moves to a closed position and moves into the tissue. Can bring about compression. If the surgeon is not satisfied with the placement of tissue between the anvil and the staple cartridge, the surgeon can open the anvil, adjust the position of the anvil and staple cartridge, and close the anvil again. Thanks to such placement and repositioning of the staple cartridge relative to the tissue, for example, the distal end of the tissue thickness compensator 10020 can be disengaged from the support portion 10010 in various situations. In some such situations, the distal end of the tissue thickness compensator 10020 may contact the tissue, peel away from the support portion 10010, or be engulfed with respect to the support portion. If desired, the staple cartridge is configured to releasably hold the tissue thickness compensator against a support portion under the staple cartridge, as described in detail below. The above functions can be included.

  Referring now to FIG. 265, staple cartridge 10300 releasably holds support portion 10310, tissue thickness compensator 10320 supported by support portion 10310, and distal end 10325 of tissue thickness compensator 10320 in place. A distal end 10302 with a nose 10303 configured to. The nose 10303 can include a slot 10305 configured to receive the distal end 10325 of the tissue thickness compensator 10320. The distal end 10325 can be compressed or wedged within the slot 10305 so that the distal end 10325 can be held in place as the staple cartridge 10300 is placed against tissue. For example, the slot 10305 can be oriented in a direction that is parallel or at least substantially parallel to the deck surface 10311 of the support portion 10310. The slot 10305 can be horizontal to the deck surface 10311. Alternatively, referring now to FIG. 266, the staple cartridge 10400 releasably holds the support portion, the tissue thickness compensator 10420 supported by the support portion, and the distal end 10425 of the tissue thickness compensator 10420 in place. And a distal end 10402 with a nose 10403 configured to. The distal end 10425 may have a protrusion extending therefrom and the nose 10403 may include a vertical slot 10405 configured to receive the protrusion at the distal end 10425. The distal end 10425 and / or the protrusion extending therefrom can be compressed or wedged within the slot 10405 so that the distal end 10425 is positioned when the staple cartridge 10400 is positioned against tissue. Can be held in place. Tissue thickness compensator 10420 may have a slot, such as slot 10429, for example, which may be configured to receive at least a portion of nose 10403 therein. The slot 10405 may be oriented in a direction that is perpendicular, or at least approximately perpendicular, to the deck surface 10411 of the support portion. Referring now to FIG. 267, the staple cartridge 10500 is releasably holding the support portion, the tissue thickness compensator 10520 supported by the support portion, and the distal end 10525 of the tissue thickness compensator 10520 in place. And a distal end 10502 with a nose configured. The nose can include a vertical slot 10505 configured to receive the distal end 10525 of the tissue thickness compensator 10520. The distal end 10525 can be compressed or wedged within the slot 10505 so that the distal end 10525 can be held in place as the staple cartridge 10500 is placed against tissue.

  Referring again to FIG. 265, the tissue thickness compensator 10320 can have an upper surface 10324 that can be disposed over the upper surface 10304 of the nose 10303. Another example where the upper surface of the tissue thickness compensator is positioned over the nose of the staple cartridge is shown in FIG. 238, for example, the upper surface 10721 of the tissue thickness compensator 10720 is the upper surface 10004 of the nose 10003. Placed on top. In use, referring again to FIG. 265, the tissue can slide over the upper surface 10304 of the nose 10303, and in certain circumstances, the tissue contacts the distal end 10325 of the tissue thickness compensator 10320. And may exert a force on the tissue thickness compensator 10320, resulting in a tendency to peel the tissue thickness compensator 10320 from the support portion 10310. This peel force can be resisted by the portion of the distal end 10325 clamped by the wedge within the nose 10303. In either case, once the tissue is properly positioned with respect to the staple cartridge 13000, the anvil is rotated to the closed position to compress the tissue and tissue thickness compensator 10320 against the support portion 10310. Can do. For example, the anvil can be rotated to a position that contacts the upper surface 10304 of the nose 10303 so that the anvil can be prevented from rotating further. In various circumstances, the upper surface 10324 of the tissue thickness compensator 10320 is positioned over the upper surface 10304 of the nose 10303 so that, for example, the upper surface 10324 is lowered toward the support portion 10310 when the anvil is closed. And in some circumstances, the upper surface 10324 may be pushed under the upper surface 10304 of the nose 10303. When the staples contained in the staple cartridge 10300 are deployed and the tissue thickness compensator 10320 is cut, the support portion 10310 and the nose 10303 are moved away from the tissue thickness compensator 10320 as described herein. Can move, thereby allowing the distal end 10325 of the tissue thickness compensator 10320 to slide out of the slot 10305.

  As described above, the anvil (eg, anvil 10060) can be rotated to the closed position, where the anvil 10060 contacts the nose upper surface 10004 of the staple cartridge (eg, staple cartridge 10000). Once the anvil reaches the closed position, the degree to which the tissue thickness compensator (eg, tissue thickness compensator 10020) is compressed depends, among other things, on the uncompressed thickness or height of the tissue thickness compensator and the tissue thickness. . Referring now to FIGS. 236 and 237, the tissue thickness compensator 10920 can include an upper surface that is coplanar with, or at least substantially coplanar with, the upper surface 10004 of the nose 10003. In such a case, the upper surface of the tissue thickness compensator 10920 can be pushed under the upper surface 10004 of the nose 10003. Referring now to FIGS. 241 and 242, a tissue thickness compensator (eg, tissue thickness compensator 10820) is positioned below the nose upper surface 10004 before the tissue thickness compensator 10820 is compressed by the tissue T and anvil 10060. The upper surface 10821 can be included. In situations where the tissue T is relatively thin, as shown in FIGS. 239 and 240, the tissue thickness compensator 10920 can provide a relatively small compression. Referring now to FIGS. 241 and 242, the tissue thickness compensator 10820 can provide greater compression when the tissue T is relatively thick. In situations where the tissue T has both thin and thicker portions, as shown in FIGS. 243 and 244, for example, the tissue thickness compensator 10820 compresses in greater amounts when placed under the thicker tissue T. And less compressed when placed under thinner tissue T. In this way, as described above, the tissue thickness compensator can compensate for different tissue thicknesses.

  Referring now to FIGS. 268-270, the surgical stapling instrument includes (1) a cartridge groove member 16670 configured to receive a staple cartridge 16600 and (2) a pivotally coupled to the cartridge groove member 16670. Anvil 16660. Staple cartridge 16600 may have a support portion 16610 and a tissue thickness compensator 16620, with distal end 16625 of tissue thickness compensator 16620 being supported by nose 16603 at distal end 16602 of staple cartridge 16600. Can be held releasably. The nose 16603 may have a slot 16605 and may be constructed of a flexible material. In use, primarily referring to FIG. 269, the nose 16603 can be bent downward to expand the opening of the slot 16605. The nose 16603 may have a notch or notch 16606, which can be configured such that the nose 16603 is bent downward. In any case, in various situations, the expanded opening of slot 16605 facilitates insertion of distal end 16625 of tissue thickness compensator 16620 into slot 16605. When the tissue thickness compensator 16620 is properly positioned, the nose 16603 is released and, due to the elasticity of the material comprising the nose 16603, the nose 16603 returns to an unbent state or at least approximately returns. The distal end 16625 of the tissue thickness compensator 16620 is sandwiched against the deck surface 16611 as shown in FIG. In use, the distal end 16625 can be withdrawn from the slot 16605 as the support portion 16610 moves away from the stapled tissue, as described above. In various situations, the flexible nose 16603 can be configured to flex when the tissue thickness compensator 16620 is disengaged from the support portion 16610. Referring again to FIG. 270, the tissue thickness compensator 16620 can include an upper surface 16621 that is aligned with, or at least substantially aligned with, the upper surface 16604 of the nose 16603.

  Referring to FIG. 271, a surgical stapling instrument includes (1) a groove member 10770 configured to receive a staple cartridge 10700, and (2) an anvil 10760 rotatably coupled to the groove member 10770. May be included. Staple cartridge 10700 can include a support portion 10710 and a tissue thickness compensator 10720. The tissue thickness compensator 10720 can be held in place by a nose sock 10703 that can slide over and overlap the support portion 10710. Referring primarily to FIG. 272, the nose sock 10703 may have one or more side slots 10707, which, for example, removably receive one or more mounting rails extending along the support portion 10710. Can be configured. The tissue thickness compensator 10720 can be placed in the middle of the side slot 10707. The nose socks 10703 may further include a distal end 10702 and a cavity 10706 defined in the distal end 10702, the cavity 10706 also configured to receive at least a portion of the support portion 10710, for example. be able to. In use, the nose socks 10703 can be slid over the support portion 10710 in a distal-to-proximal direction. The tissue thickness compensator 10720 can be removably attached to the nose socks 10703 so that after the staples are fired through the tissue thickness compensator 10720, the support portion 10710 and the nose socks 10703 are tissue thickness compensator 10720. The tissue thickness compensator 10720 can be detached from the nose socks 10703 as it moves away from the nose. The upper surface 10721 of the tissue thickness compensator 10720 can be disposed below the upper surface 10704 of the nose 10703.

  Referring now to FIGS. 273 and 274, the surgical stapling instrument includes (1) a staple cartridge groove member 11070 configured to receive a staple cartridge 11000 and (2) a rotatable connection to the groove member 11070. Anvil 11060. Staple cartridge 11000 can include a support portion 11010 and a tissue thickness compensator 11020. Tissue thickness compensator 11020 can be held in place by one or more longitudinal rails 11019 extending from deck 11011 of support portion 11010. Longitudinal rail 11019 can be embedded within tissue thickness compensator 11020. Referring primarily to FIG. 274, the tissue thickness compensator 11020 may have a longitudinal recess 11029 that can be configured to receive a longitudinal rail 11019. For example, the recess 11029 can be sized and configured to receive the rail 11019 with a press-fit mechanism, for example. Such a mechanism can be further configured to prevent or at least limit relative lateral movement between the tissue thickness compensator 11020 and the support portion 11010 relative to the above, and further, for example, Premature release of the tissue thickness compensator 11020 from the support portion 11010 can be limited. Referring now to FIG. 275, a surgical stapling instrument includes (1) a staple cartridge groove member 11170 configured to receive a staple cartridge 11100, and (2) an anvil rotatably coupled to the groove member 11770. 11160. Staple cartridge 11100 can include a support portion 11110 and a tissue thickness compensator 11120. The tissue thickness compensator 11120 can be held in place by one or more longitudinal rows of spikes (or teeth) 11119 extending from the deck 11111 of the support portion 11110. The longitudinal rows of spikes 11119 can be embedded within the tissue thickness compensator 11120.

  With respect to FIG. 273, in addition to the above, the tissue thickness compensator 11020 of the staple cartridge 11000 can be continuously released from the support portion 11010 as staples are fired from the staple cavity 10012 defined therein. More specifically, in addition to the above, staples disposed within the staple cavity 10012 are fired continuously between the proximal end 11001 of the staple cartridge 11000 and the distal end 11002 of the staple cartridge 11000, Thus, as the staple is fired, the staple applies an upward biasing force against the tissue thickness compensator 11020, which acts to push the tissue thickness compensator 11020 away from the rail 11019. In such a situation, the proximal end 11006 of the tissue thickness compensator 11020 can be released from the support portion 11010 as the staple is fired from the most proximal staple cavity 10012. The tissue thickness compensator 11020 is then continuously released from the support portion 11010 as staples are fired continuously from the support portion 11010 between the proximal end 11001 and the distal end 11002 of the staple cartridge 11000. sell. The distal end 11007 of the tissue thickness compensator 11020 can be released from the support portion 11010 when a staple disposed within the distal-most staple cavity 10012 is fired from the support portion 11010. Referring to FIG. 275, tissue thickness compensator 11120 continuously releases from spike 11119 extending from support portion 11110 as staples are fired continuously between the proximal end 11101 and distal end 11102 of the staple cartridge. Can be done.

  As described above, the tissue thickness compensator can be continuously released from the support portion of the staple cartridge as the staples are continuously fired from the support portion and contact the tissue thickness compensator. Staple legs (eg, staple legs 10032) can penetrate the tissue thickness compensator without releasing the tissue thickness compensator from the support portion. In such cases, the tissue thickness compensator can remain engaged with the support portion until the staple bottom surface (eg, bottom surface 10031) contacts the tissue thickness compensator and pushes upward. However, if desired, a non-slip and / or other mechanism extending from the support portion may counter, for example, the release of the tissue thickness compensator from the support portion. As will be described in detail below, the support portion includes a retention mechanism that can be configured to continuously release the tissue thickness compensator from the support portion as the staples are continuously fired from the staple cartridge. sell. Referring now to FIG. 283, a staple cartridge (eg, staple cartridge 11200) includes a retention mechanism 11213 that can be configured to releasably retain the tissue thickness compensator 11220 (FIG. 284) on the support portion 11210. Support portion 11210 may be included. For example, a retention mechanism 11213 can be disposed at the end of each staple cavity 11212, with each retention mechanism 11213 being defined within itself and configured to slidably receive the staple legs 10032 of the staple 10030. The guide groove 11216 may be included. In such cases, both the staple leg 10032 and the retention mechanism 11213 can be configured to releasably retain the tissue thickness compensator 11220 on the support portion 11210. In use, referring now to FIG. 284, as described above, the staple driver 10040 contained within the support portion 11210 may be driven upward by the sled 10050, and the staple driver 10040 contacts the holding mechanism 11213. The holding mechanism 11213 can be at least partially removed from the support portion 11210 and the holding mechanism 11213 can be moved away from the staple 10030 and the staple cavity 11212. As shown in FIG. 284, when the retention mechanism 11213 is disengaged from the support portion 11210 and / or moved outward, the retention mechanism 11213 can no longer retain the tissue thickness compensator 11220 against the support portion 11210. As a result, the tissue thickness compensator 11220 can be released from the support portion 11210. Similar to the above, the tissue thickness compensator 11220 can be continuously released from the support portion 11210 as the staple 10030 is continuously fired from the staple cartridge toward the anvil (eg, anvil 11260). For example, the staple driver 10040 can contact the retention mechanism 11213 when the upper surface of the staple driver 10040 is flush with, or at least substantially flush with, the deck surface 11211 of the support portion 11210. In such a case, the tissue thickness compensator 11220 can be released from the support portion 11210 at the same time as and / or immediately before the staple 10030 is formed into a fully formed or fully fired shape. For example, referring primarily to FIG. 285, the driver 10040 can be overdriven, thereby being pushed over the deck surface 11211 to fully form the staple 10030 and during the overdrive process, the retention mechanism 11213 breaks away from the support portion 11210. Referring again to FIG. 284, the retention mechanism 11213 may extend (or overhang) into the staple cavity 11212 before it is disengaged or moved so that the driver 10040 reaches the deck surface 11211 at the same time. The driver 10040 can contact the holding mechanism 11213. In either case, once the tissue thickness compensator 11220 is released from the support portion 11210, referring now to FIG. 285, the support portion 11210 can be moved away from the implanted tissue thickness compensator 11220. .

  As noted above, the compressible tissue thickness compensator of the staple cartridge can be continuously released from the staple cartridge support portion or cartridge body as the staple is fired or deployed from the staple cartridge. In various situations, such release may include continuously releasing the tissue thickness compensator from the support portion, and in some situations, complete removal from the support portion of the tissue thickness compensator may cause the anvil to open. Does not occur until the support portion has moved away from the implanted tissue thickness compensator. Referring now to FIG. 289, a staple cartridge (eg, staple cartridge 11300) can include a tissue thickness compensator 11320 that is releasably held on a support portion 11310. The support portion 11310 includes a plurality of retention members 11313 extending therefrom, which are configured to releasably compress and hold the longitudinal sides of the tissue thickness compensator 11320 to the support portion 11310. For example, each retention member 11313 may have an inwardly facing groove member or slot 11316 that can be configured to receive the longitudinal side of the tissue thickness compensator 11320 therein. In various circumstances, the plurality of retaining members 11313 can extend along the first longitudinal side of the support portion 11310, and the plurality of retaining members 11313 can be along the second longitudinal side of the support portion 11310. In certain circumstances, the retention member 11313 can be configured to prevent or at least limit relative lateral movement between the tissue thickness compensator 11320 and the support portion 11310, and In addition, the tissue thickness compensator 11320 can be prevented or at least limited from being released early from the support portion 11310. For example, the retaining member 11313 can be integrally formed with the support portion 11310, and referring further to FIG. 290, the retaining member 11313 can be configured to detach from or at least partially detach from the support portion 11310. , The tissue thickness compensator 11320 can be detached from the support portion 11310 as shown in FIG. The anvil (eg, anvil 11360) can be configured to compress the tissue thickness compensator 11320, and further, the tissue thickness compensator 11320 expands laterally in response to pressure generated in the tissue thickness compensator 11320. Thus, the retention member 11313 can be at least partially detached from or removed from the tissue thickness compensator 11320. As described above, advancement of the knife member through the anvil 11360 and staple cartridge 11300 can deploy the staples contained therein, while simultaneously pushing the anvil 11360 and staple cartridge 11300 closer together, which is tissue thickness. Additional compression pressure can be applied to the compensator 11320 so that the holding member 11313 can be continuously released as the knife member passes the staple cartridge 11300.

  Referring now to FIGS. 292-294, a staple cartridge (eg, staple cartridge 11400) may include a tissue thickness compensator 11420 removably attached to the support portion 11410. Staple cartridge 11400 may include one or more retention bars 11413 that may be configured to retain the longitudinal side of tissue thickness compensator 11420 against deck surface 11411. For example, each retention bar 11413 may have an opposing arm 11418, between which a groove member 11416 can be defined. In such a case, 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 the lip 11419 extending from the support portion 11410. Can do. Referring primarily to FIG. 292, the groove member 11416 of each retention bar 11413 is sized and configured to apply a compressive force against the longitudinal side of the tissue thickness compensator 11420 prior to use of the staple cartridge 11400. Can be. In use, referring primarily to FIG. 293, the staple cartridge 11400 can be placed in a staple cartridge groove member, and once the staple cartridge 11400 is properly placed, the anvil (eg, anvil 11460) can be The thickness compensator 11420 can be moved to a position where it can be compressed. Similar to the above, the tissue thickness compensator 11420 expands laterally or outwardly when compressed, so that the retention bar 11413 can be removed from the staple cartridge 11400. Closing the anvil 11460 does not remove the retention bar 11413 from the staple cartridge or completely. For example, by advancing the firing bar described above through the staple cartridge 11400, the staple 10030 can be deployed from the support portion 11410, while simultaneously pushing the anvil 11460 and the staple cartridge 11400 closer together and the tissue thickness compensator 11420. This is sufficient to apply the tissue thickness compensator 11420 laterally to disengage the retention bar 11413 from the staple cartridge 11400. Once the retention bar 11413 is removed from the staple cartridge 11400, referring to FIG. 294, the support portion 11410 can be moved away from the implanted tissue thickness compensator 11420 and removed from the surgical site. Alternatively, referring now to FIG. 295, the staple cartridge 11400 'may have a retention bar 11413', which may include an arm 11418 'extending therefrom, as described above. For example, each arm 11418 'may have a wedge lock ramp 11417' that can be configured to releasably retain the retention bar 11413 'on the staple cartridge 11400'. More particularly, the support portion 11410 ′ of the staple cartridge 11400 ′ may have an undercut 11419 ′ that cooperates with the wedge lock bevel 11417 ′ to move the retention bar 11413 ′ relative to the staple cartridge 11400. It may be configured to releasably hold and prevent the tissue thickness compensator 11420 from prematurely disengaging from the support portion 11410 ′. In use, similar to the above, the retention bar 11413 'can be disengaged from the staple cartridge 11400' when, for example, sufficient compressive force is applied to the tissue thickness compensator 11420.

  In various situations, and as described above and with reference again to FIGS. 259 and 260, the sled 10050 of the staple cartridge 10000 and the firing member 10052 of the surgical stapling instrument are staple cartridges from the proximal end 10001 of the staple cartridge 10000. 10000 can be moved to the distal end 10002 (FIG. 219), which deploys the staple 10030 from the support portion 10010. In at least one such situation, each staple 10030 can be moved from an unfired position to a fired position and is fired from the support portion 10010 to tissue disposed between the anvil 10060 and the staple cartridge 10000. In contrast, the entire tissue thickness compensator 10020 can be captured. In certain circumstances, the surgeon may not need to fire all of the staples 10030 from the staple cartridge 10000, and the surgeon may have the sled 10050 at a point midway between the proximal end 10001 and the distal end 10002 of the staple cartridge 10000. The firing bar 10052 may stop moving. In such a situation, the tissue thickness compensator 10020 can only be partially embedded in the tissue T, and in order to remove the unimplanted portion of the tissue thickness compensator 10020 from the support portion 10010, the surgeon 10010 can be pulled away from the partially implanted tissue thickness compensator 10020 so that the unimplanted portion can be peeled or peeled away from the support portion 10010. While these configurations are suitable in a variety of situations, improvements are shown in FIGS. 300-302, and the tissue thickness compensators (eg, tissue thickness compensator 11520) of staple cartridge 11500 can be configured to be detachable from one another. Of connected segments. For example, the tissue thickness compensator 11520 includes a first (most proximal) segment 11520a, a second segment 11520b removably coupled to the first segment 11520a, and removable to the second segment 11520b. A third segment 11520c coupled, a fourth segment 11520d removably coupled to the third segment 11520c, and a fifth segment 11520e removably coupled to the fourth segment 11520d. . The tissue thickness compensator 11520 may have at least one thin portion 11529 disposed in the middle of any two adjacent segments 11520a-11520e, which may be a predetermined thickness that allows the tissue thickness compensator segments to be separated from one another. It can be configured to define a break or separation point. The tissue thickness compensator can include any suitable arrangement of perforations, thin sections, and / or any other means of forming separation points within the tissue thickness compensator. Referring primarily to FIG. 301, the anvil 11560 is shown in the closed position and the firing member 10052 is shown partially advanced within the staple cartridge 11500, thereby providing the first segment 11520a, Staples 10030 under the second segment 11520b and the third segment 11520c are fired to capture the tissue thickness compensator 11520 against the tissue T. In such a position, for example, firing member 10052 has not yet been advanced to deploy staple 10030 under fourth segment 11520d and fifth segment 11520e. Referring now to FIG. 302, the anvil 11560 has been moved to the open position and the support portion 11510 of the staple cartridge 11500 has been moved away from the portion of the tissue thickness compensator 11520 that is implanted. As shown in FIG. 302, a thin portion 11529 (FIG. 300) intermediate the third segment 11520c and the fourth segment 11520d allows the unimplanted portion of the tissue thickness compensator 11520 to be removed from the implanted portion. It becomes possible to separate.

  Further to the above, the staple cartridge can include a plurality of fasteners configured to releasably hold the tissue thickness compensator relative to the support portion of the staple cartridge. The support portion can include, for example, a plurality of openings defined in the deck surface, with fasteners extending through the tissue thickness compensator and releasably retained within the support portion openings. In use, the fastener can be continuously released from the support portion as the staples are fired continuously from the support portion. For example, the fastener can be implanted with a tissue thickness compensator, for example, the fastener can be composed of at least one bioabsorbable material. After the tissue thickness compensator is at least partially implanted, the fastener can be disengaged from the support portion when the support portion moves away from the implanted tissue thickness compensator. Referring now to FIGS. 323-325, a staple cartridge (eg, staple cartridge 11600) can include a tissue thickness compensator 11620 releasably attached to a support portion 11610 by a plurality of fasteners 11613. Each fastener 11613 has a first end 11618 that is embedded and / or otherwise engaged within the tissue thickness compensator 11620 and a second end 11618 that engages the support portion 11610. And a connector 11616 that couples the first end 11618 to the second end 11618. Fastener 11613 may extend through knife slot 11615 defined in support portion 11610. In use, the firing member 10052 described above can move the knife edge through the knife slot 11615 of the support portion 11610 to cut the fastener 11613, thereby releasing the tissue thickness compensator 11620 from the support portion 11610. be able to. For example, the firing bar 10052 can be advanced from the proximal end 11601 of the staple cartridge 11600 to the distal end 11602 of the staple cartridge 11600, thereby (1) causing the thread 10050 to foam distally as described above. To continuously fire the staple 10030, (2) continuously cut and / or break the fastener 11613, and continuously release the tissue thickness compensator 11620 from the support portion 11610. As above, for example, the tissue thickness compensator 11620 may have a plurality of removable segments 11620a-11620e, each held against the support portion 11610 by one or more fasteners 11613. Can be done. If the firing member 10052 stops midway between the proximal end 11601 and the distal end 11602 of the staple cartridge 11600, after the anvil 11660 has opened and the support portion 11610 has moved away from the tissue T (shown in FIG. 325). The fastener 11613 assists in holding the unimplanted portion of the tissue thickness compensator 11620 relative to the support portion 11610 (FIG. 324). Further to the above, the cutting blade edge 10053 of the firing member 10052 can be configured to cut and / or break the fastener 11613. Alternatively, referring now to FIGS. 327 and 328, a staple deployment thread (eg, thread 11650) can be configured to cut the connector 11616 of the fastener 11613 as the thread 11650 traverses the staple cartridge 11600. 11653 can be included. For example, each connector 11616 may include a cylindrical member that extends between the T-shaped ends 11618 of the fasteners 11613 and the knife edge 11653 may be configured to receive, for example, a cylindrical connector 11616. 11653 can be included.

  As described above, the staple cartridge can be loaded into the staple cartridge groove member of the surgical stapling instrument. In various situations, a surgeon or other physician can apply a downward force to the staple cartridge to lock the staple cartridge in place to insert the staple cartridge into the staple cartridge groove member. In some such situations, for example, a physician can place such a downward force by placing a thumb on the upper surface of the staple cartridge. The upper surface of the staple cartridge may have the upper surface of the tissue thickness compensator, and as described above, the tissue thickness compensator may be compressible and support when a downward force is applied to the tissue thickness compensator. The tissue thickness compensator can be compressed to the extent that the physician's thumb contacts the tips of the staples stored in the section. In accordance with the present invention, a staple cartridge applicator can be utilized to insert a staple cartridge into a staple cartridge groove member, which prevents or at least restricts the possibility of a physician touching the staples in the staple cartridge. Can be configured to. After the staple cartridge is properly positioned in the staple cartridge groove member, the applicator can be removed from the staple cartridge, as will be described in detail below.

  Referring now to FIGS. 305 and 306, the staple cartridge applicator may have a rigid cover (eg, cover 10080) that can be attached to the staple cartridge 10000. In addition to the above, the cover 10080 prevents, for example, a doctor's thumb from touching the leading end of the staple 10030 disposed in the staple cartridge 10000 when the staple cartridge 10000 is inserted into the staple cartridge groove member. It can be configured to block or at least suppress. Referring now to FIGS. 307 and 308, the cover 10080 can extend over the upper surface 10021 or at least a portion of the upper surface 10021 of the tissue thickness compensator 10020, including (1) A lower surface 10081 that can extend and / or contact the tissue thickness compensator 10020 and (2) an upper surface 10024 that can provide a pressing surface for the physician to apply a downward force. In use, the physician can grasp the handle portion 10084 of the cover 10080, align the support portion 10010 of the staple cartridge 10000 with the staple cartridge groove member, and at least partially insert the staple cartridge 10000 into the staple cartridge groove member. Thereafter, the physician can place the staple cartridge 10000 fully within the staple cartridge groove member by applying a downward force to the upper surface 10082 of the cover 10880 and transmitting a downward force directly to the support portion 10010. . For example, the cover 10080 may have a proximal support 1000087 that can extend down to contact the deck surface 10011 of the support portion. The cover 10080 can further include a distal support portion 10084 that can be configured to contact the nose 10003. When a downward force is applied to the cover 10080, this downward force is transmitted through the proximal support 10087 and / or the distal support portion 10084, and this downward force is transmitted through the tissue thickness compensator 10020. There is no transmission or at least almost no transmission to the support portion 10010. In various situations, the above results in the physician not having direct contact with the tissue thickness compensator 10020. Also, as a result of the above, the cover 10080 does not compress or at least substantially compress the tissue thickness compensator 10020 when the staple cartridge 10000 is inserted into the staple cartridge groove member. In accordance with the present invention, the cover can include any suitable number of supports, which do not transmit or at least approximately transmit downward force through the tissue thickness compensator. , Configured to transmit a downward force to the support portion. The support can extend around the distal end, proximal end, and / or longitudinal side of the tissue thickness compensator. The support can extend through the tissue thickness compensator. For example, the support can extend through an opening in the tissue thickness compensator and touch the deck of the support portion. At least some of the supports cannot contact the deck before a downward force is applied to the cover. However, the cover can be configured to bend or move downward until the support contacts the deck of the support portion. At such points, downward bending or movement of the cover can be prevented or at least substantially prevented from further bending.

  As described above, the cover 10080 can be attached to the staple cartridge 10000 and can be used to manipulate the position of the staple cartridge 10000. The cover 10080 can include any suitable number of grip members, which can be configured to releasably hold the cover 10080 against the support portion 10010 of the staple cartridge 10000, for example. For example, the cover 10080 can further include, for example, one or more retaining members, such as latch arms 10088 and / or 10089. The latch arm 10099 can be configured to extend around the side of the nose 10003 and engage the lower surface 10009 (FIG. 306) of the nose 10003. Similarly, the latch arm 10088 can extend around the side of the locking projection 10008 of the support portion 10010 and engage the lower surface of the locking projection 10008. These latch arms can be configured to place the cover 10080 over a zone or region where staples are stored in the support portion 10010. In either case, the cover 10080 can be removed from the staple cartridge 10000 once the staple cartridge 10000 is properly positioned. The practitioner can apply an upward lifting force to the handle 10084 to disengage the distal end of the cover 10080 from the distal end 10002 of the staple cartridge 10000. For example, when the handle 10084 is lifted upward, the latch arms 10088 and 10089 can be bent outward, so that the latch arms 10088 and 10089 can be bent around the locking projections 10008 and the nose 10003, respectively. Thereafter, the proximal end of the cover 10080 can be lifted away from the staple cartridge proximal end 10001 and the cover 10080 can be moved away from the staple cartridge 10000.

  Referring now to FIGS. 309 and 310, a staple cartridge applicator (eg, staple cartridge applicator 10680) can be used, for example, to place a staple cartridge (eg, staple cartridge 10600) within a staple cartridge groove member, eg A thickness compensator (eg, tissue thickness compensator 10690) can be configured to be placed against the anvil. As above, the applicator 10680 may have a latch arm 10688 that can releasably engage a locking protrusion 10608 extending from a support portion 10610 of the staple cartridge 10600 so that the applicator 10680 can be stapled. The cartridge 10600 can be held in position above the tissue thickness compensator 10620. The upper tissue thickness compensator 10690 can be removably attached to the staple cartridge applicator 10680 so that the surgical instrument anvil (eg, anvil 10060) is closed on the applicator 10680 and the tissue thickness compensator 10690 is attached. Engaging and disengaging the tissue thickness compensator 10690 from the applicator 10680 can occur. The tissue thickness compensator 10690 and / or the anvil 10060 may have one or more retention mechanisms, which can be configured to releasably retain the tissue thickness compensator 10690 relative to the anvil 10060. For example, the tissue thickness compensator 10690 may have a longitudinal rail 10695 that extends from, for example, the upper surface 10691 of the tissue thickness compensator 10690 and is received in a longitudinal knife slot 10065 defined in the anvil 10060. Can be done. The tissue thickness compensator 10690 and the longitudinal rail 10695 can be comprised of any suitable compressible material, such as those described in this patent application, for example, the longitudinal rail 10695 can be, for example, It can be compressed and / or clamped in knife slot 10065. Once the anvil 10060 is engaged within the tissue thickness compensator 10690, the anvil 10060 can return to the open position, and in such circumstances, the tissue thickness compensator 10690 can be disengaged from the applicator 10680. Thereafter, the applicator 10680 can be removed from the staple cartridge 10600 so that the anvil 10060 and staple cartridge 10600 can be placed against the tissue to be stapled and / or cut. In use, a staple deployment sled (eg, sled 10050 (FIG. 236)) is advanced distally through staple cartridge 10600 by firing member 10052 (FIG. 236), for example, thereby stapling as outlined above. Are fired from the staple cartridge 10060. As the staples are deformed, each staple can capture a portion of the tissue thickness compensator 10690 for the upper surface of the tissue and a portion of the tissue thickness compensator 10620 for the lower surface of the tissue. At the same time, firing member 10052 can advance knife edge 10053 (FIG. 236) through tissue thickness compensator 10620 and / or tissue thickness compensator 10690, where it cuts longitudinal rail 10695 to cut tissue thickness. To continuously remove the compensator 10690 from the anvil 10060, the knife edge 10053 can be advanced through the longitudinal rail 10695. After the staple is deployed, the anvil 10060 can be reopened and moved away from the implanted tissue thickness compensator 10690, and similarly, the support portion 10610 of the staple cartridge 10600 can be moved to the implanted tissue thickness compensator 10620. You can move away from. Further to the above, the tissue thickness compensator 10620 and / or the tissue thickness compensator 10690 may have a plurality of removable segments, which are only a portion of the tissue thickness compensators 10620 and 10690 are implanted with staples. Can be separated from each other.

  Further to the above, the applicator 10680 may have one or more retention mechanisms, which may be configured to releasably retain the tissue thickness compensator 10690 relative to the applicator 10680. it can. For example, referring primarily to FIG. 310, the applicator 10680 may have a longitudinal retention rail 10485 that is, for example, in a longitudinal retention slot 10694 defined in the lower surface 10682 of the tissue thickness compensator 10690. It can be configured to be received by press-fitting. In various situations, the retention rail 10485 and the retention slot 10694 may cause the tissue thickness compensator 10690 relative to the applicator 10680 until sufficient upward lifting force is applied to the tissue thickness compensator 10690 by the anvil 10060 as described above. And can be configured to be held. For example, the retention rail 10665 extending from the applicator 10680 may further include end stops 10686 disposed at the proximal and distal ends of the retention rail 10665, which may include tissue thickness compensator 10690 and applicator 10680. Can be configured to prevent or at least limit relative longitudinal movement between the two. Referring again to FIG. 310, one or more adhesives (eg, longitudinal adhesive strip 10673) can be placed on the contact surface 10691 of the tissue thickness compensator 10690 so that the anvil 10060 When contacting the tissue thickness compensator 10690, the adhesive can releasably bond the tissue thickness compensator 10690 to the anvil 10060 as described above. If desired, one or more adhesives can be utilized, for example, in addition to or in place of the compressible retention mechanism described above. One or more adhesives can be utilized to releasably hold the tissue thickness compensator against the staple cartridge applicator. Referring now to FIG. 310A, the cover 10080 may include, for example, one or more adhesive pads 12185 that connect the upper tissue thickness compensator (eg, tissue thickness compensator 12190) to the upper side of the cover 10080. It can be configured to releasably hold on the surface 10082. For example, similar to the above, the anvil can be closed relative to the tissue thickness compensator 12190 and engage the longitudinal retaining rail 12195 of the tissue thickness compensator 12190. A release mechanism can be placed intermediate the tissue thickness compensator 12190 and the cover 10080, which is used to break the adhesive bond that holds the tissue thickness compensator 12190 to the cover 10080 and The compensator 12190 can be removed from the cover 10080. The release mechanism may include a pull tab 12196 and a loop 12197, which may include first and second ends attached to the pull tab 12196. The loop 12197 may include a suture, for example, which may define an outer periphery that surrounds the adhesive pad 12185 so that when the pull tab 12196 is pulled distally, the suture is tissue thickness compensator. It can slide between 12190 and cover 10080 and can contact tissue pad 12185. In such a situation, the suture may, for example, separate the adhesive pad 12185 from the tissue thickness compensator 12190, separate the adhesive pad 12185 from the cover 10080, and / or cut the adhesive pad 12185. At least one of them can be performed.

  Referring now to FIG. 311, the staple cartridge may have a support portion 10710, for example, which may include a longitudinal knife slot 10715 that extends through itself, as described above. For example, a staple cartridge applicator (eg, applicator 10780) may have a longitudinal retention and alignment member 10786 that can extend into a knife slot 10715 in the support portion 10710. The retaining member 10786 can be configured to engage the side wall of the knife slot 10715, for example, by press fit, so that the applicator 10780 can be releasably retained relative to the support portion 10710. Optionally, although not shown, the first portion of the tissue thickness compensator can be disposed on the first side of the retention member 10786 and the second portion of the tissue thickness compensator is the retention member 10786. Can be disposed on opposite second side surfaces. Similar to the above, the first and second portions of the tissue thickness compensator can be attached to the support portion 10710 of the staple cartridge via a holding member 10013, for example. Also, similar to the above, the upper tissue thickness compensator 10790 can be removably attached to the applicator 10780 via a longitudinal holding member 10785 extending from the loading surface 10784 of the applicator 10780. The tissue thickness compensator 10790 can be releasably press-fit into a longitudinal slot 10794 defined in the lower surface 10792. Optionally, and similar to the above, the tissue thickness compensator 10790 may further include a longitudinal retention member 10795 extending from the upper surface 10791 of the tissue thickness compensator 10790, which is defined within the anvil 10060. It can be releasably held in the longitudinal knife slot 10065. For example, the longitudinal retention member 10795 may have a wedge-shaped cross section that includes an upper portion that is larger than the lower portion, and the lower portion may, for example, attach the retention member 10795 to the tissue thickness compensator 10790.

  Referring now to FIGS. 312 and 313, a staple cartridge 10800 that includes a support portion 10810 and a tissue thickness compensator 10820 can be loaded into a staple cartridge groove member with, for example, a staple cartridge applicator 10880. As above, the staple cartridge applicator 10880 can be configured to position the upper tissue thickness compensator 10890 relative to, for example, an anvil (eg, anvil 10060) so that when the anvil 10060 is closed, Anvil 10060 can contact and engage tissue thickness compensator 10890. The tissue thickness compensator 10890 may have a plurality of retaining legs 10895 extending from the upper surface 10891 of the tissue thickness compensator 10890 that engages the anvil 10060 and causes the tissue thickness compensator 10890 to move against the anvil 10060. Can be configured to hold releasably. For example, the legs 10895 can be arranged in a longitudinal row, and each leg 10895 can include at least one foot configured to enter and engage a knife slot 10065 defined in the anvil 10060. . Some legs of the leg 10895 may extend in one direction and other legs may extend in another direction. Some of the feet may extend in the opposite direction. In either case, once the anvil 10060 is engaged with the tissue thickness compensator 10890, then referring to FIGS. 313 and 314, the anvil 10060 is reopened and the physician repositions the staple cartridge applicator 10880 and the tissue thickness compensator 10820. And can be moved away from 10890. Thereafter, referring to FIG. 314A, the upper tissue thickness compensator 10890 can be placed on the target tissue and the first side of the tissue thickness compensator 10820, which can have a lower tissue thickness compensator, It can be placed on the second side of the tissue. After the tissue thickness compensators 10820 and 10890 are properly positioned, referring now to FIG. 314B, the knife edge (eg, knife edge 10053) of the firing member may be advanced through the tissue and tissue thickness compensator. it can. Referring now to FIG. 318, a staple cartridge applicator (eg, applicator 12280) may have a tissue thickness compensator 12290 removably mounted thereon, similar to that described above with reference to FIG. As shown, the anvil 10060 can be engaged when inserted into the staple cartridge groove member and moved to the closed position. For example, the tissue thickness compensator 12290 may include a plurality of retaining members 12295 that extend upward from the upper surface 12291 of the tissue thickness compensator 12290, and each retaining member 12295 may include a plurality of flexible legs 12296. These can be configured to be inserted into knife slot 10065 in anvil 10060. Referring primarily to FIGS. 321 and 322, the flexible legs 12296 of each retaining member 12295 may be separated by a gap 12298 so that when the legs 12296 are inserted into the knife slot 10065, the legs 12296 are Bending inward, the expanded leg of flexible leg 12296 can elastically return to the outside after passing through knife slot 10065. The inflated foot of the flexible leg 12296 can bend across the opposing retaining lip 12997 defined in the anvil 10060 and the interaction of the leg 12296 and lip 12297 results in the tissue thickness compensator 12290 being anvil. 10060. Thereafter, the staple cartridge applicator 12280 can be moved away from the tissue thickness compensator 12290, as shown in FIG. In use, once the tissue thickness compensator 12290 is implanted into the tissue with staples deployed from the staple cartridge 10000, for example, the anvil 10060 can be reopened, and further, the anvil 10060 can be transferred to the implanted tissue thickness. When moved away from the compensator 12290, the legs 12296 of the retaining member 12995 can bend inward and thereby be withdrawn from the knife slot 10065.

  Referring now to FIGS. 315 and 316, a tissue thickness compensator (eg, tissue thickness compensator 111990) can be longitudinally loaded into an anvil (eg, anvil 11960). More particularly, the tissue thickness compensator 111990 may have one or more longitudinal rails 111995 that are inserted into the distal opening of the knife slot 11965 of the anvil 11960 and then the tissue thickness compensator. It can be pushed proximally until 11990 is properly seated within anvil 11960. For example, each rail 111995 may have a longitudinal retaining foot 111996 that may be disposed, for example, beyond a longitudinal retaining lip 111997 that at least partially defines a knife slot 11965. As shown in FIG. 316, the foot 111996 can be extended in the opposite direction for placement beyond the retention lip 11997 located on the opposite side of the knife slot 11965. In accordance with the present invention, a longitudinal gap 111998 is defined between the rails 11995, which configures the rails 11995 to bend inward from one another when the tissue thickness compensator 111990 is disengaged from the anvil 11960. be able to. Referring now to FIG. 317, a tissue thickness compensator (eg, tissue thickness compensator 12090) may have one or more locking arms 12098 that rotate around the side of the anvil (eg, anvil 12060). Can extend. In use, the lock arm 12098 can engage the anvil 12060 to releasably hold the tissue thickness compensator 12090 against the anvil 12060. For example, the anvil 12060 may have one or more notches or lock shoulders 12097, each of which can be configured to receive a foot extending from the lock arm 12098. In use, after the tissue thickness compensator 12090 has been at least partially implanted, the arm 12098 can bend outward and disengage from the anvil 12060 when the anvil 12060 moves away from the tissue thickness compensator 12090.

  As described above, a surgical stapling instrument includes a staple cartridge, an anvil rotatably coupled to the staple cartridge groove member, and a firing member including a knife edge movable relative to the anvil and the staple cartridge groove member. A staple cartridge groove member configured to receive may be included. In use, the staple cartridge is disposed within the staple cartridge groove member, and after the staple cartridge is at least partially consumed, the staple cartridge can be removed from the staple cartridge groove member and replaced with a new staple cartridge. For example, a staple cartridge groove member, anvil, and / or firing member of a surgical stapling instrument can be reused with a replacement staple cartridge. Alternatively, the staple cartridge can include a portion of a disposable loading unit assembly, which can include a staple cartridge groove member, an anvil, and / or a firing member, eg, a disposable loading unit assembly. As part of the replacement, the staple cartridge can be replaced. A specific disposable loading unit assembly is disclosed in U.S. Patent Application No. 12 / 031,817 "END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTING AND STAPLING INSTRUMENT" (filed Feb. 15, 2008). Is incorporated herein by reference. Referring now to FIG. 370, a disposable loading unit (eg, disposable loading unit 12500) includes a support portion 12510, an anvil 12560 rotatably coupled to the support portion 12510, and an elongate shaft 12570 extending from the support portion 12510. May be included. Similar to the staple cartridge described herein, the support portion 12510 can include a plurality of staple cavities 10012 and staples (eg, staples 10030) disposed in each staple cavity 10012, for example. The disposable loading unit 12500 can further include a firing member 12552, which can be advanced distally to move the anvil 12560 from the open position shown in FIG. 370 to the closed position. The disposable loading unit 12500 may further include a tissue thickness compensator 12520 disposed on or attached to the support portion 12510 such that when the anvil 12560 is in the closed position, the anvil 12560 is attached to the tissue thickness compensator 12520. In some cases, the anvil 12560 can at least partially compress the tissue thickness compensator 12520 when the anvil 12560 is in the closed position. In either case, firing member 12552 can be further advanced to fire staples from support portion 12510. As the staples are fired, the staples are deformed by the anvil 12560, and at least a portion of the tissue thickness compensator 12520 can be captured therein. The firing member 12552 can then be retracted proximally, the anvil 12560 can be reopened, and the support portion 12510 can be moved away from the implanted tissue thickness compensator 12520.

  Further to the above, the tissue thickness compensator 12520 can be removably attached to the support portion 12510. For example, the support portion 12510 includes a longitudinal retaining rail 12526 attached to each side main thereof, and each rail 12526 may have one or more openings 12528, which have a tissue thickness compensator therein. It can be configured to receive at least a portion of 12520. Once the tissue thickness compensator 12520 is at least partially implanted, the support portion 12510 can be removed and the tissue thickness compensator 12520 can be withdrawn from the opening 12528. Referring now to FIGS. 371-373, the disposable loading unit 12600 extends below a support portion 12610, a tissue thickness compensator 12620 removably attached to the support portion 12610, and a tissue thickness compensator 12620. And one or more retention rails 12626 that can be configured to attach the tissue thickness compensator 12620 to the support portion 12610. Each retention rail 12626 may include, for example, a plurality of retention hooks 12628, which may be engaged with the support portion 12610, for example, via retention slots 12614 defined within the support portion 12610. In use, for example, the tissue thickness compensator 12620 can be removed from the retaining rail 12626 after the tissue thickness compensator 12620 is at least partially implanted and the support portion 12610 is moved away from the tissue thickness compensator 12620. Can be configured. Referring now to FIGS. 374-376, the disposable loading unit 12700 may have one or more retention rails 12726, each of which has a lower bar 12725 extending below the tissue thickness compensator 12720, and a tissue thickness. And an upper bar 12727 extending above the upper surface 12621 of the compensator 12620. The tissue thickness compensator 12620 is at least partially compressed between the upper bar 12727 and the lower bar 12725 so that the retaining rail 12726 releasably holds the tissue thickness compensator 12620 relative to the support portion 12610. can do. For example, each retention rail 12726 may have one or more retention hooks 12728 that can engage the support portion 12610 to retain the retention rail 12726 on the support portion 12610.

  Referring now to FIGS. 377 and 378, the disposable loading unit 12800 may include a retention member 12822 that can be configured to attach the tissue thickness compensator 12620 to the support portion 12610. For example, the retention member 12822 may comprise a sheet of material that is disposed against the deck surface 12611 of the support portion, and the tissue thickness compensator 12620 is attached to the sheet by, for example, at least one adhesive. Can be attached to other sheet materials. The retention member 12822 can further include a longitudinal retention rail 12825 configured to extend downward into a knife slot 12615 defined in the support portion 12610. For example, the retention rail 12825 can be sized and configured to be compressed between the sidewalls of the knife slot 12615. In use, firing member 12552 includes a knife edge that can pass through knife slot 12615 as firing member 12552 is advanced distally to longitudinally cut tissue thickness compensator 12620 and retention rail 12825. sell. Also, in use, staples fired from the support portion 12610 can penetrate the retaining member 12822, the tissue thickness compensator 12820, and the tissue disposed between the tissue thickness compensator 12820 and the anvil 12560. . The retaining member 12822 can be composed of a biocompatible and / or bioabsorbable material. The retention member 12822 can be constructed of a material that is sufficiently compressible to include the tissue thickness compensator underlying the tissue thickness compensator 12620. Referring now to FIGS. 379-381, the disposable loading unit 12900 includes a lower portion 12922 that can be removably attached to the support portion 12610, an upper portion 12990 that can be removably attached to the anvil 12560, and a lower portion 12922. And a flexible joint 12991 connecting the upper portion 12990 may be included. Similar to the above, the longitudinal retaining rail 12825 may extend downward from the lower portion 12922 to enter a knife slot 12615 defined in the support portion 12610 so that the lower portion 12922 is It can be releasably held against the support portion 12610. Similarly, the longitudinal retention rail 12995 may extend upward from the upper portion 12990 and into a knife slot defined within the anvil 12560 so that the upper portion 12990 is relative to the anvil 12560. It can be held releasably. As shown in FIGS. 380 and 381, the tissue thickness compensator 12620 can be attached to the lower portion 12922 of the loading assembly, and in order to place the tissue thickness compensator 12620 relative to the support portion 12610, the physician Bending the 12990 and the lower portion 12922 closer together, placing the loading assembly between the anvil 12560 and the support portion 12610 and releasing the bent loading assembly to elastically expand the upper portion 12990 to anvil The lower portion 12922 can be biased against the support portion 12610 while biasing against the 12560. Referring now to FIGS. 382-384, the loading assembly may further include one or more latch hooks (eg, latch hook 12994) extending from itself, which connects the upper portion 12990 to the anvil 12560. The releasable connection and / or the lower portion 12922 may be configured to releasably connect to the support portion 12610.

  Referring now to FIG. 385, the disposable loading unit 15900 may include, for example, an anvil 15960 and a staple cartridge groove member 15970, which can rotate relative to the anvil 15960. For example, the anvil 15960 may not be able to rotate. The tissue can be disposed between the anvil 15960 and the staple cartridge groove member 15970, and the staple cartridge groove member 15970 can then be rotated toward the tissue to clamp the tissue against the anvil. For example, the disposable loading unit 15900 can further include a tissue thickness compensator 15920 that can be configured to contact tissue.

  As described above and with reference to FIG. 332, a staple cartridge (eg, staple cartridge 10000) may have a support portion 10010 and a tissue thickness compensator 10020, and the plurality of staples 10030 are at least partially support portion 10010. And can extend into the tissue thickness compensator 10020 when the staple 10030 is in the unfired position. The staple 10030 tip does not protrude from the tissue thickness compensator 10020 when the staple 10030 is in the unfired position. As the staple 10030 is moved from the unfired position to the fired position by the staple driver 10040, the tip of the staple 10030 can penetrate the tissue thickness compensator 10020 and / or penetrate the upper layer or coating 10022 as described above. Can penetrate. Alternatively, the staple 10030 tip can protrude through the upper surface of the tissue thickness compensator 10020 and / or the coating 10022 when the staple 10030 is in the unfired position. In any case, the staple 10030 extends upward from the support portion 10010 prior to deployment, and thus may be tilted and / or bent relative to the support portion as described above. Referring now to FIG. 329, a staple cartridge (eg, staple cartridge 13000) may have a plurality of guide members or retainers that support the support portion 13010 of the staple cartridge 13000 and the staples disposed therein. It can be configured to limit relative movement between the tip. Referring primarily to FIG. 330, the staple cartridge 13000 may have a tissue thickness compensator 13020 attached to the support portion 13010, and a plurality of pledgets attached to the upper surface 13021 of the tissue thickness compensator 13020. 13022 may be included. If desired, each pledget 13022 may have a plurality of openings 13029 defined therein to slidably receive and / or guide the legs 13022 of the staples 13030 therein. Can be configured. In addition to or instead of the openings, the pledget may have any suitable opening, such as slots, guides, and / or grooves, which slidably receive and / or guide the legs 13022. Can be configured to. As shown in FIG. 330, the tips of the staple legs 13032 can be disposed in the opening 13029 when the staples 13030 are in the unfired position. For example, the tips of the staple legs 13032 can protrude above the pledget 13022 when the staples are in the unfired position. The tip of the staple leg 13032 may be just below the pledget 13022 when the staple 13030 is in the unfired position, so that as the staple 13030 moves up through the tissue thickness compensator 13020, the staple leg 13032 enters the opening 13029 of the pledget 13022 and can slide therein. In either case, when the legs 13032 of the staples 13030 are placed in the pledget, the lateral and / or longitudinal movement of the staple legs 13032 causes the upward movement of the staple legs 13032 when the staples 13030 are deployed. You can limit without interfering. Once staple 13030 is deployed, referring now to FIG. 331, staple leg 13032 slides upward through pledget 13022, enters tissue T, and is positioned against staple cartridge 13030. And can be deformed downward to capture tissue T and tissue thickness compensator 13030 therein.

  Further to the above, the pledget 13022 can be attached to the tissue thickness compensator 13020 utilizing, for example, at least one biocompatible and / or bioabsorbable adhesive. The pledgets 13022 and / or retention members extending from each pledget can be at least partially embedded within the tissue thickness compensator 13020. For example, tissue thickness compensator 13020 includes a pocket defined therein, which can be configured to at least partially receive pledget 13022. The tissue thickness compensator 13020 can integrally mold or around the pledget 13022 during the molding manufacturing process. The pledgets 13022 can have separate retainers that can move independently of each other. Referring primarily to FIG. 330, each pledget 13022 may have an interengagement and / or key engagement feature that allows for relative lateral and longitudinal movement between pledgets 13022. And can be configured to be limited to some extent. For example, each pledget 13022 may have a protrusion 13026 and one or more recesses 13027, for example, the protrusion 13026 of the first pledget 13022 is in the recess 13027 of the adjacent second and third pledgets 13022. And / or aligned with respect thereto. If desired, there may be a gap between adjacent pledgets 13022 so that the pledgets 13022 can move or slide relative to each other until they contact the adjacent pledgets 13022. Pledgets 13022 can be gently interconnected. Pledget 13022 can be removably coupled. For example, the pledget 13022 can be manufactured as a sheet of interconnected pledgets, and when sufficient force is applied to the sheet, one or more pledgets 13022 can break away from the other pledgets. Referring again to FIG. 329, the first sheet 13024 of the pledget 13022 can be placed on the first side of the longitudinal slot 13025, and the second sheet 13024 of the pledget 13022 is the second sheet of the slot 13025. Can be placed on the side. Further to the above, the longitudinal slot 13025 extending through the tissue thickness compensator 13020 facilitates the knife edge of the firing member passing through the tissue thickness compensator 13020 and firing as the firing member passes. The member can be configured to apply a compressive force against the sheet 13024 to separate or separate at least some of the pledgets 13022.

  Pledget 13022 can be composed of, for example, a biocompatible and / or bioabsorbable plastic. Pledget 13022 can be composed of, for example, a solid material, a quasi-solid material, and / or a flexible material. Pledget 13022 may be embedded within the tissue thickness compensator so that pledget 13022 can move with the tissue thickness compensator. For example, pledget 13022 may be sufficiently flexible so that it can bend with the upper surface of the tissue thickness compensator. The pledget 13022 can be configured to remain embedded within the tissue thickness compensator, while the pledget 13022 can be configured to protrude or disengage from the tissue thickness compensator. Pledget 13022 may include an upper surface that is flush with the upper surface of the tissue thickness compensator. The upper surface of the pledget 13022 can be positioned above and / or below the upper surface of the tissue thickness compensator. The upper surface of the pledget 13022 can be positioned so that it is visible when looking at the upper surface of the tissue thickness compensator, while in the alternative, the upper surface of the pledget 13022 is, for example, below the layer of tissue thickness compensator Can be arranged. For example, a guide mechanism can be formed on the upper surface of the tissue thickness compensator. For example, the tissue thickness compensator must not be composed of a composite material and can include, for example, a unitary material.

  Referring now to FIG. 338, a staple cartridge can have, for example, a tissue thickness compensator 13620 and a coating or top layer 13621. For example, one or more pledgets or retainers 13622 can be embedded within the coating 13621, for example. Each retainer 13622 may have one or more openings 13629 defined therein, such as when the staple 13030 is in an unfired position, as shown in FIG. 13030 staple legs 13032 may be configured to be received therein. In use, in addition to the above, for example, when the staple 13030 moves from the unfired position to the fired position, the bottom surface 13031 of the staple 13030 contacts the tissue thickness compensator 13620 and the tissue thickness relative to the lower surface of the pledget 13622. The staple legs 10032 can slide through the opening 13629 until at least a portion of the compensator 13620 is compressed. Referring now to FIG. 333, the staple cartridge can have a tissue thickness compensator 13120 and a coating or top layer 13122, for example. For example, the tissue thickness compensator 13120 may have a conical ridge, protrusion, and / or protrusion 13128, for example, that can extend upward from the upper surface 13121 of the tissue thickness compensator 13120. The protrusion 13128 can be configured to receive and wrap around the tip of the staple leg 13032 of the staple 13030 when the staple 13030 is in the unfired position, as shown in FIG. The upper layer 13122 may also have conical ridges, protrusions, and / or protrusions 13129 that may be aligned with, or at least approximately aligned with, the protrusions 13128. In use, the staple legs 10032 can penetrate the protrusions 13128 and 13129 and emerge from the tissue thickness compensator 13120. Referring now to FIG. 337, a staple cartridge can have a tissue thickness compensator 13520 and a coating or top layer 13522, for example. For example, the coating 13522 may have conical ridges, protrusions, and / or protrusions 13529, for example, that can extend upward from the upper surface 13521 of the tissue thickness compensator 13520. Similar to the above, the protrusion 13529 can be configured to receive and wrap the tip of the staple leg 13032 of the staple 13030 when the staple 13030 is in the unfired position, as shown in FIG. In use, the staple legs 10032 can penetrate the protrusion 13529 and emerge from the covering 13522.

  Referring now to FIG. 334, the staple cartridge can have a tissue thickness compensator 13220 and a coating or top layer 13222, for example. For example, the tissue thickness compensator 13220 may have a conical depression and / or a recess 13128, for example, that can extend downward to the upper surface 13221 of the tissue thickness compensator 13220. As shown in FIG. 334, the tips of staple legs 13032 can extend through recess 13128 when staples 13030 are in the unfired position. The upper layer 13222 may also have conical depressions and / or recesses 13129 that may be aligned with, or at least substantially aligned with, the protrusions 13128. Referring now to FIG. 335, a staple cartridge can have, for example, a tissue thickness compensator 13320 and a coating or top layer 13322. For example, the coating 13320 can have a thick portion 13329 that can extend downward into the upper surface 13321 of the tissue thickness compensator 13320. In various situations, as shown in FIG. 335, this thick portion 13329 can be configured to receive at least a portion of the staple legs 13032 of the staple 13030 when the staple 13030 is in the unfired position. In such a case, the thick portion 13329 can hold the staple legs 13032 in place so that the legs 13032 are aligned with the anvil staple forming pockets positioned opposite the tissue thickness compensator 13320, or It can be at least approximately aligned. Referring now to FIG. 336, a staple cartridge can have a tissue thickness compensator 13420 and a coating or top layer 13422, for example. The coating 13422 may have a thick portion 13429 that can extend upward into the upper surface 13421 of the tissue thickness compensator 13420. In various circumstances, as shown in FIG. 336, this thick portion 13429 can be configured to receive at least a portion of the staple legs 13032 of the staple 13030 when the staple 13030 is in the unfired position. In such a case, the thick portion 13429 can hold the staple legs 13032 in place so that the legs 13032 are aligned with the anvil staple forming pockets positioned opposite the tissue thickness compensator 13420, or It can be at least approximately aligned.

  Referring now to FIGS. 339 and 340, the staple cartridge can include, for example, a tissue thickness compensator 13720 and a coating (or upper layer) 13721. For example, the tissue thickness compensator 13720 may have a pyramidal and / or stepped ridge, protrusion and / or protrusion 13728, for example, which may extend upward from the upper surface 13721 of the tissue thickness compensator 13720. The protrusion 13728 can be configured to receive and wrap the tip of the staple leg 13032 of the staple 13030 when the staple 13030 is in the unfired position, as shown in FIG. 340. Similarly, the upper layer 13721 may have pyramidal and / or stepped ridges, protrusions and / or protrusions 13729, which may be aligned with, or at least substantially aligned with, the protrusions 13728. The covering 13721 further includes one or more teeth 13727 extending upwardly from the protrusion 13729, which engages tissue disposed against the upper layer 13721 and includes tissue, upper layer 13721, And / or may be configured to prevent or at least limit relative lateral and / or longitudinal movement between the tips of the staple legs 13032. In use, the staple legs 13032 can penetrate the protrusions 13728 and 13729 and emerge from the tissue thickness compensator 13720 as the staple 13030 moves from the unfired position to the fired position. Referring now to FIGS. 341 and 342, the staple cartridge can include, for example, a tissue thickness compensator 13820 and a coating (or upper layer) 13821. For example, the tissue thickness compensator 13820 may have pyramidal and / or stepped ridges, protrusions and / or protrusions 13828, which, for example, can extend upward from the upper surface 13821 of the tissue thickness compensator 13820. The protrusions 13828 can be configured to receive and wrap the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in the unfired position, as shown in FIG. Similarly, the upper layer 13821 may have pyramidal and / or stepped ridges, protrusions and / or protrusions 13829, which may be aligned with, or at least substantially aligned with, the protrusions 13828. The upper layer 13821 may further include one or more teeth 13827 that extend downward into the tissue thickness compensator 13820, which may be, for example, a relative relationship between the upper layer 13821 and the tissue thickness compensator 13820. It can be configured to prevent or at least restrict lateral and / or longitudinal movement. In use, the staple legs 10032 can penetrate the protrusions 13828 and 13829 and emerge from the tissue thickness compensator 13820 as the staple 13030 moves from the unfired position to the fired position.

  Referring now to FIG. 343, the staple cartridge may have a tissue thickness compensator (eg, tissue thickness compensator 13920) that includes peaks 13923 and valleys 13924 defined therein, where the valleys 13924 are peaks. 13923 can be defined. Depending on needs, each peak 13923 can have the same height, approximately the same height, or different heights. Similarly, each valley 13924 may have the same depth, approximately the same depth, or different depths. In accordance with the present invention, a plurality of staples 13030 may be at least partially stored in the tissue thickness compensator 13920 so that the tips of the staples 13030 are disposed in the ridge 13923. For example, when the staple 13030 is stored in an unfired position, the staple leg 13032 of the staple 13030 is attached to the tissue thickness compensator 13920 and / or the tissue thickness compensator 13920 (or upper layer). It does not protrude from 13921. The peaks 13923 and / or valleys 13924 can extend in the transverse direction of the staple cartridge. For example, the staple cartridge may have a longitudinal knife slot, and the peaks 13923 and valleys 13924 may extend transversely and / or perpendicular to the knife slot. In various situations, the ridge 13923 can be configured to hold the tip of the staple leg 13032 in place until the staple 13030 moves from the unfired position to the fired position. Referring now to FIG. 344, the tissue thickness compensator and / or the coating covering the tissue thickness compensator can include longitudinal peaks and / or valleys. For example, the tissue thickness compensator can include an upper surface defined by peaks 14023 and valleys 14024, which can be defined between peaks 14023, for example. The tissue thickness compensator may have a coating 14021 that may include a plurality of openings 14029 defined therein that may each be configured to receive staple legs 13032. An opening 14029 can be defined in the ridge 14023, and the tips of the staple legs 13032 are located below the vertex 14028 of the ridge 14029, are flush with the vertex 14028, and / or above the vertex 14028. Can be arranged. In addition to or in lieu of the above, the opening 14029 can be defined in a valley 14024, for example. Each opening may be surrounded by an embossment or at least partially surrounded by an embossment to reinforce the covering and / or tissue thickness compensator surrounding the opening. In any case, in addition to the above, the coating 14021 can be attached to the tissue thickness compensator by any suitable method including, for example, at least one adhesive.

  As described above, referring again to FIG. 233, the surgical stapling instrument may have an anvil (eg, anvil 10060), which is, for example, tissue T relative to tissue thickness compensator 10020 of staple cartridge 10000. Can be moved between an open position and a closed position. In various situations, the anvil 10060 rotates toward the staple cartridge 10000 until downward movement is stopped by any portion of the staple cartridge 10000 and / or any portion of the groove member in which the staple cartridge 10000 is disposed. can do. In at least one such situation, the anvil 10060 may face downward until the downward movement is resisted by the nose 10003 of the staple cartridge 10000 and / or the tissue T located between the nose 10003 and the staple cartridge 10000. Can rotate. In certain circumstances, the anvil 10060 may sufficiently compress the tissue thickness compensator 10020 so that the tissue T can contact the tips of the staples 10030. In certain circumstances, depending on the thickness of the tissue T, the anvil 10060 can fully compress the tissue thickness compensator 10020 so that the anvil 10060 can be stapled by the time the anvil 10060 reaches the fully closed position. Contact with 10030. In other words, in such a situation, the anvil 10060 may deform the staple 10030 before the firing member 10052 is advanced through the staple cartridge 10000 to fire the staple 10030. Such a situation may be acceptable in certain cases. However, referring now to FIGS. 358 and 359, in an alternative, an anvil 10060 is closed before the firing bar 10052 is advanced through the staple cartridge 10000 using a distal clearance setting element (eg, element 10059). It is envisioned to be able to limit the distance that can be. Element 10059 may extend upward from the upper surface 10021 of tissue thickness compensator 10020 so that when tissue T is compressed against element 10059 and resistance is created therebetween, anvil 10060 Can stop downward movement. In use, as described above, the firing member 10052 can be advanced distally through the staple cartridge 10000 toward the distal end 10002 of the staple cartridge 10000, thereby moving the staple 10030 from the support portion 10010. Let it fire. At the same time, the firing member 10052 can engage the anvil 10060 and the anvil 10060 can be placed over the staple 10030 to be molded at a desired distance from the deck surface 10011 (FIG. 218) of the support portion 10010. In this manner, the firing member 10052 can control the distance or gap between the tissue contacting surface of the anvil 10060 and the deck surface 10011 at a particular position, which is determined by the firing member 10052 in the distal direction. Can be advanced in the distal direction as it is advanced. In various situations, this gap distance may be shorter than the gap between the anvil 10060 and the deck surface 10011 controlled or defined at the distal end by the gap setting element 10059 at the distal end of the tissue thickness compensator 10020. There is. Referring now to FIG. 359, the knife edge 10053 of the firing member 10052 is configured to traverse the distal end clearance setting element 10059 when the firing member 10052 reaches the distal end of the tissue thickness compensator 10020. After the element 10059 has traversed, the firing member 10052 pulls the anvil 10060 downward toward the support portion 10010 to the desired gap height when firing the staple 10030 at the distal end of the staple cartridge 10000. Close this gap. Alternatively, the distal end gap setting element can be configured to collapse as the firing member approaches the distal end of the staple cartridge. For example, the distal end gap setting element may include a post that may provide resistance to the anvil as described above, such that the firing member approaches the distal end of the staple cartridge so that the gap setting element When the buckling strength is reached, it can suddenly buckle. This buckling force can be, for example, about 44 N (10 lbf). The gap setting element can be configured to fall downward into the deck of the support portion when, for example, a force exceeding a predetermined amount is applied to the gap setting element. The distal end gap can be controlled by the nose of the staple cartridge. For example, the downward movement of the anvil 10060 is controlled by the nose until the firing member reaches the distal end of the cartridge, and when the firing member reaches the distal end of the cartridge, the nose is compressed by the compressive force applied to the nose. Can be crushed. The nose may have a cavity defined by a cavity wall, which allows the cavity to collapse when the applied compressive force exceeds a predetermined force. For example, the cavity can be defined by a collapsible wall.

  Optionally, as described above, an anvil (eg, anvil 10060) moves between an open position and a closed position to compress the tissue thickness compensator between the anvil and the support portion of the staple cartridge. be able to. In certain circumstances, referring now to FIGS. 360 and 361, the tissue thickness compensator of the staple cartridge (eg, the tissue thickness compensator 14120 of the staple cartridge 14100) is the support thickness 14110 of the staple cartridge 14100. When compressed against, it can expand laterally and / or longitudinally. The ends and / or sides of the tissue thickness compensator 14120 are not constrained by the support portion 14110 and / or the anvil 10060 so that the tissue thickness compensator 14120 generates a compression pressure within the tissue thickness compensator 14120. Can be expanded in these directions without, or at least without generating undesired compression pressures. In such cases, the firing member (eg, firing member 10052 (FIG. 236)) that passes through the tissue thickness compensator 14120 is not overly disturbed by, for example, undesirable compression pressure within the tissue thickness compensator 14120. . Alternatively, referring again to FIG. 360, the distal end 14125 of the tissue thickness compensator 14120 can be constrained, for example, by the nose 14103 of the staple cartridge 14100. In this particular embodiment, as described above, the distal end 14125 of the tissue thickness compensator 14120 is constrained by the nose 14103 to reduce the likelihood that the tissue thickness compensator 14120 will disengage from the support portion 14110 early. Can do. In either case, the above results can result in a large internal pressure in the distal end 14125, which can prevent the firing member 10052 from advancing, particularly when the firing member 10052 reaches the distal end 14125. More particularly, in certain circumstances, firing member 10052 may push, scrape, and / or displace distally tissue thickness compensator 14120 as it traverses tissue thickness compensator 14120, and as a result. Even greater internal pressure can occur within the distal end 14125 of the tissue thickness compensator 14120. To at least partially distribute this pressure within the tissue thickness compensator 14120, the nose 14103 can be composed of a flexible material so that the nose 14103 can be bent, for example, distally, Additional space can be created for the thickness compensator 14120. Referring now to FIGS. 362 and 363, the nose of the staple cartridge can include a portion that can slide in the distal direction. More particularly, the nose 14203 of the staple cartridge 14200 may have a slidable portion 14204 that may be slidably coupled to the nose 14203 such that the anvil 10060 is closed and / or the firing member 10052 is moved. When advanced to the distal end 14200 of the staple cartridge, the slidable portion 14204 slides in the distal direction, creating additional room for the tissue thickness compensator 14200, and at least partially reducing the internal pressure therein. Can be relaxed. Either one of the nose 14203 and the slidable portion 14204 may have one or more rails, and the other of the nose 14203 and the slidable portion 14204 slidably receives the rail. One or more groove members may be included. For example, the groove member and the rail can be configured to cooperatively limit movement of the slidable portion 14204, for example, to a longitudinal distal path.

  In various circumstances, in addition to the above, certain staples, such as the most distal staple in the staple cartridge, capture a larger portion of the tissue thickness compensator than the proximal staple in the staple cartridge. Yes. In such a situation, the result is that a greater clamping pressure can be applied to the captured tissue in the distal staple as compared to the proximal staple. Such a situation can occur when, as described above, at least a portion of the tissue thickness compensator is distal during use, even though the tissue thickness compensator is composed of a substantially homogeneous material having a substantially uniform thickness. This can happen if they are shifted to the side and / or gathered distally. In various situations, it may be desirable for certain staples to exert a higher clamping pressure on the tissue than other staples, and the support portion and / or tissue thickness compensator may determine which staples are against the tissue. And can be constructed and arranged to control which higher clamping pressures can be applied and which staples can apply lower clamping pressures to the tissue. Referring now to FIG. 364, the staple cartridge 14300 can include a support portion 14310 and, in addition, a tissue thickness compensator 14320 disposed on the deck surface 14311 of the support portion 14310. Compared to other embodiments disclosed in this application, including a support portion 14310 having a flat or at least substantially flat deck surface, the deck surface 14311 is proximal to the distal end 14305 of the support portion 14310. There may be an upward slope and / or a downward slope with respect to the end 14306. The deck surface 14311 of the support portion 14310 can have a deck height at the distal end 14305 that is lower than the deck height at the proximal end 14306. For example, the staple 10030 at the distal end 14300 of the staple cartridge may extend a greater distance away from the deck surface 14311 than the staple 10030 at the proximal end. Alternatively, the deck surface of the support portion may have a distal end height that is higher than the proximal end height. Referring again to FIG. 364, the tissue thickness compensator 14320 can have different thicknesses along its longitudinal length. Tissue thickness compensator 14320 can include a thickness at distal end 14325 that is greater than a thickness at proximal end 14326, for example. For example, the tissue thickness compensator 14322 can include a lower surface 14322 that can be uphill or downhill to match, or at least approximately, the uphill or downhill deck surface 14311 of the support portion 14310. As a result, the upper (or tissue contacting) surface 14321 of the tissue thickness compensator 14320 can include a surface on which the tissue T can be placed that is flat, or at least substantially flat. In either case, if the tissue thickness compensator 14320 is thicker at the distal end 14325, the distal staple 10030 can capture a larger portion of the tissue thickness compensator 14320 internally than the proximal staple 10030. As a result, the distal staple 10030 is tissue, particularly when the gap distance between the anvil 10060 and the deck surface 14311 is constant, or at least substantially constant, at the proximal and distal ends of the staple cartridge. A larger compressive force can be applied to T. However, in certain circumstances, the anvil 10060 may not reach a fully closed position, so that the clearance distance between the anvil 10060 and the deck surface 14311 is more distal than the proximal end of the staple cartridge 14300. Can be larger. In various situations, the distal staple 10030 may not be fully formed, so that the distal staple 10030 may not be able to apply the desired clamping pressure to the tissue T. If the tissue thickness compensator is thickened at the distal end of the staple cartridge, the tissue thickness compensator can compensate for underforming of the staples and apply sufficient pressure to the tissue T.

  Referring now to FIG. 365, a staple cartridge (eg, staple cartridge 14400) can include a support portion 14410 and, in addition, a tissue thickness compensator 14420 disposed on the deck surface 14411 of the support portion 14410. Similar to above, the deck surface 14411 may be uphill and / or downhill so that, for example, the distal end 14405 of the support portion 14410 is lower than the deck height at the proximal end 14406. Can be included. The tissue thickness compensator 14420 may have a uniform, or at least substantially uniform thickness along its length so that the upper (or tissue contacting) surface 14421 of the tissue thickness compensator 14420 is a deck surface 14411. Parallel to, or at least substantially parallel to Staples 10030 of staple cartridge 14400 can be fully embedded within tissue thickness compensator 14420 and support portion 14410 when staples 10030 are in an unfired position. Staple 10030 located at the proximal end of staple cartridge 14400 may be fully embedded within tissue thickness compensator 14420 and support portion 14410 when staple 10030 is in the unfired position, while Due to the descending slope of the deck 14411 and the upper surface 14421, the tip of a particular staple 10030 (including the staple 10030 at the distal end 14400 of the staple cartridge) is tissue thickness compensator 14420 when the staple 10030 is in the unfired position. Can protrude through the upper surface 14421.

  Optionally, as described above, the tissue thickness compensator is composed of a single material, and the entire tissue thickness compensator is the same, or at least approximately the same, eg, density, stiffness, spring constant, durometer, and / or It may have material properties such as elasticity throughout. Alternatively, referring now to FIG. 368, a tissue thickness compensator (eg, tissue thickness compensator 14520) can include multiple materials or layers of materials. A tissue thickness compensator 14520 is attached to each of the first (center) layer 14520a, the second (intermediate) layer 14520b attached to the opposing surface of the first layer 14520a, and each second layer 14520b. A third (outer) layer 14520c. The intermediate layer 14520b can be attached to the central layer 14520a using at least one adhesive, and similarly, the outer layer 14520c can be attached to the second layer 14520 using at least one adhesive. . In addition to or instead of the adhesive, the layers 14520a-14520c can be held together, for example, by one or more interengages and / or fasteners. In any case, the inner layer 14520a can be composed of a first material having a first group of material properties, and the intermediate layer 14520b can be composed of a second material having a second group of material properties. And the outer layer 14520c can be comprised of a third material having a third group of material properties. These material property groups can include, for example, density, stiffness, spring constant, durometer, and / or elasticity. The staple cartridge may have, for example, six rows of staples 10030, and the rows of staples 10030 may be at least partially disposed at least, for example, in each outer layer 14520c and each intermediate layer 14520b. 10030 can be at least partially disposed on the inner layer 14520a. In use, similar to the above, the staple 10030 can be fired from the staple cartridge. The staple legs 10032 of the staple 10030 can penetrate the upper surface 14521 of the tissue thickness compensator 14520 and through the tissue disposed against the upper surface 14521 by the anvil, and then contact the anvil to contact the leg 10032. Can be deformed to capture tissue thickness compensator 14520 and tissue within staple 10030. Also as described above, the firing member may traverse the tissue thickness compensator 14520 as it is advanced through the staple cartridge. For example, the firing member can traverse, for example, the inner layer 14520a and the tissue along the path defined by the axis 14529.

  Further to the above, the row of staples 10030 disposed within the inner layer 14520a may include the staple row closest to the end of the traversed tissue. Correspondingly, the row of staples 10030 disposed in the outer layer 14520c may include the staple row furthest from the end of the traversed tissue. For example, the first material that includes the inner layer 14520a may have a higher density than the density of the second material that includes the intermediate layer 14520b, and similarly, the density of the second material includes the outer layer 14520c. It may be higher than the density of the third material. In various circumstances, the resulting compression force is greater in the staple 10030 disposed in the inner layer 14520a than in the staple 10030 disposed in the intermediate layer 14520b and the outer layer 14520c. Can occur. Similarly, for example, a greater compressive force can be generated in the staples 10030 disposed in the intermediate layer 14520b than in the staples 10030 disposed in the outer layer 14520c. Alternatively, for example, the first material that includes the inner layer 14520a may have a density that is lower than the density of the second material that includes the intermediate layer 14520b, and similarly, the density of the second material may be the outer layer 14520c. It may be lower than the density of the third material containing. In various circumstances, the resulting compression force is greater in the staples 10030 disposed in the outer layer 14520c than in the staples 10030 disposed in the intermediate layer 14520b and the inner layer 14520a. Can occur. Similarly, for example, a greater compressive force can be generated in the staple 10030 disposed in the intermediate layer 14520b than in a staple force generated in the staple 10030 disposed in the inner layer 14520a. Alternatively, any other suitable layer, material, and / or material property can be utilized. In either case, the layers 14520a-14520c of the tissue thickness compensator 14520 can be configured to remain attached to each other after implantation. The layers 14520a-14520c of the tissue thickness compensator 14520 can be configured to be separated from each other after being implanted. For example, layers 14520a-14520c can be joined together utilizing one or more bioabsorbable adhesives, which can initially hold the layers together, and the layers release each other over time. Can be done.

  As described above, a tissue thickness compensator (eg, tissue thickness compensator 14520) of a staple cartridge can include a plurality of longitudinal layers. Alternatively, referring now to FIG. 369, a staple cartridge may have a tissue thickness compensator (eg, tissue thickness compensator 14620), which may include a plurality of horizontal layers. For example, the tissue thickness compensator 14620 includes a first (lower) layer 14620a, a second (middle) layer 14620b attached to the lower layer 14620a, and a third (upper) layer 14620c attached to the intermediate layer 14620b. May be included. The first layer 14620a can include, for example, a flat or substantially flat lower surface 14626a and a triangular or pyramidal upper surface 14625a. For example, the second layer 14620b may have a triangular or pyramidal lower surface 14626b that can be configured to be parallel to and in contact with the upper surface 14625a of the first layer 14620a. As above, the second layer 14620b may have a triangular or pyramidal upper surface 14625b, which may be parallel to and in contact with the triangular or pyramidal lower surface 14626c of the third layer 14620c, for example. . The upper surface 14626c of the third layer can include a tissue contacting surface 14621 that is flat, or at least substantially flat. Also as described above, the tissue thickness compensator 14620 can be configured to at least partially store six rows of staples (eg, staples 10030) therein, and the firing member extends, for example, through the shaft 14629. A tissue thickness compensator 14620 between the innermost two rows of staples along the path can be traversed. As above, each layer 14620a, 14620b, and 14620c can be composed of different materials that can have different material properties, resulting in the triangular or pyramidal shape of the layers 14620a-14620c resulting in the tissue thickness compensator 14620 being internal. Can have different characteristics throughout. For example, the outermost row of staples 10030 can capture more third layers 14620c than the first layer 14620a therein, while the innermost rows of staples 10030 than the first layer 14620a. Fewer third layers 14620c can be captured, so that the tissue thickness compensator 14620, for example, the tissue thickness compensator 14620, although the overall thickness is the same or at least approximately the same The tissue captured in the outermost staple 10030 can be compressed to a different extent than the tissue captured in the innermost staple 10030.

  Referring now to FIG. 286, the tissue thickness compensator of the staple cartridge (eg, the tissue thickness compensator 14720 of the staple cartridge 14700) can be, for example, a space, pocket, groove member, and / or defined within itself. There may be grooves, which may change the thickness of the tissue thickness compensator 14720. For example, the tissue thickness compensator 14720 can be positioned against the deck surface 14711 of the support portion 14710 of the staple cartridge 14700 so that the space 14723 defined in the lower surface 14722 of the tissue thickness compensator 14720 is , May overlap a particular staple cavity 10012 but not overlap elsewhere. The space 14723 may extend, for example, across the knife slot 14715 of the support portion 14710, perpendicular to the knife slot 14715, and / or parallel to the knife slot 14715. The space 14723 may define a tread pattern in the lower surface 14722 of the tissue thickness compensator 14720. In either case, when a staple (eg, staple 10030) is deployed from the support portion 14710, referring now to FIGS. 287 and 288, the particular staple 10030 has a tissue thickness compensator 14720 in the region that includes the space 14723. While other staples 10030 may capture tissue thickness compensator 14720 in an area located midway through space 14723. In addition to or in lieu of the above, the tissue thickness compensator 14720 can include, for example, a space, pocket, groove member, and / or groove defined in the upper (tissue contact) surface 14721. Referring now to FIGS. 366 and 367, the staple cartridge 14800 may include a tissue thickness compensator 14820, which is directed upwardly from the upper surface 14821 of the tissue thickness compensator 14820 and inward toward the central groove 14825. A plurality of treads 14823 may be included that extend in at least one of the directions and / or distal directions toward the distal end 14800 of the staple cartridge. For example, the tread 14823 can be separated by groove members, slots, and / or grooves (eg, groove member 14824). In various circumstances, as a result of the above, the overall thickness of the tissue thickness compensator may vary between staple rows and / or may vary between staples within a staple row. In certain circumstances, the tread (or thicker portion) can be constructed and positioned to flow in a desired direction (eg, inward direction) when the tissue thickness compensator is compressed.

  Referring now to FIG. 303, a staple cartridge (eg, staple cartridge 14900) can include a support portion 14910 and, in addition, a tissue thickness compensator 14920 disposed relative to the support portion 14910. As above, the support portion 14910 lifts staples (eg, staples 10030) disposed at least partially within the support portion 14910 toward an anvil (eg, anvil 10060) disposed opposite the staple cartridge 14900. Can include a staple driver that can be lifted up by a staple deployment sled. The support portion 14910 has, for example, six rows of staple cavities (eg, two outer rows of staple cavities, two inner rows of staple cavities, and two middle rows of staple cavities arranged between the inner and outer rows). The anvil 10060 may include six rows of molding pockets 10062 aligned with, or at least approximately aligned with, the staple cavities. The inner rows of staple cavities may include staple drivers 14940a disposed therein, and the intermediate rows of staple cavities may include staple drivers 14940b disposed therein, outside the staple cavities. The rows may include staple drivers 14940c disposed therein, each of the staple drivers 14940a having a cradle 14949a configured to support the staples 10030, and each of the staple drivers 14940b being staples. A cradle 14949b configured to support 10030 may be included, and the staple drivers 14940c may each include a cradle 14949c configured to support the staple 10030. In the unfired position, i.e., when the staple drivers 14940a-14940c are on the driver support pedestal 14926 extending below the support portion 14910, the cradle 14949a of the staple driver 14940a is cradle 14949b and the staple driver 14940c of the staple driver 14940b. Can be placed closer to the anvil 10060 than the cradle 14949c. In such a position, a first molding distance can be defined between the cradle 14949a and a molding pocket 10062 disposed on the cradle 14949a, and a second molding distance can be defined as the cradle 14949b. And a molding pocket 10062 disposed on the cradle 14949b, a third molding distance can be defined between the cradle 14949c and the molding pocket 10062 disposed on the cradle 14949c. For example, the first forming distance may be shorter than the second forming distance, and the second forming distance may be shorter than the third forming distance. As the staple drivers 14940a-14940c move from their unfired position (FIG. 303) to their fired positions, each staple driver 14940a-14940c is equidistant, or at least approximately equidistant, toward the anvil 10060 by a staple deployment thread, The first driver 14940a can drive each staple 10030 to a first forming height, and the second driver 14940b can move each staple 10030 to a second forming height. And the third driver 14940c drives each staple 10030 to a third forming height, for example, the first forming height may be less than the second forming height, and the second forming height The height may be shorter than the third molding height. Various alternatives are envisaged, with the first staple driver 14940a moving up a first distance, the second staple driver 14940b moving up a second distance, and the third staple driver 14940c being the first. Move up three distances, and one or more of the first distance, the second distance, and the third distance may be different.

  Referring again to FIG. 303, the deck surface 14911 of the support portion 14910 can vary in height relative to the tissue contacting surface 10061 of the anvil 10060. This height variation may occur laterally, for example, the height of the deck surface 14911 surrounding the inner row staple cavities may be higher than the height of the deck surface 14911 surrounding the outer row staple cavities. The lower surface 14922 of the tissue thickness compensator 14920 can be configured to be parallel or at least substantially parallel to the deck surface 14911 of the support portion 14910. Further to the above, the thickness of the tissue thickness compensator 14920 can also vary, and the upper (tissue contact) surface 14921 of the tissue thickness compensator 14920 can be inclined inwardly from its outer edge. For example, as a result of the above, the tissue thickness compensator 14920 can be, for example, thin in the region disposed over the inner row of staple cavities and thicker in the region disposed over the outer row of staple cavities. Referring now to FIG. 304, the deck surface of the support portion 15010 can have, for example, a stepped deck surface, for example, the highest step of the stepped surface can surround the inner row of staple cavities; The lowest step of the stepped surface can surround the outer row of staple cavities. For example, a step having an intermediate height can surround an intermediate row of staple cavities. A tissue thickness compensator (eg, tissue thickness compensator 15020) may be parallel to and in contact with the deck surface of the support portion 15010. The upper (tissue contact) surface 15021 of the tissue thickness compensator may have an arcuate, parabolic, and / or curved surface, such as an axis aligned with, or at least substantially aligned with, the staple cartridge 15000. In addition, the tissue thickness compensator 15020 may extend from the first outer side surface to the tissue thickness compensator 15020 second outer side surface. Referring now to FIG. 299, the staple cartridge 15300 includes, for example, a support portion 15310, a plurality of staple drivers 15340 movably disposed within staple cavities defined in the support portion 15310, and the support portion 15310. And a tissue thickness compensator 15320 disposed above the deck surface 15311. The staple cartridge 15300 may further include one or more lower dished portions 15326 that are attached to the support portion 15310 and extend around the underside of the support portion 15310 and are in an unfired position. Drivers 15340 and staples 15330 can be supported. As the staple deployment sled advances through the staple cartridge, the sled can also be supported by the lower dish 15326 as the sled lifts the staple driver 15340 and staple 15330 up through the tissue thickness compensator 15320. The tissue thickness compensator 15320 includes a first (inner) portion 15322a disposed over the inner row of staple cavities, a second (intermediate) portion 15322b disposed over the intermediate row of staple cavities, and an outer row. A third (outer) portion 15322c disposed above the staple cavities, for example, the inner portion 15322a may be thicker than the intermediate portion 15322b, and the intermediate portion 15322b may be thicker than the outer portion 15322c. The tissue thickness compensator 15320 may have, for example, a longitudinal groove member defined therein, which may form the thinner portions 15322b and 15322c of the tissue thickness compensator 15320. Alternatively, the longitudinal groove member can be defined in the upper surface and / or the lower surface of the tissue thickness compensator. The upper surface 15321 of the tissue thickness compensator 15320 can include, for example, a flat or at least substantially flat surface.

  Referring now to FIG. 296, the staple cartridge may have a tissue thickness compensator (eg, tissue thickness compensator 15120), which may include multiple portions having different thicknesses. The tissue thickness compensator 15120 may have a first (inner) portion 15122a that may have a first thickness and a second (intermediate) portion that may each have a second thickness and extend from the first portion 15122a. Portion 15122b and each may have a third thickness and may include a third (intermediate) portion 15122c extending from the second portion 15122b. For example, the third thickness may be greater than the second thickness and the second thickness may be greater than the first thickness, but any suitable thickness can be used. The portions 15122a-15122c of the tissue thickness compensator 15120 can include steps having different thicknesses. Similar to the above, the staple cartridge can include several rows of staples 10030 and a plurality of staple drivers having different heights that can deform the staples 10030 to different molding heights. Also, as described above, the staple cartridge is supported on itself, with a first staple driver 15140a capable of driving the staple 10030 supported on itself to a first forming height. A second staple driver 15140b capable of driving the staple 10030 to a second forming height and a third capable of driving the staple 10030 supported on itself to a third forming height. For example, the first molding height may be shorter than the second molding height, and the second molding height may be shorter than the third molding height. If desired, as shown in FIG. 296, each staple 10030 may include the same or approximately the same unfired or fired height. Alternatively, referring now to FIG. 296A, the first driver 15140a, the second driver 15140b, and / or the third driver 15140c may support staples having different unformed heights. For example, the first staple driver 15140a can support staples 15130a having a first unformed height, and the second staple driver 15140b can support staples 15130b having a second unformed height. The third staple driver 15140c can support a staple 15130c having a third unformed height, for example, the first unformed height can be shorter than the second unformed height, The unformed height may be shorter than the third unformed height. Referring again to FIG. 296A, the tips of the staples 15130a, 15130b, and / or 15130c may be in the same plane, or at least approximately in the same plane, while in the alternative, the staples 15130a, 15130b, and / or 15130c. The tips may not be in the same plane. Referring now to FIG. 297, as described above, the staple cartridge includes a tissue thickness compensator 15220 having a plurality of portions having different thicknesses that can be embedded in the tissue T by staples 15130a, 15130b, and / or 15130c. Can be included. Referring now to FIG. 298, the staples 15130a, 15130b, and / or 15130c can be deformed to different forming heights, the first staple 15130a is deformed to a first forming height, and the second The staple 15130b is deformed to the second molding height, and the third staple 15130c is deformed to the third molding height. For example, the first molding height may be shorter than the second molding height, The molding height may be shorter than the third molding height. Alternatives are envisioned, and staples 15130a, 15130b, and 15130c can be molded to any suitable forming height and / or any relative forming height.

  If desired, as described above, the anvil of the surgical stapling instrument can move between an open position and a closed position. In such a situation, the tissue contacting surface of the anvil can be moved to its final (molded) position as the anvil moves to the closed position. Once the anvil is in the closed position, the tissue contacting surface can no longer be adjusted. Alternatively, referring now to FIG. 351, a surgical stapler (eg, surgical stapler 15500) includes an anvil groove member 15560 and an adjustable tissue contact anvil adjustment plate 15561 disposed within the anvil groove member 15560; Can be included. In such a case, the anvil plate 15561 can be raised and lowered within the anvil groove member 15560 to adjust the position of the tissue contacting surface of the anvil plate 15561 relative to the staple cartridge disposed opposite the anvil plate 15561. it can. Surgical stapler 15500 may have an adjustment slide 15564, which, with reference to FIGS. 356 and 357, to control the distance between the anvil plate 15561 and the staple cartridge, the anvil groove member 15560 and the anvil plate. It can slide in the middle of 15561. Referring again to FIGS. 351 and 352, the surgical stapler 15500 may further include an actuator 15562 coupled to the adjustment slide 15564, which is proximal to slide the adjustment slide 15564 proximally. And / or can be slid distally to slide the adjustment slide 15564 distally. Referring again to FIGS. 356 and 357, the actuator 15562 can be slid between two or more predefined positions to adjust the anvil plate 15561 between two or more respective positions. Such a defined location can be marked as a landmark 15563 (FIG. 351) on the surgical stapler 15500, for example. Referring to FIG. 357, the adjustment slide 15564 may have a plurality of support surfaces (eg, a first support surface 15565a, a second support surface 15565b, and a third support surface 15565c), which may be an anvil plate. A plurality of plate placement surfaces (eg, a first placement surface 15569a, a second placement surface 15569b, and a third placement surface 15569c) on the back side of the anvil plate 15561 to place the 15561 in the first placement; Each can be aligned. To place the anvil plate 15561 in the second configuration, for example, to realign the support surfaces 15565a-15565c of the slide 15564 with respect to the placement surfaces 15569a-15569c of the anvil plate 15561, the actuator 15562 and the slide 15564 are Can be slid proximally. More particularly, referring to FIG. 356, the slide 15564 can be slid distally, thereby moving the first support surface 15565a of the slide 15564 closer to the staple cartridge. , The second placement surface 15569b of the anvil plate 15561 can be placed beyond the second placement surface 15569b, and the second support surface 15565b of the slide 15564 is placed over the third placement surface 15569c of the anvil plate 15561. be able to. In such a situation, when the anvil plate 15561 is moved from the first configuration to the second configuration, the adjustable anvil plate 15561 removes the tissue T disposed between the anvil plate 15561 and the staple cartridge. Further compression is possible. In addition to the above, the anvil plate 15561 is adjusted so that the molding pockets defined in the anvil plate 15561 move toward and / or away from the staple cartridge so that the molding height of the staples is adjusted relative to the staple cartridge. It can be controlled by the position of 15561. Although only two positions have been discussed above, the slide 15564 can be slid to a suitable number of positions to move the anvil plate 15561 closer to and / or away from the staple cartridge. In either case, once the anvil plate 15561 is properly positioned, the staple deployment sled 15550 can be slid distally within the staple cartridge, thereby providing an anvil plate 15561 as shown in FIG. The staple driver 15540 and staple 15530 can be lifted toward the tissue T to staple the tissue T. A similar surgical stapler is disclosed in US patent application Ser. No. 13 / 036,647 “SURGICAL STAPLING INSTRUMENT” (filed Feb. 28, 2011), the entire disclosure of which is incorporated herein by reference. Incorporate.

  Referring now to FIG. 353, the staple cartridge can be disposed within the staple cartridge groove member 15570 of the surgical stapler 15500, which can include a tissue thickness compensator (eg, tissue thickness compensator 15520). As the anvil plate 15561 moves toward the staple cartridge, as described above, the anvil plate 15561 compresses the tissue thickness compensator 15520 and / or the tissue T disposed between the anvil plate 15561 and the tissue thickness compensator 15520. can do. Once the staple 15530 is deployed from the staple cartridge, referring to FIG. If necessary, when the anvil plate 15561 is positioned relative to the slide 15564 and the tissue is not yet positioned between the anvil plate 15561 and the tissue thickness compensator 15520, the anvil plate 15561 is in the first configuration. A gap may be defined between the upper surface 15521 of the tissue thickness compensator 15520 and the anvil plate 15561. As the anvil plate 15561 is moved to the second configuration, the anvil plate 15561 may contact the tissue thickness compensator 15520. Alternatively, if the anvil plate 15561 is positioned relative to the slide 15564 and the tissue has not yet been positioned between the anvil plate 15561 and the tissue thickness compensator 15520, the anvil plate 15561 may be in the first configuration and / or the second A gap may be defined between the upper surface 15521 of the tissue thickness compensator 15520 and the anvil plate 15561 when in position. For example, the anvil plate 15561 cannot contact the tissue thickness compensator 15520. Alternatively, if the anvil plate 15561 is positioned relative to the slide 15564 and the tissue is not yet positioned between the anvil plate 15561 and the tissue thickness compensator 15520, for example, the anvil plate 15561 may be in the first configuration and / or the first Regardless of which of the two configurations, the anvil plate 15561 can contact the upper surface 15521 of the tissue thickness compensator 15520. Although only two positions of the anvil plate 15611 are described herein, the anvil plate 15611 can be placed in any suitable number of positions.

  If desired, as a result of the above, the surgical stapling instrument can have means for adjusting the forming height of the staples that can compensate for different tissue thicknesses in different situations. In addition, the surgical stapling instrument can include other means, for example, to compensate for different tissue thicknesses and / or thickness deviations within the tissue. For example, the anvil plate 15561 can be adjusted upward or away from the opposing staple cartridge to increase the formed (fired) height of the staples. Similarly, the anvil plate 15561 can be adjusted downward or closer to the opposing staple cartridge to reduce staple forming (fired) height. Adjustments to the anvil plate 15561 include, for example, a gap between the molding pocket defined in the anvil plate 15561 and the firing height of the staple driver, or more specifically, for example, the firing height of the staple driver cradle. Can be adjusted. For example, a tissue thickness compensator may further compensate for thicker and / or thinner tissue, even with such a function to adjust the forming height of the staples for thicker and / or thinner tissue. And / or can compensate for thickness deviations in the tissue, as described above. In such a case, the surgeon may be provided with several compensation means within the same surgical stapling instrument.

  As described above, a surgical stapling instrument can utilize a staple cartridge having a linear array of staple cavities and staples, and the firing member is advanced distally through the staple cartridge to remove staples from the staple cavities. Can be deployed. The staple cartridge can include staple cavities and rows of staples that are curved. Referring now to FIGS. 345 and 346, a surgical stapling instrument (eg, stapler 15600) includes one or more circular or annular staple cavity rows defined within a circular or annular support portion 15610. May be included. Such circular staple rows can include, for example, a circular row of inner staple cavities 15612 and a circular row of outer staple cavities 15613. For example, a circular row of staple cavities can surround a circular or annular opening 15615 defined in the stapler 15600, which can receive a circular or annular knife movably disposed therein. In use, tissue is placed against the deck surface 15611 of the support portion 15610 and an anvil (not shown) extends through the opening 15615 and / or to the surgical stapler 15600 via an actuator placed therein. Can be incorporated so that when the actuator is actuated, the anvil is clamped toward the support portion 15610 to compress the tissue against the deck surface 15611. When the tissue is fully compressed, the staples disposed within the staple cavities 15612 and 15613 are fired from the support portion 15610 and penetrate the tissue, thereby allowing the staples to contact the anvil and capture the tissue therein. It can be deformed enough to do. When the staples are fired and / or after the staples are fired, the circular knife is advanced to cut the tissue. Thereafter, the anvil can move away from the support portion 15610 and / or disengage from the surgical stapler 15600 so that the anvil and the surgical stapler 15600 can be removed from the surgical site. Such a surgical stapler 15600 and such a surgical technique can be utilized, for example, to join two parts of the large intestine. In various situations, circular staple rows can be configured to heal tissue while holding the large intestine portions together and at the same time elastically expand each portion of the large intestine. Similar surgical stapling instruments and surgical techniques are disclosed in US Pat. No. 5,285,945 “SURGICAL ANASTOMOSIS STAPLING INSTRUMENT” (issued February 15, 1994), the entire disclosure of which is hereby incorporated by reference. Is incorporated herein by reference.

  Further to the above, the tissue thickness compensator can be positioned and / or attached to, for example, the support portion 15610 of the surgical stapler 15600. The tissue thickness compensator can be composed of, for example, a circular or annular ring material including an inner diameter and an outer diameter. In certain circumstances, the tissue can be placed against this ring material, and when the anvil is used to move the tissue toward the support portion 15610, the tissue thickness compensator is placed between the tissue and the deck surface 15611. Can be compressed. In use, the staples can be fired through the tissue thickness compensator and tissue, which causes the staples to contact the anvil and deform to its fired position, and within the staples, a portion of the tissue and tissue thickness compensator. Can be captured. In various situations, in addition to the above, the ring material including the tissue thickness compensator must be sufficiently resilient so that the portion of the large intestine surrounding the staple row can expand. Referring again to FIGS. 345 and 346, the flexible tissue thickness compensator 15620 may comprise a circular or annular flexible inner ring 15624, for example, which defines a circular or annular opening 15625. Yes. Inner ring 15624 can be configured not to be captured within staples deployed from surgical stapler 15600. Rather, the inner ring 15624 can be disposed radially inward with respect to the inner row of staple cavities 15612. For example, the tissue thickness compensator 15620 may include a plurality of tags (eg, inner tag 15622 and outer tag 15623) extending from itself so that the tag is at least partially within the staple when the staple is deformed. Can be captured. More particularly, referring primarily to FIG. 345, each inner tag 15622 may have a head portion disposed over the staple cavities 15612 defined in the surgical stapler 15600, the head portions being For example, the neck 15626 can be attached to the inner ring 15624 and, similarly, each outer tag 15623 can have a head portion disposed over the staple cavities 15613 defined within the surgical stapler 15600. The head portion can be attached to the inner ring 15624 by a neck portion 156267, for example. The head portions of the inner tag 15622 and the outer tag 15623 can include any suitable shape, such as, for example, circular, oval, and / or elliptical. The necks 15626 and / or 15627 may also have any suitable shape, and the neck 15627 that connects the head of the outer tag 15623 to the inner ring 15624 is between adjacent inner staple cavities 15612 of the support portion 15610. The neck portion 15627 is not captured in staples deployed from the inner staple cavity 15612.

  Referring now to FIGS. 347 and 348, the flexible tissue thickness compensator 15720 can include a circular or annular flexible outer ring 15724, for example. Outer ring 15724 may be configured not to be captured within staples deployed from surgical stapler 15600. Rather, the outer ring 15724 can be disposed radially outward relative to the outer row of staple cavities 15613. For example, the tissue thickness compensator 15720 may have a plurality of tags (eg, inner tag 15622 and outer tag 15623) extending from itself so that the tag is at least partially disposed within the staple when the staple is deformed. Can be captured. More particularly, referring primarily to FIG. 347, each inner tag 15622 may have a head portion disposed over the staple cavities 15612 defined in the surgical stapler 15600, the head portions being For example, it can be attached to the outer ring 15724 by a neck 15726, and similarly each outer tag 15623 can have a head portion that is disposed over a staple cavity 15613 defined within the surgical stapler 15600. The head portion can be attached to the outer ring 15724 by a neck portion 15727, for example. The head portions of the inner tag 15622 and the outer tag 15623 can include any suitable shape, such as, for example, circular, oval, and / or elliptical. Neck portions 15726 and / or 15727 may also have any suitable shape such that neck portion 15726 that connects the head portion of inner tag 15622 to outer ring 15724 extends between adjacent outer staple cavities 15613. Can be configured so that the neck 15726 is not captured within the staple deployed from the outer staple cavity 15613. Alternatively, the tissue thickness compensator includes a circular or annular flexible inner ring, a circular or annular flexible outer ring, and in addition, a plurality of tags that can be coupled to the inner ring and / or outer ring. sell. Certain tags can be coupled to the inner ring and certain other tags can be coupled to the outer ring. At least some tags can be coupled to both the inner and outer rings. In any case, in addition to the above, the inner ring 15624 of the tissue thickness compensator 15620, the outer ring 15724 of the tissue thickness compensator 15720, and / or to address the expansion and / or contraction of the implanted tissue. Any other suitable tissue thickness compensator can be configured to elastically expand and / or contract. In addition, although various embodiments including circular or annular support rings are described herein, the tissue thickness compensator may include any suitable shaped support structure for connecting tags. Further to the above, a circular knife advanced by a surgical stapler to cut tissue captured between the anvil and the support portion can also cut the buttress material. The knife can separate the inner support ring and the tag, for example, by cutting the neck.

  Further to the above, the tissue thickness compensator may have a removable and / or relatively moveable portion that allows the tissue thickness compensator to handle movement of the implanted tissue. It can be configured to be able to expand and / or contract. Referring now to FIGS. 349 and 350, the circular or annular tissue thickness compensator 15820 is positioned against and / or supported by the deck surface 15611 of the surgical stapler 15600 and implanted into the tissue. This can be held in the unexpanded position (FIG. 349). After the tissue thickness compensator 15820 is implanted, the tissue thickness compensator 15820 can be configured to expand outwardly as shown in FIG. The tissue thickness compensator 15820 can include a plurality of arcuate portions 15822 that can be coupled together, for example, by an inner ring 15824. The arcuate portions 15822 can be separated from each other by seams 15828. Alternatively, arcuate portions 15822 can be coupled together, for example, arcuate portions 15822 can be separated from one another by placing perforations to separate them from one another. In any case, each arcuate portion 15822 may have an interengagement mechanism (eg, protrusion 15826 and notch 15823) that cooperates to form the arcuate portion before tissue thickness compensator 15820 is implanted. The relative movement between 15822 can be limited. Further to the above, each arcuate portion 15822 can be coupled to the inner ring 15824 with one or more connectors 15827, eg, configured to releasably hold the arcuate portion 15822 in place. can do. Referring primarily to FIG. 350, after the staple (eg, staple 10030) stored in the support portion 15610 has been utilized to embed the tissue thickness compensator 15620 into the tissue, the connector 15827 is removed from the inner ring 15824. Can be separated, thereby allowing tissue thickness compensator 15820 to at least partially expand to accommodate movement in the underlying tissue. In various situations, all of the arcuate portion 15822 can be removed from the inner ring 15824, while in other situations, only a portion of the arcuate portion 15822 can be removed from the inner ring 15824. Alternatively, the arcuate portions 15822 can be joined by flexible portions so that the arcuate portions 15822 can move relative to each other but are not separated from each other. For example, the flexible portion does not receive staples therein and can be configured to expand and contract to accommodate the relative movement of the arcuate portion 15822. In FIGS. 349 and 350, the tissue thickness compensator 15820 can include, for example, eight arcuate portions 15822. Alternatively, the tissue thickness compensator may have any suitable number of arcuate portions, and may include, for example, two or more arcuate portions.

  In addition to the above, tissue thickness compensators 15620, 15720, and / or 15820 may be used for thicker and / or thinner tissue, eg, captured between an anvil and support portion 15610 of surgical instrument 15600. , Can be configured to compensate. If desired, as described above, the formed (fired) height of the staple can be adjusted by moving the anvil closer and / or away from the support portion 15610. More specifically, the anvil can be moved closer to the support portion 15610 to reduce the forming height of the staple, while the anvil can be moved away from the support portion 15610 to increase the staple forming height. Can be increased. In such cases, as a result, the surgeon may adjust the anvil away from the support portion 15610 to accommodate thick tissue and adjust the anvil closer to the support portion 15610 to accommodate thin tissue. it can. In various other situations, the surgeon may decide not to adjust the anvil at all and to rely on the tissue thickness compensator to deal with thinner and / or thicker tissue. As a result, as a result, surgical instrument 15600 can include at least two methods for compensating for different tissue thicknesses and / or variations in tissue thickness.

  If desired, the tissue thickness compensator can be attached to the support portion of the staple cartridge, as described above. The lower surface of the tissue thickness compensator may have one of a hook layer or a loop layer, and the deck surface of the support portion may include the other of the hook layer or the loop layer. For example, the hook and loop layers can be configured to engage each other and releasably hold the tissue thickness compensator to the support portion. If desired, each hook may include, for example, an inflated head portion that extends from the neck portion. For example, multiple pads including loops can be bonded to the lower surface of the tissue thickness compensator, while multiple pads including hooks can be bonded to the deck surface of the support portion. The support portion may include, for example, one or more openings and / or recesses, which can include hooks and / or loops and can be configured to receive inserts therein. In addition to or in lieu of the above, a tissue thickness compensator can be removably attached to an anvil utilizing, for example, such hook and loop hook-and-loop arrangements. The hook and loop hook-and-loop fastener arrangement may include a fibrous surface.

  Optionally, as described above, the staple cartridge can include a support portion and a tissue thickness compensator attached to the support portion. As also described above, the support portion may have a longitudinal slot configured to receive a cutting member therein, and the tissue thickness compensator may be retained within the longitudinal slot. A member may be included. Referring now to FIG. 386, the staple cartridge 16000 can include a support portion 16010 that includes a deck surface 16011 and a longitudinal slot 16015. The staple cartridge 16000 can further include a tissue thickness compensator 16020 disposed above the deck surface 16011. The tissue thickness compensator 16020 may have a longitudinal retention member 16025 that extends downward and enters the longitudinal slot 16015. For example, the retention member 16025 can be press fit into the slot 16015 so that the interaction between the retention member 16025 and the slot 16015 causes relative movement between the support portion 16010 and the tissue thickness compensator 16020. Can resist. The body of the tissue thickness compensator 16020 can be composed of a first material and the retention member 16025 can be composed of a second or another material. The body of the tissue thickness compensator 16020 can be made of a material having a first durometer hardness, and the holding member 16025 can be made of a material having a second durometer hardness, for example, a second durometer. The hardness may be higher than the first durometer hardness. In use, the staple 10030 can be pushed up by the staple driver 10040 so that the tip of the staple 10030 penetrates the body of the tissue thickness compensator 16020 and emerges from the tissue contacting surface 16021, at least relative to the target tissue. Some tissue thickness compensators 16020 can be captured. In accordance with the present invention, a cutting member that passes through the slot 16015 can traverse the retaining member 16025 when the staple 10030 is deployed. Once the tissue thickness compensator 16020 is implanted, the retention member 16025 can be withdrawn from the slot 16015. The body of the tissue thickness compensator 16020 can be configured to separate from the retention member 16025.

  Referring now to FIGS. 387 and 389, the staple cartridge 17000 can include a support portion 17010 that includes a deck surface 17011 and a longitudinal slot 17015. The staple cartridge 17000 can further include a tissue thickness compensator 17020 disposed above the deck surface 17011. The tissue thickness compensator 17020 may have a longitudinal retention member 17025 that extends downward and enters the longitudinal slot 17015. For example, the retention member 17025 can be press fit into the slot 17015 such that the interaction between the retention member 17025 and the slot 17015 causes relative movement between the support portion 17010 and the tissue thickness compensator 17020. Can resist. The retaining member 17025 extends through the entire tissue thickness compensator 17020 toward the upper surface 17021, and the body portion 17024 of the tissue thickness compensator 17020 can be attached to the opposite side of the retaining member 17025. For example, the retention member 17025 can be configured to resist lateral deflection of the tissue thickness compensator 17020, for example. The body portion 17024 can be composed of a first material and the retaining member 17025 can be composed of a second or another material. The body portion 17024 can be composed of a material having a first durometer hardness, and the holding member 17025 can be composed of a material having a second durometer hardness, for example, the second durometer hardness is a first durometer hardness. May be higher than durometer hardness. Further to the above, the cutting member that passes through the slot 17015 can cross the retaining member 17025 when the staple 10030 is deployed. Once the tissue thickness compensator 17020 is implanted, the retention member 17025 can be withdrawn from the slot 17015. The body portion 17024 can be configured to be separated from the holding member 17025.

  Referring now to FIG. 388, the staple cartridge 18000 can include a support portion 18010 that includes a deck surface 18011 and a longitudinal slot 18015. The staple cartridge 18000 can further include a tissue thickness compensator 18020 disposed above the deck surface 18011. The tissue thickness compensator 18020 may have a longitudinal retention member 18025 that extends downward and enters the longitudinal slot 18015. For example, the retention member 18025 can be press fit into the slot 18015 so that the interaction between the retention member 18025 and the slot 18015 causes relative movement between the support portion 18010 and the tissue thickness compensator 18020. Can resist. The retention member 18025 extends through the entire tissue thickness compensator 18020 toward the upper surface 18021, and the body portion 18024 of the tissue thickness compensator 18020 can be attached to the opposite side of the retention member 18025. The retaining member 18025 may have an inflated portion 18026 that can be received in a cavity 18016 defined in the slot 18015. For example, the inflated portion 18026 can resist escape of the retaining member 18025 from the slot 18015.

  Referring to FIG. 400, a tissue thickness compensator 21020 can have a compensator body 21022 and a plurality of capsules or tubes 21024 disposed therein. Each tube 21024 has a cavity 21026 defined therein that can contain one or more drugs. As described in more detail below, the tissue thickness compensator 21020 can be manufactured, for example, by placing the tube 21024 in a mold and molding the compensator body 21022 around the tube 21024. The compensator body 21022 is solidified, lyophilized, and / or cured, for example, by placing one or more drugs in the tube 21024 before placing the tube 21024 in the mold, and then the tube 21024 is placed in the compensator body 21022. Can be encapsulated. Alternatively, referring to FIG. 401, the tissue thickness compensator 21120 may have a plurality of capsules or tubes 21124 disposed within the compensator body 21222, in which case one or more medications may be included in the compensator body 21122. After being molded around tube 21124, it can be loaded into tube 21124. For example, the tissue thickness compensator 21120 can have a port 21123 that is in fluid communication with the tube 21124 and can be configured to inject one or more drugs into the tube 21124 using, for example, a syringe 21125. In certain circumstances, a surgeon or other clinician can load one or more drugs into the tube 21124 just prior to the tissue thickness compensator 21120 being inserted into the patient's body. These configurations can be particularly useful when the tissue thickness compensator 21120 is expected or required to have a long shelf life or storage period.

  Referring now to FIG. 402, the compensator body 21022 of the tissue thickness compensator 21020 can be comprised of, for example, a bioabsorbable material. The compensator body 21022 can be composed of any suitable material such as PGA and / or PCL. The tube 21024 can be comprised of any suitable bioabsorbable material, for example. Tube 21024 can be composed of any suitable material such as hyaluronic acid, gelatin, PDS, and / or oxidized regenerated cellulose (ORC). The one or more drugs 21025 contained within the cavity 21026 can include a liquid such as doxycycline. For example, each of the tubes 21024 can be sealed such that, for example, at least a portion of the tube 21024 can be stored in the tube 21024 until dissolved and / or bioabsorbed. Referring now to FIG. 403, in use, the tube 21024 can be exposed to bodily fluids such as blood that can contact and dissolve the tube 21024. Referring to FIG. 404, for example, body fluid is pushed out of the tissue T as the tissue T and tissue thickness compensator 21020 are compressed by the anvil 21060 and / or the plurality of staples 21030. According to the present invention, the compensator body 21022 can be encapsulated or at least partially encapsulated by using a bioabsorbable wrap. For example, the wrap can be composed of hyaluronic acid and / or ORC.

  Referring now to FIG. 406, for example, a capsule or tube 21224 can have multiple layers 21224a-21224d. Each tube 21224 can have, for example, an outer layer or first layer 21224a, a second layer 21224b, a third layer 21224c, and an inner layer 21224d. The outer layer 21224a can be made of a hemostatic material such as thrombin, for example. The second layer 21224b may be composed of antibacterial and / or antibiotics such as doxycycline and / or gentamicin. The third layer 21224c can be composed of an anti-inflammatory substance such as diclofenac and / or NSAID. The inner layer 21224d can be made of a healing promoting material such as a powdered collagen synthetic material. Referring again to FIG. 406, the tube 21224 can be configured and arranged such that the outer layer 21224a dissolves before the second layer 21224b dissolves or at least partially dissolves. Referring to FIG. 405, outer layer 21224a can begin to dissolve as soon as it is exposed to bodily fluids. This time is indicated as time t0. The outer layer 21224a can be completely dissolved in minutes, hours and / or days, in which case the material comprising the outer layer 21224a reaches a maximum effect or concentration at the time indicated as time t1. be able to. At a time after a certain time, outer layer 21224a can be completely or at least substantially dissolved by the time indicated by time t2.

  As the outer layer 21224a dissolves, body fluid can reach the second layer 21224b and begin to at least partially dissolve the second layer 21224b. As above, the second layer 21224b can be completely dissolved in minutes, hours and / or days, in which case the material making up the second layer 21224b is at a time indicated as time t3. The maximum effect or concentration can be reached. In different situations, body fluid may pass through outer layer 21224a to reach second layer 21224b so that outer layer 21224a and second layer 21224b can begin to dissolve simultaneously or at least substantially simultaneously. In any case, it will be recognized by the reader that the time t1 when the material comprising the outer layer 21224a reaches its maximum effect or concentration can occur before time t3. At a time after a certain time, the second layer 21224b can be completely or at least substantially dissolved by the time indicated by time t5. As also recognized by the reader, time t5 can occur after time t2. As the second layer 21224b dissolves, body fluid can reach the third layer 21224c and begin to at least partially dissolve the third layer 21224c. As above, the third layer 21224c can be completely dissolved in minutes, hours and / or days, in which case the material making up the third layer 21224c is at a time indicated as time t6. The maximum effect or concentration can be reached. In different circumstances, body fluid passes through outer layer 21224a and second layer 21224b to reach third layer 21224c, thereby causing outer layer 21224a, second layer 21224b, and / or third layer 21224c to be simultaneous. Or it can begin to dissolve at least almost simultaneously. In any case, it will be recognized by the reader that time t3 when the material making up outer layer 21224a reaches its maximum effect or concentration can occur before time t6. At a time after a certain time, the third layer 21224c can be completely or at least substantially dissolved by the time indicated by time t8. As also recognized by the reader, time t8 can occur after time t5.

  As the third layer 21224c dissolves, the bodily fluid reaches the fourth layer 21224d and can begin to at least partially dissolve the fourth layer 21224d at the time indicated by time t4. As above, the fourth layer 21224b can be completely dissolved in minutes, hours and / or days, in which case the material making up the fourth layer 21224d is at the time indicated as time t7. The maximum effect or concentration can be reached. In different situations, body fluid passes through the outer layer 21224a, the second layer 21224b, and the third layer 21224c to reach the fourth layer 21224d, thereby causing the outer layer 21224a, the second layer 21224b, the third layer Layer 21224c and / or fourth layer 21224d may begin to dissolve simultaneously or at least approximately simultaneously. In any case, the reader will recognize that the time t6 when the material making up the third layer 21224c reaches its maximum effect or concentration can occur before time t7. At a time after a certain time, the fourth layer 21224d can be completely or at least substantially dissolved by the time indicated by time t9. As also recognized by the reader, time t9 can occur after time t8. If necessary, the above results can result in a gradual release of the drug.

  Referring now to FIGS. 410 and 412, a staple cartridge 21300 can have a cartridge body 21310 that includes a plurality of staple cavities 2112, and a plurality of staples 21330 disposed therein. The staple cartridge 21300 can further include a tissue thickness compensator 21320 that can include a compensator body 21322 that can be disposed in contact with the cartridge body 21310 and a plurality of individual capsules 21324 disposed within the compensator body 21322. The capsules 21324 can be oriented vertically, and each capsule 21324 can be positioned between the staple legs 21322 of the staples 21330 when the staples 21330 are in an unfired configuration, as shown in FIG. For example, the staple legs 21322 can extend at least partially into the tissue thickness compensator 21320 without breaking the capsule 21324 when each staple 21330 is in an unfired position. Referring now to FIG. 413, as the staples 22030 are moved from their unfired position to their fired position, the staples 21330 break the capsule 21324, thereby releasing at least one drug therein. More particularly, the staples 21330 are deformed by the forming pocket 21062 defined in the anvil 21060 as they are lifted upward so that the staple legs 21332 are downward and in the direction of the capsules 21324 disposed therebetween. Curved or deformed inward. The staples 22330 are lifted upward by a firing system consisting of drivers 21340 and sleds 21345, in which case the sleds 21345 traverse the staple cartridge 21000 longitudinally with each staple driver 21340 and the staples 21330 disposed thereon. It can be configured to sequentially lift and fire. In any case, the staple legs 21332 can clamp and / or crush the capsule 21324, thereby breaking the internal cavity 21326 defined within the capsule 21324 and enclosing one or more types contained within the internal cavity 21326. The drug can be released therefrom. The one or more drugs may include, for example, one or more powders and / or liquids contained in the drug. The staple cartridge 21300 can further cut tissue T disposed between the staple cartridge 21300 and the anvil 21060, for example, by having a cutting member 21380 that can be advanced distally with the sled 21345. Cutting member 21380 can be configured to pass through knife slot 21324 defined in cartridge body 21310, in which case one or more capsules, such as capsule 21324, for example, inside knife slot 21314 and / or By placing on it, the cutting member 21380 can cut these capsules 21324. In any case, the tissue thickness compensator 21320 can be composed of hyaluronic acid, for example, and can be disposed on the top and / or bottom of the cartridge body 21322 that can stabilize the cartridge body 21322 and / or staples 21330. The layer 21321 may be further included. For example, the cutting member 21380 can be configured to cut the layer 21321 as the cutting member 21380 is advanced through the staple cartridge 21300 as described above.

  Referring now to FIG. 414, the tissue thickness compensator 21420 can have a compensator body 21422 and a plurality of capsules 21444 disposed therein. As above, each capsule 21444 can have a sealed cavity 21446 that can be configured to releasably store one or more drugs therein. Each of the capsules 21444 can have a conical and / or tapered end 21447, for example. For example, by using the tapered end 21447, the capsule 21444 can be held in place while the cartridge body 21422 is formed around the capsule 21444. According to the present invention, the mold has a plurality of openings and / or recesses that can be configured to receive and secure the tapered end 21447 so that the compensator material is poured around the capsule 21444. The mold can hold the capsule 21444 in place as it is being pressed. In addition to the above, the capsule 21444 can be arranged and arranged so that it is not torn or ruptured, for example, until the staples are fired into and / or through the compensator body 21420 in use. it can.

  Alternatively, referring now to FIG. 415, the compensator body 21520 may have a plurality of capsules 21524 disposed within the compensator body 21522. Each capsule 21524 may have one or more openings 21528 defined in its outer wall, in which case each opening 21528 has a cavity 21526 in which one or more drugs 21525 are defined in the capsule 21524. It can be configured to be released from. The opening 21528 can be sized and configured to control the rate at which the drug 21525 is released from the cavity 21526. For example, the release rate of the drug 21525 may increase as the opening 21528 increases, and the release rate of the drug 21525 may decrease as the opening 21528 decreases. The outer wall of each capsule 21524 can be comprised of a tubular member having a closed and / or sealed end 21527. The outer wall of the capsule 21524 can be composed of, for example, one or more bioabsorbable polymers, and the end 21527 can be closed and / or sealed using, for example, a thermal staking process, a thermal welding process, and / or a laser welding process. Can be stopped. The outer wall or shell of the capsule 21524 can be manufactured using an injection molding process in which one or more drugs are placed into the shell from one or more open ends of the shell after the shell is molded. Can do. Thereafter, one or both ends of the shell can be capped using, for example, a polymer solution. If the wall of the capsule 21524 is composed of a bioabsorbable material, the opening 21528 defined in the wall can expand over time. For example, the rate at which drug 21525 is released from cavity 21526 can increase over time.

  The compensator body 21522 can be made of gelatin, for example, and can be manufactured as a foam material using, for example, a freeze-drying process. The capsule 21524 can be inserted into the compensator body 21522, in which case, for example, the compensator body 21522 can be formed with an opening configured to receive the capsule 21524. After this, for example, a layer or film can be placed over the compensator body 21522 to cap or encapsulate the capsule 21524 therein. The capsule 21524 can be placed in a mold and the compensator material can be at least partially molded around the capsule 21524 to form the compensator body 21522. In any case, the compensator body 21522 can be configured to align and orient the tissue thickness compensator 21520 with respect to the cartridge body of the staple cartridge 1 so that the capsule 21524 is positioned at a desired location. There can be more than one key mechanism or indexing mechanism.

  Referring now to FIG. 416, the surgical stapling system may include a staple cartridge 21600 and an anvil 21060 that can be disposed on both sides of the tissue T. Similar to the other staple cartridges disclosed herein, the staple cartridge 21600 can include a cartridge body 21310 having a plurality of staple cavities 2112, and a plurality of staples 21330 disposed therein. Referring to FIG. 420, in use, the staple 21330 is deformed relative to the anvil 21060 by being lifted upward from an unfired position to a fired position by a driver 21340, or more particularly within the molding pocket 21062. Is transformed. When staple 21330 is fired, staple 21330 passes through tissue thickness compensator 21620 attached to tissue T and anvil 21060 and then between its unfired form (FIG. 417) and its fired form (FIG. 418). Is transformed. Staples 21330 can be composed of any suitable material such as, for example, stainless steel and / or titanium, and are configured to exert a compressive or clamping force on tissue thickness compensator 21620 and tissue T. be able to. As shown in FIG. 416, the staples 21330 can be arranged in a plurality of rows, and a single staple 21330 can be arranged in each staple cavity 21112. Staple cartridge 21300 may be configured to engage and penetrate tissue T, tissue thickness compensator 21620, and / or one or more drug capsules disposed within tissue thickness compensator 21620, for example. It can further include a penetrating member 21635 (FIG. 419). For example, the penetrating member 21635 can be disposed within the staple cavity 21112, in which case the penetrating member 21635 can be fired or ejected from the staple cavity 21112 by the driver 21340. In addition to the above, the staples 21330 can be disposed inside some of the staple cavities 2112, and the penetrating member 21635 can be disposed inside the other staple cavities 2112, of the staple cartridge 21600. Staple cartridge 21600 includes several rows of staple cavities 2112, with only staples 21330 disposed therein, several rows with only penetrating member 21635 disposed therein, and / or staples 21330 and penetrating therein. Several rows in which both members 21635 are arranged may be included. Referring to FIG. 420, as shown, the four inner rows of staple cavities 2112, may have only staples 21330 therein, the outer rows of staple cavities 2112, the staples 21330 and penetrating members 21635. You can have both inside. The staples 21330 and penetrating members 21635 in the outer rows of staple cavities 2112, can be arranged in an alternating arrangement, for example. Referring now to FIG. 421, staples 21330 and penetrating member 21635 are, for example, two staples 21330, followed by one penetrating member 21635, followed by two more staples 21330, followed by one penetrating member 21635. , And so on.

  Referring primarily to FIG. 419, each penetrating member 21635 can have a base 21638 and legs 21737 extending upward from both sides of the base 21638. Referring now to FIG. 420, the drivers 21340 can each have a groove 21348 that can be configured to receive and support the base 21638 of the penetrating member 21635. Referring now to FIG. 421, as each driver 21340 is pushed upward by the sled 21345, the sled 21345 can fire the staple 21330 and the penetrating member 21635 sequentially. Referring now to FIG. 420, the staple 21330 contacts the anvil 21060 and is deformed, whereas the penetrating member 21635 may not contact the anvil 21060. Referring primarily to FIG. 419, one or both of the legs 21636 of each penetrating member 21635 can be configured to penetrate, for example, tissue T and / or tissue thickness compensator 21620, and legs There can be at least one barb 21537 that can be configured to hold the 21636 within the tissue T and / or tissue thickness compensator 21620. The tissue thickness compensator may not be used at all. The legs 21636 of the penetrating member 21635 may not be long enough to completely penetrate the tissue T, and may not contact the anvil 21060. Leg 21636 may be long enough to contact anvil 21060 and be deformed into a different configuration.

  The penetrating member 21635 can be made of a material different from that of the staple 21330. The penetrating member 21635 can be made of at least one bioabsorbable polymer such as PGA, for example. The penetrating member 21635 can each include at least one agent such as an antibacterial agent, an anti-inflammatory agent, an analgesic, and / or an MMP inhibitor, for example. Since the penetrating member 21635 can be disposed, for example, within a staple row, one or more drugs can be applied to the tissue T within and / or adjacent to the staple row as the penetrating member 21635 is dissolved and / or bioabsorbed. Can be supplied. The penetrating member 21635 can be coated with one or more drugs. The penetrating member 21635 can include one or more drugs embedded within the structural substrate that constitutes the penetrating member 21635. Some of the penetrating members 21635 can be composed of a first structural substrate and / or a first agent, and other penetrating members 21635 can be a second (or different) structural substrate and / or a second. Of (or different) drugs. The penetrating member 21635 can be manufactured by, for example, an injection molding process.

  Referring now to FIGS. 422 and 423, the staple cartridge 21700 can have a cartridge body 21710 and a tissue thickness compensator 21720 disposed on or adjacent to the deck surface 21711 of the cartridge body 21710. Similar to the above, the cartridge body 21710 can have a plurality of staple cavities 2112, and a plurality of staples disposed therein. The cartridge body 21710 can further include a slot 21714 that can be configured to receive a cutting member therein, such as a cutting member 21380 (FIG. 424). In use, as shown in FIG. 424, the cutting member 21380 can be configured to cut tissue T disposed between the anvil 21060 and the staple cartridge 21700. Referring again to FIGS. 422 and 423, the tissue thickness compensator 21720 can include a compensator body 21722 and a plurality of drug packets or capsules 21724 disposed within the compensator body 21722. The capsule 21724 can be disposed and arranged in the compensator body 21722 so as to overlap a slot 21714 defined in the cartridge body 21710. Referring primarily to FIG. 425, in use, the cutting member 21380 can be configured to cut the capsule 21724 as the cutting member 21380 is advanced through the staple cartridge 21700. For example, the capsule 21724 can be sealed before being cut by the cutting member 21380, and one or more drugs contained therein can be released after the capsule 21724 is cut. The placement of capsule 21724 overlying slot 21714 allows one or more drugs to be released onto the portion of tissue T that has been cut by cutting member 21380. The one or more drugs contained within the slot 21714 can include a biological agent, for example, in the form of a powder. The one or more agents in the capsule 21724 can include, for example, oxidized regenerated cellulose, alginate, and / or calcium.

  Referring again to FIGS. 422 and 423, each capsule 21724 can contain the same medicament therein. Alternatively, one or more of the capsules 21724 may contain one or more different drugs therein. The first plurality of capsules 21724 may include a first drug therein, and the second plurality of capsules 21724 may include a second drug therein. The capsule 21724 may be, for example, in the longitudinal direction of the cutting member 21380, such as a capsule 21724 containing a first drug followed by a capsule 21724 containing a second drug followed by a capsule 21724 containing a first drug. Can be arranged in an alternating arrangement along the path. The cutting member 21380 can be configured such that when the cutting member 21380 is advanced through the staple cartridge 21300, the first drug and the second drug are mixed together. Referring again to FIGS. 422 and 423, the tissue thickness compensator 21720 can further include one or more grooves 21726 extending outwardly from each capsule 21724. The groove 21726 may be configured to allow the drug within the capsule 21724 to move within the tissue thickness compensator 21720 and the tissue T disposed adjacent thereto after the capsule 21724 is cut. it can. Capsule 21724 can be configured not to rupture when a compressive load is applied by anvil 21060. Referring primarily to FIGS. 422 and 425, the cartridge body 21710 can have a plurality of recesses 21715 that can each be configured to receive at least a portion of the capsule 21724 therein. For example, the recess 21715 can be configured such that the capsule 21724 can slide downward within the recess 21715 so that the capsule 21724 does not rupture when compressive stress is applied to the capsule 21724. Alternatively, one or more capsules 21724 can be configured to rupture only when the compressive force acting on capsule 21724 meets or exceeds a specific compressive force. For example, capsule 21724 can withstand the clamping pressure applied by, for example, anvil 21060, but can rupture as the compression pressure applied to capsule 21724 increases as a result of cutting member 21380 being advanced through staple cartridge 21700. It can be constituted as follows. Capsule 21724 can include a lubricant therein that can facilitate movement of cutting member 21380 as cutting member 21380 is advanced and / or retracted within staple cartridge 21700.

  Referring now to FIG. 426, the tissue thickness compensator 21820 can have a compensator body 21822 and a longitudinal tube 21824 extending therethrough. Similar to the above, the tube 21824 can include a longitudinal cavity 21826 defined therein and one or more medicaments 21825 disposed within the cavity 21826. The longitudinal tube 21824 can further include one or more support legs 21827 that extend outwardly from the tube 21824 and can be configured to support the tube 21824. For example, referring now to FIG. 427, the support legs 21827 can support the tube 21824 within the mold 12890 while the compensator body 21822 is molded around the tube 21824. Referring now to FIGS. 428 and 429, the material comprising the compensator body 21822, such as PGA and / or PCL, for example, can be poured around the tube 21824 and then lyophilized, foamed and / or solidified. Referring again to FIG. 427, the material making up the compensator body 21822 can be poured into the cavity 21891 surrounding the tube 21824 and the cavity 21891 can then be closed by the cover 21892. Referring to FIG. 426, the end of the support leg 21827 may not be covered by the poured material and may be flush with the bottom surface 21821 of the compensator body 21822. Support legs 21827 and / or tubes 21824 can be comprised of a dissolvable and / or bioabsorbable material such as, for example, gelatin, hyaluronic acid, PDS and / or ORC. The legs 21827 are quickly dissolved, for example, by body fluids and / or saline, in which case the grooves or passages extending between the outer periphery and the interior of the tissue thickness compensator 21820 are left undissolved. By providing such a passage, one or more kinds of medicines 21825 arranged in the tube 21824 can be rapidly dissolved and / or absorbed. Alternatively, the tissue thickness compensator 21920 may include a tube 21924 having a compensator body 21922 and a plurality of support legs 21927, for example, as shown in FIG. Referring to FIG. 431, the support legs 21927 can be part of a larger support network or structural grid 21928 that can extend through the compensator body 21922.

  Referring again to FIG. 426, the legs 21827 extending from the tube 21824 may include one or more drugs therein. As noted above, when leg 21827 is dissolved and / or absorbed, one or more drugs in leg 21827 can provide a first drug response to the stapled and / or incised tissue. In contrast, one or more drugs 21825 in the tube 21824 can provide a second (or subsequent) drug reaction. Referring now to FIGS. 432 and 434, the tissue thickness compensator 22020 can have a compensator body 22022 and a longitudinal drug tube 2024 extending through the compensator body 22022. Similar to the above, the tube 22024 can define a longitudinal cavity 22026a with one or more drugs 22025a disposed therein. Again, as described above, the tube 22024 can have a plurality of longitudinal leg support elements 22027 that can extend along the length of the tube 22024. Optionally, each of the leg support elements 22027 defines a longitudinal cavity therein, such as cavities 22026b and 22026c, which can each include one or more types of agents, such as agents 22025b and 22025c, respectively. sell. The leg support element 22027 can be rapidly released from the drugs 22025b and 22025c by being composed of a material that can be rapidly dissolved and / or absorbed. Thereafter, the support leg 22027 and the tube 22024 can be further dissolved and / or absorbed to subsequently release the drug 22025a. The drugs 22025a, 22025b, and / or 22025c can be composed of the same material. Alternatively, the drugs 22025a, 22025b, and / or 22025c can be composed of different materials. Drugs 22025b and 22025c can be composed of the same material that can be different from the materials that make up drug 22025a.

  In addition to the above, the tubes 22024, legs 22027, and / or cavities 22026a-c defined therein can be manufactured by an injection molding process. Tubes 22024, legs 22027, and cavities 22026a-c can also be manufactured, for example, by an extrusion process, so that these elements can have a continuous cross-section along their length. As a result of these processes, the tube 22024 and the leg 22027 can be integrally formed. Thereafter, the drugs 22025a-22025c can be placed in the cavities 22026a-22026c, respectively. Each of the drugs 22025a to 22025c can be composed of, for example, one or more kinds of powders and / or one or more kinds of liquids. Referring now to FIG. 435, by sealing the end 22029 of the cavities 22026a-22026c, the drugs 22025a-22025c can be contained therein. In either case, for example, as described above, the tube 22024 can then be placed inside a mold such as the mold 21890, and the material making up the compensator body 22022 is shown in FIG. The tissue thickness compensator 22020 can be molded by pouring around the tube 22024. Different alternatives are shown in FIGS. 436 and 437. Referring to FIG. 436, the tissue thickness compensator 22120 can have a compensator body 22122 and a longitudinal tube 22024 that are coupled together. Each tube 22024 can define a longitudinal cavity 22126 that can each contain one or more drugs 22125 therein. The longitudinal cavities 22126 may not be in fluid communication with each other, or one or more of the longitudinal cavities 22126 may be in fluid communication with each other. Similar to the above, the compensator 22120 can further include a leg 22127 that extends downward from the tube 22124 and can include a longitudinal cavity 22126 and at least one drug 22125 therein. Tube 22124 and / or support leg 22127 can be constructed of a material that can be configured to dissolve and / or bioresorb at different rates. For example, the support legs 22127 can be constructed of a material that can be dissolved and / or bioabsorbed at a faster rate than the material comprising the tube 22124, for example. Referring now to FIG. 437, the tissue thickness compensator 22220 may have a compensator body 22222 and a longitudinal tube 22224, in which case the tube 22224 may have a plurality of leg support elements 22227 extending from the tube 22224. . A single longitudinal cavity 22226 is defined in the tube 22224 and can extend into the support leg 22227. Similar to the above, the cavity 22226 may have one or more types of drugs 22225 disposed therein.

  Referring again to FIG. 426, the support legs 21827 can be composed of one or more materials that can be configured to absorb liquids, such as blood and / or saline. Support legs 21827 can be configured to draw liquid in the direction of tube 21824 and one or more medicaments 21825 contained therein. Such wicking allows the drug 21825 to dissolve and / or bioresorb faster during the healing process. The ends of the support legs 21827 need not be covered by the compensator body 21822 and can be exposed to liquid. Such a wicking process can occur by capillary action, for example, regardless of the orientation of the tissue thickness compensator 21820.

  Referring now to FIG. 441, the tissue thickness compensator 22320 can include a compensator body 22322 and a plurality of tubes 22324 disposed therein. The compensator body 22322 can be composed of, for example, a cell-free mesh biomatrix, a mesh scaffold material (Omentum Scaffold Material), and / or a regeneration promoting tissue scaffold foam such as ACell. The net scaffold material consists of a hydrophilic foam prepared from a skeletonized net and is optionally compressible. When exposed to liquid, the netting scaffold material can expand and exert pressure on tissue placed in contact therewith. Such hydrophilic swelling of materials including mesh scaffold materials is illustrated, for example, in FIGS. ACell is a regeneration promoting product that provides an extracellular matrix or scaffold network structure that promotes cell growth and migration. The tissue scaffold constituting the compensator body 22322 can be filled with, for example, stem cells, PRP, or growth factors. The tissue scaffold constituting the compensator body 22322 can be coated with a collagen matrix, for example. The tissue scaffold matrix of the compensator body 22322 can be composed of a fiber matrix, which can be composed of randomly oriented fibers. In certain circumstances, a fiber matrix composed of randomly oriented fibers may not be able to provide the desired elasticity or elasticity within the compensator body 22322. To address this, the randomly oriented fibers are configured to expand to provide the desired elasticity to the fiber matrix and / or provide the desired compressive force to the tissue after exposure to the liquid. Can be constructed of a hydrophilic material and / or coated with a hydrophilic material. In various situations, the fiber matrix may not be exposed to the liquid until after it is captured in contact with the tissue by the plurality of staples, as described above. For example, the compensator body 22322 has a liquid impervious wrap that can be broken, perforated, incised, and / or ruptured in use to allow liquid to enter the compensator body 22322 and reach the hydrophilic fibers. May be included. In either case, as liquid is absorbed by the scaffold matrix trapped within the staple, the scaffold matrix expands, thereby applying compressive pressure to the tissue still trapped within the staple, and over time the scaffold matrix Can support the in-growth of the tissue inward.

  In addition to the above, the tube 22324 of the tissue thickness compensator 22320 can be composed of a degradable material that can be dissolved and / or bioabsorbed. Similar to the above, each tube 22324 has a sealed inner cavity in which one or more kinds of medicines are contained, and a passage for liquid to reach medicines stored in the tubes 22324 by further disassembly. Or it may have one or more support legs 22327 that may be configured to provide a flow path. Such disassembly of the support legs 22327 may be time consuming and, as a result, the drug contained within the tube 22324 may not be released immediately. In a sense, the liquid may take a certain amount of time to disassemble the leg 22327, so that the leg 22327 functions as a fuse designed to delay the release of the drug inside the tube 22324. be able to. Thus, in various situations, a leg 22327 having a greater length and / or greater thickness cross section can provide a longer delay time while a shorter length and / or smaller thickness cross section. A leg 22327 with can provide a shorter delay time. The tube 22324 can be composed of a material that dissolves quickly and / or slowly, but in each case the tube 22324 breaks down over a period of time, thereby being contained within the tube 22324. The release of one or more drugs can be delayed. According to the present invention, the first tube 22324 is composed of a first material that decomposes at a first rate, and the second tube 22324 is composed of a second material that decomposes at a second (or different) rate. Can be configured. In such a case, for example, the first drug contained within the first tube 22324 can be released before the second drug contained within the second tube 22324. For example, the first tube 22324 may have a thinner outer wall than the second tube 22324 so that the first tube 22324 can disassemble faster than the second tube 22324, The drug contained in the tube 22324 may be released before the drug in the second tube 22324. As a result of the above, the first tube 22324 is configured to release the first drug at the first time point, and the second tube 22324 is loaded with the second drug at the second (or later) time point. It can be configured to release and the third tube 22324 can be configured to release the third agent at a third (or even later) time point.

  Referring now to FIGS. 442 and 443, the tissue thickness compensator 22420 can have a compensator body 22422 and a second container 22424 disposed within the compensator body 22422. Similar to the above, the container 22424 defines a longitudinal cavity 22426 and one or more medicaments 22425 can be disposed within the longitudinal cavity 22426. Container 22424 may be resilient so that when tissue thickness compensator 22420 is compressed or flattened as shown in FIG. 443, container 22424 rebounds to its original undeformed shape. Or try to keep its shape. For example, the container 22424 may have an elastic spring member disposed in the compensator body 22422. The container 22424 can be configured to change shape without rupturing. For example, the container 22424 can be decomposed, eg, when exposed to a liquid, as described herein.

  Referring now to FIG. 444, the tissue thickness compensator 22520 can have a compensator body 22522 and a plurality of sealed containers 22524a-22524c. Each of the containers 22524a-22524c may define a perimeter configured to increase, maximize, and / or optimize the surface seat of the container in contact with a liquid, such as blood and / or saline. . In various situations, a container with a larger surface area can be exposed to a larger amount of liquid and as a result can be dissolved and / or bioabsorbed at a greater rate. Correspondingly, a container with a smaller surface area can be exposed to a smaller amount of liquid so that it can dissolve and / or bioresorb at a slower rate. The containers 22524a to 22524c can be made of, for example, gelatin, hyaluronic acid, PDS, and / or ORC. Similarly to the above, the containers 22524a to 22524c may have elasticity, and can rebound or give an elastic biasing force. Referring now to FIG. 445, the tissue thickness compensator 22620 can include a compensator body 22622 and a plurality of elastic laminate members 22624 disposed within the compensator body 22622. The elastic laminate member 22624 may include a sealed inner passage having one or more drugs disposed therein.

  Referring now to FIG. 446, the end effector of the surgical stapling instrument can include an anvil 21060 and a staple cartridge 22700. The anvil 21060 may have a tissue thickness compensator 22770 attached to the anvil 21060, and the staple cartridge 22700 may have a cartridge body 22710 and a tissue thickness compensator 22720. Referring now to FIG. 447, the tissue thickness compensator 22770 may have multiple layers, in which case the tissue thickness compensator 22720 may have a first layer 22771 and a second layer 22773. Alternatives where the tissue thickness compensator has more than two layers are also conceivable. If desired, one or more of the layers of tissue thickness compensator may comprise a woven material. The first layer 22771 can be composed of a plurality of first yarns 22773 made of a first material and a plurality of second yarns 22774 made of a second (or different) material. . Similarly, the second layer 22773 can be composed of a plurality of first yarns 22773 and a plurality of second yarns 22774. The concentration of the first yarn 22773 and the second yarn 22774 of the first layer 22771 can be the same as the concentration of the first yarn 22773 and the second yarn 22774 of the second layer 22773. As described in more detail below, the concentration of the first yarn 22773 and the second yarn 22774 in the first layer 22771 is different from the concentration of the first yarn 22773 and the second yarn 22774 in the second layer 22773. May be.

  In addition to the above, the first yarn 22773 can be composed of a bioabsorbable polymer such as PGA, PDS, PCL and / or PLA, and the second yarn 22774 can be composed of, for example, oxidized regenerated cellulose (ORC) Can be configured. The first layer 22771 can constitute the outer layer of the tissue thickness compensator 22770 and can have a tissue contacting surface. The first layer 22771 can include more first yarns 22773 than the second yarns 22774. For example, the first layer 22771 may have a ratio of about 80% first yarn 22773 to about 20% second yarn 22774, for example. The first layer 22771 can be, for example, a ratio of about 60% first yarn 22773 to about 40% second yarn 22774, about 67% second yarn 22774, about 67% second yarn 22774, for example. 1 thread 22773 ratio, about 30% second thread 22774 ratio to about 70% first thread 22773 ratio, about 25% second thread 22774 to about 75% first thread 22774 ratio It may have a ratio of yarn 22773 and / or a ratio of first yarn 22773 of about 90% to second yarn 22774 of about 10%.

  In addition to the above, the first yarn 22773 can be composed of a material that dissolves, bioresorbs, and / or changes state at a slower rate than the material comprising the second yarn 22774. For example, the second thread 22774 can be composed of an ORC thread that can change from a solid to a gel, for example, when exposed to a liquid, for example, the ORC thread reacts when exposed to platelets to a solid to gel. And can change. However, in such a case, the first layer 22773 can be composed largely of bioabsorbable polymer yarns that have a significantly slower reaction rate with the liquid compared to the ORC yarns, thereby Layer 22773 can be contacted with tissue or bodily fluids multiple times without losing its overall shape and structure. Nevertheless, the ORC fibers in the first layer 22773 may react upon initial contact with the liquid and / or tissue, while the ORC gel may be retained at least partially or largely within the first layer 22773. .

  The second layer 22773 may constitute the inner layer of the tissue thickness compensator 22770 and may not have a surface that directly contacts the tissue. The second layer 22773 can include fewer first threads 22773 than the second threads 22774. For example, the second layer 22773 may have a ratio of about 20% first yarn 22773 to about 80% second yarn 22774, for example. The second layer 22773 may comprise, for example, a ratio of about 40% of the first yarn 22773 to about 60% of the second yarn 22774, about 33% of the second yarn 22774 of about 33%. 1 thread 22773 ratio, about 70% second thread 22774 ratio to about 30% first thread 22773 ratio, about 75% second thread 22774 to about 25% first thread 22774 ratio It may have a ratio of yarn 22773 and / or a ratio of first yarn 22773 of about 10% to second yarn 22774 of about 90%.

  In addition to the above, the second layer 22773 may include more ORC yarns than, for example, bioabsorbable polymer yarns. The second layer 22773 can include more ORC yarns than the first layer 22771. Since the second layer 22773 is not the outer layer, the liquid must immediately pass through the first layer 22771 before it contacts the second layer 22773, so it immediately contacts the second layer 22773. May not. In such a case, the second layer 22773 may have a higher ORC yarn density, since the ORC yarn in the second protected layer 22773 does not immediately turn into a gel. Even if the ORC yarns in the second layer 22773 come into contact with the liquid and turn into a gel, such an ORC gel maintains its rough shape at least initially as described above. It can be contained within the tissue thickness compensator 22770 by a first layer 22771 that can provide a support mesh for the two layers 22773. ORC fibers and bioabsorbable fibers can be used, but other suitable materials can be used as needed.

  In addition to the above, and referring now to FIGS. 450-452, the tissue thickness compensator 22770 can be placed between the anvil 21060 and the tissue T, in which case the tissue thickness compensator 22770 has staples 21330 attached thereto. It can be compressed against tissue T prior to being fired from staple cartridge 22700. After the staples 21330 are fired and the tissue T and tissue thickness compensators 22720 and 22770 are captured therein, the anvil 21060 and the cartridge body 22710 of the staple cartridge 22700 are moved away from the compensators 22720 and 22770 and the tissue T. Can be removed from the site. Referring now to FIG. 448, the tissue thickness compensator layer 22871 can include a woven yarn 22873 that can have, for example, an elongated or flattened cross-section. Referring now to FIG. 449, the tissue thickness compensator layer 22971 can include a woven yarn 22971 that can have, for example, a round cross-section.

  Different alternatives are shown in FIGS. 453-456. Referring now to FIG. 454, the end effector of the surgical stapling instrument can have an anvil 21060 and a tissue thickness compensator 22770 'disposed on the anvil 21060. Referring to FIG. 453, the tissue thickness compensator 22770 'can include a layer 22771' that can include a plurality of first fibers 22773 'braided with a plurality of second fibers 22774'. For example, the first fiber 22773 'can be configured to dissolve and / or bioabsorb at a faster rate than the second fiber 22774'. Between the first fiber 22773 'and the second fiber 22774', gaps, openings, and / or pockets may be defined that allow liquid to flow through the layer 22771 '. Referring now to FIG. 456, the end effector of the surgical stapling instrument can have a tissue thickness compensator 22770 ″ attached to the anvil 21060. Referring to FIG. 455, the tissue thickness compensator 22770 ″ can include a woven fabric layer of yarn 22771 ″ that can be embedded and / or encapsulated within the substrate 22773 ″. The thread 22771 '' may be exposed, but instead, at least a portion of the substrate 22773 '' must be dissolved and / or bioabsorbed before the thread 22771 '' is exposed. May be. For example, the material making up the substrate 22773 "can fill any gaps, openings, or pockets between the yarns 22771".

  Referring now to FIG. 461, the staple cartridge 23000 can include a tissue thickness compensator 23020. As described herein, the tissue thickness compensator can be manufactured using, for example, a lyophilization process. For example, a solution containing PGA and / or PCL can be poured into a mold and this solution can be grown into an open cell foam, for example, in the presence of a vacuum atmosphere and / or low temperature. For example, the PGA material can be present in the solution, for example in a weight ratio of about 64/36 to the PLA material. Referring to FIG. 457, for example, fibers and / or filaments 23021 can be mixed into this solution. For example, by dispersing the PGA fibers in the solution before the solution is poured into the mold, the PGA fibers can be evenly or at least nearly uniformly distributed throughout the tissue thickness compensator 23020, for example. In other situations, the PGA fibers may settle or sink toward the bottom of the mold, for example by placing the PGA fibers in solution and / or directly into the mold. In other situations, the PGA fibers can be configured to float on top of the solution. In either case, a solvent such as a dioxane solvent may be present in the solution that can facilitate the lyophilization process. The dioxane solvent may not react with the PGA fibers in the solution, or at least not substantially react.

  In addition to the above, the fibers 23021 can also be coated with one or more agents in solution and / or before being mixed with the solution. Referring to FIG. 459, each fiber 23021 can include a substrate 23022 that can be at least partially coated with a coating 23023 using any suitable manufacturing process. Referring to FIG. 458, fibers 23021 can be manufactured using, for example, an extrusion process in which at least one drug coating is placed on a PGA substrate. These can be particularly useful with drugs that can withstand the high temperatures of the extrusion process. Referring to FIG. 460, the fibers 23021 can be coated and / or impregnated with a drug using a carrier fluid such as supercritical carbon dioxide. In either case, drug-coated fibers 23021 can be mixed with the solution such that the fibers 23021 are embedded within the tissue thickness compensator 23020. In various situations, as a result, the coating of fibers 23021 can begin to dissolve and elute one or more drugs contained therein. The fibers 23021 disposed near the outer periphery of the tissue thickness compensator 23020 can begin to dissolve before the fibers 23021 disposed near the interior of the tissue thickness compensator 23020. In such a case, after the fibers 23021 are dissolved, a plurality of cavities or a network of cavities remain in the tissue thickness compensator 23020, which allows cells or tissue to grow inside the tissue thickness compensator 23020. Become. The tissue thickness compensator can include a plurality of first fibers that can dissolve more rapidly than the plurality of second fibers. For example, the first fibers can include, for example, gamma irradiated PGA fibers. If necessary, the PGA fiber irradiated with gamma rays may dissolve more rapidly than the PGA fiber not irradiated with gamma rays, for example.

  If desired, one or more colorants can be added to the solution described above so that the tissue thickness compensator produced from the solution can have an appropriate color. It may be desirable for the tissue thickness compensator to have a color that is significantly different from its surrounding environment. For example, the tissue thickness compensator can be green and / or blue, for example.

  Referring now to FIGS. 462 and 464, the tissue thickness compensator 23120 can include a compensator body 23122 and a plurality of drug particles 23121 distributed throughout the compensator body 23122. The compensator body 23122 can be made of a hydrophobic material. For example, the compensator body 23122 can be composed of a material including, for example, PCL / PGA, in which case PCL and PGA can be present in the material in a weight ratio of 65/35. Referring now to FIG. 463, drug particles 23121 can be encapsulated and / or entrapped therein, for example, by a casing or shell 23124 comprised of a hydrophilic material, eg, doxycycline, percarbonate. And / or one or more drugs 23123, such as ascorbic acid phosphate. The shell 23124 can be composed of, for example, low molecular weight gelatin, hyaluronic acid, and / or CMC. The drug 23121 can be manufactured as microparticles that can be dispersed in a solution and poured into a mold, for example, the solution can be lyophilized later as described above. When the tissue thickness compensator 23120 is exposed to a liquid during use, for example, the liquid 23129 (FIG. 465) can enter the compensator body 23122 to dissolve and / or absorb the hydrophilic shell 23124 of the drug particles 23121. Referring now to FIG. 468, the tissue thickness compensator 23220 has a first layer 23222 and a second (or outer) layer 23224 with a plurality of coated drug particles 23221 dispersed therein. sell. Similar to the above, the particles 23221 can be dissolved and / or absorbed from the second layer 23224, for example leaving an opening or capillary path 23225 in the second layer 23224. Referring now to FIG. 469, the tissue thickness compensator 23320 can have, for example, a compensator body 23322 having a plurality of drug particles 23121 and a plurality of fibers 23021 dispersed therein.

  Referring now to FIGS. 470 and 471, the staple cartridge 23400 can include, for example, a cartridge body 23410 and a tissue thickness compensator 23420 disposed on the cartridge body 23410. The tissue thickness compensator 23420 can include a plurality of capsules 23421 disposed within the compensator body 23422. Capsule 23421 can be manufactured using, for example, an emulsion or spin disk process, and capsule 23421 can include, for example, solid and / or liquid biometric microspheres. Capsule 23421 can include one or more adhesives that can help secure the closure of the tissue as it is released from capsule 23421. Capsule 23421 can include, for example, a hemostatic agent. In either case, the capsule 23421 can be dispersed within the compensator body 23422 in any suitable manner. Referring now to FIG. 472, the capsule 23421 can be placed, for example, in a mold cavity 21189 defined in the mold 21890, in which case the capsule 23421 sinks to the bottom 21893 of the mold 21890. Referring to FIG. 473, the capsule 21421 can form a uniform or at least substantially uniform layer on the bottom 21893 by vibrating the mold 21890. Referring now to FIG. 474, the material making up the compensator body 23422 can be poured into the mold cavity 21891 along with the capsule 23421. The capsule 23421 is denser than the compensator body material so that the capsule 23421 can remain on the bottom 21893 of the mold 21890 as shown in FIG. For example, referring to FIG. 477, the bottom 21893 of the mold 21890 can have a plurality of recesses, recesses, or recesses 21899 that can be configured to receive the capsule 23421. Alternatively, referring to FIG. 476, the capsule 23421 may be less dense than the material of the compensator body and may float on the mold 21890. If desired, as described in more detail below, the density of capsules 23421 can be selected so that capsules 23421 can float throughout the compensator body material.

  After the mixture of the capsule 23421 and the compensator body material is appropriately poured into the mold 21890, the tissue thickness compensator 23420 is formed by subjecting the mixture to, for example, a lyophilization process. For example, the capsule 23421 can be fixed or lyophilized within the compensator body 23422. Referring again to FIG. 470, the tissue thickness compensator 23420 can then be removed from the mold 21890 and then assembled to the cartridge body 23410 of the staple cartridge 23400. As shown in FIG. 470, the tissue thickness compensator 23420 is positioned and configured such that the capsule 23421 defines or is positioned adjacent to the tissue contacting surface or skin 23425 of the tissue thickness compensator 23420. Can do. Capsule 23421 can be at least partially composed of, for example, a hydrophilic material that can be rapidly dissolved and / or bioabsorbed, for example, after tissue thickness compensator 23420 is placed in contact with the tissue. Each of the capsules 23421 can be composed of a plurality of material layers that can be dissolved and / or bioabsorbed over time. For example, the outer layer of the capsule 23421 may include a first agent, and the first agent is dissolved and / or bioabsorbed to expose a second (or inner) layer that includes the second agent. Thereafter, the second agent can be dissolved and / or bioabsorbed. A portion of the capsule 23421 is cut by the cutting member as the cutting member is advanced distally to cut the tissue and / or tissue thickness compensator 23420, as described elsewhere herein. Can be arranged as follows. Capsule 23421 can reduce the density of tissue thickness compensator 23420, thereby reducing the force or energy required to advance the cutting member through tissue thickness compensator 23420, for example.

  As noted above, the tissue thickness compensator 23420 can have a capsule 23421 disposed on one side or skin of the compensator body 23422. As also mentioned above, the tissue thickness compensator 23420 can include capsules 23421 distributed throughout the compensator body 23422. For example, the capsule 23421 may have the same density as the compensator body material so that the capsule 23421 can float in the compensator body material. The capsule 23421 can be dispersed or homogenized throughout the material of the compensator body, after which the mixture can be cooled before the capsule 23421 sinks or at least approximately sinks to the bottom of the mold.

  Referring now to FIG. 478, the compensator body 23520 can have a shell 23522 and a plurality of movable elements 23524 disposed within the shell 23522. The shell 23522 may define an enclosed and / or sealed space, such as a cavity 23523, in which the movable element 23524 can move. The movable elements 23524 may have a spherical shape, for example, and may be configured to slide and / or roll with respect to each other, for example. The tissue thickness compensator 23520 can be disposed on the cartridge body 21310 of the staple cartridge, and the staples 21330 can be fired from the staple cartridge through the tissue thickness compensator 23520, as shown in FIG. In various situations, the movable element 23524 can be configured to move to the side of the staple 21330 fired through the tissue thickness compensator 23520 so that the element 23524 does not rupture during the firing process. For example, the shell 23522 can be constructed of an elastic material that can bend and / or move to absorb the motion of the movable element 23524 and dynamically redistribute the forces generated therein. Shell 23522 can enclose the media. For example, the medium can include one or more powders, liquids, liquids, fluids, and / or gels in which the movable element 23524 can move. The movable element 23524 can be comprised of, for example, a soluble and / or bioabsorbable material and one or more agents contained therein. For example, such a configuration can be configured to provide delayed and / or sustained release of one or more drugs. Alternatively, although not shown in the figure, the tissue thickness compensator 23520 can be disposed between the tissue T and the anvil 21060, for example. In either case, the tissue thickness compensator 23520 may have a configuration like an encapsulated “bean beanbag”. The shell 23522 may be configured not to rupture or at least substantially rupture until a cutting member such as the cutting member 21380 is penetrated. At that point, one or more of the movable elements 23524 can escape from the shell 23522.

  Referring to FIG. 482, the tissue thickness compensator 23620 can have a compensator body 23622 and a plurality of capsules 23624 at least partially enclosed within the compensator body 23622. Referring now to FIG. 480, a mold 23690 can be used to manufacture the tissue thickness compensator 23620. For example, a plurality of spherical capsules 23624 can be placed in a cavity 23691 defined in the mold 23690, in which case the lateral movement of the capsule 23624 within the mold 23690 can be, for example, a lateral movement of the mold 23690. Restrained or locked by a lateral locking element 23669 extending between the directional side wall 23694 and the lateral side wall 23694. Lateral sidewall 23694 and lateral locking element 23669 can define a plurality of pockets in which capsule 23624 can be placed and housed. Capsule 23624 can be configured to fit on bottom surface 23699 of mold 23690. Referring to FIGS. 480 and 481, alternatively, the mold 23690 includes one or more longitudinal support members 23692 that can be configured to float the capsule 23624 such that the capsule 23624 does not contact the bottom surface 23699 of the mold 23690. Furthermore, you may have. For example, the longitudinal support member 23692 can be disposed on the bottom surface 23699, but the longitudinal support member 23692 can alternatively be disposed on the lateral support member 23693 with reference to FIG.

  Referring again to FIGS. 480 and 481, the material making up the compensator body 23622 can be poured into the cavity 23691 of the mold 23690 such that the capsule 23624 is at least substantially surrounded by the material. Referring primarily to FIG. 482, a portion of the capsule 23624 can protrude from the compensator body 23622 of the tissue thickness compensator 23620. The transverse support member 23669 and / or the longitudinal support member 23699 can be withdrawn from the mold 23691 during and / or after the compensator body 23622 is undergoing, for example, a freeze drying process. At this point, the capsule 23624 can float within the compensator body 23622 without structural support. Alternatively, the lateral support member 23669 and / or the longitudinal support member 23699 may remain in the compensator body 23622. For example, the transverse support member 23669 and / or the longitudinal support member 23699 can be comprised of, for example, a bioabsorbable material. The support member 23692 and / or the support member 23669 may constitute an elastic member disposed inside the compensator body 23622, which can increase the elasticity of the compensator body 23622, for example.

  Referring now to FIG. 486, the tissue thickness compensator 23720 can include a compensator body having a first portion 23722a and a second portion 23722b, and at least one capsule 23724 disposed therebetween. The tissue thickness compensator 23720 can be manufactured using a mold 21890, for example. Referring now to FIG. 483, the first portion 23722a of the compensator body can be formed by pouring the first material into the mold 21890. Thereafter, referring to FIG. 484, the capsule 23724 can be placed over the first portion 23722a. The capsule 23724 can be placed over the first portion 23722a, for example after a predetermined time and / or after the lyophilization process has been performed on the first material. Referring now to FIG. 485, the second portion 23722b of the compensator body can be formed by pouring a second material into the mold 21890. For example, after a predetermined time and / or after the lyophilization process has been performed on the first material, the tissue thickness compensator 23720 is removed from the mold 21890 and together with the staple cartridge 23700, for example, as shown in FIG. Can be used. The second material may be different from the first material, but as an alternative, the second material may be the same as the first material. In any case, the first material and / or the second material can be composed of, for example, a bioabsorbable material, and the capsule 23724 can be composed of at least one kind of drug.

  Referring now to FIG. 491, the staple cartridge 23800 can have a tissue thickness compensator 23820 that can include a compensator body 23822 and a longitudinal capsule 23824 disposed within the compensator body 23822. Referring now to FIGS. 488 and 489, the longitudinal opening 23821 can be formed in the compensator body 23822 by any suitable processing method, such as mechanical drilling and / or laser drilling. After the longitudinal opening 23821 is formed, the longitudinal capsule 23824 can be placed within the longitudinal opening 23821 as shown in FIG. Referring now to FIG. 495, the staple cartridge 23900 can have a tissue thickness compensator 23920 that can include a compensator body 23922 and a plurality of transverse capsules 23924 disposed within the compensator body 23922. Referring now to FIGS. 492 and 493, the lateral opening 23921 can be formed in the compensator body 23922 by any suitable processing method, such as mechanical drilling and / or laser drilling. After the lateral opening 23921 is formed, a plurality of lateral capsules 239824 can be placed within the lateral opening 23921 as shown in FIG.

  FIGS. 496-500 illustrate an alternate method for manufacturing tissue thickness compensator 23820 using vertical mold 24090. FIG. Referring primarily to FIG. 496, the mold 24090 can have a cavity 24091 defined by a sidewall 24092 and a lower end wall 24093. Referring to FIG. 497, the end wall 24093 has an opening 24094 that can be configured to receive the end of the longitudinal capsule 23824 and hold the capsule 23824 in an upright position as shown in FIG. Yes. Thereafter, referring now to FIG. 499, the open side of the cavity 24091 is closed and / or sealed by the cover 24095, thereby allowing the material comprising the compensator body 23822 to enter the cavity 24091 from the open end of the mold 24090. Can be poured. The tissue thickness compensator 23820 can be removed from the mold 24090 after the material comprising the compensator body has been solidified, cured, and / or lyophilized, for example.

  Referring now to FIG. 501, a staple cartridge 24100 is disposed on a cartridge body 24110, a tissue thickness compensator mat 24170 disposed against a deck surface 24111 of the cartridge body 24110, and a tissue thickness compensator mat 24170. Tissue thickness compensator 24120. The tissue thickness compensator 24120 and the tissue thickness compensator mat 24170 may both or independently be the thickness of tissue captured in staples, such as staples 21330 (FIG. 504) fired from the staple cartridge 24100. Can be compensated for. Referring primarily to FIGS. 501 and 502, the tissue thickness compensator mat 24170 is secured within a lower surface 24171 configured to abut the deck surface 24111 and, further, a knife slot 24114 defined within the cartridge body 24110. There may be a mounting flange or rail 24174 extending from the lower surface 24171 that may be configured to be received. The compensator mat 24170 can further include a plurality of packets 24172 that can extend laterally across the compensator mat 24170. For example, each of the packets 24172 may be defined along a transverse axis that is transverse and / or perpendicular to the longitudinal axis defined by the knife slot 24114, as shown in FIG. The compensator mat 24170 can have multiple layers between which packets 24172 can be defined. For example, each layer can be composed of, for example, PDS and / or collagen. Each packet 24172 can be configured to store therein one or more drugs, such as, for example, doxycycline, a coagulant, and / or an antimicrobial agent.

  Referring again to FIG. 504, the tissue thickness compensator mat 24170 can be positioned relative to the cartridge body 24110 such that each packet 24172 overlaps each staple cavity 21112 defined within the cartridge body 24110. More particularly, each packet 24172 can be arranged and arranged such that packet 24172 extends between staple legs 21332 of staples 21330. The compensator mat 24170 can have a plurality of openings and / or through holes that can be configured to receive the ends of the staples 21330, for example. These through holes can be disposed adjacent to the packet 24172, for example. As shown in FIG. 504, staple 21330 can be configured to capture packet 24172 therein as it is moved from an unfired position to a fired position. For example, the staples 21330 and packets 24172 can be configured and arranged such that the packets 24172 are not perforated or ruptured while the staples 21330 are not fired. In such a case, the packet 24172 may apply elastic or compression pressure to the tissue T captured in the staples 21330 to eliminate, for example, a gap between the tissue T and the staples 21330. Referring again to FIG. 505, the packet 24172 may be cut by the cutting member 21380 as the cutting member 21380 is advanced through the knife body 24114 defined in the cartridge body 24110, tissue T, and / or compensator mat 24170. . The reader will note that the tissue thickness compensator 24120 is not shown in FIGS. 504 and 505. Different embodiments are contemplated in which the staple cartridge 24100 has a tissue thickness compensator mat 24170, but not the tissue thickness compensator 24120, but as an alternative, referring now to FIG. It can have both a thickness compensator mat 24170 and a tissue thickness compensator 24120.

  An alternative embodiment of a staple cartridge is shown in FIG. According to the present invention, a circular staple cartridge 24200 can have a circular cartridge body 24210 that includes a plurality of staple cavities 2112, for example, concentrically arranged. For example, the staple cartridge 24200 may further include a circular tissue thickness compensator mat 24270 disposed on the cartridge body 24210, and the compensator mat 24270 may include a packet 24272 that extends radially outward, for example. Similar to the above, the packet 24272 may extend in a direction that overlaps the staple cavity 2112, whereby the packet 24272 may extend between the legs of the staples 21330 disposed within the staple cavity 21112. Again, as described above, staple 21330 can be configured to capture packet 24272 therein as it is fired from staple cartridge 24200.

  Referring now to FIG. 518, the staple cartridge 24300 can include a cartridge body 24310 and a tissue thickness compensator 24320 that includes a compensator body 24322 and a plurality of tubular members 24324 disposed within the compensator body 24322. For example, the staple cartridge 24300 can further include, for example, a tissue thickness compensator layer or sheet 24370 disposed between the tissue thickness compensator 24320 and the cartridge body 24310. Referring now to FIG. 508, a plurality of staple cartridges 24300 can be manufactured simultaneously using mold 24390. Mold 24390 can have a plurality of cavities 24391 that can each be configured to receive a cartridge body 24310 therein, as shown in FIG. Thereafter, one or more large sheets making up the tissue thickness compensator layer 24370 are placed over the cartridge body 24310. The mold 24390 may have a plurality of upwardly extending support pins or posts 24392, such that the post 24392 is shown in FIGS. 510 and 512 by pressing the sheet 24370 in contact with the post 24392 and then pushing downward. The sheet 24370 can be passed through. Referring now to FIGS. 511 and 513, one or more elongate tubes 24324 can be wrapped around and between the posts 24392 so as to pass over each cartridge body 24310 at least once. The tube 24324 can be wound around and between the posts 24392 so as to pass over each cartridge body 24310 six times, for example. The tube 24324 may be placed on the sheet 24370, but the tube 24324 is tightly wrapped around and between the posts 24392 so that the tube 24324 is tensioned and suspended on the sheet 24370. May be. Referring primarily to FIG. 514, once the tube 24324 is properly positioned, the material comprising the compensator body 24322 can be poured into the mold 24390 from above the sheet 24370. The sheet 24370 may be configured to protect or mask the cartridge body 24310 and may prevent the compensator body material 24322 from entering, for example, the staple cavities 2112, defined within the cartridge body 24310. According to the present invention, a sufficient amount of the compensator body material 24322 can be poured so that the compensator body material 24322 covers the elongated tube 24322.

  In addition to the above, a tissue thickness compensator 24320 can then be formed on the cartridge body 24310, for example, by curing, solidifying and / or lyophilizing the compensator body material 24322. Referring now to FIG. 515, the compensator body material 24322, the tissue thickness compensator sheet 24370, and the elongated tube 24322 can then be cut using the cutting die 24395. Referring now to FIG. 516, the cutting die 24395 can have a plurality of cutting blades that can be configured to individually cut and separate the tissue thickness compensator 24320 and the tissue thickness compensator sheet 24370 from each other. Cutting die 24395 can be configured to remove excess material between individually cut tissue thickness compensator 24320 and tissue thickness compensator sheet 24370, as shown in FIG. Cutting die 24395 and / or any suitable die, for example, may have, for example, one or more heating elements that may be configured to seal the ends and / or edges of tissue thickness compensator 24320. it can. The tube 24324 can be filled with one or more liquids. In such a case, the cutting blade 24396 can be configured to seal the end of the tube portion contained within the tissue thickness compensator 24320 while simultaneously cutting the tube 24324. Thereafter, the plurality of staple cartridges 24300 can be removed from the mold.

  Referring now to FIGS. 519 and 520, the staple cartridge 24400 can have a cartridge body 24410 that can be configured to store a plurality of staples therein. Further, the staple cartridge 24400 can further include a tissue thickness compensator 24420. The tissue thickness compensator 24420 may include a compensator body comprised of a plurality of layers 24422, in which case the layer 24422 may be comprised of, for example, a cellulose film. As shown in FIG. 521, the material 24424 can be disposed between two or more adjacent layers 24422, in which case the material 24424 can separate the adjacent layers 24422 from each other. Material 24424 can include a polyblend biomedical extrusion, and material 24424 can include, for example, a hemostatic material, an anti-inflammatory material, and / or an antibiotic. Referring now to FIG. 521, the material 24424 can be applied to the layer 24422 by a dispenser 24490, for example, in a corrugated pattern, in which case the corrugated pattern is one in which the material 24424 is defined within the cartridge body 24410. It can comprise so that it may be arrange | positioned on the above staple cavity. In such a case, the material 24424 can be captured in staples ejected from the staple cavity and provide an elastic biasing force to the tissue that is also captured in the staples. In either case, tissue thickness compensator 24420 can be formed by, for example, vacuum forming and / or heat sealing one or more layers 24422 onto material 24424. Thereafter, the tissue thickness compensator 22420 can be cut to a predetermined length. Different embodiments are contemplated in which a tissue thickness compensator 22420 is placed against the deck surface of the staple cartridge and another tissue thickness compensator 22420 is placed against the anvil.

  Referring now to FIG. 524, the staple cartridge 24600 can have one or more tissue thickness compensators 24620 disposed on the cartridge body 24610. Referring primarily to FIG. 523, each tissue thickness compensator 24620 can include a compressible or collapsible member 24624 disposed between a plurality of layers 24622 and layers 24622. The collapsible member 24624 may be formed of a corrugated member having a plurality of pockets formed therein, and in that case, one or more kinds of drugs can be stored inside the pocket. For example, a first agent can be placed in a pocket on the first side of the corrugated member and a second agent can be placed in a pocket on the second side of the corrugated member. Tissue thickness compensator 24620 can be formed when layer 24622 and compressible member 24624 are compressed together, for example, by roller 24590. Referring now to FIG. 522, the tissue thickness compensator 24520 can be formed, for example, from a tube of material that has been rolled into a partially collapsed shape by rollers 24590. Referring now to FIGS. 525 and 526, staples 21330 disposed within the cartridge body 24610 are ejected from the cartridge body 24610 such that the staples 21330 capture at least a portion of the tissue thickness compensator 24620 therein. be able to. In such a case, the compressible member 24624 can be configured to exert an elastic biasing force against the tissue T also captured in the staple 21330. The layer 24622 of the tissue thickness compensator 24620 can also be configured to exert an elastic biasing force on the tissue T. The staples 21330 can release one or more types of drugs that penetrate the pockets of the corrugated member 24624 and are contained therein.

  The tissue thickness compensator described above can include a substance therein. The substance can include, for example, a coagulant, a drug, and / or an anti-inflammatory agent. These materials may be liquids, but may take other forms such as, for example, solids and / or gels. In surgical devices having such a tissue thickness compensator, it may be advantageous for the surgical device to have a mechanism for guiding such material to the exterior of the tissue thickness compensator. For example, material can be guided from the tissue thickness compensator toward the incised or stapled tissue. In another example, the first tissue thickness compensator may include a first material and the second tissue thickness compensator may include a second material, in which case the first material and the second material, Can be mixed with a surgical device. As another example, for example, the substances can be guided away from each other, in the direction of the staple cartridge and / or in the direction of the anvil of the surgical device.

  FIGS. 390-391 illustrate a cutting blade 19000 having a cutting edge 19016, a staple cartridge 19002, an anvil 19008, a first tissue thickness compensator 19004 disposed on the staple cartridge 19002, and a second disposed on the anvil 19008. 1 shows a surgical stapling system having a tissue thickness compensator 19006; In use, the cutting blade 19000 is moved distally in the direction of arrow D to cut the patient tissue T and the first tissue thickness compensator 19004 and second tissue thickness compensator 19006. The first tissue thickness compensator 19004 contains the substance S, and the second tissue thickness compensator 19006 contains the substance S ′. The first tissue thickness compensator 19004 includes an inclusion body containing the substance S therein. The inclusion body may include a film of material that is cut open by a cutting blade 19000 that cuts the film, and the substance S is released when the film is cut open. The second tissue thickness compensator 19006 includes the same inclusion body, and when the inclusion body of the second tissue thickness compensator 19006 is cut open by the cutting blade 19000, the second substance S 'is released. As the cutting blade 19000 moves in the distal direction, guides 19030 and 19022 can guide or move substances S and S 'from the first and second tissue thickness compensators 19004 and 19006, respectively. For example, the substances S and S ′ can be guided in the direction of the cut tissue T. The blade 19000 can be coupled to the shaft 19012, which can be coupled to an actuator mechanism that moves the blade 19000 in the proximal direction indicated by the distal direction D and the arrow P.

  The guide 19030 can guide the substance S in the direction of the tissue T cut from the first tissue thickness compensator 19004. The mirror image element of the guide 19030 can be placed on the opposite side of the blade 19000. The guide 19030 can have two raised ridges 19032 and 19034 that define a groove C therebetween. When the surgical stapler is placed against the tissue T, the distal end 19035 of the groove C is located adjacent to the first tissue thickness compensator 19004 and the proximal end 19037 of the groove C is adjacent to the tissue T. Can be arranged. In use, when the cutting blade 19000 moves in the distal direction D, the substance S from the first tissue thickness compensator 19004 enters the groove C at the distal end 19035 and flows through the groove C and adjacent to the tissue T. Exit groove C at proximal end 19037.

  The guide 19022 can guide the substance S ′ in the direction of the tissue T cut from the tissue thickness compensator 19006. The guide 19022 has a protrusion 19025 having an inclined surface 19023. As shown in FIG. 390, the protrusion 19025 can penetrate or cut through the tissue thickness compensator 19006 to release the substance S ′. As the blade 19000 moves in the distal direction D, the inclined surface 19025 can guide the substance S ′ in the direction of the tissue T.

  The substances S and S ′ can be mixed when guided in the direction of the tissue T. Substances S and S 'may be different and may react when mixed. For example, the substances S and S ′ may react chemically to produce a new substance S ″ when mixed. The new substance S ″ may be, for example, a drug, antibiotic, coagulant, and / or any other suitable type of substance. After the blade 19000 has been appropriately advanced in the distal direction D, the cutting blade 19000 can be returned by moving it in the proximal direction P, in which case movement of the blade 19000 in the proximal direction causes the substance S and It can be further mixed with S ″.

  Alternatively, the guides 19022 and 19030 can be configured to guide the substances S and S ′ in a direction away from the tissue T. For example, the guide 19030 can be configured to guide the substance S in the direction of the staple cartridge 19002 and the guide 19022 can be configured to guide the substance S ′ in the direction of the anvil 19008. For example, the first tissue thickness compensator 19004 is held against the staple cartridge 19002 by the adhesive at the joint 19005, and the second tissue thickness compensator 19006 is adhered at the joint 19007, for example. It can be advantageous when it is held against the anvil 19008 by the agent. Substances S and S 'can at least partially exfoliate first and second tissue thickness compensators 19004 and 19006, respectively, from staple cartridge 19002 and anvil 19008 by dissolving or neutralizing the adhesive.

  FIG. 392 shows another guide 19030 ′ in which a groove C ′ is defined by a recess or groove on the surface of the blade 19014. The groove C may have one groove or a plurality of grooves.

  FIGS. 393-396 illustrate another surgical stapling instrument having a cutting blade 19060 and cutting edge 19056, a first tissue thickness compensator 19004, and a second tissue thickness compensator 19006. The blade 19060 may have a first protrusion 19062 on its first side, and the first protrusion 19062 passes from a first side of the blade 19060 to a second side of the blade 19060. Is defined. The first protrusion 19062 and the first orifice 19064 may be aligned with the first tissue thickness compensator 19004. In use, as the blade 19060 moves distally, at least a portion of the substance S in the first tissue thickness compensator 19004 can pass through the first orifice 19064. If desired, the outer shape of the first protrusion 19062 can guide the substance S in the direction of the second side of the blade 19060 and / or the tissue T.

  The blade 19060 may have a second protrusion 19066 on its second side, and the second protrusion 19068 passes from the second side of the blade 19060 to the first side of the blade 19060. Is defined. The second protrusion 19066 and the second orifice may be aligned with the second tissue thickness compensator 19006. In use, as the blade 19060 moves in the distal direction, at least a portion of the substance S ′ in the second tissue thickness compensator 19006 can pass through the second orifice 19068. If desired, the outer shape of the second protrusion 19066 can guide the substance S ′ in the direction of the first side of the blade 19060 and / or the tissue T.

  Referring primarily to FIGS. 393 and 394, the shaft 19059 can have a surface structure, such as a recess 19070, that can facilitate turbulence and / or movement of the substances S and S '. Such facilitated turbulence and / or movement allows, for example, larger portions of the substances S and S 'to come into contact with each other. The recess 19070 can be located proximal to the orifices 19064 and 19068. When the blade 19000 is advanced in the distal direction, the recess 19070 can be downstream of the orifices 19064 and 19068, while when the blade 19000 is retracted in the proximal direction, the recess 19070 can be upstream of the orifices 19064 and 19068.

  FIGS. 397-399 illustrate another surgical stapler having a cutting blade 19100 and cutting edge 19108, a first tissue thickness compensator 19120, and a second tissue thickness compensator 19122. FIG. The first tissue thickness compensator 19120 can include a first material S and a second material S '. For example, the first substance S can be included in the first inclusion body described above. The second substance S 'can be carried in a second enclosure that can be adjacent to and / or surrounding the first enclosure. The second tissue thickness compensator 19122 can include a third material S ″. The second tissue thickness compensator 1922 may include a fourth material S ′ ″. The third substance S "and the fourth substance S" "can be carried in an enclosure such as the enclosure described above. The blade 19100 may have a non-smoothed surface 19110 on its first side 19102 on which the materials S, S ′, S ″, and S ″ ″ can spread. Another non-smoothed surface can also be provided on the second side (not shown) opposite the blade 19100. The non-smoothed surface 19110 can include a series of obstructing structures, such as grooves formed, for example, by cutting, notching, etching, and / or some other method in the first surface 19102. Such blocking structures may also include a series of raised structures, such as raised ridges on the first surface 19102, for example. As shown in FIGS. 397-399, the obstructing structure of the non-smoothed surface 19110 can include a regularly repeating pattern of obstructing structures. Such disturbing structures can be arranged as a non-repeating pattern or randomly arranged.

  The blade 19100 can further include a second surface 19104 disposed proximal to the first surface 19102. The second surface 19104 may be raised with respect to the first surface 19102. The joint between the first surface 19102 and the second surface 19104 can define a third surface 19106, in which case the third surface 19106 is predetermined relative to the longitudinal axis of the blade 19100. Can be arranged at an angle of Movement of the blade 19100 in the distal direction D causes the first end 19107 of the third surface 19106 to go ahead of the second end 10109 of the third surface 19106. As a result, as shown in FIG. 399, the third surface 19106 will guide the substances S and S ″ from the first tissue thickness compensator 19120 in the direction of the cut tissue T. A surface 19105 similar to the second surface 19104 can be provided on the second side opposite the blade 19100.

  The blade 19100 shown in FIGS. 397-399 can be used in a surgical device having first and second tissue thickness compensators 19004 and 19006 shown in FIGS. 390-396. As noted above, the non-smoothed surface 19110 disperses the materials S and S ′ from each of the tissue thickness compensators 19004 and 19006 onto the first surface 19102 of the blade, thereby mixing the materials. And can be placed near tissue T.

  The blade 19100 shown in FIGS. 397-399 can also be used in a surgical device having a first tissue thickness compensator 19120 and a second tissue thickness compensator 19122 shown in FIGS. 397-399. The first tissue thickness compensator 19120 can have an inner portion 19121 that includes the first substance S. Substance S can be released from the inner portion 19121 when the first tissue thickness compensator 19120 is cut by the cutting edge 19108 of the blade 19100. As the blade 19100 moves relative to the tissue thickness compensator 19120, the material S spreads over the non-smoothed surface 19110 and the third surface 19106 can guide the material S in the direction of the tissue T. As noted above, the first tissue thickness compensator 19120 can include a second material S ′ outside the inner portion 19121. When the first tissue thickness compensator 19120 is cut by the cutting edge 19108 of the blade 19100, both the first material S and the second material S 'can be dispersed on the non-smoothed surface 19110. Due to the dispersion on the non-smoothed surface 19110, the first substance S and the second substance S 'can be mixed. When the first substance S and the second substance S ′ are mixed, they can react by, for example, a chemical reaction to generate a new substance. A third surface 19106 can guide the first substance S and the second substance S 'in the direction of the tissue. As noted above, the second tissue thickness compensator 19122 can include a third material S ″. When the second tissue thickness compensator 19122 is cut by the cutting edge 19108 of the blade 19100, the third material S '' is dispersed on the non-smoothed surface 19110, where the first material S and / or the first material S The two substances S ′ can be mixed and guided in the direction of the tissue T. As noted above, the second tissue thickness compensator 19122 may include a fourth material S '' '. When the second tissue thickness compensator 19122 is cut by the cutting edge 19108 of the blade 19100, the third material S ″ and the fourth material S ′ ″ are dispersed on the non-smoothed surface 19110, where The first substance S, the second substance S ′ and / or can be mixed with each other and guided in the direction of the tissue T.

  In addition to the above, the tissue thickness compensator can be composed of a biocompatible material. Biocompatible materials, such as foams, are made by including tackifiers, surfactants, fillers, crosslinkers, pigments, dyes, antioxidants and other stabilizers, and / or combinations thereof. Can be given the desired properties. The biocompatible foam material may include a surfactant. Surfactants can be applied to the surface of the material and / or dispersed within the material. While not wishing to be bound by any particular theory, it is believed that the surfactant applied to the biocompatible material reduces the surface tension of the liquid in contact with the material. For example, surfactants are believed to accelerate water penetration into the material by reducing the surface tension of water in contact with the material. Water acts as a catalyst. Surfactants can increase the hydrophilicity of the material.

  Surfactants can include anionic surfactants, cationic surfactants, and / or nonionic surfactants. Examples of surfactants include, but are not limited to, polyacrylic acid, methalose, methylcellulose, ethylcellulose, propylcellulose, hydroxyethylcellulose, carboxymethylcellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl Ether, polyoxyethylene octyl ether, polyoxyethylene octyl phenyl ether, polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, dialkylphenoxy poly (ethyleneoxy) ethanol , And polyoxamers, and combinations thereof. The surfactant may comprise a copolymer of polyethylene glycol and polypropylene glycol. The surfactant may include a phospholipid surfactant. Phospholipid surfactants can provide antimicrobial stabilizing properties and / or disperse other materials in the biocompatible material.

  The tissue thickness compensator can include at least one drug. The tissue thickness compensator can include one or more natural materials, non-synthetic materials, and / or synthetic materials as described herein. The tissue thickness compensator comprises a biocompatible foam comprising gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, polylactic acid, polydioxanone, polyhydroxyalkanoate, polygrecapron, and combinations thereof. May be included. The tissue thickness compensator can include a film containing the at least one drug. The tissue thickness compensator can include a biodegradable film containing the at least one drug. The medicament can include a liquid, a gel, and / or a powder. The drug can include an anticancer drug such as cisplatin, mitomycin, and / or adriamycin.

  The tissue thickness compensator can include a biodegradable material that allows controlled elution of the at least one drug as the biodegradable material degrades. Biodegradable materials degrade, degrade, or lose structural integrity when contacted with an activator, such as an activation liquid. The activation liquid can include, for example, saline or any other electrolyte. The biodegradable material can be contacted with the activation liquid by conventional methods including, but not limited to, spraying, dipping, and / or brushing. In use, for example, a surgeon activates an end effector and / or staple cartridge having a tissue thickness compensator containing the at least one agent, including a salt solution such as sodium chloride, calcium chloride, and / or potassium chloride. It can be immersed in the liquid. The tissue thickness compensator can release the drug as the tissue thickness compensator degrades. Drug elution from the tissue thickness compensator can be characterized by a rapid initial dissolution rate and a slower sustained dissolution rate.

  According to the present invention, the tissue thickness compensator can be comprised of a biocompatible material that can include, for example, an oxidizing agent. The oxidizing agent may be an organic peroxide and / or an inorganic peroxide. Examples of oxidants include, but are not limited to, hydrogen peroxide, urea peroxide, calcium peroxide, magnesium peroxide, and sodium percarbonate. The oxidant may include peroxygen and hypohalite oxidants such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodite, and percarbonate. Oxidizing agents can include alkali metal chlorites, hypochlorites, and perborates, such as sodium chlorite, sodium hypochlorite, and sodium perborate. The oxidizing agent may include vanadate. The oxidizing agent may include ascorbic acid. The oxidizing agent may include an active oxygen generator. In accordance with the present invention, the tissue scaffold can include a biocompatible material that includes an oxidizing agent.

  The biocompatible material can include a liquid, a gel, and / or a powder. The oxidizing agent can include, for example, microparticles and / or nanoparticles. For example, the oxidizing agent can be pulverized into microparticles and / or nanoparticles. The oxidizing agent can be incorporated into the biocompatible material by suspending the oxidizing agent in the polymer solution. The oxidizing agent can also be incorporated into the biocompatible material during the lyophilization process. After lyophilization, the oxidant can be allowed to interact with the tissue upon contact by attaching it to the cell wall of the biocompatible material. The oxidizing agent may not be chemically bonded to the biocompatible material. By embedding a percarbonate dry powder in a biocompatible foam, a long-term biological effect can be provided by sustained release of oxygen. By embedding the percarbonate dry powder in polymer fibers in a nonwoven structure, a long-term biological effect can be provided by sustained release of oxygen. The biocompatible material can include oxidizing agents and agents such as doxycycline and ascorbic acid.

  The biocompatible material can include an oxidizing agent that is released quickly and / or an oxidizing agent that is released more slowly and sustainably. The elution of the oxidant from the biocompatible material can be characterized by a rapid initial dissolution rate and a slower sustained dissolution rate. The oxidizing agent may generate oxygen when it comes into contact with a body fluid such as water. Examples of body fluids include, but are not limited to, blood, plasma, peritoneal fluid, cerebrospinal fluid, urine, lymph fluid, synovial fluid, vitreous fluid, saliva, gastrointestinal lumen contents, and / or bile. Can be mentioned. While not wishing to be bound by any particular theory, oxidizing agents can reduce cell death, increase tissue viability, and / or be damaged during cutting and / or stapling. It is thought to maintain the mechanical strength of the tissue.

  The biocompatible material can include at least one type of microparticles and / or nanoparticles. The biocompatible material can include one or more natural materials, non-synthetic materials, and / or synthetic materials as described herein. The biocompatible material may include particles μm having an average μm diameter of about 10 nm to about 100 nm, and / or about 10 μm to about 100 μm, such as 45-50 nm and / or 45-50 μm. The μm biocompatible material may include a biocompatible foam with at least one type of microparticles and / or nanoparticles embedded therein. The microparticles and / or nanoparticles may not be chemically bonded to the biocompatible material. Microparticles and / or nanoparticles can provide controlled release of the drug. The microparticles and / or nanoparticles can include at least one drug. The microparticles and / or nanoparticles can include, for example, hemostatic agents, antibacterial agents, and / or oxidizing agents. The tissue thickness compensator can include a biocompatible foam including a hemostatic agent including oxidized regenerated cellulose, an antibacterial agent including doxycycline and / or gentamicin, and / or an oxidizing agent including a percarbant. The microparticles and / or nanoparticles can provide controlled release of the drug over, for example, up to 3 days.

  Microparticles and / or nanoparticles can be embedded in a biocompatible material in the manufacturing process. For example, a biocompatible polymer such as PGA / PCL can be contacted with a solvent such as dioxane to form a mixture. The biocompatible polymer can also be pulverized to form particles. Dry particles with or without ORC particles can be contacted with this mixture to form a suspension. By lyophilizing this suspension, a biocompatible foam comprising PGA / PCL with embedded dry particles and / or ORC particles can be formed.

  The tissue thickness compensator or layer disclosed herein can be comprised of, for example, an absorbent polymer. The tissue thickness compensator is, for example, foam, film, fibrous woven fabric, fibrous nonwoven fabric PGA, PGA / PCL (poly (glycolic acid-co-caprolactone)), PLA / PCL (poly (lactic acid-co-polycaprolactone). )), PLLA / PCL, PGA / TMC (poly (glycolic acid-co-trimethylene carbonate)), PDS, PEPBO or other absorbent polyurethane, polyester, polycarbonate, polyorthoester, polyanhydride, polyesteramide, and It can be composed of / or a polyoxaester. According to the present invention, the tissue thickness compensator comprises, for example, PGA / PLA (poly (glycolic acid-co-lactic acid)) and / or PDS / PLA (poly (p-dioxanone-co-lactic acid)). Can do. According to the present invention, the tissue thickness compensator can be composed of, for example, an organic material. The tissue thickness compensator can be composed of, for example, carboxymethylcellulose, sodium alginate, crosslinked hyaluronic acid, and / or oxidized regenerated cellulose. According to the present invention, the tissue thickness compensator may have a durometer in the range of Shore A = 3-7 (Shore OO = 30-50), for example, with a maximum hardness of Shore A = 15 (Shore OO). = 65). The tissue thickness compensator is, for example, 40% compressibility under a load of 13N (3 lbf), 60% compressibility under a load of 27N (6 lbf), and / or 80% under a load of 89 N (20 lbf). Can indicate compression ratio. For example, one or more gases such as air, nitrogen, carbon dioxide, and / or oxygen can be passed through and / or contained within the tissue thickness compensator. The tissue thickness compensator can include beads that comprise about 50% to about 75% of the material hardness that makes up the tissue thickness compensator.

  In accordance with the present invention, tissue thickness compensators are, for example, hyaluronic acid, nutrients, fibrin, thrombin, high platelet plasma, sulfasalazine (Asalphidin® 5ASA + sulfapyridine diazo linkage))-prodrug-colon bacteria (azo) Reductase), mesalamine (5ASA with different prodrug forms for delayed release), Asacol® (5ASA + Eudragit-S coated-pH> 7 (coating dissolution)), Pentasa® (5ASA + ethylcellulose) Coated-time / pH-dependent sustained release), Mesasar (registered trademark) (5ASA + Eudragit-L coated-pH> 6), olsalazine (5ASA + 5ASA-colonic bacteria (azoreductase)), val Razide (5ASA + 4 aminobenzoyl-B-alanine) -colon bacteria (azoreductase)), granulated mesalamine, rialda (mesalamine delayed and SR formulation), HMPL-004 (TNF-α, interleukin-1β, and nucleus-κB) Herbal mixture that can inhibit activation), CCX282-B (oral chemokine receptor antagonist that inhibits migration of T lymphocytes into the intestinal mucosa), rifaximin (non-absorbable broad spectrum antibiotic), infliximab, mouse chimeric antibody (Chymieric) (TNF-α approved for relief of signs / symptoms and maintenance of clinical remission in adult / pediatric patients with moderate / severe lumen and fistula Crohn's disease with inadequate response to conventional treatment Monoclonal antibody targeting), adalimumab, all human IgG1 ( Induction of clinical remission in adult patients with moderate / severe active Crohn's disease with reduced signs / symptoms of Crohn's disease and with inadequate response to conventional treatment or intolerance to infliximab And anti-TNF-α monoclonal antibody approved for maintenance), Sertolizumab Pegor, humanized anti-TNF FAB ′ (for reduction in signs / symptoms of Crohn's disease or in response to conventional therapy) Approved for the induction and maintenance of responses in adult patients with severe / severe disease, monoclonal antibody fragments conjugated to polyethylene glycol), natalizumab, first non-TNF-α inhibitor (biological approved for Crohn's disease) Compound), humanized monoclonal IgG4 antibody (targeting α4 integrin) . About the induction and maintenance of clinical response and remission in patients with moderate / severe disease who have evidence of inflammation and who have inadequate or resistant resistance to traditional Crohn's disease treatment and inhibitors of TNFα Approved by the FDA. ), Co-administered immunomodulators that can be used in combination with infliximab, azathioprine 6-mercaptopurine (purine synthesis inhibitor-prodrug), methotrexate (dihydrofolate reductase (DHFR) enzyme involved in tetrehydrofolate synthesis), Inhibit purine synthesis), allopurinol and thiopurine therapy, PPI, acid suppressive H2, C-Diff-Frazil, vancomycin (fecal translocation treatment; probiotics; normal Re-growth of intestinal flora) and / or rifaximin (treatment of bacterial overgrowth (especially hepatic encephalopathy), not absorbed in the gastrointestinal tract and acting on intestinal bacteria).

  As described herein, the tissue thickness compensator can compensate for changes in the thickness of tissue captured in and / or contained within staples ejected from, for example, a staple cartridge. it can. In other words, a particular staple in a staple row can capture a thick portion of tissue, while other staples in that staple row can capture a thin portion of tissue. In such a situation, the tissue thickness compensator can take on different heights and thicknesses within the staple and provides constant compression to the tissue captured within the staple, regardless of whether the captured tissue is thick or thin. You can apply power. According to the present invention, the tissue thickness compensator can compensate for changes in tissue hardness. For example, a particular staple in a staple row may capture a more compressible portion of tissue while other staples in that staple row may capture a less compressible portion of tissue. . In such a situation, the tissue thickness compensator has a less compressible or higher hardness than, for example, in a staple that has captured tissue that is more compressible or less rigid. However, it can be configured to take a smaller height within a staple having a corresponding higher height. In any case, the tissue thickness compensator may be referred to as, for example, “tissue compensator” and / or “compensator”, for example, regardless of whether it compensates for changes in tissue thickness and / or changes in tissue hardness. it can.

  The devices disclosed herein can be designed to be discarded after a single use, or designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning may include any combination of equipment disassembly steps, followed by cleaning steps or specific part replacement steps, and subsequent reassembly steps. In particular, the device can be disassembled, and any number of the particular parts or members of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular members, the device can be reassembled at a reconditioning facility or by a surgical team immediately prior to a surgical procedure and then used for subsequent use. One skilled in the art will recognize that various techniques for disassembly, cleaning / replacement, and reassembly can be used to recondition the device. The use of such techniques, and the resulting reconditioned device, are all within the scope of this application.

  Preferably, the invention described herein is processed before surgery. First, a new or used instrument is obtained and cleaned as necessary. The instrument can then be sterilized. In one sterilization method, the instrument is placed in a closed and sealed container such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high energy electron beams. This radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

  Any patent publication or other disclosure that is incorporated by reference herein, in whole or in part, is the existing definition, description, or other disclosure that is incorporated in this disclosure. To the extent that they do not contradict each other. As such, and to the extent necessary, the disclosure expressly set forth herein shall supersede any conflicting content incorporated herein by reference. All content, or portions thereof, which is incorporated herein by reference but which contradicts existing definitions, views, or other disclosures contained herein, is incorporated herein by reference. It shall be incorporated only to the extent that no contradiction arises between the existing disclosure content.

  While the present invention has been described as having an exemplary configuration, the present invention can be further modified within the spirit and scope of the present disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Furthermore, this application is intended to cover developments from the present disclosure that are known in the technical fields to which the invention pertains or are included in conventional implementations.

Embodiment
(1) A disposable loading unit for a surgical stapler having an anvil,
A housing assembly;
A staple cartridge assembly having a staple cartridge body defining a staple deck and a slot, and further comprising a tissue thickness compensator disposed adjacent to the staple deck, wherein the tissue thickness compensator includes a substance therein. A staple cartridge assembly;
A knife assembly disposed within the housing assembly and disposed to move relative to the staple cartridge assembly along the slot;
A cutting surface configured to cut the tissue thickness compensator captured between the staple cartridge assembly and an anvil of the surgical stapler as the knife assembly moves relative to the cartridge assembly;
An interaction surface disposed relative to the cutting surface and configured to guide at least a portion of the material in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. A disposable loading unit having a knife assembly having an interaction surface.
(2) the knife assembly further comprises a blade, the cutting surface is defined on the blade, the blade defines a first surface and a second surface opposite the first surface; The disposable loading unit according to embodiment 1, wherein the first surface comprises the interacting surface.
(3) The disposable loading unit according to embodiment 2, wherein the interaction surface has a raised portion raised on the first surface of the blade.
(4) The disposable loading unit according to embodiment 2 or 3, wherein the interaction surface has a groove in the first surface of the blade.
(5) the interaction surface is a first interaction surface, and the second surface of the knife assembly further includes a second interaction surface disposed with respect to the cutting surface; Embodiments according to any of embodiments 2-4, wherein the interaction surface is configured to guide at least a portion of the material in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. The disposable loading unit as described.

(6) The disposable loading unit according to embodiment 5, wherein the second interaction surface has a raised portion raised on the second surface of the blade.
(7) The disposable loading unit according to embodiment 5 or embodiment 6, wherein the second interaction surface has a groove in the second surface of the blade.
(8) The tissue thickness compensator is a first tissue thickness compensator, the substance is a first substance, the interaction surface is a first interaction surface, and the disposable loading unit further comprises:
A second tissue thickness compensator configured to be disposed adjacent to the anvil of the surgical stapler, the second tissue thickness compensator including a second substance therein;
A second interactive surface disposed relative to the cutting surface, wherein at least one of the second materials in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. A disposable loading unit according to any of embodiments 1-4, comprising a second interaction surface configured to guide the part.
(9) the knife assembly further comprises a blade, the blade has the cutting surface, the blade defines a first surface and a second surface opposite the first surface; First and second interacting surfaces are disposed on the first surface of the blade, and the second surface is
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. 3 interaction surfaces;
A second one disposed against the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly; 9. The disposable loading unit according to embodiment 8, comprising 4 interacting surfaces.
(10) The disposable loading unit according to embodiment 8 or 9, wherein the first substance is different from the second substance.

11. The disposable according to any of embodiments 1-10, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a textured surface. Loading unit.
(12) a surgical stapler,
A handle,
A trigger configured to move between a non-actuated position and an actuated position;
A staple cartridge operably coupled to the trigger, the staple cartridge defining a staple deck and a slot;
An anvil operatively coupled to the handle, the anvil having at least one staple forming surface;
A tissue thickness compensator disposed relative to the staple deck and the anvil, the tissue thickness compensator including a substance therein;
A knife assembly arranged to move relative to the staple cartridge along the slot, the cutting surface configured to cut the tissue thickness compensator arranged relative to the staple cartridge and the anvil. A knife assembly further comprising a guide disposed with respect to the cutting surface, the guide in the tissue thickness compensator as the knife assembly moves relative to the staple cartridge. A surgical stapler configured to guide at least a portion of a substance.
(13) the knife assembly further comprises a blade, the cutting surface is defined on the blade, the blade defining a first surface and a second surface opposite the first surface; The surgical stapler according to embodiment 12, wherein the first surface comprises the guide.
(14) The surgical stapler according to embodiment 13, wherein the guide has a raised portion raised on the first surface of the blade.
(15) The surgical stapler according to embodiment 13 or 14, wherein the guide has a groove in the first surface of the blade.

(16) The guide is a first guide, and the second surface of the knife assembly further includes:
A second guide disposed relative to the cutting surface and configured to guide at least a portion of the substance in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. The surgical stapler according to any of embodiments 13-15, further comprising a second guide.
17. The surgical stapler according to embodiment 16, wherein the second guide has a raised portion raised on the second surface of the blade.
(18) The surgical stapler according to embodiment 16 or 17, wherein the second guide has a groove in the second surface of the blade.
(19) The tissue thickness compensator is a first tissue thickness compensator disposed with respect to the staple deck, the substance is a first substance, the guide is a first guide, The surgical stapler further includes a second tissue thickness compensator disposed with respect to the anvil, the second tissue thickness compensator including a second material therein, and the knife assembly includes the cutting surface. A second guide disposed with respect to the second material, wherein the second guide is configured to guide at least a portion of the second material in the second tissue thickness compensator. The surgical stapler according to any one of aspects 12 to 15.
(20) The knife assembly further includes:
A blade defining a cutting surface and defining a first surface and a second surface opposite the first surface, wherein the first surface is the first guide and the second guide; The second surface comprising:
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the staple cartridge. 3 guides,
A second one disposed with respect to the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the staple cartridge. Embodiment 20. The surgical stapler according to embodiment 19, comprising four guides.

(21) The surgical stapler according to embodiment 19 or 20, wherein the first substance is different from the second substance.
The surgical stapler according to any of embodiments 12-21, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a non-smoothed surface.

Claims (22)

A disposable loading unit for a surgical stapler having an anvil,
A housing assembly;
A staple cartridge assembly having a staple cartridge body defining a staple deck and a slot, and further comprising a tissue thickness compensator disposed adjacent to the staple deck, wherein the tissue thickness compensator includes a substance therein. A staple cartridge assembly;
A knife assembly disposed within the housing assembly and disposed to move relative to the staple cartridge assembly along the slot;
A cutting surface configured to cut the tissue thickness compensator captured between the staple cartridge assembly and an anvil of the surgical stapler as the knife assembly moves relative to the cartridge assembly;
An interaction surface disposed relative to the cutting surface and configured to guide at least a portion of the material in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. A disposable loading unit having a knife assembly having an interaction surface.   The knife assembly further includes a blade, the cutting surface is defined on the blade, the blade defines a first surface and a second surface opposite the first surface, the first The disposable loading unit of claim 1, wherein a surface of said comprises the interacting surface.   The disposable loading unit of claim 2, wherein the interacting surface has a raised portion raised on the first surface of the blade.   4. A disposable loading unit according to claim 2 or 3, wherein the interacting surface has a groove in the first surface of the blade.   The interaction surface is a first interaction surface, and the second surface of the knife assembly further comprises a second interaction surface disposed relative to the cutting surface, the second interaction The surface of claim 2, wherein a surface is configured to guide at least a portion of the material in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. Disposable loading unit.   6. The disposable loading unit of claim 5, wherein the second interactive surface has a raised portion that is raised on the second surface of the blade.   7. A disposable loading unit according to claim 5 or claim 6, wherein the second interactive surface has a groove in the second surface of the blade. The tissue thickness compensator is a first tissue thickness compensator, the material is a first material, the interaction surface is a first interaction surface, and the disposable loading unit further comprises:
A second tissue thickness compensator configured to be disposed adjacent to the anvil of the surgical stapler, the second tissue thickness compensator including a second substance therein;
A second interactive surface disposed relative to the cutting surface, wherein at least one of the second materials in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. A disposable loading unit according to any one of claims 1 to 4, having a second interaction surface configured to guide the part. The knife assembly further comprises a blade, the blade has the cutting surface, the blade defines a first surface and a second surface opposite the first surface, the first and A second interaction surface is disposed on the first surface of the blade, and the second surface is
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. 3 interaction surfaces;
A second one disposed against the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the cartridge assembly; The disposable loading unit of claim 8, comprising four interacting surfaces.   The disposable loading unit according to claim 8 or 9, wherein the first substance is different from the second substance.   11. A disposable loading unit according to any preceding claim, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a non-smoothed surface. A surgical stapler,
A handle,
A trigger configured to move between a non-actuated position and an actuated position;
A staple cartridge operably coupled to the trigger, the staple cartridge defining a staple deck and a slot;
An anvil operatively coupled to the handle, the anvil having at least one staple forming surface;
A tissue thickness compensator disposed relative to the staple deck and the anvil, the tissue thickness compensator including a substance therein;
A knife assembly arranged to move relative to the staple cartridge along the slot, the cutting surface configured to cut the tissue thickness compensator arranged relative to the staple cartridge and the anvil. A knife assembly further comprising a guide disposed with respect to the cutting surface, the guide in the tissue thickness compensator as the knife assembly moves relative to the staple cartridge. A surgical stapler configured to guide at least a portion of a substance.   The knife assembly further includes a blade, the cutting surface is defined on the blade, the blade defines a first surface and a second surface opposite the first surface, the first The surgical stapler according to claim 12, wherein a surface of the surgical staple includes the guide.   The surgical stapler according to claim 13, wherein the guide has a raised portion raised on the first surface of the blade.   The surgical stapler according to claim 13 or 14, wherein the guide has a groove in the first surface of the blade. The guide is a first guide, and the second surface of the knife assembly further comprises:
A second guide disposed relative to the cutting surface and configured to guide at least a portion of the substance in the tissue thickness compensator as the knife assembly moves relative to the cartridge assembly. The surgical stapler according to any one of claims 13 to 15, further comprising a second guide.   The surgical stapler according to claim 16, wherein the second guide has a raised portion raised on the second surface of the blade.   The surgical stapler according to claim 16 or 17, wherein the second guide has a groove in the second surface of the blade.   The tissue thickness compensator is a first tissue thickness compensator disposed with respect to the staple deck, the material is a first material, the guide is a first guide, and the surgical stapler Further comprises a second tissue thickness compensator disposed with respect to the anvil, the second tissue thickness compensator including a second substance therein, and the knife assembly with respect to the cutting surface The method further comprising: a second guide disposed, wherein the second guide is configured to guide at least a portion of the second material in the second tissue thickness compensator. The surgical stapler according to any one of 15. The knife assembly further comprises:
A blade defining a cutting surface and defining a first surface and a second surface opposite the first surface, wherein the first surface is the first guide and the second guide; The second surface comprising:
A first disposed with respect to the cutting surface and configured to guide at least a portion of the first material in the first tissue thickness compensator as the knife assembly moves relative to the staple cartridge. 3 guides,
A second one disposed with respect to the cutting surface and configured to guide at least a portion of the second material in the second tissue thickness compensator as the knife assembly moves relative to the staple cartridge. The surgical stapler of claim 19, comprising: 4 guides.   The surgical stapler according to claim 19 or 20, wherein the first material is different from the second material.   The surgical stapler according to any one of claims 12 to 21, wherein the knife assembly further comprises a blade, the cutting surface is defined on the blade, and the blade has a non-smoothed surface.

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