JP2018531074A6 - 中間支持構造を有する圧縮性補助材 - Google Patents
中間支持構造を有する圧縮性補助材 Download PDFInfo
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Abstract
ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材が、第1の生体適合性層と、第1の生体適合性層から離間された第2の生体適合性層と、第1の生体適合性層と第2の生体適合性層との間に延びる複数の支持支柱と、を含む。
Description
本開示は、外科用器具に関し、また様々な構成において、組織をステープル留め及び切断するように設計された、外科用ステープル留め及び切断器具、並びにそれらと共に使用するためのステープルカートリッジに関する。
添付の特許請求の範囲において、様々な実施形態の特徴を詳細に記載する。しかしながら、様々な実施形態は、その構成及び動作方法の両方に関して、それらの利点と共に、以下の説明文を添付図面と併せて参照することで最もよく理解することができる。
ハンドルと、ハンドルから延びるシャフトと、アンビル及びステープルカートリッジを含めて延びるエンドエフェクタとを備える外科用ステープル留め及び切断器具の斜視図を示す。
図1の外科用ステープル留め及び切断器具のステープルカートリッジのウェッジスレッドの斜視図である。
図1の外科用ステープル留め及び切断器具の2個構成のナイフ及び発射バー(「Eビーム」)の斜視図である。
ステープルが発射シーケンス中に未発射位置から発射済み位置へと移動した状態を示す、閉位置にあるアンビルと、硬質支持部を備えるステープルカートリッジと、圧縮性補助材との長手方向断面図である。
発射シーケンスが完了した後の開放位置にあるアンビルを示す、図4のアンビル及びステープルカートリッジの別の断面図である。
少なくとも1つの実施形態による圧縮性補助材を備えるステープルカートリッジアセンブリの部分斜視図である。
少なくとも1つのステープルによって組織に対して埋め込まれた、図6の補助材の部分斜視図である。
少なくも1つの実施形態による、少なくとも1つのステープルによって組織に対して埋め込まれた代替的な圧縮性補助材の部分斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの部分斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの部分斜視図である。
少なくとも1つの実施形態による、少なくとも1つのステープルによって組織に対して埋め込まれた代替的な圧縮性補助材の部分斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの部分断面図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの部分断面図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの部分断面図である。
少なくとも1つの実施形態による代替的な圧縮性補助材の部分斜視図である。
ステープルカートリッジのカートリッジデッキに対して配置された、図13の圧縮性補助材の斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材の部分斜視図である。
少なくとも1つの実施形態による圧縮性補助材の部分斜視図である。
図17の圧縮性補助材の断面図である。
図18の断面図の詳細図である。
少なくとも1つの実施形態による圧縮性補助材を備えるステープルカートリッジアセンブリの斜視図である。
図20のステープルカートリッジアセンブリの別の斜視図である。
図20のステープルカートリッジアセンブリの別の斜視図である。
少なくとも1つの実施形態による圧縮性補助材の部分斜視図である。
少なくとも1つの実施形態によるステープルカートリッジアセンブリの部分断面図である。
少なくとも一実施形態による、ステープルカートリッジのステープルキャビティに挿入された固定部材の部分断面図である。
少なくとも1つの実施形態による圧縮性補助材の部分断面図である。
少なくとも1つの実施形態による圧縮性補助材の部分断面図である。
少なくとも1つの実施形態による、少なくとも1つのステープルによって組織に対して埋め込まれた代替的な圧縮性補助材の部分斜視図である。
圧縮のない図28の圧縮性補助材の部分断面図である。
圧縮下における図29の部分断面図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの斜視図である。
少なくとも1つの実施形態による代替的な圧縮性補助材を備えるステープルカートリッジアセンブリの斜視図である。
少なくとも1つの実施形態による埋め込み可能な補助材を備えるステープルカートリッジアセンブリの部分斜視図である。
少なくとも1つのステープルによって組織に対して埋め込まれた、図33の補助材の部分斜視図である。
少なくとも1つの実施形態による埋め込み可能な補助材の部分斜視図である。
少なくとも1つの代替的な実施形態による埋め込み可能な補助材の部分斜視図である。
図36の埋め込み可能な補助材の部分立面図である。
少なくとも1つの実施形態によるループ結びの詳細図である。
少なくとも1つの実施形態による、図35の補助材によって利用されるループ結びの詳細図である。
図35の埋め込み可能な補助材の部分立面図である。
本明細書で説明される少なくとも1つの実施形態による、複数の起立繊維を含む圧縮性補助材の部分断面図である。
本明細書で説明される少なくとも1つの実施形態による、複数の起立繊維を含む圧縮性補助材の部分断面図である。
本明細書で説明される少なくとも1つの実施形態による、少なくとも1つのステープルによって組織に対して埋め込まれた圧縮性補助材の部分斜視図である。
本明細書で説明される少なくとも1つの代替的実施形態による繊維の部分斜視図である。
本明細書で説明される少なくとも1つの実施形態による繊維の部分斜視図である。
本明細書で説明される少なくとも1つの実施形態による圧縮性補助材の部分斜視図である。
複数の図面を通して、対応する参照符号は対応する部分を示す。本明細書に記載される例示は、本発明の様々な実施形態を1つの形態で例示するものであり、かかる例示は、いかなる方法によっても本発明の範囲を限定するものとして解釈されるべきではない。
本願の出願人は、本願と同日に出願された以下の米国特許出願を所有しており、これらはそれぞれのすべての内容が参照により本明細書に援用される:
米国特許出願第_______号、発明の名称「IMPLANTABLE LAYER COMPRISING PLASTICALLY DEFORMED FIBERS」、代理人整理番号第END7646USNP/150081号、
米国特許出願第_______号、発明の名称「IMPLANTABLE LAYER COMPRISING A CONSTRICTED CONFIGURATION」、代理人整理番号第END7647USNP/150082号、
米国特許出願第_______号、発明の名称「TUBULAR ABSORBABLE CONSTRUCTS」、代理人整理番号第END7648USNP/150083号、
米国特許出願第_______号、発明の名称「IMPLANTABLE ADJUNCT COMPRISING BONDED LAYERS」、代理人整理番号第END7649USNP/150084号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCTS WITH BONDING NODES」、代理人整理番号第END7650USNP/150085号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH CROSSING SPACER FIBERS」、代理人整理番号第END7652USNP/150087号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH LOOPING MEMBERS」、代理人整理番号第END7653USNP/150088号、
米国特許出願第_______号、発明の名称「WOVEN CONSTRUCTS WITH INTERLOCKED STANDING FIBERS」、代理人整理番号第END7654USNP/150089号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT AND METHODS FOR MAKING THE SAME」、代理人整理番号第END7655USNP/150090号、
米国特許出願第_______号、発明の名称「METHOD FOR APPLYING AN IMPLANTABLE LAYER TO A FASTENER CARTRIDGE」、代理人整理番号第END7656USNP/150091号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH ATTACHMENT REGIONS」、代理人整理番号第END7657USNP/150092号、
米国特許出願第_______号、発明の名称「PROGRESSIVELY RELEASABLE IMPLANTABLE ADJUNCT FOR USE WITH A SURGICAL STAPLING INSTRUMENT」、代理人整理番号第END7658USNP/150093号、及び、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT ASSEMBLIES WITH ATTACHMENT LAYERS」、代理人整理番号第END7659USNP/150094号。
米国特許出願第_______号、発明の名称「IMPLANTABLE LAYER COMPRISING PLASTICALLY DEFORMED FIBERS」、代理人整理番号第END7646USNP/150081号、
米国特許出願第_______号、発明の名称「IMPLANTABLE LAYER COMPRISING A CONSTRICTED CONFIGURATION」、代理人整理番号第END7647USNP/150082号、
米国特許出願第_______号、発明の名称「TUBULAR ABSORBABLE CONSTRUCTS」、代理人整理番号第END7648USNP/150083号、
米国特許出願第_______号、発明の名称「IMPLANTABLE ADJUNCT COMPRISING BONDED LAYERS」、代理人整理番号第END7649USNP/150084号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCTS WITH BONDING NODES」、代理人整理番号第END7650USNP/150085号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH CROSSING SPACER FIBERS」、代理人整理番号第END7652USNP/150087号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH LOOPING MEMBERS」、代理人整理番号第END7653USNP/150088号、
米国特許出願第_______号、発明の名称「WOVEN CONSTRUCTS WITH INTERLOCKED STANDING FIBERS」、代理人整理番号第END7654USNP/150089号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT AND METHODS FOR MAKING THE SAME」、代理人整理番号第END7655USNP/150090号、
米国特許出願第_______号、発明の名称「METHOD FOR APPLYING AN IMPLANTABLE LAYER TO A FASTENER CARTRIDGE」、代理人整理番号第END7656USNP/150091号、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT WITH ATTACHMENT REGIONS」、代理人整理番号第END7657USNP/150092号、
米国特許出願第_______号、発明の名称「PROGRESSIVELY RELEASABLE IMPLANTABLE ADJUNCT FOR USE WITH A SURGICAL STAPLING INSTRUMENT」、代理人整理番号第END7658USNP/150093号、及び、
米国特許出願第_______号、発明の名称「COMPRESSIBLE ADJUNCT ASSEMBLIES WITH ATTACHMENT LAYERS」、代理人整理番号第END7659USNP/150094号。
本発明の出願人はまた、以下に示す米国特許出願を所有しており、これらはそれぞれのすべての内容が参照により本明細書に援用される
「SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS」と題された米国特許出願第12/894,311号(現在の米国特許第8,763,877号)、
「SURGICAL STAPLE CARTRIDGES SUPPORTING NON−LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE−FORMING POCKETS」と題された米国特許出願第12/894,340号(現在の米国特許第8,899,463号)、
「JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS」と題された米国特許出願第12/894,327号(現在の米国特許第8,978,956号)、
「SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS」と題された米国特許出願第12/894,351号(現在の米国特許第9,113,864号)、
「IMPLANTABLE FASTENER CARTRIDGE HAVING A NON−UNIFORM ARRANGEMENT」と題された米国特許出願第12/894,338号(現在の米国特許第8,864,007号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER」と題された米国特許出願第12/894,369号(現在の米国特許出願公開第2012/0080344号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS」と題された米国特許出願第12/894,312号(現在の米国特許第8,925,782号)、
「SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,377号(現在の米国特許第8,393,514号)、
「SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT」と題された米国特許出願第12/894,339号(現在の米国特許第8,840,003号)、
「SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM」と題された米国特許出願第12/894,360号(現在の米国特許第9,113,862号)、
「SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS」と題された米国特許出願第12/894,322号(現在の米国特許第8,740,034号)、
「SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES」と題された米国特許出願第12/894,350号(現在の米国特許出願公開第2012/0080478号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS」と題された米国特許出願第12/894,383号(現在の米国特許第8,752,699号)、
「COMPRESSIBLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,389号(現在の米国特許第8,740,037号)、
「FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT」と題された米国特許出願第12/894,345号、(現在の米国特許第8,783,542号)、
「COLLAPSIBLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,306号、(現在の米国特許第9,044,227号)、
「FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS」と題された米国特許出願第12/894,318号(現在の米国特許第8,814,024号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX」と題された米国特許出願第12/894,330号(現在の米国特許第8,757,465号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX」と題された米国特許出願第12/894,361号(現在の米国特許第8,529,600号)、
「FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX」と題された米国特許出願第12/894,367号(現在の米国特許第9,033,203号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER」と題された米国特許出願第12/894,388号(現在の米国特許第8,474,677号)、
「FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES」と題された米国特許出願第12/894,376号(現在の米国特許第9,044,228号)、
「SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS」と題された米国特許出願第13/097,865号(現在の米国特許出願公開第2012/0080488号)、
「TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER」と題された米国特許出願第13/097,936号(現在の米国特許第8,657,176号)、
「STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION」と題された米国特許出願第13/097,954号(現在の米国特許出願公開第2012/0080340号)、
「STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF」と題された米国特許出願第13/097,856号(現在の米国特許出願公開第2012/0080336号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS」と題された米国特許出願第13/097,928号(現在の米国特許第8,746,535号)、
「TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL」と題された米国特許出願第13/097,891号(現在の米国特許第8,864,009号)、
「STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION」と題された米国特許出願第13/097,948号(現在の米国特許第8,978,954号)、
「COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY」と題された米国特許出願第13/097,907号(現在の米国特許出願公開第2012/0080338号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES」と題された米国特許出願第13/097,861号(現在の米国特許第9,113,865号)、
「STAPLE CARTRIDGE LOADING ASSEMBLY」と題された米国特許出願第13/097,869号(現在の米国特許第8,857,694号)、
「COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS」と題された米国特許出願第13/097,917号(現在の米国特許第8,777,004号)、
「STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION」と題された米国特許出願第13/097,873号(現在の米国特許第8,740,038号)、
「STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS」と題された米国特許出願第13/097,938号(現在の米国特許第9,016,542号)、
「STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/097,924号(現在の米国特許出願公開第2012/0083835号)、
「SURGICAL STAPLER WITH FLOATING ANVIL」と題された米国特許出願第13/242,029号(現在の米国特許第8,893,949号)、
「CURVED END EFFECTOR FOR A STAPLING INSTRUMENT」と題された米国特許出願第13/242,066号(現在の米国特許出願公開第2012/0080498号)、
「STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK」と題された米国特許出願第13/242,086号(現在の米国特許第9,055,941号)、
「STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT」と題された米国特許出願第13/241,912号(現在の米国特許第9,050,084号)、
「SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS」と題された米国特許出願第13/241,922号(現在の米国特許出願公開第2013/0075449号)、
「SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS」と題された米国特許出願第13/241,637号(現在の米国特許第8,789,741号)、
「SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR」と題された米国特許出願第13/241,629号(現在の米国特許出願公開第2012/0074200号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES」と題された米国特許出願第13/433,096号(現在の米国特許出願公開第2012/0241496号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS」と題された米国特許出願第13/433,103号(現在の米国特許出願公開第2012/0241498号)、
「EXPANDABLE TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,098号(現在の米国特許出願公開第2012/0241491号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR」と題された米国特許出願第13/433,102号(現在の米国特許出願公開第2012/0241497号)、
「RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,114号(現在の米国特許出願公開第2012/0241499号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT」と題された米国特許出願第13/433,136号(現在の米国特許出願公開第2012/0241492号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION」と題された米国特許出願第13/433,141号(現在の米国特許出願公開第2012/0241493号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD」と題された米国特許出願第13/433,144号(現在の米国特許出願公開第2012/0241500号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD」と題された米国特許出願第13/433,148号(現在の米国特許出願公開第2012/0241501号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS」と題された米国特許出願第13/433,155号(現在の米国特許出願公開第2012/0241502号)、
「METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS」と題された米国特許出願第13/433,163号(現在の米国特許出願公開第2012/0248169号)、
「TISSUE THICKNESS COMPENSATORS」と題された米国特許出願第13/433,167号(現在の米国特許出願公開第2012/0241503号)、
「LAYERED TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,175号(現在の米国特許出願公開第2012/0253298号)、
「TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS」と題された米国特許出願第13/433,179号(現在の米国特許出願公開第2012/0241505号)、
「ADHESIVE FILM LAMINATE」と題された米国特許出願第13/763,028号(現在の米国特許出願公開第2013/0146643号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT」と題された米国特許出願第13/433,115号(現在の米国特許出願公開第2013/0256372号)、
「TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS」と題された米国特許出願第13/433,118号(現在の米国特許出願公開第2013/0256365号)、
「MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,135号(現在の米国特許出願公開第2013/0256382号)、
「TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME」と題された米国特許出願第13/433,140号(現在の米国特許出願公開第2013/0256368号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS」と題された米国特許出願第13/433,129号(現在の米国特許出願公開第2013/0256367号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第11/216,562号(現在の米国特許第7,669,746号)、
「SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS」と題された米国特許出願第11/714,049号(現在の米国特許出願公開第2007/0194082号)、
「SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第11/711,979号(現在の米国特許第8,317,070号)、
「SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT」と題された米国特許出願第11/711,975号(現在の米国特許出願公開第2007/0194079号)、
「SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES」と題された米国特許出願第11/711,977号(現在の米国特許第7,673,781号)、
「SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS」と題された米国特許出願第11/712,315号(現在の米国特許第7,500,979号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第12/038,939号(現在の米国特許第7,934,630号)、
「SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第13/020,263号(現在の米国特許第8,636,187号)、
「ROBOTICALLY−CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第13/118,278号(現在の米国特許出願公開第2011/0290851号)、
「ROBOTICALLY−CONTROLLED CABLE−BASED SURGICAL END EFFECTORS」と題された米国特許出願第13/369,629号(現在の米国特許第8,800,838号)、
「SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS」と題された米国特許出願第12/695,359号(現在の米国特許第8,464,923号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第13/072,923号(現在の米国特許第8,567,656号)、
「LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR」と題された米国特許出願第13/766,325号(現在の米国特許出願公開第2013/0256380号)、
「ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR」と題された米国特許出願第13/763,078号(現在の米国特許出願公開第2013/0256383号)、
「LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS」と題された米国特許出願第13/763,094号(現在の米国特許出願公開第2013/0256377号)、
「END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER」と題された米国特許出願第13/763,106号(現在の米国特許出願公開第2013/0256378号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS」と題された米国特許出願第13/433,147号(現在の米国特許出願公開第2013/0256369号)、
「SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES」と題された米国特許出願第13/763,112号(現在の米国特許出願公開第2013/0256379号)、
「ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE」と題された米国特許出願第13/763,035号(現在の米国特許出願公開第2013/0214030号)、
「RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME」と題された米国特許出願第13/763,042号(現在の米国特許出願公開第2013/0221063号)、
「FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,048号(現在の米国特許出願公開第2013/0221064号)、
「FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,054号(現在の米国特許出願公開第2014/0097227号)、
「FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,065号(現在の米国特許出願公開第2013/0221065号)、
「STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER」と題された米国特許出願第13/763,021号(現在の米国特許出願公開第2014/0224686号)、
「ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR」と題された米国特許出願第13/763,078号(現在の米国特許出願公開第2013/0256383号)、
「LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES」と題された米国特許出願第13/763,095号(現在の米国特許出願公開第2013/0161374号)、
「IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES」と題された米国特許出願第13/763,147号(現在の米国特許出願公開第2013/0153636号)、
「MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES」と題された米国特許出願第13/763,192号(現在の米国特許出願公開第2013/0146642号)、
「RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME」と題された米国特許出願第13/763,161号(現在の米国特許出願公開第2013/0153641号)、
「ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR」と題された米国特許出願第13/763,177号(現在の米国特許出願公開第2013/0146641号)、
「STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION」と題された米国特許出願第13/763,037号(現在の米国特許出願公開第2014/0224857号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES」と題された米国特許出願第13/433,126号(現在の米国特許出願公開第2013/0256366号)、
「DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS」と題された米国特許出願第13/433,132号(現在の米国特許出願公開第2013/0256373号)、
「FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN」と題された米国特許出願第13/851,703号(現在の米国特許出願公開第2014/0291382号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH」と題された米国特許出願第13/851,676号(現在の米国特許出願公開第2014/0291379号)、
「FASTENER CARTRIDGE ASSEMBLIES」と題された米国特許出願第13/851,693号(現在の米国特許出願公開第2014/0291381号)、
「FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT」と題された米国特許出願第13/851,684号(現在の米国特許出願公開第2014/0291380号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,387号(現在の米国特許出願公開第2014/0166724号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,395号(現在の米国特許出願公開第2014/0166725号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,400号(現在の米国特許出願公開第2014/0166726号)、
「IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS」と題された米国特許出願第14/187,383号(現在の米国特許出願公開2015/0238185号)、
「IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS」と題された米国特許出願第14/187,386号(現在の米国特許出願公開2015/0239180号)、
「IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT」と題された米国特許出願第14/187,390号(現在の米国特許出願公開2015/0238188号)、
「IMPLANTABLE LAYER ASSEMBLIES」と題された米国特許出願第14/187,389号(現在の米国特許出願公開第2015/0238187号)、
「IMPLANTABLE LAYERS COMPRISING A PRESSED REGION」と題された米国特許出願第14/187,385号(現在の米国特許出願公開第2015/0238191号)、
「FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT」と題された米国特許出願第14/187,384号(現在の米国特許出願公開第2015/0238186号)、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,856号、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,907号、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,932号、
「MALLEABLE BIOABSORBABLE POLYMER ADHESIVE FOR RELEASABLY ATTACHING A STAPLE BUTTRESS TO A SURGICAL STAPLER」と題された米国特許出願第14/667,874号、
「ADJUNCT MATERIALS AND METHODS OF USING SAME IN SURGICAL METHODS FOR TISSUE SEALING」と題された米国特許出願第14/300,954号、
「DRUG ELUTING ADJUNCTS AND METHODS OF USING DRUG ELUTING ADJUNCTS」と題された米国特許出願第14/840,613号、
「METHOD FOR CREATING A FLEXIBLE STAPLE LINE」と題された米国特許出願第14/498,145号、及び
「IMPLANTABLE ADJUNCT SYSTEMS FOR DETERMINING ADJUNCT SKEW」と題された米国特許出願第14/865,306号。
「SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS」と題された米国特許出願第12/894,311号(現在の米国特許第8,763,877号)、
「SURGICAL STAPLE CARTRIDGES SUPPORTING NON−LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE−FORMING POCKETS」と題された米国特許出願第12/894,340号(現在の米国特許第8,899,463号)、
「JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS」と題された米国特許出願第12/894,327号(現在の米国特許第8,978,956号)、
「SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS」と題された米国特許出願第12/894,351号(現在の米国特許第9,113,864号)、
「IMPLANTABLE FASTENER CARTRIDGE HAVING A NON−UNIFORM ARRANGEMENT」と題された米国特許出願第12/894,338号(現在の米国特許第8,864,007号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER」と題された米国特許出願第12/894,369号(現在の米国特許出願公開第2012/0080344号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS」と題された米国特許出願第12/894,312号(現在の米国特許第8,925,782号)、
「SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,377号(現在の米国特許第8,393,514号)、
「SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT」と題された米国特許出願第12/894,339号(現在の米国特許第8,840,003号)、
「SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM」と題された米国特許出願第12/894,360号(現在の米国特許第9,113,862号)、
「SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS」と題された米国特許出願第12/894,322号(現在の米国特許第8,740,034号)、
「SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES」と題された米国特許出願第12/894,350号(現在の米国特許出願公開第2012/0080478号)、
「IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS」と題された米国特許出願第12/894,383号(現在の米国特許第8,752,699号)、
「COMPRESSIBLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,389号(現在の米国特許第8,740,037号)、
「FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT」と題された米国特許出願第12/894,345号、(現在の米国特許第8,783,542号)、
「COLLAPSIBLE FASTENER CARTRIDGE」と題された米国特許出願第12/894,306号、(現在の米国特許第9,044,227号)、
「FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS」と題された米国特許出願第12/894,318号(現在の米国特許第8,814,024号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX」と題された米国特許出願第12/894,330号(現在の米国特許第8,757,465号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX」と題された米国特許出願第12/894,361号(現在の米国特許第8,529,600号)、
「FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX」と題された米国特許出願第12/894,367号(現在の米国特許第9,033,203号)、
「FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER」と題された米国特許出願第12/894,388号(現在の米国特許第8,474,677号)、
「FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES」と題された米国特許出願第12/894,376号(現在の米国特許第9,044,228号)、
「SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS」と題された米国特許出願第13/097,865号(現在の米国特許出願公開第2012/0080488号)、
「TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER」と題された米国特許出願第13/097,936号(現在の米国特許第8,657,176号)、
「STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION」と題された米国特許出願第13/097,954号(現在の米国特許出願公開第2012/0080340号)、
「STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF」と題された米国特許出願第13/097,856号(現在の米国特許出願公開第2012/0080336号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS」と題された米国特許出願第13/097,928号(現在の米国特許第8,746,535号)、
「TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL」と題された米国特許出願第13/097,891号(現在の米国特許第8,864,009号)、
「STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION」と題された米国特許出願第13/097,948号(現在の米国特許第8,978,954号)、
「COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY」と題された米国特許出願第13/097,907号(現在の米国特許出願公開第2012/0080338号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES」と題された米国特許出願第13/097,861号(現在の米国特許第9,113,865号)、
「STAPLE CARTRIDGE LOADING ASSEMBLY」と題された米国特許出願第13/097,869号(現在の米国特許第8,857,694号)、
「COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS」と題された米国特許出願第13/097,917号(現在の米国特許第8,777,004号)、
「STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION」と題された米国特許出願第13/097,873号(現在の米国特許第8,740,038号)、
「STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS」と題された米国特許出願第13/097,938号(現在の米国特許第9,016,542号)、
「STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/097,924号(現在の米国特許出願公開第2012/0083835号)、
「SURGICAL STAPLER WITH FLOATING ANVIL」と題された米国特許出願第13/242,029号(現在の米国特許第8,893,949号)、
「CURVED END EFFECTOR FOR A STAPLING INSTRUMENT」と題された米国特許出願第13/242,066号(現在の米国特許出願公開第2012/0080498号)、
「STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK」と題された米国特許出願第13/242,086号(現在の米国特許第9,055,941号)、
「STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT」と題された米国特許出願第13/241,912号(現在の米国特許第9,050,084号)、
「SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS」と題された米国特許出願第13/241,922号(現在の米国特許出願公開第2013/0075449号)、
「SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS」と題された米国特許出願第13/241,637号(現在の米国特許第8,789,741号)、
「SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR」と題された米国特許出願第13/241,629号(現在の米国特許出願公開第2012/0074200号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES」と題された米国特許出願第13/433,096号(現在の米国特許出願公開第2012/0241496号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS」と題された米国特許出願第13/433,103号(現在の米国特許出願公開第2012/0241498号)、
「EXPANDABLE TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,098号(現在の米国特許出願公開第2012/0241491号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR」と題された米国特許出願第13/433,102号(現在の米国特許出願公開第2012/0241497号)、
「RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,114号(現在の米国特許出願公開第2012/0241499号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT」と題された米国特許出願第13/433,136号(現在の米国特許出願公開第2012/0241492号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION」と題された米国特許出願第13/433,141号(現在の米国特許出願公開第2012/0241493号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD」と題された米国特許出願第13/433,144号(現在の米国特許出願公開第2012/0241500号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD」と題された米国特許出願第13/433,148号(現在の米国特許出願公開第2012/0241501号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS」と題された米国特許出願第13/433,155号(現在の米国特許出願公開第2012/0241502号)、
「METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS」と題された米国特許出願第13/433,163号(現在の米国特許出願公開第2012/0248169号)、
「TISSUE THICKNESS COMPENSATORS」と題された米国特許出願第13/433,167号(現在の米国特許出願公開第2012/0241503号)、
「LAYERED TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,175号(現在の米国特許出願公開第2012/0253298号)、
「TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS」と題された米国特許出願第13/433,179号(現在の米国特許出願公開第2012/0241505号)、
「ADHESIVE FILM LAMINATE」と題された米国特許出願第13/763,028号(現在の米国特許出願公開第2013/0146643号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT」と題された米国特許出願第13/433,115号(現在の米国特許出願公開第2013/0256372号)、
「TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS」と題された米国特許出願第13/433,118号(現在の米国特許出願公開第2013/0256365号)、
「MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/433,135号(現在の米国特許出願公開第2013/0256382号)、
「TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME」と題された米国特許出願第13/433,140号(現在の米国特許出願公開第2013/0256368号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS」と題された米国特許出願第13/433,129号(現在の米国特許出願公開第2013/0256367号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第11/216,562号(現在の米国特許第7,669,746号)、
「SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS」と題された米国特許出願第11/714,049号(現在の米国特許出願公開第2007/0194082号)、
「SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第11/711,979号(現在の米国特許第8,317,070号)、
「SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT」と題された米国特許出願第11/711,975号(現在の米国特許出願公開第2007/0194079号)、
「SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES」と題された米国特許出願第11/711,977号(現在の米国特許第7,673,781号)、
「SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS」と題された米国特許出願第11/712,315号(現在の米国特許第7,500,979号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第12/038,939号(現在の米国特許第7,934,630号)、
「SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第13/020,263号(現在の米国特許第8,636,187号)、
「ROBOTICALLY−CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS」と題された米国特許出願第13/118,278号(現在の米国特許出願公開第2011/0290851号)、
「ROBOTICALLY−CONTROLLED CABLE−BASED SURGICAL END EFFECTORS」と題された米国特許出願第13/369,629号(現在の米国特許第8,800,838号)、
「SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS」と題された米国特許出願第12/695,359号(現在の米国特許第8,464,923号)、
「STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS」と題された米国特許出願第13/072,923号(現在の米国特許第8,567,656号)、
「LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR」と題された米国特許出願第13/766,325号(現在の米国特許出願公開第2013/0256380号)、
「ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR」と題された米国特許出願第13/763,078号(現在の米国特許出願公開第2013/0256383号)、
「LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS」と題された米国特許出願第13/763,094号(現在の米国特許出願公開第2013/0256377号)、
「END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER」と題された米国特許出願第13/763,106号(現在の米国特許出願公開第2013/0256378号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS」と題された米国特許出願第13/433,147号(現在の米国特許出願公開第2013/0256369号)、
「SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES」と題された米国特許出願第13/763,112号(現在の米国特許出願公開第2013/0256379号)、
「ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE」と題された米国特許出願第13/763,035号(現在の米国特許出願公開第2013/0214030号)、
「RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME」と題された米国特許出願第13/763,042号(現在の米国特許出願公開第2013/0221063号)、
「FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,048号(現在の米国特許出願公開第2013/0221064号)、
「FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,054号(現在の米国特許出願公開第2014/0097227号)、
「FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR」と題された米国特許出願第13/763,065号(現在の米国特許出願公開第2013/0221065号)、
「STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER」と題された米国特許出願第13/763,021号(現在の米国特許出願公開第2014/0224686号)、
「ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR」と題された米国特許出願第13/763,078号(現在の米国特許出願公開第2013/0256383号)、
「LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES」と題された米国特許出願第13/763,095号(現在の米国特許出願公開第2013/0161374号)、
「IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES」と題された米国特許出願第13/763,147号(現在の米国特許出願公開第2013/0153636号)、
「MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES」と題された米国特許出願第13/763,192号(現在の米国特許出願公開第2013/0146642号)、
「RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME」と題された米国特許出願第13/763,161号(現在の米国特許出願公開第2013/0153641号)、
「ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR」と題された米国特許出願第13/763,177号(現在の米国特許出願公開第2013/0146641号)、
「STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION」と題された米国特許出願第13/763,037号(現在の米国特許出願公開第2014/0224857号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES」と題された米国特許出願第13/433,126号(現在の米国特許出願公開第2013/0256366号)、
「DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS」と題された米国特許出願第13/433,132号(現在の米国特許出願公開第2013/0256373号)、
「FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN」と題された米国特許出願第13/851,703号(現在の米国特許出願公開第2014/0291382号)、
「TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH」と題された米国特許出願第13/851,676号(現在の米国特許出願公開第2014/0291379号)、
「FASTENER CARTRIDGE ASSEMBLIES」と題された米国特許出願第13/851,693号(現在の米国特許出願公開第2014/0291381号)、
「FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT」と題された米国特許出願第13/851,684号(現在の米国特許出願公開第2014/0291380号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,387号(現在の米国特許出願公開第2014/0166724号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,395号(現在の米国特許出願公開第2014/0166725号)、
「STAPLE CARTRIDGE INCLUDING A BARBED STAPLE」と題された米国特許出願第14/187,400号(現在の米国特許出願公開第2014/0166726号)、
「IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS」と題された米国特許出願第14/187,383号(現在の米国特許出願公開2015/0238185号)、
「IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS」と題された米国特許出願第14/187,386号(現在の米国特許出願公開2015/0239180号)、
「IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT」と題された米国特許出願第14/187,390号(現在の米国特許出願公開2015/0238188号)、
「IMPLANTABLE LAYER ASSEMBLIES」と題された米国特許出願第14/187,389号(現在の米国特許出願公開第2015/0238187号)、
「IMPLANTABLE LAYERS COMPRISING A PRESSED REGION」と題された米国特許出願第14/187,385号(現在の米国特許出願公開第2015/0238191号)、
「FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT」と題された米国特許出願第14/187,384号(現在の米国特許出願公開第2015/0238186号)、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,856号、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,907号、
「IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT」と題された米国特許出願第14/827,932号、
「MALLEABLE BIOABSORBABLE POLYMER ADHESIVE FOR RELEASABLY ATTACHING A STAPLE BUTTRESS TO A SURGICAL STAPLER」と題された米国特許出願第14/667,874号、
「ADJUNCT MATERIALS AND METHODS OF USING SAME IN SURGICAL METHODS FOR TISSUE SEALING」と題された米国特許出願第14/300,954号、
「DRUG ELUTING ADJUNCTS AND METHODS OF USING DRUG ELUTING ADJUNCTS」と題された米国特許出願第14/840,613号、
「METHOD FOR CREATING A FLEXIBLE STAPLE LINE」と題された米国特許出願第14/498,145号、及び
「IMPLANTABLE ADJUNCT SYSTEMS FOR DETERMINING ADJUNCT SKEW」と題された米国特許出願第14/865,306号。
本明細書に記載され、添付の図面に示される実施形態の全体的な構造、機能、製造、及び使用の完全な理解をもたらすように、多くの具体的詳細が示される。周知の動作、構成要素、及び要素は、本明細書に記載される実施形態を不明瞭にしないようにするため詳細に記載されていない。本明細書に記載及び図示される実施形態は非限定例であることが読者には理解され、それ故、本明細書に開示される特定の構造的及び機能的詳細は、典型及び例示であり得ることが理解されるであろう。それらに対する変形及び変更が、特許請求の範囲から逸脱することなく行われ得る。
用語「備える(comprise)」(「comprises」及び「comprising」など、compriseの任意の語形)、「有する(have)」(「has」及び「having」など、haveの任意の語形)、「含む(include)」(「includes」及び「including」など、includeの任意の語形)、及び「含有する(contain)」(「contains」及び「containing」など、containの任意の語形)は、開放型の連結動詞である。結果として、1つ若しくは2つ以上の要素を「備える」か、「有する」か、「含む」か、若しくは「含有する」外科用システム、デバイス、又は装置は、それら1つ又は2つ以上の要素を有しているが、それら1つ又は2つ以上の要素のみを有することに限定されない。同様に、1つ若しくは2つ以上の特徴を「備える」か、「有する」か、「含む」か、若しくは「含有する」、システム、デバイス、又は装置の要素は、それら1つ又は2つ以上の特徴を有しているが、それら1つ又は2つ以上の特徴のみを有することに限定されない。
用語「近位」及び「遠位」は、本明細書では、外科用器具のハンドル部分を操作する臨床医を基準として使用される。用語「近位」は臨床医に最も近い部分を指し、用語「遠位」は臨床医から離れて位置する部分を指す。便宜上及び明確性のために、「垂直」、「水平」、「上」、及び「下」などの空間的用語が、本明細書において図面に対して使用され得ることが更に理解されるであろう。しかしながら、外科用器具は多くの向き及び位置で使用されるものであり、これらの用語は限定的及び/又は絶対的であることを意図したものではない。
腹腔鏡下及び低侵襲性の外科的処置を行うための、様々な例示的なデバイス及び方法が提供される。しかしながら、本明細書に開示される様々な方法及びデバイスが、例えば開放型の外科的処置と関連するものを含む、多くの外科的処置及び用途で使用され得ることが、読者には容易に理解されるであろう。本明細書の「発明を実施するための形態」を読み進めることで、読者は、本明細書に開示される様々な器具が、例えば、天然の開口部を通じて、組織に形成された切開又は穿刺穴を通じてなど、任意の方法で体内に挿入され得ることを更に認識するであろう。これらの器具の作用部分すなわちエンドエフェクタ部分は、患者の体内に直接に挿入することもでき、又は、外科用器具のエンドエフェクタ及び細長シャフトを進めることが可能な作用通路を有するアクセスデバイスを通じて挿入することもできる。
外科用ステープル留めシステムは、シャフトと、シャフトから延在するエンドエフェクタとを備えることができる。エンドエフェクタは、第1顎部と第2顎部とを備える。第1の顎部は、ステープルカートリッジを備える。ステープルカートリッジは、第1の顎部に挿入可能であり、かつ第1の顎部から取り外し可能であるが、ステープルカートリッジが第1の顎部から取り外し可能でないか、又は少なくとも容易に交換可能でない、他の実施形態も想定される。第2の顎部は、ステープルカートリッジから排出されたステープルを変形させるように構成されたアンビルを備える。第2の顎部は、閉鎖軸を中心にして第1の顎部に対して枢動可能であるが、第1の顎部が第2の顎部に対して枢動可能である、他の実施形態も想定される。外科用ステープル留めシステムは、エンドエフェクタをシャフトに対して回転させる、即ち関節運動させることができるように構成された関節継手を更に備える。エンドエフェクタは、関節継手を通って延在する関節運動軸線を中心にして回転可能である。関節継手を含まない他の実施形態も想定される。
ステープルカートリッジは、カートリッジ本体を備える。カートリッジ本体は、近位端部と、遠位端部と、近位端部と遠位端部との間に延在するデッキとを含む。使用中、ステープルカートリッジは、ステープル留めされる組織の第1の側面に位置付けられ、アンビルは、組織の第2の側面に位置付けられる。アンビルは、ステープルカートリッジに向かって移動させられて、デッキに対して組織を圧縮及びクランプする。続いて、カートリッジ本体内に取り外し可能に格納されたステープルを、組織内に配備することができる。カートリッジ本体は、その内部に画定されたステープルキャビティを含み、ステープルは、ステープルキャビティ内に取り外し可能に格納される。ステープルキャビティは、6つの長手方向列に配置される。3つの列のステープルキャビティは、長手方向スロットの第1の側面に位置付けられ、3つの列のステープルキャビティは、長手方向スロットの第2の側面に位置付けられる。ステープルキャビティ及びステープルの他の配置も可能であり得る。
ステープルは、カートリッジ本体内のステープルドライバによって支持される。ドライバは、第1の、即ち未発射位置と、ステープルキャビティからステープルを排出する、第2の、即ち発射済み位置との間で移動可能である。ドライバは、カートリッジ本体の底部周辺に延在する保持具によってカートリッジ本体内に保持され、また、カートリッジ本体を把持し、かつ保持具をカートリッジ本体に対して保持するように構成された、弾性部材を含む。ドライバは、スレッドによってそれらの未発射位置とそれらの発射済み位置との間で移動可能である。スレッドは、近位端部に隣接した近位位置と、遠位端部に隣接した遠位位置との間で移動可能である。スレッドは、ドライバの下を摺動し、かつドライバを持ち上げるように構成された複数の傾斜面を備え、ステープルがその上に支持され、アンビルに向かう。
上記に加えて、スレッドは発射部材によって遠位側に移動される。発射部材は、スレッドに接触し、スレッドを遠位端部に向かって押し出すように構成されている。カートリッジ本体内に画定された長手方向スロットは、発射部材を受け入れるように構成されている。アンビルは、発射部材を受け入れるように構成されたスロットも含む。発射部材は、第1の顎部に係合する第1のカムと、第2の顎部に係合する第2のカムとを更に備える。発射部材を遠位側に前進させる際、第1のカム及び第2のカムは、ステープルカートリッジのデッキとアンビルとの間の距離、即ち組織隙間を制御することができる。発射部材はまた、ステープルカートリッジとアンビルとの中間に捕捉された組織を切開するように構成されたナイフも備える。ステープルがナイフよりも前方に排出されるように、ナイフが傾斜面に対して少なくとも部分的に近位側に位置付けられることが望ましい。
また、ステープルカートリッジは埋め込み可能な層を含み得る。埋め込み可能な層は、対応するドライバによってステープルが配備されるとき、組織と共にステープル内に捕捉されるように構成されている。埋め込み可能な層は、バットレス、組織厚さコンペンセータ、及び/又は他の補助材料を含み得る。組織厚さコンペンセータは、例えばステープルラインに沿って組織の厚さの変動などの組織特性の変動を補正するように構成される。組織厚さコンペンセータは、圧縮性でありかつ弾性であり得る。使用の際、組織厚さコンペンセータは、ステープル内及びステープル間における適切な組織の圧縮を促進すると同時に、ステープル留めされる組織の過剰な圧縮を防止又は制限する。
ステープルカートリッジの埋め込み可能な層は、ステープルカートリッジの本体に剥離可能に固定され得る。例えば、埋め込み可能な層は、剥離可能な接着剤、少なくとも1つの取付けタブ、及び/又は他の取付け機構を用いてステープルカートリッジのデッキに剥離可能に固定され得る。それに加えてあるいはそれに代わって、埋め込み可能な層は、第1の顎部又は第2の顎部に剥離可能に固定され得る。埋め込み可能な層は、例えば、エンドエフェクタのカートリッジ側及び/又はエンドエフェクタのアンビル側に配置され得る。
埋め込み可能な層は、組織の内部成長を促進するように構成され得る。様々な事例において、治療される組織(例えば、ステープル留め及び/又は切開される組織)の治癒を促進するため、及び/又は患者の回復を加速するために、埋め込み可能な層の中への組織の内部成長を促進することが望ましい。より具体的に言えば、埋め込み可能な層への組織の内部成長は、手術部位における炎症の発生率、程度、及び/又は持続期間を低減し得る。埋め込み可能な層の内部及び/又は周囲における組織の内部成長は、例えば、手術部位における感染症の伝播を管理し得る。例えば、埋め込み可能な層の内部及び/又は周囲における血管、特に白血球の内部成長は、埋め込み可能な層及びそれに隣接する組織の内部及び/又は周囲における感染症と戦い得るものである。組織の内部成長はまた、患者の身体による異物(例えば、埋め込み可能な層及びステープル)の受容を助成し得、また患者の身体が異物を拒絶する可能性を低減し得る。異物の拒絶は、手術部位における感染症及び/又は炎症を引き起こし得る。
図面を参照すると、同様の参照符号がいくつかの図を通して同様の構成要素を示しており、図1は、例えば、組織厚さコンペンセータなどの埋め込み可能な補助材と共に使用するのに適した例示的な外科用ステープル留め及び切断器具8010を示している。外科用ステープル留め及び切断器具8010はアンビル8014を備え得るが、アンビル8014は、枢動アタッチメントを中心として細長ステープルチャネル8016へと繰り返し開閉され得るものである。ステープル適用アセンブリ8012はアンビル8014とチャネル8016とを備え得るが、このアセンブリ8012は、実行部分8022を形成する細長シャフト8018に近位側で取り付けられ得る。ステープル適用アセンブリ8012が閉じているとき、又は少なくとも実質的に閉じているとき、実行部分8022は、トロカールを通ってステープル留めアセンブリ8012を挿入するのに好適な、充分に小さな断面を呈し得る。
様々な状況下で、ステープルカートリッジアセンブリ8012は、細長シャフト8018に連結されたハンドル8020によって操作される。ハンドル8020は、細長シャフト8018の長手方向軸線を中心として細長シャフト8018及びステープル適用アセンブリ8012を回転させる回転ノブ8030、並びにステープル適用アセンブリ8012を閉鎖するためにピストルグリップ8036の前方で枢動し得る閉鎖トリガ8026などのユーザ制御装置を備え得る。閉鎖解放ボタン8038は、閉鎖トリガ8026が締め付けられるとき、ハンドル8020上で外向きに呈され、そのため、解放ボタン8038は、例えば、閉鎖トリガ8026を締付け解除し、ステープル適用アセンブリ8012を開放するために、押下され得る。
発射トリガ8034は、閉鎖トリガ8026の前方で枢動し得るものであり、ステープル適用アセンブリ8012に、その中に締め付けられた組織を切断させると同時にステープル留めさせる。様々な状況において、複数の発射ストロークが、ストローク1回につき外科医の手によって加えられることが要求される力の量を低減するために、発射トリガ8034を使用して用いられ得る。特定の実施形態では、ハンドル8020は、例えば、発射進行状況を指示し得る回転式インジケータホイール8041などの1つ又は2つ以上の回転式インジケータホイールを備え得る。手動発射解放レバー8042は、必要に応じて、完全な発射行程が完了する前に発射システムを後退させることができ、加えて、発射解放レバー8042は、発射システムが動かなくなりかつ/又は機能しなくなった場合に、外科医又は他の臨床医が発射システムを後退させることを可能にする。
外科用ステープル留め及び切断器具8010及び本開示と共に使用するのに適した他の外科用ステープル留め及び切断器具に関する更なる詳細が、例えば、参照によってそのすべての開示内容が本明細書に援用される、2013年3月27日に出願された米国特許出願第13/851,693号、発明の名称「FASTENER CARTRIDGE ASSEMBLY」に記載されている。更に、電動の外科用ステープル留め及び切断器具もまた本開示と共に利用され得る。例えば、参照によってそのすべての開示内容が本明細書に援用される、2008年8月8日出願の米国特許出願公開第2009/0090763A1号、発明の名称「POWERED SURGICAL STAPLING DEVICE」を参照されたい。
図2及び3を参照すると、例えば発射アセンブリ9090などの発射アセンブリが、ウェッジスレッド9126を前進させるために、外科用ステープル留め及び切断器具8010と共に利用され得、ウェッジスレッド9126は、ステープル適用アセンブリ8012からアンビル8014と細長ステープルチャネル8016との間に捕捉された組織の中へステープルを配備するように構成された複数のウェッジ9204を備えている。更に、発射アセンブリ9090の遠位部分にあるEビーム9102が、ステープル適用アセンブリ8012からステープルを発射し得ると共に、発射の間に細長ステープルチャネル8016に対してアンビル8014を位置決めし得る。Eビーム9102は、一対の上部ピン9110、ウェッジスレッド9126の部分9218に従動し得る一対の中央ピン9112、下部ピン又はフット9114、並びに、発射アセンブリ9090が遠位側に前進されているとき、捕捉された組織を切断するように構成され得る鋭利切断縁部9116を含む。加えて、切断縁部9116の各垂直端部を持ち受けする、一体的に形成されかつ近位側に突出する上部ガイド9118及び中央ガイド9120が更に、切断されるのに先立って組織を鋭利切断縁部9116へ案内するのを支援する組織ステージングエリア9122を画定し得る。中間ガイド9120はまた、ステープル適用アセンブリ8012によるステープル成形を実現するウェッジスレッド9126(図2)の階段状中央部材9124と当接することによって、ステープル適用アセンブリ8012と係合しかつステープル適用アセンブリ8012を発射するように働き得る。
様々な状況下で、ステープルカートリッジは、ステープルカートリッジから配備されるステープル内に捕捉される組織の厚さを補正するための手段を備え得る。図4を参照すると、ステープルカートリッジ10000などのステープルカートリッジは、例えば、外科用ステープル留め及び切断器具8010と共に利用され得るものであり、また、例えば支持部分10010などの剛性の第1の部分と、例えば組織厚さコンペンセータ10020などの圧縮性の第2の部分とを含み得る。支持部分10010は、カートリッジ本体と、複数のステープルキャビティ10012とを備え得る。例えば、ステープル10030は、各ステープルキャビティ10012内に取り外し可能に配置することができる。主に図4及び5を参照すると、各ステープル10030は、基部10031と、基部10031から延びる1つ又は2つ以上の脚部10032とを備え得る。ステープル10030が配備されるのに先立って、ステープル10030の基部10031が、支持部分10010内に配置されたステープルドライバによって支持され得ると同時に、ステープル10030の脚部10032が、ステープルキャビティ10012内に少なくとも部分的に収容され得る。
様々な状況において、ステープル10030は、脚部10032が組織厚さコンペンセータ10020を通して移動し、組織厚さコンペンセータ10020の頂部表面を貫通し、組織Tに貫入し、ステープルカートリッジ10000の反対に配置されたアンビルと接触するように、未発射位置と発射済み位置との間に配備され得る。脚部10032がアンビルに当たって変形すると、各ステープル10030の脚部10032が、各ステープル10030内で、組織厚さコンペンセータ10020の一部と組織Tの一部とを捕捉し、この組織に圧縮力をかけることができる。上記に加えて、各ステープル10030の脚部10032は、組織T及び組織厚さコンペンセータ10020がその中に捕捉され得るステープル捕捉領域を形成するように、ステープルの基部10031に向かって下向きに変形され得る。様々な状況下で、ステープル捕捉領域は、変形した脚部10032の内側表面と、基部10031の内側表面との間に画定され得る。ステープルの捕捉領域の大きさは、例えば、脚部の長さ、脚部の直径、基部の幅、及び/又は脚部の変形の程度などのいくつかの要素に依存し得る。
使用の際、上記に加えて、また主として図4を参照すると、閉鎖トリガ8026を押下してEビーム9102を前進させることによって、外科用ステープル留め及び切断器具8010のアンビル8014などのアンビルがステープルカートリッジ10000の反対側の閉鎖位置へと移動され得る。アンビル8014は、組織厚さコンペンセータ10020に対して組織を配置し、また様々な状況下で、例えば、支持部分10010に対して組織厚さコンペンセータ10020を圧迫し得る。アンビル8014が適当に配置されると、ステープル10030が、同様に図4に示されているように配備され得る。
様々な状況下で、上述のように、ステープル発射スレッド10050は、多くの点でスレッド9126(図3を参照)と類似したものであり、図5に示すように、ステープルカートリッジ10000の近位端部から遠位端部10002に向かって移動され得る。発射アセンブリ9090が前進されるとき、スレッド10050は、ステープルドライバ10040と接触し、ステープルドライバ10040をステープルキャビティ10012内で上向きに持ち上げ得る。少なくとも1つの例では、スレッド10050及びステープルドライバ10040はそれぞれ、ステープルドライバ10040を未発射位置から上向きに移動させるように協働し得る、1つ又は2つ以上のスロープ又は傾斜表面を備え得る。ステープルドライバ10040がそれぞれのステープルキャビティ10012内で上向きに持ち上げられると、ステープルドライバ10040はステープル10030を上向きに持ち上げ、そのため、ステープル10030がステープルキャビティ10012から出現し得る。様々な状況下で、スレッド10050は、発射シーケンスの一部として複数のステープルを同時に上向きに移動させ得る。
図5を参照するが、ステープル10030のステープル脚部10032は、ステープル10030が未発射位置にあるときに、支持部分10010を越えてコンペンセータ10020の中へと延び得る。様々な状況下で、ステープル10030が未発射位置にあるとき、ステープル脚部10032の先端部も、又はステープル脚部10032のいかなる他の部分も、組織厚さコンペンセータ10020の上部組織接触表面10021を通して突出し得ない。特定の状況下で、ステープル脚部10032の先端部は、組織厚さコンペンセータ10020を切開しかつそれに貫入し得る鋭利先端部を備え得る。
図6を参照すると、ステープルカートリッジアセンブリ10が示されている。ステープルカートリッジアセンブリ10は、外科用ステープル留め及び切断器具8010と共に使用され得るステープルカートリッジ12を含む。ステープルカートリッジ12は、多くの点でステープルカートリッジ10000に類似している。ステープルカートリッジ10000と同様に、ステープルカートリッジ12は複数のステープル10030を有しており、それらのステープル10030は、ステープルカートリッジ12内に画定された複数のキャビティ又はポケット内に収容される。また、ステープルカートリッジ12の複数のステープル10030は、外科用ステープル留め及び切断器具8010の発射シーケンスで配備され得る。
ステープルカートリッジ12は、カートリッジデッキ16とナイフスロット37(図14及び16)を更に含み、ナイフスロット37は、切断縁部9116が外科用ステープル留め及び切断器具8010によって捕捉された組織を切断するために前進されるときに、その切断縁部9116を収容する。スレッド10050がステープルカートリッジ12を通して前進することにより、上記で説明したように、ステープル10030がステープルカートリッジ10000から配備されるのと同じか又は実質的に同じ方式で、ステープルカートリッジ12のステープル10030がそれぞれのポケットから組織の中へと配備されることになる。
再び図6を参照するが、ステープルカートリッジアセンブリ10は、多くの点で組織厚さコンペンセータ10020と類似した組織厚さコンペンセータ又は圧縮性補助材11を更に含む。圧縮性補助材11は、カートリッジデッキ16に対して配置される。圧縮性補助材11は、カートリッジデッキ16に付着される。例えば、圧縮性補助材11は、カートリッジデッキ16の上へと部分的に溶融され、次いで冷却によって再固化され得るが、それによって圧縮性補助材11はカートリッジデッキ16に結合されることになる。また、圧縮性補助材11をカートリッジデッキ16に付着させるために、様々な付着機構が用いられ得る。
圧縮性補助材11は、カートリッジデッキ16に対して配置されかつ/又はカートリッジデッキ16に付着されるように構成された第1の生体適合性層14を含み、それに加えて、アンビル8014とステープルカートリッジ12との間に捕捉された組織に対し配置されるように構成された第2の生体適合性層15を含む。第1の生体適合性層14と第2の生体適合性層15は、図6に示すように、第1の生体適合性層14と第2の生体適合性層15との間に延びるか又は起立する複数の支持部材又は支柱19によって離間されている。支柱19は、部分的に支柱19の平均高さ(H)によって規定される、第1の生体適合性層14と第2の生体適合性層15との間の平均距離を維持する。
図6に示すように、支柱19は、同じか又は少なくとも実質的に同じ高さ(H)を有している。それに代わって、特定の事例では、支柱19は種々の高さを有し得る。更に、図6に示すように、支柱19は、同じか又は少なくとも実質的に同じ横断面領域を有している。それに代わって、支柱19は種々の横断面領域を有し得る。少なくとも1つの事例では、支柱19の横断面領域は、支柱19の高さ(H)に沿って変動し得る。例えば、支柱19は、幅広の中間区間と、幅狭の端部区間とを有してもよい。それに代わって、支柱19は、幅狭の中間区間と、幅広の端部区間とを有してもよい。それに代わって、支柱19は、幅広の中間区間と、1つの幅広の端部区間と、1つの幅狭の端部区間とを有してもよい。それに代わって、支柱19は、幅狭の中間区間と、1つの幅狭の端部区間と、1つの幅広の端部区間とを有してもよい。
図6に示すように、支柱19は、円形の又は少なくとも実質的に円形の横断面領域を有している。それに代わって、支柱19のうちの1つ又は2つ以上が非円形の横断面領域を有してもよい。少なくとも1つの例では、支柱19のうちの1つ又は2つ以上が、卵形状、クローバ形状、三日月形状、又は三角形状の横断面領域を有してもよい。支柱19の横断面領域の他の形状も本開示によって企図される。
一般に、支柱19の材料組成、高さ、及び/又は横断面積がその剛性又は圧縮下で撓曲する能力を少なくとも部分的に制御し、次いでその能力が、圧縮性補助材11の圧縮性を少なくとも部分的に制御する。したがって、支柱19は、圧縮性補助材11の圧縮性を1つ又は2つ以上の所望の値へと調整するように構成され得る。圧縮性補助材11の様々な区間が、例えば種々の剛性又は圧縮性を有する支柱19を有し得る。
支柱19は、アンビル8014がステープルカートリッジ12の反対側の閉鎖位置へと移動されるとき、圧縮性補助材11に加えられる圧縮力を受けて撓曲可能である。支柱19の弾力性により、圧縮性補助材11は、外科用ステープル留め及び切断器具8010の発射シーケンスの間にアンビル8014とステープルカートリッジ12との平均距離を同じか又は少なくとも実質的に同じに維持する一方で、種々の組織厚さを有する組織部分を備えた組織(T)に適応することが可能となる。
図6Aに示すように、ステープル10030が、圧縮性補助材11及び組織(T)の中へと発射され、組織(T)は、平均組織厚さ(T1)を有する第1の組織部分72と、組織厚さ(T1)よりも厚い平均組織厚さ(T2)を有する第2の組織部分74とを備えている。発射済みのステープル10030は、捕捉された圧縮性補助材11と捕捉された組織(T)を収容するための空間をその中に画定している。発射済みのステープル10030によって画定される空間は、図6Aに示すように、発射済みのステープル10030の高さ(H3)によって少なくとも部分的に制限される。捕捉された組織(T)の最終的な厚さと圧壊された圧縮性補助材11の最終的な高さとの合計は、発射済みのステープル10030の高さ(H3)と等しいか又は少なくとも実質的に等しくなる。捕捉された組織(T)の厚さの変動を補償するために、圧縮性補助材11のうちの第2の組織部分(T2)に対して配置された部分は、圧縮性補助材11のうちの第1の組織部分(T1)に対して配置された部分の最終的な高さ(H1)よりも高い最終的な高さ(H2)へと圧縮される。支柱19のこの弾力性により、圧縮性補助材11は、第1の組織部分72よりも高度に、第2の組織部分74に対して圧縮されることが可能となり、それにより、圧縮性補助材11は、発射済みのステープル10030によって画定された空間内における組織部分72及び74の種々の厚さを補償することが可能となる。
アンビル8014が閉鎖位置へと移動されるとき、アンビル8014は組織Tと接触し、組織T及び圧縮性補助材11に圧縮力を加え得る。支柱19の材料組成、有孔性、度数、寸法、及び/又は配向は、圧縮性補助材11の圧縮性を制御するか又は同調させるように調整され得る。
特定の事例では、支柱19は、例えば圧縮力に反応して近位方向(P)などの、第1の方向におけるまとまった圧壊を選ぶように傾斜又は斜行され得る。他の事例ではしかしながら、支柱19は、例えば圧縮力に反応して遠位方向(D)などの、第1の方向とは異なる第2方向におけるまとまった圧壊を選ぶように傾斜又は斜行され得る。特定の事例では、圧縮性補助材11は、第1の方向における屈曲を選ぶように傾斜又は斜行された第1の群の支柱19と、第1の方向とは異なる第2の方向における屈曲を選ぶように傾斜又は斜行された第2の群の支柱19とを有し得る。そのような事例では、種々の屈曲方向が、まとまりのない様式で圧縮性補助材11を屈曲させ得る。
図6を参照すると、支柱19は、各支柱19が第1の生体適合性層14及び第2の生体適合性層15と交差する横軸に沿って延びるか又は少なくとも実質的に延びるように配向されている。支柱19は、第1の生体適合性層14及び第2の生体適合性層15に対して垂直であるか又は少なくとも実質的に垂直である。したがって、支柱19は、互いに対して平行に又は少なくとも実質的に平行に延びている。図6に示すように、支柱19は、互いから離間されており、また平行な列をなして配列されている。
特定の事例では、支柱19は、第1の生体適合性層14及び/又は第2の生体適合性層15に対して斜めに傾斜又は配向される。特定の事例では、支柱19は、例えば同心円などをなして、所定のパターンをなして構成される。圧縮性補助材11の特定の区間内における支柱19の度数は、とりわけ、そのような区間の圧縮性に影響を及ぼし得る。特定の事例では、支柱は、例えば圧縮性補助材11のうちの特定の区間における柱強度を高めるために、そのような区間に計画的に集中され得る。少なくとも1つの事例では、支柱19は、圧縮性補助材11のうちの、外科用ステープル留め及び切断器具8010が発射されたときにステープルを受容するように構成された区間に集中され得る。それに代わって、支柱19は、圧縮性補助材11のうちの、外科用ステープル留め及び切断器具8010が発射されたときにステープルを受容しない区間に集中され得る。特定の事例では、支柱19は、図6に示すように、外周の周りに配列され、それによって圧縮性補助材11の側壁を画定する。
支柱19の各々は、第1の生体適合性層14に固定された第1の終端部分18と第2の生体適合性層15に固定された第2の終端部分20との間に延びる中間起立部分22を含む。終端部分18及び20はそれぞれ、第1の生体適合性層14及び第2の生体適合性層15に埋め込まれ得る。例えば、終端部分18及び20はそれぞれ、第1の生体適合性層14及び第2の生体適合性層15の中へと編み込まれるか又は織り込まれ得る。特定の事例では、終端部分18及び20はそれぞれ、第1の生体適合性層14及び第2の生体適合性層15上へと熱又は溶剤を用いて溶着され得る。特定の事例では、終端部分18及び20はそれぞれ、第1の生体適合性層14及び第2の生体適合性層15に接着され、引っ掛けられ、かつ/又は締結され得る。
図6に示すように、第1の生体適合性層14及び第2の生体適合性層15は織物層である。特定の事例では、第1の生体適合性層14及び/又は第2の生体適合性層15は編物層であり得る。特定の事例では、第1の生体適合性層14及び/又は第2の生体適合性層15は発泡体層であり得る。特定の事例では、第1の生体適合性層14及び/又は第2の生体適合性層15はフィルム層であり得る。
図6Bを参照すると、圧縮性補助材61が組織(T)にステープル留めされている。圧縮性補助材61は第1の生体適合性層64を含み、第1の生体適合性層64は、ステープルカートリッジ12のカートリッジデッキ16に対して配置されかつ/又はステープルカートリッジ12のカートリッジデッキ16に付着されるように構成されている。ループ部材69が第1の生体適合性層64から突出している。ループ部材69は、アンビル8014とステープルカートリッジ12との間に捕捉された組織に対して直接的に配置されている。それに代わって、圧縮性補助材61は、第2の生体適合性層が存在することを含んでもよく、またループ部材69は、生体適合性層の間の平均距離又は離間距離を維持し得る。換言すれば、ループ部材69は、第1の生体適合性層64の上に第2の生体適合性層を持ち上げるか又は上昇させ得る。
第1の生体適合性層64及び/又は第2の生体適合性層は織物層であり得る。特定の事例では、第1の生体適合性層64及び/又は第2の生体適合性層は編物層であり得る。特定の事例では、第1の生体適合性層64及び/又は第2の生体適合性層は発泡体層であり得る。特定の事例では、第1の生体適合性層64及び/又は第2の生体適合性層はフィルム層であり得る。例えば、ウィービング及び/又はニッティングなどの様々な技法によって、1つ又は2つ以上のループ部材69を形成するために、例えば、モノフィラメント及び/又はマルチフィラメント繊維などの1種類又は2種類以上の細長軟質部材が使用され得る。少なくとも1つの事例では、例えば、細長軟質部材はループ部材69を形成するように第1の生体適合性層64の中に通され得る。
図6Bに示すように、ループ部材69は、第1の終端部分69aと、第2の終端部分69bと、第1の終端部分69aと第2の終端部分69bとの間に延びる中間曲線状部分69cとを含む。終端部分69a及び69bは第1の生体適合性層64に部分的に埋め込まれかつ/又は付着されている一方で、中間曲線状部分69cは、第1の終端部分69a及び第2の終端部分69bによって、第1の生体適合性層64から持ち上げられるか又は離間されている。ループ部材69は、同じか又は少なくとも実質的に同じ高さを有し得る。それに代わって、特定の事例では、ループ部材69は種々の高さを有し得る。
第2の生体適合性層が存在する場合、例えば、ループ部材69は第1の生体適合性層64と第2の生体適合性層との間に配置され得、中間曲線状部分69cは第2の生体適合性層に付着され得る。例えば、生体適合性接着剤を使用することなど、様々な付着技法が第2の生体適合性層を中間曲線状部分69cに固定するために用いられ得る。特定の事例では、中間曲線状部分69cは第2の生体適合性層に縫い付けられ得る。
図6Bに示すように、第1の生体適合性層64は、互いに離間された係留アイランド62を備える。係留アイランド62は、平行又は少なくとも実質的に平行な列をなして配列されている。各係留アイランド62は、係留アイランド62において交差するループ部材69の第1の終端部分69aと第2の終端部分69bによって画定されている。特定の事例では、ループ部材69の終端部分69a及び69bは、例えば、互いに離間された2つの係留アイランド62によって受容され得る。特定の事例では、例えば、単一の終端部分69a又は69bのみが係留アイランド62を受容される。それに代わって、例えば、係留アイランド62は、終端部分69a及び/又は69bのうちの3つ又は4つ以上を受容するように構成され得る。係留アイランド62は、例えば、終端部分69aのうちの1つ又は2つ以上を受容するが、終端部分69bのうちのいずれも受容しないように構成され得る。
上記に加えて、ループ部材69のうちの1つ又は2つ以上は、係留アイランド62から延びる幅狭ネック部分63aと、その幅狭ネック部分63aから延びる幅広ヘッド部分63bとを含む。特定の事例では、ヘッド部分63bは第2の生体適合性層に対して配置され得る。それに代わって、ヘッド部分63bは組織(T)に対して配置され得る。
図6Bに示すように、ループ部材69は、概ね垂直な方向に第1の生体適合性層64から突出し、それによって、ループ部材69は、圧縮性補助材61に対して配置された組織(T)を通して伝達される圧縮力に反応して、まとまりのない様式で屈曲されることになる。特定の事例では、ループ部材69は、例えば圧縮力に反応して近位方向(P)などの第1の方向におけるまとまった圧壊を選ぶように傾斜又は斜行され得る。他の事例ではしかしながら、ループ部材69は、例えば圧縮力に応答して遠位方向(D)などの、第1の方向とは異なる第2方向におけるまとまった圧壊を選ぶように傾斜又は斜行され得る。特定の事例では、圧縮性補助材61は、第1の方向における屈曲を選ぶように傾斜又は斜行された第1の群のループ部材69と、第1の方向とは異なる第2の方向における屈曲を選ぶように傾斜又は斜行された第2の群のループ部材69とを含み得る。そのような事例では、種々の屈曲方向が、まとまりのない様式で圧縮性補助材69を屈曲させ得る。
図7を参照すると、圧縮性補助材31は、以下でより詳細に説明するように、穿孔フィルム層である第1の生体適合性層34と第2の生体適合性層35とを含む。圧縮性補助材31は、多くの点で圧縮性補助材11に類似している。例えば、圧縮性補助材31は、多数の点で圧縮性補助材11の支柱19と類似した複数の支柱39を備える。支柱19とは異なり、支柱39は平行な列をなして配列されていない。支柱39は、互いに交差するように構成されているが、そのため、剪断荷重及び/又は圧縮荷重下における圧壊に対する耐性を向上させることによって、圧縮性補助材31の安定性を改善させ得る。
図7に示すように、支柱39aは支柱39bと交差するように構成されている。支柱39aの第1の終端部分38aは、第1の終端部分38a及び第2の終端部分40bによって規定される第1の横軸が生体適合性層34及び第2の生体適合性層35に対して垂直となるように、支柱39bの第2の終端部分40bと整列されている。同様に、支柱39bの第1の終端部分38bは、第1の終端部分38b及び第2の終端部分40aによって規定される第2の横軸が生体適合性層34及び第2の生体適合性層35に対して垂直となるように、支柱39aの第2の終端部分40aと整列されている。更に、支柱39a及び39bの中間部分42a及び42bはそれぞれ、例えば溶着などによって互いに付着され得る。それに代わって、中間部分42a及び42bは、互いに対して自在に移動することが可能となり得る。
異なる構成配置では、特定の支柱39が、結合節又は境界を共有するように構成され得る。図7に示すように、支柱39c及び支柱39dは、結合節44において第1の生体適合性層34に付着されている。支柱39c及び39dは、結合節44から様々な方向に延びて、第2の生体適合性層35上の2つの異なる結合節46及び48において終端している。それに加えて、支柱39eが結合節48から延びて、第1の生体適合性層34上の結合節49において終端している。生体適合性層34と35との間で支柱39c〜39eの構成配置が繰り返されることにより、それらの間にジグザグのパターンが生じ得る。3つ又は4つ以上の支柱39が1つの結合節から延出又は出現してもよいことを理解されたい。
上記に加えて、生体適合性層34及び35の穿孔フィルムが、フィルムに穴50をパンチングすることによって生成され得る。穴50は、圧縮性補助材31の中への組織の内部成長を改善し得る。特定の事例では、穴50は、フィルムが調製された後に生成される。例えば、フィルムの各区間を除去して穴50を生成するために、溶剤又は熱が用いられ得る。他の事例では、フィルムは、例えば金型を使用して穴50を調製され得る。図7に示すように、穴50は列をなして構成配置されている。それに加えて、第1の生体適合性層34の穴50は、圧縮性補助材31を通した組織の成長のための経路を設けるために、第2の生体適合性層35の穴50と整列される。代替的に、穴50は不規則に配置されてもよい。少なくとも1つの事例では、穴50は、生体適合性層34及び35の一方にのみ存在する。
図8を参照すると、圧縮性補助材51は、複数の支持又は起立支柱又は繊維59によって互いから離間された第1の生体適合性層54と第2の生体適合性層55とを含む。圧縮性補助材51は、多くの点で圧縮性補助材11及び31に類似している。例えば、図8に示すように、圧縮性補助材51は、ステープルカートリッジ12のカートリッジデッキ16に対して配置され得る。圧縮性補助材51は、横編みのダブルファブリックを含む。特定の事例では、圧縮性補助材51は、2つのテザー層を生成するように構成された2つの編成する繊維の組を備える。
圧縮性補助材51は、平行な又は少なくとも実質的に平行な列をなして延びる複数のループ66を含む。各ループ66は、生体適合性層54及び55の一方に配置されるか若しくはその一方で始まり、生体適合性層54及び55のもう一方に向かって延びる2つの起立繊維59を画定している。起立繊維59は、第2の生体適合性層55に対して配置された組織(T)を通して第2の生体適合性層55に加えられた圧縮力に反応して、例えば近位方向(P)など、第1の方向におけるまとまった圧壊を選ぶように傾斜又は斜行されている。代替的に、起立繊維59は、例えば圧縮力に反応して遠位方向(D)などの第1の方向とは反対の第2方向におけるまとまった圧壊を選ぶように傾斜又は斜行され得る。代替的に、圧縮性補助材は、第1の方向における屈曲を選ぶように傾斜又は斜行された第1の群の起立繊維59と、第2の方向における屈曲を選ぶように傾斜又は斜行された第2の群の起立繊維59とを含み得る。種々の屈曲方向が、まとまりのない様式で圧縮性補助材51を屈曲させ得る。
図8に示すように、第2の生体適合性層55に由来する第1のループ66aは、第2の生体適合性層55から第1の生体適合性層54に向かって延びる第1の対の起立繊維59aを画定している。第1のループ66aは、同様に第2の生体適合性層55に由来する第2のループ66bによって画定された第2の対の起立繊維59bを保持する。第2のループ66bは、第1のループ66aに対して遠位側の位置に配置されている。第2の対の起立繊維59bもまた、第1の生体適合性層54に向かって延びている。記載したパターンは規則的な間隔で繰り返されている。同様に、第1の生体適合性層54に由来する同様のループ66が、第1の生体適合性層54から第2の生体適合性層55に向かって延びる一対の起立繊維59を画定している。
起立繊維59の2つの連続する対間の間隔は、圧縮性補助材51の圧縮性をそれぞれ増大又は減少させるように増大又は減少され得る。一般に、より多数の起立繊維59が圧縮性補助材51の特定の区間にあることは、圧縮力下において圧縮性補助材51のその区間の安定性がより高いことに対応する。
第1の生体適合性層54のループ66は、平行又は少なくとも実質的に平行な列57aをなして配列されており、第2の生体適合性層55のループ66は、列57aから離間された平行又は少なくとも実質的に平行な列57bをなして配列されている。
図9を参照すると、ステープル10030が、圧縮性補助材51及び組織(T)の中へと発射され、組織(T)は、平均組織厚さ(T1)を有する第1の組織部分72と、組織厚さ(T1)よりも厚い平均組織厚さ(T2)を有する第2の組織部分74とを備えている。発射済みのステープル10030は、捕捉された圧縮性補助材51と捕捉された組織(T)を収容するための空間をその中に画定している。発射済みのステープル10030によって画定される空間は、図9に示すように、発射済みのステープル10030の高さ(H3)によって少なくとも部分的に制限される。捕捉された組織(T)の最終的な厚さと圧壊された圧縮性補助材51の最終的な高さとの合計は、発射済みのステープル10030の高さ(H3)と等しいか又は少なくとも実質的に等しくなる。捕捉された組織(T)の厚さの変動を補償するために、圧縮性補助材51のうちの第2の組織部分(T2)に対して配置された部分は、圧縮性補助材51のうちの第1の組織部分(T1)に対して配置された部分の最終的な高さ(H1)よりも高い最終的な高さ(H2)へと圧縮される。起立繊維59のこの弾力性により、圧縮性補助材51は、第1の組織部分72よりも高度に、第2の組織部分74に対して圧縮されることが可能となり、それにより、圧縮性補助材51は、発射済みのステープル10030によって画定された空間内における組織部分72及び74の種々の厚さを補償することが可能となる。起立繊維59の材料組成、有孔性、度数、寸法、及び/又は配向は、圧縮性補助材51の圧縮性を制御するか又は同調させるように調整され得る。
図10〜12を参照すると、様々な圧縮性補助材が、ステープルカートリッジ12のカートリッジデッキ16に対して配置されている。図10〜12の圧縮性補助材は、多くの点で圧縮性補助材11、31、及び51に類似している。図10〜12の圧縮性補助材は、1つ又は2つ以上の起立繊維によって相互連結される結合節又は境界を更に特徴とする。例えば、図10に示すように、圧縮性補助材81は、第1の生体適合性層84内に画定された第1の一連の結合節84a〜84eと、第1の生体適合性層84から離間された第2の生体適合性層85内に画定された第2の一連の結合節85a〜85eとを含む。スペーサ又は起立繊維89が、第1の一連の結合節84a〜84e及び/又は第2の一連の結合節85a〜85eから延びている。
結合節84a〜84eは垂直方向に、対応する結合節85a〜85eと整列されるか又は少なくとも実質的に整列されている。更に、結合節84a〜84e及び結合節85a〜85eはそれぞれ、対応する列102及び103をなして配列されるか又は少なくとも実質的に配列されている。1列の結合節のみが生体適合性層84及び85の各々に示されているが、生体適合性層84及び/又は85はそれぞれ、複数の列の結合節又は境界を含んでもよい。
図10に示すように、起立繊維89は、メッシュ様の構造を形成するように交錯された第1の群の起立繊維89aと第2の群の起立繊維89bとを含んでもよい。起立繊維89aは、垂直軸線に対して近位方向(P)に傾斜又は斜行された、平行又は少なくとも実質的に平行な経路に概ね追従している。他方で、起立繊維89bは、垂直軸線に対して遠位方向(D)に傾斜又は斜行された、平行又は少なくとも実質的に平行な経路に概ね追従している。
例えば結合節85eなどの結合節から延びる繊維89aと89bとの間に、角度αが規定されている。角度αは、例えば約10°〜約160°の範囲内の任意の角度である。特定の事例では、角度αは、例えば約45°〜約135°の範囲内の任意の角度である。特定の事例では、角度αは、例えば約60°〜約110°の範囲内の任意の角度である。
図10に示すように、起立繊維89bは、結合節85aから結合節84dへと近位方向(P)に延びている。換言すれば、起立繊維89bは、列102における第1の位置にある結合節を、列103における第4の位置にある結合節と連結している。結果として、起立繊維89bは、起立繊維89aのうちの4つと交差する。特定の事例では、起立繊維89bは、起立繊維89bによって交差される4つの起立繊維89aのうちの1つ又は2つ以上に付着され得る。
更に、起立繊維89aは、結合節85eから結合節84bへと遠位方向(P)に延びている。換言すれば、起立繊維89aは、列103における第5の位置にある結合節を、列102における第2の位置にある結合節と連結している。結果として、起立繊維89aは、起立繊維89bのうちの4つと交差する。特定の事例では、起立繊維89aは、起立繊維89aによって交差される4つの起立繊維89bのうちの1つ又は2つ以上に付着され得る。起立繊維89aと89bを交差させることにより、圧縮力及び/又は剪断力下における圧縮性補助材81の安定性が改善される。
特定の事例では、起立繊維は、生体適合性層上の結合節の列における第1の位置にある結合節と、異なる生体適合性層上の結合節の列における第2の位置にある結合節との間に延び得る。特定の事例では、起立繊維は、生体適合性層上の結合節の列における第1の位置にある結合節と、異なる生体適合性層上の結合節の列における第3の位置にある結合節との間に延び得る。特定の事例では、起立繊維は、生体適合性層上の結合節の列における第1の位置にある結合節と、異なる生体適合性層上の結合節の列における第5の位置にある結合節との間に延び得る。様々な他の位置にある様々な結合節が起立繊維89によって連結され得る。様々な事例において、相互連結された結合節の間の距離を増大させることにより、圧縮性補助材81の剛性が低下する。
図12を参照すると、生体適合性層85の結合節81は、生体適合性層85の結合節の間に延びる架橋部材92を介して相互連結されている。図12に示すように、架橋部材92が結合節85aと85bとの間に延びている。別の架橋部材92も結合節85bと85cとの間に延びている。追加的な架橋部材92が、生体適合性層85の同じ列又は別の列にある様々な結合節の間に延びていてもよい。
特定の事例では、生体適合性層84及び85の少なくとも一方の結合節が架橋部材92を介して相互連結される。特定の事例では、生体適合性層84及び85の少なくとも一方の結合節が、互いから連結解除される。図10に示すように、第1の生体適合性層84の結合節84a〜84eは、直接的には互いに連結されていない。
図12を参照すると、圧縮性補助材81’が示されている。圧縮性補助材81’は、多くの点で圧縮性補助材81に類似している。それに加えて、生体適合性層84及び85の垂直に整列された結合節の各対は、一対の起立繊維94によって連結されている。例えば、一対の起立繊維94が、結合節85aと結合節84aとの間に延びる。起立繊維94は、圧縮力及び/又は剪断力下における圧縮性補助材81’の安定性を改善する。特定の事例では、1つの起立繊維94のみが、生体適合性層84及び85の垂直に整列された結合節の間に延びる。特定の事例では、3つ又は4つ以上の起立繊維94が、生体適合性層84及び85の垂直に整列された結合節の間に延びる。
図11を参照すると、圧縮性補助材100が示されている。圧縮性補助材100は、多くの点で圧縮性補助材81及び81’に類似している。例えば、圧縮性補助材100は、結合節84a及び84bを含む第1の生体適合性層84’と、連結された結合節85a及び85bを含む第2の生体適合性層85’と、を含むが、第1の生体適合性層84’は、第1の生体適合性層84’の結合節84a及び84bが第2の生体適合性層85’の結合節85a及び85bと垂直方向に整列されないように、第2の生体適合性層85’と食違いにされている。代替的な実施形態では、しかしながら、第1の生体適合性層84’の結合節と、第2の生体適合性層85’の対応する結合節は、垂直方向に整列され得る。
図11に示すように、第1の生体適合性層84’と第2の生体適合性層85’との間の食違いにより、結合節84a及び84bと結合節85a及び85bとの間に延びる起立繊維94’は、所定の方向における屈曲を選ぶように傾斜又は斜行されることになる。例えば、図11に示す実施形態では、第1の生体適合性層84’は、第2の生体適合性層85’よりも遅れており、それにより、結合節85aは、例えば、結合節84aよりも先行することになる。その結果、結合節85aと84aとの間に延びる起立繊維94’は、遠位方向(D)における屈曲を選ぶ。結合節84bと85bとの間に延びる起立繊維94’はまた、遠位方向(D)における屈曲を選ぶように斜行又は傾斜されている。代替的な実施形態では、起立繊維94’は、近位方向(P)における屈曲を選ぶように配向され得る。このパターンは、起立繊維の各対が互いに対して平行か又は少なくとも実質的に平行になるまで繰り返される。少なくとも1つの実施形態では、起立繊維94’のうちの1つ又は2つ以上が、近位方向(P)における屈曲を選ぶように配向され、また起立繊維94’のうちの1つ又は2つ以上が、遠位方向(D)における屈曲を選ぶように配向される。起立繊維94’の屈曲方向は、治療される組織(T)の種別、位置、及び配向に少なくとも部分的に基づいて選定され得る。
再び図10及び12を参照すると、生体適合性層84及び85の外側表面は、様々なステープルカートリッジデッキ及び組織表面に適応するように調整され得る。例えば、図10〜12に示すように、生体適合性層84の結合節又は境界は、互いに直接的には連結されておらず、それによって、例えば、階段状のカートリッジデッキに適応する柔軟性が生体適合性層84にもたらされている。特定の事例では、圧縮性補助材の起立繊維は、生体適合性層の外側表面を改質するように、生体適合性層を越えて延びていてもよい。
図13及び14を参照すると、圧縮性補助材110は、多くの点で圧縮性補助材11、31、51、81、81’、及び100に類似している。例えば、圧縮性補助材110は、ステープルカートリッジ12のカートリッジデッキ16に対して配置され得る。また、圧縮性補助材110は、第1の生体適合性層114と、第2の生体適合性層115と、スペーサ又は起立繊維119とを含み、それらは多くの点でそれぞれ、圧縮性層84、圧縮性層85、及び起立繊維89に類似している。
起立繊維119は、圧縮性補助材110を構造的に支持するように構成されている。図13に示すように、隣接する繊維部分119a及び119bは、圧縮性補助材110の安定性を増大させるために、互いに交差するように構成されている。圧縮力を圧縮性補助材110に加えることにより、繊維部分119a及び119bは互いに対して屈曲及び/又はシフトされ得る。
図13〜16に示すように、圧縮性補助材110及び130は、圧縮性補助材110の外周に、かつ/又は、特定の事例では、様々な他の中央位置に配置されるビルディングブロック111を含む。圧縮性補助材110のビルディングブロック111は一対の繊維部分119aを有し、この一対の繊維部分119aは、圧縮性層114と115との間の中間の距離に既定される平面において、一対の繊維部分119bと交差するように構成されている。それに加えて、4つの繊維部分122が、ビルディングブロック111の4つのコーナーを画定している。4つの繊維部分122の各々は、生体適合性層114及び115を切断する垂直軸線に沿って延びるか、又は少なくとも実質的に延びている。特定の事例では、ビルディングブロック111は、垂直な繊維部分を含まない。隣接するビルディングブロック111は、共通の繊維部分122を共有している。
図13に示すように、交差する繊維部分119a及び119bは角度βを規定しており、この角度βは、例えば、約10°〜約170°の範囲内の任意の角度であり得る。特定の事例では、角度βは、例えば約30°〜約100°の範囲内の任意の角度であり得る。特定の事例では、角度βは、例えば約50°〜約70°の範囲内の任意の角度であり得る。
圧縮性補助材110の起立繊維119は、第1の生体適合性層114から突出する把持機構を更に画定している。把持機構は、牽引ループ120の形態をなし得る。図13に示すように、2つの繊維部分119a及び119bは、第1の生体適合性層114の内側表面116にある結合節又は境界105において交差し、次いで、第1の生体適合性層114の外側表面118の上にループ120を形成するように、第1の生体適合性層114を貫いて延びている。繊維119が第1の生体適合性層114に通されて、いくつかのループ120を形成し得る。代替的に、ループ120は、繊維119とは独立に外側表面118の上に形成され得る。例えば、第1の生体適合性層114の上にループ120を形成するために、別の繊維が用いられ得る。図13に示すように、ループ120は、結合節又は境界105と整列されている。代替的に、特定の事例では、ループ120は結合節105と整列されない。
図13に示すように、ループ120は列123をなして離間及び配列されている。ステープルカートリッジ12のカートリッジデッキ16に対して牽引をもたらすために、ループ120は、生体適合性層114の外周に、かつ/又は、特定の事例では、第1の生体適合性層114上の様々な他の位置に配置され得る。
第1の生体適合性層114の特定の区間におけるループ120の度数、位置、配列、及び/又は寸法は、第1の生体適合性層114のその区間において、所望の程度の牽引をカートリッジデッキ16に対して達成するように制御され得る。例えば、カートリッジデッキ16に対する付加的な牽引が第1の生体適合性層114の近位部分において望まれる場合、第1の生体適合性層114の外側表面118の近位部分の上に、外側表面118の残部と比較してより多数の牽引ループ120が形成され得る。
それに加えて、カートリッジデッキはまた、例えば、圧縮性補助材110とカートリッジデッキ16との間の牽引を改善するために、牽引ループ120を解放可能に保持するための取付け手段を含み得る。更に、第1の生体適合性層114は、カートリッジデッキ16の熱成形又は接合のための特に密な区間を含むように設計されてもよい。
第1の生体適合性層114と同様に、第2の生体適合性層115もまた、組織に対して牽引力を与えるための把持機構を含み得る。例えば、図15及び16に示すように、圧縮性補助材130は、多くの点で牽引ループ120と同様である牽引ループ140を含む。牽引ループ140は、第2の生体適合性層115の外側表面138の上に配置されている。代替的に、第2の生体適合性層115の外側表面138は、平滑であるか若しくは少なくとも実質的に平滑であること、並びに/又は組織の内部成長及び/若しくは癒着を最小限にするように処理されることが可能である。
様々な事例において、生体適合性層114及び115の把持機構は、ループ120及び140を含めて、それぞれ直接、生体適合性層114及び115の上に編み込まれるか又は織り込まれ得る。少なくとも1つの事例では、第1の生体適合性層114及び/又は第2の生体適合性層115は、第1の方向にはより長く、第1の方向と交差する第2の方向にはより短い、露出した糸を有するサテン型の織物を含み得る。サテン型の織物は、第2の方向における流動に抵抗することによって、牽引力を増大させ得る。様々な事例において、生体適合性層114及び115は、1つ又は2つ以上のマルチフィラメント繊維から編み込まれ得るが、起立繊維119はモノフィラメント繊維を含む。モノフィラメント繊維119は、ループ120及び140を形成するように、生体適合性層114及び115を越えて延出され得る。起立繊維119の延出部は、例えば、生体適合性層114及び115の編みパターンの途中でループ化され得る。
様々な事例において、生体適合性層114及び115の把持機構は、ループ120及び140を含めて、所定の方向における牽引力を改善するように傾斜又は斜行され得る。例えば、図15及び16に示すように、ループ140は、遠位方向(D)における隣接する組織の流動に抵抗するために、近位方向(P)にわずかに傾斜又は斜行されている。代替的な実施形態では、ループ140は、近位方向(P)における隣接する組織の流動に抵抗するために、遠位方向(D)にわずかに傾斜又は斜行されてもよい。特定の事例では、ループ140のうちのいくつかは近位方向(P)に傾斜又は斜行されてよく、またループ140のうちのいくつかは遠位方向(D)に傾斜又は斜行されてよい。様々な事例において、ループ140の高さを増大させることにより、隣接する組織の流動に対する抵抗が増加する。
図14及び16を参照すると、ナイフチャネル又はスロット137が、圧縮性補助材110及び130の各々の本体内に画定されている。圧縮性補助材110及び114がステープルカートリッジ12に対して配置されるとき、ナイフスロット137は、ステープルカートリッジ12内に画定されたナイフスロット37と整列されるか又は少なくとも実質的に整列される。ナイフスロット37及び137は、切断縁部9116が外科用ステープル留め及び切断器具8010によって捕捉された組織を切断するために前進されるときに、その切断縁部9116を収容するように構成される。
例えば圧縮性補助材110及び/又は130などの圧縮性補助材が、ナイフスロット137を伴って製造され得る。例えば、ナイフスロット137は、圧縮性補助材の本体にある繊維密度の低減された局所的に薄いエリアとして、織り込まれるか又は編み込まれ得る。代替的に、ナイフスロット137は、製造後に圧縮性補助材内に形成されてもよい。例えば、ナイフスロット137は、溶剤、加熱操作、ダイ切断操作、レーザー切断操作、超音波切断操作、又はこれらの技法の組み合わせを用いて、圧縮性補助材の中に切り込まれ得る。ナイフスロット137は、切断縁部9116の前進に対する圧縮性補助材の抵抗を最小にするのを助けるが、このことはとりわけ、切断縁部9116の寿命を改善し、かつ/又は切断縁部9116を前進させるのに必要な力を低減し得る。
特定の事例では、ナイフスロット137は、圧縮性補助材を2つの完全に別々の部分に分離し得る。代替的に、図17及び18に示すように、圧縮性補助材150の2つの部分150aと150bとの間に延びるナイフスロット137は、それら2つの部分150aと150bとを繋ぎ止めるように構成された1つ又は2つ以上の架橋部材152によって割り込まれ得る。圧縮性補助材110及び130と同様に、圧縮性補助材150の部分150a及び150bの各々は、カートリッジデッキ16に対して配置可能な第1の生体適合性層114と、捕捉された組織に対して配置可能な第2の生体適合性層115と、多くの点で起立繊維119に類似したスペーサ又は起立繊維179と、を含む。
図17〜19を参照すると、起立繊維179は、圧縮性補助材150を構造的に支持するように構成されている。図17〜19に示すように、隣接する繊維部分179a及び179bは、圧縮力及び/又は剪断力下での圧縮性補助材150の安定性を増大させるために、互いに交差するように構成されている。圧縮力を圧縮性補助材150に加えることにより、繊維部分179a及び179bは互いに対して屈曲及び/又はシフトされ得る。圧縮性補助材51(図9)と同様に、圧縮性補助材150は、種々の厚さの部分を有する組織に適応し得る。
図19を参照すると、圧縮性補助材150の生体適合性層114及び115は、互いに対して平行に又は少なくとも実質的に平行に延びている。繊維部分179a、179b、及び172は、生体適合性層114と115との間の分離を維持するように、生体適合性層114と115との間に延びている。繊維部分179aは、互いに平行か又は少なくとも実質的に平行である。繊維部分179aは、生体適合性層114及び115と角度α1で交差する軸線171に沿って延びるか又は少なくとも実質的に延びている。同様に、繊維部分179bは、互いに平行か又は少なくとも実質的に平行である。繊維部分179bは、生体適合性層114及び115と角度α2で交差する軸線173に沿って延びるか又は少なくとも実質的に延びている。特定の事例では、角度α1とα2は同じであるか、又は少なくとも実質的に同じである。
角度α1は、例えば約10°〜約170°の範囲内の任意の角度であり得る。特定の事例では、角度α1は、例えば約30°〜約100°の範囲内の任意の角度であり得る。特定の事例では、角度α1は、例えば約50°〜約70°の範囲内の任意の角度であり得る。角度α1に対する他の値も、本開示では企図される。
角度α2は、例えば約10°〜約170°の範囲内の任意の角度であり得る。特定の事例では、角度α2は、例えば約30°〜約100°の範囲内の任意の角度であり得る。特定の事例では、角度α2は、例えば約50°〜約70°の範囲内の任意の角度であり得る。角度α2に対する他の値も、本開示では企図される。
図19に示すように、繊維部分179aと179bは互いに交差して、複数の「X字形状の」構造を画定し得る。結合節又は境界175及び178は、それぞれ生体適合性層115及び114内に、隣接するX字形状の構造の間に画定されている。繊維部分179a及び179bの端部は、結合節175及び178において交差している。角度βが、交差する繊維部分179aと179bとの間に規定される。角度βは、例えば約10°〜約180°の範囲内の任意の角度であり得る。特定の事例では、角度βは、例えば約30°〜約100°の範囲内の任意の角度であり得る。特定の事例では、角度βは、例えば約50°〜約70°の範囲内の任意の角度であり得る。少なくとも1つの事例では、角度βは、例えば角度α1及び/又は角度α2に等しいか又は少なくとも実質的に等しい。
更に、繊維部分172a〜172eを含めて繊維部分172は、生体適合性層114と115との間に延びている。繊維部分172は、生体適合性層114及び第2の生体適合性層115に対して垂直であるか又は少なくとも実質的に垂直である。図19に示すように、繊維部分172aは、生体適合性層114及び115と角度α3で交差する軸線177に沿って延びるか又は少なくとも実質的に延びている。角度α3は、例えば約80°〜約100°の範囲内の任意の角度であり得る。特定の事例では、角度α3は、例えば約85°〜約95°の範囲内の任意の角度であり得る。特定の事例では、角度α3は、例えば約87°〜約93°の範囲内の任意の角度であり得る。角度α3の他の値も本開示では考慮される。
更に、繊維部分172は互いに離間されている。繊維部分172は、互いから等距離にあるか、又は任意の他の好適な構成で配列され得る。図19に示すように、繊維部分172cが、交差する繊維部分179aと179bによって画定されたX字形状の構造の交差点174を通過している。繊維部分172dが、交差する繊維部分179aと179bによって画定されたX字形状の構造の交差点174を部分的に通過している。特定の事例では、2つ又は3つ以上の繊維部分172が、交差する繊維部分179aと179bによって画定されたX字形状の構造の交差点を通過するか又は部分的に通過し得る。特定の事例では、結合節又は境界が、例えば生体適合性接着剤などの生体適合性結合剤を使用することによって、交差点174のうちの1つ又は2つ以上に形成され得る。
図19を参照すると、繊維部分172bは、交差する繊維部分179aと179bのX字形状の構造の片側に配置され、繊維部分172bがそのようなX字形状の構造の交差する繊維部分179a及び179bに交差するようになっている。特定の事例では、2つ又は3つ以上の繊維部分172が、2つ又は3つ以上のX字形状の構造に対して、繊維部分172bと同様に配置され得る。
図19に示すように、結合節175は垂直方向に、結合節178と整列されるか又は少なくとも実質的に整列されている。特定の事例では、例えば繊維部分172eなど、繊維部分172は、垂直方向に整列される結合節175と178との間に延び得る。
図17及び18を参照するが、架橋部材152は、外科用ステープル留め及び切断器具8010によって捕捉された組織を切断するために切断縁部9116が前進される間に、切断縁部9116によって切断される。代替的に、架橋部材152のうちの1つ又は2つ以上は、切断縁部9116の経路の外側に配置されてもよく、また、外科用ステープル留め及び切断器具8010が発射された後も引き続き部分150aと150bとを繋ぎ止めてもよい。
図20〜22を参照すると、圧縮性補助材160の部分150a及び150bが、架橋部材162によって繋ぎ止められている。図20に示すように、架橋部材162は、ナイフスロット137の長さに沿って部分150aと150bとの間に別個の取付け手段を設けるように分離されている。架橋部材162のうちの1つ又は2つ以上は、切断縁部9116が外科用ステープル留め及び切断器具8010によって捕捉された組織を切断するために前進されるときに、その切断縁部9116によって切断され得る。
図21及び22に示すように、架橋部材162はまた、圧縮性補助材160をステープルカートリッジ12に取り付けるか又は繋ぎ止めるように構成されている。架橋部材162の区間は、圧縮性補助材160をステープルカートリッジ12に固定するように、ステープルカートリッジ12の底部部分17の切り込み又は穴164を通して延出されている。架橋部材162はまた、ナイフスロット37及び137に通され得る。架橋部材162は、外科用ステープル留め及び切断器具8010によって捕捉された組織を切断するために切断縁部9116が前進されるときに切断縁部9116が通ることによって生じる剪断又は切断動作によって、部分150a及び150bを互いからかつ/又はステープルカートリッジ12から解放するために切断され得る。
図21及び22に示すように、切り込み164は、ステープルカートリッジ12のナイフスロット37の両側の別個の位置に形成されている。特定の事例では、架橋部材162は、例えば、圧縮性補助材160をステープルカートリッジ12に取り付けるために切り込み164に突き通される縫合糸の形態をなす。特定の事例では、切り込み164は、ステープルカートリッジ12の底部部分17から延びる突出部と置き換えられるか又はそれと組み合わせて使用され得る。突出部は、架橋部材162のうちの圧縮性補助材160をステープルカートリッジ12に取り付ける区間を保持するように構成され得る。架橋部材162によって圧縮性補助材160をステープルカートリッジ12に取り付けることを促進するために、他の取付け手段がステープルカートリッジ12に形成され得る。
図23を参照するが、架橋シース182が圧縮性補助材180の2つの部分の間に延び得る。図23では、架橋シース182は、切断縁部9116によって切断されている。圧縮性補助材180の一方の部分150aのみが示されている。また、切断された架橋シース182のうちの圧縮性補助材180の部分150aに依然として付着した部分が示されている。切断縁部9116は、架橋シース182を切断するために、長手方向軸線AAによって規定される経路に沿って、ナイフスロット37及び137を通して前進される。
特定の事例では、図23に示すように、架橋シース182は、圧縮性補助材180のうちのナイフスロット137の底面の部分の間に画定される。そのような事例では、架橋シース182は、圧縮性補助材180の2つの部分の間に延びる第1の生体適合性層114の一部であり得る。また、そのような事例では、圧縮性補助材180がステープルカートリッジ12のカートリッジデッキ16に対して配置されるとき、架橋シース182は、圧縮性補助材180のナイフスロット137とステープルカートリッジ12のナイフスロット37とを分離するか又は少なくとも部分的に分離する。
他の事例では、架橋シース182は、圧縮性補助材180のうちの、圧縮性補助材180のナイフスロット137の頂面の部分の間に画定される。そのような事例では、架橋シース182は、圧縮性補助材180の2つの部分の間に延びる第2の生体適合性層115の一部であり得る。また、そのような事例では、圧縮性補助材180がステープルカートリッジ12のカートリッジデッキ16に対して配置されるとき、架橋シース182は、圧縮性補助材180のナイフスロット137をステープルカートリッジ12のナイフスロット37から分離しない。その代わりに、ナイフスロット137及び37は、架橋シース182の下方に配置される。更に他の事例では、架橋シース182は、例えば、圧縮性補助材180の生体適合性層114と115との間に規定される平面を通して、又は少なくとも実質的に通して、圧縮性補助材180の部分の間に延び得る。
再び図23を参照すると、圧縮性補助材180は、架橋シース182をステープルカートリッジ16の底部部分17に繋ぎ止めることによって、ステープルカートリッジ16に取り付けられ得る。例えば、架橋シース182をステープルカートリッジ12の底部部分に繋ぎ止めるために、縫合糸などの取付け手段が架橋シース182及び切り込み164に通され得る。縫合糸は、例えば、圧縮性補助材180をステープルカートリッジ12から徐々に解放するために、切断縁部9116によって切断され得る。ナイフスロット137の底面において架橋シース182のみに縫合糸を通すことによって圧縮性補助材180をステープルカートリッジ16に取り付けることにより、縫合糸の取付け張力を失うことなく圧縮性補助材180の残部が自在に圧縮される。同じことが、例えば、第1の生体適合性層114のみに縫合糸を通すことによって達成され得る。
図24及び25を参照すると、圧縮性補助材190が、ステープルカートリッジ12のカートリッジデッキ16に対して配置されている。圧縮性補助材190は、多くの点で圧縮性補助材11、31、51、81、81’、100、110、130、150、及び/又は180に類似している。例えば、圧縮性補助材190は、第1の生体適合性層114と、第2の生体適合性層115と、生体適合性層114と115との間に延びるスペーサ又は起立繊維199と、を含む。
図24に示すように、圧縮性補助材190は、固定部材191によってステープルカートリッジ12に固定されており、固定部材191は、細長支持部材194から突出する屈曲可能な棘又は突起192を含む。屈曲可能な突起192は、構造の中には比較的容易に貫入するが、屈曲可能な突起192を細長支持部材194から離して屈曲させるように十分な力が加えられるまで、構造からの除去には抵抗するように構成された矢頭のように付形されている。
屈曲可能な突起192は、細長支持部材194の両側の終端部分195及び196に配列されている。少なくとも1つの例において、図24に示すように、3つの屈曲可能な突起192が、両側の終端部分195及び196の各々に配置される。両側の終端部分195及び196の各々の屈曲可能な突起192は、それらの間に等しい距離をおいて離間されている。3つより多数又は少数の屈曲可能な突起192が、両側の終端部分195及び196の各々に置かれてもよい。細長支持部材194に対する屈曲可能な突起192の他の構成も本開示では企図される。
図24を参照すると、圧縮性カートリッジ190の少なくとも一部分をステープルカートリッジ12に固定するために、2つの固定部材191が用いられている。圧縮性カートリッジ190をステープルカートリッジ12に固定するために、2つより多数又は少数の固定部材191が用いられてもよい。図24に示すように、固定部材191の終端部分195は生体適合性層114を通して挿入されているが、終端部分196は、カートリッジデッキ16を通してステープルカートリッジ12のステープルキャビティ197の中に挿入されている。ステープル10030がステープルキャビティ197内に配置されている。ステープルキャビティ197からのステープル10030の配備は、終端部分196によって阻止されるか又は少なくとも部分的に阻止される。ステープル10030がステープルキャビティ197から配備されるとき、ステープル10030は、終端部分196をステープルキャビティ197から押し出して、固定部材191をステープルカートリッジ12から解放する。
他の固定部材191の終端部分196は、それぞれのステープル10030の配備の間にステープルカートリッジ12の他のステープルキャビティ197から徐々に解放され得る。ステープル10030は、ウェッジスレッド9126(図4)の前進によってそれぞれのステープルキャビティ197から徐々に解放されるので、それに対応して圧縮性補助材190が徐々に解放されることもまた、外科用ステープル留め及び切断器具8010の発射シーケンスの間にウェッジスレッド9126が前進することによって達成される。本質的に、より近位側のステープルキャビティの中に挿入される終端部分196を備える固定部材191は、より遠位側のステープルキャビティの中に挿入される終端部分196を備える固定部材191よりも前に解放される。
圧縮性補助材190を徐々に解放することにより、カートリッジデッキ16上の個々の位置における圧縮性補助材190とステープルカートリッジ12との間の相対的な配置は、そのような位置のステープル10030がそれぞれのステープルキャビティ197から発射されるまで維持される。固定部材191はまた、外科用ステープル留め及び切断器具8010の発射シーケンスの間に切断縁部9116が前進されるときに生じ得る、圧縮性補助材190の集積に抵抗する。
図24を参照すると、ステープルキャビティ197にある固定部材191は、互いに平行に又は少なくとも実質的に平行に延びている。少なくとも1つの事例では、ステープルキャビティ197にある固定部材191は、例えば、互いに交差して「X字」形状を画定し得る。
図24を参照するが、細長支持部材194の両側の終端部分195及び196の各々にある最も外側の屈曲可能な突起192は、構造に貫入するための穿孔先端部を画定し得る。穿孔先端部は、構造への貫入を促進するために特別に硬化され得る。更に、屈曲可能な突起192の矢頭形状は、例えば、屈曲可能な突起192と起立繊維199との絡み合いによって、固定部材191と圧縮性補助材190との間の付着の安定性を改善し得る。
図25を参照すると、固定部材191の細長支持部材194の終端部分196が、ステープルカートリッジ12のステープルキャビティ197の中に挿入されている。終端部分196は、細長支持部材194の第1の側部で細長支持部材194から突出する付着部分192aと、第1の側部とは反対の細長支持部材194の第2の側部で細長支持部材194から突出する付着部分192bとを画定する、4つの屈曲可能な突起192を含む。付着部分192aは、第1の側部上で細長支持部材194に対して角度α1を規定するが、付着部分192bは、第2の側部上で細長支持部材194に対して角度α2を規定している。
特定の事例では、角度α1及び/又は角度α2は、例えば約1°〜約90°の範囲内の任意の角度であり得る。特定の事例では、角度α1及び角度α2は、例えば約30°〜約70°の範囲内の任意の角度であり得る。特定の事例では、角度α1及び/又は角度α2は、例えば約40°〜約60°の範囲内の任意の角度であり得る。少なくとも1つの事例では、角度α1は、角度α2に等しいか又は少なくとも実質的に等しい。少なくとも1つの事例では、角度α1は、角度α2とは異なる。
図25に示すように、屈曲可能な突起192はそれぞれ、細長支持部材194上の同じ位置から延びる付着部分192a及び192bを含む。代替的に、屈曲可能な突起192が、付着部分192a及び192bの一方のみを含み得る。少なくとも1つの事例では、屈曲可能な突起192の付着部分192a及び192bは、細長支持部材194から延びる生体適合性繊維から作製される。少なくとも1つの事例では、細長支持部材194もまた、生体適合性繊維から作製され得る。
様々な事例において、圧縮性補助材の縁部は、ステープルカートリッジ12のカートリッジデッキ16への付着性を改善し、かつ/又は圧縮性補助材の構造性能を改善するように構成され得る。例えば、図17に示すように、圧縮性補助材150の部分150a及び150bそれぞれの縁部151a及び151bはそれぞれ、圧縮性補助材150の外周を画定する外側リップ153へと形成され、カートリッジデッキ16に付着され得る。
特定の事例では、外側リップは、圧縮性補助材の製造後に形成され得る。例えば、圧縮性補助材の生体適合性層の外周は、外側リップを形成するために、熱及び/又は圧力を受け得る。特定の事例では、外側リップは、例えば、圧縮性補助材の生体適合性層の外周を、外側リップを画定する一体的な構造へと織り込むこと又は編み込むことによって形成され得る。図26に示すように、圧縮性補助材200の外側リップ203は、圧縮性補助材200の生体適合性層114及び115それぞれの外周217及び218を、外側リップ203を画定する一体的な構造へと編み込むことによって形成される。
圧縮性補助材の生体適合性層の外周を一体化することは、圧縮性補助材を安定化させ、かつ/又は圧縮中の剪断圧壊を最小限にするのに役立ち得る。特定の事例では、しかしながら、この改良の結果として生じ得る圧縮性補助材の外周と中央との構造的な差異及び/又は他の差異を最小限にするために、圧縮性補助材の生体適合性層の外周間の間隔を維持することが望ましい。
図27を参照すると、先細の縁部212が圧縮性補助材210に画定されている。圧縮性補助材210は第1の生体適合性層214を含み、第1の生体適合性層214は、第2の生体適合性層215を越えて横方向に延びている。代替的に、圧縮性補助材210は第2の生体適合性層215を含み得、第2の生体適合性層214は、第1の生体適合性層214を越えて横方向に延びている。
生体適合性層214及び215は、多くの点で生体適合性層114及び115に類似している。例えば、第1の生体適合性層214は、カートリッジデッキ16に対して配置されかつ/又はカートリッジデッキ16に付着されるように構成され、第2の生体適合性層215は、アンビル8014とステープルカートリッジ12との間に捕捉された組織に対して配置されるように構成される。少なくとも1つの事例では、圧縮性補助材210の先細の縁部212は、圧縮性補助材210の一部分を除去すること又は切り落とすことによって形成される。切断平面は、先細の縁部212の所望の先鋭度に基づいて所定の角度をなして形成され得る。
図28〜30を参照すると、圧縮性補助材230が示されている。圧縮性補助材230は、本開示で説明する他の圧縮性補助材と類似している。例えば、圧縮性補助材51(図9)と同様に、圧縮性補助材230は、ステープル10030によって圧縮性補助材230と共に捕捉された組織(T)の厚さの変動を補償し得る。図28に示すように、圧縮性補助材230は、組織部分72及び74がステープル10030によって圧縮性補助材230と共に捕捉されるとき、種々の組織厚さを有する組織部分72及び74を有する組織(T)に適応するように構成されている。
図28を参照すると、圧縮性補助材230は、カートリッジ接触表面234と組織接触表面235との間に配置された複数の構造セル236を含む。構造セル236のうちの1つ又は2つ以上は、圧縮性補助材230の全長に沿って又は少なくとも実質的に沿って、長手方向に延び得る。構造セル236は、構造セル236上に外周を画定する壁によって概ね囲まれている。隣接する構造セル236は、1つ又は2つ以上の壁を共有し得る。
図29を参照すると、構造セル236は6つの壁によって画定され、六角形の形状を備えている。少なくとも1つの事例では、構造セル236のうちの1つ又は2つ以上がそれぞれ、3つ又は4つ以上の壁を含み得る。圧縮性補助材230の構造セル236は、同じ個数の壁を含み得る。例えば、代替的に、第1の群の構造セル236は第1の個数の壁を含み得るが、第2の群の構造セル236は、第1の壁の個数とは異なる第2の個数の壁を含み得る。少なくとも1つの事例では、構造セル236は、圧縮性補助材230の全長の少なくとも一部分に沿って又は少なくとも実質的に沿って長手方向に延びるハニカム形状を画定する。
このハニカム形状は、圧縮力及び/又は剪断力下における圧縮性補助材230の安定性を改善する。加えて、ハニカム形状の構造セル236は、アンビル8014がステープルカートリッジ12とは反対の閉鎖位置へと移動されるときに、圧縮性補助材230、及び第2の生体適合性層215に対して配置された組織(T)に加えられる圧縮力下で屈曲可能である。図29及び30に示すように、ハニカム形状の構造セル236は、圧縮力が圧縮性補助材230に加えられているときに高さの低減を受けるように構成されており、それにより、図28に示すように、圧縮性補助材230は、種々の組織厚さを有する組織部分72及び74がステープル10030によって圧縮性補助材230と共に捕捉されるときに、組織部分72及び74を有する組織(T)に適応することが可能となっている。
図29及び30を参照すると、構造セル236は、アンビル8014がステープルカートリッジ12とは反対の閉鎖位置へと移動されるときに圧縮性補助材230に加えられる圧縮力に反応して、図29に示すような第1の高さ(H1)から、図30に示すような第2の高さ(H2)への高さの低減を受けている。この高さの低減は、構造セル236が位置する圧縮性補助材230に対して配置された、捕捉された組織(T)の厚さに対応し得る。換言すれば、組織部分の厚さが増すにつれて、その組織部分に対して配置された圧縮性補助材230の一部分に位置する構造セル236の高さの低減も増すことになる。
第2の高さ(H2)と第1の高さ(H1)との比は、例えば、約0.05〜約0.95の任意の値であり得る。特定の事例では、第2の高さ(H2)と第1の高さ(H1)との比は、例えば、約0.2〜約0.7の任意の値であり得る。特定の事例では、第2の高さ(H2)と第1の高さ(H1)との比は、例えば、約0.3〜約0.6の任意の値であり得る。第2の高さ(H2)と第1の高さ(H1)との比の他の値も本開示によって企図される。
構造セル236の壁は、同じか又は少なくとも実質的に同じ厚さを備え得る。代替的に、図29に示すように、構造セル236の壁は種々の厚さを備えてもよい。一対の対向する壁242が第1の厚さ(T1)を備えてよく、一対の対向する壁244が第2の厚さ(T2)を備えてよく、一対の対向する壁246が第3の厚さ(T3)を備えてよく、ここで、第1の厚さ(T1)、第2の厚さ(T2)、及び/又は第3の厚さ(T3)のうちの少なくとも2つは互いに異なるものである。例えば、図29に示すように、壁242の第1の厚さ(T1)は壁244の第2の厚さ(T2)よりも厚く、かつ壁246の第3の厚さ(T3)よりも厚い。
図28〜30を参照すると、構造セル236の壁242は、第1の生体適合性層234及び第2の生体適合性層235と平行又は少なくとも実質的に平行に延びている。特定の事例では、構造セル236の壁242は、第1の生体適合性層234の一部分を画定し得る。特定の事例では、構造セル236の壁242は、第2の生体適合性層235の一部分を画定し得る。
図28に示すように、圧縮性補助材230のビルディングブロックは、他の4つの構造セル236と壁を共有する中央の構造セル236を含む5つの構造セル236を含む。圧縮性補助材230の高さ(H)は、図29に示すように、壁244を共有する2つの構造セル236の積み重ねによって規定され得る。代替的に、圧縮性補助材230の高さ(H)は、図29に示すように、2つの四壁型の構造セル237と、それら構造セル237の間に延びる1つの構造セル236との積み重ねによって規定され得る。構造セル236は、構造セル237の各々と壁242を共有している。圧縮性補助材230の構造壁の他の幾何学的形状及び配列も本開示によって企図される。
様々なアタッチメントが、本開示の圧縮性補助材に定着又は固定され得る。アタッチメントは、圧縮性補助材と同じか又は少なくとも実質的に同じ材料から作製され得る。代替的に、アタッチメントは、圧縮性補助材とは異なる材料から作製され得る。少なくとも1つの事例では、アタッチメントは、圧縮性補助材と同じ材料から作製され得るが、その材料は、例えば、アタッチメントの化学的及び/又は物理的特性のうちの1つ又は2つ以上を改良するために、別々に処理される。
少なくとも1つの事例では、圧縮性補助材は、圧縮性補助材に固定されるアタッチメントよりも硬質又は軟質であり得る。より硬質のアタッチメントは、例えば、アタッチメントをカートリッジデッキに固定するための望ましい剛性をもたらし得る。代替的に、より軟質のアタッチメントは、例えば、敏感な組織とのより繊細な相互作用を生じ得る。少なくとも1つの事例では、圧縮性補助材は、圧縮性補助材に固定されるアタッチメントの表面と比べて、より滑らかな又はより粗い表面を備え得る。最終的に、アタッチメントは、圧縮性補助材と共に様々な機能を実施するように調整され得る。様々な事例において、アタッチメントは、圧縮性補助材のためのサイドアタッチメント又はエンドキャップの形態をなし得る。
図28〜30を参照すると、サイドアタッチメント250が圧縮性補助材230に定着又は固定されている。少なくとも1つの事例では、サイドアタッチメント250は、例えば、熱又は溶剤を用いた溶着によって圧縮性補助材230に固定され得る。サイドアタッチメント250は、圧縮性補助材230の先細の縁部252を画定している。
更に、サイドアタッチメント250は、例えば、圧縮性補助材230をステープルカートリッジ12のカートリッジデッキ16に取り付けるために用いられ得る。少なくとも1つの事例では、サイドアタッチメント250は、例えば、熱又は溶剤を用いることによってカートリッジデッキ16の上に溶着され得る。サイドアタッチメント250を圧縮性補助材230にかつ/又はカートリッジデッキ16に固定するための他の技法も本開示によって企図される。例えば、サイドアタッチメント250のテザー254(図29)が、ステープルカートリッジ12に固定されかつ/又はステープルカートリッジ12の周りに巻き付けられ得る。
圧縮性補助材及び/又はサイドアタッチメントは、組織の内部成長を促進するように構成され得る。例えば、図28〜30に示すように、圧縮性補助材230及びサイドアタッチメント250は、圧縮性補助材230及びサイドアタッチメント250の中への組織の内部成長を促進するように構成された孔254を含む。孔254は、組織の内部成長が望まれる領域において、圧縮性補助材230及び/又はサイドアタッチメント250を通して選択的に形成され得る。
様々な事例において、圧縮性補助材230及び/又はサイドアタッチメント250は、例えば、様々な押出し技法によって製造され得、孔254は、例えば、圧縮性補助材230及び/又はサイドアタッチメント250の所望の部分の中にレーザー穿孔され得る。サイドアタッチメント250は、例えば、押出しの後に圧縮性補助材230に取り付けられ得る。例えば、構造セル236などの構造セルの壁を所定の厚さに製作することによって、調整された圧縮抵抗が圧縮性補助材230において達成され得る。例えば、圧縮性補助材230の製作において使用される材料にかかわらず所望の剛性を達成するように、圧縮性補助材230内の構造セルの柔軟性を調整するために、非一様な肉厚のパターンが押出しされ得る。
図31を参照すると、圧縮性補助材260が示されている。圧縮性補助材260は、ステープルカートリッジ12のカートリッジデッキ16に対して配置された第1の生体適合性層114を含む。加えて、圧縮性補助材260は、組織(T)に対して配置可能な第2の生体適合性層115を含む。複数の起立壁又はスペーサ壁262が生体適合性層114と115との間に画定されている。起立壁262は、図31に示すように、生体適合性層114と115との間の空間を維持するように構成されている。加えて、起立壁262は、アンビル8014がステープルカートリッジ12とは反対の閉鎖位置へと移動されるときに、圧縮性補助材260、及び第2の生体適合性層115に対して配置された組織(T)に加えられる圧縮力下で屈曲可能である。
起立壁262は、生体適合性層114及び115に取り付けられ、互いから離間されている。代替的に、起立壁262は、互いに繋ぎ止められるか若しくは付着され得る。起立壁262のうちの一部は、互いに平行に又は少なくとも実質的に平行に配列される。しかしながら、他の起立壁262が、交差する平面内に延びている。
更に、起立壁262は、起立壁262の柔軟性を改善する切り抜き又は間隙264を備えている。少なくとも1つの事例では、起立壁262のうちの1つ又は2つ以上が、例えば押出しによって、切り抜き264を伴って製作され得る。代替的に、切り抜き264は、起立壁262の製作が完了した後に形成され得る。切り抜き264は、例えば、圧縮性補助材260の所望の柔軟性を達成するように計画的に配置され得る。
図32を参照すると、圧縮性補助材270は、ステープルカートリッジ12のカートリッジデッキ16に対して配置された第1の生体適合性層114を含む。圧縮性補助材270は第2の生体適合性層を欠いている。したがって、組織(T)は直接、圧縮性補助材270の複数のスペーサ又は起立壁272に対して配置される。代替的に、圧縮性補助材270は、起立壁272の反対側に第2の生体適合性層を含み得る。そのような事例では、組織(T)は第2の生体適合性層に対して配置され得る。加えて、起立壁272は、アンビル8014がステープルカートリッジ12とは反対の閉鎖位置へと移動されるときに、圧縮性補助材270、及び起立壁272に対して配置された組織(T)に加えられる圧縮力下で屈曲可能である。
起立壁272は、縦壁272aと、その縦壁272aと交差する横壁272bとを含む。起立壁272は、図32に示すように、中空又は少なくとも実質的に中空のフレームを備えている。代替的に、起立壁272は中実のフレームを備えてもよい。様々な事例において、起立壁272は、例えば三角柱の形状を備える。起立壁272は、三角の断面領域を備える。起立壁272は、三角の断面領域に加えてあるいはそれに代わって、正方形の形状、矩形、及び/又は曲線状の断面領域を備えてもよい。図32に示すように、縦壁272aは、三角形状をなす縦断面領域を備え、横壁272bは、三角形状をなす縦断面領域を備えている。
縦壁272aは、第1の生体適合性層114によって画定される底辺276aと、隣接する縦壁272aの他の頂点274aと平行に又は少なくとも実質的に平行に長手方向に延びる頂点274aと、を備えている。横壁272bはまた、第1の生体適合性層114によって画定される底辺276bと、隣接する横壁272bの他の頂点274bと平行に又は少なくとも実質的に平行に横方向に延びる頂点274bと、を備えている。
図32に示すように、圧縮性補助材272は、転置されたピラミッド形状を備える構造セル278を含む。構造セル278が、2つの平行な又は少なくとも実質的に平行な壁272aと、その壁272aと交差する2つの平行な又は少なくとも実質的に平行な壁272bとの間に画定されている。構造セル278の底辺280は、交差する壁272aと272bによって画定される4つの角282を備える。構造セル278の頂点284は、第1の生体適合性層114に画定されている。各構造セル278は、図32に示すように、頂点284から延び、底辺280で終端している。
様々な事例において、例えば、圧縮性補助材110の第2の生体適合性層115など、本開示の圧縮性補助材の第2の生体適合性層は、圧縮性補助材110がステープルカートリッジ12のカートリッジデッキ16に対して配置されているときに視認可能である。様々な事例において、特定の情報が、第2の生体適合性層の上に編み込まれるか又は印刷される画像、言葉、記号、及び/又は色を通して操作者に伝達され得る。例えば、ナイフの移動長さを示すために編み線が用いられ得るが、このことは、操作者が手技で用いられる負荷の数を低減する助けとなり得る。編み線はまた、ステープルクラウンの位置を示すためにも用いられ得る。更に、編み線はまた、例えばステープル高さなど、圧縮性補助材と共に用いられるステープルカートリッジに関する情報を提供するためにも用いられ得る。更に、編み線はまた、治療される組織を圧縮性補助材に対して配置するための最適な位置を描くためにも用いられ得る。
埋め込み可能な層4000を含むステープルカートリッジアセンブリが図33に示されている。ステープルカートリッジアセンブリは、層4000を支持するデッキ16を含むカートリッジ本体12を更に備える。層4000は、デッキ16によって支持される底部部分4004を、またそれに加えて、頂部部分4005を備えて。底部部分4004と頂部部分4005は壁4009によって連結されている。壁4009は、層4000を越えて横方向に延びているが、壁4009は、例えば長手方向など、任意の好適な方向に延び得る。少なくとも1つの実施形態では、カートリッジ本体12は、切断部材を受容するように構成された長手方向スロットを備え、壁4009は長手方向スロットの全体にわたって延びている。
壁4009は、それらの間にチャンバ4008を画定している。荷重が層4000に加えられるとき、チャンバ4008は、壁4009を屈曲、撓曲、及び/又は圧壊させる。壁4009が屈曲する量は、層4000に対して押し付けられる組織の厚さに依存する。組織が層4000の上へと下向きに圧迫されるとき、層4000は、層4000に対して圧迫されている組織の厚さに適応し得る。別の言い方をすれば、層4000は、図34に示すように、組織厚さの局所的な変動に対して、局所的な適応をもたらし得る。様々な事例において、壁4009は、層4000にシームを画定している。それらのシームは、例えば、横方向シーム及び/又は長手方向シームであり得る。シームの配列は、層4000の撓曲を制御し得る。
上記に加えて、層4000は、構造繊維4006と、強化繊維4007とを含む。構造繊維4006は、底部部分4004と、頂部部分4005と、壁4009とを形成するように配列されている。少なくとも1つの事例では、図33に示すように、構造繊維4006は、長手方向シームを間に形成する長手方向列をなして配列される。構造繊維4006は、底部部分4004と頂部部分4005との間に延び、それらを連結する柱又は支柱を形成する。強化繊維4007は、底部部分4004、頂部部分4005、及び/又は壁4009の中で織り合されている。少なくとも1つの事例では、強化繊維4007は、構造繊維4006の周りに結び付けられ、ループ化され、かつ/又は巻き付けられる。様々な事例において、強化繊維4007は、構造繊維4006と組み合わされる。
強化繊維4007は、壁4009内の構造繊維4006を連結する。強化繊維4007は、壁4009に所望の構造特性を与えるように、壁4009内の支柱を互いに保持するか又は結び付ける。例えば、より高密度の強化繊維4007を有する壁4009は、より低密度を有する壁4009よりも強固である。同様に、底部部分4004及び/又は頂部部分4006内の強化繊維4007の密度は、部分4004及び/又は4006の強度に影響を及ぼし得る。
上記の結果として、壁4009内の構造支柱は互いに屈曲及び移動し得る。更に、壁4009内の構造繊維支柱4006は、強化繊維4007による隣接する構造繊維支柱2006によって支持される。図33に示すように、一方の壁4009内の強化繊維4007は、隣接する壁4009内の強化繊維4007に直接的には連結されていないが、第1の壁4009内の強化繊維4007は、底部部分4004及び/又は頂部部分4006を介して第2の壁4009内の強化繊維4007に連結され得る。様々な代替的な実施形態において、強化繊維4007は、隣接する壁4009の間に直接的に広がり、それらを連結し得る。
構造繊維4006と強化繊維4007は、結節境界において互いに付着され得る。結節境界は、任意の好適な結節タイプを含み得る。用いられる結節境界のタイプは、層4000の剛性に影響を及ぼし得る。例えば、緩い結節が用いられる場合、層4000は、剛性がより低くなるか、又はより低い弾性率を有し得る。代替的に、堅い結節が用いられる場合、層4000は、剛性がより高くなるか、又はより高い弾性率を有し得る。層4000は、任意の好適なタイプの結節を利用し得る。
上記に加えて、構造繊維4006と強化繊維4007との間の結節は、層4000の種々の部分に種々の剛性又は弾性率を選択的に与えるために利用され得る。例えば、構造繊維4006と強化繊維4007との間における結節のタイプ及び/又は結節の度数は、第1の圧縮ゾーンと第2の圧縮ゾーンとを生成するように選択され得る。第1の圧縮ゾーンは第1の剛性を有し、第2の圧縮ゾーンは、第1の剛性よりも高い第2の剛性を有する。少なくとも1つの事例では、第1の圧縮ゾーンは、切断部材を受容するように構成された、デッキ12内に画定された長手方向スロットと整列され、かつその長手スロットの上に配置され、第2の圧縮ゾーンは、デッキ12内に画定されたステープルキャビティと整列され、かつそのステープルキャビティの上に配置される。そのような配列は、層4000の切断を促進する一方で、組織に対して層4000を捕捉するステープル10030内における所望の組織厚さ補償特性をもたらし得る。特定の事例では、第1の圧縮ゾーンはデッキ12の近位端部と整列され、第2の圧縮ゾーンは、第1の圧縮ゾーンに対して遠位側に配置される。少なくとも1つのそのような事例では、別の第1の圧縮ゾーンが、第2の圧縮ゾーンに対して遠位側に配置される。そのような配列は、切断部材の切断行程の開始時及び終了時における層4000の切断を促進し得る。
構造繊維4006は、第1の断面幅又は直径を備え、強化繊維4007は、第1の断面幅とは異なる第2の断面幅又は直径を備える。図33及び34に示すように、構造繊維4006の断面幅は、強化繊維4007の断面幅よりも広い。少なくとも1つの事例では、例えば、構造繊維4006の断面幅は、強化繊維4007の断面幅の2倍程度である。
構造繊維4006は第1の材料で構成され、強化繊維4007は、第1の材料とは異なる第2の材料で構成される。少なくとも1つの事例では、構造繊維4006は第1の高分子材料で構成され、強化繊維4007は、第1の高分子材料の弾性率よりも低い弾性率を有する第2の高分子材料で構成される。代替的な実施形態では、構造繊維4006は第1の高分子材料で構成され、強化繊維4007は、第1の高分子材料の弾性率よりも高い弾性率を有する第2の高分子材料で構成される。特定の実施形態では、構造繊維4006は、1種類又は2種類以上の高分子材料で構成され、かつ/又は、強化繊維4007は1種類又は2種類以上の高分子材料で構成される。少なくとも1つのそのような実施形態では、構造繊維4006と強化繊維4007は、互いに共通する少なくとも1種類の材料と、共通しない少なくとも1種類の材料とを有する。
ここで図35を参照すると、埋め込み可能な層4100は、頂部部分4105と、その頂部部分4105を支持する支柱壁4109とを備える。頂部部分4105は、支柱壁4109を備える構造繊維4106によって相互連結される長手方向構造又は繊維4103を備える。構造繊維4106は、任意の好適な方式で長手方向繊維4103の周りにループ化され、巻き付けられ、かつ/又は編み付けられる。図38A及び38Bは、構造繊維4106が縦繊維4103に相互連結される2つの例示的な方式を開示している。
上記に加えて、図38Aは二重ループ型の巻き付けを示している。構造繊維4106は第1の縦繊維4103の周りに巻き付けられ、第2の縦繊維4103へと架橋され、第2の縦繊維4103の周りに巻き付けられている。二重ループ型の構造繊維4106は、支柱壁4109の一部である脚部又は支柱を備える2つの起立端部を備える。構造繊維4106のどちらのループも、閉鎖ループ及び/又は少なくとも1つのターンを備えるが、縦繊維4103を中心としたラウンドターン及び/又は複数回のターンをループそれぞれが含む代替的な実施形態も想定される。図38Aの二重ループ型の巻き付けは、内側二重ループとも呼ばれ得る。より具体的に言えば、構造繊維4106の支柱のいずれもが、隣接する第1及び第2の縦繊維4103の間に画定された間隙を通る。様々な実施形態において、外側二重ループが利用され得る。
上記に加えて、図38B及び39は、第1の縦繊維4103の周りに巻き付けられ、第2の縦繊維4103へと架橋され、第2の縦繊維4103の周りに巻き付けられる構造繊維4106を示している。第1の縦繊維4103の周りへの巻き付けは開ループを含むが、例えば、閉ループ及び/若しく1つは又は2つ以上のターンも利用され得る。第2の縦繊維4103の周りへの巻き付けはターンを含むが、例えば、ラウンドターンも利用され得る。上記と同様に、図38Bの構造繊維4106は、支柱壁4109の一部である脚部又は支柱を備える2つの起立端部を備える。構造繊維4106の起立端部は、縦繊維4103の間の種々の間隙を通して延びている。
ここで図36及び37を参照すると、層4200は縦構造又は繊維4103を含む。層4200は、構造繊維4206と、強化繊維4107とを更に含む。強化繊維4107は、縦繊維4103内で横方向に織り合されている。構造繊維4206は、壁4209を形成するように複数の縦繊維4013の周りに巻き付けられている。図示のように、各構造繊維4206は、例えば、壁4209を形成するように、4つの縦繊維4103の周りに巻き付けられている。上記の結果として、各構造繊維4206は、層4200の頂部部分4205を支持するいくつかの閉鎖型ループ支柱を形成する。構造繊維4206の端部は頂部部分4205を支持しないが、構造繊維4206の端部が構造支柱を構成する代替的な実施形態も企図される。
本明細書で開示される実施形態は、複数の方向に圧縮及び曲げ特性を有するより大きなマトリックスを形成する方式で別の足場と織り合された、圧縮及び曲げ特性を有する組織化された繊維足場を提供し得る。そのような圧縮及び曲げ特性は、本明細書で開示する特徴のうちの1つ又は2つ以上を調節することによって調整され得る。マトリックスの壁は、マクロボイドの配列を画定し得る。様々な事例では、マトリックスは、マトリックス中の壁と、その壁を構成する繊維間に画定された間隙との間に規定されるマクロボイドを有する双峰性を有し得る。そのようなマクロボイドと間隙は、組織の内部成長及び体内へのマトリックスの集積を促進するように協働し得る。
図40は、組織厚さコンペンセータ又は圧縮性補助材2000を示している。圧縮性補助材2000は、多数のデバイスと共に使用され得る。少なくとも1つの実施形態では、圧縮性補助材2000は、外科用ステープル留め及び切断器具8010と共に用いられ得る。圧縮性補助材2000は、ステープルカートリッジのステープルカートリッジデッキ16に取り付けられ得る。代替的に、特定の実施形態では、圧縮性補助材2000はアンビル8014に取り付けられ得る。
図40を参照すると、圧縮性補助材2000が、少なくとも1つの実施形態において、組織Tによって部分的に圧縮されて示されている。ステープル2002は、多くの点でステープル10030に類似しており、ステープル2002が外科用ステープル留め及び切断器具8010によって発射及び成形されるときに圧縮性補助材2000と係合する。成形されたステープル2002は、ステープル基部2004と、第1のステープル脚部2006と、第2のステープル脚部2008とを有する。本実施形態では、第1のステープル脚部2006は、組織T及び圧縮性補助材2000と係合する。
圧縮性補助材2000は、組織接触境界面2010を有する第1の部分2012を含む。圧縮性補助材2000が組織Tによって係合されるとき、組織接触境界面2010は組織Tと接触及び相互作用する。圧縮性補助材2000は、カートリッジ境界面2014を有する第2の部分2016を含む。本実施形態では、カートリッジ境界面2014は、ステープルカートリッジデッキ16の上に若しくはそれに隣接して、解放可能に付着又は配置され得る。
圧縮性補助材2000は、第1の部分2012と第2の部分2016との間に配置される中央部分を含む。中央部分は、複数の起立繊維支柱2018と、複数の相互連結繊維2024とを含む。起立繊維支柱2018は、第1の部分/起立繊維支柱境界面2020において第1の部分2012と係合する。起立繊維支柱2018は、第2の部分/起立繊維支柱境界面2022において第2の部分2016と係合する。複数の相互連結繊維2024は、起立繊維支柱/相互連結繊維境界面2026において複数の起立繊維支柱2018と係合する。
第1の部分2012及び第2の部分2016は、様々な生体適合性材料を含む。第1及び第2の部分2012、2016はまた、患者の回復時間を支援し得る止血剤、抗菌剤、又は抗微生物剤などの様々な薬剤を含侵又は被覆され得る。第1の部分2012は、様々な厚さ及び材料特性を有し得る。少なくとも1つの実施形態では、第1の部分2012は、第1の部分2012に所望の適応特性を与えるために、様々な密度及び弾力性を有し得る。同様に、第2の部分2016は、様々な厚さ及び材料特性を有し得る。少なくとも1つの実施形態では、第2の部分2016は、第2の部分2016に所望の適応特性を与えるために、様々な密度及び弾力性を有し得る。
起立繊維支柱2018は、1種類又は2種類以上の生体適合性材料を含む。起立繊維支柱2018は、適切な引張強度及び弾力性を有する弾性繊維であり得る。起立繊維支柱2018は、一様な材料特性及び性質を備え得るか、あるいは、材料特性及び性質は、圧縮性補助材2100に所望の適応特性を与えるために、変動され得る。少なくとも1つの実施形態では、起立繊維支柱2018は、列をなして整列されてもよく、また各列が異なる材料特性を有してもよい。外科用ステープラと共に用いられるとき、外科用ステープラのナイフスロットに最も接近して又は切開部の最も近くに配置される起立繊維支柱2018は、より高度な弾力性を有し、起立繊維支柱2018が屈曲又は座屈されるまでに更なる力を必要とし得る。これにより、切開部の近くに圧力の増加を生じ得るが、このことは患者の治療において有益となり得る。代替的に、特定の事例では、外科用ステープラのナイフスロットに最も接近して又は切開部の最も近くに配置される起立繊維支柱2018は、より高い弾性を有し、起立繊維支柱2018が屈曲又は座屈されるまでに、より小さな力を必要とし得る。
他の実施形態では、起立繊維支柱2018の材料特性は、圧縮性補助材2000に所望の適応特性を与えるために、近位側から遠位側へと変動され得る。複数の起立繊維支柱2018は、種々の密度及び断面積又は直径を含み得る。起立繊維支柱2018が相対的により高密度な又はより大きな断面積若しくは直径を含む場合、起立繊維支柱2018の所望の撓曲に影響を及ぼすために必要な力が増大し得る。同様に、起立繊維支柱2018が相対的により低密度な又はより小さな断面積若しくは直径を含む場合、所望の撓曲に影響を及ぼすために必要な力が減少し得る。加えて、起立繊維支柱2018の密度及び断面積又は直径は、力が増加するか又は圧縮性補助材2000が厚さの変動する組織Tと会合するときに、起立繊維支柱2018が種々の曲げモーメントを有することが可能となるように変動され得る。そのような一実施形態では、起立支柱繊維2018は、第2の部分2016により接近した部分においてより高い密度を有し得、第1の部分2012により接近した部分においてより低い密度を有し得る。これにより、更なる圧縮力が加えられるときに、圧縮性補助材2000の弾力性の増大が可能となり得、またその力及び圧縮プロファイルは、圧縮性補助材2000の変位及び圧縮に関して変動する。
起立繊維支柱2018は、第1の部分/起立繊維支柱境界面2020において第1の部分2012と係合する。第1の部分/起立繊維支柱境界面2020は、起立繊維支柱2018が第1の部分2012に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2018は、第1の部分/起立繊維支柱境界面2020において第1の部分2012に固定可能に又は解放可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2018は第1の部分2012に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2018は、第1の部分2012に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、編み込まれるか、又は締結され得る。
起立繊維支柱2018は、第2の部分/起立繊維支柱境界面2022において第2の部分2016と係合する。第2の部分/起立繊維支柱境界面2022は、起立繊維支柱2018が第2の部分2016に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2018は、第2の部分/起立繊維支柱境界面2022において第2の部分2016に固定可能に又は解放可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2018は第2の部分2016に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2018は、第2の部分2016に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、編み込まれるか、又は締結され得る。
複数の相互連結繊維2024は、1種類又は2種類以上の生体適合性材料を含む。相互連結繊維2024は、適切な引張強度及び弾力性を有する弾性繊維であり得る。相互連結繊維2024は、一様な材料特性及び性質を備え得るか、あるいは、材料特性及び性質は、圧縮性補助材2000に所望の適応特性を与えるために、変動され得る。
少なくとも1つの実施形態では、相互連結繊維2024は、マトリックスを形成するように列又は柱をなして整列されてもよく、また各列及び/又は柱が異なる材料特性を有してもよい。外科用ステープラと共に用いられるとき、外科用ステープラのナイフスロット又は切開部に最も接近して配置された相互連結繊維2024はより弾力的となり得るが、ナイフスロットから更に離れた相互連結繊維2024はより弾性的となり得る。これにより、切開部の近くで圧力が発生及び増大し得るが、このことは患者の治療において有益となり得る。代替的に、特定の事例では、外科用ステープラのナイフスロット又は切開部に最も接近して配置された相互連結繊維2024はより弾性的となり得るが、ナイフスロットから更に離れた相互連結繊維2024はより弾力的となり得る。
他の実施形態では、相互連結繊維2024の材料特性は、患者の要求に応じて近位側から遠位側へと変動され得る。相互連結繊維2024は、種々の密度及び断面積又は直径を含み得る。相対的により高密度な又はより大きな断面積若しくは直径を有する相互連結繊維2024が使用される場合、相互連結繊維2024の所望の撓曲に影響を及ぼすために必要な張力が増大する。同様に、相互連結繊維2024がより低密度な又はより小さな断面積若しくは直径を有する場合、相互連結繊維2024の所望の撓曲に影響を及ぼすために必要な張力が低下する。それに加えて、相互連結繊維2024の密度及び断面積又は直径は、圧縮性補助材2000が厚さの変動する組織Tに会合する場合に相互連結繊維2024が種々の物理特性及び弾性を有することを可能にするように、ステープルカートリッジ12の近位部分とステープルカートリッジ12の遠位部分との間で変動され得る。
起立繊維支柱2018と相互連結繊維2024は、起立繊維支柱/相互連結繊維境界面2026において互いに係合する。起立繊維支柱/相互連結繊維境界面2026は、起立繊維支柱2018が相互連結2024に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2018は、起立繊維支柱/相互連結繊維境界面2026において相互連結繊維2024に固定可能に、解放可能に、又はスライド可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2018は相互連結繊維2024に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2018は、相互連結繊維2024に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、巻かれるか、又は締結され得る。
相互連結繊維2024はまた、各起立繊維支柱2018に対して、また圧縮性補助材2000の全体に対して、付加的な安定性を生じ得る。再び図40を参照すると、相互連結繊維2024は、第1の部分2012と第2の部分2016との間で離間されている。3つの相互連結繊維2024は、互いから実質的に等距離に離間された各起立繊維支柱2018と係合されるが、任意の好適な数の相互連結繊維2024が用いられ得る。他の実施形態では、相互連結繊維2024の数は、起立繊維支柱2018の安定性を増大させるために、又は、圧縮性補助材2000を圧縮するのに必要となる弾力性及び力を増大させるために増加され得る。別の実施形態では、相互連結繊維2024の間隔及び量は、圧縮性補助材2000に所望の適応特性を与えるように調節され得る。相互連結繊維2024が第2の部分2016により接近して配置される場合、圧縮性補助材2000は、圧縮性補助材2000のうちの第2の部分2016に最も近い部分においてより高い剛性を、また圧縮性補助材2000のうちの第1の部分2012に最も近い部分においてより低い剛性を有する。
図41を参照すると、圧縮性補助材2100が、少なくとも1つの実施形態において、組織Tによって部分的に圧縮されて示されている。ステープル2102は、ステープル2102が外科用ステープラによって発射及び成形されるときに圧縮性補助材2100と係合する。成形されたステープル2102は、ステープル基部2104と、第1のステープル脚部2106と、第2のステープル脚部2108とを有する。本実施形態では、第1のステープル脚部2106は、組織T及び圧縮性補助材2100と係合する。
圧縮性補助材2100は、組織接触境界面2110を有する第1の部分2112を含む。圧縮性補助材2100が組織Tと係合するとき、組織接触境界面2110は組織Tと接触及び相互作用する。圧縮性補助材2100は、カートリッジ境界面2114を有する第2の部分2116を含む。カートリッジ境界面2114は、ステープルカートリッジデッキ16の上に若しくはそれに隣接して、解放可能に付着又は配置され得る。
圧縮性補助材2100は、第1の部分2112と第2の部分2116との間に配置される中央部分を含む。中央部分は、複数の起立繊維支柱2118と、複数の相互連結繊維2124とを含むが、任意の好適な数の相互連結繊維2124が用いられ得る。起立繊維支柱2118は、第1の部分/起立繊維支柱境界面2120において第1の部分2112と係合する。起立繊維支柱2118は、第2の部分/起立繊維支柱境界面2122において第2の部分2116と係合する。相互連結繊維2124は、起立繊維支柱/相互連結繊維境界面2126において複数の起立繊維支柱2118と係合する。
第1の部分2112及び第2の部分2116は、1種類又は2種類以上の生体適合性材料を含む。第1及び第2の部分2112、2116はまた、患者の回復時間を支援し得る止血剤、抗菌剤、又は抗微生物剤などの様々な薬剤を含侵又は被覆され得る。第1の部分2112は、様々な厚さ及び材料特性を有し得る。少なくとも1つの実施形態では、第1の部分2112は、第1の部分2112に所望の適応特性を与えるために、様々な密度及び弾力性を有し得る。同様に、第2の部分2116は、様々な厚さ及び材料特性を有し得る。少なくとも1つの実施形態では、第2の部分2116は、第2の部分2116に所望の適応特性を与えるために、様々な密度及び弾力性を有し得る。
起立繊維支柱2118は、1種類又は2種類以上の生体適合性材料を含む。起立繊維支柱2118は、適切な引張強度及び弾力性を有する弾性繊維であり得る。起立繊維支柱2118は、一様な材料特性及び性質を備え得るか、あるいは、材料特性及び性質は、圧縮性補助材2100に所望の適応特性を与えるために、変動され得る。少なくとも1つの実施形態では、起立繊維支柱2118は、列をなして整列されてもよく、また各列が異なる材料特性を有してもよい。外科用ステープラと共に用いられるとき、外科用ステープラのナイフスロットに最も接近して又は切開部の最も近くに配置される起立繊維支柱2118は、より高度な弾力性を有し、起立繊維支柱2118が屈曲又は座屈されるまでに更なる力を必要とし得る。これにより、切開部の近くに圧力の増加を生じ得るが、このことは患者の治療において有益となり得る。代替的に、特定の事例では、外科用ステープラのナイフスロットに最も接近して又は切開部の最も近くに配置される起立繊維支柱2118は、より高い弾性を有し、起立繊維支柱2118が屈曲又は座屈されるまでに、より小さな力を必要とし得る。
他の実施形態では、起立繊維支柱2118の材料特性は、圧縮性補助材2100に所望の適応特性を与えるために、近位側から遠位側へと変動され得る。複数の起立繊維支柱2118は、種々の密度及び断面積又は直径を含み得る。起立繊維支柱2118が相対的により高密度な又はより大きな断面積若しくは直径を含む場合、起立繊維支柱2118の所望の撓曲に影響を及ぼすために必要な力が増大し得る。同様に、起立繊維支柱2118が相対的により低密度な又はより小さな断面積若しくは直径を有する場合、所望の撓曲に影響を及ぼすために必要な力が減少し得る。加えて、起立繊維支柱2118の密度及び断面積又は直径は、力が増加するか又は圧縮性補助材2100が厚さの変動する組織Tと会合するときに、起立繊維支柱2118が種々の曲げモーメントを有することが可能となるように変動され得る。そのような一実施形態では、起立支柱繊維2118は、第2の部分2116により接近した部分においてより高い密度を有し得、第1の部分2112により接近した部分においてより低い密度を有し得る。これにより、更なる圧縮力が加えられるときに、圧縮性補助材2100の弾力性の増大が可能となり得、またその力及び圧縮プロファイルは、圧縮性補助材2100の変位及び圧縮に関して変動する。
起立繊維支柱2118は、第1の部分/起立繊維支柱境界面2120において第1の部分2112と係合する。第1の部分/起立繊維支柱境界面2120は、起立繊維支柱2118が第1の部分2112に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2118は、第1の部分/起立繊維支柱境界面2120において第1の部分2112に固定可能に又は解放可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2118は第1の部分2112に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2118は、第1の部分2112に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、編み込まれるか、又は締結され得る。
起立繊維支柱2118は、第2の部分/起立繊維支柱境界面2122において第2の部分2116と係合する。第2の部分/起立繊維支柱境界面2122は、起立繊維支柱2118が第2の部分2116に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2118は、第2の部分/起立繊維支柱境界面2122において第2の部分2116に固定可能に又は解放可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2118は第2の部分2116に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2118は、第2の部分2116に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、編み込まれるか、又は締結され得る。
相互連結繊維2124は、1種類又は2種類以上の生体適合性材料を含む。相互連結繊維2124は、適切な引張強度及び弾力性を有する弾性繊維であり得る。相互連結繊維2124は、一様な材料特性及び性質を備え得るか、あるいは、材料特性及び性質は、圧縮性補助材2100に所望の適応特性を与えるために、変動され得る。
他の実施形態では、相互連結繊維2124の材料特性は、所望の適応特性を与えるために、近位側に変動され得る。相互連結繊維2124は、種々の密度及び断面積を含み得る。
相対的により高密度な又はより大きな断面積若しくは直径を含む相互連結繊維2124が使用される場合、相互連結繊維2124の所望の撓曲に影響を及ぼすために必要な張力が増大する。同様に、相互連結繊維2124がより低密度な又はより小さな断面積若しくは直径を有する場合、相互連結繊維2024の所望の撓曲に影響を及ぼすために必要な張力が低下する。それに加えて、相互連結繊維2124の密度及び断面積又は直径は、圧縮性補助材2100が厚さの変動する組織Tに会合する場合に相互連結繊維2124が種々の物理特性及び弾性を有することを可能にするように、ステープルカートリッジ12の近位部分とステープルカートリッジ12の遠位部分との間で変動され得る。
起立繊維支柱2118と相互連結繊維2124は、起立繊維支柱/相互連結繊維境界面2126において互いに係合する。起立繊維支柱/相互連結繊維境界面2126は、起立繊維支柱2118が第2の部分2124に固定可能に付着されない摩擦又は抵抗の関係の1つであり得る。他の実施形態では、起立繊維支柱2118は、起立繊維支柱/相互連結繊維境界面2126において相互連結繊維2124に固定可能に、解放可能に、又はスライド可能に付着され得る。少なくとも1つの実施形態では、起立繊維支柱2118は相互連結繊維2124に埋め込まれ得る。代替的な実施形態では、起立繊維支柱2118は、相互連結繊維2124に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、編み込まれるか、織り込まれるか、巻かれるか、又は締結され得る。
相互連結繊維2124はまた、圧縮性補助材2100の全体に対して、また各起立繊維支柱2118に対して付加的な安定性を生じ得る。再び図41を参照すると、単一の相互連結繊維2124が、第1の部分2112と第2の部分2116との間で離間されている。単一の相互連結繊維2124は、実質的に起立繊維支柱2118の中点において各起立繊維支柱2118と係合する。他の実施形態では、相互連結繊維2124の数は、起立繊維支柱2118の安定性を増大させるために、又は、圧縮性補助材2100を圧縮するのに必要となる弾力性及び力を増大させるために増加され得る。別の実施形態では、相互連結繊維2124の間隔は、圧縮性補助材2100に所望の適応特性を与えるように調節され得る。相互連結繊維2124が第2の部分2116により接近して配置される場合、圧縮性補助材2100は、圧縮性補助材2100のうちの第2の部分2116に最も近い部分においてより高い剛性を、また圧縮性補助材2100のうちの第1の部分2112に最も近い部分においてより低い剛性を有する。
図41を参照すると、境界面2126は、相互連結繊維2124が起立繊維支柱2118の間でスリップ、移動、及び/又はシフトすることを可能にするスリップジョイントの形態をなし得る。この特徴により、起立繊維支柱2118は、相互連結繊維2124によって画定されたスリップジョイント境界面を通した他の起立繊維支柱2118との結合係合を維持する一方で、種々の角度に自在に屈曲することが可能となる。
図42を参照すると、圧縮性補助材2200が示されている。圧縮性補助材2200は、様々な組織厚さを有する組織Tと係合されている。組織Tは、第1の組織厚さT1と、第2の組織厚さT2とを有する。少なくとも1つのステープル2202が圧縮性補助材2200と係合する。ステープル2202は、ステープル基部2204と、ステープル基部2204から延びる第1のステープル脚部2206及び第2のステープル脚部2208と、を有する。ステープル2202は成形され、第1のステープル脚部2206及び第2のステープル脚部2208の一部分は、組織T及び圧縮性補助材2200と係合する。
圧縮性補助材2200は、隣接する組織Tと相互作用するように構成された組織接触境界面2210を含む。圧縮性補助材2200は、様々な外科手技で使用され得、外科用ステープラ又はステープルカートリッジ内で用いられ得る。圧縮性補助材2200は、ステープルカートリッジ12のデッキ16に載置され得るか又は固定可能に付着され得るカートリッジ境界面2214を含む。圧縮性補助材2200は、複数の起立繊維支持部分2214と、圧縮性補助材基底部分2216と、を含み得る。複数の起立繊維支持部分2214は、圧縮性補助材基底部分2216から延び得る。
圧縮性補助材2200は、様々な厚さT1、T2を有する組織Tと係合されている。組織厚さに反応して、圧縮性補助材2200は、第1の圧縮高さH1及び第2の圧縮高さH2へと圧縮される。本実施形態では、圧縮性補助材2200は、変動する厚さを有する組織Tに関して、応答性及び適合性を有している。圧縮性補助材2200は、1種類又は2種類以上の生体適合性材料を含む。
起立繊維支持部分2214は、様々な材料特性を有するように適応及び構成され得る。起立繊維支持部分2214は、様々な密度、断面積及び直径、並びに有孔性を有し得る。起立繊維支持部分2214は、各起立繊維支持部分2214内に複数の織り合された又は撚り合わされた繊維を含み得る。これらの個々の繊維は、様々な密度、断面積及び直径、並びに有孔性を有し得る。各起立繊維支持部分2214は、少なくとも2つの撚り合わされた繊維を含み、圧縮性補助材基底部分2214に固定可能に付着される。代替的に、起立繊維支持部分2214は、圧縮性補助材基底部分2216に解放可能に又はスライド可能に付着され得る。少なくとも1つの実施形態では、起立繊維支持部分2214は圧縮性補助材基底部分2216に埋め込まれ得る。代替的な実施形態では、起立繊維支持部分2214は、圧縮性補助材基底部分2216に付着されるか、接着されるか、溶着されるか、溶融されるか、引っ掛けられるか、織り込まれるか、編み込まれるか、巻き付けられるか、又は締結され得る。
少なくとも1つの実施形態では、各起立繊維支持部分2214は、互いに撚り合わされるか又は噛み合わされた少なくとも2つの繊維を含み得る。撚り合わされた繊維は、圧縮性補助材2200の所望の弾力性及び圧縮性に影響を及ぼすように調節され得る。少なくとも1つの実施形態では、起立繊維支持部分2214の繊維は、起立繊維支持部分2214のうちの圧縮性補助材基底部分2216の近くの一部分において、より堅く撚り合わされるか又は巻かれ得る。同様に、起立繊維支持部分2214の繊維は、起立繊維支持部分2214のうちの組織接触境界面2210の近くの一部分において、より緩く撚り合わされるか若しくは巻かれ得る。起立繊維支持部分2214の繊維の堅さが可変であることにより、圧縮性補助材2200の圧縮性は様々となり得る。別の実施形態では、起立繊維支持部分2214の繊維は、圧縮性補助材2200がより厚い厚さを有する組織と会合するかあるいは起立繊維支持部分2214がより高い抵抗を受けたときに撚りを解くか又は巻きを解くように構成され得る。
別の実施形態では、起立繊維支持部分2214の軸方向強度は、圧縮性補助材2200に所望の適応特性を与えるように調節及び適応され得る。起立繊維支持部分2214はまた、起立繊維支持部分2214の繊維が組織接触境界面2210により接近したところで解け、圧縮性補助材基底部分2216の近くで圧縮し得る動的な系を発生させ得る。この動的な系は、圧縮性補助材2200が、変動する厚さを有する組織と動的に相互作用することを可能にする。起立繊維支持部分2214は、組織のうちのより厚い厚さを有する部分と係合するとき、圧縮性補助材2200の圧縮性をより高度にするように適応的に調節され得る。起立繊維支持部分2214が、組織のうちのより薄い厚さを有する部分と係合するとき、圧縮性補助材2200は、変動する組織厚さを補償するように、依然としてより剛性であり得る。変動する厚さを有する組織に合わせて調節されるこの動的な能力は、係合された組織Tを固定するための適切なステープル成形及び圧縮を促進するのに役立つ。
図43を参照すると、繊維2300が示されている。繊維2300は、様々な材料及び物理特性を有し得、また種々の形状、寸法及び長さを有するように作製され得る。図43に示すように、繊維2300は、円形又は少なくとも実質的に円形の形状を備えている。他の実施形態では、繊維2300は、正方形、長方形、卵形、八角形、又は任意の他の横断面形状を有し得る。繊維2300は軟質かつ弾性であり得、また本開示の様々な圧縮性補助材を製造する上で使用され得る。繊維2300は、1種類又は2種類以上の生体適合性材料を含む。
繊維2300の材料組成、高さ、及び/又は横断面積は、その剛性、つまり圧縮下で屈曲する能力に影響を及ぼす。繊維2300の剛性は、圧縮性補助材の圧縮性を1つ又は2つ以上の所望の値へと調整するように調節され得る。
図44を参照すると、繊維2400が示されている。繊維2400は、ガス収着プロセスを受けたものである。ガス収着プロセスは、繊維2400の繊維内側部分2406に複数の繊維内孔2408を充満させる。繊維2400の外側繊維表面2402もまた、複数の外側繊維表面孔2404を含むようにガス収着プロセスを通して変質され得る。
ガス収着プロセスによるバッチ発泡は、使用される基材又は繊維2400を選択することを含む。この方法は、高圧でガスを繊維2400又は基材の中に押し込むことを更に含む。次いで、圧力が低下され、結果として、処理された繊維2400又は基材は膨張し得る。膨張した繊維2400又は基材は、増大した有孔性、低下した密度、並びに/又は増大した断面表面積及び直径を有し得る。ガス収着プロセスは、例えば、繊維2400の剛性などの材料特性を、化学溶剤を必要とすることなく調節及び調整することを可能にするので、他の従来の方法よりも有利となり得る。
ガス収着バッチ発泡プロセスは様々な基材に適用され得る。少なくとも1つの実施形態では、ガス収着バッチ発泡の方法は、埋め込み可能なデバイス又は圧縮性補助材として使用され得る生体適合性ポリマーフィルムに適用され得る。高圧にあるガスがポリマーフィルムに押し込まれ得る。次いで、ポリマーフィルムは、圧力を低下させることによって、独立気泡構造へと膨張され得る。ポリマーフィルムは、化学溶剤を必要とすることなく、圧縮性の独立気泡構造となり得る。
ガス収着プロセスのための別の望ましい基材には、メルトブローン不織構造物が挙げられる。様々な事例において、メルトブローンプロセスは、オリフィスを通して溶融ポリマーを押し出し、線維性の不織構造物を形成するように溶融ポリマーをオリフィスの近くからコンベヤ又はテークアップスクリーン上へと吹き付ける高温/高速ガスの作用によって、押出し物を繊維へと細くすることを含む。
メルトブローン不織構造物は、厚さを増大させるにつれて、剛性を急激に増大させる。特定の事例では、それに伴って剛性を増大させることなく、より厚い厚さを有する圧縮性補助材が望まれる。このことは、メルトブローンプロセスの限界を提示している。特定の事例では、より厚い厚さと適切な剛性を有する圧縮性補助材が化学溶剤を使用して獲得され得る。
図45を参照すると、より厚い厚さと適切な剛性を備える圧縮性補助材2500が、化学溶剤に頼ることなく生産されている。圧縮性補助材2500は、複数の繊維2501を備えたメルトブローン不織中間基材を生成するメルトブローンプロセスによって作製されている。メルトブローン不織中間基材は、適切な剛性を生じるように、ガス収着プロセスによって更に処理される。メルトブローン不織中間基材をガス収着プロセスで更に処理することにより、中間基材は膨張され、密度、圧縮性、及び/又は有孔性が所望のパラメータに調節され得る。
メルトブローン不織中間基材は、メルトブローンプロセスを用いて生産される。ガス収着プロセスに適切な基材を生産するために、他の適切な技法も用いられ得る。少なくとも1つの事例では、エレクトロスピニングプロセスが用いられ得る。少なくとも1つの事例では、ニッティング、ウィービング、又は任意の他の適切なプロセスによって生産され得る。
本開示の圧縮性補助材のうちの1つ又は2つ以上は、密度、圧縮性、及び/又は有孔性を所望のパラメータに調節するように、ガス収着プロセスによって改良され得る。本開示の圧縮性補助材の様々な支柱、スペーサ繊維、起立繊維、及び/又はループ部材は、密度、圧縮性、及び/又は有孔性を所望のパラメータに調節するように、ガス収着プロセスによって改良され得る。
図45を参照すると、ガス収着プロセスにより、外側繊維表面2502は外側繊維表面孔2504を形成され得る。それに加えて、ガス収着プロセスは、繊維内側部分2506に複数の繊維内側孔2508充満させ得る。ガス収着プロセスを通して、中間基材は、密度を減少させかつ基材の有孔性を増大させる一方で、体積において膨張され得る。組み合わせプロセスのいくつかの潜在的な利点には、メルトブローンプロセスとガス収着プロセスとを組み合わせることによって達成される有孔性の向上により、圧縮性補助材2500の中への組織の内部成長が高まることが挙げられ得る。圧縮性補助材2500は、図45に示すように、個々の繊維2501内にガス収着プロセスによって生成された孔に加えて、メルトブローンプロセスにおいて繊維2501の間に生成された複数の孔2510を含む。
圧縮性補助材2500が所望の特性に形成されると、更なる処理が行われ得る。少なくとも1つの実施形態では、構造全体の厚さを増加させるため又は異なる材料特性を加えるために、複数の圧縮性補助材2500が積層されてもよい。少なくとも1つの実施形態では、種々の材料から又は種々の有孔性及び密度で作製された圧縮性補助材2500が使用され得る。一例では、組織境界面のより近くにおける密度及び有孔性は、組織の内部成長を高めるために、より高められ得る。複数の圧縮性補助材が、溶融、締結、接着、ニッティング、ウィービング、フッキング、及び他の付着技法によって付着され得る。
圧縮性補助材2500は、様々な物質を圧縮性補助材2500に被覆するか又は埋め込むことによって、更に改善され得る。少なくとも1つの実施形態では、止血剤、抗細菌剤、又は抗菌剤を圧縮性補助材2500に被覆又は注入することが有益となり得る。
ステープルカートリッジに付着された補助材及び/又はステープルカートリッジ上に配置された補助材を含む、様々な実施形態が開示される。そのような教示は、補助材が外科用器具のアンビルに付着及び/又は配置される実施形態に適用可能であることを理解されたい。実際、第1の補助材がカートリッジに付着及び/又は配置され、第2の補助材がアンビルに付着及び/又は配置される実施形態が企図される。
本開示の圧縮性補助材は、例えば、ステープルカートリッジ12のカートリッジデッキ16など、ステープルカートリッジのカートリッジデッキに対して配置され得る。少なくとも1つの事例では、圧縮性補助材は、例えば、外科用ステープル留め及び切断器具8010(図1)などの外科用器具上にステープルカートリッジをロードするのに先立って、ステープルカートリッジのカートリッジデッキに対して配置され得る。代替的に、圧縮性補助材は、ステープルカートリッジが外科用ステープル留め及び切断器具にロードされた後に、ステープルカートリッジのカートリッジデッキに対して配置され得る。ステープルカートリッジのカートリッジデッキの上に圧縮性補助材を置くために、ローディングユニットが用いられ得る。ローディングユニットは、カートリッジデッキに対して圧縮性補助材を操作及び配置するための様々な付着機構及び/又は配置機構を含み得る。圧縮性補助材がカートリッジデッキに対して正しく配置されると、ローディングユニットは圧縮性補助材を解放し得る。
上記に加えて、圧縮性補助材は、ステープルカートリッジへの付着を伴うことなく、カートリッジデッキに対して配置され得る。代替的に、圧縮性補助材は、ステープルカートリッジが外科用ステープル留め及び切断器具にロードされる前又はロードされた後に、ステープルカートリッジに付着され得る。例えば、圧縮性補助材は、カートリッジデッキの上へと部分的に溶融され、次いで冷却によって再固化され得るが、それによって圧縮性補助材はカートリッジデッキに結合されることになる。また、例えば、縫合糸、ストラップ、棘、及び/又は他の機械的付着機構など、様々な付着機構が、ステープルカートリッジに圧縮性補助材を付着させるために用いられ得る。
実施例1−ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、第1の生体適合性層と、第1の生体適合性層から離間された第2の生体適合性層と、第1の生体適合性層と第2の生体適合性層との間に延びる複数の支持支柱と、を備える、圧縮性補助材。
実施例2−支持支柱の各々は、第1の生体適合性層に付着される第1の終端部分と、第2の生体適合性層に付着される第2の終端部分と、を備える、実施例1の圧縮性補助材。
実施例3−第1の終端部分及び第2の終端部分は、第1の生体適合性層及び第2の生体適合性層と交差する横軸を規定する、実施例2の圧縮性補助材。
実施例4−横軸は、第1の生体適合性層に対して第1の角度を規定し、横軸は、第2の生体適合性層に対して第2の角度を規定し、第1の角度及び第2の角度は、約80°〜約100°の範囲から選択されている、実施例3の圧縮性補助材。
実施例5−第1の終端部分は、第1の生体適合性層の中に織り込まれている、実施例2、3、又は4の圧縮性補助材。
実施例6−第1の終端部分は、第1の生体適合性層に溶着されている、実施例2、3、4、又は5の圧縮性補助材。
実施例7−複数の支持支柱は、第1の支持支柱と、第1の支持支柱と交差する第2の支持支柱と、を含む、実施例1、2、3、4、5、又は6の圧縮性補助材。
実施例8−第1の生体適合性層と第2の生体適合性層の少なくとも一方は、織物のマトリックスを含む、実施例1、2、3、4、5、6、又は7の圧縮性補助材。
実施例9−第1の生体適合性層と第2の生体適合性層の少なくとも一方は、編物のマトリックスを含む、実施例1、2、3、4、5、6、7又は8の圧縮性補助材。
実施例10−第1の生体適合性層と第2の生体適合性層の少なくとも一方は、フィルムを含む、実施例1、2、3、4、5、6、8又は9の圧縮性補助材。
実施例11−第2の生体適合性層は、組織を把持するように構成された外側表面を備える、実施例1、2、3、4、5、6、8、9、又は10の圧縮性補助材。
実施例12−外側表面は複数の把持機構を備え、把持機構の各々は、外側表面に対して鋭角を規定する、実施例11の圧縮性補助材。
実施例13−第1の生体適合性層は、第2の生体適合性層よりも高い密度を有する、実施例1、2、3、4、5、6、8、9、10、11、又は12の圧縮性補助材。
実施例14−本体部分と、本体部分を少なくとも部分的に囲む外側縁部であって、本体部分は、外側縁部よりも厚い厚さを備える、外側縁部と、を更に備える、実施例1、2、3、4、5、6、8、9、10、11、12、又は13の圧縮性補助材。
実施例15−外側縁部は先細である、実施例14の圧縮性補助材。
実施例16−外側縁部は、第1の生体適合性層から延びる第1の外側縁部と、第2の生体適合性層から延びる第2の外側縁部であって、第1の外側縁部部分と第2の外側縁部部分は、第1の生体適合性層と第2の生体適合性層とを接合するように構成された連続的な側方部分へと一体化されている、第2の外側縁部と、を備える、実施例14又は15の圧縮性補助材。
実施例17−外科用器具によって捕捉された組織を切断するためのナイフを受容するように構成されたナイフスロットを更に備え、ナイフスロットは2つの側部を画定し、ナイフは2つの側部の間を通る、実施例1、2、3、4、5、6、8、9、10、11、12、13、14、15、又は16の圧縮性補助材。
実施例18−2つの側部の間に延びるテザーを更に備え、ナイフは、テザーを切断して2つの側部を分離するように構成されている、実施例17の圧縮性補助材。
実施例19−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、外側表面を備えるカートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、外側表面に対して配置可能な圧縮性補助材を更に備え、圧縮性補助材は、組織に面する生体適合性層と、外側表面に対して配置可能なデッキに面する生体適合性層と、を備え、組織に面する生体適合性層は、デッキに面する生体適合性層から離間され、スペーサ繊維は、組織に面する生体適合性層及びデッキに面する生体適合性層と交差し、スペーサ繊維は、組織に面する生体適合性層をデッキに面する生体適合性層の上に持ち上げるように構成されている。
実施例20−ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、第1の生体適合性層と、第1の生体適合性層から離間された第2の生体適合性層と、第1の生体適合性層と第2の生体適合性層とを相互連結する細長軟質部材と、を備え、細長軟質部材は、第1の生体適合性層と第2の生体適合性層との間で起立する複数の支持構造を形成するように構成されている、圧縮性補助材。
実施例21−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、カートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、カートリッジデッキに対して配置可能な圧縮性補助材を更に備え、ステープルは、圧縮性補助材に対して捕捉された組織の中に配備可能であり、圧縮性補助材は、第1の部分を備える第1の生体適合性層と、第2の部分を備える第2の生体適合性層と、第1の部分と第2の部分との間に延びる交差したスペーサ繊維と、を備える。
実施例22−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、カートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、カートリッジデッキに対して配置可能な圧縮性補助材を更に備え、ステープルは、圧縮性補助材に対して捕捉された組織の中に配備可能であり、圧縮性補助材は、第1の結合節と、第1の結合節と共に第1の列をなして配列された第2の結合節と、を備える、組織に面する層を備える、ステープルカートリッジアセンブリ。圧縮性補助材はデッキに面する層を更に備え、組織に面する層はデッキに面する層から離間され、デッキに面する層は、第1の結合節と垂直方向に整列された第3の結合節と、第2の結合節と垂直方向に整列された第4の結合節と、を備え、第4の結合節は、第2の結合節と垂直方向に整列され、第4の結合節は、第3の結合節と共に第2の列をなして配列されている。圧縮性補助材は、第1の結合節と第4の結合節との間に延びる第1のスペーサ繊維と、第2の結合節と第3の結合節との間に延びる第2のスペーサ繊維と、を更に備え、第1のスペーサ繊維は第2のスペーサ繊維と交差する。
実施例23−第1の列は第2の列に対して平行である、実施例22のステープルカートリッジアセンブリ。
実施例24−第1の列は、第1の結合節と第2の結合節との間に第5の結合節を更に備える、実施例22又は23のステープルカートリッジアセンブリ。
実施例25−第1の結合節と第5の結合節とを相互連結する第1の繊維部分を更に備える、実施例24のステープルカートリッジアセンブリ。
実施例26−第2の結合節と第5の結合節とを相互連結する第2の繊維部分を更に備える、実施例24又は25のステープルカートリッジアセンブリ。
実施例27−第2の列は、第3の結合節と第4の結合節との間に第6の結合節を更に備える、実施例22、23、24、25、又は26のステープルカートリッジアセンブリ。
実施例28−第3の結合節と第6の結合節とを相互連結する第3の繊維部分を更に備える、実施例27のステープルカートリッジアセンブリ。
実施例29−第4の結合節と第6の結合節とを相互連結する第4の繊維部分を更に備える、実施例27又は28のステープルカートリッジアセンブリ。
実施例30−第5の結合節は、第6の結合節と垂直方向に整列されている、実施例27、28、又は29のステープルカートリッジアセンブリ。
実施例31−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、近位端部と遠位端部とを画定するカートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、カートリッジデッキに対して配置可能な圧縮性補助材を更に備え、ステープルは、圧縮性補助材に対して捕捉された組織の中に配備可能であり、圧縮性補助材は、第1の結合節と、第1の結合節と共に第1の列をなして配列された第2の結合節と、を備える、組織に面する層を備える、ステープルカートリッジアセンブリ。圧縮性補助材はデッキに面する層を更に備え、組織に面する層はデッキに面する層から離間され、デッキに面する層は、第3の結合節と第4の結合節とを備え、第4の結合節は、第3の結合節と共に第2の列をなして配列されている。圧縮性補助材は、第1の結合節から第3の結合節へと延びる第1のスペーサ繊維と、第1の結合節からデッキに面する表面に向かって近位方向に延びる第2のスペーサ繊維と、第1の結合節からデッキに面する表面に向かって遠位方向に延びる第3のスペーサ繊維と、を更に備える。圧縮性補助材は、第2の結合節から第4の結合節へと延びる第4のスペーサ繊維を更に備える。
実施例32−第2の結合節からデッキに面する表面に向かって近位方向に延びる第5のスペーサ繊維を更に備える、実施例31のステープルカートリッジアセンブリ。
実施例33−第2の結合節からデッキに面する表面に向かって遠位方向に延びる第6のスペーサ繊維を更に備える、実施例31又は32のステープルカートリッジアセンブリ。
実施例34−第6のスペーサ繊維は第2のスペーサ繊維と交差する、実施例33のステープルカートリッジアセンブリ。
実施例35−第1の結合節から第3の結合節へと延びる第7のスペーサ繊維を更に備える、実施例31、32、33、又は34のステープルカートリッジアセンブリ。
実施例36−第2の結合節から第4の結合節へと延びる第8のスペーサ繊維を更に備える、実施例31、32、33、34、又は35のステープルカートリッジアセンブリ。
実施例37−第1の結合節は、第3の結合節と垂直方向に整列されている、実施例31、32、33、34、35、又は36のステープルカートリッジアセンブリ。
実施例38−第2の結合節は、第4の結合節と垂直方向に整列されている、実施例31、32、33、34、35、36、又は37のステープルカートリッジアセンブリ。
実施例39−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、近位端部と遠位端部とを画定するカートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、カートリッジデッキに対して配置可能な圧縮性補助材を更に備え、ステープルは、圧縮性補助材に対して捕捉された組織の中に配備可能であり、圧縮性補助材は組織に面する層とデッキに面する層とを備え、組織に面する層はデッキに面する層から離間され、デッキに面する層は外側表面と内側表面とを備える。圧縮性補助材は、組織に面する層から内側表面に向かって延びる第1のスペーサ繊維と、組織に面する層から内側表面に向かって延びる第2のスペーサ繊維と、を更に備え、第1のスペーサ繊維及び第2のスペーサ繊維は、デッキに面する層、並びに、外側表面上に第1のスペーサ繊維及び第2のスペーサ繊維によって画定されたループを通して延びる。
実施例40−第1のスペーサ繊維と第2のスペーサ繊維は、デッキに面する層において交差する、実施例39のステープルカートリッジアセンブリ。
実施例41−組織に面する層から延びる第3のスペーサ繊維を更に備え、第3のスペーサ繊維は、第1のスペーサ繊維及び第2のスペーサ繊維とデッキに面する層において交差する、実施例39又は40のステープルカートリッジアセンブリ。
実施例42−ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、生体適合性層と、その生体適合性層から突出する複数の生体適合性ループ部材と、を備える、圧縮性補助材。生体適合性ループ部材の各々は、生体適合性層に付着される第1の終端部分と、生体適合性層に付着される第2の終端部分と、第1の終端部分と第2の終端部分との間に延びる中間曲線状部分と、を備え、中間曲線状部分は、第1の終端部分及び第2の終端部分と比べて、生体適合性層から更に離れている。
実施例43−生体適合性層から離間された別の生体適合性層を更に備える、実施例42の圧縮性補助材。
実施例44−複数の生体適合性ループ部材は、生体適合性層と別の生体適合性層との間に配置されている、実施例43の圧縮性補助材。
実施例45−中間曲線状部分は、別の生体適合性層に付着されている、実施例43又は44の圧縮性補助材。
実施例46−別の生体適合性層は織物の層を含む、実施例43、44、又は45の圧縮性補助材。
実施例47−生体適合性層は、互いから離間されている複数の係留アイランドを備え、係留アイランドの各々は、生体適合性ループ部材のうちの少なくとも1つの第1の終端部分及び第2の終端部分によって画定されている、実施例42、43、44、45、又は46の圧縮性補助材。
実施例48−係留アイランドは、平行な列をなして配列されている、実施例47の圧縮性補助材。
実施例49−生体適合性ループ部材の各々は、幅広ヘッド部分と、幅広ヘッド部分と生体適合性層との間に延びる幅狭ネック部分と、を備える、実施例42、43、44、45、46、又は47の圧縮性補助材。
実施例50−生体適合性ループ部材の各々は、繊維で構成されている、実施例42、43、44、45、46、47、又は48の圧縮性補助材。
実施例51−繊維はマルチフィラメント繊維である、実施例50の圧縮性補助材。
実施例52−生体適合性ループ部材は、圧縮力に反応してまとまりのない様式で屈曲するように構成されている、実施例42、43、44、45、46、47、48、49、50、又は51の圧縮性補助材。
実施例53−生体適合性ループ部材は、圧縮力に反応してまとまった様式で屈曲するように構成されている、実施例42、43、44、45、46、47、48、49、50、又は51の圧縮性補助材。
実施例54−ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、複数の第1の列をなして配列された第1の繊維ループを備える第1の生体適合性層と、第1の生体適合性層から離間された第2の生体適合性層であって、複数の第1の列から離間された複数の第2の列をなして配列された第2の繊維ループを備える、第2の生体適合性層と、第1の繊維ループの各々から第2の生体適合性層に向かって延びる一対の第1の繊維部分と、を備える、圧縮性補助材。圧縮性補助材は、第2の繊維ループの各々から第1の生体適合性層に向かって延びる一対の第2の繊維部分を更に備える。
実施例55−第1の繊維部分は、圧縮力に反応して第1の方向への屈曲を選ぶように斜行されている、実施例54の圧縮性補助材。
実施例56−第2の繊維部分は、圧縮力に反応して第1の方向への屈曲を選ぶように斜行されている、実施例55の圧縮性補助材。
実施例57−第1の繊維部分及び第2の繊維部分は、圧縮力に反応してまとまりのない様式で屈曲するように構成されている、実施例54、55、又は56の圧縮性補助材。
実施例58−第1の繊維部分及び第2の繊維部分は、圧縮力に反応してまとまった様式で屈曲するように構成されている、実施例54、55、又は56の圧縮性補助材。
実施例59−外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、複数のステープルと、近位端部と遠位端部とを画定するカートリッジデッキと、を備える、ステープルカートリッジを備える、ステープルカートリッジアセンブリ。ステープルカートリッジアセンブリは、カートリッジデッキに対して配置可能な圧縮性補助材を更に備え、圧縮性補助材は、第1の生体適合性層と、第1の生体適合性層から離間された第2の生体適合性層と、を備える。第2の生体適合性層は、第1の繊維ループと、第1の繊維ループから第1の生体適合性層に向かって延びる一対の第1の繊維部分と、第1の繊維ループの近位側にある第2の繊維ループであって、一対の第1の繊維部分は第2の繊維ループを通過する、第2の繊維ループと、第2の繊維ループから第1の生体適合性層に向かって延びる一対の第2の繊維部分と、を備える。
実施例60−第2の生体適合性層は、第2の繊維ループの近位側にある第3の繊維ループであって、一対の第2の繊維部分が第3の繊維ループを通過する、第3の繊維ループと、第3の繊維ループから第1の生体適合性層に向かって延びる一対の第3の繊維部分と、を備える、実施例59のステープルカートリッジアセンブリ。
実施例61−第2の層は編物の層である、実施例59又は60のステープルカートリッジアセンブリ。
実施例62−ステープルカートリッジアセンブリであって、デッキ、及びデッキ内に画定された複数のステープルキャビティを含むカートリッジ本体と、ステープルキャビティ内に取り外し可能に格納された複数のステープルと、ステープルキャビティの上に配置された埋め込み可能な層と、を備え、埋め込み可能な層は、頂部表面、底部表面、及び頂部表面と底部表面との間に延びる支柱壁へと織られた構造繊維と、支柱壁内で織り合された強化繊維と、を備える、ステープルカートリッジアセンブリ。
実施例63−強化繊維は、頂部表面及び底部表面内で織り合されている、実施例62のステープルカートリッジアセンブリ。
実施例64−強化繊維は構造繊維の周りに巻き付けられている、実施例62又は63のステープルカートリッジアセンブリ。
実施例65−埋め込み可能な層は、強化繊維と構造繊維との間に第1の密度のループを備える第1の圧縮ゾーンと、強化繊維と構造繊維との間に第2の密度のループを備える第2の圧縮ゾーンと、を備え、第2の密度は第1の密度よりも高い、実施例62、63、又は64のステープルカートリッジアセンブリ。
実施例66−カートリッジ本体は、切断部材を受容するように構成された長手方向スロットを更に備え、第1の圧縮ゾーンは長手方向スロットと整列され、第2の圧縮ゾーンはステープルキャビティと整列されている、実施例65のステープルカートリッジアセンブリ。
実施例67−カートリッジ本体は近位端部と遠位端部とを備え、第1の圧縮ゾーンは近位端部と整列され、第2の圧縮ゾーンは、第1の圧縮ゾーンに対して遠位側に配置されている、実施例62、63、64、65、又は66のステープルカートリッジアセンブリ。
実施例68−カートリッジ本体は、切断部材を受容するように構成された長手方向スロットを更に備え、支柱壁は長手方向スロットの全体にわたって延びる、実施例62、63、64、65、66、又は67のステープルカートリッジアセンブリ。
実施例69−各構造繊維は、カートリッジ本体の近位端部と遠位端部との間に延びる長手方向シームを備える、実施例62、63、64、65、66、67、又は68のステープルカートリッジアセンブリ。
実施例70−各強化繊維は、支柱壁を通して延びる横方向シームを備える、実施例62、63、64、65、66、67、68、又は69のステープルカートリッジアセンブリ。
実施例71−構造繊維は第1の材料で構成され、強化繊維は、第1の材料とは異なる第2の材料で構成されている、実施例62、63、64、65、66、67、68、69、又は70のステープルカートリッジアセンブリ。
実施例72−強化繊維は構造繊維と結び付けられている、実施例62、63、64、65、66、67、68、69、70、又は71のステープルカートリッジアセンブリ。
実施例73−埋め込み可能な層は、強化繊維と構造繊維との間に第1の密度の結節を備える第1の圧縮ゾーンと、強化繊維と構造繊維との間に第2の密度の結節を備える第2の圧縮ゾーンと、を備え、第2の密度は第1の密度よりも高い、実施例62、63、64、65、66、67、68、69、70、71、又は72のステープルカートリッジアセンブリ。
実施例74−ステープルカートリッジアセンブリであって、デッキ、及びデッキ内に画定された複数のステープルキャビティを含むカートリッジ本体と、ステープルキャビティ内に格納された複数のステープルと、ステープルキャビティの上に配置された埋め込み可能な層と、を備え、埋め込み可能な層は、織り合された繊維で構成される相互連結された構造壁と、構造壁の間に画定されたポケットと、を備える、ステープルカートリッジアセンブリ。
実施例75−構造壁は、頂部表面、底部表面、及び頂部表面と底部表面との間に延びる支柱壁へと織られた構造繊維と、支柱壁内で織り合された強化繊維と、で構成されている、実施例74のステープルカートリッジアセンブリ。
実施例76−強化繊維は構造繊維の周りに巻き付けられている、実施例75のステープルカートリッジアセンブリ。
実施例77−埋め込み可能な層は、強化繊維と構造繊維との間に第1の密度のループを備える第1の圧縮ゾーンと、強化繊維と構造繊維との間に第2の密度のループを備える第2の圧縮ゾーンと、を備え、第2の密度は第1の密度よりも高い、実施例75又は76のステープルカートリッジアセンブリ。
実施例78−カートリッジ本体は、切断部材を受容するように構成された長手方向スロットを更に備え、第1の圧縮ゾーンは長手方向スロットと整列され、第2の圧縮ゾーンはステープルキャビティと整列されている、実施例77のステープルカートリッジアセンブリ。
実施例79−カートリッジ本体は近位端部と遠位端部とを備え、第1の圧縮ゾーンは近位端部と整列され、第2の圧縮ゾーンは、第1の圧縮ゾーンに対して遠位側に配置されている、実施例77又は78のステープルカートリッジアセンブリ。
実施例80−構造繊維は第1の材料で構成され、強化繊維は、第1の材料とは異なる第2の材料で構成されている、実施例75、76、77、78、又は79のステープルカートリッジアセンブリ。
実施例81−カートリッジ本体は、切断部材を受容するように構成された長手方向スロットを更に備え、構造壁は長手方向スロットの全体にわたって延びる、実施例75、76、77、78、79、又は80のステープルカートリッジアセンブリ。
実施例82−構造壁は、カートリッジ本体の近位端部と遠位端部との間に延びる長手方向シームを備える、実施例75、76、77、78、79、80、又は81のステープルカートリッジアセンブリ。
実施例83−構造壁は、長手方向シームに対して横方向に延びる横方向シームを更に備える、実施例82のステープルカートリッジアセンブリ。
実施例84−ステープルカートリッジアセンブリであって、デッキ、及びデッキ内に画定された複数のステープルキャビティを含むカートリッジ本体と、ステープルキャビティ内に格納された複数のステープルと、ステープルキャビティの上に配置された埋め込み可能な層と、を備え、埋め込み可能な層は、頂部部分と、底部部分と、頂部部分と底部部分との間で織り合された壁と、を備える、ステープルカートリッジアセンブリ。
実施例85−圧縮性補助材であって、第1の部分と、第2の部分と、中央部分と、を備え、中央部分は、第1の部分と第2の部分との間に配設され、第1の部分と第2の部分との間に実質的に延びる第1の支柱、第2の支柱と、少なくとも第1の支柱及び第2の支柱と係合するように構成された相互連結部材と、を備え、圧縮性補助材がある力によって圧縮されるとき、第1の支柱は第1の撓曲だけ撓曲するように構成され、第2の支柱は第2の撓曲だけ撓曲するように構成され、第1の撓曲は第2の撓曲とは異なる、圧縮性補助材。
実施例86−相互連結部材は、第1の支柱及び第2の支柱と固定可能に係合する、実施例85の圧縮性補助材。
実施例87−相互連結部材は、第1の支柱及び第2の支柱とスライド式で係合する、実施例85又は86の圧縮性補助材。
実施例88−第1の支柱は第1の断面直径を備え、第2の支柱は第2の断面直径を備え、第1の直径は第2の直径とは異なる、実施例85、86、又は87の圧縮性補助材。
実施例89−第1の断面直径は第2の断面直径よりも大きく、第2の撓曲は第1の撓曲よりも大きい、実施例88の圧縮性補助材。
実施例90−第1の支柱は第1の密度を備え、第2の支柱は第2の密度を備え、第1の密度は第2の密度とは異なる、実施例85、86、87、88又は89の圧縮性補助材。
実施例91−第1の密度は第2の密度よりも高く、第2の撓曲は第1の撓曲よりも大きい、実施例90の圧縮性補助材。
実施例92−第1の支柱は第1の断面直径を備え、第2の支柱は第2の断面直径を備え、相互連結部材は第3の断面直径を備え、第1の断面直径及び第2の断面直径は第3の断面直径とは異なる、実施例85、86、87、88、89、90、又は91の圧縮性補助材。
実施例93−第1の支柱は第1の密度を備え、第2の支柱は第2の密度を備え、相互連結部材は第3の密度を備え、第1の密度及び第2の密度は第3の密度とは異なる、実施例85、86、87、88、89、90、91、又は92の圧縮性補助材。
実施例94−第1の支柱は、第1の端部と、第2の端部と、中央区間と、を備え、第1の端部は第1の部分と係合し、第2の端部は第2の部分と係合し、相互連結部材は中央区間と係合する、実施例85、86、87、88、89、90、91、92、又は93の圧縮性補助材。
実施例95−圧縮性補助であって、基底部分と、複数の支柱と、を備え、複数の支柱は、第1の支柱と第2の支柱とを備える第1の支持体を備え、第1の支柱及び第2の支柱は基底部分と係合し、第1の支柱と第2の支柱は相互連結されている、圧縮性補助材。複数の支柱は、第3の支柱と第4の支柱とを備える第2の支持体を更に備え、第3の支柱及び第4の支柱は基底部分と係合し、第3の支柱と第4の支柱は相互連結され、圧縮性補助材がある力によって圧縮されるとき、第1の支持体は第1の撓曲だけ撓曲するように構成され、第2の支持体は第2の撓曲だけ撓曲するように構成され、第1の撓曲は第2の撓曲とは異なる。
実施例96−第1の支持体は第1の材料を備え、第2の支持体は第2の材料を備え、第1の材料は第2の材料とは異なる、実施例95の圧縮性補助材。
実施例97−第1の支持体は第1の平均密度を有し、第2の支持体は第2の平均密度を有し、第1の平均密度は第2の平均密度とは異なる、実施例95又は96の圧縮性補助材。
実施例98−第1の平均密度は第2の平均密度よりも高く、第2の撓曲は第1の撓曲よりも大きい、実施例97の圧縮性補助材。
実施例99−第1の支柱は第1の断面直径を備え、第2の支柱は第2の断面直径を備え、第1の直径は第2の直径とは異なる、実施例95、96、97、又は98の圧縮性補助材。
実施例100−第1の支柱は第1の断面直径を備え、第2の支柱は第2の断面直径を備え、第3の支柱は第3の断面直径を備え、第4の支柱は第4の断面直径を備える、実施例95、96、97、98、又は99の圧縮性補助材。
実施例101−第1の直径は第3の直径とは異なり、第2の直径は第4の直径とは異なる、実施例100の圧縮性補助材。
実施例102−第1の支持体は第1の平均高さを備え、第2の支持体は第2の平均高さを備え、第1の高さは第2の高さとは異なる、実施例95、96、97、98、99、100又は101の圧縮性補助材。
実施例103−第1の平均高さは第2の平均高さよりも高く、第1の撓曲は第2の撓曲よりも大きい、実施例102の圧縮性補助材。
実施例104−第1の支柱と第2の支柱は互いに織られ、圧縮性補助材が圧縮されるとき、第1の支柱及び第2の支柱は部分的に解かれるように構成されている、実施例95、96、97、98、99、100、101、102、又は103の圧縮性補助材。
実施例105−所望の厚さを有する繊維質の圧縮性構造を生産する方法であって、1.所望の厚さよりも薄い厚さを備える生体適合性メルトブローン不織基材を生産する工程であって、生体適合性メルトブローン不織基材は複数の繊維を備える、工程と、2.その厚さを所望の厚さに改良するために、生体適合性メルトブローン不織基材にガス収着プロセスを適用する工程と、を含む、方法。
実施例106−ガス収着プロセスを適用する工程は、生体適合性メルトブローン不織基材に高圧ガスを加えることを含む、実施例105の方法。
実施例107−生体適合性メルトブローン不織基材を生産する工程は、ポリマーを押出しすることと、高温及び高速ガスの作用によって押出し物を繊維へと細くすることと、繊維質の不織布を形成するために繊維を収集することと、を含む、実施例105又は106の方法。
実施例108−ガス収着プロセスを適用する工程は、1.生体適合性メルトブローン不織基材に高圧ガスを加えることと、2.ガスの圧力を低減することと、を含む、実施例105、106、又は107の方法。
様々な状況下で、本開示の圧縮性補助材のうちの1つ又は2つ以上は、1種類又は2種類以上の生体適合性材料で構成される。圧縮性補助材は高分子組成物を含み得る。この高分子組成物は、1つ若しくは2つ以上の合成ポリマー及び/又は1つ若しく2つ以上の非合成ポリマーを含み得る。この合成ポリマーは、合成吸収性ポリマー及び/又は合成非吸収性ポリマーを含み得る。様々な状況において、高分子組成物は、均一な孔形態又は漸進的な孔形態(すなわち、小さな孔がある方向において発泡体の厚さ全体にわたって大きな孔へと寸法を漸進的に増加させる)を有する孔構造を備え得る。
様々な状況において、圧縮性補助材は、例えば、ある表面には小さな孔、他の表面にはより大きな孔など、勾配構造を呈する孔形態を有する。そのような形態は、組織の内方成長又は止血作用に、より最適であり得る。更に、この勾配は、様々な生体吸収プロファイルと共に構成することもできる。短期の吸収プロファイルは、止血に対処するために好ましく、一方、長期の吸収プロファイルは、漏出なくより良い組織治癒に対処することがある。
様々な状況において、高分子組成物は、医薬活性剤を含み得る。高分子組成物は、治療有効量の医薬活性剤を放出し得る。様々な状況において、医薬活性剤は、高分子組成物が脱着/吸着されるときに放出され得る。様々な状況において、医薬活性剤は、高分子組成物上又はその中を通過する、例えば血液などの流体内に放出され得る。
以下の開示内容全体を参照により本明細書に援用するものである。すなわち、
1995年4月4日に発行された米国特許第5,403,312号、発明の名称「ELECTROSURGICAL HEMOSTATIC DEVICE」;
2006年2月21日に発行された米国特許第7,000,818号、発明の名称「SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS」;
2008年9月9日に発行された米国特許第7,422,139号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK」;
2008年12月16日に発行された米国特許第7,464,849号、発明の名称「ELECTRO−MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS」;
2010年3月2日に発行された米国特許第7,670,334号、発明の名称「SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR」;
2010年7月13日に発行された米国特許第7,753,245号、発明の名称「SURGICAL STAPLING INSTRUMENTS」;
2013年3月12日に発行された米国特許第8,393,514号、発明の名称「SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE」;
米国特許出願第11/343,803号、発明の名称「SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES」、現在は、米国特許第7,845,537号;
2008年2月14日に出願された米国特許出願第12/031,573号、発明の名称「SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES」;
2008年2月15日に出願された米国特許出願第12/031,873号、発明の名称「END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT」、現在は、米国特許第7,980,443号;
米国特許出願第12/235,782号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING INSTRUMENT」、現在は、米国特許第8,210,411号;
米国特許出願第12/249,117号、発明の名称「POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM」、現在は、米国特許第8,608,045号;
2009年12月24日に出願された米国特許出願第12/647,100号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY」、現在は、米国特許第8,220,688号;
2012年9月29日に出願された米国特許出願第12/893,461号、発明の名称「STAPLE CARTRIDGE」、現在は、米国特許第8,733,613号;
2011年2月28日に出願された米国特許出願第13/036,647号、発明の名称「SURGICAL STAPLING INSTRUMENT」、現在は、米国特許第8,561,870号;
米国特許出願第13/118,241号、発明の名称「SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS」、現在は、米国特許第9,072,535号;
2012年6月15日出願の米国特許出願第13/524,049号、発明の名称「ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE」、現在は、米国特許第9,101,358号;
2013年3月13日に出願された米国特許出願第13/800,025号、発明の名称「STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM」、現在は、米国特許出願公開第2014/0263551号;
2013年3月13日に出願された米国特許出願第13/800,067号、発明の名称「STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM」、現在は、米国特許出願公開第2014/0263552号;
2006年1月31日に出願された米国特許出願公開第2007/0175955号、発明の名称「SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM」、及び、
2010年4月22日に出願された米国特許出願公開第2010/0264194号、発明の名称「SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR」、現在は、米国特許第8,308,040号。
1995年4月4日に発行された米国特許第5,403,312号、発明の名称「ELECTROSURGICAL HEMOSTATIC DEVICE」;
2006年2月21日に発行された米国特許第7,000,818号、発明の名称「SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS」;
2008年9月9日に発行された米国特許第7,422,139号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK」;
2008年12月16日に発行された米国特許第7,464,849号、発明の名称「ELECTRO−MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS」;
2010年3月2日に発行された米国特許第7,670,334号、発明の名称「SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR」;
2010年7月13日に発行された米国特許第7,753,245号、発明の名称「SURGICAL STAPLING INSTRUMENTS」;
2013年3月12日に発行された米国特許第8,393,514号、発明の名称「SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE」;
米国特許出願第11/343,803号、発明の名称「SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES」、現在は、米国特許第7,845,537号;
2008年2月14日に出願された米国特許出願第12/031,573号、発明の名称「SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES」;
2008年2月15日に出願された米国特許出願第12/031,873号、発明の名称「END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT」、現在は、米国特許第7,980,443号;
米国特許出願第12/235,782号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING INSTRUMENT」、現在は、米国特許第8,210,411号;
米国特許出願第12/249,117号、発明の名称「POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM」、現在は、米国特許第8,608,045号;
2009年12月24日に出願された米国特許出願第12/647,100号、発明の名称「MOTOR−DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY」、現在は、米国特許第8,220,688号;
2012年9月29日に出願された米国特許出願第12/893,461号、発明の名称「STAPLE CARTRIDGE」、現在は、米国特許第8,733,613号;
2011年2月28日に出願された米国特許出願第13/036,647号、発明の名称「SURGICAL STAPLING INSTRUMENT」、現在は、米国特許第8,561,870号;
米国特許出願第13/118,241号、発明の名称「SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS」、現在は、米国特許第9,072,535号;
2012年6月15日出願の米国特許出願第13/524,049号、発明の名称「ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE」、現在は、米国特許第9,101,358号;
2013年3月13日に出願された米国特許出願第13/800,025号、発明の名称「STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM」、現在は、米国特許出願公開第2014/0263551号;
2013年3月13日に出願された米国特許出願第13/800,067号、発明の名称「STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM」、現在は、米国特許出願公開第2014/0263552号;
2006年1月31日に出願された米国特許出願公開第2007/0175955号、発明の名称「SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM」、及び、
2010年4月22日に出願された米国特許出願公開第2010/0264194号、発明の名称「SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR」、現在は、米国特許第8,308,040号。
特定の開示された実施形態と関連してデバイスの様々な実施形態について本明細書に記載してきたが、それらの実施形態に対して多くの修正及び変更が実施可能である。また、材料が特定の構成要素に関して開示されているが、他の材料が使用されてもよい。更に、様々な実施形態に従って、所与の機能を実行するために、単一の構成要素を複数の構成要素に置き換えてもよく、また複数の構成要素を単一の構成要素に置き換えてもよい。以上の説明及び以下の特許請求の範囲は、そのような修正及び変更をすべて包含することが意図される。
本明細書に開示されるデバイスは、1回の使用後に廃棄されるように設計することができ、又は複数回使用されるように設計することができる。しかしながら、いずれの場合も、本デバイスは、少なくとも1回の使用後に再使用のために再調整することができる。再調整には、デバイスの分解工程、それに続く特定の部品の洗浄工程又は交換工程、及びその後の再組立工程の任意の組み合わせを含むことができる。特に、デバイスは分解可能であり、デバイスの任意の数の特定の部品又は部分を、任意の組み合わせで選択的に交換するか又は取り外すことができる。特定の部分を洗浄及び/又は交換した後、デバイスを後の使用のために、再調整施設で、又は外科処置の直前に外科チームによって再組み立てすることができる。当業者であれば、デバイスの再調整が、分解、洗浄/交換、及び再組立のための様々な技術を利用できることを理解するであろう。かかる技術の使用、及び結果として得られる再調整されたデバイスは、すべて本出願の範囲内にある。
単なる例として、本明細書で説明される態様は、手術前に処理されてもよい。最初に、新品又は使用済みの器具が入手され、必要に応じて洗浄されてもよい。次いで器具を滅菌することができる。1つの滅菌技術では、器具は、プラスチックバッグ又はTYVEKバッグなど、閉鎖され密封された容器に入れられる。次いで、容器及び器具を、γ線、X線、又は高エネルギー電子などの容器を透過し得る放射線野に置くことができる。放射線は、器具上及び容器内の細菌を死滅させることができる。この後、滅菌済みの器具を滅菌容器内で保管することができる。密封容器は、医療施設で開けられるまで、器具を滅菌状態に保つことができる。デバイスはまた、β線若しくはγ線、エチレンオキシド、過酸化水素プラズマ、又は水蒸気が挙げられるが、これらに限定されない、当該技術分野で既知の任意の他の技術を用いて滅菌され得る。
代表的な設計を有するものとして本発明について記載してきたが、本発明は、本開示の趣旨及び範囲内で更に修正されてもよい。したがって、本出願は、その一般的原理を使用する本発明のあらゆる変形、使用、又は適合を包含するものとする。
全体又は部分的に、参照により本明細書に援用されると言及されるいずれの特許、刊行物又はその他の開示物も、援用される内容が既存の定義、記載、又は本開示に記載されているその他の開示物と矛盾しない範囲でのみ本明細書に援用されるものとする。それ自体、また必要な範囲で、本明細書に明瞭に記載される開示内容は、参照により本明細書に援用されるいかなる矛盾する記載にも優先するものとする。参照により本明細書に援用されるものとするが、現行の定義、記載、又は本開示に記載されているその他の開示内容と矛盾する、任意の文献、又はそれらの部分は、援用文献と既存の開示内容との間に矛盾が生じない範囲においてのみ援用されるものとする。
〔実施の態様〕
(1) ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層との間に延びる複数の支持支柱と、を備える、圧縮性補助材。
(2) 前記支持支柱の各々は、
前記第1の生体適合性層に付着される第1の終端部分と、
前記第2の生体適合性層に付着される第2の終端部分と、を備える、実施態様1に記載の圧縮性補助材。
(3) 前記第1の終端部分及び前記第2の終端部分は、前記第1の生体適合性層及び前記第2の生体適合性層と交差する横軸を規定する、実施態様2に記載の圧縮性補助材。
(4) 前記横軸は、前記第1の生体適合性層に対して第1の角度を規定し、前記横軸は、前記第2の生体適合性層に対して第2の角度を規定し、前記第1の角度及び前記第2の角度は、約80°〜約100°の範囲から選択されている、実施態様3に記載の圧縮性補助材。
(5) 前記第1の終端部分は、前記第1の生体適合性層の中に織り込まれている、実施態様2に記載の圧縮性補助材。
(1) ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層との間に延びる複数の支持支柱と、を備える、圧縮性補助材。
(2) 前記支持支柱の各々は、
前記第1の生体適合性層に付着される第1の終端部分と、
前記第2の生体適合性層に付着される第2の終端部分と、を備える、実施態様1に記載の圧縮性補助材。
(3) 前記第1の終端部分及び前記第2の終端部分は、前記第1の生体適合性層及び前記第2の生体適合性層と交差する横軸を規定する、実施態様2に記載の圧縮性補助材。
(4) 前記横軸は、前記第1の生体適合性層に対して第1の角度を規定し、前記横軸は、前記第2の生体適合性層に対して第2の角度を規定し、前記第1の角度及び前記第2の角度は、約80°〜約100°の範囲から選択されている、実施態様3に記載の圧縮性補助材。
(5) 前記第1の終端部分は、前記第1の生体適合性層の中に織り込まれている、実施態様2に記載の圧縮性補助材。
(6) 前記第1の終端部分は、前記第1の生体適合性層に溶着されている、実施態様2に記載の圧縮性補助材。
(7) 前記複数の支持支柱は、
第1の支持支柱と、
前記第1の支持支柱と交差する第2の支持支柱と、を含む、実施態様1に記載の圧縮性補助材。
(8) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、織物のマトリックスを含む、実施態様1に記載の圧縮性補助材。
(9) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、編物のマトリックスを含む、実施態様1に記載の圧縮性補助材。
(10) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、フィルムを含む、実施態様1に記載の圧縮性補助材。
(7) 前記複数の支持支柱は、
第1の支持支柱と、
前記第1の支持支柱と交差する第2の支持支柱と、を含む、実施態様1に記載の圧縮性補助材。
(8) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、織物のマトリックスを含む、実施態様1に記載の圧縮性補助材。
(9) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、編物のマトリックスを含む、実施態様1に記載の圧縮性補助材。
(10) 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、フィルムを含む、実施態様1に記載の圧縮性補助材。
(11) 前記第2の生体適合性層は、組織を把持するように構成された外側表面を備える、実施態様1に記載の圧縮性補助材。
(12) 前記外側表面は複数の把持機構を備え、前記把持機構の各々は、前記外側表面に対して鋭角を規定する、実施態様11に記載の圧縮性補助材。
(13) 前記第1の生体適合性層は、前記第2の生体適合性層よりも高い密度を有する、実施態様1に記載の圧縮性補助材。
(14) 本体部分と、
前記本体部分を少なくとも部分的に囲む外側縁部であって、前記本体部分は、前記外側縁部よりも厚い厚さを備える、外側縁部と、を更に備える、実施態様1に記載の圧縮性補助材。
(15) 前記外側縁部は先細である、実施態様14に記載の圧縮性補助材。
(12) 前記外側表面は複数の把持機構を備え、前記把持機構の各々は、前記外側表面に対して鋭角を規定する、実施態様11に記載の圧縮性補助材。
(13) 前記第1の生体適合性層は、前記第2の生体適合性層よりも高い密度を有する、実施態様1に記載の圧縮性補助材。
(14) 本体部分と、
前記本体部分を少なくとも部分的に囲む外側縁部であって、前記本体部分は、前記外側縁部よりも厚い厚さを備える、外側縁部と、を更に備える、実施態様1に記載の圧縮性補助材。
(15) 前記外側縁部は先細である、実施態様14に記載の圧縮性補助材。
(16) 前記外側縁部は、
前記第1の生体適合性層から延びる第1の外側縁部部分と、
前記第2の生体適合性層から延びる第2の外側縁部部分であって、前記第1の外側縁部部分と前記第2の外側縁部部分は、前記第1の生体適合性層と前記第2の生体適合性層とを接合するように構成された連続的な側部部分へと一体化されている、第2の外側縁部部分と、を備える、実施態様14に記載の圧縮性補助材。
(17) 前記外科用器具によって捕捉された組織を切断するためのナイフを受容するように構成されたナイフスロットを更に備え、前記ナイフスロットは2つの側部を画定し、前記ナイフは前記2つの側部の間を通る、実施態様1に記載の圧縮性補助材。
(18) 前記2つの側部の間に延びるテザーを更に備え、前記ナイフは、前記テザーを切断して前記2つの側部を分離するように構成されている、実施態様17に記載の圧縮性補助材。
(19) 外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、
ステープルカートリッジであって、
複数のステープルと、
外側表面を備えるカートリッジデッキと、を備える、ステープルカートリッジと、
前記外側表面に対して配置可能な圧縮性補助材であって、
組織に面する生体適合性層と、
前記外側表面に対して配置可能なデッキに面する生体適合性層であって、前記組織に面する生体適合性層は、前記デッキに面する生体適合性層から離間されている、デッキに面する生体適合性層と、
前記組織に面する生体適合性層及び前記デッキに面する生体適合性層と交差するスペーサ繊維であって、前記組織に面する生体適合性層を前記デッキに面する生体適合性層の上に持ち上げるように構成されている、スペーサ繊維と、を備える、圧縮性補助材と、を備える、ステープルカートリッジアセンブリ。
(20) ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層とを相互連結する細長軟質部材であって、前記第1の生体適合性層と前記第2の生体適合性層との間で起立する複数の支持構造を形成するように構成されている、細長軟質部材と、を備える、圧縮性補助材。
前記第1の生体適合性層から延びる第1の外側縁部部分と、
前記第2の生体適合性層から延びる第2の外側縁部部分であって、前記第1の外側縁部部分と前記第2の外側縁部部分は、前記第1の生体適合性層と前記第2の生体適合性層とを接合するように構成された連続的な側部部分へと一体化されている、第2の外側縁部部分と、を備える、実施態様14に記載の圧縮性補助材。
(17) 前記外科用器具によって捕捉された組織を切断するためのナイフを受容するように構成されたナイフスロットを更に備え、前記ナイフスロットは2つの側部を画定し、前記ナイフは前記2つの側部の間を通る、実施態様1に記載の圧縮性補助材。
(18) 前記2つの側部の間に延びるテザーを更に備え、前記ナイフは、前記テザーを切断して前記2つの側部を分離するように構成されている、実施態様17に記載の圧縮性補助材。
(19) 外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、
ステープルカートリッジであって、
複数のステープルと、
外側表面を備えるカートリッジデッキと、を備える、ステープルカートリッジと、
前記外側表面に対して配置可能な圧縮性補助材であって、
組織に面する生体適合性層と、
前記外側表面に対して配置可能なデッキに面する生体適合性層であって、前記組織に面する生体適合性層は、前記デッキに面する生体適合性層から離間されている、デッキに面する生体適合性層と、
前記組織に面する生体適合性層及び前記デッキに面する生体適合性層と交差するスペーサ繊維であって、前記組織に面する生体適合性層を前記デッキに面する生体適合性層の上に持ち上げるように構成されている、スペーサ繊維と、を備える、圧縮性補助材と、を備える、ステープルカートリッジアセンブリ。
(20) ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層とを相互連結する細長軟質部材であって、前記第1の生体適合性層と前記第2の生体適合性層との間で起立する複数の支持構造を形成するように構成されている、細長軟質部材と、を備える、圧縮性補助材。
Claims (20)
- ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層との間に延びる複数の支持支柱と、を備える、圧縮性補助材。 - 前記支持支柱の各々は、
前記第1の生体適合性層に付着される第1の終端部分と、
前記第2の生体適合性層に付着される第2の終端部分と、を備える、請求項1に記載の圧縮性補助材。 - 前記第1の終端部分及び前記第2の終端部分は、前記第1の生体適合性層及び前記第2の生体適合性層と交差する横軸を規定する、請求項2に記載の圧縮性補助材。
- 前記横軸は、前記第1の生体適合性層に対して第1の角度を規定し、前記横軸は、前記第2の生体適合性層に対して第2の角度を規定し、前記第1の角度及び前記第2の角度は、約80°〜約100°の範囲から選択されている、請求項3に記載の圧縮性補助材。
- 前記第1の終端部分は、前記第1の生体適合性層の中に織り込まれている、請求項2に記載の圧縮性補助材。
- 前記第1の終端部分は、前記第1の生体適合性層に溶着されている、請求項2に記載の圧縮性補助材。
- 前記複数の支持支柱は、
第1の支持支柱と、
前記第1の支持支柱と交差する第2の支持支柱と、を含む、請求項1に記載の圧縮性補助材。 - 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、織物のマトリックスを含む、請求項1に記載の圧縮性補助材。
- 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、編物のマトリックスを含む、請求項1に記載の圧縮性補助材。
- 前記第1の生体適合性層と前記第2の生体適合性層の少なくとも一方は、フィルムを含む、請求項1に記載の圧縮性補助材。
- 前記第2の生体適合性層は、組織を把持するように構成された外側表面を備える、請求項1に記載の圧縮性補助材。
- 前記外側表面は複数の把持機構を備え、前記把持機構の各々は、前記外側表面に対して鋭角を規定する、請求項11に記載の圧縮性補助材。
- 前記第1の生体適合性層は、前記第2の生体適合性層よりも高い密度を有する、請求項1に記載の圧縮性補助材。
- 本体部分と、
前記本体部分を少なくとも部分的に囲む外側縁部であって、前記本体部分は、前記外側縁部よりも厚い厚さを備える、外側縁部と、を更に備える、請求項1に記載の圧縮性補助材。 - 前記外側縁部は先細である、請求項14に記載の圧縮性補助材。
- 前記外側縁部は、
前記第1の生体適合性層から延びる第1の外側縁部部分と、
前記第2の生体適合性層から延びる第2の外側縁部部分であって、前記第1の外側縁部部分と前記第2の外側縁部部分は、前記第1の生体適合性層と前記第2の生体適合性層とを接合するように構成された連続的な側部部分へと一体化されている、第2の外側縁部部分と、を備える、請求項14に記載の圧縮性補助材。 - 前記外科用器具によって捕捉された組織を切断するためのナイフを受容するように構成されたナイフスロットを更に備え、前記ナイフスロットは2つの側部を画定し、前記ナイフは前記2つの側部の間を通る、請求項1に記載の圧縮性補助材。
- 前記2つの側部の間に延びるテザーを更に備え、前記ナイフは、前記テザーを切断して前記2つの側部を分離するように構成されている、請求項17に記載の圧縮性補助材。
- 外科用ステープル留め器具と共に使用するためのステープルカートリッジアセンブリであって、
ステープルカートリッジであって、
複数のステープルと、
外側表面を備えるカートリッジデッキと、を備える、ステープルカートリッジと、
前記外側表面に対して配置可能な圧縮性補助材であって、
組織に面する生体適合性層と、
前記外側表面に対して配置可能なデッキに面する生体適合性層であって、前記組織に面する生体適合性層は、前記デッキに面する生体適合性層から離間されている、デッキに面する生体適合性層と、
前記組織に面する生体適合性層及び前記デッキに面する生体適合性層と交差するスペーサ繊維であって、前記組織に面する生体適合性層を前記デッキに面する生体適合性層の上に持ち上げるように構成されている、スペーサ繊維と、を備える、圧縮性補助材と、を備える、ステープルカートリッジアセンブリ。 - ステープルカートリッジを含む外科用器具と共に使用するための圧縮性補助材であって、
第1の生体適合性層と、
前記第1の生体適合性層から離間された第2の生体適合性層と、
前記第1の生体適合性層と前記第2の生体適合性層とを相互連結する細長軟質部材であって、前記第1の生体適合性層と前記第2の生体適合性層との間で起立する複数の支持構造を形成するように構成されている、細長軟質部材と、を備える、圧縮性補助材。
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2015
- 2015-09-30 US US14/871,119 patent/US10285699B2/en active Active
- 2015-09-30 US US14/871,057 patent/US20170086829A1/en not_active Abandoned
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2016
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- 2016-09-21 CN CN201680068224.3A patent/CN108289672B/zh active Active
- 2016-09-21 WO PCT/US2016/052793 patent/WO2017058597A2/en active Application Filing
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- 2016-09-21 CN CN201680068037.5A patent/CN108289670B/zh active Active
- 2016-09-21 WO PCT/US2016/052812 patent/WO2017058602A1/en active Application Filing
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- 2016-09-21 MX MX2018003951A patent/MX2018003951A/es unknown
- 2016-09-21 CN CN201680068117.0A patent/CN108289671B/zh active Active
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