JP6290262B2 - End effector with distal tissue abutment member - Google Patents

Description

(Cross-reference of related applications)
This application is a continuation-in-part of US Patent Application No. 13 / 433,129, entitled “Tissue Thickness Compensator Compiling a Plurality of Medicines” filed March 28, 2012. Application, the entire contents of which are incorporated herein by reference.

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

The features and advantages of the present invention, as well as the manner in which they are realized, will become more apparent and a deeper understanding of the invention itself will be obtained when the following description of embodiments of the invention is read in conjunction with the accompanying drawings. Let's go.
FIG. 5 is a left front perspective view of a surgical stapling and cutting instrument with a handle portion including a link trigger type automatic retraction and ratchet type manual retraction mechanism. The surgical stapling and cutting instrument of FIG. 1 with a portion of the elongate shaft cut away and the right half shell of the handle housing removed to expose the automatic firing distance end retract mechanism and the manual fire retract mechanism. It is a right rear perspective view. FIG. 2 is a right rear exploded perspective view of the handle portion of FIG. 1 and the elongated shaft of the surgical stapling and cutting instrument. FIG. 2 is a right side view of the surgical stapling and cutting instrument of FIG. 1 partially exploded. The closure mechanism has been closed and clamped, the side pawl mechanism has completed the first stroke, and the retracting mechanism has been removed to expose the distal link of the linkage rack that triggers the automatic retracting of the firing mechanism. FIG. 3 is a partially exploded right rear perspective view of a surgical stapling and cutting instrument. FIG. 5 is a partially exploded left side view of the stapling and cutting instrument of FIG. 4 in an initial state with the end effector opened and the anti-backup mechanism engaged. FIG. 4 is a partially exploded left side view of the stapling and cutting instrument 4. FIG. 2 is an exploded left side detail view of the surgical stapling and cutting instrument of FIG. 1 immediately after the distal link is actuated to lock the anti-backup release lever forward and allow the linkage rack to retract. FIG. 3 is a right exploded perspective view of the play back gear of the surgical stapling and cutting instrument of FIG. 1 and the manual retract lever and ratchet pawl of the manual retract mechanism. Partially exploded left side of the surgical stapling and cutting instrument of FIG. 1 with an anti-backup mechanism engaged to a fully fired linkage rack that has been disconnected from the combined tension / compression spring prior to actuation of the manual retract lever of FIG. FIG. FIG. 10 is a partially exploded left side view of the surgical stapling and cutting instrument of FIG. 9, with hidden portions of the anti-backup release lever, rear gear, and manual firing release lever shown in dashed lines. FIG. 11 is a partially exploded left side view of the surgical stapling and cutting instrument of FIG. 10 after actuation of a manual firing release lever manually retracts the linkage rack. FIG. 12 is a partially exploded left side view of the surgical stapling and cutting instrument of FIG. 11 depicting a manual firing release lever that omits the linkage rack and disengages the anti-backup mechanism. FIG. 10 is a right side view of an alternative anti-backup release mechanism with the linkage rack in the retracted position and the anti-backup release lever positioned proximally with the anti-backup plate engaged with the firing rod. FIG. 14 is a detailed right side view of the rear gear, the automatically retracting cam wheel and the most distal link of FIG. 13. FIG. 7 is a right side view of the automatic release mechanism after a further firing stroke has caused the automatic retract cam wheel to slide distally, lock the anti-backup release lever, and disengage the anti-backup mechanism. FIG. 10 is a left front perspective view of an open staple loading assembly, wherein the right half of the replaceable staple cartridge is included in the staple channel. FIG. 17 is an exploded perspective view of the staple loading assembly of FIG. 16 having a fully replaceable staple cartridge and a non-articulated shaft configuration. FIG. 6 is a perspective view of a plurality of staple drivers that can be positioned inside the cartridge body of the staple cartridge. FIG. 17 is a perspective view of the two-piece knife and firing bar (“E-beam”) of the staple loading assembly of FIG. 16. FIG. 6 is a perspective view of a wedge-shaped thread of a staple cartridge of a staple loading assembly. FIG. 17 is a left side view of the staple loading assembly of FIG. 16 taken in a longitudinal section through the centerline 21-21. FIG. 17 is a perspective view of the open staple loading assembly of FIG. 16 without a replaceable staple cartridge and without the distal portion of the staple channel. FIG. 17 is a front view taken in section through line 23-23 of the staple loading assembly of FIG. 16 depicting the internal staple driver and a portion of the two-piece knife and firing bar of the staple cartridge. Line 24 of the closed staple loading assembly of FIG. 16 to include a center contact point between the two-piece knife and the wedge-shaped thread but laterally offset to show the staples and staple drivers inside the staple cartridge. It is a left view obtained substantially along the longitudinal axis of -24. FIG. 25 is a left side detail view of the staple loading assembly of FIG. 24 with the two-piece knife retracted slightly more as a typical staple cartridge change. FIG. 26 is a left side detail view of the staple loading assembly of FIG. 25 corresponding to the configuration depicted in FIG. 24 with the two-piece knife beginning to fire. FIG. 25 is a left side cross-sectional view of the closed staple loading assembly of FIG. 24 after a two-piece knife and firing bar have been fired distally. FIG. 28 is a left side cross-sectional view of the closed staple loading assembly of FIG. 27 after firing the staple cartridge and retracting the two-piece knife. FIG. 29 is a left side cross-sectional detail view of the staple loading assembly of FIG. 28 with the two-piece knife allowed to fall into the lockout position. FIG. 5 is a partial perspective view of a jaw of an end effector assembly with various elements removed in accordance with various embodiments of the present disclosure, depicting a firing assembly in an unfired position and further depicting a thread engaged with an actuator release stop; is there. FIG. 29B is a partial perspective view of the jaw of FIG. 29A depicting the firing assembly in a partially fired position with various elements removed and further depicting the thread disengaged from the actuator release stop. 1 is a perspective view of a surgical stapling instrument including a shaft and a detachable end effector. FIG. FIG. 31 is a partial perspective view of the shaft and end effector of the surgical stapling instrument of FIG. 30; FIG. 31 is a partial perspective view of the end effector assembled to the shaft of the surgical stapling instrument of FIG. 30; FIG. 31 is another partial perspective view of the endfector assembled to the shaft of the surgical stapling instrument of FIG. 30; FIG. 31 is a partial cross-sectional elevation view showing the end effector separated from the shaft of the surgical stapling instrument of FIG. 30; FIG. 31 is a partial cross-sectional elevation view showing the end effector coupled to the shaft of the surgical stapling instrument of FIG. 30 and further showing the slide annulus in the open lock release position. FIG. 31 is a partial cross-sectional elevation view showing the end effector coupled to the shaft of the surgical stapling instrument of FIG. 30 and further showing the slide annulus in the closed lock position. FIG. 31 is an exploded view of the end effector of FIG. 30 shown with components removed. FIG. 30 is an exploded view of the shaft. Longitudinal direction of the anvil in the closed position and the staple cartridge with the rigid support portion and the compressible tissue thickness compensator shown with the staples moved from the unfired position to the fired position during the first sequence It is sectional drawing. FIG. 40 is another cross-sectional view of the anvil and staple cartridge of FIG. 39 showing the anvil in an open position after the firing sequence is completed. FIG. 40 is a partial detail view of the staple cartridge of FIG. 39, showing the staple in an unfired position. FIG. 3 is a cross-sectional elevation view of a staple cartridge with a rigid support portion and a compressible tissue thickness compensator showing the staple in an unfired position. FIG. 43 is a detailed view of the staple cartridge of FIG. 42. FIG. 5 is an elevational view of an anvil in an open position and a staple cartridge including a rigid support portion and a compressible tissue thickness compensator showing the staple in an unfired position. Elevations of an anvil in a closed position and a staple cartridge with a rigid support portion and a compressible tissue thickness compensator showing staples and tissue captured between the staple and anvil in the unfired position and the tissue thickness compensator FIG. FIG. 46 is a detailed view of the anvil and staple cartridge of FIG. 45. FIG. 46 is an elevational view of the anvil and staple cartridge of FIG. 45 showing tissue having different thicknesses positioned between the anvil and the staple cartridge. FIG. 48 is a detailed view of the anvil and staple cartridge of FIG. 45 as shown in FIG. 47. FIG. 4 shows a tissue thickness compensator that is captured within different staples and compensates for different tissue thicknesses. FIG. 5 shows a tissue thickness compensator that applies compression pressure to one or more blood vessels traversed by a staple row. It is a figure which shows the structure | tissue captured inside the staple. FIG. 3 shows a thick tissue and tissue thickness compensator captured within a staple. FIG. 5 shows a thin tissue and tissue thickness compensator captured within a staple. FIG. 4 shows a tissue having an intermediate thickness captured within the staple and a tissue thickness compensator. FIG. 3 is a partial cross-sectional view of an end effector of a surgical stapling instrument according to at least one embodiment. FIG. 6 is a partial cross-sectional view of an end effector according to at least one alternative embodiment. 6 is a partial cross-sectional view of an end effector according to another alternative embodiment. FIG. It is a fragmentary sectional view of the end effector shown in the bent state. FIG. 59 is a partial cross-sectional view of the end effector of FIG. 58 in a released state. FIG. 3 is a perspective cross-sectional view of a staple cartridge comprising a transverse retention member configured to retain a tissue thickness compensator against a support portion. FIG. 61 is a cross-sectional view of the staple cartridge of FIG. 60 being used to staple tissue. 1 is a perspective view of a staple cartridge including a cartridge body and a tissue thickness compensator attached to the cartridge body by a plurality of fireable attachment members. FIG. FIG. 63 is an exploded view of the staple cartridge of FIG. 62. FIG. 63 is an elevational view of the staple cartridge of FIG. 62. FIG. 63 is a cross-sectional view of the staple cartridge of FIG. 62 showing the fireable attachment member in an unfired position, taken along the cutting line in FIG. FIG. 65 is a cross-sectional view of the staple cartridge of FIG. 62, showing the fireable attachment member in the fire break position, taken along the cut line in FIG. It is a perspective view of a tissue thickness compensator. FIG. 167 is a perspective view of the tissue thickness compensator of FIG. 167 assembled to a staple cartridge; FIG. 69 is an exploded view of the tissue thickness compensator and staple cartridge of FIG. 68. FIG. 6 is a perspective view of a tissue thickness compensator proximal end. FIG. 71 is a partial elevation view of the tissue thickness compensator of FIG. 70 assembled to a staple cartridge. FIG. 72 is a plan view of the tissue thickness compensator and staple cartridge of FIG. 71. It is a front view of the mount part holding a tissue thickness compensator with respect to a staple cartridge. FIG. 74 is a side view of the mount portion of FIG. 73. FIG. 74 is a rear view of the mount portion of FIG. 73. FIG. 74 is a bottom view of the mount portion of FIG. 73. FIG. 3 is a partial cross-sectional view of a staple cartridge including a retention pin configured to releasably hold a tissue thickness compensator relative to the cartridge body of the staple cartridge. FIG. 78 is a partial cross-sectional perspective view of the staple cartridge of FIG. 77 with a portion removed for illustration. FIG. 78 is a partial cross-sectional view of the staple cartridge of FIG. 77 showing the retention pin in a disabled state. FIG. 78 is a partial perspective cross-sectional view of the staple cartridge of FIG. 77 further illustrating the retaining pin in a disabled state. FIG. 6 is a partial cross-sectional view of a staple cartridge including a clamp configured to releasably hold a tissue thickness compensator relative to the cartridge body, showing the clamp in a closed state. FIG. 81 is a partial cross-sectional view of the staple cartridge of FIG. 80 showing the clamp in an operational state. A staple cartridge comprising a layer such as a tissue thickness compensator and / or buttress material disposed thereon, disposed relative to the end effector cutting edge and with the remaining end effector portion removed for purposes of illustration. It is a perspective view. FIG. 81A is a cross-sectional plan view of the staple cartridge of FIG. 81A representing the cutting edge cutting the distal end of a layer disposed in a distal cavity in the staple cartridge, where the cutting edge is not deployed and the staple is omitted for clarity purposes. It is. FIG. 81B is a cross-sectional plan view of the staple cartridge of FIG. 81A with the cutting edge cut through the distal end of the layer deployed and the staples omitted for clarity purposes. FIG. 7 is a perspective view of a jaw of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator clamped to the cartridge body by a proximal connector and a distal connector, further depicting a firing assembly in an unfired position. . FIG. 85 is a partial plan view of the jaw of FIG. 84 depicting the actuator in a pre-operation position. FIG. 85 is a partial plan view of the jaw of FIG. 84 depicting the actuator in a post-actuation position. FIG. 85B is a detailed view of the jaw of FIG. 85B. FIG. 85 is an elevation view of the jaw of FIG. 84 depicting the actuator in a post-actuated position and further depicting the proximal and distal connectors destroyed. FIG. 84 is a partial elevational view of the jaw of FIG. 84 depicting the cartridge body sled with various elements removed and engaged with the tabs of the actuator of FIG. 85A. FIG. 85 is a partial elevational view of the jaw of FIG. 84 depicting the cartridge body sled with various elements removed and disengaged from the actuator tab. FIG. 7 is a partial plan view of a jaw of an end effector assembly according to various embodiments of the present disclosure depicting a firing bar of the firing assembly in contact with an actuator release stop. FIG. 87B is a partial plan view of the jaw of FIG. 87A depicting a firing bar of a firing assembly extending through an actuator release stop. FIG. 5 is a perspective view of a jaw of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator clamped to a cartridge body and further depicting a firing assembly in an unfired position. FIG. 89 is a partial elevational view of the jaw of FIG. 88, with various elements transparently depicted, depicting an actuator extending through the jaw and further depicting the firing assembly in an unfired position. FIG. 6 is a partial cross-sectional view of a staple cartridge including a retention pin configured to releasably retain a tissue thickness compensator relative to the cartridge body, showing the retention pin in an activated state. FIG. 93 is a partial cross-sectional view of the staple cartridge of FIG. 90 showing the retention pin in an invalid state. FIG. 93 is a perspective view of an actuator of the staple cartridge of FIG. 90 configured to disable a retention pin. FIG. 5 is a perspective view of a fastener cartridge assembly of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator released from the cartridge body of the fastener cartridge assembly and further depicting a firing assembly in an unfired position. . FIG. 93B is a perspective view of the fastener cartridge assembly of FIG. 93A depicting a tissue thickness compensator clamped to the cartridge body of the staple cartridge assembly. FIG. 93B is an elevation view of the fastener cartridge assembly of FIG. 93A depicting the firing assembly with various elements removed and in a pre-fired position. FIG. 93B is an elevation view of the fastener cartridge assembly of FIG. 93A depicting the firing assembly with various elements removed and in a partial firing position. FIG. 6 is a partial perspective view of a fastener cartridge assembly of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator released from the cartridge body of the fastener cartridge assembly. FIG. 6 is a partial perspective view of a fastener cartridge assembly of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator released from the cartridge body of the fastener cartridge assembly. FIG. 96 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 95 depicting a mount of a tissue thickness compensator held in a bridge of the cartridge body. FIG. 6 is a perspective view of a fastener cartridge assembly of an end effector assembly according to various embodiments of the present disclosure depicting a tissue thickness compensator released from the cartridge body of the fastener cartridge assembly. FIG. 98 is a perspective view of the fastener cartridge assembly of FIG. 97 depicting a tissue thickness compensator clamped to the cartridge body of the fastener cartridge assembly. FIG. 98 is an elevational cross-sectional view of the end effector assembly of FIG. 97 depicting a tissue thickness compensator clamped to the cartridge body of the fastener cartridge assembly and further depicting the end effector in a clamp release position. FIG. 98 is an elevational cross-sectional view of the end effector assembly of FIG. 97 depicting an untightened tissue thickness compensator on the cartridge body of the fastener cartridge assembly and further depicting the end effector in a clamped position. FIG. 5 is a perspective view of a staple cartridge applicator assembly comprising an upper tissue thickness compensator including a plurality of retention features extending from an upper tissue thickness compensator and a staple cartridge comprising a lower tissue thickness compensator. FIG. 102 is an elevational view of the staple cartridge applicator assembly of FIG. 101 disposed within a staple cartridge channel and an anvil closed over the staple cartridge applicator assembly. 102 is an elevational view of the anvil of FIG. 102 in the resume position and the staple cartridge applicator of FIG. 101 removed from the end effector. FIG. 102 is a cross-sectional view of tissue positioned intermediate an upper tissue thickness compensator and a lower tissue thickness compensator of FIG. 101. FIG. 6 is a cross-sectional view showing an upper tissue thickness compensator and a lower tissue thickness compensator stapled to tissue and cut by a cutting member. FIG. 6 is a perspective view of a staple cartridge applicator assembly comprising an upper tissue thickness compensator configured to be attached to an anvil according to at least one embodiment. FIG. 107 is an elevational view of the staple cartridge applicator assembly of FIG. 106 positioned within the staple cartridge channel and the anvil being moved toward the upper tissue thickness compensator. FIG. 107 illustrates the staple cartridge applicator of FIG. 106 removed from the end effector after the upper tissue thickness compensator is engaged with the anvil. FIG. 107 is an end cross-sectional view of the anvil being moved toward the upper tissue thickness compensator of FIG. FIG. 6 is an end cross-sectional view of an anvil engaged with an upper tissue thickness compensator. 1 is a perspective view of a staple cartridge having a piece of buttress material releasably retained in a staple cartridge according to one non-limiting embodiment of the present invention. FIG. FIG. 110 is an exploded perspective view of the staple cartridge and the piece of buttress material of FIG. 109, wherein the piece of buttress material includes a plurality of members extending therefrom. 110 is a cross-sectional view taken along line 111-111 in FIG. 109 showing the member of FIG. 110 engaged with a staple cavity according to one non-limiting embodiment of the present invention. 1 is a cross-sectional view of a piece of buttress material including a member engaged with a staple cavity of a staple cartridge according to one non-limiting embodiment of the present invention. FIG. FIG. 113 is an exploded view of FIG. 112 showing the members separated from the staple cavities of the staple cartridge according to one non-limiting embodiment of the present invention. FIG. 6 is a partial perspective view of a support portion of a staple cartridge with a removable and / or replaceable staple leg guide. FIG. 115 is a partial cross-sectional view of the staple cartridge of FIG. 114 showing the staples being deployed from the staple cartridge. FIG. 115 is a detailed cross-sectional view of FIG. 114 after the staple cartridge has been fired. FIG. 5 is a partial perspective view of a cartridge body, shell, and tissue thickness compensator according to various embodiments of the present disclosure depicting protrusions extending from the cartridge body. FIG. 3 is a partial perspective view of a cartridge body, shell, and tissue thickness compensator according to various embodiments of the present disclosure depicting protrusions extending from the shell. FIG. 7 is a partial cross-sectional view of an end effector assembly according to various embodiments of the present disclosure, depicting staples positioned within the staple cavities of the cartridge body of the end picture factor assembly and further depicting the staples in an unformed configuration. FIG. 119 is a partial cross-sectional view of the end effector assembly of FIG. 119 depicting the staples released from the staple cavity and further depicting the staples in the forming configuration. 1 is a perspective view of staples and locks according to various embodiments of the present disclosure depicting locks in a lock configuration. FIG. FIG. 122 is a perspective view of the staple and lock of FIG. 121 depicting a lock in a locked configuration; FIG. 122 is a perspective view of the staple and lock of FIG. 121 depicting the lock in a pre-fired position within the staple cavity and further depicting the lock in a locked configuration; FIG. 122 is a perspective view of the staple and lock of FIG. 121 depicting the lock in a firing position within the staple cavity and further depicting the lock in the unlocked configuration; FIG. 7 is a perspective view of a fastener cartridge assembly of an end effector assembly according to various embodiments of the present disclosure depicting a lock extending from a lock cavity in the cartridge body of the fastener cartridge assembly. FIG. 126 is a cross-sectional view of the lock of FIG. 125 depicting the lock and the connector not tightened to the lock in the unlocked configuration. FIG. 126 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125 depicting the cartridge body, connector, tissue thickness compensator, and lock in a partially assembled position. FIG. 126 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125 depicting a lock in a locked configuration, depicting an anvil in a clamped position, and depicting a driver key in an unfired position. FIG. 126 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125 depicting a lock in the unlocked configuration, depicting an anvil in a clamped position, and further depicting a driver key in a partial firing position. FIG. 126 is a partial cross-sectional view of the fastener cartridge assembly of FIG. 125 depicting the lock in the unlocked configuration, depicting the anvil in the clamped position, and further depicting the driver key in the firing position. FIG. 6 is a cross-sectional view of the end effector showing the firing member in a partial firing position. 130 is a cross-sectional view of the end effector of FIG. 130 showing the support portion being separated from the partially implanted tissue thickness compensator. FIG. FIG. 4 is a partial cutaway view of a staple cartridge comprising staple drivers having different heights according to at least one embodiment. FIG. 132 illustrates the staple driver of FIG. 132 and staples having different unfired heights supported on the staple driver. FIG. 2 is a cross-sectional view of a staple cartridge comprising a tissue thickness compensator and a support portion according to at least one embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 141 is a detailed view of a region surrounding the leading end portion of the staple of FIG. 141. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 143 is a detailed view of a region surrounding the leading end portion of the staple of FIG. FIG. 5 is a partial cross-sectional view of a tissue thickness compensator, a staple guide layer, and a staple in an unfired position according to at least one alternative embodiment. FIG. 4 is a perspective view of a staple guide layer and a plurality of staples in an unfired position according to at least one alternative embodiment. FIG. 5 is an exploded view of the tissue thickness compensator and staple cartridge body. FIG. 5 is an elevational view of a disposable loading unit including a pivotable jaw configured to support a staple cartridge. FIG. 6 is a perspective view of a tissue thickness compensator applicator positioned within an effector of a disposable loading unit. 149 is a top perspective view of the tissue thickness compensator applicator of FIG. 149; FIG. 149 is a bottom perspective view of the tissue thickness compensator applicator of FIG. 149; FIG. 1 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple driver having deck surfaces with different heights and irregularities according to at least one embodiment. FIG. FIG. 3 is a cross-sectional view of an end effector of a surgical stapling instrument comprising a staple driver having different heights and stepped deck surfaces according to at least one embodiment. FIG. 6 shows a tissue thickness compensator with varying thickness, a staple driver having a different height, and a staple having a different green height. FIG. 157 shows the staple and tissue thickness compensator of FIG. 154 embedded in tissue. It is a fragmentary sectional view of the tissue thickness compensator attached to the staple cartridge body. 156 is a partial cross-sectional view of the tissue thickness compensator and staple cartridge body of FIG. 156; FIG. 156 is a partially exploded view of the tissue thickness compensator of FIG. 156; FIG. FIG. 3 is a partially exploded view of a tissue thickness compensator, staple cartridge body, and firing member. FIG. 159 is a partial elevation view of the embodiment of FIG. 159; It is a bottom view of a staple cartridge. FIG. 167 is a detailed bottom view of the staple cartridge of FIG. 161. It is an exploded view of a staple cartridge showing a staple driver arrangement configuration. A tissue thickness compensator, such as a tissue thickness compensator, attached to the staple cartridge and disposed intermediate the retainer and the staple cartridge, wherein the retainer, the layer, and the staple cartridge are positioned relative to the surgical staple, and the staple cartridge channel is FIG. 6 is a perspective view of an embodiment of a retainer removed for purposes of illustration. 164 is a perspective view of the retainer of FIG. 164. FIG. 164 is a plan view of the retainer, layer, and staple cartridge of FIG. 164; FIG. 167 is a cross-sectional view of the retainer, layer, and staple cartridge of FIG. 164 with the lip of the staple extending from the staple cavity into and into the staple cartridge. FIG. FIG. 6 is a perspective view of an embodiment of a retainer in which the retainer includes a movable cam portion and a locking tab portion. 168 is a perspective view of the retainer of FIG. 168 attached to a staple cartridge with the staple cartridge and retainer positioned for insertion into a staple cartridge channel of an end effector of a surgical stapler. FIG. 168 is a plan view of the retainer of FIG. 168 positioned in the cartridge channel of the surgical end effector but not fully inserted. FIG. 172 is a cross-sectional end view of the retainer of FIG. 168 positioned within the staple cartridge channel of FIG. 170 but not fully inserted. 170 is a plan view of the retainer of FIG. 168 fully inserted into the staple cartridge channel of FIG. 170. FIG. 170 is an end cross-sectional view of the retainer of FIG. 168 fully inserted into the staple cartridge channel of FIG. 170 with the retainer unlocked and removed from the staple cartridge. FIG. 6 is a plan view of an end effector insert according to at least one embodiment. 174 is an elevational view of the end effector insert of FIG. 174; FIG. 174 is a perspective view of the end effector insert of FIG. 174; FIG. FIG. 174 is a partial perspective view of the end effector insert of FIG. 174 depicting an end effector insert engaging an end effector anvil of a surgical instrument; FIG. 174 is a partial perspective view of the end effector insert of FIG. 174 showing the end effector insert engaging the staple cartridge of the end effector of the surgical instrument; 174 is an elevational view of the end effector insert of FIG. 174 depicting an end effector insert engaging an end effector of a surgical instrument. FIG. 174 is an elevational view of the end effector insert of FIG. 174 positioned within an end effector of a surgical instrument. FIG. FIG. 3 is a partial perspective view of an embodiment of a staple cartridge assembly including a staple cartridge layer and an anvil attachable layer positioned relative to the staple cartridge. FIG. 181 is a partial perspective view of the staple cartridge assembly of FIG. 181 with an anvil attachable layer fastened to the staple cartridge. A staple cartridge layer positioned relative to the staple cartridge and an anvil attachable layer, wherein the proximal end portion of the anvil attachable layer is attached to an attachment feature of the staple cartridge by adhesive or welding, FIG. 6 is a partial perspective view of an embodiment of a staple cartridge assembly that shows a portion of the anvil attachable layer as being transparent. 188 is a partial perspective view of the staple cartridge assembly of FIG. 183 with the corners of the proximal end portion of the anvil-attachable layer cut away from the staple cartridge and shown raised; FIG. FIG. 6 is a partial perspective view of an embodiment of a staple cartridge assembly including a staple cartridge layer and an anvil attachable layer positioned relative to a staple cartridge, wherein the anvil attachable layer is attached to the staple cartridge layer. FIG. 186 is a detailed view of the staple cartridge of FIG. 185 and an anvil-attachable layer attached to the staple cartridge. FIG. 5 is a partial plan view of an embodiment of an anvil attachable layer. 187 is a partial plan view of the anvil-attachable layer of FIG. 187 cut by a cutting blade. FIG. 2 is a plan view of a sleeve tissue compensator according to at least one embodiment; FIG. FIG. 189 is a perspective view of the tissue compensator of FIG. 189. FIG. 189 is an elevation view of the tissue compensator of FIG. 189; It is a perspective view of a tissue thickness compensator. 192 is a perspective view of the tissue thickness compensator of FIG. 192 attached to a staple cartridge. FIG. 192 is a detailed view of one tissue thickness compensator of FIG. 192 at least partially overlapped with another tissue thickness compensator of FIG. FIG. 2 is a perspective view of a staple cartridge including a tissue thickness compensator attached to the staple cartridge. 196 is a detailed view of one tissue thickness compensator of FIG. 195 at least partially overlapped with another tissue thickness compensator of FIG. 195; 3 is an exploded view of a staple cartridge having a tissue thickness compensator including a plurality of layers. FIG. FIG. 197 is a cross-sectional view of the tissue thickness compensator of FIG. 197 embedded in one side of the patient tissue and another tissue thickness compensator of FIG. 197 embedded in the other side of the tissue. 1 is an exploded perspective view of an end effector of a stapling instrument comprising a staple cartridge and a tissue thickness compensator according to various embodiments. FIG. FIG. 199 is a cross-sectional view of the tissue thickness compensator in FIG. 199 according to various embodiments. 1 is a plan view of a tissue thickness compensator including a plurality of circular pieces according to various embodiments. FIG. 1 is a plan view of a tissue thickness compensator including a plurality of circular pieces according to various embodiments. FIG. FIG. 4 is a cross-sectional view of a tissue thickness compensator according to various embodiments. FIG. 6 is a plan view of a tissue thickness compensator according to various embodiments. FIG. 6 is a plan view of a tissue thickness compensator including a plurality of hexagonal pieces according to various embodiments. FIG. 6 is a plan view of a tissue thickness compensator including a plurality of pieces according to various embodiments. FIG. 6 is a plan view of a tissue thickness compensator including a plurality of slits according to various embodiments. 2 is an exploded view of a staple cartridge and layers according to at least one embodiment. FIG. 2 is a cross-sectional view of a layer and tissue T captured between a staple cartridge and an anvil according to at least one embodiment. FIG. FIG. 3 is a perspective view of a layer comprising a columnar anti-slip according to at least one embodiment. 207C is a cross-sectional view of the layer in FIG. 207C. It is a perspective view of a layer provided with the linear protrusion part by at least 1 embodiment. FIG. 209 is a cross-sectional view of the layer in FIG. 209. FIG. 6 is a perspective view of a layer comprising a dome-shaped protrusion according to at least one embodiment. FIG. 222 is a cross-sectional view of the layer in FIG. 211. FIG. 6 is a perspective view of a layer comprising a linear depression according to at least one embodiment. 213 is a cross-sectional view of the layers in FIG. 213. It is a perspective view of a layer provided with the linear protrusion part by at least 1 embodiment. 227 is a cross-sectional view of the layer in FIG. It is a perspective view of a layer provided with the linear protrusion part by at least 1 embodiment. FIG. 6 is a perspective view of a layer comprising a conical protrusion according to at least one embodiment. FIG. 6 is a perspective view of a layer comprising a pyramidal protrusion according to at least one embodiment. 219 is a cross-sectional view of the layers in FIG. 219 according to at least one embodiment. FIG. 3 is a perspective view of a layer according to at least one embodiment. 224 is a cross-sectional view of the layer in FIG. FIG. 6 is a perspective view of a layer comprising a recess according to at least one embodiment. 224 is a cross-sectional view of the layer in FIG. 223; FIG. 3 is a cross-sectional view of a layer T comprising a reduced thickness portion and tissue T captured between an anvil comprising a plurality of staple forming pockets and a staple cartridge according to at least one embodiment. FIG. 3 is a cross-sectional view of tissue T captured between a layer comprising a plurality of protrusions and an anvil comprising a plurality of staple forming pockets and a staple cartridge according to at least one embodiment. FIG. 6 is a perspective cross-sectional view of a tissue thickness compensator-like layer clamped to an anvil of an end effector of a surgical instrument according to at least one embodiment. 226 is a cross-sectional view of the layer of FIG. 225 clamped to the anvil. 226 is a cross-sectional view of the layer of FIG. FIG. 6 is a perspective view of an embodiment of a retainer used with a staple cartridge. 229 is a perspective view of a staple cartridge assembly including the retainer of FIG. 228 engaged with a staple cartridge and an anvil-attachable layer. 229 is a plan view of the staple cartridge assembly of FIG. 229; FIG. 229 is an end cross-sectional view of the staple cartridge assembly of FIG. 229 with the staple cartridge assembly inserted into the staple cartridge channel of the end effector and the end effector anvil positioned relative to the staple cartridge assembly; 234 is an end cross-sectional view of the staple cartridge assembly and end effector depicted in FIG. 231 with the anvil pressed against the anvil-attachable layer and retainer. 234 is an end cross-sectional view of the staple cartridge assembly and end effector depicted in FIG. 231 with the anvil lifted from the retainer and the attached anvil attachable layer removed from the retainer. 234 is a cross-sectional plan view of the end effector depicted in FIG. 231 with the anvil attachable layer attached to the anvil and the anvil and retainer removed. FIG. 3 is a perspective view of an embodiment of an anvil attachable layer according to at least one embodiment. FIG. 3 is a perspective view of an embodiment of an anvil attachable layer according to at least one embodiment. FIG. 3 is a perspective view of an embodiment of an anvil attachable layer according to at least one embodiment. FIG. 6 is a perspective view of an embodiment of an anvil attachable layer having a deployable attachment feature in a non-deployed configuration. 238 is a perspective view of the embodiment of the anvil-attachable layer of FIG. 238 with the deployable attachment features represented in a deployed configuration. 237 is a cross-sectional plan view of the anvil attachable layer of FIG. 238 positioned relative to the anvil of the end effector with the deployable attachment feature deployed in the slot of the anvil. FIG. 6 is a perspective view of an embodiment of an anvil attachable layer having a deployable attachment feature in a non-deployed configuration. 242 is a perspective view of the embodiment of the anvil-attachable layer of FIG. 241 in which the deployable attachment features are represented in a deployed configuration. 242 is a cross-sectional plan view of the anvil-attachable layer of FIG. 241 positioned relative to the anvil of the end effector with the deployable attachment feature deployed in the slot of the anvil. 2 is an exploded perspective view of an anvil and tissue thickness compensator according to at least one embodiment. FIG. FIG. 6 is a cross-sectional plan view of an anvil comprising a plurality of staple forming pockets and an anvil attachable layer, such as a tissue thickness compensator, comprising a plurality of capsules aligned with the forming pockets, according to at least one embodiment. FIG. 254 is a detailed view of the anvil attachable layer capsule of FIG. 245; 258 shows the anvil and anvil-attachable layer of FIG. 245 positioned on tissue stapled by staples from a staple cartridge positioned on the opposite side of the tissue. 247 illustrates the anvil of FIG. 245 moved in the direction of the staple cartridge of FIG. 247 and the staples partially fired from the staple cartridge. FIG. 10 is a cross-sectional view of an embodiment of an anvil attachable layer positioned relative to an anvil and patient tissue with staples of a staple cartridge fired through the anvil attachable layer and patient tissue. FIG. 10 is a cross-sectional view of an embodiment of an anvil attachable layer positioned relative to an anvil and patient tissue with staples of a staple cartridge fired through the anvil attachable layer and patient tissue. FIG. 7 shows a retainer assembly being inserted into a surgical instrument with an anvil and a staple cartridge channel, with a portion of the insertion tool removed for purposes of illustration. 262 illustrates the retainer assembly of FIG. 251 being inserted into a surgical instrument with a portion of the insertion tool removed for purposes of illustration. A staple cartridge in the staple cartridge channel and an anvil-attachable layer, such as a tissue thickness compensator, are moved relative to the retainer to engage the anvil and have been partially removed for purposes of illustration. FIG. 262 is a diagram showing the insertion tool of FIG. 262 illustrates the anvil-attachable layer and the insertion tool of FIG. 251 moved relative to the retainer to disengage the retainer from the staple cartridge and partially removed for purposes of illustration. An embodiment of a retainer engaged with a staple cartridge, wherein the anvil attachable layer has a deployable attachment feature engaged with the retainer, the retainer being positioned for insertion into the end effector. It is a perspective view. FIG. 260 is a perspective view of the retainer of FIG. 255. FIG. 256 is an elevational view of the retainer of FIG. 255. The retainer of FIG. 255, staple cartridge, and staple cartridge inserted into the end effector with the deployable attachment feature of the anvil attachable layer deployed and a portion of the anvil and anvil attachable layer removed for purposes of illustration. FIG. 6 is an elevational view of a layer to which an anvil can be attached. An anvil attachable layer containing a deployable attachment feature is disposed in the retainer and inserted into the end effector, with the retainer, the anvil attachable layer, and a portion of the anvil removed for illustrative purposes. FIG. 6 is an elevational view of an embodiment of the retainer. The retainer deploys the deployable attachment feature of the anvil attachable layer and the retainer, anvil attachable layer, and a portion of the anvil have been removed for purposes of illustration, and the retainer embodiment of FIG. FIG. The retainer, anvil attachable layer, and anvil embodiment of FIG. 259 in which the deployable attachment feature is not deployed and the retainer, anvil attachable layer, and a portion of the anvil have been removed for illustrative purposes. FIG. The retainer, anvil attachable layer of FIG. 259, wherein the deployable attachment feature is deployed into a slot in the anvil and the retainer, anvil attachable layer, and a portion of the anvil have been removed for purposes of illustration. FIG. 3 is a detailed elevation view of an embodiment of an anvil. FIG. 3 shows a tissue thickness compensator with a flowable attachment portion according to certain non-limiting embodiments. FIG. 6 illustrates a pressure sensitive adhesive laminate in an unstressed position aligned with a slot in a staple cartridge according to certain non-limiting embodiments. FIG. 264 illustrates the pressure sensitive adhesive laminate of FIG. 264 releasably attached to a staple cartridge according to certain non-limiting embodiments. FIG. 3 shows a tissue thickness compensator with a flowable attachment portion according to certain non-limiting embodiments. FIG. 6 illustrates a pressure sensitive adhesive laminate in an unstressed position aligned with staple cavities in a staple cartridge according to certain non-limiting embodiments. FIG. 268 shows the pressure sensitive adhesive laminate of FIG. 267 releasably attached to a staple cartridge according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 6 shows a pressure sensitive adhesive laminate with an adhesive tab portion according to certain non-limiting embodiments. FIG. 5 shows a pressure sensitive adhesive laminate with a tab for releasably attaching to an anvil according to certain non-limiting embodiments. FIG. 5 shows a pressure sensitive adhesive laminate with a tab for releasably attaching to an anvil according to certain non-limiting embodiments. FIG. 5 shows a pressure sensitive adhesive laminate with a tab for releasably attaching to an anvil according to certain non-limiting embodiments. FIG. 5 shows a pressure sensitive adhesive laminate with a tab for releasably attaching to an anvil according to certain non-limiting embodiments. FIG. 3 shows a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments. FIG. 3 shows a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments. FIG. 3 shows a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments. FIG. 3 shows a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments. FIG. 3 shows a pressure sensitive adhesive laminate releasably attached to an anvil using an applicator according to certain non-limiting embodiments. FIG. 3 illustrates a pressure sensitive adhesive laminate releasably attached to an anvil according to certain non-limiting embodiments. FIG. 3 illustrates a pressure sensitive adhesive laminate releasably attached to an anvil according to certain non-limiting embodiments. FIG. 3 illustrates a pressure sensitive adhesive laminate releasably attached to an anvil according to certain non-limiting embodiments. FIG. 3 illustrates a pressure sensitive adhesive laminate releasably attached to an anvil according to certain non-limiting embodiments. 1 is a perspective view of an end effector of a surgical stapling instrument including an implantable transition portion extending from an anvil and an implantable transition portion extending from a staple cartridge. FIG. FIG. 294 depicts tissue positioned between the anvil and staple cartridge of the surgical stapling instrument of FIG. 293;

  Similar numerals refer to similar parts throughout the several views. The illustrations set forth in this specification are intended to represent specific embodiments of the invention in one form, and such illustrations should be construed as limiting the scope of the invention in any way. is not.

The applicant of this application also has the right to file for the following US patent applications, the entire contents of which are hereby incorporated by reference:
US patent application Ser. No. 12 / 894,311 entitled “SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFFT SEGMENTS”, which is currently published US 2012/0080496;
‘SURGITAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WIth application No. 12 / No.
US patent application Ser. No. 12 / 894,327 entitled “JAW CLOSER ARRANGEMENTS FOR SURGICAL INSTRUMENTS”, which is currently published US 2012/0080499,
US patent application Ser. No. 12 / 894,351, entitled “SURGICAL COUNTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS 502”
US patent application Ser. No. 12 / 894,338 entitled “IMPLANTABLE FASTNER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT”, which is currently published US 2012/0080481,
US patent application Ser. No. 12 / 894,369 entitled “IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER”, which is currently published US 2012/0080344;
US patent application Ser. No. 12 / 894,312 entitled “IMPLANTABLE FASTNER CARTRIDGE COMPRISING MULTIPLE LAYERS”, which is currently published US 2012/0080479,
US patent application Ser. No. 12 / 894,377 entitled “SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE”, which is currently published US 2012/0080334;
US patent application Ser. No. 12 / 894,339 entitled “SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT”, which is now US Patent Application Publication No. 2012/0080500,
US patent application Ser. No. 12 / 894,360 entitled “SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAFORM FORMING SYSTEM”, which is currently published US 2012/0080484;
US patent application Ser. No. 12 / 894,322 entitled “SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPE CARTRIDGE ARRANGEMENTS”, which is currently published US 2012/0080501;
“SURGITAL STATURE CARTIDGES WITH DETACHABLE SUPPORT STRUCTURES AND US SURGICAL STAPPING INSTRUMENTS WITH SYSTEM SYSTEM FOR PREVENTING ACTIVATION” 0080478,
US patent application Ser. No. 12 / 894,383 entitled “IMPLANTABLE FASTNER CARTRIDGE COMPRISING BIO ABSORBABLE LAYERS”, which is currently published US 2012/0080345;
US patent application Ser. No. 12 / 894,389, entitled “COMPRESSABLE FASTNER CARTRIDGE”, which is currently published US 2012/0080335;
US patent application Ser. No. 12 / 894,345 entitled “FASTENERS SUPPORTED BY A FASTNER CARTRIDGE SUPPORT”, which is currently published US 2012/0080483;
US patent application Ser. No. 12 / 894,306 entitled “COLLAPSIBLE FASTENER CARTRIDGE”, which is currently published US 2012/0080332;
US patent application Ser. No. 12 / 894,318 entitled “FASTENER SYSTEM COMPRISING A PLULARITY OF CONNECTED RETENTION MATRIX ELEMENTS”, which is currently published US 2012/0080480,
US patent application Ser. No. 12 / 894,330 entitled “FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX”, which is currently published US 2012/0080503;
US patent application Ser. No. 12 / 894,361 entitled “FASTENER SYSTEM COMPRISING A RETENTION MATRIX”, which is currently published US 2012/0080333;
US patent application Ser. No. 12 / 894,367 entitled “FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX”, which is currently published US 2012/0080485,
US patent application Ser. No. 12 / 894,388 entitled “FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER”, which is currently published US 2012/0080487,
US patent application Ser. No. 12 / 894,376 entitled “FASTENER SYSTEM COMPRISING A PLULARITY OF FASTENER CARTRIDGES”, which is now US Patent Application Publication No. 2012/0080486,
US patent application Ser. No. 13 / 097,865 entitled “SURGICAL STAPLER ANVIL COMPRISING A PLULARITY OF FORMING POCKETS”, which is currently published US 2012/0080488,
US Patent Application No. 13 / 097,936 entitled “TISSUE TICHKNESS COMPENSATOR FOR A SURGICAL STAPLE”, which is currently published US Patent Application No. 2012/0080339,
US Patent Application No. 13 / 097,954, entitled “STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESIBLE PORTION”, which is currently published US 2012/0080340;
US Patent Application No. 13 / 097,856, entitled “STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITH A COMPRESIBLE PORTION THEREOF”, which is currently published US 2012/0080336,
US patent application Ser. No. 13 / 097,928 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS”, which is now US Patent Application Publication No. 2012/0080490,
US Patent Application No. 13 / 097,891, entitled “TISSUE TICHKNESS COMPENSATOR FOR A SURGICAL STAPLLER COMPRISING AN ADJUSTABLE ANVIL”, which is currently published US 2012/0080489,
US Patent Application No. 13 / 097,948, US Patent Application Publication No. 2012/0083836, entitled “STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISPORTATION”
US Patent Application No. 13 / 097,907 entitled “COMPRESSABLE STAPLE CARTRIDGE ASSEMBLY”, current US Patent Application Publication No. 2012/0080338,
US Patent Application No. 13 / 097,861, entitled “TISSUE THICKNESS COMPENSATOR COMPRISING PORATIONS HAVING DIFFERENT PROPERITES”, which is currently published US 2012/0080337;
U.S. Patent Application No. 13 / 097,869 entitled "STAPLE CARTRIDGE LOADING ASSEMBLY", now U.S. Patent Application Publication No. 2012/0160721,
US Patent Application No. 13 / 097,917 entitled “COMPRESSABLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS”, which is now US Patent Application Publication No. 2012/0083834,
US Patent Application No. 13 / 097,873 entitled “STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTITION”, which is now US Patent Application Publication No. 2012/0083833,
US Patent Application No. 13 / 097,938 entitled “STAPLE CARTRIDGE COMPRISING COMPRESIBLE DISTORTION RESISTANT COMPONENTS”, now US Patent Application Publication No. 2012/0080491,
US patent application Ser. No. 13 / 097,924, entitled “STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR”, which is currently published US 2012/0083835,
US Patent Application No. 13 / 242,029 entitled “SURGICAL STAPLER WITH FLOATING ANVIL”, which is now US Patent Application Publication No. 2012/0080493,
US Patent Application No. 13 / 242,066 entitled “CURVED END EFFECTOR FOR A STAPLING INSTRUMENT”, which is now US Patent Application Publication No. 2012/0080498,
US patent application Ser. No. 13 / 242,086 entitled “STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK”;
US patent application Ser. No. 13 / 241,912, entitled “STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT”;
US patent application Ser. No. 13 / 241,922, entitled “SURGICAL STAPLIER WITH STATIONARY STAPLE DRIVERS”,
US Patent Application No. 13 / 241,637, entitled “SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATION MULTIPLE ACTION MOTIONS”, now published US Patent Application No. 2012/0074201;
US Patent Application No. 13 / 241,629 entitled "SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULABLE END EFFECTOR", which is currently published US 2012/0074200;
US Patent Application No. 13 / 433,096 entitled “TISSUE THICKNESS COMPENSATOR COMPRISING A PLULARITY OF CAPSULES”, which is currently published US 2012/0241496,
US Patent Application No. 13 / 433,103 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING A PLULARITY OF LAYERS”, which is currently published US 2012/0241498,
US patent application Ser. No. 13 / 433,098 entitled “EXPANDABLE TISSUE TICHKNESS COMPENSATOR”, which is currently published US 2012/0241491;
US Patent Application No. 13 / 433,102 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING A RESERVOIR”, which is currently published US 2012/0241497,
US Patent Application No. 13 / 433,114 entitled “RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR”, which is now US Patent Application Publication No. 2012/0241499,
US patent application Ser. No. 12 / 433,136 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING AT Least ONE MEDIACAMENT”, which is currently published US 2012/0241492;
US Patent Application No. 13 / 433,141 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION”, which is currently published US 2012/0241493,
US Patent Application No. 13 / 433,144 entitled “TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD”, which is currently published US 2012/0241500,
US Patent Application No. 13 / 433,148 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD”, which is currently published US 2012/0241501,
US Patent Application No. 13 / 433,155 entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS”, which is currently published US 2012/0241502,
US Patent Application No. 13 / 433,163 entitled “METHODS FOR FORMING TISSUE TICHKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLES”, which is currently published US 2012/0248169,
U.S. Patent Application No. 13 / 433,167 entitled "TISSUE TICHKNESS COMPENSATORS", now U.S. Patent Application Publication No. 2012/0241503,
U.S. Patent Application No. 13 / 433,175 entitled "LAYERED TISSUE TICHKNESS COMPENSATOR", now U.S. Patent Application Publication No. 2012/0253298,
US Patent Application No. 13 / 433,179 entitled “TISSUE TICHKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLES”, which is currently published US 2012/0241505,
US Patent Application No. 13 / 433,115 entitled “TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFING A LOW PRESURE ENVIRONMENT”;
US patent application Ser. No. 13 / 433,118 entitled “TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLULARITY OF MATERIALS”,
US Patent Application No. 13 / 433,135 entitled “MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR”;
US patent application Ser. No. 13 / 433,140 entitled “TISSUE TICHKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME”
US patent application Ser. No. 13 / 433,147 entitled “TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS”,
US patent application Ser. No. 13 / 433,126, entitled “TISSUE TICHKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES”;
U.S. Application No. 13 / 433,132 entitled "DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS 13 U.S. .

The applicant of this application also has the right to file for the following US patent applications, the entire contents of which are hereby incorporated by reference:
US Patent Application No. 11 / 216,562 entitled “STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS”, now US Pat. No. 7,669,746,
US Patent Application No. 11 / 714,049 entitled “SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS”, now published US Patent Application No. 2007/0194082;
US patent application Ser. No. 11 / 711,979 entitled “SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS”, now US Pat. No. 8,317,070;
US patent application Ser. No. 11 / 711,975 entitled “SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT”, which is currently published US 2007/0194079;
US patent application Ser. No. 11 / 711,977 entitled “SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIIPLE WIRED DIAMETER STAPLES”, which is currently patent 7,673,781;
US patent application Ser. No. 11 / 712,315 entitled “SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS”, now US Pat. No. 7,500,979;
US patent application Ser. No. 12 / 038,939 entitled “STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS”, now US Pat. No. 7,934,630;
US Patent Application No. 13 / 020,263 entitled “SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS”, which is currently published US 2011/0147434,
US Patent Application No. 13 / 118,278, entitled “ROBOTICALLY-CONTROL SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS”, currently published US patent application No. 2011/029085
US Patent Application No. 13 / 369,629 entitled “ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS”, which is currently published US 2012/0138660,
US Patent Application No. 12 / 695,359, entitled “SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS”, and US Patent Application Publication Nos. 2010/0127042 US Patent Application No. 13 / 072,923, entitled “STAPLE HEIGHTS”, current US Patent Application Publication No. 2011/0174863.

Applicants also have the rights to file the following US patent applications filed on the same day as the present application, each of which is incorporated herein by reference in its entirety:
U.S. Patent Application No. ________________________________________________________ representative (Attorney Docket No. END7104USCIP1 / 110606CIP1), “SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES”
U.S. Patent Application No. ___________ (Attorney Docket No. END6843USCIP19 / 100528CP19) entitled "ADHEESIVE FILM LAMIDATE";
US Patent Application No. _________ (Attorney Docket No. END6848USCIP2 / 10053CIP2) entitled "ACTUTOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTNER CARTRIDGE",
US Patent Application __________ (Attorney Docket No. END6848USCIP3 / 100533CIP3) entitled "RELEASABLE TISSUE TICHKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME",
US patent application __________________________________________ (Attorney Docket No. END6848USCIP4 / 100533CIP4), “FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR”
US Patent Application No. _________ (Attorney Docket Number END6848USCIP5 / 100533) entitled “FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE TICHKNESS COMPENSATOR”
US Patent Application No. __________ (Attorney Docket No. END6848USCIP6 / 100533CIP6), entitled “FASTENER CARTRIDGE COMPRISING A RELEASABLE ATTACHED TISSUE THICKNESS COMPENSATOR”,
US patent application ______________________________________________________ (Attorney docket number END7201USNP / 120294), entitled "STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER",
US Patent Application No. _________ (Attorney Docket No. END7102USCIP2 / 110604CIP2) entitled "ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR";
US Patent Application No. _________ (Attorney Docket No. END7102USCIP3 / 110604CIP3) entitled "LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS";
US Patent Application No. ___________ (Attorney Docket No. END6232USCIP1 / 070348CIP1) entitled "LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES",
US Patent Application No. _________ (Attorney Docket No. END 6232 USCIP2 / 070348CIP2) entitled “IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”
US Patent Application No. __________ (Attorney Docket No. END6840USCIP2 / 100525CIP2) entitled "MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES",
US Patent Application No. __________ (Attorney Docket No. END6232USCIP3 / 070348CIP3) entitled "RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME"
_________________________________________________________________________________________________ (_ (PAT) and STRIPG _ ______________________________________________________________________________ (_ (_ () (STIPG) Agent reference number END7200USNP / 120302).

  Certain exemplary embodiments are described below to provide a general understanding of the principles of structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. The devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the various embodiments of the present invention is defined by the claims. It will be understood by those skilled in the art that only The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

  Throughout this specification, references such as “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment” are the specifics described in connection with that embodiment. Of features, structures, or characteristics are included in at least one embodiment. Thus, throughout the specification, phrases such as “in various embodiments”, “in some embodiments”, “in one embodiment”, or “in an embodiment” appear, These are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the specific features, structures, or characteristics illustrated or described with respect to one embodiment are not limited, and may be in whole or in part with the features, structures, or characteristics of one or more other embodiments. Or may be combined. Such modifications and variations are intended to be included within the scope of the present invention.

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

  Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgery. However, one of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein can be used in a number of surgical procedures and applications, including, for example, in connection with open surgery. Like. As reading this “Mode for Carrying Out the Invention”, the various instruments disclosed herein may be used in any way, such as through natural holes or through incision holes or puncture holes formed in tissue. It will be further understood by those skilled in the art that can be inserted into the body. The working or end effector portions of these instruments can be inserted directly into the patient's body or inserted through an access device having a working channel capable of passing the end effector and elongated shaft of the surgical instrument. obtain.

  In FIGS. 1 and 2, the surgical stapling and cutting instrument 8010 can include an anvil 8014 that can be repeatedly opened and closed around a pivotable attachment to an elongated staple channel 8016. The stapling assembly 8012 can include an anvil 8014 and a channel 8016 that can be attached proximally to an elongate shaft 8018 that forms a tool portion 8022. When the stapling assembly 8012 is closed, or at least substantially closed, the tool portion 8022 can show a sufficiently small cross section suitable for inserting the stapling assembly 8012 from the trocar. In various embodiments, the assembly 8012 can be operated by a handle 8020 connected to the shaft 8018. The handle 8020 may comprise a user control device, such as a rotary knob 8030 that rotates the elongate shaft 8018 and staple loading assembly 8012 about the longitudinal axis of the shaft 8018, for example. A closure trigger 8026, which can pivot in front of the pistol grip 8036 about a closure trigger pin 8152 (FIG. 3) laterally engaged across the handle housing 8154, closes the staple loading assembly 8012. Can be pushed into. In various embodiments, as will be described in detail below, a closure release button 8038 is used to clamp release the closure trigger 8026 and open the staple loading assembly 8012 when the closure trigger 8026 is clamped. There can be outwardly on the handle 8020 so that the 8038 can be pushed in. A firing trigger 8034 that can be pivoted in front of the closure trigger 8026 can cause the staple loading assembly 8012 to simultaneously cut and staple the tissue clamped in the staple loading assembly. In various situations, the firing trigger 8034 may be used to reduce the amount of force that multiple firing strokes are required to be applied by the surgeon's hand per stroke, as described in detail below. May be used. In certain embodiments, the handle 8020 can include rotatable right and / or left indicator wheels 8040, 8041 (FIG. 3) that can indicate firing progress. By way of example, a full firing movement distance may require three full firing strokes of the firing trigger 8034, so the indicator wheels 8040, 8041 will rotate one third for each stroke of the firing trigger 8034. Can rotate up to. As will be described in detail below, the manual firing release lever 8042 can optionally retract the firing system before the full firing movement distance is complete, and the firing release lever 8042 can be If the firing system becomes stuck and / or fails, the surgeon or other clinician can retract the firing system.

  Referring to FIGS. 1 and 3, the elongate shaft 8018 is a longitudinally reciprocating closure that pivots the anvil 8014 toward the closed position of the anvil in response to the proximal push of the closure trigger 8026 of the handle 8020. An outer structure including a tube 8024 can be provided. The elongate channel 8018 may be connected to the handle 8020 by a frame 8028 (FIG. 3) that is internal to the closure tube 8024. Frame 8028 is rotationally engageable with handle 8020 so that rotation of rotation knob 8030 (FIG. 1) can rotate hand portion 8022. With particular reference to FIG. 3, the rotary knob 8030 can be comprised of two half-shells that can include one or more inward projections 8031, which are within the closure tube 8024. One or more elongated side openings 8070 can extend through and engage the frame 8028. As a result of the above, the rotary knob 8030 and the frame 8028 can rotate together or synchronously such that the rotational position of the knob 8030 determines the rotational position of the tool portion 8022. In various embodiments, the longitudinal length of the longer opening 8070 is sufficient to allow the longitudinal closing and opening of the closure tube 8024. With reference primarily to FIGS. 3 and 5 with respect to causing the closing action of the closing tube 8024, the upper portion 8160 of the closing trigger 8026 can push the closing yoke 8162 (FIG. 4) using the closing link 8164. The closure link 8164 is pivotally attached to the closure yoke 8162 by a closure yoke pin 8166 at its distal end and pivotally attached by a closure link pin 8168 at its proximal end. In various embodiments, the closure trigger 8026 can be pushed to the open position by a closure trigger tension spring 8246, which is connected proximally to the upper portion 8160 of the closure trigger 8026 and is connected to the right and left Are connected to a handle housing 8154 formed by the half shell portions 8156, 8158. The tension applied by the tension spring 8246 can be overcome by the closure force applied to the closure trigger 8026 to advance the yoke 8162, the closure link 8164, and the closure tube 8024 distally.

  When the closure trigger 8026 is actuated or depressed as described above, the closure release button 8038 allows the surgeon or other clinician to press the closure release button 8038 if desired, as well as the closure trigger 8026. And other surgical instruments can be positioned so that they can be returned to an inoperative state. In various embodiments, the closure release button 8038 can be connected to the locking arm 8172 by a central lateral pivot axis 8173 so that motion can be transmitted between the release button 8038 and the pivot locking arm 8172. Referring again to FIG. 3, the compression spring 8174 can bias the closure release button 8038 proximally, ie, clockwise about the central lateral pivot axis 8173 when viewed from the right, The upper portion 8160 of the trigger 8026 can include a proximal apex 8170 with a rear notch 8171. As the closure trigger 8026 is depressed, the pivoting locking arm 8172 may rest on the proximal apex 8170 and, of course, when the closure trigger 8026 reaches the fully depressed position, the rear notch The portion 8171 is under a pivotal locking arm 8172 that falls into the rear notch 8171 and locks against the rear notch 8171 under the push of the compression spring 8174. At this point, manual depression of the closure release button 8038 will cause the pivotal locking arm 8172 to rotate upward and out of the rear notch 8171, thereby unlocking the closure trigger 8026 and the closure trigger 8026 being Allow return to clamp release position of closure trigger.

  Once the closure trigger 8026 is clamped proximally, as described above, the firing trigger 8034 can be pulled toward the pistol grip 8036 to advance the firing rod 8032 distally from the handle 8020. In various embodiments, the firing trigger 8034 can pivot about a transverse firing trigger pin 8202 and engages the right and left half shells 8156, 8158 of the handle 8020. . The firing trigger 8034 can advance the coupled transmission firing mechanism 8150 when actuated. The coupled transmission firing mechanism 8150 is attached to the pistol grip 8036 of the handle 8020 on the one hand, and on the other hand to one of the links of the linked transmission firing mechanism 8150, for example, as described in detail below. The spring 8184 can be pushed to the rear unfired position. The spring 8184 can comprise a non-moving end 8186 connected to the housing 8154 and a moving end 8188 connected to the proximal end 8190 of the steel band 8192. The end 8194 disposed on the distal side of the steel band 8192 can be attached to an attachment feature 8195 on the forward link 8196a of the plurality of links 8196a-8196d forming the connecting rack 8200. The linkage rack 8200 can be flexible so that it can be easily retracted into the piston grip 8036 and the length of the handle 8020 can be minimized, plus a significant firing force can be applied to the firing rod. A straight rigid rack assembly may be formed that may transmit up to 8032 and / or through the firing rod 8032. As described in more detail below, firing trigger 8034 engages first link 8196a during first actuation of firing trigger 8034 and engages with second link 8196b during second actuation of firing trigger 8034. Combined with the third link 8196c during the third actuation of the firing trigger 8034 and with the fourth link 8196d during the fourth actuation of the firing trigger 8034. Each of these actuations may advance the linkage rack 8200 distally by an incremental amount. In various embodiments, in addition to the above, multiple strokes of the firing trigger 8034 can rotate the right and left indicator gauge wheels 8040, 8041 to indicate the distance the linkage rack 8200 has been advanced.

  Referring now to FIGS. 3 and 5, the anti-backup mechanism 8250 can prevent the combined tension / compression spring 8184 from retracting the linkage rack 8200 between firing strokes. In various embodiments, the coupling slide tube 8131 abuts the first link 8196a and connects to the firing rod 8032 to convey the firing motion. Firing rod 8032 exits the proximal end of frame 8028 and extends proximally through through hole 8408 in anti-backup plate 8266. The through-hole 8408 is dimensioned to slidably receive the firing rod 8032 when vertically aligned but to restrain when tilted. The lower tab attachment 8271 extends proximally from the lower lip of the proximal end of the frame 8028 that extends through the opening 8269 in the lower edge of the anti-backup plate 8266. The lower tab attachment 8271 attracts the lower portion of the anti-backup plate 8266 near the frame 8028 so that the anti-backup plate 8266 is vertical when the firing rod 8032 is advanced distally and the firing rod When the 8032 attempts to retract, it is allowed to enter the combined state and tilt back upward. The anti-retraction compression spring 8264 is constrained distally by the proximal end of the frame 8028 and abuts the top of the anti-backup plate 8266 proximally to bias the anti-backup plate 8266 to a locked state. The anti-backup cam tube 8268 slidably surrounds the coupling sliding tube 8131 and abuts against the anti-backup plate 8266 against the spring bias. A proximally protruding anti-backup yoke 8256 attached to the anti-backup cam tube 8268 extends over the closure yoke 8162.

  Referring to FIG. 3, a link trigger automatic retraction mechanism 8289 is incorporated into the surgical stapling and cutting instrument 8010 to retract the knife at the end of the full firing distance. Thus, the distal link 8196d includes a tongue 8290 that protrudes upward when the distal link 8196d is advanced into a rack channel 8291 (FIG. 3) formed in the closure yoke 8162. This tongue 8290 is aligned to actuate the lower proximal cam 8292 on the anti-backup release lever 8248 (FIG. 6). With particular reference to FIG. 6, the structures formed in the right and left half shells 8156, 8158 constrain the movement of the anti-backup release lever 8248. A pin receiver 8296 and a circular pin 8293 formed between the right and left half shells 8156, 8158, respectively, are formed in an anti-backup release lever 8248 on the distal side of the lower proximal cam 8292. Receiving through the longitudinally elongated opening 8294, thus allowing rotation around the circular pin 8293 with longitudinal translation. In the right half shell 8156, the proximal open channel communicates with a portion that receives a rightward rearward pin 8297 near the proximal end of the anti-backup release lever 8248, angled upward and distally. Including a proximal horizontal portion, thus imparting an upward rotation as the anti-backup release lever 8248 reaches the most distal portion of translation of this lever. When the blocking structure formed in the right half shell 8156 proximal to the anti-backup release lever 8248 is assembled to maintain a right-facing rear pin 8297 in the proximal open channel, described below. Prevent the proximal movement of this anti-backup release lever.

  In addition to the above, and referring now to FIGS. 3 and 7, the distal end 8254 of the anti-backup release lever 8248 is thus pushed distally and downwardly, causing the right forward pin 8298 to move to the right half shell. The distal open step structure 8299 formed in the portion 8156 is dropped onto the anti-backup release lever 8248 between the right-facing forward pin 8298 and the longitudinally elongated opening 8294. The left spring hook 8301 is engaged by a compression spring 8300 (FIG. 3). The other end of the compression spring 8300 is attached to a hook 8302 (FIG. 6) formed in the right half shell 8156 at a more proximal and lower position just above the closure yoke 8266. The compression spring 8300 thus pulls the distal end 8254 of the anti-backup release lever 8248 downward and rearward so that when it is advanced distally, the right forward pin 8298 is moved to the distal open step. Locked into structure 8299. Thus, once removed, referring to FIG. 7, the anti-backup release lever 8248 stays forward with the anti-backup plate 8266 held vertically, thus retreating the connecting rack 8200. Can do. When the end effector 8012 clamp is released and the closure yoke 8266 is subsequently retracted, the upwardly protruding reset tongue 8303 on the closure yoke 8266 contacts the lower distal cam 8305 of the anti-backup release lever 8248. The anti-backup compression spring 8264 then moves the anti-backup cam tube 8268 and the anti-backup release lever 8248 closer to their retracted positions (FIG. 6) as the right forward pin 8298 is lifted out of the distal open step structure 8299. Can be pushed on the side.

  In various embodiments, referring to FIGS. 1-3, the firing trigger 8034 can be operatively engaged with the linkage rack 8200 in any suitable manner. With particular reference to FIGS. 2 and 3, the firing trigger 8034 pivots about a firing trigger pin 8202 connected to the housing 8154. The upper portion 8204 of the firing trigger 8034 moves distally around the firing trigger pin 8202 when the firing trigger 8034 is pushed toward the pistol grip 8036, and the upper portion 8204 of the firing trigger 8034 and the housing 8154 Stretch the proximally placed firing trigger tension spring 8206 (FIG. 3), connected proximally between. The upper portion 8204 of the firing trigger 8034 engages the connecting rack 8200 during each firing trigger push through a spring biased side pawl mechanism 8210. When the firing trigger is released, the side pawl mechanism is disengaged from the linkage rack 8200, and the firing trigger can be returned to the unfired position, ie, the unfired position. In use, in each of the links 8196a-8196d, the sloped right track formed by the slope 8284 facing the proximal side and the right side is engaged by the side pawl assembly 8285. In particular, the pawl slide 8270 (FIGS. 3 and 4) includes a left track 8274 (FIG. 3) formed in the closure yoke 8266 below the rack channel 8291 and a right in the closure yoke rail 8276 parallel to the rack channel 8291. A rack channel cover 8277 that has a right lower guide and a left lower guide 8272 that respectively slide on a track 8275 and that closes the right open portion of the rack channel 8291 in the closure yoke 8266 on the distal side of the pawl slide 8270 motion. Is attached. 3-5, compression spring 8278 is mounted between hook 8279 in the upper proximal position on closure yoke rail 8276 and hook 8280 on the distal right side of pawl slide 8270, which Pulls pawl slide 8270 proximally and keeps it in contact with upper portion 8204 of firing trigger 8034.

  With particular reference to FIG. 3, the pawl block 8318 sits on a pawl slide 8270 that pivots about a vertical rear pin 8320 that passes through the left proximal corner of the pawl block 8318 and pawl slide 8270. The kickout block recess 8322 receives a kickout block 8324 whose lower tip is pivotally pinned therein by a vertical pin 8326 that extends into the pawl spring recess 8328 on the upper surface of the pawl slide 8270. Therefore, it is formed at the distal portion of the upper surface of the block 8318. The pawl spring 8330 in the pawl spring recess 8328 extends to the right of the vertical forward pin 8326 that rotates clockwise when the pawl block 8318 is viewed from above and engages the inclined right track 8282. A small coil spring 8332 in the kickout block recess 8322 rotates the kickout block 8324 clockwise when viewed from above, and the proximal end of this kickout block is in the closure yoke 8266 above the rack channel 8291. It is made to contact with the formed uneven lip part 8334. As shown in FIG. 5, the more robust mechanical advantage of pawl spring 8330 over small coil spring 8332 is that pawl block 8318 tends to engage with a clockwise rotated kickout block 8324. means. In FIG. 3, when the firing trigger 8034 is fully depressed and begins to be released, the kickout block 8324 collides with the raised portion 8336 in the uneven lip 8334 as the pawl slide portion 8270 retracts and kicks out. Block 8324 is rotated clockwise as viewed from above, thereby releasing pawl block 8318 from engagement with linking rack 8200. The shape of the kickout block recess 8322 stops the clockwise rotation of the kickout block 8324 toward the direction perpendicular to the uneven lip 8334 that maintains this disengagement during full retraction, thereby Eliminate ratchet noise.

  3, 4, 8 and 12, the surgical stapling and cutting instrument 8010 performs a manual retraction for manual release of the firing mechanism, and in one version (FIGS. 13-15), automatic at the end of the full firing motion. A manual retraction mechanism 8500 can be included that further performs the retraction. Referring now to FIGS. 3 and 8, in particular, the front idler gear 8220 is engaged with the toothed upper left surface 8222 of the connecting rack 8200, which forward idler gear 8220 has a rear idler gear 8230 having a smaller right ratchet gear 8231. Are further engaged. Both the front idler gear 8220 and the rear idler gear 8230 are rotatably connected to the handle housing 8154 by a front idler shaft 8232 and a rear idler shaft 8234, respectively. Both ends of the rear shaft 8232 extend through the right housing half shell 8156 and the left housing half shell 8158, respectively, and are attached to the left and right indicator gauge wheels 8040, 8041. The rear shaft 8234 is connected to the handle housing 8154. The indicator gauge wheels 8040, 8041 rotate with the rear gear 8230 because it spins freely within and has a key engagement to the rear gear 8230. The gear mesh between the connecting rack 8200, the idler gear 8220, and the rear gear 8230 has a tooth dimension that the tooth-like upper surface 8222 is suitably sturdy so that the rear gear 8230 is fully fired of the connecting transmission firing mechanism 8150. May be advantageously selected so that only one rotation takes place during In addition to the gear mechanism 8502 that visually indicates firing distance or advancement, the gear mechanism 8502 can also be used to manually retract the knife. In various embodiments, the smaller right ratchet gear 8231 of the rear idler gear 8230 is a manually retracted lever 8042 specifically aligned with a vertically longitudinally aligned slot 8508 (FIG. 8) that branches off the hub 8506. Extends into the hub 8506. The lateral through hole 8510 of the hub 8506 communicates with the upper recess 8512. The anterior portion 8514 is shaped to receive a proximally directed locking pawl 8516 that pivots about a right-facing lateral pin 8518 formed at the distal end of the upper recess 8512. The rear portion 8520 is shaped to receive an L-shaped spring tab 8522 that urges the locking pawl 8516 downward to engage the smaller right ratchet gear 8231. The hold-up structure 8524 (FIG. 6) prevents the lock pawl 8516 from engaging the small right ratchet gear 8231 from the right half shell 8156 when the manual retract lever 8042 is lowered (FIG. 10). Project into the upper recess 8512. Coil spring 8525 (FIG. 3) pushes manual retraction lever 8042 downward.

  In use, as shown in FIGS. 9 and 10, the compression tension spring 8184 may become disconnected from the distally disposed linkage rack. 11 and 12, when the manual retraction lever 8042 is raised, the lock pawl 8516 rotates clockwise and is not obstructed by the hold-up structure 8524, engages the small right ratchet gear 8231, and plays backward. The gear 8230 is rotated clockwise as viewed from the left. Accordingly, the forward idle gear 8220 responds counterclockwise to retract the connecting rack 8200. In addition, a ridge 8510 that curves to the right protrudes from the hub 8506 and contacts the anti-retraction release lever 8248 to release the anti-retraction mechanism 8250 when the manual retraction lever 8042 is rotated, and the anti-retraction release lever. Is dimensioned to move distally.

  13-15, the automatic retraction mechanism 8600 for the surgical stapling and cutting instrument has a circular groove in the cam wheel 8606 until it hits an obstruction after a nearly complete rotation corresponding to three firing strokes. A forward idler gear 8220a having teeth 8602 that move within 8604 can incorporate automatic retraction at the end of the full firing distance. In such a situation, the right ridge 8610 is rotated upward to contact the lower cam recess 8612 to move the anti-backup release lever 8248a distally. With particular reference to FIG. 13, anti-backup release lever 8248a includes a distal end 8254 that operates as described above. Circular pins 8293 and pin receivers 8296 formed in the right and left half shells 8156 and 8158 have a generally rectangular opening 8294a formed in the anti-backup release lever 8248a behind the lower cam 8192. Received in this manner, thus allowing longitudinal translation and downward locking movement of the distal end 8254 of the anti-backup release lever 8248a. In the right half shell portion 8156, a channel that opens horizontally proximally receives a rightward rearward pin near the proximal end of the anti-backup release lever 8248a.

  During operation, prior to firing in FIGS. 13 and 14, the linkage rack 8200 and anti-backup cam tube 8268 are in the retracted position and the anti-backup mechanism 8250 when the anti-backup compression spring 8264 tilts the anti-backup plate 8266 proximally. Lock. The automatic retraction mechanism 8600 is in an initial state in which the anti-backup release lever 8248a is retracted using the link 8196a that is in contact with the front idler gear 8220a. The tooth 8602 is at the 6 o'clock position with the full distance of movement of the circular groove 8604 traveling in the counterclockwise direction of the tooth when the rightward ridge 8610 is just proximal to the tooth 8602. After the first firing stroke, the connecting rack 8200 brings the raised distal link 8196b into contact with the forward idler gear 8220a. The teeth 8602 are advanced one third of a turn in the circular groove 8604 of the stationary cam wheel 8606. After the second firing stroke, the connecting rack 8200 brings the raised distal link 8196c into contact with the forward idler gear 8220a. The teeth 8602 are advanced two-thirds of the rotation in the circular groove 8604 of the stationary cam wheel 8606. After the third firing stroke, the connecting rack 8200 brings the raised distal link 8196d into contact with the forward idler gear 8220a. The teeth 8602 rotate the circular groove 8604 one full turn to contact the above-mentioned obstacle and counterclockwise (when viewed from the right) of the cam wheel 8606 that contacts the right-facing ridge to the anti-backup release lever 8248a. Start spinning. In FIG. 15, the anti-backup release lever 8248a moves distally in response to locking to the step structure 8299 that opens the right-facing forward pin 8298 distally and releases the anti-backup mechanism 8250. A similar surgical stapling instrument is disclosed in US Pat. No. 7,083,075, issued August 1, 2006, the entire disclosure of which is incorporated herein by reference. It is.

  Referring to FIG. 16, the stapling assembly 9012 of the surgical stapling instrument 9010 is capable of clamping to tissue by two distinctly different movements transmitted longitudinally below the shaft 9016 relative to the shaft frame 9070. The function of driving the staples and the function of cutting the cells are realized. The shaft frame 9070 is attached proximally to the handle of the surgical stapling instrument and is coupled to the handle for rotation about the longitudinal axis. An exemplary multi-stroke handle for a surgical stapling and cutting instrument is co-pending and by the same applicant, "SURGICAL STAPLING INSTRUMENTING A MULTISTROKING FIRING POSITION AND CHANNEL AND RETRANSION US application" 10 / 374,026, the entire disclosure of which is hereby incorporated by reference. Another application consistent with the present invention is described in US patent application Ser. No. 10 / 441,632, co-pending and entitled “SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSEING AND FIRING SYSTEMS” by the same applicant. The entire disclosure of this U.S. patent application is incorporated herein by reference.

  With particular reference to FIG. 17, the distal end of the shaft frame 9070 is attached to the staple channel 9018. Anvil 9022 has a proximal pivot end 9072 pivotally received within a proximal end 9074 of staple channel 9018 that is just distal to engagement of the staple channel and shaft frame 9070. As the anvil 9022 is pivoted downward, the anvil 9022 moves the tissue contacting surface 9028 and the molding pocket 9026 toward the opposing staple cartridge, as detailed below. The pivot end 9072 of the anvil 9022 is proximal but is close to pivotal attachment with the staple channel 9018 but includes a closure mechanism 9076 on the distal side. Accordingly, the closure tube 9078, which includes a horseshoe-shaped opening 9080 whose distal end engages this closure mechanism 9076, is similar to that described above while sliding over the shaft frame 9070 in response to a closure trigger. An opening motion is selectively applied to the anvil 9022 during the lateral longitudinal motion and a closing motion is selectively applied to the anvil 9022 during the distal longitudinal motion of the closure tube 9078. The shaft frame 9070 surrounds a two-piece knife and firing bar 9090 that reciprocates in the longitudinal direction, and guides the firing movement from the handle through the knife and firing bar. In particular, the shaft frame 9070 includes a two-piece knife and a proximal portion of the firing bar 9090, specifically a longitudinal firing bar slot 9092 that receives a laminated tapered firing bar 9094. It will be appreciated that the laminated tapered firing bar 9094 may be replaced with a solid firing bar and / or other suitable material.

  The E-shaped beam 9102 is the distal portion of a two-piece knife and firing bar 9090 that facilitates separate closure and firing and also spaced the anvil 9022 from the elongated staple channel 9018 during firing. Make it easier to realize. With particular reference to FIGS. 17 and 19, in addition to any attachment process, such as brazing or adhesive, the knife and firing bar 9090 is a corresponding male attachment member represented distally by a laminated tapered firing bar 9094. It takes the form of a female vertical attachment opening 9104 formed proximally within the E-shaped beam 9102 that receives 9106, each part having a completely different function (eg, strength, flexibility, friction). Therefore, it is made to be formed with a suitable selected material and process. The E-shaped beam portion 9102 is formed of a material having suitable material characteristics for forming a pair of upper pins 9110, a pair of intermediate pins 9112, and a lower pin or foot portion 9114, and capable of obtaining a sharp cutting edge 9116. This may be advantageous. In addition, an integrally molded proximally projecting upper guide 9118 and intermediate guide 9120 that bracket each vertical end of the cutting edge 9116 guide tissue to the sharp cutting edge 9116 prior to cutting. An auxiliary tissue staging area 9122 is further defined. The intermediate guide 9120 engages the stapling instrument 9012 by abutting a stepped central member 9124 of a wedge-shaped thread 9126 (FIG. 20) for stapling by the stapling assembly 9012, as will be described in detail below. Further help to fire. Molding these features (e.g., upper pin 9110, middle pin 9112, and lower foot 9114) integrally with E-shaped beam portion 9102 is more stringent than each other when assembled from multiple parts. It is easy to achieve manufacturing with errors and ensures desirable operation during firing of the stapling assembly 9012 and / or effective interaction with various lockout features.

  21 and 22, the staple loading assembly 9012 is shown in an open state with the E-shaped beam 9102 fully retracted. During assembly, the lower foot portion 9114 of the E-shaped beam portion 9102 is dropped into the staple channel 9018 through the widened hole 9130, and the E-shaped beam portion 9102 is molded into the staple channel 9018. Advance along the lower track 9132 formed to slide distally. In particular, the lower track 9132 is widened on the lower surface of the stable channel 9018 to form an inverted T-shape in the transverse cross section that communicates with the widened hole 9130, particularly as shown in FIGS. A narrow slot 9133 that widens as a slot 9134. When assembled, the component proximally connected to the laminated tapered firing bar 9094 will move again proximally to the hole 9130 widened to allow the lower foot 9114 to disengage. not allowed. Referring to FIG. 24, a laminated tapered firing bar 9094 facilitates insertion of the staple loading assembly 9012 through the trocar. In particular, the more distal downward projection 9136 lifts the E-shaped beam 9102 when fully retracted. This is accomplished by the placement of the downward protrusion 9136 where the downward protrusion 9136 cams upward at the proximal edge of the widened hole 9130 in the staple channel 9018. Referring now to FIG. 25, the laminated tapered firing bar 9094 is incorporated into the staple channel 9018 by including a closer upward projection 9138 that is pushed downward by the shaft frame 9070 during the initial portion of the firing motion distance. Enhance the operation of certain lockout features that may be. In particular, the transverse bar 9140 is defined between a pair of rectangular openings 9142 in the shaft frame 9070 (FIG. 17). A clip spring 9144 wrapping the transverse bar 9140 pushes a portion of the laminated tapered firing bar 9094 projecting distally from the longitudinal firing bar slot 9092, which is a particular advantageous lockout feature. To be engaged when appropriate. This push is even more pronounced when the upward protrusion 9138 contacts the clip spring 9144 and is limited to only a portion of the firing movement distance.

  21 and 22, the E-beam 9102 is retracted by the E-beam upper pin 9110 within the anvil pocket 9150 near the pivoting proximal end of the anvil 9022. A downward-facing open vertical anvil slot 9152 (FIG. 16) enters an anvil interior track 9154 that captures the upper pin 9110 of the E-shaped beam 9102 that is advanced distally during firing, as shown in FIGS. Spreads laterally within the anvil 9022 and securely pulls the anvil 9022 away from the staple channel 9018. In this way, with the E-beam 9102 retracted, the surgeon can repeatedly open and close the stapling assembly 9012 until satisfied with the placement and orientation of the tissue captured therein for stapling and cutting. In addition, the E-shaped beam 9102 helps to properly position the tissue relative to the staple mounting assembly 9012 that has a small diameter and correspondingly reduced stiffness. In FIGS. 16, 17, 20, 21, 23, and 29, a staple loading assembly 9012 is shown with a replaceable staple cartridge 9020 that includes a wedge-shaped thread 9126. A plurality of vertically aligned parallel downward open wedge-shaped slots 9202 (FIG. 23) receive respective wedge-shaped portions 9204 integrated into the wedge-shaped thread 9126. 23-25, the wedge-shaped thread 9126 thus cams upwards to a plurality of staple drivers 9206 that are vertically slidable within the staple driver recess 9208. In this exemplary version, each staple driver 9206 includes two vertical projections that translate upward into staple holes 9210 or cavities 9024, respectively, to place the overlying staples 9023 on the staple forming surface 9214 of the anvil 9022 ( FIG. 25) is forced to push upward and deform. A central firing recess 9216 (FIG. 17) defined within the staple cartridge 9020 proximate the staple channel 9018, along with the lower horizontal portion 9218 (FIG. 20) of the wedge-shaped thread 9126, passes through the intermediate pin 9112 of the E-beam 9102. Forgive. Specifically, the staple cartridge tray 9220 (FIGS. 17 and 23) is attached to a polymeric staple cartridge body 9222 having staple driver recesses 9208, staple holes 9210, and a central firing recess 9216 formed therein. Underneath the polymer staple cartridge body. Since the staple 9023 is thus formed on either side, the sharp cutting edge 9116 enters a vertical through slot 9230 that passes through the longitudinal axis of the staple cartridge 9020 except for the farthest end.

  The firing of the stapling assembly 9012 was pulled proximally until the downward projection 9136 camped on the intermediate guide 9120 on the E-beam 9102 upward and rearward, as shown in FIG. Beginning with a two-piece knife and firing bar 9090, a new staple cartridge 9020 is inserted into the staple channel 9018 when the anvil 9022 is open as shown in FIGS. In FIG. 26, the two-piece knife and firing bar 9090 is advanced distally by a small distance and the downward projection 9136 is moved under the push of the clip spring 9144 against the upward projection 9138 of the laminated tapered firing bar 9094. Drop into the widened hole 9130 of the lower track 9132. The intermediate guide 9120 further prevents downward rotation by resting on the stepped central member 9124 of the wedge-shaped thread 9126, thus holding the intermediate pin 9112 of the E-shaped beam portion within the central firing recess 9216. . In FIG. 27, a two-piece knife and firing bar 9090 is clamped between the anvil 9022 and the staple cartridge 9020 at the same time as it is fired distally and advances the wedge-shaped thread 9126 to cause the formation of staples 9023. The tissue 9242 is cut using a sharp Hasaki 9116. Thereafter, in FIG. 28, the two-piece knife and firing bar 9090 is retracted, leaving the wedge-shaped thread 9126 positioned distally. In FIG. 29, the intermediate pin 9112 is adapted to translate downward into a lockout recess 9240 formed in the staple channel 9018 (see also FIGS. 22 and 25). In this way, the operator can use the intermediate pin when the wedge-shaped thread 9126 (not shown in FIG. 29) is not positioned proximally (ie, staple cartridge 9020 not reached or used staple cartridge 9020). A tactile indication will be received as 9112 impacts the distal edge of lockout recess 9240. A similar surgical stapling instrument is disclosed in US Pat. No. 7,380,696, issued June 3, 2008, the entire disclosure of which is incorporated herein by reference.

  In various embodiments, now referring to FIGS. 30-38, a surgical instrument 12000 includes a handle 12010, a shaft 12020 extending from the handle 12010, and an end effector 12040 removably attachable to the shaft 12020. Can do. The handle 12010 can include a trigger 12014 on the one hand to close the end effector 12040 and on the other hand to advance the firing member 12043 distally through the end effector 12040. Although not shown in FIGS. 30-38, the handle 12010 is any suitable drive configured to transmit the rotational motion of the trigger 12014 and translate it into linear motion of the firing member 12023 extending through the shaft 12010. A system can be included. In use, the trigger 12014 can be actuated toward the pistol grip 12012 of the handle 12010 to advance the firing member 12023 distally within the shaft 12020 along the longitudinal axis 12039, and more particularly As described below, when the shaft firing member 12023 is operatively coupled to the end effector firing member 12043, distal movement of the shaft firing member 12023 can be transmitted to the end effector firing member 12043. When the end effector firing member 12043 is advanced proximally, the end effector firing member 12043 engages the first jaw 12040a including the anvil and / or the second jaw 12040b including the staple cartridge channel. However, at least one of the first jaw 12040a and the second jaw 12040b may be configured to move toward the other. In addition to the above, referring primarily to FIGS. 30-32, the end effector 12040 can be assembled to the shaft 12010 in a direction across the longitudinal axis 12039. As an example, end effector 12040 can be assembled to shaft 12010 in a direction that is perpendicular to longitudinal axis 12039, for example. Under this circumstance, end effector 12040 is such that frame 12041 of end effector 12040 engages and connects to frame 12021, and proximal end 12044 of firing member 12043 is distal end 12024 of firing member 12023. Can be moved toward the shaft 12010 to engage and couple. The shaft frame 12021 can include a channel 12022 defined in the shaft frame that can be configured to slidably receive the shaft firing member 12023 and define a longitudinal axis 12039. To align the end effector frame 12041 with the shaft frame 12021, in various embodiments, the proximal end 12045 of the end effector frame 12041 and the distal end 12025 of the shaft frame 12021 are, for example, end relative to the shaft 12020. Cooperating dovetail features that can place the effector 12040 in the correct orientation can be included. The shaft frame 12021 can further include a mount opening 12026 that can be configured to receive a mount protrusion 12046 defined in the shaft frame that extends from the end effector frame 12041. As a result of cooperating dovetail and / or mounting features 12026, 12046 of the ends 12025, 12045, the end effector 12040 can be securely mounted to the shaft 12020 in various situations. In various embodiments, the surgical instrument 12000 can further comprise a lock ring 12030 that can be configured to lock the end effector 12040 to the shaft 12020. Referring now primarily to FIGS. 34-36, the lock ring 12030 can be moved between a unlocked position (FIGS. 34 and 35) and a locked position (FIG. 36). When the lock ring 12030 is in the unlocked position of this lock ring, referring to FIG. 34, the end effector 12040 can be attached to the shaft 12020. When the end effector 12040 engages the shaft 12020, the lock ring 12030 can be slid over the interconnection between the end effector 12040 and the shaft 12020 to lock the end effector 12040 in place. More specifically, in at least one embodiment, the lock ring 12030 can define an inner opening 12031 that can be configured to snugly receive the outer circumference of the end effector 12040 and the shaft 12020. In certain embodiments, the surgical instrument 12000 can comprise a spring or biasing member configured to bias the lock ring 12030 to the locked position of the lock ring. In such an embodiment, the clinician pulls the locking ring 12030 proximally against the biasing force of the spring, and then releases the locking ring 12030, causing the spring to lock the locking ring 12030 into the locking position of the locking ring. It can be made to return.

  Referring again to FIGS. 30-38 and primarily FIGS. 32 and 33, the surgical instrument 12000 can include an articulation joint 12050. The articulation joint 12050 may be configured to allow the distal portion of the end effector 12040 to pivot about an axis defined by the articulation joint 12050 in various embodiments. In such an embodiment, the end effector 12040 includes a proximal portion that is securely mounted on the shaft 12020 and a distal portion that can rotate relative to the proximal portion about the articulation joint 12050. Can do. In certain embodiments, surgical instrument 12000 can include a lock configured to engage and disengage end effector 12040. By way of example, the end effector 12040 can be pushed distally to lock the distal portion of the end effector 12040 in place and / or proximal to unlock the distal portion of the end effector 12040. An end effector lock portion 12047 that can be pulled to the side can be included. Surgical instrument 12000 can further include a lock actuator 12060 adjacent to handle 12010 that can be pulled proximally, for example, to pull end effector lock portion 12047 proximally. In such an embodiment, the lock actuator 12060 is operatively connected to the end effector lock portion 12047 or operably connected to the lock portion 12027 extending through the shaft 12020 that is operably connectable. Can be done. In at least one such embodiment, the proximal end 12048 of the end effector lock portion 12047 can be assembled to the distal end 12028 of the lock portion 12027 when the end effector 12040 is assembled to the shaft 12020. In at least one such embodiment, end effector lock portion 12047 can be assembled to lock portion 12027 at the same time as end effector firing member 12043 is assembled to shaft firing member 12023.

  In various embodiments, as described above, a staple cartridge can comprise a cartridge body that includes a plurality of staple cavities defined therein. The cartridge body can comprise a deck and an upper deck surface, and each staple cavity can define an opening in the deck surface. Similarly, as described above, staples can be positioned within each staple cavity such that the staples are stored within the cartridge body until the staples are released from the cartridge body. Before the staples are released from the cartridge body, in various embodiments, the staples can be contained within the cartridge body so that the staples do not protrude above the deck surface. Because the staples are located below the deck surface, in such embodiments, the staple damage and / or the possibility of premature contact with the target tissue can be reduced. In various situations, the staple is between an unfired position where the staple does not protrude from the cartridge body and a fired position where the staple emerges from the cartridge body and can contact an anvil positioned on the opposite side of the staple cartridge. Can be moved by. In various embodiments, the anvil, and / or the molding pocket defined within the anvil, is formed on the deck surface such that when the staple is deployed from the cartridge body, the staple is deformed to a predetermined shape height. It can be positioned a predetermined distance above. In some situations, the thickness of the tissue captured between the anvil and the staple cartridge may vary, so that thicker tissue may be captured within a particular staple. Thinner tissue may be trapped inside certain other staples. In any case, the clamping pressure or clamping force applied to the tissue by the staples may vary, for example, between the staples, or the staples at one end of the staple row and the other of the staple row. May vary between staples at one end. In certain circumstances, the gap between the anvil and the staple cartridge deck can be controlled such that the staples apply a certain minimum clamping pressure within each staple. However, in some such situations, there may still be significant fluctuations in clamping pressure within different staples.

  In use, in addition to the above, and referring primarily to FIG. 39, an anvil such as anvil 10060 can be moved to a closed position, for example, opposite the staple cartridge 10000. As will be described in detail below, the anvil 10060 can position tissue relative to the tissue thickness compensator 10020, and in various embodiments, for example, the tissue thickness compensator 10020 can be placed on the deck of the support portion 10010. The surface 10011 can be pressed. Once the anvil 10060 is properly positioned, the staple 10030 can be deployed as also shown in FIG. In various embodiments, as described above, the staple firing sled 10050 can be moved from the proximal end 10001 of the staple cartridge 10000 toward the distal end 10002, as shown in FIG. As the thread 10050 is advanced, the thread 10050 may contact the staple driver 10040 and lift the staple driver 10040 upward within the staple cavity 10012. In at least one embodiment, sled 10050 and staple driver 10040 each comprise one or more bevels or ramps that can cooperate to move staple driver 10040 upward from their unfired position. it can. In at least one such embodiment, each staple driver 10040 can comprise at least one inclined surface, and the sled 10050 is sled inclined as the sled 10050 is advanced distally within the staple cartridge. At least one or more inclined surfaces can be provided that can be configured such that the surface can slide under the driver inclined surface. As the staple drivers 10040 are lifted upward within the respective staple cavities 10012, the staple drivers 10040 may allow the staples 10030 to emerge from the staple cavities 10012 of these staples through openings in the staple deck 10011. Staple 10030 can be lifted upward (FIG. 41). During the example firing sequence, the sled 10050 can contact the first staple 10030 and begin to lift the first staple 10030 upward. As the sled 10050 advances further distally, the sled 10050 can begin to lift additional staples 10030 and other subsequent staples in turn. The sled 10050 can drive the staple 10030 upward such that the staple legs 10032 contact the opposing anvil, are deformed into the desired shape, and are ejected from the support portion 10010. In various situations, the sled 10050 can move several staples upward simultaneously as part of the firing sequence.

  49-54, each staple 10030 may be deformed such that a compression zone 1000039 is defined within each staple. By way of example, each staple 10030 can comprise a base 10031 and one or more legs 10032 extending from the base 10031, which when deformed, cooperate with the base 10031 to define an area. Within this region, tissue T and tissue thickness compensator 10020 can be captured. Within the compression zone 10030, the tissue thickness compensator 10020 can apply pressure to the tissue T and take different compression heights depending on the thickness of the tissue T in certain circumstances. In some situations, the tissue thickness compensator 10020 can elastically fill gaps or empty spaces that exist within the compression zone 10030 defined by the staples 10030.

  As described above, referring to FIG. 41, the staple legs 10032 of the staple 10030 can extend over the deck surface 10011 of the support portion 10010 when the staple 10030 is in the unfired position. In various embodiments, the tips of staple legs 10032 or other portions of staple legs 10032 pass through the upper tissue contacting surface 10021 of the tissue thickness compensator 10020 when the staples 10030 are in their unfired positions. It may not protrude. As the staple 10030 moves from these unfired positions to these fired positions, the tips of the staple legs can project through the tissue contacting surface. In various embodiments, the tip of staple leg 10032 can comprise a sharp tip that cuts through and penetrates tissue thickness compensator 10020. In certain embodiments, the tissue thickness compensator 10020 includes a plurality of openings that can be configured to receive the staple legs 10032 and cause the staple legs 10032 to slide relative to the tissue thickness compensator 10020. it can. In certain embodiments, the support portion 10010 can further comprise a plurality of guides 10013 (FIG. 41) extending from the deck surface 10011. The guide 10013 can be positioned adjacent to the staple cavity opening in the deck surface 10011 so that the staple legs 10032 can be at least partially supported by the guide 10013. In certain embodiments, the guide 10013 can be positioned at the proximal and / or distal end of the staple cavity opening. In various embodiments, the first guide 10013 can be positioned at the first end of each staple cavity opening, the second guide 10013 can be positioned at the second end of each staple cavity opening, Each first guide 10013 can support the first staple leg 10032 of the staple 10030, and each second guide 10013 can support the second staple leg 10032 of the staple. . In at least one embodiment, referring to FIG. 41, each guide 10013 can comprise a groove or slot, such as groove 10016, for example, in which the staple legs 10032 are slidably received. it can. In various embodiments, each guide 10013 can include a non-slip, a protrusion, and / or a sharpened portion that can extend from the deck surface 10011 and can extend into the tissue thickness compensator 10020. Can do. In at least one embodiment, as described in detail below, anti-slip, protrusions, and / or spikes can reduce relative movement between the tissue thickness compensator 10020 and the support portion 10010. In certain embodiments, the tips of the staple legs 10032 may be positioned within the guide 10013 when the staple 10030 is in their unfired position and do not extend over the top surface of the guide 10013. There is. In at least such embodiments, guide 10013 can define a guide height, and staples 10030 do not extend above the guide height when these staples are in their unfired positions. There is.

  In various embodiments, a tissue thickness compensator, such as tissue thickness compensator 10020, can be comprised of, for example, a single sheet material. In at least one embodiment, the tissue thickness compensator comprises one continuous sheet material that can cover the entire upper deck surface 10011 of the support portion 10010 or that can cover only a portion of the deck surface 10011. be able to. In certain embodiments, the sheet material can cover the staple cavity openings of the support portion 10010, while in other embodiments, the sheet material can be aligned or at least partially aligned with the staple cavity openings. An opening can be provided. In various embodiments, the tissue thickness compensator can be composed of multiple layers of material. In some embodiments, the tissue thickness compensator can comprise a compressible core and a wrap that encloses the compressible core.

  In various embodiments, the tissue thickness compensator can comprise a wrap that releasably holds the compressible core against the support portion 10010. In at least one such embodiment, the staple cartridge can further comprise a retainer clip that can be configured to prevent the wrap and compressible core from being removed from the support portion 10010 midway. In certain embodiments, as described above, the tissue thickness compensator can be removably attached to the support portion 10010 by staples 10030. More specifically, as also described above, the legs of staple 10030 can extend into tissue thickness compensator 10020 when staple 10030 is in the unfired position, resulting in tissue thickness compensator. 10020 can be held open to the support portion 10010. In at least one embodiment, the legs of the staples 10030 can contact the sidewalls of the respective staple cavities 10012 of these staples, and the staple 10030 and tissue, thanks to friction between the staple legs 10032 and the sidewalls. The thickness compensator 10020 can be held in place until the staple 10030 is deployed from the staple cartridge 10000. When the staple 10030 is deployed, the tissue thickness compensator 10020 can be captured inside the staple 10030 and pressed against the stapled tissue T. When the anvil is subsequently moved to the open position to release the tissue T, the support portion 10010 can be separated from the tissue thickness compensator 10020 that is anchored to the tissue. In certain embodiments, an adhesive can be utilized to removably press the tissue thickness compensator 10020 against the support portion 10010. In at least one embodiment, a two-component adhesive can be used, and in at least one embodiment, when the tissue thickness compensator 10020 presses against the deck surface 10011, the adhesive is activated and supports the tissue thickness compensator 10020. The first component of the adhesive can be placed on the deck surface 10011 so that the first component can contact the second component for releasable bonding to the portion 10010 and the second component of the adhesive. Can be placed in the tissue thickness compensator 10020. In various embodiments, other suitable means can be used to detachably press the tissue thickness compensator against the support portion of the staple cartridge.

  In various embodiments, in addition to the above, the sled 10050 can be advanced from the proximal end to the distal end to fully deploy all of the staples 10030 contained within the staple cartridge 10000. In at least one embodiment, referring now to FIG. 44, the sled 10050 is advanced distally within the longitudinal cavity within the support portion 10010 by the firing member of the surgical stapler, ie, the knife bar 10052. obtain. In use, the staple cartridge 10000 can be inserted into a staple cartridge channel in the jaws of the surgical stapler, and the firing member 10052 is advanced toward contact with the sled 10050, as shown in FIG. Can be made. As the sled 10050 is advanced distally by the firing member 10052, the sled 10050 can contact the nearest staple drive, or group of drives 10040, and from the cartridge body 10010 as described above. 10030 can be fired or released. As shown in FIG. 44, the firing member 10052 can further comprise a cutting edge 10053 that can be advanced distally through a knife slot in the support portion 10010 as the staple 10030 is fired. In various embodiments, a corresponding knife slot can extend through an anvil positioned on the opposite side of the staple cartridge 10000, and in at least one embodiment, the cutting edge 10053 is between the anvil and the support portion 10010. A tissue and tissue thickness compensator that extends and is positioned between the anvil and the support portion can be incised. In various situations, the sled 10050 can be advanced distally by the firing member 10052 until the sled 10050 reaches the distal end 10002 of the staple cartridge 10000. At this point, the firing member 10052 can be retracted proximally. In some embodiments, the sled 10050 can be retracted proximally with the firing member 10052, but in various embodiments, the sled 10050 can be retracted while the firing member 10052 is retracted. It can be left in the distal end 10002 of 10,000. When the firing member 10052 is fully retracted, the anvil can be reopened and the tissue thickness compensator 10020 can be removed from the support portion 10010, including the support portion 10010, of the used staple cartridge 10000. The remaining unimplanted portion can be removed from the staple cartridge channel 10070.

  After the used staple cartridge 10000 is removed from the staple cartridge channel, in addition to the above, a new staple cartridge 10000, or other suitable staple cartridge, can be inserted into the staple cartridge channel. In various embodiments, in addition to the above, the staple cartridge channel, firing member 10052, and / or staple cartridge 10000 can constitute a cooperating feature that is new, i.e., uncopied. The firing member 10052 can be prevented from being advanced distally more than once without the firing staple cartridge 10000 being positioned within the staple cartridge channel 10070. More particularly, as the firing member 10052 is advanced to contact the sled 10050 and when the sled 10050 is in its proximal unfired position, the support nose of the firing member 10052 is the firing member 10052. Is held in an upward position sufficient to prevent the lock or beam 10054 extending from the firing member 10052 from falling into a lock recess defined within the staple cartridge channel. Can be positioned in contact with and / or over the support ledge portion. Because lock 10054 does not fall into the lock recess, in such circumstances, lock 10054 may not abut the distal sidewall of the lock recess as firing member 10052 is advanced. As firing member 10052 pushes sled 10050 distally, firing member 10052 may be supported in an upward firing position of the firing member due to the support nose portion resting on the support ledge portion. As described above, when the firing member 10052 is retracted relative to the sled 10050, the firing member 10052 is moved from an upward position of the firing member because the support nose is no longer placed on the support ledge portion of the sled 10050. Can fall downwards. In at least one such embodiment, the surgical stapler can include a spring and / or other suitable biasing element that can be configured to bias the firing member 10052 to a downward position of the firing member. . Once the firing member 10052 is fully retracted, the firing member 10052 cannot be advanced distally through the used staple cartridge 10000 again. More particularly, the firing member 10052 is held by the sled 10050 above the firing member because the sled 10050 is left at the distal end of the staple cartridge 10000 at this point in the sequence of operations. I can't. In this manner, when the firing member 10052 is advanced again without replacing the staple cartridge, as described above, the locking beam 10054 re-advances the firing member 10052 distally toward the staple cartridge 10000. It will contact the side wall 10057 of the locking recess that prevents it from being moved. In other words, when the used staple cartridge 10000 is replaced with a new staple cartridge, the new staple cartridge holds the firing member 10052 in a position above the firing member and advances the firing member 10052 again distally. It would have a thread 10050 positioned proximally.

  As described above, the sled 10050 can be configured to move the staple driver 10040 between a first unfired position and a second fired position to release the staple 10030 from the support portion 10010. In various embodiments, the staple driver 10040 can be housed within the staple cavity 10012 after the staple 10030 is released from the support portion 10010. In certain embodiments, the support portion 10010 can comprise one or more retention features that can be configured to prevent the staple driver 10040 from being released or dropped from the staple cavity 10012. In various other embodiments, the sled 10050 can be configured to fire the staple driver 10040 from the support portion 10010 in the staple 10030. In at least one such embodiment, staple driver 10040 may be constructed from a bioabsorbable and / or biocompatible material such as, for example, Ultem. In certain embodiments, a staple driver can be attached to the staple 10030. In at least one such embodiment, a staple driver may be molded on and / or around the base of each staple 10030 such that the driver is integrally formed with the staple. Filed on September 29, 2006, “SURGICAL STAPLES HAVING COMPRESIBLE OR CRUSSHABLE MEMBERS FOR SECURING TISSUE THE CONTENTS AND THE STAPLING INSTRUMENTS FORDE11” The entirety of which is incorporated herein by reference.

  In various situations, in addition to the above, the compressible tissue thickness compensator can move, twist, and / or distort relative to the rigid support portion of the underlying staple cartridge. In various embodiments, the support portion of the staple cartridge, and / or other suitable portion, includes one or more features configured to limit relative movement between the tissue thickness compensator and the support portion. Can be provided. As described above, at least a portion of the staple 10030 can extend above the deck surface 10011 of the support portion 10010, and in certain circumstances, the lateral force applied to the tissue thickness compensator is the staple 10030, And / or may be subjected to resistance by, for example, a non-slip 10013 extending from the support portion 10010. In various situations, the staple 10030 may tilt and / or bend within the staple cavity 10012 while resisting lateral movement of the tissue thickness compensator, and in various embodiments, the staple cavity 10012. And the staple 10030 maintains a relative alignment between the leg 10032 of the staple 10030 and the forming pocket in the opposite anvil 10060 so that the staple 10000 is properly formed during the staple forming process. Can be sized and configured. In various embodiments, the staple 10030 and / or the anti-slip 10013 can be configured to prevent or at least limit lateral strain within the tissue thickness compensator 10020. In at least one such embodiment, the staple 10030 and / or the anti-slip 10013 can be, for example, a first, ie, tissue contacting, surface of the tissue thickness compensator relative to the second, ie, lower surface. It can be configured to stiffen or limit lateral and / or longitudinal movement. In various embodiments, the staple cartridge, and / or the staple cartridge channel in which the staple cartridge is positioned, may extend upward to limit lateral and / or longitudinal movement or distortion of the tissue thickness compensator. At least one possible strain minimizing member can be provided. The wrap that at least partially surrounds the tissue thickness compensator may prevent or at least limit lateral and / or longitudinal movement, or distortion, of the tissue thickness compensator, as described above.

  In various embodiments, the staple cartridge can comprise a plurality of staple cavities each storing a staple disposed therein, wherein the staple cavities can be arranged in a plurality of rows on the opposite side of the staple cartridge. The positioned anvil can include a plurality of molding pockets corresponding to staple cavities in the staple cartridge. In other words, the anvil may comprise a plurality of forming pocket rows, each forming pocket being positioned in the staple cartridge opposite the staple cavity. In various embodiments, each molding pocket can comprise two molding cups configured to receive staple legs 10032 of staples 10030, each molding cup receiving, for example, staple legs 10032. The staple leg 10032 is configured to be shaped or rounded toward the other staple leg 10032. In various situations, the leg 10032 may not reach the molding cup or may not fit properly, so that the staple leg 10032 may become malformed during the firing sequence. In various embodiments described herein, the anvil can comprise an array or grid of molding pockets each configured to receive and mold the staple legs. In at least one such embodiment, the array of molding pockets can comprise more molding pockets than the number of staples contained within the staple cartridge. In at least one embodiment, the staple cartridge can comprise, for example, six rows of longitudinal rows of staple cavities, and the anvil includes six rows of molding pockets aligned with the six rows of staple cavities, plus molding. There may be a row of pockets and a molded pocket positioned between the rows. For example, on one side of the anvil, the anvil has a first row of molding pockets that can be positioned over the row of first staple cavities and a second staple adjacent to the row of first staple cavities. A second row of molding pockets that can be positioned over the cavities, and in addition, a row of molding pockets positioned between the first molding pocket row and the second molding pocket row. Can be provided.

  In various embodiments, as described above, the anvil can be moved from an open position to a closed position to press tissue against a tissue thickness compensator, eg, tissue thickness compensator 10020, of a staple cartridge. In various situations, the tissue thickness compensator can be positioned adjacent to the support portion of the staple cartridge before the tissue thickness compensator is positioned relative to the tissue. In certain embodiments, the tissue thickness compensator 10020 can be in a position where the tissue thickness compensator abuts the support portion 10018 before the anvil is moved to the closed position. In certain other embodiments, the tissue thickness compensator 10020 can be in a position where a gap exists between the tissue thickness compensator 10020 and the support portion 10018. In at least one such embodiment, the anvil can move the tissue and tissue thickness compensator 10020 downward until the tissue thickness compensator 10020 abuts the support portion 10018, at which point the anvil is It can be moved to the closed position of the anvil to provide compression inside the tissue. If the surgeon is not satisfied with the positioning of the tissue between the anvil and the staple cartridge, the surgeon can open the anvil, adjust the position of the anvil and staple cartridge, and close the anvil again. Due to such positioning and repositioning of the staple cartridge relative to the tissue, in various situations, for example, the distal end of the tissue thickness compensator 10020 can be removed from the support portion 10010. In some such situations, the distal end of the tissue thickness compensator 10020 can contact tissue and be detached from the support portion 10010 or can rotate relative to the support portion 10010. In various embodiments, the staple cartridge is configured to releasably hold the tissue thickness compensator relative to the underlying support portion of the staple cartridge, as described in detail below. Can be provided.

  In various embodiments, referring now to FIG. 55, a staple cartridge 10300 includes a support portion 10310, a tissue thickness compensator 10320 supported by the support portion 10310, and a distal end 10325 of the tissue thickness compensator 10320. And a distal end 10302 including a nose 10303 configured to releasably hold in place. In at least one embodiment, the nose portion 10303 can comprise a slot 10305 configured to receive the distal end 10325 of the tissue thickness compensator 10320. In various embodiments, the distal end 10325 is compressed within the slot 10305 so that the staple cartridge 10300 is positioned relative to the tissue so that the distal end 10325 can be held in place. Or can be wedged. In at least one such embodiment, the slot 10305 may be oriented in a direction that is parallel to or at least substantially parallel to the deck surface 10311 of the support portion 10310. In various embodiments, the slot 10305 can be horizontal to the deck surface 10311. In various other embodiments, referring now to FIG. 56, a staple cartridge 10400 includes a support portion, a tissue thickness compensator 10420 supported by the support portion, and a distal end 10425 of the tissue thickness compensator 10420. And a distal end 10402 that forms a nose portion 10403 that is configured to releasably hold in place. In at least one embodiment, the distal end 10425 can comprise a protrusion extending from the distal end, and the nose 10403 is configured to receive the protrusion of the distal end 10425. Vertical slots 10405 may be provided. In various embodiments, the distal end 10425, and / or the protrusion extending from the distal end, is positioned relative to the tissue so that the distal end 10425 is predetermined. It can be compressed inside the slot 10405 or wedged so that it can be held in position. In certain embodiments, the tissue thickness compensator 10420 can comprise a slot, such as slot 10429, that can be configured to receive at least a portion of the nose portion 10403 therein. In at least one embodiment, the slot 10405 may be oriented in a direction that is perpendicular to or at least substantially perpendicular to the deck surface 10411 of the support portion. In various embodiments, referring now to FIG. 57, a staple cartridge 10500 includes a support portion, a tissue thickness compensator 10520 supported by the support portion, and a distal end 10525 of the tissue thickness compensator 10520 as defined. And a distal end 10502 including a nose configured to releasably hold in position. In at least one embodiment, the nose portion can comprise a vertical slot 10505 configured to receive the distal end 10525 of the tissue thickness compensator 10520. In various embodiments, the distal end 10525 can be compressed within the slot 10505 so that the staple cartridge 10500 is positioned relative to the tissue so that the distal end 10525 can be held in place. Or it can be wedged.

  In various embodiments, referring again to FIG. 55, the tissue thickness compensator 10320 can comprise an upper surface 10324 that can be positioned above the upper surface 10304 of the nose portion 10303. Another exemplary embodiment in which the upper surface of the tissue thickness compensator is positioned above the nose portion of the staple cartridge is shown in FIG. 44, for example, the upper surface 10721 of the tissue thickness compensator 10720 is the upper surface of the nose portion 10003 Positioned above 10004. In use, referring again to FIG. 55, tissue can slide over the upper surface 10304 of the nose portion 10303, and in some situations, the tissue can be distal end portion 10325 of the tissue thickness compensator 10320. Force can be applied to the tissue thickness compensator 10320, which tends to peel off the tissue thickness compensator 10320 from the support portion 10310. In the embodiments described herein, this peel force can be resisted by a portion of the distal end 10325 that is wedged inside the nose 10303. In any event, once the tissue is properly positioned relative to the staple cartridge 13000, the anvil can be rotated to a closed position to press the tissue and tissue thickness compensator 10320 against the support portion 10310. In at least one such embodiment, the anvil can be rotated to a position where the anvil contacts the upper surface 10304 of the nose portion 10303 so that the anvil can be prevented from rotating further. In various situations, the top surface 10324 of the tissue thickness compensator 10320 is positioned above the top surface 10304 of the nose portion 10303 so that the top surface 10324 faces down toward the support portion 10310 as the anvil closes. In some circumstances, for example, the top surface 10324 may be pushed below the top surface 10304 of the nose portion 10303. After the staples contained within the staple cartridge 10300 have been deployed and the tissue thickness compensator 10320 has been cut, the support portion 10310 and the nose portion 10303 have a tissue thickness compensator 10320 as described herein. Can be moved away from the tissue thickness compensator 10320 so that its distal end 10325 can slide out of the slot 10305.

  As described above, for example, an anvil such as anvil 10060 may be rotated to a closed position where anvil 10060 contacts an upper nose surface 10004 of a staple cartridge such as staple cartridge 10000, for example. When the anvil reaches the closed position of the anvil, the amount by which the tissue thickness compensator, such as, for example, the tissue thickness compensator 10020, is compressed is, among other things, the uncompressed thickness or height of the tissue thickness compensator and the tissue thickness. Will depend on. 42 and 43, the tissue thickness compensator 10920 can comprise an upper surface that is coplanar or at least substantially coplanar with the upper surface 10004 of the nose portion 10003. In such an embodiment, the upper surface of the tissue thickness compensator 10920 can be pushed below the upper surface 10004 of the nose portion 10003. Referring now to FIGS. 47 and 48, a tissue thickness compensator, such as, for example, a tissue thickness compensator 10820, is below the nose top surface 10004 before the tissue thickness compensator 10820 is compressed by the tissue T and anvil 10060. An upper surface 10821 can be provided. As shown in FIGS. 45 and 46, in situations where the tissue T is relatively thin, the tissue thickness compensator 10920 may undergo relatively little compression. 47 and 48, the tissue thickness compensator 10820 may undergo significant compression when the tissue T is relatively thick. In situations where the tissue T has both thin and thicker sections, as shown in FIGS. 47 and 48, the tissue thickness compensator 10820 is positioned, for example, below the tissue T where the tissue thickness compensator When being done, it may be compressed by a greater amount and by a lesser amount when positioned under the thinner tissue T. Thus, as described above, the tissue thickness compensator can compensate for different tissue thicknesses.

  In various embodiments, referring now to FIGS. 58 and 59, the surgical stapling instrument includes a cartridge channel 16670 configured to receive a staple cartridge 16600 on one hand and a cartridge channel 16670 on the other hand. And an anvil 16660 that is pivotally connected. Staple cartridge 16600 can include a support portion 16610 and a tissue thickness compensator 16620, wherein the distal end 16625 of tissue thickness compensator 16620 is supported by a nose portion 16603 at the distal end 16602 of staple cartridge 16600. May be releasably retained relative to 16610. In at least one embodiment, the nose portion 16603 can include a slot 16605 and can be constructed of a flexible material. In use, referring primarily to FIG. 58, the nose portion 16603 can flex downward to expand the opening of the slot 16605. In certain embodiments, the nose portion 16603 can comprise a notch or cutout 16606 that can be configured to allow the nose portion 16603 to flex downward. In any case, in various situations, the expanded opening of slot 16605 facilitates the insertion of distal end 16625 of tissue thickness compensator 16620 into slot 16605. When the tissue thickness compensator 16620 is properly positioned, the nose portion 16603 can be opened and, due to the elasticity of the material that makes up the nose portion 16603, the nose portion 16603 is shown in FIG. The section can return to an undeflected state, or at least substantially return to capture the distal end 16625 of the tissue thickness compensator 16620 in contact with the deck surface 16611. In use, similar to the above, the distal end 16625 can be withdrawn from the slot 16605 when the support portion 16610 is released from the stapled tissue. In various situations, the flexible nose portion 16603 can be configured to distort as the tissue thickness compensator 16620 is pulled away from the support portion 16610. In various embodiments, referring again to FIG. 59, the tissue thickness compensator 16620 can comprise an upper surface 16621 that is aligned with or at least substantially aligned with the upper surface 16604 of the nose portion 16603. .

  In various embodiments, referring now to FIGS. 60-61, for example, a staple cartridge, such as staple cartridge 11400, can comprise a tissue thickness compensator 11420 removably attached to support portion 11410. In at least one embodiment, the staple cartridge 11400 can include one or more retainer bars 11413 that can be configured to hold the longitudinal side of the tissue thickness compensator 11420 against the deck surface 11411. In at least one such embodiment, each retainer bar 11413 can comprise an opposing arm 11418 that can define a channel 11416 in the middle. In such embodiments, one of the arms 11418 can be configured to extend over the tissue thickness compensator 11420 and the other arm 11418 can be a lip 11419 that extends from the support portion 11410. Can be configured to extend below. Referring primarily to FIG. 60, the channel 11416 of each retainer bar 11413 can be sized and configured to apply a compressive force to the longitudinal side of the tissue thickness compensator 11420 before the staple cartridge 11400 is used. In use, referring primarily to FIG. 61, the staple cartridge 11400 can be positioned within the staple cartridge channel, and once the staple cartridge 11400 is properly positioned, an anvil such as an anvil 11460, for example, The anvil can be moved to a position where the tissue thickness compensator 11420 can be compressed. Similar to the above, the tissue thickness compensator 11420 expands laterally or outwardly when compressed, so that the retainer bar 11413 can be removed from the staple cartridge 11400. In certain other embodiments, closing the anvil 11460 may not remove or completely remove the retainer bar 11413 from the staple cartridge. In at least one such embodiment, advancement of the firing bar through the staple cartridge 11400, as described above, can deploy the staple 10030 from the support portion 11410 while simultaneously laterally expanding the tissue thickness compensator 11420. And the anvil 11460 and staple cartridge 11400 can be pushed from both sides closer together to apply a sufficient compressive force to the tissue thickness compensator 11420 to remove the retainer bar 11413 from the staple cartridge 11400. When the retention bar 11413 is removed from the staple cartridge 11400, the support portion 11410 can be moved away from the implanted tissue thickness compensator 11420 and removed from the surgical site.

  In various embodiments, in addition to the above, the staple cartridge can comprise a plurality of fasteners configured to releasably hold the tissue thickness compensator relative to the support portion of the staple cartridge. In certain embodiments, the support portion can comprise, for example, a plurality of openings defined in the deck surface, and the fastener can extend through the tissue thickness compensator and within the support portion opening. Can be releasably held. In use, the fastener may be gradually released from the support portion as the staple is gradually fired from the support portion. In at least one such embodiment, the fastener can be implanted with a tissue thickness compensator, and in at least one embodiment, the fastener can be comprised of, for example, at least one bioabsorbable material. In certain embodiments, the fastener can be removed from the support portion after the tissue thickness compensator has been at least partially implanted and as the support member is released from the implanted tissue thickness compensator. In various embodiments, referring now to FIGS. 130-131, for example, a staple cartridge, such as staple cartridge 11600, has a tissue thickness compensator 11620 releasably mounted to support portion 11610 by a plurality of fasteners 11613. Can be provided. Each fastener 11613 is engaged with a support portion 11610 and a first end 11618 embedded within and / or otherwise engaged with the tissue thickness compensator 11620. A second end 11618 and a connector 11616 connecting the first end 11618 to the second end 11618 can be provided. In various embodiments, the fastener 11613 can extend through a knife slot 11615 defined in the support portion 11610. In use, firing member 10052 can move the knife edge through knife slot 11615 in support portion 11610 and can cut fastener 11613 to release tissue thickness compensator 11620 from support portion 11610. In at least one such embodiment, firing bar 10052, on the other hand, from support portion 11610, on the other hand, to advance sled 10050 distally and gradually fire staple 10030 as previously described. The fastener 11613 can be advanced from the proximal end of the staple cartridge 11600 to the distal end of the staple cartridge 11600 to gradually open and / or break the fastener 11613 to gradually open the tissue thickness compensator 11620. In certain embodiments, similar to the above, the tissue thickness compensator 11620 can include a plurality of removable segments, each of which can be held against the support portion 11610, for example, by one or more fasteners 11613. Can be provided. As shown in FIG. 130, when the firing member 10052 is stopped midway between the proximal and distal ends of the staple cartridge 11600, as shown in FIG. Once opened and the support portion 11610 is released from the tissue T, the fastener 11613 can help hold the unimplanted portion of the tissue thickness compensator 11620 against the support portion 11610. In various embodiments, in addition to the above, the cutting edge 10053 of the firing member 10052 can be configured to incise and / or break the fastener 11613.

  In various embodiments, referring now to FIG. 132, a staple cartridge can include a tissue thickness compensator, such as a tissue thickness compensator 15120, which can include multiple portions having different thicknesses, for example. it can. In at least one embodiment, the tissue thickness compensator 15120 can have a first or inner portion 15122a that can have a first thickness and a second thickness, respectively, and a first portion. 15122a extending from 15122a, each having a second or intermediate portion 15122b, which can have a second thickness, and each extending from a second portion 15122b, each having a third thickness. A third or intermediate portion 15122c that can be provided. In at least one such embodiment, for example, the third thickness may be greater than the second thickness, the second thickness may be greater than the first thickness, but other suitable Various thicknesses may be utilized in various other embodiments. In various embodiments, portions 15122a-15122c of tissue thickness compensator 15120 can comprise steps having different thicknesses. In at least one embodiment, similar to the above, the staple cartridge includes a plurality of rows of staples 10030 and a plurality of staple drivers having different heights that can deform the staples 10030 to different molding heights. it can. Further, similar to the above, the staple cartridge has a first staple driver 15140a capable of driving the staple 10030 supported thereon to a first molding height, and a second staple 10030 supported thereon. A second staple driver 15140b that can be driven to a third forming height and a third staple driver 15140c that can drive the staple 10030 supported thereon to a third forming height. For example, the first molding height can be shorter than the second molding height, and the second molding height can be shorter than the third molding height. In various embodiments, as shown in FIG. 132, each staple 10030 can comprise the same or substantially the same unformed or unfired height. In certain other embodiments, referring now to FIG. 133, the first driver 15140a, the second driver 15140b, and / or the third driver 15140c support staples having different unformed heights. Can do. In at least one such embodiment, the first staple driver 15140a can support a staple 15130a having a first unformed height, and the second staple driver 15140b can be a second unformed height. A third staple driver 15140c can support a staple 15130c having a third unformed height, for example, the first unformed height can be The second unshaped height can be shorter than the second unshaped height, and the second unshaped height can be shorter than the third unshaped height. In various embodiments, referring again to FIG. 133, the tips of staples 15130a, 15130b, and / or 15130c can be coplanar, or at least substantially, while others In this embodiment, the tips of the staples 15130a, 15130b, and / or 15130c may not be coplanar.

  In certain embodiments, referring now to FIG. 154, as described above, the staple cartridge can be embedded into tissue T with staples 15130a, 15130b, and 15130c, and have multiple portions having different thicknesses. A tissue thickness compensator 15220 can be included. In at least one embodiment, referring now to FIG. 155, the staples 15130a, 15130b, and / or 15130c can be deformed to different molding heights, and the first staple 15130a is at the first molding height. The second staple 15130b can be deformed to a second forming height and the third staple 15130c can be deformed to a third forming height, for example, the first staple 15130b can be deformed. The molding height can be shorter than the second molding height, and the second molding height can be shorter than the third molding height. Other embodiments are contemplated in which staples 15130a, 15130b, and 15130c may be formed to other suitable forming heights and / or other relative forming heights.

  As described above and with reference to FIG. 134, for example, a staple cartridge, such as staple cartridge 10000, can include a support portion 10010 and a tissue thickness compensator 10020, wherein the plurality of staples 10030 are at least on the support portion 10010. Partially retracted and can extend into the tissue thickness compensator 10020 when the staple 10030 is in these unfired positions. In various embodiments, the tips of the staples 10030 do not protrude from the tissue thickness compensator 10020 when the staples 10030 are in their unfired positions. As described above, as the staple 10030 is moved from the unfired position to the fired position by the staple driver 10040, the tip of the staple 10030 penetrates the tissue thickness compensator 10020 and / or penetrates the upper layer or epidermis 10022. can do. In certain alternative embodiments, when the staples 10030 are in their unfired position, the tips of the staples 10030 can project through the upper surface of the tissue thickness compensator 10020 and / or the epidermis 10022. . In any event, since the staple 10030 extends outwardly from the support portion 10010 before being deployed, it can also be tilted and / or distorted relative to the support portion as described above. .

  In various embodiments, referring now to FIG. 140, a staple cartridge can comprise a tissue thickness compensator 13620 and, for example, an epidermis or top layer 13621. In at least one such embodiment, for example, one or more pledgets or retainers 13622 can be embedded within the skin 13621. In certain embodiments, each retainer 13622 may be configured to receive staple legs 13032 or staples 13030 therein when the staples 13030 are in their unfired positions, as shown in FIG. The above openings 13629 can be defined in each retainer. In use, in addition to the above, the staple legs 10032 can be used, for example, until the base 13031 of the staple 13030 contacts the tissue thickness compensator 13620 and presses at least a portion of the tissue thickness compensator 13620 against the lower surface of the pledget 13622. As the staples 13030 move from their unfired positions to their fired positions, they can slide through the openings 13629. In various embodiments, referring now to FIG. 135, the staple cartridge can comprise a tissue thickness compensator 13120 and, for example, an epidermis or top layer 13122. In at least one such embodiment, the tissue thickness compensator 13120 can be, for example, a conical ridge, protrusion, and / or protrusion that can extend upward from the upper surface 13121 of the tissue thickness compensator 13120. 13128 may be provided. Protrusion 13128 may be configured to receive and wrap the tips of staple legs 13032 of staples 13030 when staples 13030 are in their unfired positions, as shown in FIG. The upper layer 13122 can further comprise a conical ridge, protrusion, and / or protrusion 13129 that can be aligned with, or at least substantially aligned with, the protrusion 13128. In use, the staple legs 10032 can penetrate the protrusions 13128 and 13129 and emerge from the tissue thickness compensator 13120. In various embodiments, referring now to FIG. 139, a staple cartridge can comprise a tissue thickness compensator 13520 and, for example, an epidermis or top layer 13522. In at least one such embodiment, the epidermis 13522 comprises conical ridges, protrusions, and / or protrusions 13529 that can extend upward from the upper surface 13521 of the tissue thickness compensator 13520, for example. be able to. Similar to the above, the protrusion 13529 can be configured to receive and wrap the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as shown in FIG. 139. In use, the staple legs 10032 can penetrate the protrusion 13529 and emerge from the skin 13522.

  In various embodiments, referring now to FIG. 136, the staple cartridge can comprise a tissue thickness compensator 13220 and, for example, an epidermis or top layer 13222. In at least one such embodiment, the tissue thickness compensator 13220 can comprise a conical recess and / or recess 13128 that can extend downward, for example, to the upper surface 13221 of the tissue thickness compensator 13220. it can. In various embodiments, as shown in FIG. 136, the tips of the staple legs 13032 can extend through the recesses 13128 when the staples 13030 are in their unfired positions. In at least one embodiment, the upper layer 13222 can further comprise a conical depression and / or a recess 13229 that can be aligned with, or at least substantially aligned with, the recess 13228. In various embodiments, referring now to FIG. 137, a staple cartridge can comprise a tissue thickness compensator 13320 and, for example, an epidermis or top layer 13322. In at least one such embodiment, the epidermis 13320 can comprise a thick portion 13329 that can extend down into the upper surface 13321 of the tissue thickness compensator 13320. In various situations, as shown in FIG. 137, this thick portion 13329 can be configured to receive at least a portion of the staple legs 13032 of the staple 13030 when the staple 13030 is in the unfired position. In such an embodiment, the thick portion 13329 is stapled such that the legs 13032 are aligned or at least substantially aligned with the anvil staple forming pocket positioned opposite the tissue thickness compensator 13320. Legs 13032 can be held in place. In various embodiments, referring now to FIG. 138, the staple cartridge can comprise a tissue thickness compensator 13420 and, for example, an epidermis or top layer 13422. In at least one such embodiment, the epidermis 13422 can comprise a thick portion 13429 that can extend upward from the top surface 13421 of the tissue thickness compensator 13420. In various situations, this thick portion 13429 can be configured to receive at least a portion of the staple legs 13032 of the staple 13030 when the staple 13030 is in the unfired position, as shown in FIG. 138. In such an embodiment, the thick portion 13429 is stapled such that the legs 13032 are aligned or at least substantially aligned with the anvil staple forming pocket positioned opposite the tissue thickness compensator 13420. The leg 13032 can be held in place.

  In various embodiments, referring now to FIGS. 141 and 142, a staple cartridge can comprise a tissue thickness compensator 13720 and, for example, an epidermis or upper layer 13721. In at least one such embodiment, the tissue thickness compensator 13720 can be, for example, a pyramidal and / or stepped ridge, protrusion, and A projection 13728 may be provided. Protrusion 13728 may be configured to receive and wrap the tips of staple legs 13032 of staples 13030 when staples 13030 are in their unfired positions, as shown in FIG. Similarly, the upper layer 13721 can comprise pyramidal and / or stepped ridges, protrusions and / or protrusions 13729 that can be aligned or at least substantially aligned with the protrusions 13728. In various embodiments, the epidermis 13721 engages tissue positioned against the upper layer 13721, and the relative lateral direction between the tissue, the upper layer 13721, and / or the tips of the staple legs 13032 and One or more teeth 13727 may be further provided extending upwardly from the protrusion 13729 that may be configured to prevent or at least limit longitudinal movement. In use, the staple legs 13032 can penetrate the protrusions 13728 and 13729 and emerge from the tissue thickness compensator 13720 as the staples 13030 are moved from the unfired position of these staples to the fired position. In various embodiments, referring now to FIGS. 143 and 144, a staple cartridge can comprise a tissue thickness compensator 13820 and, for example, an epidermis or top layer 13821. In at least one such embodiment, the tissue thickness compensator 13820 can be, for example, a pyramid and / or stepped ridge, protrusion, and A protrusion 13828 can be provided. The protrusions 13828 can be configured to receive and wrap the tips of the staple legs 13032 of the staples 13030 when the staples 13030 are in their unfired positions, as shown in FIG. Similarly, the top layer 13821 can comprise pyramidal and / or stepped ridges, protrusions and / or protrusions 13829 that can be aligned or at least substantially aligned with the protrusions 13828. In various embodiments, the upper layer 13821 can be configured to prevent or at least limit relative lateral and / or longitudinal movement between the upper layer 13821 and the tissue thickness compensator 13820, for example. One or more teeth 13827 may also be provided that extend downward into the compensator 13820. In use, the staple legs 10032 can penetrate the protrusions 13828 and 13829 and emerge from the tissue thickness compensator 13820 as the staples 13030 are moved from the unfired position of these staples to the fired position.

  In various embodiments, referring now to FIG. 145, a staple cartridge can include a tissue thickness compensator, such as a tissue thickness compensator 13920, which can include, for example, a ridge 13923 and a valley 13924 defined therein. In at least one embodiment, a trough 13924 can be defined between the ridges 13923. In various embodiments, each ridge 13923 can comprise the same height, substantially the same height, or different heights. Similarly, each trough 13924 can have the same depth, substantially the same depth, or different depths. In various embodiments, the plurality of staples 13030 can be at least partially stored within the tissue thickness compensator 13920 such that the tips of the staples 13030 can be positioned within the heel 13923. In at least one such embodiment, the staple legs 13032 of the staples 13030 are, for example, tissue thickness compensator 13920 and / or tissue thickness when the staples 13030 are stored in their unfired positions. The epidermis or upper layer 13921 attached to the compensator 13920 may not protrude. In various embodiments, the ridge 13923 and / or the valley 13924 can extend laterally across the staple cartridge. In at least one such embodiment, the staple cartridge can comprise a longitudinal knife slot, with the ridge 13923 and the trough 13924 in a direction transverse to the knife slot and / or perpendicular to the knife slot. Can be extended. In various situations, the collar 13923 can be configured to hold the tips of the staple legs 13032 in place until the staples 13030 are moved from the unfired position of these staples to the fired position. In various embodiments, referring now to FIG. 146, the tissue thickness compensator and / or the epidermis covering the tissue thickness compensator can comprise longitudinal ridges and / or valleys. In at least one such embodiment, the tissue thickness compensator can comprise an upper surface defined by a ridge 14023 and a trough 14024, where the trough 14024 is defined between the ridge 14023, for example. obtain. In various embodiments, the tissue thickness compensator comprises an epidermis 14021 that can comprise a plurality of openings 14029 defined in the epidermis, each configured to receive a staple leg 13032. it can. In certain embodiments, the opening 14029 can be defined in the heel 14023 and the tip of the staple leg 13032 is positioned below the apex 14028 of the heel 14029 and is flush with the apex 14028. May be positioned and / or positioned above the apex 14028. In certain embodiments, in addition to or in lieu of the above, an opening 14029 can be defined in the valley 14024, for example. In certain embodiments, each opening may be surrounded or at least partially surrounded by a raised portion that may reinforce the epidermis and / or tissue thickness compensator surrounding the opening, for example. In any event, in addition to the above, the epidermis 14021 can be attached to the tissue thickness compensator in other suitable ways including, for example, using at least one adhesive.

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

  In various embodiments, referring now to FIGS. 149-151, the disposable filling unit 12900 includes a lower portion 12922 that can be removably attached to the support portion 12610 and an upper portion 12990 that can be removably attached to the anvil 12560. And a flexible joint 12991 connecting the lower portion 12922 and the upper portion 12990 can be provided. Similar to the above, the longitudinal retention rail 12825 has a knife slot defined downwardly from the lower portion 12922 and within the support portion 12610 such that the lower portion 12922 can be releasably retained relative to the support portion 12610. Can extend into 12615. Similarly, the longitudinal retention rail 12995 extends upward from the upper portion 12990 and into a knife slot defined within the anvil 12560 such that the upper portion 12990 can be releasably retained relative to the anvil 12560. be able to. As shown in FIGS. 150 and 151, the tissue thickness compensator 12620 can be implemented in the lower portion 12922 of the loading assembly to position the tissue thickness compensator 12620 relative to the support portion 12610. The physician can deflect the upper portion 12990 and the lower portion 12922 toward each other, position the loading assembly between the anvil 12560 and the support portion 12610, the elastic expansion of the loading assembly, The flexed loading assembly can also be released so that portion 12990 can be biased against anvil 12560 and lower portion 12922 can be biased against support portion 12610.

  In various embodiments, referring now to FIG. 152, for example, a staple cartridge, such as staple cartridge 14900, includes a support portion 14910 and, in addition, a tissue thickness compensator 14920 positioned against the support portion 14910. Can be provided. Similar to the above, support portion 14910 moves staples, eg, staple 10030, at least partially positioned within support portion 14910 toward an anvil such as anvil 10060 positioned on the opposite side of staple cartridge 14900. For lifting, a staple driver can be provided that can be lifted upward by a staple deployment thread. In certain embodiments, the support portion 14910 includes, for example, two rows of outer staple cavities, two rows of inner staple cavities, and two rows positioned midway between the inner and outer rows. There may be six rows of staple cavities, such as rows of intermediate staple cavities, and the anvil 10060 may comprise six rows of molding pockets 10062 aligned or at least substantially aligned with the staple cavities. it can. In various embodiments, the rows of inner staple cavities can include staple drivers 14940a positioned therein, the rows of intermediate staple cavities can include staple drivers 14940b positioned therein, and The rows of outer staple cavities can include staple drivers 14940c positioned therein, and each of the staple drivers 14940a can include a cradle 14949a configured to support staples 10030, the staple drivers Each of 14940b can include a cradle 14949b configured to support staples 10030, and each of the staple drivers 14940c can be a cradle 14949c configured to support staples 10030. It can be included. In these unfired positions, i.e., when the staple drivers 14940a-14940c are seated on a driver support pedestal 14926 extending below the support portion 14910, the pedestal 14949a of the staple driver 14940a is received by the staple driver 14940b. It can be positioned closer to the anvil 10060 than the platform 14949b and the platform 14949c of the staple driver 14940c. In such a position, a first molding distance can be defined between the cradle 14949a and a molding pocket 10062 positioned over the cradle 14949a, and a second molding distance can be defined as the cradle 14949b. And a molding pocket 10062 positioned on the cradle 14949b, and a third molding distance can be defined between the cradle 14949c and the molding pocket 10062 disposed on the cradle 14949c. In various embodiments, for example, the first forming distance can be shorter than the second forming distance, and the second forming distance can be shorter than the third forming distance. be able to. As the staple drivers 14940a-14940c are moved from their unfired positions (FIG. 152) to their fired positions, each staple driver 14940a-14940c causes the first driver 14940a to move its respective staple 10030 to a first forming height. Staples so that the second driver 14940b drives each staple 10030 to a second forming height and the third driver 14940c drives each staple 10030 to a third forming height. The unfolding thread can be moved upward by an equal distance, or at least substantially the same distance, toward the anvil 10060, for example, the first molding height can be shorter than the second molding height, The molding height of 2 may be shorter than the third molding height. Kill. The first staple driver 14940a is moved upward by a first distance, the second staple driver 14940b is moved upward by a second distance, and the third staple driver 14940c is upward by a third distance. Various other embodiments are contemplated that may be moved and that one or more of the first distance, the second distance, and the third distance may be different.

  In various embodiments, referring again to FIG. 152, the deck surface 14911 of the support portion 14910 can vary in height with respect to the tissue contacting surface 10061 of the anvil 10060. In certain embodiments, this height variation may occur laterally, and in at least one embodiment, for example, the height of the deck surface 14911 that surrounds the rows of inner stable cavities is greater than the rows of outer staple cavities. Can be higher than the height of the deck surface 14911 that surrounds. In various embodiments, the lower surface 14922 of the tissue thickness compensator 14920 can be configured to be parallel or at least substantially parallel to the deck surface 14911 of the support portion 14910. In addition to the above, the tissue thickness compensator 14920 can also vary in thickness, and in at least one embodiment, the upper or tissue contacting surface 14921 of the tissue thickness compensator 14920 is from an outer or lateral edge of this surface. Can tilt inward. In at least one such embodiment, as a result of the above, the tissue thickness compensator 14920 can be thinned, for example, in a region positioned over the rows of inner staple cavities, It can be thickened in the region positioned above. In various embodiments, referring now to FIG. 153, the deck surface of the support portion 15010 can comprise, for example, a stepped deck surface, for example, the highest step of the stepped surface is a row of inner staple cavities. And the lowest step of the stepped surface can surround a row of outer staple cavities. In at least one such embodiment, a step having an intermediate height can surround a row of intermediate staple cavities. In certain embodiments, a tissue thickness compensator, such as tissue thickness compensator 15020, for example, can include a lower surface that is parallel to and can abut the deck surface of support portion 15010. In at least one embodiment, the upper or tissue contacting surface 15021 of the tissue thickness compensator can comprise, for example, an arcuate surface, a parabolic surface, and / or a curved surface, the surface being at least one such implementation. In configuration, for example, the second of tissue thickness compensator 15020 from the first side of tissue thickness compensator 15020 with the apex aligned or at least substantially aligned with the center of staple cartridge 15000. Can extend to the side.

  In various embodiments, in addition to the above, the staple firing thread 10050 of the staple cartridge 10000 can be positioned proximally of the staple cartridge 10000, as shown in FIGS. 161 and 162, using firing members shown elsewhere. It can be moved from the end toward the distal end 10002 of the staple cartridge. As the sled 10050 is advanced, the sled 10050 may contact the staple driver 10040 and lift the staple driver 10040 upward within the staple cavity 10012 defined within the cartridge body 10010 of the staple cartridge 10000. In at least one embodiment, the sled 10050 and staple driver 10040 can each cooperate to move the staple driver 10040 and staples supported by the staple driver upward from an unfired position of these staples. The above slope or inclined surface can be provided. The staple cartridge 10000 can further include a tray 10027 that can at least partially surround the lower portion of the cartridge body 10010 and can at least partially accommodate the staple driver 10040 within the cartridge body 10010. The cartridge body 10010 can further comprise a longitudinal slot 10016 defined within the cartridge body and configured to at least partially receive the firing member as the firing member passes the staple cartridge 10000.

  Referring now to FIG. 163, staples contained within the stable cartridge body 10010 can be fired sequentially between the proximal end 10001 and the distal end 10002 of the staple cartridge 10000. In various embodiments, the staple cartridge 10000 can include, for example, staple drivers 10040a, 10040b, and 10040c that can fire staples in a predetermined manner. By way of example, staple cartridge 10000 includes a proximal driver 10040c positioned on the first side of longitudinal slot 10016 and a second proximal driver 10040c positioned on the second or opposite side of slot 10016. Can be provided. Each driver 10040c may be configured to fire two staples simultaneously, ie the two most proximal staples. Such a staple is positioned within a staple cavity, indicated at 10012c. In fact, of the two staple cavities indicated by 10012c on each side of the slot 10016, such staple cavities 10012c comprise a distal staple cavity indicated by 10013c and a proximal staple cavity 10014c. be able to. The reader will understand that the staple cavity 10013c is positioned in a different staple row than the staple cavity 10014c. In practice, staple cavities 10013c and 10014c may be located within the two innermost staple rows, with the third outermost staple row having no staples fired by driver 10040c. In addition, the staple cartridge 10000 includes an intermediate driver 10040b positioned on the first side of the longitudinal slot 10016, and a second intermediate driver 10040b positioned on the second or opposite side of the slot 10016. Can be provided. Each driver 10040b may be configured to fire three staples simultaneously. Such a staple is positioned within the staple cavity, indicated at 10012b. In fact, of the three staple cavities indicated by 10012b on each side of the slot 10016, such staple cavities 10012b include a distal staple cavity indicated by 10013b, an intermediate staple cavity 10014b, and a distal Staple cavities 10015b. The reader will further understand that the staple cavities 10013b, 10014b, and 10015b are all positioned in different staple rows. In addition, the staple cartridge 10000 includes a distal driver 10040a positioned on the first side of the longitudinal slot 10015 and a second distal driver positioned on the second or opposite side of the slot 10015. 10040a. Each driver 10040a may be configured to fire four staples simultaneously. Such a staple is positioned in a staple cavity, indicated at 10012a. In fact, of the four staple cavities indicated by 10012a on each side of the slot 10016, such staple cavities 10012a include two distal staple cavities indicated by 10013a, an intermediate staple cavity 10014a, A distal staple cavity 10015a. The reader will further appreciate that the staple cavities 10013a, 10014a, and 10015a are all positioned in an array that extends across the three rows of staples on the sides of the longitudinal slot 10016. In practice, the most distal staples positioned within the most distal cavities 10013a within the cartridge body 10010 are positioned in the inner and outer staple rows, and the inner staple cavity rows and Extending distally relative to the most distal staple cavity 10014a in an intermediate row positioned between the outer staple cavity rows. Although only a small number of staple drivers 10040a, 10040b, and 10040c are described above, the staple cartridge 10000 may include a number of suitable numbers of staple drivers for discharging staples from the staple cavity. Such staples can release two, three, four, and / or more staples simultaneously. With particular reference to FIG. 18, the staple cartridge is, for example, one or more staple drivers 41040a configured to support two staples from below, eg, one configured to support three staples from below. One or more drivers 41040b and / or one or more staple drivers 41040c configured to support four staples from below may be provided. In various embodiments, the last or most distal driver housed within the cartridge may include two distal support pedestals 41041c that can hold the last staple in a staple row. A driver 41040c that can be provided As an example, drivers 41040a-c support staples in six staple rows, and driver 41040c supports the last staple in four of these rows. Such staples can be aligned or at least substantially aligned along an axis that is perpendicular to a cutting path extending along the longitudinal axis. Such staples can provide various hemostatic benefits because of their arrangement. The last staple in the other two staple rows can be supported by the cradle 41041b.

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

  In certain embodiments where the distal end of this layer is attached to a staple cartridge, the staple cartridge is disposed distally, cutting the layer released from the distal end attached to the staple cartridge. A cutting blade can be included. 81A-83 illustrate a staple cartridge assembly 2300 that includes a staple cartridge 2330 and a distal cutting blade 2324 disposed in a distal cavity 2332 of the staple cartridge 2330. As described in more detail below, the distal cutting blade 2324 is cut from an undeployed position inside the distal cavity 2332 to sever the distal end 2316 of the layer 2306 disposed in the staple cartridge. Can be moved to a deployed position extending from the distal cavity 2332.

  82 and 83, in various embodiments, the distal portion 2316 of the layer 2306 is captured between the staple cartridge 2300 and a panel 2310 that extends proximally from the nose 2308 of the staple cartridge assembly 2300. By doing so, the staple cartridge 2300 can be attached. In certain embodiments, the layer 2306 can be captured by being compressed between the staple cartridge 2330 and the panel 2310. In other words, the gap between the staple cartridge 2330 and the panel 2310 is such that the distal portion of the layer 2306 positioned within the gap such that the distal portion 2316 is compressed between the staple cartridge 2330 and the panel 2310. The thickness can be smaller than 2316. In certain embodiments, referring to FIGS. 82 and 83, the distal portion 2316 of the layer 2306 can include one or more openings 2320. One or more pegs 2318 can extend from the panel 2308 and pass through the opening 2320 to capture the distal portion 2316 of the layer 2306. In certain embodiments, the distal portion 2316 of the layer 2306 can be attached to the staple cartridge 2330 by, for example, adhesive, welding, and / or heat staking.

  A distal cutting blade 2324 that separates the distal portion 2316 of the layer 2306 from the remaining portion of the layer 2306 may be disposed in the distal cavity 2332 of the staple cartridge 2330. The distal cavity 2332 and the distal cutting blade 2324 cause the distal cutting blade 2324 to sever the distal portion 2316 of the layer 2306 at a proximal location relative to where the distal portion 2316 is attached to the staple cartridge 2330. Can be positioned. For example, referring to FIGS. 82 and 83, the distal cutting blade 2324 includes a distal portion 2316 of the layer 2306 at a proximal location relative to the peg 2318 and an opening 2320 that attaches the distal portion 2316 to the staple cartridge 2330. Can be divided. As a result, when the distal cutting blade 2324 severes the distal portion 2316 of the layer 2306, the remaining portion of the layer 2306 can be released from the staple cartridge.

  The distal cutting blade 2324 can include a cam 2322 that can push the distal cutting blade 2324 out of the distal cavity 2332. The cam 2322 has a rail and / or within the distal cavity 2332 that can constrain movement of the cam 2322 and the distal cutting blade 2324 in a particular direction as the distal cutting blade 2324 extends out of the distal cavity 2332. Alternatively, channel 2334 can be engaged. Rails and / or channels 2334 are shown in FIGS. 82 and 83 as being perpendicular to the staple deck 2302 of the staple cartridge 2330. In such an arrangement, the distal cutting blade 2324 is perpendicular to the staple deck 2302 of the staple cartridge 2330 when moved from the undeployed position (shown in FIG. 82) to the deployed position (shown in FIG. 83). Can extend from the distal cavity 2332 in a direction. In various embodiments, the rails and / or channels 2334 may be disposed at any suitable angle that is relative to the staple deck 2302 of the staple cartridge 2330. For example, the rail or channel 2334 may be such that the distal cutting blade 2324 extends partially out of the distal cavity 2322 in a distal direction that is 30 ° from vertical to the staple deck 2302 of the staple cartridge 2330. It may be positioned at an angle of 30 ° relative to 2330 staple decks 2302.

  Cam 2322 can be pushed by firing member 2326 to deploy the distal cutting blade. Firing member 2326 may be disposed in a slot in staple cartridge 2330, such as knife slot 2304, for example. Firing member 2326 may include cam surfaces 2328 and 2329 that engage cam 2322 to move cam 2322 and distal cutting blade 2324 toward layer 2306. Firing member 2326 may move distally relative to cam 2322 and distal cutting blade 2324 from an inoperative position to an activated position to deploy cutting blade 2324 and sever distal portion 2316 of layer 2306. it can. FIG. 82 shows firing member 2326 in a non-actuated position with cam surfaces 2328 and 2329 not engaging cam 2322. In various embodiments, the surfaces 2328 and 2329 of the firing member 2326 can contact the cam in the inoperative position as long as the distal cutting blade 2324 is not pushed out of the distal cavity 2332. As the firing member 2326 moves distally to the activated position shown in FIG. 83, the cam surface 2328 of the firing member 2326 has a cam 2322 and a A cam 2322 is engaged to gradually push the distal cutting blade 2324 into the deployed position.

  As described above, the cam 2322 can engage the rail and / or channel 2334 within the distal cavity 2332. Moreover, the rails and / or channels 2334 can be disposed at an angle relative to the staple deck 2302 of the staple cartridge 2330. In various embodiments, the rails and / or channels 2334 can be positioned at an angle such that the cam 2322 and the distal cutting blade 2324 move distally as the blade 2324 deploys from the distal cavity. In various situations, placing the rail at such an angle is to actuate the firing member 2326 by aligning the cam 2322 and blade 2324 motion components in the direction of the longitudinal axis along which the firing member 2326 moves. Can reduce the amount of force required. Placing the rail at such an angle may allow for a coupling between the cam 2322 and the firing member 2326 and / or between the cam 2322 in the distal cavity 2332 and the rail and / or channel 2324. Further reduction can be achieved.

  In various embodiments, firing member 2326 can be moved distally from an inoperative position to an activated position by cutting blade 2312 and / or staple driver 2340. In various embodiments, the firing member 2326 includes a tissue cutting blade such that the firing member 2326 passes through the staple cartridge 2330 with the tissue cutting blade 2312 and / or the staple driver 2340 and travels along the longitudinal axis of the staple cartridge 2330. 2312 and / or staple driver 2340. In various embodiments, the firing member 2326 can be separated from the tissue cutting blade 2312 and / or the staple driver 2340. In such embodiments, the tissue cutting blade 2312 and / or the staple driver 2340 can push the firing member 2326 through the staple cartridge 2330. Alternatively, in such embodiments where firing member 2326 is separate from tissue cutting blade 2312 and / or staple driver 2340, firing member 2326 is staple cartridge 2330 in an inoperative position, as shown in FIG. Can be positioned at the distal end. The cutting blade 2312 and / or staple driver 2340 advances through the staple cartridge 2330, and then the firing member 2326 is moved as shown in FIG. Can be pushed into the operating position indicated in. In all of these embodiments, the movement of the tissue cutting blade 2312 and / or staple driver 2340 in a direction along the longitudinal axis of the staple cartridge 2330 is different from the tissue cutting blade and / or staple driver 2340. Can be deployed in any direction.

  In various embodiments, the distal cutting blade 2324 is deployed to sever the distal portion 2316 of the layer 2306 until the firing stroke of the tissue cutting blade 2312 and / or staple driver 2340 is complete or nearly complete. Not. In such embodiments, the distal portion 2316 of the layer 2306 can remain attached to the staple cartridge 2330 so that most or all of the staples are fired by the staple driver 2340 and / or Stabilize layer 2306 relative to staple cartridge 2330 until patient tissue and layer 2306 are severed by tissue cutting blade 2312. In various other embodiments, the distal cutting blade 2324 can be deployed to sever the distal portion 2316 of the layer 2306 before the tissue cutting blade 2312 and / or the staple driver 2340 begins these firing strokes. For example, firing member 2326 may be moved from the non-actuated position shown in FIG. 82 to the actuated position shown in FIG. 83 by the first actuation of the firing trigger of the surgical stapler. Subsequent firing trigger actuation can move the tissue cutting blade 2312 and / or the staple driver 2340. As a result, the distal portion 2316 of the layer 2306 can be removed from the staple cartridge 2330 before the tissue cutting blade 2312 severes patient tissue and / or before the staples capture the layer 2306 and patient tissue. As another example, firing member 2326 may be actuated by a first trigger of a surgical instrument and tissue cutting blade 2312 and / or staple driver 2340 may be actuated by a second trigger.

  As described above, the nose portion 2308 of the staple cartridge assembly 2300 can include a panel 2310 that extends proximally from the nose portion 2308 and at least partially covers the distal portion 2316 of the layer 2306. Panel 2310 can include an inwardly facing surface 2309 that can face distal portion 2316 of layer 2306. In certain embodiments, the inwardly facing surface 2309 of the panel 2310 can support the distal portion 2316 of the layer 2306 as the distal cutting blade 2324 severes the distal portion 2316. In various situations, when the distal cutting blade 2324 is deployed, the distal cutting blade 2324 can eventually make contact with the inwardly facing surface 2309, so that the distal portion 2316 of the layer 2306 can be removed from the rest of the layer 2306. Divide completely from the part.

  The panel 2310 can also protect patient tissue from the distal cutting blade 2324. In various situations, unaffected patient tissue that is not severed by the tissue cutting blade 2312 and / or stapled from the staple cartridge 2330 can pass over the outwardly facing surface 2311 of the panel 2310. . In such a situation, the panel 2310 can protect unaffected tissue from the distal cutting blade 2324. For example, as shown in FIG. 83, the panel 2310 may have a distal cutting blade 2324 extending outwardly from the distal cavity 2332 and an outwardly facing surface 2311 of the panel 2310 so that patient tissue is not exposed to the distal cutting blade 2324. It can be positioned between adjacent patient tissues.

  77-79, the staple cartridge 20000 can include a cartridge body 20010 and a tissue thickness compensator 20020 releasably attached to the cartridge body. The staple cartridge 20000 is distal to the staple cartridge 20000 to capture at least a portion of the tissue thickness compensator 20020 and at least a portion of patient tissue within the staple, as described elsewhere herein. Any suitable arrangement of staples, staple cavities, and / or staple drivers fired by sleds or firing members passing through the side may be provided. The discussion of such staples, staple cavities, and staple drivers will not be repeated here for the sake of brevity to the reader. Referring primarily to FIGS. 77 and 77A, the staple cartridge 20000 can include a sled 20060 that is advanced distally by the firing member 20050. At certain points during advancement of the firing member 20050 and the sled 20060 on the far side, the sled 20060 is configured to release the tissue thickness compensator 20020 from the cartridge body 20010, as shown, for example, in FIGS. Can be done. As an example, the distal end 20022 of the tissue thickness compensator 20020 can be releasably held at the distal end of the cartridge body 20010 by a flexible clamp 20013 and a retaining pin 20072, and the sled 20060 is retained by the retaining pin There is a possibility of ruining or pulling out 20072. The flexible clamp 20013 can be configured to securely hold the tissue thickness compensator 20020 against the deck 20015 of the cartridge body 20010. Under such circumstances, the flexible clamp 20013 can provide sufficient clamping force to the tissue thickness compensator 20020 to hold the tissue thickness compensator 20020 in place. The retention pin 20072 may hold the tissue thickness compensator 20020 firmly against the cartridge body 20010. By way of example, referring to FIGS. 77 and 77A, the distal end 22022 of the tissue thickness compensator 20020 is defined in the distal end and has an opening 20027 that can be configured to receive the retention pin 20072. Due to the interaction between the retention pin 20072 and the side wall of the opening 20027, the retention pin 20072 prevents the tissue thickness compensator 20020 from sliding out between the clamp 2001 and the cartridge deck 20015. be able to. Moreover, the retention pin 20072 and the clamp 20013 can cooperatively limit the movement of the tissue thickness compensator 20020, and the tip of the retention pin 20072 can abut the clamp 20013 in various situations. Alternatively, it can be positioned in close proximity to the clamp 20013.

  In use, in addition to the above, the retaining pin 20072 can be lowered by the sled 20060, as shown in FIGS. More specifically, the retaining pin 20072 can extend from the cam 20070, and the cam 20070 rests on an elastic member or spring 20012 that extends from a tray 20011 attached to the cartridge body 20010, Alternatively, the sled 20060 can engage the cam 20070 and the sled 20060 can push down the cam 20070 and the retaining pin 20072, thus compressing the spring 20012. The cartridge body 20010 can include a guide 20018 that is defined within the cartridge body and restricts movement of the cam 20070 along a substantially vertical path, ie, a path that is perpendicular to the cartridge deck 20015. In various embodiments, the sled 20060 can include a cam actuator 20062 that extends distally with respect to the staple driver lift surface 20063. When the pin 20072 is lowered sufficiently, the tissue thickness compensator 20020 can slide relative to the cartridge deck 20015 and slide out of the clamp 20013. In various situations, the pin 20072 can be lowered by a sufficient amount, but still protrudes at least partially from the cartridge deck 20015. In other situations, the pin 20072 can be lowered under the cartridge deck 20015. In any case, the cam actuator 20062 and staple driver lift surface 20063 of the sled 20060 allow the retaining pin 20072 to be lowered sufficiently at the same time that the last or most distal staple is fired by the sled 20060. Can be configured. In other situations, the cam actuator 20062 and the staple driver lift surface 20063 of the sled 20060 may allow the retaining pin 20072 to be lowered sufficiently before the last or most distal staple is fired by the sled 20060. Can be configured. In yet other situations, the cam actuator 20062 and staple driver lift surface 20063 of the sled 20060 may be sufficiently lowered so that the retaining pin 20072 is sufficiently lowered after the last or most distal staple is fired by the sled 20060. Can be configured. Although the cam 20070 is described herein as having a single retention pin 20072, a plurality of retention pins 20072 can extend from the cam 20070, each with a tissue thickness compensator 20020. The cartridge body 20010 may be configured to be releasably held. Accordingly, the tissue thickness compensator 20020 can include an appropriate number of openings 20027 configured to receive the retention pin 20072.

  80 and 81, the cartridge 21000, for example, releases the tissue thickness compensator 21020 from the cartridge body 21010, the tissue thickness compensator 21020 releasably clamped to the cartridge body 21010, and the cartridge body 21010. Thread 21060 that may be configured as such. Similar to the above, the sled 21060 is configured to lift the staple driver and staples supported by the staple driver toward an anvil positioned opposite the tissue thickness compensator 21020. Can be provided. Further, similar to the above, the sled 21060 further comprises a cam actuator 21062 that can be configured to stop a clamp 21013 that holds the distal end 21022 of the tissue thickness compensator 21020 against the deck surface 21015 of the cartridge body 21010. More specifically, the clamp 21013 can include a cam 21072 that extends downward into the cartridge body 21010 such that the sled 21060 is advanced distally through the staple cartridge 21000. As it is engaged, it can be engaged by cam actuator 21062. When the cam actuator 21062 engages the cam 21072, the cam actuator 21062 lifts the cam 21072 upward and deflects the clamp 21013 away from the distal end 21022 of the tissue thickness compensator 21020, as shown in FIG. I can do it. At such time, the cartridge body 21010 can be separated from the tissue thickness compensator 21020. In other words, by the time the tissue thickness compensator 21020 is released from the cartridge body 21010, the tissue thickness compensator 21020 is embedded in the patient tissue with one or more staples, and the tissue thickness compensator 21020 is Once released, the cartridge body 21010 can be moved away from the implanted tissue thickness compensator 21020 and removed from the surgical site.

  In addition to the above, cam actuator 21062 and staple driver lift surface 21063 of sled 21060 have cam 20072 added by clamp 21013 at the same time that the last or most distal staple is fired by sled 20060. It can be configured to be raised sufficiently to sufficiently reduce the clamping force. In other situations, the cam actuator 21062 and staple driver lift surface 21063 of the sled 21060 are clamped by the cam 21072 applied by the clamp 21013 before the last or most distal staple is fired by the sled 21060. It can be configured to be raised sufficiently to reduce the force sufficiently. In yet other situations, the cam actuator 21062 and staple driver lift surface 21063 of the sled 21060 are clamped by the cam 20072 applied by the clamp 21013 after the last or most distal staple has been fired by the sled 21060. It can be configured to be raised sufficiently to reduce the force sufficiently. Although the clamp 21013 is described herein as having one cam 21072 extending from the clamp, a plurality of cams 21072 can extend from the clamp 21013, each lifting the clamp 21013. , And may be configured to release the tissue thickness compensator 20020 from the cartridge body 20010.

  In addition to the above, the sled or firing member passing through the staple cartridge releases the tissue thickness compensator from the cartridge body at or near the end of the distal movement of the sled and / or at the end of the firing stroke of the firing member. can do. In other words, the tissue thickness compensator can be released from the cartridge body at the same time or at about the same time as all of the staples are fired from the staple cartridge. In various other embodiments, the tissue thickness compensator can be released from the cartridge body at the same time or before the first or most proximal staple is fired from the staple cartridge. One such exemplary embodiment is depicted in FIGS. 90-92 showing a staple cartridge 22000. Similar to the above, the staple cartridge 22000 can include a cartridge body 22010 and a tissue thickness compensator 22020 releasably clamped to the cartridge body. The staple cartridge 22000 can further include a staple firing sled as described above, where the sled may not release the tissue thickness compensator 22020; rather, the staple cartridge 22000 is at the beginning of the firing stroke of the firing member. An actuator 22011 may further be provided that can be advanced farther by the firing member. Various other embodiments are disclosed herein that disclose means for advancing the actuator distally and are not repeated with respect to this embodiment for the sake of brevity to the reader. In any case, the actuator 22011 extends from the actuator and, as shown in FIG. 90, a cam support 22012 that can be configured to support the cam 22070 when the actuator 22011 is in an inoperative state of the actuator. Can be included. Moreover, the staple cartridge 22000 can further comprise a biasing member or spring 22074 that can be configured to hold or bias the cam 22070 relative to the cam support 22012, but again, the actuator 22011 includes the actuator 22011. In the inoperative position shown in FIG. In such a position of the cam 22070, the holding pin 22072 extending from the cam 22070 is similar to the holding pin 22072 and / or the holding pin 22072 corresponding to the clamp 22013 extending from the cartridge main body 22010. Engage with and extend through an opening 22023 defined in the distal end 22022 of the tissue thickness compensator 22020 so that the thickness compensator 22020 can be held in place. Can do.

  When the actuator 22011 is advanced distally by the firing member, referring now to FIG. 91, the cam support 22012 can be advanced distally so that the cam support 22012 no longer supports the cam 22070. it can. In such a situation, the spring 22074 biases the cam 22070 downward such that the retention pin 22072 is biased to disengage or at least partially disengage the tissue thickness compensator 22020. Sometimes. In at least one situation, the spring 22074 can bias the cam 22070 downward such that the retention pin 22072 is positioned below the deck 22015 of the cartridge 22010. In any event, distal advancement of the actuator 22011 can release the tissue thickness compensator 22020 from the cartridge body 22010. In other words, when the retention pin 22072 is lowered, the clamp 22013 still provides retention force to the tissue thickness compensator 22020 so that the tissue thickness compensator 22020 remains pinned to the staple deck 22015. However, the tissue thickness compensator 22020 can be slid out of the underlying clamp 22013 when sufficient relative force is applied between the tissue thickness compensator 22020 and the cartridge body 22010. In addition to the above, the release of the tissue thickness compensator 22020 from the cartridge body 22010 was fired before, at the same time as and / or before the most proximal staple was fired from the staple cartridge 22000. It can happen immediately. In such a situation, an intermediate release of the tissue thickness compensator 22020 may allow the tissue thickness compensator 22020 to be released from the cartridge body 22010, for example, even if the staple cartridge 22000 is only partially fired. .

  Referring now to FIGS. 84-87, the end effector assembly 5000 can include a first jaw and a second jaw 5002 shown elsewhere. In various embodiments, the second jaw 5002 can include a cartridge assembly that includes a fastener cartridge body 5050 and a tissue thickness compensator 5058 releasably clamped to the fastener cartridge body 5050. Referring primarily to FIG. 84, the fastener cartridge body 5050 can have a cartridge deck 5052 and a fastener cavity 5054 defined in the cartridge deck 5052. Moreover, the second jaw 5002 can include a fastener, such as a surgical staple, that can be releasably positioned within the fastener cavity 5054, for example. For example, fasteners can be releasably positioned within each fastener cavity 5054 of the cartridge body 5050. In certain embodiments, the cartridge body 5050 can include a slot 5056 that can extend from the proximal portion 5004 of the second jaw 5002 toward the distal portion 5006 of the second jaw 5002. . In various embodiments, the firing assembly 5030 can translate along the slot 5056 of the cartridge body 5050. For example, firing assembly 5030 can translate within slot 5056 during a firing stroke and can release fasteners from fastener cavity 5054 during the firing stroke.

  Referring primarily to FIGS. 84, 86 and 87, the firing assembly 5030 can include a firing bar (FIG. 84), a cutting edge 5036, a crossbar 5038, and a foot 5044 (FIGS. 86 and 87). Cutting edge 5036 can cut tissue and / or cut tissue thickness compensator 5058 as firing assembly 5030 is fired through second jaw 5002 during the firing stroke. For example, the crossbar 5038 can hold the first jaw relative to the cartridge body 5050 and the foot 5044 can hold the firing assembly 5030 relative to the cartridge body 5050. In various embodiments, the crossbar 5038 and foot 5044 can hold a cutting element 5036 that is perpendicular to the deck 5052 of the fastener cartridge 5050, for example. Referring primarily to FIGS. 29A and 29B, firing assembly 5030 can engage sled 5034 within cartridge body 5050 during a firing stroke. The firing assembly 5030 can, for example, push the sled 5034 distally during the firing stroke to release the fastener from the fastener cavity 5054.

  Referring primarily to FIG. 84, the tissue thickness compensator 5058 can be releasably tightened to the cartridge body 5050 by at least one connector 5080a, 5080b. In certain embodiments, the plurality of connectors 5080a, 5080b can clamp the tissue thickness compensator 5058 to the cartridge body 5050. For example, the proximal connector 5080a can clamp the tissue thickness compensator 5058 to the cartridge body 5050 at the proximal portion 5004 of the second jaw 5002, and the distal connector 5080b can tighten the tissue thickness compensator 5058 to the second The distal portion 5006 of the jaw 5002 can be clamped to the cartridge body 5050. In certain embodiments, an additional connector can clamp tissue thickness compensator 5058 to cartridge body 5050. In such embodiments, additional connectors can be spaced along at least a portion of the length of the cartridge body 5050, for example, positioned between the proximal connector 5080a and the distal connector 5080b. .

  Still referring primarily to FIG. 84, the connectors 5080a, 5080b can hold a tissue thickness compensator 5058 relative to the cartridge body 5050. The tissue thickness compensator 5058 can be released from the cartridge body 5050 when the connectors 5080a, 5080b are broken, cut, removed, or otherwise removed. In certain embodiments, firing assembly 5030 can overcome connectors 5080a, 5080b as firing assembly 5030 translates along slot 5056 in fastener cartridge 5050 during the firing stroke. During such a firing stroke, the firing assembly 5030 can cut tissue clamped between the first jaw and the second jaw 5002 and is clamped from the fastener cavity 5054. The fastener can be moved further into the tissue. In various embodiments, firing assembly 5030 can push sled 5034 (FIGS. 86 and 87) distally during the firing stroke. The sled 5034 can have a cam surface or ramp 5042 that can engage a driver in the fastener cavity 5054. When ramp 5042 engages the driver, ramp 5042 can push the driver toward deck 5052 to release the fastener from fastener cavity 5054. In addition, firing assembly 5030 can cut tissue thickness compensator 5058 and connectors 5080a, 5080b during the firing stroke.

  Referring primarily to FIG. 84, the cutting edge 5036 of the firing assembly 5030 can, for example, cut the proximal connector 5080a at the beginning or near the beginning of the firing stroke and the distal connector 5080b at the end or near the end of the firing stroke. Can be cut. In certain embodiments, thread 5034 (FIGS. 86 and 87) removes fasteners from fastener cavity 5054 after cutting edge 5036 cuts proximal connector 5080a and before cutting edge 5036 cuts distal connector 5080b. Can be released. In such embodiments, if the firing assembly 5030 does not complete the firing stroke, the cutting edge 5036 of the firing assembly 5030 may stop before reaching the distal connector 5080b, and the tissue thickness compensator 5058 may be The distal portion 5006 of the jaw 5002 may remain clamped to the cartridge body 5050. In certain embodiments, the tissue thickness compensator 5058 may remain clamped to the cartridge body 5050 until the operator cuts the distal connector 5080b or otherwise overcomes the distal connector 5080b. it can. For example, the operator may introduce additional surgical instruments and / or steps to the surgery to overcome the distal connector 5080b.

  With continued reference to FIGS. 84-87, in various embodiments, the second jaw 5002 can overcome the connectors 5080a, 5080b at the beginning or near the beginning of the firing stroke. In other words, the elements of the second jaw 5002 may include the proximal connector 5080a, the distal connector 5080b, and any additional number between the proximal and distal connectors at the beginning or almost the beginning of the firing stroke. You can overcome a simple connector. For example, the second jaw 5002 and / or cartridge assembly can include an actuator 5010 that can overcome the distal connector 5080b before the fastener is released from the fastener cavity. The actuator 5010 can overcome the distal connector 5080b and the tissue thickness compensator 5358 can be used even when the firing stroke is terminated midway, ie, for example, when the firing assembly 5030 is distant from the second jaw 5002. Prior to reaching the central portion 5006, it can be released from the cartridge body 5050. In various embodiments, the actuator 5010 can include a bottom surface 5016 (FIGS. 85A-85C) and a side surface 5018 (FIGS. 84 and 85D). The side surface 5018 can extend from the bottom surface 5016 and around at least a portion of the cartridge body 5050. The bottom surface 5016 and / or the side surface 5018 can extend past or around a fastener positioned within the fastener cavity 5054. Moreover, the actuator 5010 can be held movably with respect to the cartridge body 5050. For example, the actuator 5010 can move from a pre-actuated position (FIG. 85A) to a post-actuated position (FIGS. 85B and 85D). In certain embodiments, the sidewall 5018 of the actuator 5010 can engage a slit in the cartridge body 5050 such that the actuator 5010 moves within the first slit to slide relative to the cartridge body 5050. it can. As the actuator 5010 moves relative to the cartridge body 5050, the actuator 5010 can slide relative to a fastener positioned within the fastener cavity 5054 of the cartridge body 5050. For example, the actuator 5010 can slide past or about a fastener positioned within the fastener cavity 5054.

  Referring primarily to FIGS. 85A-85C, the actuator 5010 can include a slot 5012 that can extend from the proximal portion 5004 of the second jaw 5002 toward the distal end 5006. Slot 5012 in actuator 5010 may correspond to and / or be aligned with slot 5056 (FIG. 84) in cartridge body 5050, for example. Moreover, firing assembly 5030 may be along slot 5012 in actuator 5010 as firing assembly 5030 translates along slot 5056 in cartridge body 5050 and / or within slot 5056 during the firing stroke. And / or translation within the slot 5012. In various embodiments, the firing assembly 5030 can engage the actuator 5010 to move the actuator 5010 distally when the firing assembly 5030 is at the beginning or near the beginning of the firing stroke. In such embodiments, firing assembly 5030 can actuate actuator 5010 at proximal portion 5004 of second jaw 5002. When the actuator 5010 is actuated and moves distally, the distal end of the actuator 5010 can, for example, cut the distal connector 5080b or overcome the distal connector 5080b. In other words, proximal actuation of the actuator 5010 can achieve a distal release of the tissue thickness compensator 5058 from the cartridge body 5050. In various embodiments, the actuator 5010 can simply shift distally to overcome the distal connector 5080b. In at least one embodiment, the actuator 5010 can be shifted, for example, approximately 1 mm before overcoming the distal connector 5080b. In certain embodiments, the actuator 5010 can be shifted, for example, from approximately 0.5 mm to approximately 5 mm before overcoming the distal connector 5080b.

  Referring primarily to FIGS. 85A and 85B, the actuator 5010 moves to a pre-actuated position (FIG. 5) as the firing assembly 5030 moves between an unfired position and a partially fired position during a portion of the firing stroke. 85A) to a post-actuation position (FIG. 85B). In various embodiments, the actuator 5010 can include a release stop, such as a detent tab portion 5022, for example. Advancement of the firing element relative to the actuator 5010 can be paused by a detent tab portion 5022. In other words, the detent tab portion 5022 can temporarily stop the advancement of the firing assembly 5030 relative to the actuator 5010. For example, while the actuator 5010 is moving from the pre-actuated position toward the post-actuated position, the detent tab portion 5022 is relative to the actuator 5010 such that the actuator 5010 moves between the pre-actuated position and the post-actuated position. The sled 5034 and / or the firing assembly 5030 can be engaged to hold the firing assembly 5030. For example, referring primarily to FIGS. 86 and 87, the bottom surface 5016 of the actuator 5010 can include a detent tab portion 5022 and the thread 5034 can include a recess or groove 5040. In various embodiments, the groove 5040 can receive the tab portion 5022 when the thread 5034 is positioned within the proximal portion 5004 of the second jaw 5002. For example, the groove 5040 aligns with the tab portion 5022 when the firing assembly 5030 moves from the pre-fire position to the post-fire position, and thus when the actuator is pushed from the pre-actuated position (FIG. 85A) to the post-actuated position (FIG. 85B). Can be made. In various embodiments, at least one tab portion 5022 can be positioned on either side of a slot 5012 (FIGS. 85A-85C) in the actuator 5010, with each tab portion 5022 engaging a thread 5034. it can.

  Referring primarily to FIG. 85A, the sled 5034 can engage the detent tab portion 5022 as the firing assembly 5030 and sled 5034 translate along the slot 5056 (FIG. 84) during the firing stroke. For example, the detent tab portion 5022 can engage the sled 5034 at the beginning or near the beginning of the firing stroke. In certain embodiments, the detent tab portion 5022 can be proximate to the proximal end of the actuator 5010 and the sled 4034 can engage the detent tab portion 5022 as soon as the firing stroke begins. . When firing bar 5032 is moved distally and detent tab 5022 is engaged with recess 5040 in sled 5034 (FIGS. 86 and 87), actuator 5010 can be carried distally and / or Can be shifted. In certain embodiments, primarily referring to FIG. 85B, the actuator 5010 can move distally until, for example, the actuator reaches a rigid stop 5060 defined within the cartridge body 5050. A rigid stop 5060 may be present at the distal portion 5006 of the second jaw 5002, for example, to prevent further distal movement of the actuator 5010. In various embodiments, the actuator 5010 can abut the rigid stop 5060 as the firing assembly 5030 releases at least one fastener from the fastener cavity 5054 of the cartridge body 5050 (FIG. 84). In some embodiments, the actuator 5010 may cause the firing assembly 5030 to release at least one fastener from the fastener cavity 5054 and / or the firing assembly 5030 may remove at least one fastener from the fastener cavity 5054. After release, it can abut against a rigid stop 5060.

  Referring primarily to FIG. 85D, when the actuator 5010 is pushed distally by the sled 5034 and / or firing assembly 5030, the actuator 5010 moves from the cartridge body 5050 at the distal portion 5006 of the second jaw 5002. To release the compensator 5058, it is possible to cut the distal connector 5080b or otherwise overcome the distal connector 5080b. In certain embodiments, the actuator 5010 can include a notch 5024 that receives and retains the distal connector 5080b. The notch 5024 can hold the distal connector 5080b as the actuator 5010 shifts further toward the rigid stop 5060. Moreover, the actuator 5010 can include a cutting edge 5020 along the notch 5024, for example. In certain embodiments, when the actuator 5010 moves toward the rigid stop 5060, the distal connector 5080b may be pushed between the rigid stop 5060 and the cutting edge 5020 of the actuator 5010. In various embodiments, the cutting edge 5020 can cut the distal connector 5080b when the cutting edge 5020 is pushed into the rigid stop 5060 and / or pushed toward the hard stop 5060. In such embodiments, the distal connector 5080b can be cut by the cutting edge 5020 of the actuator 5010 at the beginning or near the beginning of the firing stroke and before the fastener is fired from the fastener cavity 5054 (FIG. 84). ). In some embodiments, the actuator 5020 may cause the firing assembly 5030 to release at least one fastener from the fastener cavity 5054 and / or the firing assembly 5030 may remove at least one fastener from the fastener cavity 5054. After release, the distal connector 5080b can be cut. In various embodiments, the actuator 5010 can overcome the distal connector 5080b without cutting the distal connector 5080b. For example, the actuator 5010 can remove or stretch the distal connector 5080b from place so that the distal connector 5080b no longer holds the tissue thickness compensator 5058 relative to the cartridge body 5050.

  In various embodiments, the proximal connector 5080a can be cut by the proximal cutting edge of the actuator 5010. Similarly, additional connectors along the length of the cartridge body 5050 can be disconnected or otherwise overcome by the actuator 5010 at the beginning or near the beginning of the firing stroke. Additionally or alternatively, the cutting edge 5036 of the firing assembly 5030 cuts the proximal connector 5080a and / or additional connector, or otherwise into the proximal connector 5080a and / or additional connector. You can overcome it. For example, the cutting edge 5036 of the firing assembly 5030 cuts the proximal connector 5080a and the cutting edge 5020 of the actuator 5010 cuts the distal connector 5080b before the fastener is released from the fastener cavity 5054 of the cartridge body 5050. (FIG. 84).

  Referring primarily to FIG. 87, the sled 5034 and / or firing assembly 5030 can be configured to overcome the detent tab portion 5022 of the actuator 5010. As sled 5034 and / or firing assembly 5030 overcome detent tab 5022, firing assembly 5030 and sled 5034 can move relative to actuator 5010. For example, firing assembly 5030 can push sled 5034 distally to move actuator 5010 distally until further distal movement of the actuator is prevented by rigid stop 5060 (FIG. 85A). 85C and 85D). With continued reference to FIG. 87, when the actuator 5010 is prevented from further distal movement, the firing assembly 5030 can deform, distort and / or remove the detent tab portion 5022 from the recess 5040 in the sled 5034. The thread 5034 can be pushed with sufficient force. For example, the tab portions 5022 can each include a cantilever that can flex downward and release engagement with the groove 5040 after a sufficient longitudinal force is applied to the thread 5034. When firing assembly 5030 pushes sled 5034 to release engagement with detent tab 5022, firing assembly 5030 and sled 5034 can move relative to actuator 5010. In various embodiments, the detent tab portion 5022 may be sufficiently rigid to withstand the force of the firing assembly 5030 as the actuator 5010 shifts distally toward the rigid stop 5060. The actuator 5010 can be sufficiently flexible to distort without requiring excessive force by the motor and / or operator when the actuator 5010 reaches the rigid stop 5060. In various situations, the detent tab portion 5022 is configured to allow the firing bar 5032 to pass through the cartridge body 5050 after the force applied to the detent tab portion 5022 exceeds a predetermined force. Can be done.

  Referring now to FIGS. 29A and 29B, the end effector assembly 5100 can include a first jaw and a second jaw 5102 shown elsewhere. In various embodiments, the second jaw 5102 and / or a fastener cartridge assembly positionable within the second jaw can include an actuator 5110. The actuator 5110 can slide or shift relative to a fastener cartridge body, such as, for example, a fastener cartridge body 5050 (FIG. 84) of the fastener cartridge assembly. Moreover, in certain embodiments, the actuator 5110 can include a bottom wall 5116 and a side wall 5118 that can be positioned at least partially around the cartridge body 5050. The bottom wall 5116 and / or the side wall 5118 can extend beside or around a fastener positioned in the fastener cavity 5054 (FIG. 84) when the actuator is held against the cartridge body 5050. In various embodiments, the actuator 5110 can include a slot 5112 that extends along at least a portion of the bottom wall 5116. Moreover, the bottom wall 5118 can include a lip 5122 and / or a lip 5124 that can be slidably engaged with the cartridge body 5050. For example, the lip 5122 can extend around the cartridge body 5050 and into a slit in the deck 5052 (FIG. 84) of the cartridge body 5050. In addition, the lip 5124 can extend into the slit along the side of the cartridge body 5050, for example. In various embodiments, the lip portions 5122, 5124 can slide within the slit as the actuator 5110 moves relative to the cartridge body 5050. In such embodiments, the lip can constrain and / or define relative movement between, for example, the actuator 5110 and the cartridge body 5050. As the actuator 5110 moves relative to the cartridge body 5050, the actuator 5110 can slide relative to a fastener positioned within the fastener cavity 5054 of the cartridge body 5050. For example, the actuator 5110 can slide past or about the fastener within the fastener cavity 5054.

  With continued reference to FIGS. 29A and 29B, the actuator 5110 can include a release stop, such as a detent 5114, for example, at the proximal portion 5104 of the second jaw 5102. Referring primarily to FIG. 29A, the detent 5114 can include a detent arm 5120 that can operatively hold the sled 5134 of the cartridge body 5050 (FIG. 84). For example, the sled 5134 can include a groove 5144 and the detent arm 5120 can engage the groove 5144 to keep the sled 5134 relative to the actuator 5110. In various embodiments, the detent 5114 can be Can have a plurality of detent arms 5120 that can be retained in a groove 5144 in the sled 5134. The detent arm 5120 can extend, for example, from the opposite side of the actuator 5110, and the sled 5134 can be positioned, for example, in the middle of the detent arm 5120. In certain embodiments, firing assembly 5030 can push sled 5134 and shift actuator 5110 distally while detent arm 5120 is retained in groove 5144 of sled 5134 ( FIG. 29A). The detent arm 5120 can be sufficiently rigid to hold the sled 5134 relative to the actuator 5110 as the actuator 5110 is pushed away by the firing assembly 5030. The actuator 5110 can then abut a rigid stop, such as a rigid stop 5060 (FIGS. 84-85B, 85D) that can prevent further distal movement of the actuator 5110, for example.

  Referring primarily to FIG. 29B, the firing assembly 5030 can push the sled 5134 through the detent 5114 when the actuator 5010 abuts a rigid stop 5060 (FIGS. 84-85B and 85D). In other words, firing assembly 5030 can advance sled 5134 to overcome detent arm 5120. In such an embodiment, the detent arm 5120 is sufficiently flexible so that it can flex until it is out of engagement with the groove 5144 of the thread 5134, between the detent arms 5120 and The firing assembly 5030 may be allowed to pass along the slot 5112 in the actuator 5110. Similar to actuator 5010, actuator 5110 may, for example, cut a distal connector similar to distal connector 5080b (FIGS. 84 and 85D) when this actuator 5110 is shifted distally by firing assembly 5030, or , Can include an edge that can otherwise overcome the distal connector. Thereafter, the firing assembly 5030 and sled 5134 can translate along the slot 5112, for example, to release the fastener from a fastener cavity 5054 in the cartridge body. In various embodiments, the actuator 5110 can overcome the distal connector and / or the additional connector (s) before the fastener is fired from the fastener cartridge 5050. In certain embodiments, the actuator 5110 includes a distal connector and / or as the at least one fastener is fired from the fastener cavity and / or after the at least one fastener is fired from the fastener cavity. Or additional connectors (s) can be overcome.

  Referring now to FIGS. 87A and 87B, the end effector assembly 5200 can include a first jaw and a second jaw 5202 shown elsewhere. In various embodiments, the second jaw 5202 and / or fastener cartridge assembly can be slid relative to a fastener cartridge body, such as, for example, a fastener cartridge body 5050 (FIG. 84). 5210 can be included. Moreover, in certain embodiments, the actuator 5210 can include a bottom wall 5216 and side walls. The sidewall can be positioned, for example, at least around the cartridge body 5050. The actuator 5210 can include a slot 5212 that extends along at least a portion of the bottom wall 5216. Moreover, the actuator 5210 can be held movably with respect to the cartridge body 5050. As actuator 5210 moves relative to cartridge body 5050, actuator 5210 can move relative to a fastener positioned within fastener cavity 5054 of cartridge body 5050. For example, the actuator 5210 can slide past or about a fastener positioned within the fastener cavity 5054.

  In various embodiments, firing assembly 5030 can translate along slot 5212 and / or within slot 5212 during the firing stroke. Similar to actuators 5010, 5110, actuator 5210 can include a release stop 5214. In various embodiments, the release stop 5214 can include a frangible portion 5220 that can be, for example, a bridge across the slot 5212. Referring primarily to FIG. 87A, the firing assembly 5030 can abut the release stop 5214 to push the actuator 5210 away. The actuator 5210 can then abut a rigid stop such as a rigid stop 5060 (FIGS. 84-85B, 85D) that can prevent further distal movement of the actuator 5210. Referring primarily to FIG. 87B, upon reaching rigid stop 5060, firing assembly 5030 may break fragile portion 5220 of release stop 5214 to continue moving along slot 5212 during the firing stroke. it can. Fragile portion 5220 can be sufficiently rigid to withstand the force of firing assembly 5030 as actuator 5210 shifts distally toward rigid stop 5060 (FIG. 85D) When 5210 reaches a rigid stop 5060, it may be fragile enough to break without requiring excessive force by the motor and / or operator. In various embodiments, the actuator 5210 can overcome the distal connector 5080b and / or the additional connector (s) before the fastener is fired from the fastener cartridge 5050. In certain embodiments, the actuator 5210 includes a distal connector and / or as at least one fastener is fired from the fastener cavity and / or after at least one fastener is fired from the fastener cavity. Or additional connectors (s) can be overcome.

  88 and 89, the end effector assembly 5300 can include a first jaw and a second jaw 5302 shown elsewhere. In various embodiments, the second jaw 5302 can include a cartridge body 5350 and a tissue thickness compensator 5358 releasably clamped to the cartridge body 5350. Similar to the second jaw 5002, the second jaw 5302 can include a fastener, such as a surgical staple, that can be releasably positioned within a fastener cavity in the cartridge body 5350, for example. it can. For example, fasteners can be releasably positioned within each fastener cavity. In certain embodiments, the cartridge body 5350 can include a slot 5356 (FIG. 88) that can extend from the proximal portion 5304 of the second jaw 5302 toward the distal portion 5306. In various embodiments, the firing assembly 5030 can translate along the slot 5356 of the cartridge body 5350. The firing assembly 5030 can, for example, translate within the slot of the fastener cartridge 5350 during the firing stroke and can release the fastener from the fastener cavity during the firing stroke. Firing assembly 5030 can engage sled 5334 (FIG. 89) within cartridge body 5350, for example, during a firing stroke, and can push sled 5334 distally, for example, during the firing stroke. Moreover, during the firing stroke, firing assembly 5030 and / or actuator 5310 can release tissue thickness compensator 5358 from cartridge body 5350.

  With continued reference to FIGS. 88 and 89, the tissue thickness compensator 5358 can include a body 5360, a proximal mount 5362 extending from the body 5360, and a distal mount 5364 extending from the body 5360. . Referring primarily to FIG. 89, the pin 5366 is mounted proximally such that, for example, the pin 5366 holds the tissue thickness compensator 5358 relative to the cartridge body 5350 at the proximal portion 5304 of the second jaw 5302. The portion 5362 can extend through the opening 5356a in the cartridge body 5350. Pin 5366 can be friction fitted and / or snap fitted into opening 5356a, for example. In certain embodiments, the pin 5366 can be retained in the opening 5456a using, for example, one or more adhesives. In some embodiments, at least a portion of the cartridge body 5350 and / or the pin 5366 can be welded, for example. In various embodiments, the tissue thickness compensator 5358 includes a plurality of proximal mounts 5362 that can be releasably tightened to the cartridge body 5350 at one or both sides of the slot 5356 (FIG. 88) in the cartridge body 5350. it can. In certain embodiments, the distal mount 5364 can be clamped to the cartridge body 5350 at the distal portion 5306 of the second jaw 5302, for example. The distal mount portion 5364 can be clamped to the cartridge body 5350 with at least one adhesive between the distal mount portion 5364 and the cartridge body 5350, for example. Additionally or alternatively, the distal mount 5364 can be clamped to the cartridge body 5350 by, for example, at least one pin and / or other fastener.

  Referring primarily to FIG. 89, the actuator 5310 can loop around the distal mount 5364 and can extend to a thread 5334 in the second jaw 5302. In various embodiments, the actuator 5310 can be a cable or cord that can extend, for example, through the cartridge body 5350 and / or through the channel 5346 defined in the second jaw 5302 or thread 5334. Can be provided. In various embodiments, distal movement of the sled 5334 can pull the actuator 5310 to break through the distal mount 5364 of the tissue thickness compensator 5358. For example, the actuator 5310 includes a first end 5316 fastened to the sled 5334, a second end 5318 fastened inside the cartridge body 5350, a first end 5316, and a second end 5318. And a loop 5320 between them. The loop 5320 can loop around the distal mount 5364, for example. In various embodiments, the loop 5320 can wrap around the distal mount 5364 between the portion of the distal mount 5364 clamped to the cartridge body 5350 and the body 5360 of the tissue thickness compensator 5358. . In certain embodiments, the second end 5318 is fixedly clamped within the cartridge body 5350 such that the loop 5320 tightens around the distal mount 5364 as the first end 5316 moves. Can do. In various embodiments, the second jaw 5302 and / or the cartridge body 5350 can include buttons, pins, and / or casters such as, for example, a first button 5312 and a second button 5314. The actuator 5310 can be wound around the first button 5312 and the second button 5314, for example. The position of the buttons 5312, 5314 and the attitude of the actuator 5310 around the buttons 5312, 5314 are such that when the sled 5334 and the firing assembly 5330 move distally during the firing stroke, the distal mount 5364 on the loop 5320 of the actuator 5310. Can be tightened around. Moreover, as the loop 5320 tightens around the distal mount 5364, the loop 5320 releases the body 5360 of the tissue thickness compensator 5358 from the cartridge body 5350 at the distal location 5306 of the second jaw 5302. Thus, the distal mount 5364 can be broken through. Thus, in view of the above, the distal mount 5364 can be disengaged during the beginning of the firing stroke.

  In various embodiments, the pin 5366 that clamps the proximal mount 5362 of the tissue thickness compensator 5358 to the cartridge body 5350 when the distal mount 5364 of the tissue thickness compensator 5358 is released from the cartridge body 5350 is the cartridge 5350. The inner opening 5356 can be released. For example, the pin 5366 can be released from the opening 5356 at the beginning or near the beginning of the stroke. Pin 5366 can be sheared or cut, for example, by cutting edge 5036 of firing assembly 5030 and / or can be pushed out and / or driven out of opening 5356 by an element of firing assembly 5030. In such an embodiment, the tissue thickness compensator 5358 is released from the cartridge body 5350 at the beginning or near the beginning of the firing stroke when both the proximal mount 5362 and the distal mount 5364 are released from the cartridge body 5350. Can be done. In other words, the actuator 5310 can release the tissue thickness compensator 5358 from the cartridge body 5350 before the firing assembly 5030 and / or the sled 5334 releases the fastener from the fastener cavity in the cartridge body 5350. In some embodiments, the firing assembly 5030 and / or the threat 5334 may be at least one fastened from the fastener cavity before and / or during which the actuator 5310 releases the tissue thickness compensator 5358 from the cartridge body 5350. The tool can be released.

  The fastener cartridge assembly can include a cartridge body with a plurality of fastener cavities and a slot. The fastener cartridge assembly can further comprise a plurality of fasteners, each fastener releasably positioned within the fastener cavity. The fastener cartridge assembly includes a firing element configured to move along a slot, a tissue thickness compensator releasably clamped to the cartridge body, a tissue thickness compensator clamped to the cartridge body, and a plurality of fasteners. And a mount portion positioned distal to one of the fasteners. The fastener cartridge assembly can further include a cable between the firing element and the mount that is configured to break the mount as the firing element moves distally along the slot. The tissue thickness compensator can be released from the cartridge body when the cable breaks the mount. The cable can break the mount prior to removal of the fastener from the fastener cavity. The fastener cartridge assembly can further comprise a channel through which the cable extends.

  Referring now to FIGS. 93A-93D, the end effector assembly 5600 can include a first jaw and a second jaw 5602 shown elsewhere. In various embodiments, the second jaw 5602 includes a fastener cartridge body 5650 and a tissue thickness compensator 5658 releasably clamped to the second jaw 5602 and / or the fastener cartridge body 5650. be able to. In certain embodiments, the fastener cartridge body 5650 and the tissue thickness compensator 5658 releasably clamped to the fastener cartridge body can be releasably clamped to the fastener cartridge assembly. Referring primarily to FIG. 93A, the cartridge body 5650 can have a cartridge deck 5562 and a fastener cavity 5654 defined in the cartridge deck 5562. Moreover, the second jaw 5602 can include a fastener, such as a surgical staple, that can be releasably positioned within the fastener cavity 5654, for example. For example, a single fastener can be releasably positioned within each fastener cavity 5654 of the cartridge body 5650. Still referring primarily to FIG. 93A, the cartridge body 5650 can include a collar 5648 extending from the cartridge deck 5562. The collar 5648 can extend around at least a portion of the fastener cavity 5654, for example. In various embodiments, the fastener tip can protrude from the fastener cavity 5654 when the fastener is positioned within the fastener cavity 5654. In such an embodiment, the ridge 5648 positioned at least partially around the fastener cavity 5654 supports and / or guides the tip of the fastener when the fastener is released from the fastener cavity 5654. can do. In certain embodiments, still referring to FIG. 93A, the cartridge body 5650 can extend from the proximal portion 5604 of the second jaw 5602 toward the distal portion 5606 of the second jaw 5602. A slot 5656 can be included. In various embodiments, the firing assembly 5630 can translate along the slot 5656 of the cartridge body 5650. For example, firing assembly 5630 can translate along slot 5656 during the firing stroke and can release fasteners from fastener cavity 5654 during the firing stroke.

  With continued reference to FIGS. 93A-93D, firing assembly 5630 can include firing bar 5632, cutting edge 5636, crossbar 5638, and foot 5644. Cutting edge 5636 can cut tissue and / or cut tissue thickness compensator 5658 as firing assembly 5630 is fired through second jaw 5602 during the firing stroke. A crossbar 5638 can engage a slot in the anvil of the first jaw to hold the firing assembly 5630 against the first jaw, and the foot 5644 can be attached to the cartridge body 5650, for example. A slot in the second jaw 5602, such as slot 5656 in the cartridge body 5650, can be engaged to hold the first jaw against. In various embodiments, the crossbar 5638 and the foot 5644 can hold the cutting edge 5636 of the firing assembly 6530 that is perpendicular to the deck 5562 of the fastener cartridge 5650, for example. Referring primarily to FIGS. 93A and 93D, firing assembly 5630 can engage sled 5634 within cartridge body 5650 during a firing stroke. The firing assembly 5630 can, for example, push the sled 5634 distally during the firing stroke to release the fastener from the fastener cavity 5654. In various embodiments, the sled 5634 can have a cam surface or ramp 5642 that can engage a driver and / or fastener, for example, in a fastener cavity 5654. When ramp 5642 engages the driver, ramp 5642 can push the driver toward deck 5562 to release the corresponding fastener from fastener cavity 5654. Moreover, in various embodiments, firing assembly 5630 can cut tissue thickness compensator 5658 during the firing stroke.

  Referring primarily to FIGS. 93A and 93B, the tissue thickness compensator 5658 can include a cartridge contact surface 5562 (FIG. 93A) and a tissue contact surface 5664 (FIG. 93B). The cartridge contact surface 5562 can be positioned relative to the cartridge deck 5562, for example, when the tissue thickness compensator 5658 is clamped to the cartridge body 5650 (FIG. 93B). Moreover, the tissue contacting surface 5664 can be positioned relative to the tissue, for example, when the tissue is clamped between the first jaw and the second jaw 5602. Referring primarily to FIG. 93A, the tissue thickness compensator 5658 can include a mount 5660. In various embodiments, the mount 5660 can be, for example, a rectangular or triangular flap that can extend from the tissue thickness compensator 5658. Moreover, the mount 5660 can be a cutout portion of the tissue thickness compensator 5658 such that a space 5666 corresponding to the shape of the mount 5660 is left in the tissue thickness compensator 5658. The mount 5660 can be aligned with the slot 5656 of the cartridge body 5650, for example, when the tissue thickness compensator 5658 is positioned relative to the cartridge body 5650. Moreover, the mount 5660 can extend into the slot 5656 when the cartridge contacting surface 5562 of the tissue thickness compensator 5658 is positioned adjacent the deck 5562 of the cartridge body 5650. In various embodiments, the mount 5660 can be friction fitted into the slot 5656 when the tissue thickness compensator 5658 is clamped to the cartridge body 5650. The mount 5660 can hold at least a portion of the tissue thickness compensator 5658 relative to the cartridge body 5650. For example, when the mount 5660 is friction fitted in the slot 5656, the cartridge contact surface 5562 can be positioned relative to the deck 5562 of the cartridge body 5650.

  In various embodiments, the tissue thickness compensator 5658 can include a plurality of mounts 5660 that can be aligned with the slots 5656 of the cartridge body 5650. For example, at least one mount 5660 can be positioned within the proximal portion 5604 of the second jaw 5602 and the at least one mount 5660 is within the distal portion 5606 of the second jaw 5602. Can be positioned. In various embodiments, the mounts 5660 can be spaced along at least a portion of the length of the tissue thickness compensator 5658. For example, the slot 5656 can be a longitudinal slot that extends from the proximal portion 5604 of the second jaw 5602 to the distal portion 5606. The mount 5660 can be friction fitted into the longitudinal slot 5656, for example, and the tissue thickness compensator 5658 can be clamped to the cartridge body 5650.

  Referring primarily to FIGS. 93A and 93D, the sled 5634 can include a tongue 5640 that can project from the sled 5634 toward the distal portion 5606 of the second jaw 5602. The tongue 5640 can move along the slot 5656 within the cartridge body 5650 when the firing assembly 5630 pushes the sled 5634 during the firing stroke. Referring primarily to FIG. 93D, the tongue 5640 can move along a slot 5656 adjacent to the cartridge contacting surface 5664 of the tissue thickness compensator 5658. Moreover, the tongue 5640 can move relative to the mount 5660 positioned within the slot 5656. In various embodiments, the mount 5660 can be distorted. When the tongue 5640 pushes the mount 5660, the tongue 5640 can distort the mount 5660 to align with, or at least substantially align with, the body of the tissue thickness compensator 5658. For example, when the tongue 5640 moves within the cartridge body 5650, the mount 5660 can be distorted in turn into the corresponding space 5666 defined in the tissue thickness compensator 5658. When the mount 5660 is distorted out of the slot 5656, the tissue thickness compensator 5658 can be clamped and / or released from the cartridge body 5650. In various embodiments, the sled 5634 and / or another element of the firing assembly 5630 can be mounted out of the slot 5656 to clamp and release the tissue thickness compensator 5658 from the cartridge body 5650. 5660 can be distorted.

  Referring now to FIG. 94, the end effector assembly 5700 can include a first jaw shown elsewhere and a second jaw 5702, similar to the end effector assembly 5600. In various embodiments, the second jaw 5702 can include a fastener cartridge body 5750 and a tissue thickness compensator 5758 releasably clamped to the cartridge body 5750 and / or the second jaw 5702. it can. In certain embodiments, the fastener cartridge body 5750 and the tissue thickness compensator 5758 releasably clamped to the fastener cartridge body can comprise, for example, a fastener cartridge assembly. Similar to the cartridge body 5650, the cartridge body 5750 includes a cartridge deck 5752, a fastener cavity 5754 defined in the cartridge deck 5752 and holding fasteners, at least a flange 5748 around the fastener cavity 5754, and / or , A slot 5756 that extends from the proximal portion 5704 of the second jaw 5702 toward the distal portion 5706 of the second jaw 5702. In various embodiments, the cartridge body 5750 can include a bridge 5780 that extends across or beyond the slot 5756. The bridge 5780 can be, for example, a fragile and / or splittable bridge. In certain embodiments, the bridge 5780 can be a thin fragile portion and can be a solid absorbent material such as, for example, PGA, PCL, PGA / PCL, PLA / PCL, and / or TMC. it can. The bridge 5780 can have an opening 5782 that can extend at least partially through the bridge 5780.

  With continued reference to FIG. 94, in various embodiments, the firing assembly 5630 can translate along the slot 5756 of the cartridge body 5750. For example, the firing assembly 5630 can translate along the slot 5756 during the firing stroke and can release fasteners from the fastener cavity 5754 during the firing stroke. Firing assembly 5630 can include firing bar 5632, cutting edge 5636, crossbar 5638, and foot 5644. Cutting edge 5636 can cut tissue and / or cut tissue thickness compensator 5758 as firing assembly 5630 is fired through second jaw 5702 during the firing stroke. The crossbar 5638 can engage a slot in the anvil of the first jaw to hold the first jaw relative to the cartridge body 5750 and the foot 5644 can be, for example, the second jaw To hold firing assembly 5630 against portion 5702, a slot in second jaw 5702, such as slot 5756 in cartridge body 5750, can be engaged. In various embodiments, the crossbar 5638 and the foot 5644 can hold a cutting edge 5636 that is perpendicular to the deck 5752 of the fastener cartridge 5750, for example.

  With continued reference to FIG. 94, the tissue thickness compensator 5758 can include a cartridge contact surface 5762 and a tissue contact surface. The cartridge contact surface 5762 can be positioned relative to the cartridge deck 5752 when, for example, the tissue thickness compensator 5758 is clamped to the cartridge body 5750 and / or the second jaw 5702. Moreover, the tissue contacting surface can be positioned relative to the tissue, for example, when the tissue is clamped between the first jaw and the second jaw 5702. In various embodiments, the tissue thickness compensator 5758 can include a mount 5760. The mount 5760 can be, for example, a protrusion, pin, tab, and / or strut that can extend from the cartridge contact surface 5762 of the tissue thickness compensator 5758. The mount 5760 can be aligned with, or at least substantially aligned with, the opening 5784 in the bridge 5780, for example, when the tissue thickness compensator 5758 is positioned relative to the cartridge body 5750. Moreover, the mount 5760 can extend at least partially into the opening 5782 when the cartridge contacting surface 5762 of the tissue thickness compensator 5758 is positioned adjacent to the deck 5752 of the cartridge body 5750. . In various embodiments, the mount 5760 can be friction fitted into the opening 5782 when the tissue thickness compensator 5758 is clamped to the cartridge body 5750. The mount 5760 can hold and / or tighten the tissue thickness compensator 5758 against the cartridge body 5750 and / or the second jaw 5702. For example, the cartridge contact surface 5762 can be positioned relative to the deck 5752 of the cartridge body 5750 when the mount 5760 is friction fitted into the opening 5882 of the bridge 5780.

  In various embodiments, the fastener cartridge 5750 can include a plurality of bridges 5780 that extend beyond the slots 5756 of the cartridge body 5750. The bridges 5780 can be spaced along at least a portion of the length of the slot 5756, for example. For example, the slot 5756 can be a longitudinal slot that extends from the proximal portion 5704 of the second jaw 5702 to the distal portion 5706. Moreover, in various embodiments, the tissue thickness compensator 5758 can include a plurality of mounts 5760 that can be aligned with the bridge 5780 of the cartridge body 5750. For example, at least one mount 5760 can be positioned within the proximal portion 5704 of the second jaw 5702 when the tissue thickness compensator 5758 is positioned relative to the cartridge body 5750, and at least one One mount 5760 may be positioned within the distal portion 5706 of the second jaw 5702. In various embodiments, the mounts 5760 can be spaced along at least a portion of the length of the tissue thickness compensator 5758. The mount 5760 can be friction fitted into the slot 5756, for example, and the tissue thickness compensator 5758 can be clamped to the cartridge body 5750 and / or the second jaw 5702.

  With continued reference to FIG. 94, the cutting edge 5636 of the firing assembly 5630 moves between the first and second jaws 5702 of the end effector assembly 5700 as the firing assembly 5630 moves along the slot 5756 during the firing stroke. The tissue thickness compensator 5758 and / or tissue clamped therebetween may be cut. In addition, firing assembly 5630 can split bridge 5780 as firing assembly 5630 moves through slot 5756. For example, the cutting edge 5636 of the firing assembly 5630 can break or cut the bridge 5780 as the firing assembly moves along the slot 5756. In various embodiments, the cutting edge 5636 can continuously cut each bridge 5780 as the firing assembly 5630 moves within the slot 5756 during the firing stroke. When the bridge 5780 is cut or broken by the cutting edge 5636, the tissue thickness compensator 5758 can be clamped and / or released from the cartridge body 5750. In certain embodiments, the cutting edge 5636 can break or cut the mount 5760 aligned with the cutting edge during the firing stroke. In various embodiments, another element of the sled and / or firing assembly 5630 can break or cut the bridge 5780 to release the tissue thickness compensator 5758 from the cartridge body 5750.

  Referring now to FIGS. 95 and 96, the end effector assembly 5800 can include a first jaw shown elsewhere and a second jaw 5802, similar to the end effector assembly 5600. . In various embodiments, the second jaw 5802 includes a fastener cartridge body 5850 and a tissue thickness compensator 5858 releasably clamped to the cartridge body 5850 and / or the second jaw 5802. it can. In certain embodiments, the fastener cartridge body 5850 and the tissue thickness compensator 5858 releasably clamped to the fastener cartridge body can constitute a fastener cartridge assembly. Similar to the cartridge body 5650, the cartridge body 5850 is positioned around at least a portion of the cartridge deck 5852, a fastener cavity 5854 defined in the cartridge deck 5852 and configured to receive fasteners. And a slot 5856 that can extend from the proximal portion 5804 of the second jaw 5802 to the distal portion 5806 of the second jaw 5802. In various embodiments, the cartridge body 5850 can include a bridge 5880 that extends across the slot 5856 or at least partially beyond the slot 5856. Pledget 5880 can be, for example, a fragile and / or splittable bridge. In certain embodiments, the bridge 5880 can include a first leg 5884 and a second leg 5886. Referring primarily to FIG. 96, the first leg 5884 can extend, for example, from the first side of the cartridge body 5850 into the slot 5856, and the second leg 5886 is the cartridge body 5850. Can extend into the slot 5856 from its second side. The first leg 5884 and the second leg 5886 can be angled with respect to the axis of the slot 5856, for example, the first leg 5884 is approximately 90 relative to the second leg 5886. The angle can be tilted by a degree. In certain embodiments, the first leg 5884 and / or the second leg 5886 can be distorted. In certain embodiments, the bridge 5880 can include a cap between, for example, the first leg 5884 and the second leg 5886.

  Still referring to FIGS. 95 and 96, in various embodiments, the firing assembly 5630 can translate along the slot 5856 of the cartridge body 5850. For example, firing assembly 5630 can translate along slot 5856 during the firing stroke and can release fasteners from fastener cavity 5854 during the firing stroke. Firing assembly 5630 can include firing bar 5632, cutting edge 5636, crossbar 5638, and foot 5644. Cutting edge 5636 can cut tissue and / or cut tissue thickness compensator 5858 as firing assembly 5630 is fired through second jaw 5802 during the firing stroke. A crossbar 5638 can engage a slot in the anvil of the first jaw to hold the first jaw relative to the cartridge body 5850, and the foot 5644 can be, for example, the second jaw. To hold firing assembly 5630 against portion 5802, a slot in second jaw 5802, such as slot 5856 in cartridge body 5850, can be engaged. In various embodiments, the crossbar 5638 and the foot 5644 can hold a cutting edge 5636 that is perpendicular to the deck 5852 of the fastener cartridge 5850, for example.

  With continued reference to FIGS. 95 and 96, the tissue thickness compensator 5858 can include a cartridge contacting surface 5862 and a tissue contacting surface. The cartridge contact surface 5862 can be positioned relative to the cartridge deck 5852 when, for example, the tissue thickness compensator 5858 is clamped to the cartridge body 5850 and / or the second jaw 5802. Moreover, the tissue contacting surface can be positioned relative to the tissue, for example, when the tissue is clamped between the first jaw and the second jaw 5802. In various embodiments, the tissue thickness compensator 5858 can include a fixture 5860. Similar to the fixture 5760, the mount 5860 can be, for example, a protrusion, pin, tab, and / or strut that can extend from the cartridge contacting surface 5862 of the tissue thickness compensator 5858. The mount 5860 can be aligned with the gap between the legs 584, 5886 of the bridge 5880 when, for example, the tissue thickness compensator 5858 is positioned relative to the cartridge body 5850. Moreover, the mount 5860 can be held by the legs 584, 5886 of the bridge 5880 when the cartridge contacting surface 5862 of the tissue thickness compensator 5858 is positioned adjacent to the deck 5852 of the cartridge body 5850. In various embodiments, the mount 5860 can be friction fitted into the gap between the legs 5884, 5886 when the tissue thickness compensator 5858 is clamped to the cartridge body 5850. The mount-bridge engagement of the second jaw 5802 can hold the tissue thickness compensator 5858 relative to the cartridge body 5850. For example, the cartridge contact surface 5862 can be held against the deck 5852 of the cartridge body 5850 when the mount 5860 is friction fitted between the legs 584, 5886 of the bridge 5880.

  In various embodiments, primarily referring to FIG. 95, the fastener cartridge 5850 can include a plurality of bridges 5880 that extend beyond the slots 5856 of the cartridge body 5850. The bridges 5880 can be spaced along at least a portion of the length of the slot 5856, for example. For example, the slot 5856 can be a longitudinal slot that extends from the proximal portion 5804 to the distal portion 5806 of the second jaw 5802. Moreover, in various embodiments, the tissue thickness compensator 5858 can include a plurality of mounts 5860 that can be aligned with the bridge 5880 of the cartridge body 5850. For example, at least one mount 5860 may be positioned within the proximal portion 5804 of the second jaw 5802 when the tissue thickness compensator 5858 is positioned relative to the cartridge body 5850 and / or the second jaw 5802. The at least one mount 5860 can be positioned within the distal portion 5806 of the second jaw 5802. In various embodiments, the mounts 5860 can be spaced along at least a portion of the length of the tissue thickness compensator 5858. The mount 5860 can be friction fitted into the bridge 5880, for example, and the tissue thickness compensator 5858 can be clamped to the cartridge body 5850.

  With continued reference to FIGS. 95 and 96, the cutting edge 5636 of the firing assembly 5630 may be configured such that the first and second jaws 5802 of the end effector assembly 5800 when the firing assembly 5630 moves along the slot 5856 during the firing stroke. Tissue thickness compensator 5858 and / or tissue clamped between and can be cut. Moreover, firing assembly 5630 can split bridge 5880 as firing assembly 5630 moves through slot 5856. For example, the cutting edge 5636 of the firing assembly 5630 can distort or split the legs 5884, 5886 of the bridge 5880 as the firing assembly 5630 moves through the slot 5856. In various embodiments, the cutting edge 5636 can continuously distort the legs 584, 5886 of each bridge 5880 and split the bridge 5880 as the firing assembly 5630 moves within the slot 5856 during the firing stroke. When the legs 584, 5886 of the bridge 5880 are distorted by the cutting edge 5636, the bridge 5880 can release the corresponding mount 5860 of the tissue thickness compensator 5858. The tissue thickness compensator 5858 can be clamped and / or released from the cartridge body 5850 when each mount 5860 is released from each bridge 5880 along the length of the cartridge body 5850. In certain embodiments, the cutting edge 5636 can cut or break the mount 5860 aligned with the cutting edge during the firing stroke. In various embodiments, another element of the sled and / or firing assembly 5630 can divide the bridge 5880 to release the tissue thickness compensator 5858 from the cartridge body 5850.

  97-100, the end effector assembly 5900 includes a first jaw or anvil 5910 (FIGS. 99 and 100) and a second jaw 5902, similar to the end effector assembly 5600. Can do. In various embodiments, the second jaw 5902 includes a fastener cartridge body 5950 and a tissue thickness compensator 5958 releasably clamped to the fastener cartridge body 5950 and / or the second jaw 5902. be able to. In certain embodiments, the fastener cartridge body 5950 and the tissue thickness compensator 5958 releasably clamped to the fastener cartridge body may comprise, for example, a fastener cartridge assembly. Referring primarily to FIG. 98, the fastener cartridge body 5950 can have a cartridge deck 5952 and a cavity defined within the cartridge deck 5962. Mount cavity 5948 and / or fastener cavity 5954 may be defined within cartridge deck 5952, for example. In various embodiments, the mount cavity 5948 and the fastener cavity 5954 can have the same or similar structure and / or geometry. Second jaw 5902 can include a fastener, such as, for example, a surgical staple that can be releasably positioned within fastener cavity 5954. In certain embodiments, the cartridge body 5950 can include a slot 5956 that can extend from the proximal portion 5904 of the second jaw 5902 toward the distal portion 5906 of the second jaw 5902. .

  Still referring to FIGS. 97-100, in various embodiments, the firing assembly 5630 can translate along the slot 5956 of the cartridge body 5950 during the firing stroke and from the fastener cavity 5954 during the firing stroke. Can be released. Cutting edge 5636 may cut tissue and / or cut tissue thickness compensator 5958 as firing assembly 5630 is fired through end effector assembly 5900 during the firing stroke. Crossbar 5638 can engage slot 5912 in anvil 5910 (FIGS. 99 and 100) to hold the first jaw relative to cartridge body 5950, and foot 5644 can be, for example, a second To hold the firing assembly 5630 against the jaw 5902, a slot in the second jaw 5902, such as a slot 5956 in the cartridge body 5950, can be engaged. In various embodiments, the crossbar 5638 and the foot 5644 can hold a cutting edge 5636 that is perpendicular to the deck 5952 of the fastener cartridge 5950, for example.

  With continued reference to FIGS. 97-100, the tissue thickness compensator 5958 can include a cartridge contact surface 5962 (FIG. 97) and a tissue contact surface 5964 (FIGS. 98 and 99). The cartridge contact surface 5962 can be positioned relative to the cartridge deck 5952 when, for example, the tissue thickness compensator 5958 is clamped to the cartridge body 5950 and / or the second jaw 5902. Moreover, the tissue contacting surface 5964 can be positioned relative to the tissue when, for example, the tissue is clamped between the anvil 5910 and the second jaw 5902. In various embodiments, the tissue thickness compensator 5958 can include a mount 5960. Similar to mount portion 5760 and mount portion 5860, for example, mount portion 5960 is, for example, a protrusion, pin, tab portion, and / or strut that can extend from cartridge contact surface 5962 of tissue thickness compensator 5958. Can be. In certain embodiments, the tissue thickness compensator 5958 can include a recess 5970 that can be adjacent to the mount 5960, for example. The recess 5970 can be aligned vertically with the mount 5970, for example. Referring primarily to FIG. 99, the recess 5970 can be defined in the tissue contacting surface 5964 of the tissue thickness compensator 5958 and can extend toward the mount 5960. In various embodiments, a slice of tissue thickness compensator 5958 can be positioned between recess 5970 and mount 5960, for example.

  The mount 5960 can be aligned with the mount cavity 5948 in the cartridge deck 5952 when, for example, the tissue thickness compensator 5958 is positioned relative to the cartridge body 5950. In addition, the mount 5960 can be positioned within the mount cavity 5948 when the cartridge contacting surface 5962 of the tissue thickness compensator 5958 is positioned adjacent to the deck 5952 of the cartridge body 5950. In various embodiments, the mount 5960 can be friction fitted into the mount cavity 5948 when the tissue thickness compensator 5958 is clamped to the cartridge body 5950. The friction fit engagement between the mount 5960 and the mount cavity 5948 can retain at least a portion of the tissue thickness compensator 5958 relative to the cartridge body 5950. For example, the cartridge contact surface 5962 can be held against the deck 5952 of the cartridge body 5950 when the mount 5960 is friction fitted within the mount cavity 5948.

  Referring primarily to FIGS. 97 and 98, the fastener cartridge 5950 can include a plurality of mounting cavities 5948 defined in the cartridge deck 5952. In certain embodiments, corresponding mount cavities 5948 can be defined in the cartridge deck 5952 on either side of the slot 5956. The first mount portion cavity 5948 can be defined, for example, on a first longitudinal side of the cartridge body 5950, and the corresponding second mount portion cavity 5948 can be, for example, a second longitudinal portion of the cartridge body 5950. It can be defined on the directional side. For example, a first corresponding mount cavity 5948 pair can be positioned within the proximal portion 5904 of the second jaw 5902 and / or a second corresponding mount cavity 5948 pair. Can be positioned within the distal portion 5906 of the second jaw 5902. In various embodiments, the fastener cavities 5954 are mounted between corresponding pairs of mount cavities 5948, ie, closer to the slot 595 and in the proximal portion 5904 of the second jaw 5902. Between the pair of upper cavities 5948 and the pair of mount cavities 5948 in the distal portion 5906 of the second jaw 5902, ie, in the middle portion of the cartridge body 5950. Moreover, in various embodiments, the tissue thickness compensator 5958 can include a plurality of mounts 5960 that can be aligned with the mount cavities 5948 of the cartridge body 5950. For example, at least one mount 5960 can be positioned within the proximal portion 5904 of the second jaw 5902 and the at least one mount 5960 can be within the distal portion 5906 of the second jaw 5902. Can be positioned. In various embodiments, the pair of mounts 5960 can be positioned within the proximal portion 5904 of the second jaw 5902 and the pair of mounts 5960 can be positioned at the distal portion of the second jaw 5902. 5906 may be positioned. The fitting 5960 can be friction fitted into the mount cavity 5948, for example, and at least a portion of the tissue thickness compensator 5958 can be clamped to the cartridge body 5950.

  Referring primarily to FIGS. 99 and 100, the mount 5960 can be removed from the mount cavity 5948 during the firing stroke. In various embodiments, a driver 5920 movably positioned within the mount cavity 5948 can eject the mount 5960 from the mount cavity 5948 during a firing stroke. For example, a driver 5920 can be positioned within each mount cavity 5948. During the firing stroke, elements of firing assembly 5630 and / or sleds in second jaw 5902, for example, move driver 5920 toward cartridge deck 5952 and / or toward tissue thickness compensator 5958. The driver 5920 can be engaged with the driver. As the driver 5920 moves, the driver 5920 can, for example, push a mount 5960 positioned within the mount cavity 5948 into the deck 5952 and / or press against the tissue thickness compensator 5958. In various embodiments, a recess 5970 defined in the tissue thickness compensator 5958 corresponding to the depressed mount 5960 can receive the depressed mount 5960. For example, the driver 5920 can push the mount 5960 into the recess 5970. The mount 5960 may be crushed, deformed, and / or compressed into the recess 5970, for example. The tissue thickness compensator 5958 can be clamped and / or released from the cartridge body 5950 when the mount 5960 is removed from the mount cavity 5960 and pushed into the corresponding recess 5970 during the firing stroke.

  In various embodiments, referring now to FIGS. 62-66, the staple cartridge 13000 includes a cartridge body 13010, a tissue thickness compensator 13020, and a tissue thickness compensator 13020 as described in more detail below. A plurality of fireable connectors configured to releasably hold relative to 13010. The cartridge body 13010 can comprise a proximal end 13011, a distal end 13012, and a deck 13015 configured to support a tissue thickness compensator 13020. The cartridge body 13010 can include one or more proximal stops 13013 that extend from the cartridge body and can be configured to prevent or resist proximal movement of the tissue thickness compensator 13020. Similarly, the cartridge body 13010 can include one or more distal stops 13014 that can be configured to prevent or resist proximal movement of the tissue thickness compensator 13020. Referring primarily to FIG. 63, the cartridge body 13010 can further comprise a plurality of staple cavities 13016 defined within the cartridge body. In various embodiments, the staple cartridge 13000 can include a plurality of connectors 13030 and 13040 configured to releasably hold the tissue thickness compensator 13020 relative to the cartridge body 13010. Each connector 13030 includes, for example, a plurality of cavity plugs 13031 that are positionable within the staple cavity 13016 and a connection bar 13032 that extends between the cavity plugs 13031 and over the tissue thickness compensator 13020. Can do. The cavity plug 13031 can fit snugly within the staple cavity 13016 in at least one embodiment. In certain embodiments, the cavity plug 13031 can be press fit and / or snapped into the staple cartridge 13016. Each connector 13040 can include, for example, a cavity plug 13031 and a head 13042 extending from the cavity plug, the head 13042 extending at least partially over the tissue thickness compensator 13020. Can do. Referring again to FIG. 63, a tissue thickness compensator 13020 extending from the proximal connector 13030 is defined, for example, at the proximal end 13021 of the tissue thickness compensator 13020 and configured to receive the cavity plug 13031. A set of proximal notches 13023, an intermediate notch 13024 configured to receive a cavity plug 13031 extending from the intermediate connector 13040, respectively, and a distal end 13022 of the tissue thickness compensator 13020 are defined. And a set of distal notches 13025 configured to receive a cavity plug 13031 extending from the distal connector 13030.

  In use, a thread, or firing member, can be advanced distally through the staple cartridge 13000 to release staples positioned within the staple cavity 13016. In various embodiments, the staple cavity 13016 with the staples positioned therein may not have the cavity plug 13031 inserted. In certain embodiments, a staple cavity having a cavity plug 13031 positioned therein may not have a staple positioned therein. In some embodiments, although not shown, the staple cavity may have fasteners and cavity plugs 13031 positioned therein. Referring now to FIGS. 65 and 66, the staple cartridge 13000 may further comprise a plurality of staple drivers 13050 that support, for example, staples in an unfired position. As the firing member is advanced distally, eg, through the staple cartridge, the firing member faces the staple driver 13050 and staples upward, ie toward the deck 13015 of the cartridge body 13010 and the tissue thickness. It can be lifted towards an anvil positioned opposite the compensator 13020. Similarly, at least a portion of the staple driver 13050 can contact a cavity plug 13031 positioned within a portion of the staple cavity 13016 and lift the cavity plug toward the anvil. When the staples are lifted upward by the staple driver 13050, the staple legs pass through the tissue thickness compensator 13020 through the tissue positioned between the tissue thickness compensator 13020 and the anvil and on the opposite side of the tissue. A positioned anvil can be contacted. The staple driver 13050 can then drive the staples against the anvil such that the staples are deformed to capture the tissue thickness compensator 13020 and tissue therein. When the cavity plug 13031 is lifted upward by the driver 13050, the anvil may resist upward movement of the cavity plug 13031. Under such circumstances, referring primarily to FIG. 63, the cavity plug 13031 may deform, distort, and / or break. In certain embodiments, the cavity plug 13031 includes one or more notches that can cause deformation, distortion, and / or failure of the cavity plug 13031, for example, at specific locations within the notches. Can do. In various situations, the entire cavity plug 13031, or at least substantially the entire, may be ejected from the staple cavity 13016 by the staple driver 13050. At such time, the connectors 13030 and / or 13040 may no longer connect the tissue thickness compensator 13020 to the cartridge body 13010, so that the cartridge body 13010 is separated from the tissue thickness compensator 13020 embedded in the tissue. Can be done.

  In use, in addition to the above, the firing member can be advanced from the proximal end 13011 of the staple cartridge 13000 toward the distal end 13012. The cartridge body 13010 can include a longitudinal slot 13019 configured to slidably receive at least a portion of the firing member therein. As the firing member is advanced distally, the firing member releases the staples positioned in the most proximal staple 13016 and then fires the most proximal connector 13030. Can do. The firing of the most proximal connector 13030 can release the proximal end 13021 of the tissue thickness compensator 13020 from the cartridge body 13010. In other embodiments, the firing member can fire the most proximal connector before firing any staples. In any case, the firing member can be further advanced distally to release the staples from the staple cavity 13016 and thereafter the intermediate connector 13040 can be fired. At such time, only the most distal connector 13030 may remain intact, holding the tissue thickness compensator 13020 against the cartridge body 13010. When firing the connector 13030 with the firing member furthest distal, the tissue thickness compensator 13020 may no longer be attached to the cartridge body 13010. The above sequence describes a fully or fully fired staple cartridge. Other situations may occur where less than all of the staples contained in the staple cartridge are fired. Under such circumstances, a portion of the connector that holds the tissue thickness compensator 13020 relative to the cartridge body 13010 may not be fired. When partial use of the staple cartridge 13000 is complete, the anvil may be opened and the cartridge body 13010 may be pulled away from the partially implanted tissue thickness compensator 13020. In such a situation, the unfired connector may be configured to exit the staple cavity 13016 even if not yet fired. In any event, connectors 13030 and 13040 may be constructed of any suitable biocompatible and / or bioabsorbable material, for example.

  In addition to the above, the firing member may be configured to cut the tissue thickness compensator 13020 and tissue laterally, for example, as the firing member is advanced distally through the staple cartridge 13000. May contain parts. In such a situation, the cutting portion may be further configured to cut the connection bar 13032 of the connector 13030 laterally.

  In various embodiments, referring now to FIGS. 101 and 102, a staple cartridge 10800 comprising a support portion 10810 and a tissue thickness compensator 10820 can be loaded into a staple cartridge channel using, for example, a staple cartridge applicator 10880. . Similar to the above, the staple cartridge applicator 10880 may be, for example, such as an anvil 10060 so that the anvil 10060 can contact and engage the tissue thickness compensator 10890 when the anvil 10060 is closed. It may be further configured to position the upper tissue thickness compensator 10890 relative to the anvil. In at least one embodiment, the tissue thickness compensator 10890 can engage the anvil 10060 and from the top surface 10891 of the tissue thickness compensator 10890 that can releasably hold the tissue thickness compensator 10890 relative to the anvil 10060. A plurality of retaining legs 10895 can be provided. In at least one such embodiment, the legs 10895 can be arranged in a longitudinal row, with each leg 10895 entering and engaging a knife slot 10065 defined within the anvil 10060. At least one foot. In certain embodiments, some of the legs of leg 10895 can extend in one direction and the other legs can extend in another direction. In at least one embodiment, some of the feet can extend in opposite directions.

  In any event, once the anvil 10060 engages the tissue thickness compensator 10890, referring now to FIGS. 102 and 103, the anvil 10060 can be reopened, and the clinician can remove the tissue thickness compensator 10820 and 10890 from The staple cartridge applicator 10880 can be released. Thereafter, referring to FIG. 104, the upper tissue thickness compensator 10890 can be positioned on the first side of the target tissue and the tissue thickness compensator 10820, which can comprise the lower tissue thickness compensator, Can be positioned on the second side. After the tissue thickness compensators 10820 and 10890 are properly positioned, referring now to FIG. 105, the cutting edge of a firing member, such as the cutting edge 10053, can be advanced through the tissue and tissue thickness compensator.

  In various embodiments, referring now to FIG. 106, for example, a staple cartridge applicator, such as applicator 12280, can comprise a tissue thickness compensator 12290 removably mounted on the applicator, which The tissue thickness compensator can be inserted into the staple cartridge channel and engaged by the anvil 10060 when it is in the closed position, as shown in FIG. 106A, as described above. The applicator 12280 may include a handle 10084 that positions the compensator 12290 relative to the staple cartridge. In addition, the applicator 10084 may include a plurality of legs 10081 that may clamp the compensator 12290 to the staple cartridge. In at least one such embodiment, the tissue thickness compensator 12290 can comprise a plurality of retention members 12295 extending upward from the top surface 12291 of the tissue thickness compensator 12290, each retention member 12295 being A plurality of flexible legs 12296 may be provided that may be configured to be inserted into knife slots 10065 in anvil 10060. Referring primarily to FIGS. 107 and 108, the flexible leg 12296 of each retaining member 12295 allows the leg 12296 to flex inward as the leg 12296 is inserted into the knife slot 10065; Thereafter, the enlarged sides of the flexible legs 12296 can be separated by a gap 12298 so that they can be resiliently restored outward as they pass through the knife slot 10065. In various embodiments, the enlarged foot of the flexible leg 12296 can be deflected to the back of the opposite retaining lip 12297 defined within the anvil 10060, and the leg 12296 and lip As a result of the 12297 interaction, the tissue thickness compensator 12290 can be retained relative to the anvil 10060. Thereafter, the staple cartridge applicator 12280 can be moved away from the tissue thickness compensator 12290, as shown in FIG. 106B. In use, when the tissue thickness compensator 12290 is implanted into the tissue with staples deployed from the staple cartridge 10000, for example, the anvil 10060 can be reopened and separated from the implanted tissue thickness compensator 12290. As such, the legs 12296 of the retention member 12995 can flex inward so that it can be withdrawn from the knife slot 10065.

  As outlined above, the end effector assembly can include a staple cartridge, an anvil, and at least one piece of buttress material positioned intermediate the staple cartridge and the anvil. In at least one embodiment, referring now to FIGS. 109-111, a piece of buttress material, such as buttress material 336, of the staple cartridge 322 to releasably retain the piece of buttress material within the end effector. Can be configured to snap fit to at least one of the two and / or an anvil (not shown). Referring to FIGS. 110 and 111, the staple cartridge 322 can include a first sidewall 302 and a second sidewall 304, at least one of the first sidewall and the second sidewall extending outward. A tip 306 can be included. In various embodiments, the buttress material 336 includes a first edge or side 308, a second edge or side 310, and at least one lip that extends at least partially along the length of the edges 308 and 310. Part 312. In at least one embodiment, referring to FIG. 111, the lip 312 is configured to engage the lip 306 in a snap-fit manner to maintain the buttress material 336 releasably with respect to the staple cartridge 322. Can be done.

  In addition to the above, referring to FIG. 111, buttress material 336 can include a surface 316 that can be configured to be positioned adjacent or in contact with deck 328 of staple cartridge 322. In at least one embodiment, the side edges 308 and 310 can comprise sidewalls that can extend perpendicular or transverse to the surface 316. In such an embodiment, the lip 312 can extend from these sidewalls so that the lip 312 can be interlocked on the back side of the lip 306 of the staple cartridge 322. In various embodiments, the lip 312 of the buttress material 336 can be disengaged from the lip 306 of the staple cartridge 322 when the staple is deployed from the staple cartridge 322. More particularly, when the staples are deployed, the staples can contact the buttress material 336, apply an upward force to the buttress material 336, and remove the buttress material 336 from the staple cartridge 322. Advantageously, as a result, the buttress material 336 is automatically disengaged from the staple cartridge 322 when the staple is deployed from the staple cartridge and / or when the end effector is opened, as described above. Sometimes.

  In various embodiments, referring to FIGS. 110 and 111, a piece of buttress material extends from the piece and can be configured to releasably maintain the buttress material in one of the staple cartridge and / or anvil. One member can be included. In at least one embodiment, member 318 can extend from buttress material 336 in a direction that is perpendicular or parallel to surface 316. In various embodiments, the member 318 includes a staple cavity 320 and / or anvil pocket in a friction fit or pressure fit manner to releasably hold the buttress piece against one of the staple cartridge and the anvil. Can be engaged with one of the two. Similar to the above, in various embodiments, staples deployed from staple cavities 320 can apply an upward force to buttress material 336 and disengage member 318 from staple cavities 320. In various embodiments, the staple can be pierced through member 318 and / or buttress material 336 to clamp the buttress material to the tissue, as outlined above.

  As shown in FIG. 110, the piece of buttress material may include two or more members or guards extending from the buttress material to hold the piece of buttress material against one of the staple cartridge and the anvil. it can. In various embodiments, referring now to FIGS. 112 and 113, two or more members 318 'can extend from a piece of buttress material 336', for example. In at least one embodiment, the member 318 ′ enters the staple cavity 320 ′ of the staple cartridge 322 ′ so that the member can frictionally hold a piece of buttress material against the staple cartridge and / or anvil as outlined above. And / or may be pressure fitted into the anvil pocket (not shown) of the anvil. As described in more detail herein, staple cartridges and / or anvils receive protrusions or retaining members extending from pieces of buttress material in addition to staple cavities of staple cartridges and anvil pockets of anvils. Slots or openings can be included in the staple cartridge and / or anvil.

  In certain embodiments, as will be described in detail below, the support portion may be configured to gradually release the tissue thickness compensator from the support portion as the staples are gradually fired from the staple cartridge. Things can be provided. Referring now to FIG. 114, for example, a staple cartridge, such as staple cartridge 11200, can be configured to releasably hold tissue thickness compensator 11220 (FIG. 115) against support portion 11210. A support portion 11210 can be provided. In various embodiments, a retention feature 11213 can be positioned at the end of each staple cavity 11212, for example, and each retention feature 11213 is defined in the retention feature and staples of staples 10030. A guide groove 11216 configured to slidably receive the leg 10032 may be provided. In such an embodiment, both staple leg 10032 and retention feature 11213 may be configured to releasably retain tissue thickness compensator 11220 on support portion 11210.

  In use, and referring now to FIG. 115, the staple driver 10040 housed within the support portion 11210 can be driven upward by the sled 10050 as described above, and the staple driver 10040 can be held by the retention feature 11213. , And at least partially decouple the retention feature 11213 from the support portion 11210 and move the retention feature 11213 outward and away from the staple 10030 and the staple cavity 11212. When the retention feature 11213 is disconnected from the support portion 11210 and / or moved outward, the retention feature 11213 can no longer hold the tissue thickness compensator 11220 against the support portion 11210. As a result, the tissue thickness compensator 11220 can be released from the support portion 11210. Similar to the above, the tissue thickness compensator 11220 can be gradually released from the support portion 11210 as the staple 10030 is gradually released from the staple cartridge toward an anvil, eg, an anvil 11260. In various embodiments, the staple driver 10040 contacts the retention feature 11213 when, for example, the top surface of the staple driver 10040 is flush with, or at least substantially flush with, the deck surface 11211 of the support portion 11210. There are things to do. In such an embodiment, the tissue thickness compensator 11220 may be released from the support portion 11210 at the same time and / or just prior to the staple 10030 being molded into a fully molded or fully fired configuration.

  In at least one such embodiment, primarily referring to FIG. 116, the driver 10040 can be overdriven so that the driver is pushed over the deck surface 11211 to fully form the staple 10030. During the overdriven process, the retention feature 11213 away from the support portion 11210 can be destroyed. In various embodiments, referring again to FIG. 115, the retaining feature 11213 is separated or outwardly so that the driver 10040 contacts the retaining feature 11213 just as the driver 10040 reaches the deck surface 11211. May be spread over or over the staple cavities 11212 before being moved to. In any case, once the tissue thickness compensator 11220 is released from the support portion 11210, referring now to FIG. 116, the support portion 11210 can be moved away from the implanted tissue thickness compensator 11220.

  Referring now to FIG. 117, a fastener cartridge assembly 6002 for use with an end effector assembly can include a cartridge body 6050 and a tissue thickness compensator 6058 releasably clamped to the cartridge body. Similar to cartridge body 5650, for example, cartridge body 6050 includes a slot 6056 configured to guide the firing assembly and / or a fastener configured to removably retain a fastener within cartridge body 6050. Tool cavity 6054. In various embodiments, the cartridge body 6050 can include protrusions 6048 such as struts, mounts, tabs, and / or collars, for example. The protrusion 6048 can extend from the cartridge deck of the cartridge body 6050 into the tissue thickness compensator 6058 when the tissue thickness compensator 6058 is positioned relative to the cartridge deck. In various embodiments, the cartridge body 6050 can include a plurality of protrusions 6048 extending from the cartridge deck. The protrusion 6048 can be positioned, for example, along the length of the cartridge body 6050, for example, between adjacent fastener cavities 6054.

  With continued reference to FIG. 117, in various embodiments, the tissue thickness compensator 6058 can be thermoformed around the protrusion 6048 of the tissue thickness compensator 6058. For example, the tissue thickness compensator 6058 can be positioned relative to the cartridge deck of the cartridge body 6050. Once positioned, the tissue thickness compensator 6058 is deformed to accommodate the shape of the cartridge deck, including the shape of the protrusion 6048 that extends from the tissue thickness compensator 6058. And can be heated to a sufficient temperature. The tissue thickness compensator 6058 can be, for example, locally heated and can reach a temperature that is near and / or close to the glass transition temperature of the material comprising the tissue thickness compensator 6058, for example. The tissue thickness compensator can be heated to, for example, approximately 90 degrees Celsius, approximately 120 degrees Celsius. In certain embodiments, the tissue thickness compensator can be heated to, for example, approximately 75 degrees Celsius, approximately 150 degrees Celsius. As the tissue thickness compensator 6058 deforms to fit around the protrusion 6048, the heat source can be removed or reduced and the tissue thickness compensator 6058 can cool. The tissue thickness compensator 6058 may be exposed to elevated temperatures for approximately 2 seconds, approximately 5 seconds, for example, to achieve sufficient deformation around the protrusion 6048. In other situations, the tissue thickness compensator 6058 may be exposed to elevated temperatures for approximately 1 second, approximately 10 seconds, for example, to achieve sufficient deformation around the protrusion 6048. is there. As it cools, the tissue thickness compensator 6058 can, for example, shrink closer to and around the protrusion 6048 and / or more tightly. In various embodiments, the heat-deformed tissue thickness compensator 6058 is laterally shifted and / or seated between the fastener cavities 6054 and along the length of the cartridge body 6050. Bending can be prevented and / or limited.

  Additionally or alternatively, the tissue thickness compensator 6058 can be thermoformed around at least a portion of a fastener that is removably positioned within the fastener cavity 6054. For example, the tissue thickness compensator 6058 can be thermoformed around the legs of the staples that extend over the cartridge deck. With continued reference to FIG. 117, in various embodiments, the fastener cartridge assembly 6002 can include a cover or shell 6060 around at least a portion of the cartridge body 6050. The shell 6060 can extend around, for example, the bottom surface, side surfaces, and / or the cartridge deck of the cartridge body 6050. The shell 6060 can be fastened to the cartridge body 6050 by, for example, a pin 6062. Moreover, in various embodiments, the shell 6060 can comprise a metallic material such as, for example, stainless steel 300, stainless steel 400 series, titanium, and / or medical grade aluminum. The metal shell 6060 can facilitate heat conduction in the cartridge body 6050 and / or the protrusion 6048, for example, to improve the thermoforming effect.

  Referring now to FIG. 118, a fastener cartridge assembly 6102 for use with an end effector assembly can include a cartridge body 6150 and a tissue thickness compensator 6158 releasably clamped to the cartridge body. Similar to the cartridge body 5650, the cartridge body 6150 includes, for example, a slot 6156 configured to guide the firing assembly and a fastener configured to removably retain a fastener within the cartridge body 6150, for example. A cavity 6154. The cartridge body 6150 can further include a collar 6146 similar to the collar 5648 extending from the cartridge deck 6152. The collar 6146 can extend around at least a portion of the fastener cavity 6154, for example. In various embodiments, the tip of the fastener can protrude from the fastener cavity 6148 when the fastener is positioned within the fastener cavity 6154. In such an embodiment, the ridge 6146 positioned at least partially around the fastener cavity 6154 supports and / or guides the tip of the fastener when the fastener is released from the fastener cavity 6154. can do. In various embodiments, the cartridge body 6150 can include a plurality of collars 6146 that at least partially surround the fastener cavity 6154. For example, the collar 6146 can extend around at least the proximal and / or distal end of each fastener cavity 6154.

  With continued reference to FIG. 118, in various embodiments, the fastener cartridge assembly 6102 can include a cover or shell 6160 similar to the shell 6060 positioned, for example, around at least a portion of the cartridge body 6150. . The shell 6160 can, for example, extend around the bottom surface and / or side surface of the cartridge body 6150 and can be clamped to the cartridge body 6150 by pins 6162, for example. In various embodiments, the shell 6160 can include protrusions 6148, such as struts, mounts, tabs, and / or collars, for example. The protrusion 6148 can extend to the back side of the cartridge deck 6152 of the cartridge body 6150. In various embodiments, the protrusion 6148 can extend into the tissue thickness compensator 6158 when the tissue thickness compensator 6158 is positioned relative to the cartridge deck. In various embodiments, the shell 6160 can include a plurality of protrusions 6148 extending from the shell. The protrusion 6148 can be positioned, for example, along the length of the shell 6160 and, for example, around the periphery of the cartridge body 6150.

  Similar to the tissue thickness compensator 6058, the tissue thickness compensator 6158 can be thermoformed around the protrusion 6148 of the shell 6160. In various embodiments, the tissue thickness compensator 6158 can be wider than the shell 6160 such that a portion of the tissue thickness compensator 6158 extends beyond the periphery of the cartridge body 6150. In such embodiments, the tissue thickness compensator 6158 can be thermoformed into the protrusion 6148, for example, around the periphery of the cartridge body 6150. Additionally or alternatively, the tissue thickness compensator 6158 can be thermoformed into, for example, a heel 6146 and / or a staple leg extending from the fastener cavity 6154. In various embodiments, the shell 6160 may be made of, for example, stainless steel 300 series, stainless steel 400 series, titanium, and / or medical grade aluminum to facilitate heat transfer and improve thermoforming effects. Such metal materials can be included.

  119 and 120, the end effector assembly 6200 can include a first jaw or anvil 6210 and a second jaw 6202. The second jaw 6202 can include a cartridge body 6250 and a tissue thickness compensator 6258 releasably clamped to the cartridge body. Similar to the cartridge body 5650, the cartridge body 6250 can include a fastener cavity 6254 and a fastener, such as a surgical staple, that can be removably positioned within the fastener cavity. In various embodiments, the surgical staple 6290 can be positioned on the driver 6220 within the fastener cavity 6254. Referring primarily to FIG. 119, a portion of the staple 6290 can be positioned within the fastener cavity 6254 when the driver 6220 is in the pre-fire position. In various embodiments, the staple 6290 can include a base 6292 and legs 6294a, 6294b extending from the base 6292. For example, the first leg 6294a can extend from the first end of the base 6292, and the second leg 6294b can extend from the second end of the base 6292, for example. In various embodiments, when the driver 6220 is in the pre-fire position and the staple 6290 is in the pre-molded configuration, the base 6292 of the staple 6290 can be positioned within the fastener cavity 6254 and the legs of the staple 6290 6294a, 6294b can extend from the fastener cavity 6254 and into the tissue thickness compensator 6258.

  In various embodiments, with continued reference to FIGS. 119 and 120, the staple legs 6294a, 6294b can include hooks between the base 6292 and the distal ends 6299a, 6299b of each staple leg 6294a, 6294b. . The hanging portion may be, for example, a sharp protrusion such as a spine and / or a sharp protrusion. In various embodiments, the staple wire diameter is, for example, approximately 0.1753 mm (0.0069 inch), approximately 0.2007 mm (0.0079 inch), and / or approximately 0.2261 mm (0.0089 inch). can do. The hanging portion may be, for example, approximately 0.0254 mm (0.001 inch). In certain circumstances, the hanger can be, for example, from about 0.0105 mm (0.0005 inch) to about 0.076 mm (0.003 inch). In certain embodiments, the first lower hook 6296a can be positioned on the first staple leg 6294a and the second lower hook 6296b can be positioned on the second staple leg 6294b. . The lower hooks 6296a and 6296b can be positioned between the base 6292 and the tips 6299a and 6299b of the staple legs 6294a and 6294b. In addition, the first upper hook 6298a may be positioned on the first staple leg 6294a, and the second upper hook 6298b may be positioned on the second staple leg 6294b. The upper hooks 6298a and 6298b can be positioned between the lower hooks 6296a and 6296b and the tips 6299a and 6299b of the respective staple legs 6294a and 6294b. When the driver 6220 is in the pre-fire position and the staple 6290 is in the pre-molded configuration, at least one hook 6296a, 6296b, 6298a, 6298b of the staple 6290 can be positioned within the tissue thickness compensator 6258. In such an embodiment, the hooks 6296a, 6296b, 6298a, 6298b can grip and / or hold the tissue thickness compensator 6258 relative to the cartridge body 6250, for example. Hang portions 6296a, 6296b, 6298a, 6298b embedded within the tissue thickness compensator 6258 can, for example, prevent and / or limit lateral movement of the tissue thickness compensator 6258 relative to the cartridge deck and / or For example, lifting of the tissue thickness compensator 6258 away from the cartridge deck can be prevented. Additionally or alternatively, in various embodiments, the hooks can be positioned at the tips 6299a, 6299b of the staple legs 6294a, 6294b.

  Referring primarily to FIG. 120, when the driver 6220 moves to the firing position, the staple 6290 can be removed from the fastener cavity 6254 and / or released. Moreover, the tissue thickness compensator 6258 and the tissue T can be clamped between the anvil 6210 of the end effector assembly 6200 and the cartridge body 6250. The staple forming pocket 6214 in the anvil 6210 can, for example, form the staple 6290 into a B shape. Moreover, at least one hook 6296a, 6296b, 6298a, 6298b of the staple 6290 can engage tissue clamped within the staple 6290, for example. The hooks 6296a, 6296b, 6298a, 6298b can grip and / or hold the tissue T captured within the staple 6290.

  121-124, the fastener 6390 can be releasably held by a lock driver 6320 in a fastener cartridge 6350 (FIGS. 123 and 124) used with an end effector assembly. In various embodiments, the fastener 6390 can include a base 6392 and legs 6394a, 6394b extending from the base 6392. The first leg 6394a can, for example, extend from a first end of the base 6392, and the second leg 6394b can, for example, extend from a second end of the base 6392. it can. In certain embodiments, the lock driver 6320 can releasably hold the base 6392 of the fastener 6390. In various embodiments, the lock driver 6320 can include a catch portion 6340 that can releasably hook and / or hold the base 6392. The catch portion 6340 can be flexible, for example, and can be bent, for example, to release the base 6392 of the fastener 6390. In various embodiments, the lock driver 6320 and / or the catch portion 6340 can be either with or without glass filler, for example, so that the catch portion 6340 deforms sufficiently elastically and / or plastically. It can be made of plastic such as Ultem.

  Referring primarily to FIGS. 123 and 124, the lock driver 6320 can be movably positioned in a fastener cavity 6354 defined in the cartridge deck 6352 of the cartridge body 6350. The lock driver 6320 can move from the locked position (FIG. 123) to the unlocked position (FIG. 124) within the fastener cavity. A sled and / or driver in the cartridge body 6350 can engage the lock driver 6320 during the firing stroke to move the lock driver 6320 from the locked position to the unlocked position. In various embodiments, the fastener 6390 can be tightened to the lock driver 6320 when the lock driver 6320 is in the locked position and can be released from the lock driver 6320 when the lock driver 6320 is moved to the unlocked position. . When the lock driver 6320 moves from the locked position to the unlocked position, the fastener 6390 can be released from the fastener cavity 6354. Key 6353 adjacent to fastener cavity 6354 can release fastener 6390 from lock driver 6320, for example. The key 6353 can be, for example, a lip that extends inwardly from at least a portion of the edge of the fastener cavity 6354. In various embodiments, the key 6353 can have a cam surface 6355. When the lock driver 6320 moves from the lock position to the lock release position, the ledge portion 6344 of the catch portion 6340 can come into contact with the cam surface 6355 of the key 6353. In such an embodiment, as the catch portion 6340 moves against the cam surface 6355, the cam surface 6355 can deflect the catch portion 6340 such that the hook 6342 releases the base 6392 of the fastener 6390. . In various embodiments, the hook 6342 can rotate upward to release the base 6392. For example, the hook 6342 can move so that the opening of the hook 6342 is directed toward the tissue thickness compensator 6358 and the base 6392 can move upwardly through the opening and away from the lock driver 6320. Can rotate upwards.

  With continued reference to FIGS. 123 and 124, the tissue thickness compensator 6358 can be releasably clamped to the cartridge deck 6352 of the cartridge body 6350. Staple legs 6394a, 6394b can extend from fastener cavity 6354 and into tissue thickness compensator 6358 when lock driver 6320 is in the locked position (FIG. 123). Staple legs 6394a, 6394b can, for example, hold tissue thickness compensator 6358 relative to cartridge deck 6352, for example, to prevent and / or prevent lateral movement of tissue thickness compensator 6358 relative to cartridge deck 6352. Or it can be restricted. In addition, when the lock driver 6320 moves to the unlocked position and the fastener 6390 is released from the fastener cavity 6354 (FIG. 124), the catch portion 6340 engages the lock driver 6320 and the cartridge body 6350. The base 6392 of the fastener 6390 can be released so that it can be released. The tissue thickness compensator 6858 is clamped and released from the cartridge body 6350 when the fasteners 6390 removably positioned within the fastener cavities 6354 are released from the respective fastener cavities 6354 and disengage the cartridge bodies 6350. Can be obtained and / or opened.

  125-129, the end effector assembly 6400 may include a first jaw and / or anvil 6410 (FIGS. 127-129) and a second jaw 6402. The second jaw 6402 can include a fastener cartridge body 6450 and a tissue thickness compensator 6458 releasably clamped to the second jaw 6402 and / or tissue thickness compensator 6458. In certain embodiments, the fastener cartridge body 6450 and the tissue thickness compensator releasably clamped to the fastener cartridge body can comprise, for example, a fastener cartridge assembly. In various embodiments, the cartridge body 6450 can include a cartridge deck 6452 and a slot 6456 that extends through at least a portion of the cartridge body 6450. The cavity may be defined in the cartridge deck 6452 and into the cartridge body 6450. For example, a fastener cavity 6454 can be defined in the cartridge deck 6452 and can receive a fastener 6490 (FIGS. 126A-129) within the fastener cavity. Fastener 6490 may be removably positioned within fastener cavity 6454. For example, a single fastener 6490 can be removably positioned within each fastener cavity 6454 and can be released from the fastener cavity 6454 during a firing stroke. Moreover, a lock cavity 6448 can be defined in the cartridge deck 6452 and can receive a lock 6440 in the lock cavity. For example, a single lock 6440 can be movably positioned within each lock cavity 6448 and moved from the locked position (FIGS. 127 and 128) to the unlocked position (FIG. 129) during the firing stroke.

  Referring primarily to FIG. 126, lock 6440 can include a base 6444 and a hook 6442 movably positioned relative to base 6444. For example, the hook 6442 can move within an opening formed through at least a portion of the base 6444. The hook 6442 can receive and / or hold a connector 6480, for example. The hook 6442 can be made of, for example, a liquid crystal polymer (LCP), nylon, ultem, polycarbonate, and / or ABS. Connector 6480 may be a suture, for example. In certain embodiments, the connector can be comprised of, for example, PDS, PGA / PCL, PLLA / PCL, TMC / PCL, PGA and / or PCL. In various embodiments, the hook 6442 can restrain the connector 6480 when the hook 6442 is embedded or partially embedded within the base 6444. Connector 6480 may be held between hook 6442 and base 6444, for example. When the hook 6442 is lifted or partially lifted out of the base 6444, the connector 6480 can be released, for example, from being restrained by the hook 6442 and can be released from engagement with the lock 6440, for example. it can. In various embodiments, the connector 6480 can come out of engagement with the lock 6440 when the hook 6442 is lifted at least partially from within the base 6444.

  Referring primarily to FIG. 126A, the connector 6480 can extend from the tissue thickness compensator 6458. The tissue thickness compensator 6458 can be friction fitted or thermoformed with the connector 6480, for example. In various embodiments, the connector 6480 can be passed through the hook 6442 of the lock 6440 when the lock 6440 is in the unlocked position. As connector 6480 is passed through hook 6442, tissue thickness compensator 6458 can move to a position relative to cartridge body 6450. For example, the tissue thickness compensator 6458 can be positioned on the cartridge deck 6452 of the cartridge body 6450. Referring primarily to FIG. 127, when the tissue thickness compensator 6458 is positioned relative to the cartridge body 6450, the lock 6440 can be moved from the unlocked position to the locked position. For example, the hook 6442 of the lock 6440 can be embedded or partially embedded in the base 6444 such that the lock 6440 surrounds and / or restrains the connector 6480. In various embodiments, lock 6440 and / or driver 6420 can include, for example, a spring that can bias lock 6440 to the unlocked position. In the locked position, the tissue thickness compensator 6458 can be clamped to the cartridge body 6450 by, for example, a connector-lock engagement.

  Referring primarily to FIGS. 128 and 129, the key can move along at least a portion of the cartridge body 6450 during the firing stroke. The key can be, for example, a thread 6434 and / or an element of a firing assembly. In various embodiments, the sled 6434 can engage a driver in the cavity at the cartridge body 6450 during the firing stroke. The sled 6434 presses the driver against the cartridge deck 6452 and / or the tissue thickness compensator 6458 to release the fastener from the fastener cavity 6454 and / or move the lock 6440 from the locked position to the unlocked position. be able to. Referring primarily to FIG. 128, the sled 6434 can engage the driver 6420 within the lock cavity 6448 during the firing stroke. The sled 6434 can move the driver 6420 toward the cartridge deck 6452 and / or toward the tissue thickness compensator 6458. Moreover, referring primarily to FIG. 129, the driver 6420 can move the lock 6440 from the locked position to the unlocked position. For example, the driver 6420 can push the hook 6442 out of the base 6444. When the hook 6442 is lifted out of the base 6444, the connector can be released from the lock 6440 restraint. In such embodiments, the tissue thickness compensator 6458 can be released, for example, from being clamped to the cartridge body 6450 and / or released from the cartridge body 6450.

  Referring now to FIG. 67, the tissue thickness compensator 17050 can include, for example, a first portion 17052 and a second portion 17054 that extends relative to the first portion 17052. The tissue thickness compensator 17050 can form part of a staple cartridge assembly. In some situations, the tissue thickness compensator 17050 can be attached to the cartridge body of the staple cartridge assembly. In certain embodiments, the tissue thickness compensator can be assembled to the anvil of the surgical stapling instrument. In any case, the first portion 17052 of the tissue thickness compensator 17050 can be compressible. In use, the first portion 17052 can be captured within the staples ejected from the staple cartridge, and a compressive force can be applied to tissue similarly captured within the staples. The second portion 17054 of the tissue thickness compensator 17050 can extend through the first portion 17052, and the second portion 17054 can include a proximal end 17053 extending from the first portion 17052 and A distal end 17055 can be provided. As will be described in more detail below, the second portion 17054 may have a lower flexibility and / or a higher stiffness than the first portion 17052. Referring now to FIG. 68, the staple cartridge assembly 17000 can comprise a cartridge body 17010 that includes a plurality of staple cavities defined therein and a plurality of staples at least partially stored within the staple cavities. As shown in FIG. 68, the tissue thickness compensator 17050 can be mounted on the cartridge body 17010.

  The staple cartridge assembly 17000 includes a proximal mount 17060 configured to releasably hold the proximal end 17053 of the second portion 17054 relative to the cartridge body 17010 and a distal end 17055 to the second. A distal mount 17070 configured to releasably hold against portion 17054. Proximal mount 17060 can comprise a single component or more than one component. As shown in FIG. 68, the proximal mount portion 17060 includes a first mount portion 17060a and a second mount configured to at least partially capture and hold the second portion 17054 against the cartridge body 17010. Mounting portion 17060b. Referring now to FIG. 69, each mount portion 17060a, 17060b can include a key 17062 that can be releasably tightened within a key slot 17012 defined within the cartridge body 17010. Each key 17062 and key slot 17012 may be sized and configured such that the side wall of the key slot 17012 can apply a holding force to the key 17062 that resists the removal of the key 17062 from the key slot 17012. In various situations, the key 17062 can be releasably pressure fitted and / or snap fit within the key slot 17012. In at least one situation, the key 17062 can include an enlarged end 17063 that can be releasably clamped between the sidewalls of the key slot 17012, for example. As shown in FIGS. 68 and 69, each mount portion 17060a, 17060b can include a window 17064 configured to at least partially receive the proximal end 17053 of the second portion 17054. In such a situation, the sidewall of the window 17064 can be configured to engage the tissue thickness compensator 17030 and press against the deck 17014 of the cartridge body 17010. Moreover, at least a portion of the second portion 17054 can be constrained within the mount portions 17060a, 17060b.

  Referring again to FIGS. 68 and 69, similar to the above, the distal mount 17070 includes a window 17074 that can be sized and configured to receive at least a portion of the distal end 17055 of the second portion 17054. it can. Further, as described above, the sidewalls of the window 17074 can be configured to engage the tissue thickness compensator 17030 and press against the deck 17014 of the cartridge body 17010. Moreover, at least a portion of the second portion 17054 can be constrained within the mount portion 17070. The distal mount portion 17070 has one or more pins 17072 extending from the distal mount portion that can be releasably clamped within one or more pin openings 17011 defined in the cartridge body 17010. Can be provided. Each pin 17070 and pin opening 17011 may be sized and configured such that the sidewall of the pin opening 17011 can apply a holding force to the pin 17072 that resists the removal of the pin 17072 from the pin opening 17011. In various situations, each pin 17072 can be releasably pressure fitted and / or snap fit within the pin opening 17011.

  To assemble the staple cartridge 17000, in at least one situation, the tissue thickness compensator 17030 can be positioned against the deck 17014 of the cartridge body 17010 and the proximal mount 17060 and the distal mount 17070 can be Thereafter, the cartridge body 17010 can be assembled. Mounts 17060, 17070 can be attached to the cartridge body 17010 to capture or capture the tissue thickness compensator 17050 relative to the cartridge body 17010 as described above. Similarly, as described above, the mounts 17060, 17070 can be configured to capture the end of the second portion 17074 and releasably hold it relative to the cartridge body 17010. In certain circumstances, the proximal mount portion 17060 and the distal mount portion 17070 can be configured to capture at least a portion of the first portion 17052 therein. Although the tissue thickness compensator 17050 depicted in FIGS. 67-69 comprises two parts, various alternatives are possible where the tissue thickness compensator can comprise more than two parts. For example, the tissue thickness compensator can comprise a compressible first portion 17052 and two or more rigid second portions 17054 extending therethrough. Similarly, for example, a tissue thickness compensator can comprise two or more compressible portions arranged in any suitable arrangement, for example, two or more layers.

  Once assembled, the staple cartridge 17000 can be assembled to a surgical stapler. In at least one situation, the staple cartridge 17000 can be removably held using a channel defined in the end effector of the surgical stapler and then inserted into the surgical site inside the patient. Proximal mount portion 17060 and / or distal end portion 17070 can be configured to hold tissue thickness compensator 17050 against cartridge body 17010 while staple cartridge 17000 can be positioned within the surgical site. And / or manipulated inside the surgical site. The second portion 17054 of the tissue thickness compensator 17050 is tissue thickness until one or more of the proximal end 17060 and / or the distal end 17070 is dissected and / or disconnected from the cartridge body 17010. Sufficient rigidity can be provided to the tissue thickness compensator 17050 so that the thickness compensator 17050 is not separated from the cartridge body 17010. Thanks to the rigidity of the second portion 17054, in various situations, the attributes of the first portion 17052 of the tissue thickness compensator 17050 can be used primarily to provide desirable tissue compensation characteristics of the tissue thickness compensator 17050 or Can be selected exclusively. In use, the second portion 17054 of the tissue thickness compensator 17050 can resist relative movement between the proximal end 17053 and the distal end 17055, and in various situations the proximal end 17053. And the distal end 17055 can resist movement toward each other.

  Once the staple cartridge 17000 is properly positioned, in various situations, the firing member 17030 can be advanced through the staple cartridge 17000 to deploy the removably positioned staples within the staple cartridge. Staple cartridge 17000 can include a movable member 17034 that can be advanced by firing member 17030 from the proximal end of staple cartridge 17000 toward the distal end of staple cartridge 17000. In addition to the above, the movable member 17034 can be configured to lift staples detachably stored within the cartridge body 17010 between an unfired position and a fired position. The firing member 17030 further includes a cutting portion such as a knife 17032 that can be configured to transversely cut the tissue being stapled as the firing member 17030 is advanced distally through the staple cartridge 17000, for example. Can be provided. Knife 17032 may be further configured to cut laterally tissue thickness compensator 17050 as firing member 17030 is advanced distally through staple cartridge 17000. Referring primarily to FIGS. 67 and 68, the proximal end 17053 of the second portion 17054 can be cut by a knife 17032. In at least one such embodiment, tissue thickness compensator 17050 is at least partially cut or fully cut along a longitudinal axis at least partially defined by a notch 17057 defined therein. Can be cut into pieces. As shown in FIG. 68, the notch 17057 can be aligned with or at least substantially aligned with a longitudinal knife slot 17015 extending through the cartridge body 17010. When the proximal end 17053 of the second portion 17054 is at least partially laterally cut by the knife 17032, the second portion 17054 can be at least partially released from the proximal mounts 17060a, 17060b, or Can be made releasable. In such a situation, the tissue thickness compensator 17050 may be disconnected from the cartridge body 17010. By way of example, firing member 17030 can be at least partially advanced or fully advanced through staple cartridge 17000 to at least partially or fully embed tissue thickness compensator 17050 into tissue. And because of at least partial transverse cutting of the tissue thickness compensator 17050, particularly the second portion 17054, the tissue thickness compensator 17050 is sufficient to exit the proximal mount portions 17060a, 17060b and the distal mount portion 17070. It can have flexibility. In use, in various situations, the firing member 17030 can be positioned proximally, i.e., starting, after the firing member 17030 is at least partially fired and the tissue thickness compensator 17050 is at least partially implanted. The cartridge body 17010 can then be withdrawn from the implanted tissue thickness compensator 17050. As an example, if the cartridge body 17010 is pulled away from the tissue thickness compensator 17050 along the longitudinal axis, the tissue thickness compensator 17050 cut at least partially laterally may be buckled in the longitudinal direction. The proximal and distal ends of the tissue thickness compensator 17050 may move toward each other, for example.

  Referring now to FIGS. 70-72, the tissue thickness compensator 17150 can include a compressible portion 17152 and a mount portion 17154 that extends through and / or extends from the compressible portion 17152. it can. The compressible portion 17152 can comprise a proximal end 17153 that can include a thickness that is less than the thickness of the body portion 17156 of the tissue thickness compensator 17150. In at least one such embodiment, the proximal end 17153 can comprise a tapered portion, for example. Referring again to FIGS. 70-72, for example, a staple cartridge assembly, such as staple cartridge 17100, may be configured to releasably clamp mount portion 17154 of tissue thickness compensator 17150 to cartridge body 17010. Can be included. The distal mount portion 17160 can include one or more locks 17162 that extend from the distal mount portion and can be received within one or more keyholes 10112 defined within the cartridge body 17110. In at least one such embodiment, each of the locks 17162 can comprise a leg and a foot extending from the leg, the leg as the lock 17162 is inserted into the keyhole 17112. Laterally flexed and then elastically restored to the undeflected configuration of the lock so that the foot can releasably engage the side wall of the keyhole 17112 or move behind the side wall. Or at least substantially restore. Similar to above, the proximal mount portion 17160 can further comprise a cavity 17164 configured to receive the proximal mount portion 17154 of the tissue thickness compensator 17150. The cavity 17164 can be configured to compress the proximal mount portion 17154 against the deck of the cartridge body 17110 and hold the proximal end of the tissue thickness compensator 17150 in place. In various embodiments, for example, a firing member, such as firing member 17030, is configured to incise proximal mount portion 17160 as firing member 17030 is advanced to incise tissue thickness compensator 17150. Can be done. In at least one such situation, an incision in the proximal mount portion 17160 can release the tissue thickness compensator 17150 from the cartridge body 17110. Referring again to the embodiment depicted in FIG. 68, for example, firing member 17030 passes through a slot defined between proximal mount portions 17060a, 17060b, and in at least some situations, proximal mount portion 17060a. , 17060b can be configured to pass through these proximal mounts without incision.

  Referring now to FIGS. 73-76, in addition to the above, the proximal mount that releasably retains the tissue thickness compensator with respect to the cartridge body may have a longitudinal gap or slot 17267 when assembled to the cartridge body. The longitudinal gap or slot may be sized and configured to allow the firing member 17030 to pass there between. The first and second portions 17260a, 17260b may be defined. Similar to the above, each of the first and second portions 17260a, 17260b can include a cavity 17264 configured to at least partially receive and hold the tissue thickness compensator in place. Further, similar to the above, each of the first and second portions 17260a, 17260b can include a lock 17262 that extends from these portions and can be configured to engage the cartridge body.

  As described above, the staple cartridge assembly includes a proximal mount or attachment portion configured to hold the proximal end of the tissue thickness compensator against the proximal end of the cartridge body, and a distal portion of the tissue thickness compensator. A distal mount or attachment portion configured to hold the distal end against the distal end of the cartridge body. In certain other embodiments, the staple cartridge assembly may comprise only at least one proximal mount or at least one distal mount that holds the tissue thickness compensator relative to the cartridge body. Referring now to FIG. 147, the cartridge assembly 17300 can comprise a cartridge body 17310 and a tissue thickness compensator 17350 with the distal end of the tissue thickness compensator 17350 releasably mounted on the cartridge body 17310. A distal end 17355 configured as such can be provided. In at least this embodiment, the distal end of the cartridge body 17310 can include a locking opening 17011 configured to receive and attach to the cartridge body 17310 at least one distal mount. The reader will appreciate that at least for this embodiment, the cartridge assembly 17300 does not further include a proximal mount that mounts the proximal end of the tissue thickness compensator 17350 to the cartridge body 17310. In various situations, the distal end 17355 can be molded integrally with the body portion 17356 of the tissue thickness compressor 17350, or alternatively can be attached to the body portion 17356.

  In various embodiments, referring now to FIGS. 156 and 157, a staple cartridge assembly, such as, for example, staple cartridge 10400, can be configured to releasably hold tissue thickness compensator 10450 in place. A cartridge body 10410 including a distal end or nose portion 10419 can be provided. Similar to the above, the tissue thickness compensator 10450 can comprise a first portion 10452 mounted to the second portion 10454, such that the second portion 10454 is releasably held by the nose portion 10419. The distal end 10455 may be configured. In various situations, the nose portion 10419 and the deck 10414 of the cartridge body 10410 can define a slot 10418 configured to receive the distal end 10455 between the nose portion and the deck. The nose portion 10419 can be constructed of an elastic material that can be sized and configured such that the nose portion 10419 is biased into engagement with the distal end 10455. In use, with reference to FIG. 157, the nose portion 10419 is configured such that the tissue thickness compensator 10450 is lowered when the cartridge body 10410 is released from the tissue thickness compensator 10450 after the tissue thickness compensator 10450 is at least partially implanted. It can be flexible enough to allow it to escape from some nose portion 10419. Referring now to FIG. 158, in addition to the above, the first layer 10452 can be comprised of a compressible foam that can be mounted on the second layer 10454. In various situations, one or more adhesives may be utilized to mount the first layer 10552 to the second layer 10454. The first layer 10452 can be implemented on the second layer 10454 such that the distal end 10455 and the notch 10457 defined in the distal end 10455 are left exposed. The first layer 10452 may be mounted on the second layer 10454 such that the first layer 10552 is centered laterally with respect to the longitudinal central axis 10559 defined by the second layer 10454. is there.

  As previously described, the staple cartridge assembly is at least partially stored within the staple cartridge assembly and is movable to be configured to lift staples stored within the staple cartridge assembly between an unfired position and a fired position. A firing member may be included. Referring now to FIGS. 159 and 160, a staple cartridge assembly 10500 includes a cartridge body 10510, a tissue thickness compensator 10550, a movable firing member or thread 10034 slidably housed within the stable cartridge assembly. Can be included. The sled 10034 can include one or more bevels 10033 that are defined in the sled and can be configured to lift the staples from an unfired position of staples to a fired position of staples during use. Prior to use, the thread 10034 may be releasably locked in place. In at least one such embodiment, the tissue thickness compensator 10550 is advanced distally to allow the sled 10034 to eject staples from the staple cartridge assembly 10500 and dissect the tissue thickness compensator 10550. The sled 10034 may be configured to releasably hold in a proximal position. The tissue thickness compensator 10550 can include one or more tabs or detents 10557 that extend from the tissue thickness compensator and can releasably engage the thread 10034. As an example, thread 10034 can position detent 10557 internally until sufficient force is applied to thread 10034 to cause thread 10034 to overcome the holding force applied to thread 10034 by detent 10557. One or more recesses 10037 may be included. In use, detent 10557 can be configured to hold sled 10034 in place until the longitudinal firing force applied to sled 10034 in the distal direction exceeds a threshold force. When this threshold force is exceeded, the sled 10034 can slide distally and the detent 10557 can flex sufficiently to allow the sled 10034 to slide by, or so on. Otherwise it can be deformed. In at least one embodiment, the detent 10557 is proximal to the staple cavity defined in the cartridge body 10510 so that the sled 10034 can be releasably held in an unfired position on the proximal side of the staple. And / or can be positioned proximal to the staples stored within the cartridge body 10510. As the thread 10034 is advanced distally, the thread 10034 may be advanced toward the staples.

  In addition to the above, referring to FIGS. 159 and 160, the cartridge body 10510 can include one or more retention slots 10517 that can be configured to receive at least a portion of the detent 10557. More particularly, in at least the illustrated embodiment, the retention slot 10517 defined on one side of the cartridge body 10510 can be simultaneously positioned within the retention slot 10517 and the recess 10037 in which the detent 10557 is aligned. As such, when the sled 10034 is in its proximal unfired position, it can be aligned with the recess 10037 defined in the corresponding side of the sled 10034. In at least one such embodiment, the sidewall of the retention slot 10517 defined in the cartridge body 10510 can support the detent 10557, which will be removed from the recess 10037 midway. Can at least be prevented. As described above, the thread 10034 can be advanced distally so that the recess 10037 is no longer aligned with the detent 10557, but in at least the illustrated embodiment, the detent 10557 has at least a portion of the thread 10034. May be kept in alignment with the retention slot 10517 and / or positioned within the retention slot 10517 after being advanced forward. Referring primarily to FIG. 159, a first arrangement comprising a detent 10557, a sled recess 10037, and a cartridge retaining slot 10517 can be arranged with respect to the first side of the sled 10034 and a second detent A second arrangement comprising 10557, a second sled recess 10037, and a second cartridge retention slot 10517 may be arranged with respect to the second or opposite side of the sled 10034.

  Certain embodiments of the staple cartridge can include a flexible layer, such as, for example, a tissue thickness compensator and / or buttress material on the staple deck, where the staples are unfired staple tips into the layer. It can be arranged to extend. In certain other embodiments, the flexible layer comprises a staple cartridge that is compressible and / or squeezable that can be implanted in a patient and that deforms and / or contracts when captured within the staple. Can do. A flexible layer and / or implantable staple cartridge can be used by a surgeon, nurse, or other user ("user" or "user group"), for example, a flexible layer or implantable finger or other finger. If inadvertently pressed against the staple cartridge, it can be further deformed and / or shrunk. Such deformation and / or contraction can render the staple cartridge unusable.

  Staple cartridge retainers are often provided with a retainer that can assist the user in filling the staple cartridge into the surgical stapler. The retainer can further cover the staple deck and any flexible layer, thereby preventing a user from inadvertently squeezing, crushing and / or deforming the flexible layer. However, users may occasionally remove the staple cartridge retainer halfway before fully installing the staple cartridge in the surgical stapler end effector. By removing the retainer in the middle, the user may risk damaging the flexible layer.

  FIGS. 164-167 illustrate an embodiment of a retainer 10000 that can be attached to the staple cartridge 10010. With reference to FIGS. 166 and 167, the staple cartridge 10010 can include a flexible layer 10020, such as a tissue thickness compensator and / or buttress material, disposed on the staple deck 10011 of the staple cartridge 10010. As shown in FIG. 167, the staple 10030 can extend into the flexible layer 10020 exposed from the staple cartridge 10010. If the retainer 10000 is removed in the middle, the user may inadvertently squeeze the flexible layer 10020 while pushing the staple cartridge 10010 into the staple cartridge channel of the end effector, thereby causing the layer 10020 to move. It may be squeezed and / or deformed.

  FIGS. 168-173 can be locked to the staple cartridge 2650 and cannot be unlocked until the staple cartridge 2650 is fully inserted into the staple cartridge channel 2670 of the end effector. FIG. 9 shows an embodiment of a retainer 2600 that cannot be removed from. As best shown in FIG. 168, the proximal end portion 2604 of the retainer 2600 can include a movable cam portion 2616 with a locking tab portion 2626 extending from the movable cam portion 2616. Lock tab portion 2626 extends into and engages slot 2652, such as a knife slot, in staple cartridge 2650. Engagement of the locking tab portion 2626 inside the slot 2652 releasably holds the retainer 2600 and staple cartridge 2650 together. As will be described in more detail below, the locking tab portion is configured so that the retainer 2600 engages a key within the staple cartridge channel 2670 that causes the cam portion 2616 of the retainer 2616 to deflect the cam portion 2616 inward toward each other. It simply disengages from the slot 2652 so that it can be released and removed from the staple cartridge 2650. Moreover, in various embodiments, the cam portion 2616 can only engage the key when the staple cartridge 2650 is properly seated within the staple cartridge channel 2670.

  As described above, in certain embodiments, the proximal end portion 2604 of the retainer 2600 can include cam portions 2616, each of which is attached to the body 2606 of the retainer 2600 by a neck portion 2624. The cam portions 2616 can be separated from each other by a gap 2622. The cam portion 2616 can flex inward in the direction of arrow I (shown in FIG. 172) when an inward compression force is applied, with respect to the neck 2624 (shown in FIG. 170). It can be elastically bent outward in the direction of O. A locking tab portion 2626 can extend from each cam portion 2618. As described in more detail below, when disposed in staple cartridge 2650, locking tab portion 2626 extends into staple cartridge 2650 into slot 2652, such as a knife slot, releasably engaging slot 2652. Can be combined. Referring primarily to FIGS. 170 and 171, the cam portion is deflected outwardly such that a lip 2628 extending from the locking tab portion 2626 engages the collar 2654 in the slot 2652 in the staple cartridge 2650. Can be energized. Biasing the cam portion 2616 in the outwardly deflected position has no locking tab 2626 so that the retainer 2600 is locked to the staple cartridge 2650 because there is no inward compression from the key of the staple cartridge channel 2670. The lip 2628 can be pushed into engagement with the collar 2654 in the slot 2652.

  Referring primarily to FIGS. 170-173, in various embodiments, the key of the staple cartridge channel 2670 is the cam portion 2616 as the retainer 2600 and staple cartridge 2650 are inserted into the staple cartridge channel 2670 (FIG. The inner wall of the staple cartridge channel 2670 can be included that gradually increases the inward compression force on the cam portion 2616 so that it can deflect inwardly in the direction of arrow I (shown at 172). For example, the staple cartridge channel 2670 can include a first inner wall 2672 that defines a first width that can accommodate the cam portion 2616 in a biased and outwardly deflected position. Staple cartridge channel 2670 can include a second inner wall 2676 that defines a second width that can accommodate cam portion 2616 in an inwardly deflected position, as shown in FIG. The staple cartridge channel 2670 can include an intermediate inner wall 2673 positioned intermediate the first inner wall 2672 and the second inner wall 2676 and capable of transitioning from a first width to a second width. In use, the staple cartridge 2650 and the retainer 2600 are positioned in a proximal direction relative to the staple cartridge channel 2670 to be inserted into the staple cartridge channel 2670 as indicated by the arrow P in FIGS. 170 and 172. Moved towards channel 2670. Referring primarily to FIGS. 170 and 171, as the staple cartridge 2650 and retainer 2600 are moved toward the staple cartridge channel 2670, the rounded end 2620 and the outwardly facing surface 2618 of the cam portion 2616 are stapled. The first wall 2672 of the cartridge channel 2670 can be engaged. As described above, in certain embodiments, the first wall 2672 can define a width that can accommodate the cam portion 2616 in these biased, outwardly deflected positions. In various other embodiments, the first wall 2672 can define a width that can accommodate the cam portion 2616 in a partially inwardly deflected position, the amount of partial inward deflection being: It is sufficient for the retainer 2600 to be unlocked from the staple cartridge 2650 without the lip 2628 of the locking tab 2626 being disengaged from the collar 2654 of the staple cartridge 2650. Referring now to FIGS. 172 and 173, as the staple cartridge 2650 and retainer 2600 continue to move proximally toward the staple cartridge channel 2670 in the direction of arrow P, the rounded end 2620 and outward. Surface 2618 engages intermediate wall 2674 and consequently second wall 2676. The intermediate wall 2694 and the second wall 2676 can provide a gradually increasing force that can cause the cam portion 2616 to flex gradually inward. Eventually, the cam portion 2616 will flex inward by the amount that the lip 2628 of the locking tab 2626 can be disengaged from the collar 2654 in the slot 2652 of the staple cartridge 2650. When the locking tab portion 2626 is disengaged from the collar 2654, the retainer 2600 is unlocked from the staple cartridge 2650 so that the retainer 2600 can be removed from the staple cartridge 2650. In various embodiments, the cam portion 2616 flexes inward so that the tab portion 2626 disengages from the collar 2654 only when the staple cartridge 2650 is fully inserted into the staple cartridge channel 2670. .

  In certain embodiments, a lockable retainer, such as the retainer 2600 described above with respect to FIGS. 168-173, is intended to be used with staple cartridges having a particular size different from a staple cartridge having a particular size. It can also be prevented from being inserted into the end effector. For example, the staple cartridge 2650 can include a reference surface 2632 that can engage the reference surface 2673 of the staple cartridge channel 2670. The first predetermined distance from the reference surface 2632 of the staple cartridge 2650 to the cam portion 2616 is between the reference surface 2673 of the staple cartridge channel 2670 and the walls 2672, 2694, and 2676 that form the keys of the staple cartridge channel 2670. Of the second predetermined distance. The first and second predetermined distances for a retainer and staple cartridge having a particular dimension and a staple cartridge channel intended for use with a particular size staple cartridge are retainers having other different dimensions. The first and second predetermined distances for the staple cartridge and the staple cartridge channel may be different. In other words, the respective dimensions of the staple cartridge, retainer, and staple cartridge channel have a first predetermined distance and a second predetermined distance that is different from the other dimensions of the staple cartridge, retainer, and staple cartridge channel. Can have. As a result, attempts to insert the staple cartridge and retainer into the wrongly sized staple cartridge channel may result in the retainer cam portion not engaging the staple cartridge channel wall and / or the staple cartridge reference surface and the staple cartridge channel. May not result in engagement. For example, when the staple cartridge 2650 and retainer 2600 are inserted into a correctly sized staple cartridge channel, the locking tab portion 2626 is removed from the slot 2652 in the staple cartridge 2650 when the reference surfaces 2632 and 2675 engage each other. To the extent they are disengaged, the cam portion 2616 can be arranged to engage only the second wall 2676 of the staple cartridge channel 2670. For example, if the staple cartridge 2650 and the retainer 2600 are very short with respect to the staple cartridge channel 2670, the cam portion 2616 has the locking tab portion 2626 in the slot 2552 in the staple cartridge 2650 when the datum surfaces 2632 and 2674 are engaged. The second wall 2676 may not be reached so that it can be disengaged from. As a result, the retainer 2600 will not be unlocked from the staple cartridge 2650 and cannot be removed. Conversely, if the staple cartridge 2650 and the retainer 2600 are very long, for example with respect to the staple cartridge channel 2670, the cam portion 2616 that engages the second wall 2676 of the staple cartridge channel 2670 may be the reference surface of the staple cartridge 2650. 2632 and 2674 and staple cartridge channel 2670 could be prevented from engaging each other. As a result, the staple cartridge 2650 will not seat completely within the staple cartridge channel 2670.

  In addition to the locking tab portion 2626 extending from the cam portion 2616, the retainer 2600 includes a pair of proximal tab portions 2612 disposed near the proximal end portion 2602 of the retainer 2600 and a distal end portion 2604 of the retainer 2600. It may further include a pair of distal tab portions 2610 disposed nearby. Proximal tab portion 2608 and distal tab portion 2610 can extend from body 2606 and can engage and releasably hold staple cartridge 2650. In certain embodiments, the proximal tab portion 2612 and the distal tab portion 2610 can engage and hold the staple cartridge 2650 until the staple cartridge 2650 is fully seated within the staple cartridge channel 2670. In other words, the proximal tab portion 2612 and / or the distal tab portion 2610 is another feature that prevents the retainer 2600 from being removed from the staple cartridge 2650 before the staple cartridge 2650 is fully seated within the staple cartridge channel 2670. It can serve as a lock.

  Referring primarily to FIG. 168, each proximal tab portion 2612 can include a proximal lip portion 2614 and each distal tab portion 2610 can include a distal lip portion 2610. Each proximal lip 2614 can include an inwardly angled surface 2615 and each distal lip 2610 can include an inwardly angled surface 2611. Proximal lip 2614 and distal lip 2610 can engage and releasably retain the outer surface of staple cartridge 2650. When the staple cartridge 2650 and the retainer 2600 are inserted into the staple cartridge channel 2670, the inwardly angled surfaces 2611 and 2615 can engage the edges 2672 and 2678 of the staple cartridge channel 2670. The edges 2672 and 2678 of the staple cartridge channel 2670 may be positioned on the proximal tab 2612 and / or the distal tab 2610 such that the proximal lip 2614 and the distal lip 2610 disengage from the outer surface of the staple cartridge 2650. Can be bent outward. When the proximal lip 2614 and the distal lip 2610 are disengaged, the retainer 2600 can be released from the staple cartridge 2650 and removed.

  With reference to FIGS. 174-180, for example, the end effector 12 of a surgical instrument may be configured to receive an end effector insert 28010. In various embodiments, the end effector insert 28010 can comprise a compensator body 28812 and at least one clip 28014a, 28014b. In various embodiments, the end effector insert 28010 can comprise, for example, a proximal clip 28014b at the proximal end of the compensator body 28812 and a distal clip 28014a at the distal end of the compensator body 28812. it can. Referring primarily to FIG. 177, the distal clip 28014a may be clamped to the anvil 25060 of the end effector 12 at or near the distal end of the anvil 25060. For example, the distal clip 28014a can be substantially aligned with the longitudinal slot 25062 of the anvil 25060 and / or partially positioned within the longitudinal slot 25062. Referring primarily to FIG. 178, the proximal clip 28014b can be clamped to the staple cartridge 25000 within the lower jaw 25070 of the end effector 12 (FIG. 179). Proximal clip 28014b may be clamped to staple cartridge 25000 at or near the proximal end of staple cartridge 25000. For example, the proximal clip 28014b can be substantially aligned with the longitudinal slot 25004 in the staple cartridge 25000 and / or positioned within the longitudinal slot 25004.

  Referring now to FIGS. 179 and 180, the end effector insert 28010 may be inserted into the end effector 12 of the surgical instrument. In various embodiments, at least a portion of the end effector insert 28010, such as, for example, the compensator body 28812, the distal clip 28814a, and / or the proximal clip 28014b, is deformable and / or elastic. Can do. When the end effector insert 28010 is inserted into the end effector 12, the distal and / or proximal clips 28014a, 28014b can bend or deflect. For example, when the clips 28014a, 28014b are deflected, the clips 28014a, 28014b can, for example, attempt to restore to their initial undeformed configuration and generate a corresponding springback or restoring force. . In various embodiments, the end effector insert 28010 can apply a spring load to the end effector 12 when the end effector insert 28010 is positioned within the end effector 12. In some embodiments, the end effector insert 28010 allows the operator to grip the insert 28010 when the operator is inserting the end effector insert 28010 and staple cartridge 25000 into the end effector 12. Can be hardened or substantially hardened.

  In some embodiments, end effector insert 28010 may be removed from end effector 12 prior to end effector 12 cutting and / or fastening operations. In other embodiments, the end effector insert 28010 can remain positioned within the end effector 12 during a cutting and / or firing operation. For example, end effector insert 28010 may be cut laterally by cutting element 25052 as staples are fired from staple cavities 25002 (FIG. 178) within staple cartridge 25000. In various embodiments, the end effector insert 28010 can comprise a tissue thickness compensation material that is similar to at least one of the tissue thickness compensators described herein. For example, end effector insert 28010 can comprise a polymer composition such as, for example, a bioabsorbable, biocompatible elastic polymer. End effector insert 28010 can further comprise a bioabsorbable polymer such as, for example, lyophilized polysaccharide, glycoprotein, elastin, proteoglycan, gelatin, collagen, and / or oxidized regenerated cellulose (ORC). In some embodiments, the end effector insert 28010 can comprise at least one therapeutic agent, such as a pharmaceutically active agent or drug.

  With continued reference to FIGS. 174-180, the end effector insert 28010 can be releasably attached to the end effector 12 and / or the anvil 25060 and / or staple cartridge 25000 of the end effector 12. Proximal clip 28014b can be releasably tightened to staple cartridge 25000 (FIG. 178), for example, and distal clip 28814a can be releasably tightened to anvil 25060 (FIG. 177), for example. In various embodiments, the proximal clip 28014b can be aligned with and / or retained within the slot 25004 within the slot 25004 of the staple cartridge 25000. Moreover, in certain embodiments, the distal clip 28014a can be aligned with and / or retained within the slot 25062 of the anvil 25060. Referring primarily to FIG. 179, in certain embodiments, the proximal clip 28014b can be releasably tightened to the staple cartridge 25000 before the staple cartridge 25000 is positioned in the lower jaw 25070 (FIG. 179). As staple cartridge 25000 and attached end effector insert 28010 are moved toward and / or into end effector 12 and / or lower jaw 25070, distal clip 28014a can be positioned within anvil 25060, for example. It can begin to be aligned with slot 25062. In various embodiments, distal clip 28014a can releasably engage anvil 25060 when staple cartridge 25000 and end effector insert 28010 are positioned within end effector 12 (FIG. 180). Distal clip 28014a can slide into slot 25062 in anvil 25060, for example. In various embodiments, the distal clip 28014a can be positioned relative to the anvil 25060 before or while the proximal clip 28014b is positioned relative to the staple cartridge 25000.

  When end effector insert 28010 is releasably clamped within end effector 12 by proximal clip 28014b and distal clip 28814a, for example, as described herein, end effector insert 28010 is end It can be pulled and held in the effector 12. In other words, the proximal clip 28014b clamped relative to the staple cartridge 25000 within the lower jaw 25070 is, for example, a distal clip clamped along the end effector insert 28010 and relative to the anvil 25060. A traction force can be exerted on 28014a. In various embodiments, the tension between the proximal clip 28015b and the distal clip 28014a can help retain the end effector insert 28010 within the end effector 12.

  In various embodiments, when the staple cartridge 25000 and the end effector insert 28010 are positioned within the end effector 12, the proximal clip 28014b is positioned intermediate the unfired thread 25056 (FIG. 178) and the staple cartridge 25000. obtain. For example, unfired thread 25056 can be proximal to proximal clip 28013b. In certain embodiments, during the firing stroke, the sled 25056 can move distally, for example, beyond the proximal clip 28014b, and can distort the proximal clip 28014b. In various embodiments, the proximal clip 28014b can be released from the slot 25004 in the staple cartridge 25000 when the sled 25056 distorts the proximal clip 28014b during the firing stroke. In certain embodiments, sled 25056 and / or elements of firing bar 25050 (shown elsewhere) can release proximal clip 28014b from staple cartridge 25000. Moreover, when the proximal clip 28014b is released from the staple cartridge 25000, the tension in the end effector insert 28010 can be at least partially relaxed. In the absence of a tensile force exerted on the distal clip 28014a, the distal clip 28014a can be free from the anvil 25060. Thus, the end effector insert 28010 can be released from the end effector 12, for example, can remain in the patient's tissue after the end effector 12 is removed from the patient.

  In certain embodiments, the proximal end of an anvil attachable layer, such as a tissue thickness compensator and / or buttress material, is aligned with an anvil of an end effector into which a staple cartridge can be inserted and attached to the anvil. Thus, it can be releasably attached to the proximal end of the staple cartridge. In general, the anvil-attachable layer can be disposed relative to the anvil-facing side of the staple cartridge. The anvil attachable layer can be disposed on the staple deck of the staple cartridge and / or can be disposed on the staple deck layer. The proximal end of the anvil attachable layer can be attached to the proximal end of the staple cartridge or the proximal end of the staple deck layer. After the staple cartridge is inserted into the surgical staple end effector, the surgical staple anvil can be closed relative to the anvil-attachable layer such that the layer will be attached to the anvil. When the anvil is reopened, the anvil-attachable layer attached to the anvil can now move away from the staple cartridge along with the anvil. In various situations, as the attached layer moves with the anvil, the attached layer can pivot about the staple cartridge and / or the proximal end of this layer attached to the staple cartridge layer. . In various other situations, as the attached layer moves with the anvil, the proximal end of the layer can be detached from the staple cartridge. The surgical stapler can now cut and staple the patient tissue with the anvil attachable layer attached to the anvil. The anvil attachable layer may be cut by a surgical stapler and captured by staples. The surgical stapler may be removed from the patient after the anvil-attachable layer and patient tissue are captured by the staples. In various embodiments where the anvil-attachable layer is directly attached to the staple cartridge, the surgical stapler can break the attachment between the layer and the staple cartridge and be free to withdraw from the layer.

  FIGS. 181 and 182 illustrate an embodiment of a staple cartridge assembly 2400 comprising an anvil attachable layer 2414. Anvil attachable layer 2414 can comprise, for example, a tissue thickness compensator and / or buttress material. The proximal end 2416 of the anvil attachable layer 2414 can be attached to the proximal end 2418 of the staple cartridge body 2402. In various embodiments, the staple cartridge assembly 2400 can include a staple cartridge layer 2412 such as, for example, a tissue thickness compensator and / or buttress material disposed on a staple deck of the staple cartridge body 2402. The cartridge pan 2404 can, for example, at least partially surround the staple cartridge body 2402 and can be composed of a metallic material. The staple cartridge body 2402 can include a surface 2406 and a groove 2408 defined in the surface 2406 at the proximal end 2418 of the cartridge body 2402. Referring to FIG. 181, the proximal end portion 2416 of the anvil attachable layer 2414 can be positioned over the groove 2408 to attach the anvil attachable layer 2414 to the staple cartridge body 2402. Thereafter, as shown in FIG. 182, the tab portions 2410 extending from the cartridge pan 2404 are, for example, layers in which the tab portions can be anvil mounted in the groove 2408 between the side wall of the groove 2408 and the tab portion 2410. The proximal end portion 2416 of 2414 can be deformed to extend into the groove 2408 with the capture. Tab portion 2410 may further capture, for example, an anvil attachable layer 2414 between the bottom of groove 2408 and tab portion 2410.

  In use, the staple cartridge assembly 2400 shown in FIG. 182 can be inserted into the staple cartridge channel of the end effector of the surgical stapler. As a result, the end effector anvil can be closed against the anvil-attachable layer 2414. The anvil attachable layer 2414 is disposed on the staple cartridge body 2402 such that the layer 2414 is properly aligned with the anvil when the staple cartridge assembly 2400 is inserted into the staple cartridge channel 2400 and the anvil is subsequently closed. Can be done. In various embodiments, the anvil facing surface 2415 of the anvil attachable layer 2414 is an adhesive that can adhere to the surface of the anvil and / or to attach the anvil attachable layer 2414 to the anvil. One or more attachment features that engage the anvil can be included. For example, the anvil-facing surface 2415 can include one or more protrusions that extend from this surface and can engage the anvil's knife slot. After the anvil attachable layer 2414 is attached to the anvil, the anvil can return to the open position with the anvil attachable layer 2414 attached to the anvil. The portion of the anvil attachable layer 2414 attached to the anbis pivots about the proximal end 2416 of the layer 2414 attached to the staple cartridge body 2402 to allow the layer 2414 to move with the anvil. can do. The surgical stapler can then include a staple cartridge layer 2412 aligned on the staple cartridge body 2402 and an anvil attachable layer 2414 attached to the anvil and aligned with the anvil.

  When the staple cartridge body 2402 is aligned with the staple cartridge layer 2412 and the anvil attachable layer 2414 is attached to the anvil and aligned with the anvil, the surgical stapler can cut and staple the patient tissue. Ready to use. The staple cartridge body 2402 and the staple cartridge layer 2412 can be positioned on one side of the patient tissue, and the anvil and anvil-attachable layer 2414 can be positioned on the opposite side of the patient tissue. Attachment of the anvil attachable layer 2414 to the anvil and staple cartridge body 2402 can stabilize the anvil attachable layer 2414 relative to the anvil while the staples are positioned relative to the patient tissue. When the surgical stapler is properly positioned relative to the patient tissue, the anvil is attachable to the staple cartridge body 2402 and staple cartridge layer 2412 on one side of the tissue and the anvil and anvil on the other side of the tissue. The tissue can be closed with the layer 2414 captured.

  After the anvil is closed with the patient tissue captured between the staple cartridge body 2402 and staple cartridge layer 2412 on one side and the anvil and anvil-attachable layer 2414 on the other side, the surgical stapler is fired. obtain. For example, the stapler driver can be advanced distally through the staple driver slot 2422 in the staple cartridge body 2402 to fire and mold the staples stored in the staple cartridge. The fired and shaped staples can capture the staple cartridge layer 2412, the anvil-attachable layer 2414, and the patient layer therebetween. Similarly, the cutting blade may be advanced distally through knife slot 2420 in cartridge body 2402 and knife slot in the anvil. The cutting blade can cut the staple cartridge layer 2412, the anvil-attachable layer 2414, and the patient tissue between them as the cutting blade is advanced. In various embodiments, the staple driver and the cutting blade can be advanced simultaneously. In various situations, the staple driver can guide the cutting blade so that the staple is fired and molded before the cutting blade cuts the patient tissue, the staple cartridge layer 2412, and the anvil-attachable layer 2414. .

  After the staple cartridge layer, the anvil attachable layer 2414, and the patient tissue between them are captured by the staple and cut by the cutting blade, the anvil can be reopened. When the anvil is reopened, the staple cartridge layer 2412 and the anvil-attachable layer 2414 attached to the patient tissue by the staples can now be separated from the anvil. For example, as the anvil is opened and / or as the surgical stapler is removed from the patient, the anvil-attachable layer 2414 is an adhesive that holds the layer 2414 to, for example, the anvil. It can be held in place by staples and patient tissue so that it can be pulled away from the layers and / or attachment features. Moreover, the proximal end 2416 of the anvil attachable layer 2414 can be pulled away from the staple cartridge body 2402 so that it can be disconnected from the proximal end 2416 of the staple cartridge body 2402. For example, in various situations, the portion of the proximal end 2416 of the anvil attachable layer 2414 captured between the groove 2408 in the cartridge body 2402 and the tab 2410 of the cartridge pan 2404 may be It can be pulled out from between 2408. In various other situations, the anvil attachable layer 2414 can be peeled away from the portion of the anvil attachable layer 2414 captured between the groove 2408 and the tab portion 2410 of the cartridge pan 2404. For example, the anvil attachable layer 2414 captured between the groove 2408 and the tab portion 2410 may reduce the force required to tear off the remaining portion of the layer 2414 and / or the layer. To define where the 2414 will tear, it can be fatigued by a tab 2410 that press fits into a portion of the layer 2414. For example, a tab portion 2410 that extends into the anvil adjustable layer 2414 may, for example, partially cut the layer 2414, cut the layer 2414, and / or perforate the layer 2414. After the staple cartridge 2412 is disconnected from the staple cartridge body 2402 and the anvil attachable layer 2414 is disconnected from the staple cartridge body 2402 and the anvil, the surgical staple remains with the layers 2412 and 2414 embedded in the patient. Can be removed from the patient. Layers 2412 and 2414 can support rows of staples and / or have different thicknesses within different staples, for example, to provide at least a minimum amount of compression to patient tissue captured by the staples. Can be pressed.

  With continued reference to FIGS. 181 and 182, in various embodiments, the anvil attachable layer 2414 can be detached from the staple cartridge body 2402 after the layer 2414 is attached to the anvil and the anvil is reopened. As described above, after the staple cartridge assembly 2400 has been inserted into the staple cartridge channel and the anvil has closed on the anvil-attachable layer 2414, the layer 2414 has adhesive on the anvil-facing surface 2415 of the layer 2414 and It can be attached to the anvil by attachment features. When the anvil is reopened, the anvil attachable layer 2414 can move away from the staple cartridge 2402 with the anvil. In various situations, the movement of the anvil and anvil-attachable layer 2414 away from the staple cartridge body 2402 can be caused by the tab 2410 of the cartridge pan 2404 and the proximal end 2416 of the layer 2414 to move further with the anvil. The portion of the layer 2414 captured between the cartridge body 2402 and the groove 2408 can be pulled out from between the tab portion 2410 and the groove 2408.

  FIGS. 183 and 184 illustrate another embodiment comprising a staple cartridge assembly 2450 that includes an anvil attachable layer 2464 attached to a staple cartridge body 2452. In this embodiment, the proximal end 2466 of the anvil attachable layer 2464 is attached to a surface 2472 on an attached portion 2470 that can extend from the surface 2456 of the cartridge body 2452. The proximal end 2466 of the anvil attachable layer 2464 can be attached to the surface 2472 by, for example, adhesive, ultrasonic welding, thermal welding, and / or thermal staking. In various embodiments, the staple cartridge assembly 2450 can include a staple cartridge layer 2462 disposed on the staple cartridge body 2462. In such embodiments, attachment portion 2470 can extend from surface 2456 of cartridge body 2452 such that surface 2472 is approximately level with surface 2467 facing the anvil of staple cartridge layer 2462. As a result, the anvil attachable layer 2464 can be placed substantially flat across the anvil facing surface 2467 and surface 2472 of the staple cartridge layer 2462. In various situations, the end effector anvil may be anvil-attachable layer 2464 after the staple cartridge assembly 2450 has been inserted into the staple cartridge channel of the end effector, similar to the embodiment described above with respect to FIGS. 181 and 182. The anvil-facing side 2465 can be closed for contact. An adhesive and / or attachment feature on the anvil-facing side 2465 of the anvil attachable layer 2464 can attach the anvil attachable layer 2464 to the anvil. Thereafter, when the anvil is reopened, the anvil attachable layer 2464 can pivot about the proximal end 2466 attached to the surface 2472. Similar to the embodiments described above with respect to FIGS. 181 and 182, the staple cartridge layer 2462, the anvil-attachable layer 2464, and the patient tissue therebetween can be cut and stapled together. Thereafter, the anvil of the surgical stapler is reopened and / or the surgical stapler is removed from the patient, the anvil attachable layer 2464 can be detached from the anvil, and the staple cartridge layer 2462 can be stapled. It can be separated from the cartridge body 2452. Similarly, the proximal end 2466 of the anvil attachable layer 2464 can be separated from the adhesive and / or attachment to the surface 2472 such that the anvil attachable layer 2464 can be implanted in the patient.

  With continued reference to FIGS. 183 and 184, in various embodiments, when the anvil is reopened after the anvil attachable layer 2464 is attached to the anvil, the proximal end 2466 of the anvil attachable layer 2464 is: It can be cut off from surface 2472. For example, the proximal end 2466 of the anvil attachable layer 2464 can be attached to the anvil. As the anvil and attached anvil-attachable layer 2464 move away from the staple cartridge body 2452 and / or staple cartridge layer 2462, the proximal end 2466 of the layer 2464 can be pulled away from the surface 2472 and detached. In such embodiments, the anvil attachable layer 2464 is detached from the staple cartridge before the staple cartridge layer 2464, the anvil attachable layer 2464, and the patient tissue therebetween are cut and stapled. Can be.

  FIGS. 185 and 186 illustrate another embodiment comprising a staple cartridge assembly 2500 that includes a staple cartridge layer 2506 and an anvil attachable layer 2510. In the embodiment shown in FIGS. 185 and 186, the anvil attachable layer 2510 can be attached to the staple cartridge layer 2506 instead of the staple cartridge body 2502. Staple cartridge layer 2506 and anvil attachable layer 2510 can each comprise, for example, a tissue thickness compensator and / or buttress material. Anvil attachable layer 2510 can include a first proximal tab portion 2512 extending from the proximal end 2508 of layer 2510. The first proximal tab portion 2512 can be attached to the proximal end surface 2516 of the staple cartridge layer 2506. For example, the first proximal tab portion 2512 can be glued, welded, and / or overmolded onto the proximal end surface 2516 of the staple cartridge layer 2506. In certain embodiments, the anvil attachable layer 2510 can include a second proximal tab portion 2514 extending from the first proximal tab portion 2512. The second proximal tab portion 2514 can be attached to the bottom surface 2518 of the staple cartridge layer 2506, for example, by gluing, welding, and / or overmolding.

  Similar to the embodiment described above with respect to FIGS. 181-184, after the staple cartridge assembly 2500 has been inserted into the staple cartridge channel of the end stapler of the surgical stapler, the end effector anvil is an anvil attachable layer. When closed over 2510, the anvil-facing surface 2511 of the anvil-attachable layer 2510 can be attached to the anvil by an adhesive and / or by attachment features. When the anvil is reopened, the anvil attachable layer 2510 can move away from the staple cartridge layer 2506 and the staple cartridge 2502 with the anvil. In various situations, the anvil attachable layer 2510 can pivot about the first tab portion 2512 as the anvil reopens. After the anvil attachable layer 2510 is attached to the anvil, the end effector is positioned with the staple cartridge body 2502 and the staple cartridge layer 2506 on the first side of the patient tissue, and the anvil and anvil attachable layer 2510 is the patient tissue. Can be closed over the patient tissue so as to be positioned on the second half-valley side of the patient. As described above in connection with FIGS. 181 and 182, the cutting blade can be advanced through knife slot 2520 in cartridge body 2502 and the staple driver can be advanced through staple driver slot 2422 in cartridge body 2502. Can be. Referring primarily to FIG. 185, in certain embodiments, the first tab portion 2512 and the second tab portion 2514 of the anvil attachable layer can be aligned with the knife slot 2512. As the cutting blade is advanced through the knife slot 2520, the cutting blade can cut the first multi-portion 2512 and the second tab portion 2514. In various situations, the cutting of the first tab portion 2512 and the second tab portion 2514 by the cutting blade can detach the first tab portion 2512 and the second tab portion 2514 from the staple cartridge layer 2506. After the cutting blade and staple driver have been advanced and the staple cartridge layer 2506, the anvil attachable layer 2510, and the patient tissue between them have been cut and stapled, the anvil has an anvil attachable layer 2510. Separated from the anvil, the staple cartridge layer 2506 may be reopened to separate from the staple cartridge body 2502. As described above, the anvil attachable layer 2510 in the embodiment of FIGS. 185 and 186 is attached to the staple cartridge layer 2506 but not attached to the staple cartridge body 2502. In this manner, no action is required to separate the anvil attachable layer 2510 from the staple cartridge body 2502. The first tab portion 2512 and / or the second tab portion 2514 of the anvil attachable layer 2510 can remain attached to the staple cartridge layer 2506 because both layers are stapled, This is because it can be implanted in a patient. For example, if the cutting blade does not separate the first tab portion 2512 and the second tab portion 2514 from the staple cartridge layer 2506, the staple cartridge layer 2506 and the anvil attachable layer 2510 are formed by the formed staples as well as the first staple portion. The first and second tab portions 2512 and 2514 will be attached to each other inside the patient.

  With continued reference to FIGS. 185 and 186, in various embodiments, after the staple cartridge assembly 2500 is inserted into the staple cartridge channel and the anvil attachable layer 2510 is attached to the anvil, the first tab portion 2512 and The second tab portion 2514 can be detached from the staple cartridge layer 2506 when the anvil is reopened and the anvil attachable layer 2510 leaves the staple cartridge layer 2506. For example, the anvil and the anvil-attachable layer 2510 attached to the anvil can be separated from the staple cartridge layer 2506 such that the first tab portion 2512 and the second tab portion 2514 are separated from the staple cartridge layer 2506. Tab portion 2512 and second tab portion 2514 can be pulled apart.

  FIGS. 187 and 188 illustrate another embodiment with an anvil attachable layer 2550 for use with a surgical stapler. As will be described below, the proximal end portion 2554 of the anvil-attachable layer 2550 is for insertion of the surgical stapler into the end effector and for alignment and attachment of the end effector to the anvil. Attached to the proximal end portion. The body 2552 of the anvil attachable layer 2550 can be separated from the staple cartridge by the cutting blade of the surgical stapler at the beginning of the cutting blade stroke. For example, the cutting blade 2570 shown in FIG. 188 may be used before any patient tissue is cut and before any portion of the body 2552 of the anvil-attachable layer 2550 is captured by the staples. The anvil-attachable layer 2550 can be detached from the staple cartridge.

  Referring primarily to FIG. 187, the anvil attachable layer 2550 can include a body 2552 and a proximal end portion 2554. The proximal end portion 2554 includes an attachment feature 2556 that can be attached to the proximal end portion of the staple cartridge. For example, the attachment feature 2556 can include adhesive, welding, and / or heat staking. Attachment feature 2556 can further comprise a portion captured between a slot in the staple cartridge and a tab portion of the cartridge pan, for example, as described above with respect to FIGS. 181 and 182. Anvil attachable layer 2550 can be attached to and aligned with the staple cartridge such that the staple cavities of the staple cartridge are aligned with the body 2552 of layer 2550. In other words, when staples from the staple cartridge are fired, the staples will capture the body 2552 of the anvil attachable layer 2550. Similar to the embodiment described above with respect to FIGS. 181-186, a staple cartridge assembly that includes an anvil attachable layer 2550 attached to a staple cartridge can be inserted into a staple cartridge channel of an end effector of a surgical stapler. The anvil of the end effector can be closed on the anvil facing surface 2553 of the anvil attachable layer 2550. The anvil facing surface 2553 can include adhesive and / or attachment capabilities that releasably attach the anvil attachable layer 2550 to the anvil when the anvil is closed over the anvil facing surface 2553. When the anvil is reopened, the anvil attachable layer 2550 can pivot around the attachment feature 2556 to move with the anvil. Similar to the embodiments described above with respect to FIGS. 181-186, the staple cartridge can include a staple cartridge layer such as, for example, a tissue thickness compensator and / or buttress material.

  Anvil attachable layer 2550 can comprise a first lateral side 2566 and a second lateral side 2568. The first lateral side surface 2566 and the second lateral side surface 2568 can define a midline 2564 therebetween. In certain embodiments, the anvil attachable layer 2550 can be attached to the anvil of the end effector such that the midline 2564 is aligned with the knife slot in the anvil and the knife slot in the staple cartridge, and Can be aligned. The body 2552 of the anvil attachable layer 2550 includes a first lateral slit 2558 positioned near the proximal end and extending from the first lateral side 2566 beyond the midline 2564. it can. The body 2552 of the anvil attachable layer 2550 has a second laterally positioned proximally relative to a first lateral slit 2558 extending from the second lateral side 2568 beyond the midline 2564. A directional slit 2560 may further be included. The first lateral slit 2558 and the second lateral slit 2560 allow the connector portion 2562 to connect the body 2552 of the anvil-attachable layer 2550 to the proximal end portion 2554 of the layer 2550. Can be defined between.

  Referring primarily to FIG. 188, after the anvil attachable layer 2550 is releasably attached to the anvil of the end effector, the end effector has the anvil and anvil attachable layer 2550 on one side of the tissue, and the staple cartridge And / or can be closed on the patient tissue such that the staple cartridge layer is on the opposite side of the tissue. Thereafter, the cutting blade 2570 can be advanced through a knife slot in the cartridge and a knife slot in the anvil, such as the knife slot 2418 shown in FIGS. The midline 2564 of the anvil attachable layer 2550 may be aligned with the knife slot such that the cutting blade 2570 gradually cuts the anvil attachable layer 2550 along the midline. As the cutting blade advances through the anvil-attachable layer 2550 in the distal direction indicated by arrow D, the cutting edge 2572 of the cutting blade 2570 first cuts the proximal end portion 2554 of the layer 2550 and then the connector The portion 2562 is cut open to separate the body 2552 of the layer 2550 from the proximal end portion 2554 of the layer 2550. Finally, the cutting blade 2570 cuts through the body 2552 of the anvil-attachable layer 2550. After the cutting blade 2570 has been advanced through the anvil-attachable layer 2550, this layer is divided into four pieces. The body 2552 of the anvil attachable layer 2550 is separated from the proximal portion 2554 of the layer 2550. Moreover, the body 2552 of the anvil attachable layer 2550 is divided into two pieces 2580 and 2582 and the proximal portion 2554 of the layer 2550 is divided into two pieces 2586 and 2588.

  In various situations, a surgeon using a surgical stapler may not fire the stapler completely. For example, referring to FIG. 188, the surgeon need only advance the cutting blade 2570 and staple driver halfway through the body 2552 of the anvil-attachable layer 2550. Continuing the example, the body 2552 of the anvil attachable layer 2550 is released from the staple cartridge at the beginning of the cutting stroke of the cutting blade 2570 when the blade 2570 cuts the connector portion 2560 of the layer 2550. The cutting blade 2570 will then be advanced to cut according to the midline 2564 along approximately half the length of the body 2552 of the anvil attachable layer 2550. Similarly, the staple driver can be advanced to fire and mold staples within the patient tissue and half of the body 2552 of the layer 2550 cut by the cutting blade 2570. The other half of the body 2552 of the anvil attachable layer 2550 is not cut and captured by the staples. The cutting blade 2570 and staple driver can then be retracted and the anvil can be reopened. When the anvil is reopened, the portion of the body 2552 of the anvil-attachable layer 2550 captured by the staples and attached to the patient tissue can be detached from the anvil. As described above, the connector portion 2560 that connects the body 2552 of the anvil-attachable layer 2550 to the proximal end portion 2554 can be used before any staple is fired and the cutting blade 2570 can be attached to any patient tissue or Prior to cutting any portion of the body 2552 of the layer 2550, it can be cut. As a result, the body 2552 of the layer 2550 has already been released from the staple cartridge. When the surgical stapler is removed from the patient, the portion of the body 2552 of the anvil-attachable layer 2550 captured by the patient tissue can pull the remaining portion of the body 2552 away from the anvil. As described in this example, the anvil attachable layer 2550 is a connector of the anvil attachable layer 2550 before any staples from the staple cartridge are fired and molded within the body 2552 of the layer 2550. Because portion 2560 can be cut by cutting blade 2570, incomplete firing of the surgical stapler can be accommodated.

  The above embodiments associated with FIGS. 181-186 can similarly accept incomplete firing of the surgical stapler. In each instance, the cutting blade of the surgical stapler is not required to separate the anvil attachable layer from the staple cartridge. In the embodiment described with reference to FIGS. 181-184, the anvil-attachable layer can be withdrawn and released from the attachment of this layer to the staple cartridge body after a portion of the surgical instrument has been fired. In the embodiment described above with respect to FIGS. 185 and 186, the anvil attachable layer is attached to the staple cartridge layer rather than attached to the staple cartridge. As noted above, both the staple cartridge layer and the anvil attachable layer are implantable within the patient. In this manner, whether or not the surgical instrument has been fully fired is not related to separating the anvil-attachable layer from the staple cartridge in the surgical staple in the embodiment described above with respect to FIGS.

  In various situations, the surgeon can use the second surgical instrument to detach the anvil-attachable layer described with reference to FIGS. 181-184 from the staple cartridge. For example, in various situations, a surgical stapler is used for fragile tissue such as lung tissue, and the surgeon may create this tissue by pulling and releasing the surgical stapler from the anvil-attachable layer. Sometimes you want to avoid the traction above. In such a situation, the surgeon may use another surgical tool such as a grasping tool to stably hold the stapled patient tissue and the anvil attachable layer while the surgical stapler is removed from the patient. Equipment can be introduced. In various embodiments of the anvil attachable layer described above with reference to FIGS. 185-188, the surgeon does not require a second surgical tool to separate the anvil attachable layer from the surgical staples. There is. Referring again to the embodiment described above with respect to FIGS. 185 and 186, the anvil attachable layer 2510 is attached to a staple cartridge layer 2506 that is also implanted in the patient. There is no attachment of an anvil attachable layer to the staple cartridge in the surgical stapler. As a result, the patient tissue does not need to be pulled or pulled to separate the anvil-attachable layer from the staple cartridge when the stapler is removed from the patient. Referring again to the above embodiment in connection with FIGS. 187 and 188, the body 2552 of the anvil-attachable layer 2550 is mechanically separated from the surgical stapler by the cutting blade 2570 at the beginning of the cutting blade stroke. Again, there is no attachment of the body 2552 of the anvil-attachable layer 2550 to the staple cartridge in the surgical stapler when the surgical stapler is ready to be removed from the patient after cutting and stapling the patient tissue. . As a result, the patient tissue need not be pulled or pulled to separate the body 2552 of the anvil-attachable layer 2550 from the staple cartridge when the stapler is removed from the patient.

  Referring primarily to FIGS. 189-190, a compensator 27120 for the sleeve 27110 can include a body 27122 having a longitudinal protrusion 27124 that extends along at least a portion of the body 27122. The longitudinal protrusion 27124 can define a longitudinal path along the midline of the body 27122, for example. In various embodiments, the longitudinal protrusion 27124 can be received by a longitudinal slot in the anvil when the sleeve 27110 is positioned on the anvil. Referring primarily to FIG. 191, the vertical protrusion 27124 can include a rounded protrusion. For example, the cross-section of the longitudinal protrusion 27124 can form an arc and / or a partial ring. In other embodiments, the longitudinal protrusion 27124 can comprise a cornered and / or stepped protrusion. The compensator 27120 can further comprise an edge 27126 that can be, for example, linear, curved, grooved, wavy, and / or zigzag. In various embodiments, the edge 27126 can comprise a gap 27128 that can be configured to receive a catch extension extending from the anvil when the assembled sleeve 27110 is positioned on the anvil.

  As outlined herein, for example, a layer such as a tissue thickness compensator can be implanted into the tissue by one or more fasteners released from the staple cartridge. Similarly, as outlined herein, in various situations, the entire staple row can capture at least a portion of the layer in contact with the tissue. By way of example, a staple that is most proximal in a staple row can capture at least a portion of the layer within the staple, and a staple that is distal most in the staple row is likewise of the layer. At least a portion can be captured within the staple. In certain circumstances, the proximal portion of the layer may extend proximally with respect to the staple that is most proximal in the staple row, and / or the distal portion of the layer may be in the staple row. It can extend distally with respect to the most distal staple among them. In use, the series of layers may be embedded. In at least one such situation, the layer can be continuously embedded along the cut. In some situations, a layer can be embedded so that one layer partially overlaps another layer. As an example, the distal end of the first embedded layer can overlap the proximal end of the second embedded layer. Similarly, the distal end of the second embedded layer can overlap the proximal end of the third layer, and so on. As a result, certain fasteners may capture portions of two or more layers within the fastener. The presence of two or more layers captured within the staple increases the pressure applied to the tissue captured within the staple, particularly when a plurality of adjacent staples capture two or more layers. And / or may increase the stiffness of the tissue. Referring now to FIGS. 192-194, as will be described in more detail below, the tissue thickness compensator 11050 can include a proximal end 11053 and / or a distal end 11055, the proximal end 11053. And / or the distal end 11055 can comprise one or more strain relief portions that can reduce the stiffness of the tissue thickness compensator 11050 and the stiffness of the stapled tissue.

  Referring again to FIGS. 192-194, the distal end 11055 of the tissue thickness compensator 11050 can include one or more slots 11058 defined in the distal end. The slot 11058 can comprise, for example, cuts and / or cuts defined in the tissue thickness compensator 11050. The slots 11058 can define protrusions or tabs 11056 that can be configured to move and / or deflect at least partially relative to each other and / or relative to the body portion of the tissue thickness compensator 11050. . In other words, the slot 11058 can provide localized strain relaxation to the tissue thickness compensator 11050 and the underlying tissue. In certain circumstances, the first tissue thickness compensator 11050 tab portion 11056 may be superimposed at the proximal end 11053 of the second tissue thickness compensator 11050. In various situations, the slot 11058 allows the first tissue thickness compensator 11050 and the second tissue thickness compensator to pivot relative to each other. In certain circumstances, primarily referring to FIG. 194, the tab portion 11056 of the first tissue thickness compensator 11050 may be overlaid with the tab portion 11056 of the second tissue thickness compensator 11050. In various situations, the slot 11058 in the superimposed distal end 11055 can further reduce the internal stiffness of the underlying tissue. The illustrated embodiment of the tissue thickness compensator 11050 only includes an arrangement of tabs 11057 and slots 11058 at one end thereof, and the tissue thickness compensator can be, for example, at both ends thereof. An arrangement of tabs 11057 and slots 11058 may be provided.

  In certain embodiments, in addition to the above, each tab 11056 can comprise a tapered cross-sectional shape. For example, each tab portion 11056 can comprise a base attached to the body of a tissue thickness compensator 11050 having a base width and a free end having an end width at the opposite end, where the base width is , Can be wider than the end width. In certain embodiments, the end width can be wider than the base width. Referring primarily to FIG. 194, the end 11055 can comprise a plurality of tab portions 11056 having different configurations. As an example, the tab portions 11056 can have different lengths. As shown in FIG. 194, for example, the farthest tab portion 11056a can have a first length and the second tab portion 11056b has a second length that is longer than the first length. The third tab portion 10056c can have a third length that is longer than the second length, and the fourth tab portion 10056d has a fourth length that is longer than the third length. The fifth tab portion 10056e can have a fifth length that is longer than the fourth length, and the sixth tab portion 10056f has a sixth length that is longer than the fifth length. be able to. In such embodiments, the tab portion 10056 can be gradually shortened toward the distal end of the tissue thickness compensator 10050. In other embodiments, the length of the tab portion 10056 may be arranged in other suitable arrangements.

  In various situations, in addition to the above, the layer can comprise an edge that defines the perimeter of the layer. These edges may be straight, substantially straight, straight, and / or substantially straight in certain circumstances. In some such situations, the layer edge may affect and / or otherwise substantially affect the surrounding tissue. Similarly, in some such situations, the edge may be rigid and may firmly support the tissue. In practice, certain parts of the tissue may not be supported by the layers, and these particular parts are adjacent to other parts of the tissue that are firmly supported by the layer, but transition between these parts. There is no. Referring once again to FIGS. 192-194, the periphery of the tissue thickness compensator 11050 can include an uneven configuration that can provide a transient, rigid region to the underlying tissue. The perimeter of the tissue thickness compensator 11050 can include a plurality of notches or recesses 11059 that are defined around the perimeter and can define a tab portion 11057. Similar to the above, the tab portion 11057 can extend from the body of the tissue thickness compensator 11050 and can move relative to the tissue thickness compensator. Again, each tab 11057 can include a proximal end attached to the body of the tissue thickness compensator 11050 and a free end that is movable relative to the proximal end. In certain circumstances, the free end of tab portion 11057 may have a width that is narrower than the width of the proximal end of tab portion 11057, while in other circumstances, the free end of tab portion 11057 may be tab portion 11057. It can have a width wider than the width of the base end. The tab portion 11057 may comprise any suitable configuration, such as, for example, a semi-circular or at least partially arcuate configuration. As a result of the above, tissue under and / or fastened to the body thickness of the tissue thickness compensator 11050 can be firmly supported by the body portion and under the tab portion 11057 and / or Or the tissue fastened to the tab portion can never be firmly supported by the tab portion 11057 and the tissue adjacent to the tab portion 11057 but not under the tab portion 11057 is the tissue thickness compensator 11050. May not be supported by.

  Referring now to FIGS. 195 and 196, the staple cartridge assembly 11100 can include a cartridge body 11110 and a tissue thickness compensator 11150 attached to the cartridge body 11110. The cartridge assembly 11100 can further comprise one or more attachment members 11160 configured to releasably hold the tissue thickness compensator 11150 relative to the cartridge body 11110. In at least one situation, each attachment member can comprise a strap that extends around the cartridge body 11110 and the tissue thickness compensator 11150. In use, in addition to the above, firing member 10030 dissects tissue thickness compensator 11150 to fire staples stored at least partially within cartridge body 11110 and cut staple member 11100 to cut attachment member 11160. Can be advanced through. The tissue thickness compensator 11150 can include a first or proximal end 11157 and a second or distal end 11155. The distal end 11155 can comprise an elongated protrusion 11156 extending from the body portion 11153 of the tissue thickness compensator 11150. As shown in FIG. 195, the elongated protrusion 11156 can extend distally with respect to the most distal attachment member 11160. In at least the illustrated embodiment, the cartridge body 11110 can include a deck 11113 that can define a staple cavity of the cartridge body 11110 within the deck. In various situations, the body 11153 of the tissue thickness compensator 11150 can be configured and arranged to cover the deck 11113 and staple cavities defined within the cartridge body 11110. In at least some situations, as also shown in FIG. 195, the elongated protrusion 11156 extends distally from the deck 11113 and extends distally with respect to the staple cavity defined in the deck 11113. can do.

  In use, in addition to the above, the tissue thickness compensator 11150 can be fastened to tissue and provide tissue thickness compensator characteristics as described herein. Similar to the above, the tissue under the tissue thickness compensator 11150 may be firmly supported by the tissue thickness compensator 11150 and the staples that clamp the tissue thickness compensator, but surround the tissue thickness compensator 11150. May not be supported by the tissue thickness compensator 11150 and may be flexible. In such a situation, the tissue between the flexible unsupported tissue and the rigidly supported tissue under the tissue thickness compensator 11150, i.e., the transitional tissue, may be subjected to undesirable strain. There is sex. Such distortion can adversely affect the transitional organization. By way of example, when a tissue thickness compensator is clamped to, for example, lung tissue, i.e. lung tissue, the tissue directly surrounding the tissue thickness compensator, i.e., surrounding tissue, in particular situations, particularly tissue The surrounding tissue adjacent to and / or surrounding the distal end of the thickness compensator, i.e., the surrounding tissue, may tear. The distal protrusion 11156 of the tissue thickness compensator 11150, however, can support the peri-end tissue. In other words, the distal protrusion 11156 can provide transient support to the tissue surrounding the end. Such transient support may be less than the support provided by the body of the tissue thickness compensator 11150, such as unsupported tissue and fully supported tissue under the tissue thickness compensator 11150. It is possible to reduce the change in distortion between the two. In various situations, the distal protrusion 11156 can provide an enlarged area where force can be transmitted between unstapled tissue and stapled tissue. Distal protrusion 11156 may be configured to flex and move with unsupported tissue and tissue thickness compensator 11150. In various situations, the distal protrusion 11156 can move relative to the body of the tissue thickness compressor 11150 and / or unsupported tissue.

  Referring again to FIGS. 195 and 196, the tissue thickness compensator 11150 can further comprise a notch 11157 defined in the proximal end 11153 thereof. A notch 11157 may be defined between the two distally extending protrusions 11158. The notch 11157 can have any suitable shape, such as a parabolic shape, for example. Similar to the above, the distally extending protrusion 11158 can provide transient support to the tissue surrounding the proximal end. Such transient support may be less than the support provided by the body of the tissue thickness compensator 11150, such as unsupported tissue and fully supported tissue under the tissue thickness compensator 11150. It is possible to reduce the change in distortion between the two. In various situations, the proximal protrusion 11158 can provide an enlarged area that can transmit force between unstapled and stapled tissue. Proximal protrusion 11158 may be configured to flex and move with unsupported tissue and tissue thickness compensator 11150. In various circumstances, the proximal protrusion 11158 can move relative to the body of the tissue thickness compressor 11150 and to each other and / or to unsupported tissue. Various alternative embodiments are possible in which two or more protrusions extend from the proximal and / or distal ends of the tissue thickness compensator.

  As shown in FIG. 196, two or more tissue thickness compensators 11150 can be implanted end to end along the path. In such a situation, the distal end 11155 of the first tissue thickness compensator 11150 can overlap the proximal end 11153 of the second tissue thickness compensator 11150. Similarly, the distal end 11155 of the second tissue thickness compensator 11150 can overlap the proximal end 11153 of the third tissue thickness compensator 11150. In various situations, the distal end 11156 of the first tissue thickness compensator 11150 can be aligned with, or at least substantially aligned with, the recess 11157 of the second tissue thickness compensator 11150. Similarly, in various embodiments, the distal protrusion 11156 and the proximal recess 11558 can be sized and configured such that they have substantially the same dimensions and / or shape. In various situations, the distal protrusion 11156 can be configured to be positioned within the proximal recess 11157 of the adjacent tissue thickness compensator 11150.

  Referring now to FIGS. 293 and 294, the end effector of the surgical stapling instrument includes a first jaw that includes a cartridge channel 11390 configured to receive a staple cartridge 11300 therein, and a first jaw that includes an anvil 11391. Two jaws. Similar to the above, the staple cartridge 11300 can include a cartridge body 11310 and a tissue thickness compensator 11350. The staple cartridge 11300 can further include a tissue abutting member 11355 attached to the staple cartridge. The tissue abutting member 13555 can be detachably attached to the cartridge body 11310 in various situations. In addition to or instead of being detachably attached to the cartridge body 11310, the tissue abutment member 11355 can be attached to the tissue thickness compensator 11350. In at least one such embodiment, the abutment member 11355 can be releasably tightened to the tissue thickness compensator 11350. In use, similar to the above, the fastener can be deployed from the cartridge body 11310 to clamp the tissue thickness compensator 11350 to the tissue T captured between the tissue thickness compensator 11350 and the anvil 11391. In various situations, the fastener may not penetrate the tissue abutting member 11355. In certain other situations, the fastener may penetrate at least a portion of the tissue abutment member 11355, be captured within the fastener, and clamp the tissue abutment member 11355 to the tissue T. In any event, similar to the above, at least a portion of the tissue abutment member 11355 is transient between the unsupported tissue and the tissue under the tissue thickness compensator 11350 that is firmly supported by the fasteners. May be configured to provide general support. The tissue abutting member 11355 can have any suitable shape, such as a tongue. In at least one embodiment, the tissue abutment member 11355 can include one or more notches 11358 that can define a tab 11356 between the two. When the tissue thickness compensator 11350 is positioned and clamped relative to the tissue T, the tissue abutment member 11355 deflects relative to the tissue thickness compensator 11350 and into the tissue adjacent to the distal end of the tissue thickness compensator 11350. It can be configured to provide support. In various situations, the tissue abutment member 11355 can deflect relative to the tissue thickness compensator 11350, and the tab portions 11356 can be, for example, relative to each other, relative to the body of the tissue abutment member 11355, and / or. Or it can be deflected relative to the tissue thickness compensator 11350.

  Referring again to FIGS. 293 and 294, at least a portion of the tissue abutment member 11355 can overlap the tissue thickness compensator 11350. In various situations, a portion of such a tissue abutment member 11355 can be attached to the tissue thickness compensator 11350 by, for example, one or more adhesives. In certain circumstances, at least a portion of the tissue abutment member 11355 causes the staples released from such staple cavities to capture at least a portion of the tissue abutment member 11355 and clamp the tissue abutment member 11355 to the tissue. Can overlap one or more staple cavities defined in the cartridge body 11310. At least a portion of the tissue contact member 11355 can overlap the nose portion 11311 of the cartridge body 11310. In various situations, a portion of such tissue abutting member 11355 can be attached to the nose portion 11311 by, for example, one or more adhesives. In other situations, a portion of such tissue abutment member 11355 may not be attached to the nose portion 11311. Referring primarily to FIG. 294, at least a portion of the tissue abutment member 11355 can overlap the distal portion 11312 of the nose portion 11311. In various situations, a portion of such tissue abutment member 11355 may not be attached to the distal portion 11312 of the nose portion 11311. In at least some situations, a gap can be defined between the tissue abutting members 11355. At least a portion of the tissue contact member 11355 can overlap the nose portion 11311 of the cartridge body 11310. In such an embodiment, the tissue abutment member 11355 can comprise a cantilever.

  In use, in addition to the above, the staple cartridge 11300 can be positioned on the first side of the tissue and the anvil 11391 can be positioned on the second side. The anvil 11391 can then be pivoted toward the staple cartridge 11300 about a pivot 11392 defined within the shaft 11393 of the surgical stapling instrument. When the anvil 11391 and staple cartridge 11300 are properly positioned, the staples stored within the cartridge body 11310 can be released from the cartridge body and pass through the tissue thickness compensator 11350, and the tissue thickness compensator. 11350 can be clamped to tissue T. Thereafter, the anvil 11391 can be opened and the end effector can be separated from the tissue T. In such a situation, the cartridge body 11310 can be pulled away from the tissue thickness compensator 11350, thereby leaving the tissue thickness compensator 11350. At the same time, the tissue abutment member 11355 can be detached from the staple cartridge 11300 along with the tissue thickness compensator 11350. As long as the tissue abutment member 11355 is attached to the tissue thickness compensator 11350, the tissue thickness compensator 11350 can hold the tissue abutment member 11355 against the tissue. In various circumstances, the tissue abutment member 11355 can be biased against the tissue T by the tissue thickness compensator 11350. As the tissue moves, expands and / or flexes, for example, the tissue abutment member 11355 flexibly supports the underlying tissue T and applies forces, stresses and / or strains over a large area. Can be distributed.

  Referring again to FIGS. 293 and 294, the end effector of the surgical instrument can include a tissue abutting member, such as a tissue abutting member 11395 attached to the anvil 11391, for example. In various circumstances, the tissue abutment member 11395 can be the same or at least substantially the same as the tissue abutment member 11355. In at least one situation, the tissue abutment member 11395 can include a notch 11398 defined between the tab portions 11396. In use, the tissue abutment member 11395 can be attached to the anvil 11391 using, for example, one or more adhesives, and the tissue abutment member 11395 is positioned after the anvil 11391 relative to the tissue T. When closed, it can be positioned relative to tissue T. When the anvil 11391 is reopened after the staples are fired from the staple cartridge, the tissue abutment member 11395 can be detached from the anvil 11391 and remain attached to the tissue. In various situations, at least a portion of the tissue abutment member 11395 can be captured within staples ejected from the cartridge body 11310, for example. In at least some such situations, the tissue abutment member 11395 can at least partially overlap a staple cavity defined in the anvil 11391 or can extend over the staple cartridge. In some situations, for example, one or more adhesives, such as activatable adhesives, are located on the tissue contacting surface of the tissue abutting member 11395 such that the tissue abutting member 11395 contacts the tissue T. can do. In any case, referring primarily to FIG. 294, one or both of tissue abutment member 11355 and tissue abutment member 11395 may be utilized to flexibly support tissue T. In embodiments where both tissue abutment member 11355 and tissue abutment member 11395 are utilized, tissue abutment members 11355 and 11395 may be composed of the same material or different materials. The tissue abutment members 11355 and 11395 may have the same shape and configuration, or different shapes and configurations. The tissue abutment members 11355 and 11395 may have the same thickness or different thicknesses. The characteristics of such tissue abutting members 11355 and 11395 can be selected to provide the desired support cross-section to the tissue positioned between these tissue abutting members. As an example, such characteristics may be selected such that one of the tissue thickness compensators 11355 and 11395 is more rigid than the other. At the same time, such characteristics may be selected such that one of the tissue thickness compensators 11355 and 11395 is more flexible than the other.

  In various embodiments, the tissue thickness compensator can comprise multiple layers. As an example, the tissue thickness compensator can comprise a first layer and a second layer. Such layers can be composed of the same material or different materials. Some layers may be configured to provide different properties to the tissue thickness compensator. By way of example, the tissue thickness compensator can comprise a compressible first layer that provides tissue thickness compensation properties and a more rigid second layer that can support the first layer. Referring primarily to FIGS. 197 and 198, the tissue thickness compensator 11250 can comprise a first layer 11251 and a second layer 11252. The second layer 11252 can be compressible and can provide tissue thickness compensation characteristics. The first layer 11251 can be rigid and can be supported with the second layer 11252. The second layer 11252 can be positioned relative to the cartridge body 11210 and / or attached to the cartridge body, for example. In certain circumstances, the first layer 11251 extends along the entire length of the first layer and is releasably retained in a longitudinal knife slot 11215 defined in the cartridge body 11210. A longitudinal channel 11253 can be provided that can be sized and configured. In various situations, the second layer 11252 can be clamped to the first layer 11251 and held in place by the first layer 11251.

  Referring again to FIGS. 197 and 198, the compensator 11250 may comprise multiple layers. Moreover, the outer periphery 11218 of the second layer 11252 may be at least partially widened beyond the outer periphery 11220 of the first layer 11251. In addition, the first layer 11251 and the second layer 11252 may have different stiffnesses. For example, the second layer 11252 may be configured to be more flexible than the first layer 11251. This arrangement may provide a sufficiently rigid inner region of first layer 11251 and second layer 11252 that may be suitable to provide adequate support for staples 11260 and tissue T, eg, by staples 11260. And a sufficiently flexible layer consisting of a second layer 11252 that may be suitable during and / or after capture of the tissue thickness compensator 11250 to provide sufficient flexibility to mitigate impact on the tissue T. Some outer regions may be provided in the tissue thickness compensator 11250. Layers 11251 and 11252 can be bonded by, for example, an adhesive. Other attachment means for attaching the first layer 11251 to the second layer 11252 are contemplated within the scope of this disclosure.

  In addition to the above, the first layer 11251 may include an inner portion 11254 and an outer portion 11256 that at least partially surrounds the inner portion 11254, such that the outer portion 11256 is more flexible than the inner portion 11254. May be configured. For example, the outer portion 11254 may comprise a plurality of slits 11210 that may increase the flexibility of the outer portion 11254. Moreover, as described above, the second layer 11252 may be configured to be more flexible than the first layer 11251. This arrangement may provide the tissue thickness compensator 11250 with three regions having different configurations, with the three regions having the highest stiffness, the first layer 11251 and the second layer 11252. The first inner region composed of the inner portion 11254 and the intermediate region having intermediate rigidity and the outer region 11256 of the first layer 11251 and the second layer 11252 have the lowest rigidity. And a third outer region comprising only the second layer 11252.

  The second layer 11252 of the tissue thickness compensator 11250 can comprise a woven structure that may include a plurality of fibers woven into the woven structure. The woven structure may provide the second layer 11252 with sufficient flexibility to mitigate impact on the tissue T during and / or after capture of the tissue T and tissue thickness compensator 11250 by the staples 11260, for example. . Moreover, the outer periphery 11218 can be composed of fibers that can provide an intact tissue contacting surface to minimize impact on the tissue T, as described above. Woven structures and fibers can be composed of biocompatible materials. Moreover, the woven structure and / or fibers can be composed of bioabsorbable materials such as, for example, PLLA, PGA, PCL, and / or combinations thereof.

  Referring to FIGS. 199-201, the staple cartridge channel can be configured to receive a staple cartridge 1060 that can comprise a cartridge body 1062, a cartridge deck 1064, and a support 1065. In addition, a tissue thickness compensator, such as, for example, a tissue thickness compensator 1100, may be removably positioned against or adjacent to the cartridge deck 1064, as shown in FIG.

  Referring again to FIGS. 199-201, the tissue thickness compensator may be configured to be absorbed after implantation in a patient. The absorption process may first break the tissue thickness compensator into smaller pieces that may include rough edges that may undesirably affect the surrounding tissue T. To mitigate these effects, the tissue thickness compensators 1100 may each have an intact perimeter and may be combined to form a single structure, as shown in FIG. Sometimes, a plurality of pieces 1140 may be at least partially assembled. Fragments 1140 are combined to shape the tissue thickness compensator 1100 in such a way that the absorption process first breaks the tissue thickness compensator 1100 into fragments 1140, thereby minimizing the presence of rough edges. obtain. For example, the fragment 1140 may have a circular cross-sectional shape, and other cross-sectional shapes and other means of joining the fragment 1140 that may be joined by thermal bonding to form the tissue thickness compensator 1100 are disclosed herein. Can be considered within the scope of In one example, the fragment 1140 may be joined by an adhesive 1143 (see FIG. 200) configured to be absorbed faster than the fragment 1140 to cause separation of the fragment 1140 in an early stage of the absorption process. As shown in FIG. 200, a fragment 1140 is formed such that one end portion of one piece 1140 is releasably attached to another end portion 1140 such that the two end portions of the piece 1140 are releasably attached to each other, for example, by an adhesive. May be arranged in an overlapping arrangement overlapping the end portions of the. Under certain circumstances, the fragment 1140 is another piece that can be positioned over the plurality of fragments 1140 and releasably attached to the plurality of fragments, as shown in FIG. Can be arranged in an overlapping array.

  Referring to FIGS. 202-204, as described above, the tissue thickness compensator may be configured to be absorbed after implantation in a patient, and the absorption process may be performed by first aligning the tissue thickness compensator with May break into small pieces. Guiding the absorption process to produce a small piece with an intact outer edge may be accomplished by starting with a small piece with an intact outer edge, as described above. Another approach may include changing the tissue thickness compensator in a manner that causes the tissue thickness compensator to separate into smaller pieces having an intact perimeter in the early stages of the absorption process. For example, as shown in FIG. 202, a tissue thickness compensator 1200 can be formed or sculpted, for example, in the form of a tissue thickness compensator 1200 to produce a plurality of circular portions 1210, for example. The pattern may be provided. Portion 1210 may be defined by reducing tissue thickness compensator 1200 along circumference 1214 of circular portion 1210 as shown in cross-sectional view in FIG. 202A. As a result, faster absorption along the circumference 1214 of the circular portion 1210 may occur, which may cause the circular portions 1210 to separate from each other in the early stages of the absorption process. Patterns with portions having other geometric shapes including intact perimeters are contemplated within the scope of this disclosure. For example, as shown in FIG. 203, tissue thickness compensator 1200 ′ may include a cross-sectional shape 1218 that may extend longitudinally within a wavy cross-sectional shape along the length of tissue thickness compensator 1200 ′. A pattern 1216 may be provided. In another example, as shown in FIG. 204, the tissue thickness compensator 1200 ″ may include a pattern 1220 that may include a hexagonal shaped portion 1222.

  Referring to FIG. 205, as described above, a tissue thickness compensator, such as tissue thickness compensator 1250, may be captured with tissue T by a staple, such as staple 1002, for example, after implantation in a patient. May be configured to break into intact fragments, such as fragment 1226, in the early stages of the absorption process. Upon separation, the pieces 1226 can move and / or slide relative to each other and can affect the surrounding tissue T. To minimize relative movement between the pieces 1226, the firing staple 1002 is spatially coupled to the tissue thickness compensator 1250 such that the staple 1002 captures a plurality of pieces 1226, as shown in FIG. Can be placed. This may also help to maintain the tissue thickness compensator 1250 in a substantially unique structure even after the fragments 1226 are separated from each other in the early stages of the absorption process. Accordingly, the tissue thickness compensator 1250 may continue to provide support for the tissue T captured by the staples 1002 after the pieces 1226 are separated from each other in the early stages of the absorption process.

  In addition to the above, referring now to FIG. 206, yet another approach may be required to guide the absorption process of the tissue thickness compensator to produce small fragments that include intact outer edges. For example, as shown in FIG. 206, a tissue thickness compensator, such as tissue thickness compensator 1300, can be strategically positioned to improve the flexibility of tissue thickness compensator 1300 as described above. A slit 1310 may be provided. Moreover, the slit 1310 may be partially divided into a plurality of portions 1312 that may separate the tissue thickness compensator 1300 from each other during the initial stages of the absorption process. The slit 1312 can reduce the width of the tissue thickness compensator 1300 along the outer periphery 1314 of the portion 1312 as shown in FIG. This reduction in width may lead to faster absorption along the perimeter 1314 of the portion 1312 and, as a result, the tissue thickness compensator 1300 can be broken into separate portions 1312 during the initial stages of the absorption process.

  Referring to FIGS. 207A and 207B, the end effector of the surgical stapling instrument can comprise a first jaw and a second jaw, wherein at least one of the first jaw and the second jaw is , Can be configured to be moved relative to the other. In certain embodiments, the end effector can comprise a first jaw that includes a staple cartridge channel 1010 and a second jaw that includes an anvil 1012 (FIG. 207B), where the anvil 1012 includes, for example, a staple. It can pivot toward the cartridge channel 1010 and / or away from the staple cartridge channel 1010. The staple cartridge channel 1010 may be configured to receive a staple cartridge 1020 that may be removably held within the staple cartridge channel 1010, for example. Other embodiments may include staple cartridges that can be easily removed from the cartridge channel 1010. The staple cartridge 1020 can comprise a cartridge body 1022, a cartridge deck 1024, and a layer 1000, with the layer 1000 in contact with or adjacent to the cartridge deck 1024 as shown in FIG. 207A. May be positioned in the formula.

  As with the other embodiments described herein, referring again to FIGS. 207A and 207B, the cartridge body 1022 includes a plurality of staple cavities 1026 and staples 1002 positioned within each staple cavity 1026. Can be provided. Again, as with other embodiments described herein, the staple 1002 can be supported by a staple driver 1028 positioned within the cartridge body 1022, as shown in FIG. The firing member can be advanced through the staple cartridge 1020 to, for example, raise the staple driver 1028 upward within the staple cavity 1026 and release the staple 1002 from the staple cavity 1026. Tissue T and / or layer 1000 may be captured by staple 1002 as staple 1002 is released from staple cavity 1026 as shown in FIG. 207B.

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

  Referring again to FIG. 207B, the layer 1000 can include a tissue contacting surface 1003 that can be configured to reduce slip between the layer 1000 and the tissue positioned in contact with the layer. The force applied to the tissue T in contact with the tissue contact surface 1003 may depend in part on the contact area between the tissue T and the tissue contact surface 1003. Since pressure is inversely proportional to area, reducing the contact area may produce higher pressure on the tissue T, which in turn may produce better anti-slip. The tissue contacting surface 1003 may include a plurality of anti-slip 1030 that includes a small contact area, and the anti-slip 1030 may reduce slip between the layer 1000 and the tissue T positioned against the layer. . The layer 1000 can be manufactured using a non-slip 1030, for example, by compression molding techniques. Alternatively, the anti-slip 1030 can be molded over the tissue contacting surface 1003 after the layer 1000 has been manufactured, for example, by laser and / or chemical etching techniques that can result in multiple protruding structures. Moreover, the anti-slip 1030 can be organized using photolithographic techniques, which can typically use off-the-shelf photomasks as masters that can obtain, for example, final micrometer and / or nanometer scale anti-slip. Micrometer and / or nanometer scale structures formed on the contact surface 1003 may be provided. Other techniques for forming micrometer and / or nanometer scale non-slip 1030 are utilized and contemplated within the scope of this disclosure. In one embodiment, electron beam lithography may be utilized to create the anti-slip 1030.

  Referring now to FIGS. 207C-224, the anti-slip 1030 can have multiple shapes. For example, as shown in FIG. 207C, the tissue contacting surface 1003 can include a square and / or rectangular base and columns that are substantially vertical sides extending generally away from the tissue contacting surface 1003. A shape anti-slip 1038 may be included. In addition, the columnar anti-slip 1038 may terminate at a generally narrow top or tip 1040, as shown in the cross-sectional view of FIG. In addition, the tissue contacting surface 1003 may have a conical anti-slip 1032 as shown in FIG. 218, a pyramidal anti-slip 1034 as shown in FIG. 219, and / or a dome-shaped anti-slip 1042 as shown in FIG. May be included. The pyramidal anti-slip 1034 includes a square and / or triangular base and an inclined side that may extend generally away from the tissue contacting surface 1003, with an upper portion 1036 as shown in cross-section in FIG. May terminate.

  Anti-slip 1030 may be spatially disposed on tissue contacting surface 1003 in a predetermined pattern or arrangement. For example, the anti-slip 1030 may be spatially disposed on the tissue contacting surface 1003 in a plurality of rows that may extend longitudinally along the entire length of the surface 1003 parallel to each other. The anti-slip 1030 can also be spatially arranged in a circular shape. For example, the anti-slip 1030 can be arranged concentrically. Alternatively, the anti-slip 1030 can be irregularly positioned on the tissue contacting surface 1003.

  In addition to the above, the tissue contacting surface 1003 may have a plurality of shapes, a plurality of heights, and / or a plurality of spatial to provide various degrees of slip prevention along various regions of the tissue contacting surface 1003. An anti-slip 1030 with an arrangement may be included. For example, greater anti-slip may be required in and / or around the area of tissue contacting surface 1003 and staple 1002 is configured to penetrate tissue T and capture tissue T. Has been.

  Referring to FIGS. 209, 210, and 215-217, the layer 1000 may comprise a linear protrusion 1044 that may be deployed over the tissue contacting surface 1003. The linear protrusion 1044 may extend in the vertical direction. For example, the linear protrusions 1044 may extend parallel to each other along the entire length of the layer 1000, as shown in FIG. Alternatively, the linear protrusions 1044 may extend parallel to each other along the width of the layer 1000, as shown in FIG. In addition, the vertical and horizontal linear protrusions 1044 may intersect the path. For example, as shown in FIG. 217, the first pattern 1046 of the linear protrusion 1044 may extend parallel to the first direction on the tissue contacting surface 1003, and the first pattern 1046 of the linear protrusion 1044 The second pattern 1048 may extend parallel to the second direction on the tissue contacting surface 1003, and the first direction may be perpendicular to or substantially perpendicular to the second direction. . In addition, the linear protrusion 1044 may have a substantially uniform cross-sectional area, as shown in FIG. Alternatively, the linear protrusion 1044 may have a different cross-sectional area (not shown). In certain circumstances, the first pattern 1046 and the second pattern 1048 may be continuous or intermittent.

  In addition to the above, the layer 1000 may include non-linear protrusions that can be deployed on the tissue contacting surface 1003 alone or in combination with the linear protrusions 1044. Moreover, linear protrusions 1044 and / or non-linear protrusions can be deployed on tissue contacting surface 1003 in combination with anti-slip 1030 to provide the desired degree of anti-slip.

  Referring to FIGS. 213 and 214, the layer 1000 may comprise a plurality of depressions 1050 that can be carved into the tissue contacting surface 1003 as shown in FIG. 223. The indentation 1050 may comprise a substantially uniform socket shape, as shown in FIG. Alternatively, the indentations 1050 may have different depths that may provide different degrees of slip protection along various regions of the tissue contacting surface 1003. In general, the greater depth of a particular depression may result in greater flexibility in the area where the depression is present and higher contractibility of such area. Moreover, as described above in connection with the anti-slip 1030, the indentation 1050 may have multiple shapes and / or spatial arrangements. Moreover, the layer 1000 may comprise a combination of a recess 1050 and a non-slip 1030 that are spatially disposed on the tissue contacting surface 1003. In certain situations, the anti-slip 1030 and the indentation 1050 may be arranged in an alternating pattern.

  Referring again to FIGS. 223 and 224, the layer 1000 is similar to the linear protrusion 1044 (above), for example, as shown in FIG. A linear depression 1052 that may extend may be provided. Moreover, the layer 1000 may comprise a combination of linear depressions 1052 and linear protrusions 1044 spatially disposed on the tissue contacting surface 1003, for example, in an alternating pattern. Moreover, referring now to FIGS. 221 and 222, the combination of linear depressions 1052 and linear protrusions 1044 may be arranged in a corrugated pattern 1054 as shown in FIG.

  Referring now to FIGS. 244-246, a tissue thickness compensator, such as compensator 22320, for example, can be aligned with staple forming pockets 22062a and 22062b, respectively, and a plurality of first cavities 22322a and a plurality of second cavities 22322b. Can be provided. Referring primarily to FIG. 245, staple forming pockets 22062a and 22062b may be defined in separate stepped surfaces on anvil 22060. More particularly, the molding pocket 22062a can be defined in the first surface 22069a of the anvil 22060 and the molding pocket 22062b can be defined in the second surface 22069b, for example, the first surface. 22069a can be positioned offset or higher relative to the second surface 22069b. The first cavity 22322a of the tissue thickness compensator 22320 can be larger than the second cavity 22322b, and in at least one such embodiment, the first cavity 22322a is above the second cavity 22322b. Can extend towards. As a result of the above, the first cavity 22322a can extend upward into the first staple forming pocket 22062a, while at the same time the second cavity 22322b enters into the second staple forming pocket 22062b. Can extend upwards. The first cavity 22322a and / or the second cavity 22322b can be configured to contain a drug.

  In addition to the above, the first cavities 22322a can be arranged in specific rows and the second cavities 22322b can be arranged in different rows. Cavity 22322a and / or cavity 22322b may be configured to fit snugly within the interior of staple forming pockets 22062a and 22062b, respectively. In addition, the compensator 22320 can be assembled to the anvil 22060 such that the second layer 22327 of the compensator 22320 is positioned against the second surface 22069b of the anvil 22060. Referring now to FIGS. 247 and 248, the compensator 22320 is moved to the anvil 22060 when the anvil 22060 is displaced toward the staple cartridge 22000 to compress the tissue T between the anvil and the staple cartridge. It can be positioned adjacent to the anvil 22060 to abut.

  Referring now to FIGS. 224A and 224B, similar to the above, the layer 1000 is formed when the anvil 1012 is displaced toward the staple cartridge 1020 to compress the tissue T between the anvil and the staple cartridge. It can also be positioned adjacent to the anvil 1012 so that 1000 can abut against the anvil 1012. Again, as described above, the layer 1000 may be captured by the staple 1002 as the staple 1002 is released from the staple cavity 1026 by the staple driver 1028. In particular, as shown in FIGS. 224A and 224B, the staple 1002 includes a base 1060, a first deformable member 1062 comprising a first tip 1063, and a second comprising a second tip 1065. The deformable member 1064, and the second tip together with the first tip 1063 as the staple 1002 is released from the staple cavity 1026 by the staple driver 1028, and Layer 1000 may be penetrated to reach respective molding pockets 1066 and 1068 at the second tip. Moreover, tips 1063 and 1065 may each penetrate layer 1000 once more as tips 1063 and 1065 are guided on the return path exiting molding pockets 1066 and 1068, respectively.

  Referring again to FIG. 224A, the layer 1000 may include a portion 1070 that has a reduced thickness compared to the rest of the layer 1000. For example, as shown in FIG. 224A, the layer 1000 may comprise a substantially uniform thickness “A” and the portion 1070 may comprise a thickness that is less than the thickness “A”. In addition, the layer 1000 may cause the tips 1063 and 1065 of the staple 1002 to move as the tips 1063 and 1065 of the deformable members 1062 and 1064 advance toward the respective pockets 1066 and 1068 upon firing the staple 1002. Through tissue T and the total layer thickness “A” of layer 1000, these tips penetrate portions 1070 that are reduced in thickness as they are guided out of pockets 1066 and 1068, respectively. Can be aligned with the staple cartridge 1020. The reduced thickness portion 1070 may improve re-drilling of the tips 1063 and 1065 to the tissue T on the return path of the tips 1063 and 1065 from the pockets 1066 and 1068, respectively.

  Referring now to FIG. 224B, the layer 1000 may include a protrusion 1080 that has an increased thickness compared to the rest of the layer 1000. For example, as shown in FIG. 224B, the layer 1000 may comprise a substantially uniform thickness “A” and the protrusion 1080 comprises a thickness “A + B” that is greater than the thickness “A”. There is. As soon as the staples 1002 are fired, the layer 1000 advances the tips 1063 and 1065 of the deformable members 1062 and 1064 toward the respective pockets 1066 and 1068 so that the tips 1063 and 1065 of the staple 1002 move with the tissue T. The staple cartridge 1020 can be aligned to penetrate through the entire layer thickness “A” of the layer 1000. In addition, the tips 1063 and 1065 of the staple 1002 may penetrate the thickness “A” of the layer 1000 as they are guided out of the pockets 1066 and 1068, respectively, thereby The deformable members 1062 and 1064 may be wrapped or substantially wrapped around the protrusion 1080 at least partially. In other words, the tissue T and protrusion 1080 may be captured between the deformable members 1062 and 1064, respectively, and the base 1060 of the staple 1002. In addition to the above, the protrusions 1080 may be arranged in rows and may be configured to fit snugly within the staple forming pockets of the anvil 1020. For example, as shown in FIG. 224B, the protrusion 1080 can comprise a curved cross-sectional shape that can be configured for mating engagement with the molding pockets 1066 and 1068.

  As noted above, certain embodiments of the surgical stapler may include layers such as buttress material and / or tissue thickness compensators disposed on the surface of the end effector anvil. This layer is susceptible to movement and / or misalignment. For example, the layer may be moved relative to the anvil if the layer is dragged over the patient tissue while the surgeon positions the surgical stapler before stapling the tissue. In certain embodiments, the layer can releasably include a retention feature that attaches the layer to the anvil such that the layer remains aligned with the anvil until after the surgical stapler has been fired. In certain embodiments, the releasable retention feature can be implantable in the patient.

  In certain embodiments, referring now to FIGS. 225-227, an anvil attachable layer 33420, such as a buttress material and / or tissue thickness compensator, is a shell 33426, a cavity 33424 defined within the shell 33426. , And a core 33425 positioned within the cavity 33424. In at least one such embodiment, the shell 33426 can comprise a film body molded from a continuous extrusion shape and the core 33425 can comprise a fiber drug core, such as, for example, an ORC. In at least one embodiment, the shell 33426 may be configured to extend into a knife slot 22063 defined within the anvil 22060 to releasably hold the anvil attachable layer 33420 to the anvil 22060. One or more flexible legs 33423 can be provided.

  In certain other embodiments, referring to FIGS. 244-248, an anvil attachable layer 22320 such as a buttress material and / or tissue thickness compensator can be attached to the anvil 22060. In at least one embodiment, the anvil attachable layer 22320 can include a cavity 22322a and / or a cavity 22322b that can be configured to fit snugly within the staple forming pockets 22062a and / or 22062b, respectively. This snug fit can releasably retain the anvil-attachable layer 22320 relative to the anvil 22060. In certain embodiments, the anvil attachable layer 22320 can be assembled to the anvil 22060 such that the second layer 22327 of the anvil attachable layer 22320 is positioned against the second surface 22069b of the anvil 22060. it can. In certain embodiments, referring now to FIGS. 247 and 248, the anvil attachable layer 22320 is displaced toward the staple cartridge 22000 for the anvil 22060 to compress the tissue T between the anvil and the staple cartridge. When positioned, the anvil attachable layer 22320 can be positioned adjacent to the anvil 22060 so that it can abut the anvil 22060.

  Referring to FIGS. 228-234, the retainer may be used to align and attach the anvil attachable layer to the end effector anvil. Referring primarily to FIGS. 229 and 230, the anvil attachable layer 2030 can include a body 2034 and a protrusion 2036 extending from the body 2034. Referring to FIGS. 231-234, the protrusion 2036 can engage a slot 2048, such as a knife slot in the end effector anvil 2042. In certain embodiments, the protrusion 2036 can be wider than the slot 2048 so that it is compressed when the protrusion 2036 is inserted into the slot 2048. In certain embodiments, the protrusion 2036 can be deformed so that the protrusion bulges outward and compresses the surface of the slot 2048. The compressive force between the protrusion 2036 and the slot 2048 can provide a holding force that holds the anvil-attachable layer 2030 against the anvil 2042.

  The anvil attachable layer 2030 can be releasably attached to the retainer 2000. The retainer 2000 can align the anvil attachable layer 2030 with the anvil 2042 and attach the anvil attachable layer 2030 to the anvil 2042. An embodiment of the retainer 2000 can include a cover 2006 and tab portions 2008, 2010 (tab portions 2010 shown in FIGS. 228-230) extending from the cover. As shown in FIGS. 229 and 230, the tab portion can engage the staple cartridge 2020 with the retainer 2000 and releasably hold it. A retainer extends from the cover 2006 and a grip portion that a user may grasp to insert the retainer 2000, staple cartridge 2020, and anvil-attachable layer 2030 into the end effector staple cartridge channel 2040. 2002 can be further included.

  The retainer 2000 may further include a tab portion 2014 that extends from the cover 2006. In certain embodiments, the retainer 2000 can include two tab portions 2014 with one tab portion extending from each side of the cover 2006. As best seen in FIG. 228, each tab portion 2014 can include an inwardly facing groove 2016 and an inwardly facing angular surface 2018. Referring to FIGS. 229 and 230, the lateral edges of the anvil-attachable layer 2030 can engage the grooves 2016 in the tab portion 2014. When the anvil attachable layer 2030 is engaged in the slot 2016 of the retainer 2000 in various embodiments, the anvil attachable layer 2030 and the retainer 2000 cover 2006 may define a gap therebetween. it can. Anvil-attachable layer 2030 may be disposed on retainer 2000 such that protrusion 2036 of layer 2030 extends away from retainer 2000. As best seen in FIGS. 228 and 231, the retainer 2000 can further include a raised ridge 2022 extending from the cover 2006. As best shown in FIG. 231, the raised ridge 2022 of the retainer 2000 can be aligned with the protrusion 2036 of the anvil attachable layer 2030.

  In use, the surgeon, nurse, clinician or other user inserts the staple cartridge 2020 into the staple cartridge channel 2040 of the end effector and anvils on the retainer to release the anvil-attachable layer from the retainer. And attach the layer to the anvil, after which the retainer can be removed from the end effector. Referring primarily to FIGS. 231-234, a user can grasp the retainer 2000 by the grip portion 2002 and insert the staple cartridge 2020 into the staple cartridge channel 2040 of the end effector. As the staple cartridge 2020 is inserted into the staple cartridge channel 2040, the tab portion 2008 of the retainer 2000 can engage the staple cartridge channel 2040 of the end effector. FIG. 231 shows the staple cartridge 2020 loaded into the staple cartridge channel 2040 with the retainer 2000 and anvil attachable layer 2030 on top of the staple cartridge 2020. As further shown in FIG. 231, the end effector anvil 2042 is positioned over the anvil attachable layer 2030 and the retainer 2000. Referring now to FIG. 232, the anvil 2042 can be moved toward the retainer 2000 and the anvil attachable layer 2030. As the anvil 2042 is moved, the surface 2044 of the anvil 2042 can contact the body 2034 of the anvil attachable layer 2030. Moreover, a slot 2046, such as a knife slot in the anvil 2042, can engage the ridge 2036 of the anvil-attachable layer 2030. Similarly, as the anvil 2042 is moved toward the staple cartridge 2020, the lateral edge 2050 of the anvil 2042 can engage the inwardly facing angular surface 2018 of the film retention tab portion 2014; The inward tab portion 2014 is pushed outward so that the inwardly facing groove 2016 moves away from the lateral edge of the anvil-attachable layer 2030.

  Subsequent movement of the anvil 2042 toward the anvil attachable layer 2030 can push the anvil attachable layer 2030 toward the cover 2006 of the retainer 2000. Similarly, as the anvil 2042 continues to move toward the staple cartridge 2020, the raised ridge 2022 of the retainer 2000 supports the protrusion 2036 of the anvil attachable layer 2034 when engaging the slot 2046 of the anvil 2042. can do. As described above, the raised ridge 2022 of the retainer 2000 can deform the protrusion 2036 of the anvil attachable layer 2030 such that the outer dimension of the protrusion 2036 of the anvil attachable layer 2030 extends outward. it can. In other words, as the ridge 2036 of the anvil attachable layer 2030 enters the slot 2046 of the anvil 2042, the raised ridge 2022 of the retainer 2000 causes the protrusion 2036 to inflate and / or the slot 2046 of the anvil 2042. And can be pressed into the anvil-attachable layer 2030 under the protrusion 2036. The resulting contact between the enlarged protrusion 2036 and the slot 2046 can hold the collar 2036 of the anvil attachable layer 2030 inside the slot 2046. The slot 2046 can capture at least a portion of the protrusion 2036 and can further include a lip 2048 that continues to hold the protrusion 2036 within the slot 2046 of the anvil 2042.

  Referring now to FIG. 233, when the anvil 2042 is moved away from the retainer 2000, the anvil attachable layer 2030 is carried away from the retainer 2000 along with the anvil 2042. As shown in FIG. 234, when the anvil 2042 and the anvil attachable layer 2030 are moved away from the retainer 2000, the retainer 2000 leaves the anvil attachable layer 2030 and the staple cartridge 2020 in the end effector. It can be removed from the end effector.

  Referring again to FIGS. 229 and 230, in certain embodiments, the proximal end 2032 of the anvil attachable layer 2030 can be attached to the staple cartridge 2020. For example, the anvil attachable layer 2030 can be attached to the staple cartridge 2020 by adhesive, tack welding, and / or heat staking. In various embodiments, the anvil attachable layer 2030 can be detached from the staple cartridge 2020 after the anvil attachable layer 2030 is attached to the anvil 2042 and the anvil is reopened. In various other embodiments, the anvil attachable layer 2030 is placed on the staple cartridge 2020 until after the staples in the staple cartridge have been fired and captured within the fired staple. The attached state can be maintained.

  FIG. 235 shows the anvil attachable layer 2030 separated from the retainer 2000. 236 and 237 illustrate other embodiments of umbilically attachable layers. FIG. 236 shows an embodiment of an anvil attachable layer 2060 that includes a body 2064 and separate protrusions 2062 extending from the body. FIG. 237 illustrates another embodiment of an anvil attachable layer 2070 that includes a body 2074 with separate protrusions 2072 extending from the body. For example, each separate protrusion 2072 can include a nail 2073 extending from the body of the anvil-attachable layer 2070 and a cap 2075 extending from the nail 2073. In certain embodiments, the cap 2075 has a larger dimension than the nail portion 2073 such that when the protrusion 2072 is inserted into the slot 2046, the cap extends to the lateral edge 2048 of the slot 2046 in the anvil 2042. be able to.

  Referring now to FIGS. 238-243, various embodiments of an anvil attachable layer can include one or more deployable attachment features that can be molded into the body of the anvil attachable layer. FIGS. 238-240 illustrate an embodiment of an anvil attachable layer 2080 that includes a body 2082 and an array of deployable attachment features 2084 molded into the body 2082. Each deployable attachment feature 2084 can be molded into the body 2082 by molding an opening 2085 in the body 2082. Each deployable attachment feature 2084 can include a longitudinal portion 2086 attached to the body 2082 and a transverse portion 2088 attached to the longitudinal portion 2086. In various embodiments, the longitudinal portion 2086 can be attached to the body 2082 by a hinge 2087. An opening 2085 and a hinge 2087 surrounding each deployable attachment feature 2084 may allow movement of the deployable attachment feature 2084 between a non-deployed configuration and a deployed configuration, as described in more detail below. it can. In various other embodiments, the hinge 2087 may not be present. In such an embodiment, the deployable attachment feature 2084 can be bent around the longitudinal portion 2086, for example, to move between an undeployed configuration and a deployed configuration.

  FIG. 238 shows the deployment features 2084 deployable in a non-deployed configuration, each one of the deployable attachment features 2084 substantially within the plane defined by the body 2082 of the anvil attachable layer 2084. Exists. FIG. 239 shows deployable attachment features 2084 in a deployed configuration, each one of the deployable attachment features 2084 extending out of the plane defined by the body 2082 of the anvil attachable layer 2080. . For example, the deployable attachment feature 2084 can rotate around a hinge 2087 to extend out of the plane defined by the body 2082. As shown in FIG. 240, the deployable attachment feature 2084 can be deployed within the slot 2046 of the anvil 2042. When deployed, the longitudinal portion 2086 of the deployable attachment feature 2084 can extend into the slot 2046 of the anvil 2042 and the lateral portion 2088 can extend further into the slot 2046. In various situations, the lateral portion 2088 of the deployable attachment feature 2084 engages the lip 2048 in the slot 2046 to provide a stronger retention between the anvil attachable layer 2080 and the anvil 2042. can do. Moreover, engagement between the lateral portion 2088 of the deployable attachment feature 2084 and the lip 2048 in the slot 2046 prevents the deployable attachment feature 2084 from returning to the undeployed position. In certain embodiments, the longitudinal portion 2086 of each deployable attachment feature 2084 can be shorter than the narrow portion 2047 of the slot 2046. In such an embodiment, the longitudinal portion 2086 can be under tension when the transverse portion 2088 engages the lip 2048 in the slot 2046. The tension in the transverse portion 2088 can hold the body 2082 of the anvil-attachable layer 2080 in close contact with the anvil 2042.

  The body 2082 and deployable attachment feature 2084 may be molded from a single body. Thereafter, the opening 2085 can be formed into the body 2082 by, for example, cutting the opening 2085 into the body 2082. Opening 2085 may be cut by a stapling tool, cutting blade, laser, or other suitable means. In various other embodiments, the anvil-attachable layer 2080 and the opening 2085 can be molded with a mold. In certain embodiments, the opening 2085 can include a gap between the body 2082 and the deployable attachment feature 2084. In certain other embodiments, the opening 2085 does not provide a gap between the body 2082 and the deployable attachment feature 2084. In various embodiments, the hinge 2087 can be shaped, for example, by thinning or rolling the anvil-attachable layer 2080 between the body 2082 and the longitudinal portion 2086. In various other embodiments, the hinge does not change the thickness between the body 2082 and the longitudinal portion 2086 of the deployable attachment feature 2084.

  FIGS. 238-240 above illustrate an embodiment of an anvil attachable layer 2080 that includes a transverse portion 2088 in which the deployable attachment features 2084 each include a circular portion. The transverse portion can include other suitable shapes including, but not limited to, triangles, ellipses, and polygons. For example, FIGS. 241-243 illustrate an embodiment of an anvil attachable layer 2090 in which the deployable attachment features 2094 include lateral portions 2098 each having a rectangular cross section. Each deployable attachment feature 2094 can be attached to the body 2092 by a hinge 2097.

  In certain embodiments, the body of the anvil attachable layer and the deployable attachment feature can be composed of a flexible and / or elastic material. For example, referring again to FIGS. 238-240, the body 2082 and deployable attachment feature 2084 of the anvil-attachable layer 2080 can be comprised of a flexible and / or elastic material. As another example, referring to FIGS. 241-243, the body 2092 and deployable attachment feature 2094 of the anvil-attachable layer 2090 can be constructed of a flexible and / or elastic material. Referring to the anvil attachable layer 2080 of FIGS. 238-240, when each deployable attachment feature 2084 is deployed into a slot 2046, such as a knife slot in the anvil 2042, the transverse portion 2088 is in the slot 2046. Can be deflected and / or deformed to pass through the narrow portion 2047 of the. Later, as the lateral portion 2088 extends beyond the lip 2048 of the slot 2046 and into the wide portion 2049 of the slot 2046, the lateral portion 2088 is not deflected and / or deformed. Return to shape. As the lateral portion 2088 returns to an undeflected and / or undeformed shape, the lateral portion 2088 can extend laterally into the wide portion 2049 of the slot 2046. As the lateral portion 2088 extends laterally into the wide portion 2049 of the slot 2046, the narrow portion 2047 of the slot 2046 can provide an interference fit that prevents the lateral portion 2088 from being easily pulled out of the slot 2046. it can. In other words, the transverse portion 2088 needs to bend and / or deform again to pass through the narrow portion 2047 of the slot 2046 so that it can be pulled out of the slot 2046. In various embodiments, the lateral portion 2088 and / or the narrow portion 2047 of the slot 2046 can be sufficiently large in traction required to pull the deployable attachment feature 2084 out of the slot, such that The anvil 2042 may be dimensioned such that the anvil 2042 is positioned relative to the patient tissue and the anvil attachable layer 2080 is not displaced from the anvil 2042. However, the traction force can be sufficiently small so that the anvil attachable layer 2080 can be withdrawn from the anvil after the anvil attachable layer 2080 is captured by the staples.

  In various embodiments, the surgical staple cutting blade can cut the deployable attachment feature of the anvil-attachable layer. Referring to FIG. 240, the cutting blade can be advanced through the slot 2046 of the anvil 2042. The cutting blade can cut each deployable attachment feature 2084 substantially in half. Half of each deployable attachment feature 2084 can be easily pulled out of the slot 2046 when the anvil attachable layer 2080 is removed from the anvil 2042 after the staples are fired.

  For an anvil attachable layer that includes a deployable attachment feature, such as the anvil attachable layer disclosed in FIGS. 238-243, the retainer aligns the anvil attachable layer with the anvil, and , Can be used to deploy deployable attachment features into slots in the anvil. FIGS. 251-254 show a retainer 19700 that initially incorporates the staple cartridge 19690 into the staple cartridge channel 19740 and then presses the anvil attachable layer 2056 against the anvil 19720. The retainer 19700 includes a first portion 2052 and a second portion 2054, the first portion 2052 being in the direction indicated by arrows Q and S (shown in FIGS. 253 and 254, respectively). Can move relative to 2054. The first portion 2052 can include a cam that includes anti-lobe portions 19646 and 19647 and lobe portions 19642 and 19643. The second portion can include cam protrusions 19614 and 19616 that engage the cam of the first portion 2052. As shown in FIGS. 251 and 252, when the retainer 19700 is inserted into the end effector, the cam protrusions 19614 and 19616 engage the cam anti-lobe portions 16646 and 16647 of the first portion 2052. To do. Referring now to FIGS. 253 and 254, after the staple cartridge is seated within the end effector staple cartridge channel 19740, the first portion 2052 moves in the direction of arrow Q relative to the second portion 2054. Can do. Moving the first portion 2052 in the direction of the arrow Q causes the cam protrusions 19614 and 19616 to engage the cam lobes 19642 and 19643 of the first portion 2052. The lobes 19642 and 19643 push open the cam protrusions 19614 and 19616, thereby pushing the anvil attachable layer 2056 into contact with the anvil 19720.

  Referring now to FIGS. 255-258, in certain embodiments, the retainer incorporates a staple cartridge into the staple cartridge channel, places an anvil attachable layer on the anvil, and deployable attachment of the anvil attachable layer. The feature can be deployed in engagement with the anvil. Referring to FIGS. 256 and 257, an embodiment of the retainer 2110 can include a grip portion 2112, a staple-cartridge facing portion 2114, and an anvil facing portion 2118. The staple-cartridge facing portion 2114 and anvil-facing portion 2118 can be spaced apart and can be disposed at a relative angle to each other by the support 2116. As best seen in FIG. 258, the staple-cartridge facing portion 2114 and the anvil facing portion 2118 are similar to the angle between the staple cartridge channel 2160 and the anvil 2150 when the anvil 2150 is in the fully open position. Can be arranged at an angle. The portion 2114 facing the staple-cartridge can include a first clip portion 2124 and a second clip portion 2126 extending from this portion. As shown in FIG. 255, the first clip portion 2114 can engage the staple cartridge 2140 with the retainer 2110 and hold it releasably. The second clip portion 2126 can engage the staple cartridge channel 2160 of the end effector such that the retainer 2110 is releasably retained relative to the staple cartridge channel 2160. The anvil facing portion 2118 can include a clip portion 2120 that holds an anvil attachable layer, such as the anvil attachable layer 2080 shown in FIGS. The anvil facing portion 2118 can further include a separate protrusion 2122 positioned relative to the location of the deployable attachment feature 2084 of the anvil attachable layer 2080. As shown in FIG. 255, when the anvil attachable layer 2080 is loaded over the anvil facing portion 2118 of the retainer 2110, the anvil attachable layer 2080 rests on top of separate protrusions 2122. Can do.

  Referring to FIG. 258, in certain embodiments, as the retainer 2110 is inserted into the end effector and the staple cartridge 2140 is seated within the staple cartridge channel 2160, the anvil-attachable layer 2080 is coupled to the anvil 2150. Can touch. When the anvil attachable layer 2080 contacts the anvil 2150, the retainer 2110 and staple cartridge 2140 can continue to move relative to the anvil 2150 until the anvil cartridge 2140 is fully seated. In such an embodiment, the anvil facing portion 2118 of the retainer 2110 is illustrated as a separate projection 2122 extending from the anvil facing portion 2118 of the retainer 2110 that can be deployed in the layer 2080. It can be moved toward and pressed against the anvil-attachable layer 2080 so that it can be pushed into the deployed configuration associated with 238-243. In various embodiments, each deployable protrusion 2122 of the anvil-facing portion 2118 of the retainer 2110 can include a bevel 2123 that can engage the deployable attachment feature 2084. As the retainer 2110 is moved relative to the anvil 2150 and the anvil attachable layer 2080, the beveled surface 2123 causes the deployable attachment feature 2084 to rotate about the hinge 2087 and into the slot 2152 of the anvil 2150. Until deployed, it can gradually engage with deployable attachment feature 2084. As shown in FIG. 258, the slopes 2123 of the separate protrusions 2122 may be provided on each deployable attachment feature such that the longitudinal portion 2086 and the transverse portion 2088 both deploy into the slot 2152 of the anvil 2150. Both the longitudinal portion 2086 and the lateral portion 2088 can be supported.

  In certain other embodiments, the retainer 2110 may seat the staple cartridge 2140 completely within the staple cartridge channel 2160 without the anvil attachable layer 2080 contacting the anvil 2150. In such an embodiment, after the staple cartridge 2140 is fully seated within the staple cartridge channel 2160, the anvil 2150 contacts the anvil 2150 attachable layer 2080 and separate protrusions 2122 can be deployed. The special attachment feature 2084 may be moved from the fully open position toward the closed position to deploy into the slot 2052 of the anvil 2050.

  259-262 illustrate another embodiment of a retainer 2170. The retainer 2170 can include a staple-cartridge facing portion 2174 and an anvil facing portion 2178 that are spaced apart and disposed at an angle to each other by the support 2190. The portion 2174 facing the staple-cartridge can engage and releasably hold the staple cartridge 2140. The staple-cartridge facing portion 2174 can also engage and releasably retain the end effector staple cartridge channel 2160. An anvil attachable layer, such as the anvil attachable layer 2080 described above with respect to FIGS. As shown in more detail in FIGS. 261 and 262, the anvil facing portion 2178 can be aligned with the deployable attachment feature 2084 of the anvil attachable layer 2080 disposed on the anvil facing portion 2178. An opening 2182 can be included. Each opening 2182 can include a cam 2202 disposed within the opening. Each cam 2202 is anviled by the flexible member 2204 such that the cam 2202 can rotate out of the opening 2182 and about the flexible member 2204 in contact with the deployable attachment feature 2084. Can be attached to the portion 2178 facing the surface. Each cam 2202 can include a curved surface 2203 that can gradually deploy a deployable attachment feature 2084 into a slot 2152 in the anvil 2150. Referring to FIG. 261, as the cam exits the opening 2182 and begins to be moved toward contact with the deployable attachment feature 2084, the curved surface 2203 of the cam 2202 has a lateral portion 2088 with a slot 2152 in the anvil 2150. As will be deployed within, it will first contact the lateral portion 2088 of the deployable attachment feature 2084. Referring now to FIG. 262, as the cam 2202 continues to exit the opening 2182, the curved surface 2203 of the cam 2202 can be deployed such that the lateral portion 2086 is further deployed within the slot 2152 of the anvil 2150. The lateral portion 2086 of the feature 2086 can be contacted.

  The support 2190 between the staple-cartridge facing portion 2174 and the anvil facing portion 2178 can include a stationary portion 2194 and a movable portion 2196. The movable part 2196 can be operatively coupled to a button 2192 that a user can press to move the movable part 2196 relative to the stationary part 2194. The movable portion 2196 of the support 2190 can include a series of cam surfaces 2206 that can engage the cam portion 2202 to push the cam portion 2202 out of the opening 2182. When the movable portion 2196 is moved proximally relative to the stationary portion 2194, the cam surface 2206 exits the cam 2202 from the opening 2182 and contacts the deployable attachment feature 2084 of the film 2080 as described above. Can be made.

  In certain embodiments, the movable portion 2196 of the support 2190 can be biased in a distal position relative to the stationary portion 2194, as shown in FIG. For example, a spring or the like may be disposed between the stationary portion 2194 and the movable portion 2196. The spring can bias the movable portion 2196 of the support 2190 in a distal position relative to the stationary portion 2194. In various embodiments, the biasing force can be sufficiently high so that the force required to seat the staple cartridge 2140 within the staple cartridge channel 2160 does not overcome the biasing force. As a result, the deployable attachment feature 2084 can be deployed by the cam 2202 if the force required to fully seat the staple cartridge 2140 in the staple cartridge channel 2160 is inadvertently applied to the button 2192. Is low.

  In various embodiments in which the anvil attachable layer is releasably retained on the anvil of the surgical stapler, the anvil attachable layer is an additional feature for stabilizing patient tissue relative to the layer and the anvil. Can be included. Referring now to FIGS. 249 and 250, anvil attachable layers 22320a and 22320b are shown in a position between anvil 22060 and patient tissue T. FIG. Embodiments of anvil-attachable layers 22320a and 22320b can include a protrusion 2078 that extends from the body on the side facing the patient tissue T. Protrusions 2078 penetrate or puncture tissue T and provide a grip force between tissue T and anvil-attachable layers 22320a and 22320b. This gripping force can prevent the tissue from sliding against the anvil-attachable layers 22320a and 22320b.

  In various embodiments, the retention feature may be separated from the anvil-attachable layer after the surgical staple incorporating the layer is fired. In such embodiments, the retention feature can be attached to one or more strings. The string may be attached to the surgical stapler or another object external to the patient such that after the stapler is fired, the retention feature is removed from the patient by pulling the string.

  In various embodiments, the tissue thickness compensator can comprise a polymer composition. The polymer composition may include one or more synthetic polymers and / or one or more non-synthetic polymers. The synthetic polymer may include an absorbent synthetic polymer and / or a non-absorbable synthetic polymer. In various embodiments, the polymer composition may include, for example, a biocompatible foam. The biocompatible foam may include, for example, a porous open cell foam and / or a porous closed cell foam. The biocompatible foam can have a uniform pore morphology, or a tilted pore morphology (ie, small pores gradually increase in size across the foam thickness in one direction to larger pores Form). In various embodiments, the polymer composition comprises a porous backbone, porous matrix, gel matrix, hydrogel matrix, solvent matrix, fibrous matrix, tubular matrix, composite matrix, membrane matrix, biostable polymer, biostable. One or more of degradable polymers and combinations thereof may be included. For example, a tissue thickness compensator may comprise a foam reinforced with a fibrous matrix to further compress the tissue or comprise a foam having an additional hydrogel that expands in the presence of body fluids. Sometimes. In various embodiments, the tissue thickness compensator may further include a second or third layer that expands in the presence of a coating and / or bodily fluid on the material to further compress the tissue. obtain. Such a layer can be, for example, a hydrogel, which can also be a synthetic material and / or a naturally derived material, and can be biodurable and / or biodegradable. In certain embodiments, the tissue thickness compensator is reinforced using, for example, a fibrous nonwoven material or a fibrous mesh type element that can provide additional flexibility, stiffness, and / or strength. There can be. In various embodiments, the tissue thickness compensator has a porous morphology that exhibits a graded structure such as, for example, small pores on one surface and larger pores on the other surface. Such a configuration may be even more optimal for tissue ingrowth or hemostasis. In addition, the slope may be a composition that varies the bioabsorbable distribution. A short-term absorbability distribution is preferred to address hemostasis, while a long-term absorbability distribution may address better tissue healing without leakage.

  Examples of non-synthetic polymers include, but are not limited to, lyophilized polysaccharides, glycoproteins, elastin, proteoglycans, gelatin, collagen, and oxidized regenerated cellulose (ORC). Examples of synthetic absorbent polymers are poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (trimethylene carbonate) (TMC), Polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), glycolide / ε-caprolactone copolymer (PGCL), glycolide / trimethylene carbonate copolymer, poly (glycerol sebacate) (PGS), polydioxanone, poly (ortho Ester), polyanhydride, polysaccharide, poly (ester amide), tyrosine polyarylate, tyrosine polyimino carbonate, tyrosine polycarbonate, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate) Poly (E-caprolactone , Polyethylene glycol (PEG), poly [bis (carboxymethyl Lato phenoxy) phosphazene], poly (amino acids), pseudo-poly (amino acids), absorbent polyurethane, and combinations thereof, without limitation.

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

  In various embodiments, the synthetic absorbable polymer may comprise an elastomeric copolymer that is bioabsorbable and biocompatible. A suitable bioabsorbable and biocompatible elastomeric copolymer is an ε-caprolactone / glycolide copolymer (preferably having a molar ratio of ε-caprolactone to glycolide of about 30:70 to about 70:30. , Preferably 35:65 to about 65:35, more preferably 45:55 to 35:65); ε-caprolactone and L-lactide, D-lactide, a combination thereof, or lactic acid An elastomeric copolymer with lactide, including a copolymer (molar ratio of ε-caprolactone to lactide is preferably about 35:65 to about 65:35, more preferably 45:55 to 30:70); Elastomer copolymer of p-dioxanone (1,4-dioxan-2-one) and lactide containing L-lactide, D-lactide and lactic acid (p-dioxane) The molar ratio of non to lactide is preferably about 40:60 to about 60:40); an elastomeric copolymer of ε-caprolactone and p-dioxanone (molar ratio of ε-caprolactone to p-dioxanone is Preferably from about 30:70 to about 70:30); an elastomeric copolymer of p-dioxanone and trimethylene carbonate (molar ratio of p-dioxanone to trimethylene carbonate is preferably from about 30:70 to An elastomeric copolymer of trimethylene carbonate and glycolide (the molar ratio of trimethylene carbonate to glycolide is preferably from about 30:70 to about 70:30); , L-lactide, D-lactide, blends thereof, or lactides including lactic acid copolymers Elastomer copolymer (molar ratio of trimethylene carbonate to-lactide, preferably, about 30: 70 to about 70:30), and including those formulations, but are not limited to. In one embodiment, the elastomeric copolymer is a glycolide / ε-caprolactone copolymer. In another embodiment, the elastomeric copolymer is a lactide / ε-caprolactone copolymer.

  U.S. Pat. No. 5,468,253 entitled “ELASTOMERIC MEDICAL DEVICE” issued on November 21, 1995, and “FOAM BUTTRESS FOR STAPLING APPARATUS” issued on December 4, 2001 The disclosures of the subject US Pat. No. 6,325,810 are hereby incorporated by reference in their entirety.

  In various embodiments, synthetic absorbent polymers can be obtained, for example, from Ethicon, Inc. 90/10 poly (glycolide-L-lactide) copolymer sold under the trade name VICRYL (polygraphic 910) from American Cyanamid Co. Polyglycolide, Ethicon, Inc., commercially available under the trade name DEXON. Polydioxanone commercially available under the trade name PDS from American Cyanamid Co. Poly (glycolide-trimethylene carbonate) random block copolymer commercially available under the trade name MAXON from Ethicon, Inc. May contain one or more of the 75/25 poly (glycolide-ε-caprolactone) copolymer (polygrecaprolactone 25) marketed under the trade name MONOCRYL.

  Examples of synthetic non-absorbing polymers are foamed polyurethane, polypropylene (PP), polyethylene (PE), polycarbonate, polyamide such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), Polyester, polyetheretherketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetal, polysulfone, and combinations thereof Including, but not limited to. Synthetic non-absorbable polymers may include, but are not limited to, foamed elastomers and porous elastomers such as, for example, silicone, polyisoprene, and rubber. In various embodiments, the synthetic polymer is a W.I. L. Gore & Associates, Inc. May include expanded polytetrafluoroethylene (ePTFE) commercially available under the trade name GORE-TEX Soft Tissue Patch from Co., Ltd. and co-polyether ester urethane foams sold under the trade name NASOPORE from Polyganics.

  The polymer composition of the tissue thickness compensator may be characterized by, for example, percent porosity, pore size, and / or hardness. In various embodiments, the porous composition may have a percent porosity of, for example, about 30% to about 99% by volume. In certain embodiments, the polymer composition may have a percent porosity of, for example, about 60% to about 98% by volume. In various embodiments, the polymer composition may have a percent porosity of, for example, about 85% to about 97% by volume. In at least one embodiment, the polymer composition may include, for example, about 70% by weight PLLA and about 30% by weight PCL, for example, may have a porosity of about 90% by volume. In at least one such embodiment, as a result, the polymer composition will comprise about 10% by volume of copolymer. In at least one embodiment, the polymer composition may comprise, for example, about 65% by weight PGA and about 35% by weight PCL, for example, having a porosity of about 93% to about 95% by volume. Can have. In various embodiments, the polymer composition may have a porosity greater than 85% by volume. The polymer composition may have a pore size of, for example, about 5 μm to about 2000 μm. In various embodiments, the polymer composition may have a pore size of, for example, from about 10 μm to about 100 μm. In at least one such embodiment, the polymer composition can include, for example, a copolymer of PGA and PCL. In certain embodiments, the polymer composition may have a pore size of, for example, from about 100 μm to about 1000 μm. In at least one such embodiment, the polymer composition can include, for example, a copolymer of PLLA and PCL. According to a particular embodiment, the hardness of the polymer composition may be expressed as a Shore hardness, which is determined against a permanent indentation of the material, as determined by a durometer such as a Shore durometer. Can be defined as repulsion. In order to evaluate the durometer value of a given material, the pressure is in accordance with ASTM procedure D2240-00 entitled “Standard Test Method for Rubber Property-Durometer Hardness”, the entire contents of which are incorporated herein by reference. Is added to the material using the lower part of the durometer indenter. The lower part of the durometer indenter may be applied to the material for a sufficient time, for example 15 seconds, and the reading is then taken from the appropriate scale. Depending on the type of scale used, a reading of 0 can be taken when the bottom of the indenter has penetrated completely through the material, and a reading of 100 is when no penetration into the material is made. Can be acquired. This reading is dimensionless. In various embodiments, the durometer may be determined according to any suitable scale, such as, for example, a Type A and / or Type OO scale, according to ASTM D2240-00. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness value of about 4A to about 16A, for example, about 45 OO to about 65 OO in the Shore OO range. In at least one such embodiment, the polymer composition can include, for example, a PLLA / PCL polymer or a PGA / PCL polymer. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness value of less than 15A. In various embodiments, the tissue thickness compensator polymer composition may have a Shore A hardness value of less than 10A. In various embodiments, the polymer composition of the tissue thickness compensator may have a Shore A hardness value of less than 5A. In certain embodiments, the polymer composition may have a Shore OO composition value of, for example, from about 35 OO to about 75 OO.

  In various embodiments, the polymer composition may have at least two of the properties described above. In various embodiments, the polymer composition may have at least three of the properties described above. The polymerizable composition has a porosity of 85 volume% to 97 volume%, a pore diameter of 5 micrometers to 2000 micrometers, a Shore A hardness of 4A to 16A, and a Shore OO hardness value of 45 OO to 65 OO. May have. In at least one embodiment, the polymer composition may comprise, for example, 70 wt% PLLA polymer composition and 30 wt% PCL polymer composition, 90 vol% porosity, It has a pore size of micrometer to 1000 micrometers, a Shore A hardness of 4A to 16A, and a Shore OO hardness value of 45 OO to 65 OO. In at least one embodiment, the polymer composition may comprise, for example, 65% by weight PGA polymer composition and 35% by weight PCL polymer composition, and 93% to 95% by volume porous. With a pore size of 10 micrometers to 100 micrometers, a Shore A hardness value of 4A to 16A and a Shore OO hardness value of 45 OO to 65 OO.

  In various embodiments, the tissue thickness compensator may be releasably attached to the staple cartridge and / or anvil by a flowable attachment portion. The flowable attachment portion may be operatively associated with the staple cartridge and / or the anvil. In various embodiments, a flowable attachment portion may be provided between the tissue thickness compensator and the staple cartridge and / or anvil. In various embodiments, at least a portion of the outer surface of the tissue thickness compensator may comprise a flowable attachment portion. In various embodiments, the adhesive laminate may comprise a tissue thickness compensator and a flowable attachment portion. The adhesive laminate may comprise a base layer that includes a tissue thickness compensator, and an adhesive laminate that is on at least a portion of the surface of the base layer and includes a flowable attachment portion. The adhesive laminate may comprise a tissue contacting surface that includes a tissue thickness compensator and an opposite surface that includes a flowable attachment portion. The adhesive laminate may releasably attach the adhesive laminate to the staple cartridge and / or anvil.

  In various embodiments, the flowable attachment portion may comprise a flowable polymer composition such as, for example, a pressure sensitive adhesive (“PSA”). An effective amount of PSA may be applied to the tissue thickness compensator to provide the staple cartridge and / or anvil with the appropriate cohesive strength to produce the desired adhesive properties. The PSA group has the following characteristics: (1) aggressive and permanent adhesiveness, (2) adhesion with slight finger pressure, (3) sufficient ability to hold the adherend, and (4) adherend May be characterized by one or more of the adhesive strengths sufficient to cleanly remove from the. In various embodiments, the flowable attachment portion may move freely when pressure, heat, and / or stress is applied to the flowable attachment portion. Such pressure and / or stress may be applied directly by hand and / or by a device such as, for example, a mechanical device, and may be a manual process and / or an automated process.

  In various embodiments, the flowable attachment portion may be responsive to temperature changes and / or pressure changes. In various embodiments, the flowable attachment portion may flow from a first position to a second position when heat and / or pressure is applied to the flowable attachment portion. In various embodiments, the flowable attachment portion can flow at body temperature (37 ° C.) and / or room temperature (25 ° C.). In various embodiments, the flowable attachment portion can flow at body temperature (37 ° C.) rather than at room temperature (25 ° C.). In various embodiments, the flowable attachment portion is in a first position when the tissue thickness compensator is at a first temperature and when the tissue thickness compensator is at a second temperature. The fluid attachment portion may be responsive to temperature changes such that the fluid attachment portion is in the second position. In various embodiments, the second temperature may be higher than the first temperature. In various embodiments, the first temperature can be room temperature and the second temperature can be body temperature. In various embodiments, the flowable attachment portion is in a first position when the tissue thickness compensator is at a first pressure and when the tissue thickness compensator is at a second pressure. The fluid attachment portion may be responsive to pressure changes such that it is in the second position. In various embodiments, the second pressure may be higher than the first pressure. In various embodiments, the first pressure can be atmospheric pressure and the second pressure can be finger pressure. In various embodiments, the flowable attachment portion may flow from a first position when at room temperature and / or atmospheric pressure to a second position when under body temperature and / or pressure. In various embodiments, the flowable attachment portion flows from a first (unstressed) position to a second position when pressure and / or stress is applied to the flowable attachment portion. There is.

  In various embodiments, the flowable attachment portion may flow into a void in the staple cartridge and / or anvil. In various embodiments, the flowable attachment portion flows when heat and / or pressure is applied to the flowable attachment portion, at least a portion of the surface of the staple cartridge and / or anvil lacking the flowable attachment portion. And / or fill at least a portion of a void in a staple cartridge and / or anvil, such as, for example, a slot and / or a staple cavity. In various embodiments, the flowable attachment portion may flow in vivo to fill at least a portion of the void in the staple cartridge and / or anvil. In various embodiments, the flowable attachment portion may flow such that the flowable attachment portion has a shape that is complementary to at least a portion of the void in the staple cartridge and / or anvil. In various embodiments, the flowable polymer composition may flow to fill at least a portion of the slots and / or staple cavities in the anvil. In various embodiments, the flowable attachment portion may flow into the void when pressure is applied to the flowable attachment portion and take the form of a void. While not wishing to be bound by any particular theory, filling at least a portion of the void in the staple cartridge and / or anvil with the flowable attachment portion may cause attachment of the tissue thickness compensator to the staple cartridge and / or anvil. It may be improved.

  In various embodiments, a flowable attachment portion, such as a PSA, for example, to move between a first position and / or a first cross-sectional shape and a second position and / or a second cross-sectional shape. May respond to changes in temperature and / or pressure. In various embodiments, the flowable attachment portion may have a first position remote from the staple cartridge and / or anvil. In various embodiments, the flowable attachment portion is pierced through a void in the staple cartridge and / or anvil when the flowable attachment portion is in the second position and / or the staple cartridge and / or It may be configured to fill at least a portion of the void in the anvil. As described herein, the flowable attachment portion has a void shape such that when the flowable attachment portion is in the second cross-sectional shape, the flowable attachment portion has a cross-sectional shape complementary to the void. May take shape. In various embodiments, the first position and / or the first cross-sectional shape may be spaced from the staple cartridge and / or the anvil, and the second position and / or the second cross-sectional shape is the staple cartridge. And / or may touch the anvil. In various embodiments, the first location and / or the first cross-sectional shape may comprise a neutral (original) cross-sectional shape when at room temperature and / or atmospheric pressure, and the second location and / or the first cross-sectional shape. The two cross-sectional shapes may comprise a cross-sectional shape that is complementary to the gap in the staple cartridge and / or anvil when under body temperature and / or pressure. The cross-sectional shape of the flowable attachment portion may flow to achieve complementary shapes and dimensions of the voids in the staple cartridge and / or anvil.

  In various embodiments, a method of adhering a tissue thickness compensator to a substrate, such as a staple cartridge and / or an anvil, includes placing the tissue thickness compensator and a flow, eg, a pressure sensitive adhesive. Applying the sexual attachment portion to at least a portion of the surface of the tissue thickness compensator and generally contacting the flowable attachment portion and the surface. In various embodiments, a method of adhering a tissue thickness compensator to a substrate can include applying pressure to at least one of the tissue thickness compensator and the substrate. The flowable attachment portion may flow from a first location on the outer surface of the tissue thickness compensator to a second location that further includes the outer surface and / or the inner surface of the substrate. The flowable attachment portion may contact the substrate and cause adhesion of the tissue thickness compensator to the substrate. In various embodiments, the flowable attachment portion may adhere the tissue thickness compensator to the substrate. In various embodiments, the flowable attachment portion may flow into at least one void in the substrate, such as, for example, a slot and / or a staple cavity. In various embodiments, the flowable attachment portion may fill at least a portion of at least one void in the substrate when in the second position.

  In various embodiments, a method of attaching a tissue thickness compensator to a substrate, such as, for example, a staple cartridge and / or an anvil, includes, for example, at least one separate of a flowable polymer composition, such as a pressure sensitive adhesive. Applying a ball and / or strip to the surface of the tissue thickness compensator; contacting the surface with at least one separate ball and / or strip of flowable polymer composition; and tissue thickness compensator To releasably attach the substrate to the substrate and at least one ball and / or elongated piece of flowable polymer composition to one of the substrate and at least one ball and / or elongated piece of flowable polymer composition And generally pushing into the other. In various embodiments, a method of attaching a tissue thickness compensator to a substrate includes at least one separate ball of flowable polymer composition around and / or central axis of the tissue thickness compensator at the expected substrate location and And / or may include applying an elongated strip to the substrate. In various embodiments, a method of attaching a tissue thickness compensator to a substrate includes at least one separate ball and / or elongate piece of flowable polymer composition longitudinally and / or transversely with respect to the tissue thickness compensator. May be applied.

  In various embodiments, a method of attaching a tissue thickness compensator to a substrate includes the flowable polymer composition in a preselected pattern and amount based at least in part on an expected load on the tissue thickness compensator. It may include applying at least one separate ball and / or strip to the substrate. The pattern and amount of flowable polymer composition to be applied may be selected to withstand stresses associated with the operation of the clinician's medical device, eg, shear stress. The pattern and amount of the flowable polymer composition to be applied is preferably the flowable polymer composition resulting from the clinician's operation in a state that facilitates application and / or storage of the flowable polymer composition. Sometimes selected to balance the load on an object. Moreover, the composition of the flowable polymer composition may be considered when selecting the pattern and amount of the flowable polymer composition to be applied.

  In various embodiments, the flowable attachment portion partially adheres the tissue thickness compensator to the staple cartridge and / or anvil and / or completely disposes the tissue thickness compensator to the staple cartridge and / or anvil. May be adhered to. A fully adhered tissue thickness compensator may include a complete layer of a flowable polymer composition, such as a pressure sensitive adhesive, between the tissue thickness compensator and the substrate. A fully adhered tissue thickness compensator may lack a portion of the tissue thickness compensator that does not include the flowable polymer composition. A partially adhered tissue thickness compensator comprising at least a portion of a tissue thickness compensator that does not include a flowable polymer composition is an effective amount of flowable polymer between the tissue thickness compensator and the substrate. May contain a composition. A partially adhered tissue thickness compensator may apply greater shear stress to the flowable polymer composition as compared to a fully adhered tissue thickness compensator. As a result, the shear properties of the flowable polymer composition and / or the amount and pattern of the flowable polymer composition may be selected to withstand the expected medical device operation by the clinician.

  In various embodiments, the flowable polymer composition may be applied to the tissue thickness compensator in one of a continuous pattern and a discontinuous pattern. In various embodiments, the continuous pattern of flowable polymer composition may comprise separate elongated pieces of flowable polymer composition applied to at least a portion of the tissue thickness compensator. In various embodiments, the continuous pattern of flowable polymer composition is aligned longitudinally along at least a portion of the central axis of the tissue thickness compensator and / or along at least a portion of the periphery of the tissue thickness compensator. May comprise a continuous ball of flowable polymer composition. The flowable polymer composition can be a continuous complete sheet or a variety of other patterns and configurations on a substrate, such as a cross pattern or other diagonal pattern, to achieve desirable adhesive properties. May be applied in layers or in other designs. In various embodiments, a continuous pattern of flowable polymer compound may be applied along the inner circumference and / or outer circumference of the tissue thickness compensator. In various embodiments, a continuous pattern of flowable polymer composition is applied along the inner circumference of the tissue thickness compensator so that it is positioned along the central longitudinal axis of the substrate when attached to the substrate. Sometimes. In various embodiments, the tissue thickness compensator is such that a continuous pattern of flowable polymer composition is aligned with at least one void in the substrate, such as a slot and / or staple cavity, when attached to the substrate. It may be applied along the inner periphery of the. In various embodiments, a continuous pattern of flowable polymer composition may be applied along the outer periphery of the tissue thickness compensator so that it is positioned along the outer periphery of the substrate when attached to the substrate. . In various embodiments, the flowable polymer composition may be applied to the tissue thickness compensator to leave an inner portion and / or periphery that does not include the flowable polymer composition on the substrate.

  In various embodiments, the discontinuous pattern of the flowable polymer composition may comprise a plurality of separate balls and / or strips of the flowable polymer composition that are spaced apart from each other on the substrate. In various embodiments, at least a portion of the plurality of balls and / or strips of the flowable polymer composition may be compressed together when pressure and / or stress is applied. In various embodiments, a plurality of compressed balls and / or strips of a flowable polymer composition may form a continuous pattern of the flowable polymer composition. In various embodiments, the partially adhered tissue thickness compensator comprises a free space in which at least a portion of the tissue thickness compensator lacks a flowable polymer composition when pressure is applied. The surface of the tissue thickness compensator spaced apart from each other may comprise a plurality of separate balls and / or strips of flowable polymer composition. The free space includes a portion of the tissue thickness compensator where the flowable polymer composition balls and / or strips do not touch each other and the tissue thickness compensator where the flowable polymer composition balls and / or strips are not applied. And a portion of. In various embodiments, this free space may comprise an inner portion and / or a peripheral edge on the substrate.

  In various embodiments, a method of attaching a tissue thickness compensator to a substrate may include applying at least one separate elongated piece of flowable polymer composition to the tissue thickness compensator. In various embodiments, separate elongated pieces of flowable polymer composition may extend along a portion of the central longitudinal axis of the tissue thickness compensator. In at least one embodiment, separate elongated strips of flowable polymer composition are applied along a portion of a tissue thickness compensator aligned with at least one void in the substrate, such as a slot and / or staple cavity. May be. In various embodiments, a method for attaching a tissue thickness compensator to a substrate may include applying a plurality of parallel, separate elongated pieces of flowable polymer composition to the tissue thickness compensator. In various embodiments, two separate strips of flowable polymer composition may extend longitudinally along opposite side edges of the tissue thickness compensator. In at least one embodiment, each of the two separate strips of flowable polymer composition is a tissue thickness compensator aligned with at least one void in the substrate, such as, for example, a slot and / or staple cavity. May be applied along a portion of In various embodiments, the distance between the strips and / or side edges is such that when attached to the substrate, the flowable polymer composition is within the substrate, for example, at least one staple cavity in the anvil. It may be preselected such that it may flow into at least one air gap.

  In various embodiments, the distance between a plurality of parallel separate strips and / or side edges of the flowable polymer composition is sufficient to fully adhere the tissue thickness compensator to the substrate and the tissue thickness. May be preselected to partially adhere the compensator to the substrate. In various embodiments, the width of the elongated strip can be, for example, at least 1 mm. In various embodiments, the width of the strip can be, for example, from about 0.5 mm to about 1.5 mm. In various embodiments, the width of the strip can be, for example, from about 1.0 mm to about 1.25 mm. In various embodiments, the width of the gap between the adhesive strip and / or the side edges can be at least 1 mm, for example. In various embodiments, the distance between the elongated strip and / or the side edges may be determined using a tissue thickness compensator using a preselected adhesive to free space ratio based on an expected load on the tissue thickness compensator. May be preselected to partially adhere to the substrate. In various embodiments, the adhesive to free space ratio is 1:10 to 10: 1, such as 1: 1, 1: 2, 1: 3, 1: 4, 1: 5, and 2: 3, for example. May be up to.

  In various embodiments, a minimum value of 0.25 mm for the PSA substrate may be required, for example, to have fluidity. In various embodiments, the PSA substrate can include a thickness of about 1.25 mm to about 1.50 mm, for example. In various embodiments, the PSA substrate can include a thickness of about 0.5 mm to about 0.75 mm, for example.

  As described herein, in various embodiments, the flowable attachment portion may comprise a flowable polymer composition. The flowable polymer composition may include a pressure sensitive adhesive. The flowable polymer composition may comprise a pressure sensitive adhesive laminate. In various embodiments, the flowable attachment portion may comprise an adhesive laminate comprising a tissue thickness compensator and a flowable polymer composition. The polymer composition may include one or more synthetic polymers and / or one or more natural polymers. The polymer composition may have bioabsorbability, biocompatibility, and / or biodegradability. Examples of natural polymers are lyophilized polysaccharides, glycoproteins, elastin, proteoglycans, gelatin, collagen, fibrin, fibronectin, fibrinogen, elastin, serum albumin, hemoglobin, ovalbumin, oxidized regenerated cellulose (ORC), and these Including, but not limited to, combinations. Examples of polysaccharides include, but are not limited to, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, chitin / chitosan, agarose, alginic acid, and combinations thereof. Examples of synthetic absorbent polymers are poly (lactic acid) (PLA), poly (L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly (glycolic acid) poly (hydroxybutyrate) ), Poly (phosphazine), polyester, poly (trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoate (PHA), glycolide / ε-caprolactone copolymer (PGCL), glycolide / trimethylene carbonate Copolymer, poly (glycerol sebacate) (PGS), polydioxanone, poly (orthoester), polyanhydride, polyacrylamide, polysaccharide, poly (ester amide), tyrosine polyarylate, tyrosine polyiminocarbonate, tyrosine Polyca Bonate, poly (D, L-lactide-urethane), poly (B-hydroxybutyrate), poly (E-caprolactone), polyethylene glycol (PEG), polyethylene oxide, poly [bis (carboxylatophenoxy) phosphazene], poly (Amino acids), pseudopoly (amino acids), absorbent polyurethanes, polyhydroxyethyl methyl acrylate, polyvinyl pyrrolidone, polyvinyl alcohol, polyacrylic acid, polyacetate, polycaprolactone, polypropene, nylon, and combinations thereof, including these It is not limited to.

  In various embodiments, the flowable polymer composition may comprise an ε-caprolactone / glycolide copolymer (PCL / PGA). In various embodiments, the flowable polymer composition comprises, for example, from about 50 wt% to about 90 wt% PGA polymer composition and from about 50 wt% to about 10 wt% PCL polymer composition. May be included. In various embodiments, the flowable polymer composition comprises, for example, from about 50% to about 75% by weight PGA polymer composition and from about 50% to about 25% by weight PCL polymer composition. May be included. In various embodiments, the flowable polymer composition comprises, for example, from about 50% to about 60% by weight PGA polymer composition and from about 50% to about 40% by weight PCL polymer composition. May be included. In at least one embodiment, the flowable polymer composition may comprise, for example, about 70% by weight PGA polymer composition and about 30% by weight PCL polymer composition. In at least one embodiment, the flowable polymer composition may comprise, for example, about 64% by weight PGA polymer composition and about 36% by weight PCL polymer composition.

  In various embodiments, the flowable polymer composition comprises a copolymer of ε-caprolactone and lactide including L-lactide, D-lactide, blends thereof, and lactic acid copolymer. is there. In various embodiments, the flowable polymer composition comprises a 30:70 to 70:30 PCL pair such as, for example, 35:65 to 65:35, 45:55 to 35:65, and 50:50. May contain PGA molar ratio. In various embodiments, the amount of ε-caprolactone may be, for example, 30-45 mole percent glycolide, such as 35-40 mole percent ε-caprolactone, where glycolide is balanced. In various embodiments, the PSA may comprise a 36:64 (mol / mol) [poly (ε-caprolactone-co-glycolide)] copolymer. In various embodiments, the flowable polymer composition comprises a copolymer of p-dioxanone (1,4-dioxane-2-one) and lactide including L-lactide, D-lactide, and lactic acid. May contain. In various embodiments, the flowable polymer composition may comprise a molar ratio of p-dioxanone to lactide of 40:60 to 60:40. In various embodiments, the flowable polymer composition may comprise an ε-caprolactone / dioxanone copolymer. In various embodiments, the tissue thickness compensator may comprise a molar ratio of ε-caprolactone to p-dioxanone to lactide of 30:70 to 70:30.

  In various embodiments, the tissue thickness compensator and the flowable attachment portion may include one of the same polymer composition and a different polymer composition. In various embodiments, the tissue thickness compensator and the flowable attachment portion may each comprise the same bioabsorbable material, such as, for example, ε-caprolactone / glycolide copolymer (PCL / PGA). In various embodiments, the tissue thickness compensator and flowable attachment portion may differ in at least one property selected from composition, modulus, elongation, intrinsic viscosity, crystallinity, and bioabsorbability. In various embodiments, the tissue thickness compensator and the flowable attachment portion have the same co-weight that differs in at least one property selected from composition, elastic modulus, elongation, intrinsic viscosity, crystallinity, and bioabsorbability. May include coalescence. For example, the tissue thickness compensator and the flowable attachment portion may each comprise a PCL / PGA copolymer having a different weight percentage of ε-caprolactone and glycolide and / or a molar ratio of ε-caprolactone to glycolide. In at least one embodiment, the tissue thickness compensator may comprise about 50% by weight PGA polymer composition and about 50% by weight PCL polymer composition, and the flowable attachment portion comprises about 64% by weight. Of PGA polymer composition and about 36% by weight of PCL polymer composition. In at least one embodiment, the tissue thickness compensator may comprise a PCL / PGA copolymer having a molar ratio of ε-caprolactone to glycolide of 50:50, and the flowable attachment moiety comprises 36:64 ε- May contain PCL / PGA copolymers having a molar ratio of caprolactone to glycolide.

  In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can each differ by at least 1 weight percent with respect to the weight of the polymer composition. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 5 weight percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 10 weight percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 15 weight percent. In various embodiments, the concentration of [epsilon] -caprolactone in the pressure sensitive adhesive and the concentration of [epsilon] -caprolactone in the tissue thickness compensator can vary from 1 to 15 weight percent. In various embodiments, the concentration of [epsilon] -caprolactone in the pressure sensitive adhesive and the concentration of [epsilon] -caprolactone in the tissue thickness compensator can vary from 10 to 15 weight percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by 14 weight percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive is, as described above, such that the concentration of ε-caprolactone in the pressure sensitive adhesive is greater than the concentration of ε-caprolactone in the tissue thickness compensator, and May be different from the concentration of ε-caprolactone in the tissue thickness compensator, such as one of the smaller.

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

  In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 1 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 5 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 10 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by at least 15 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can vary from 1 to 15 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can vary from 10 to 15 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive and the concentration of ε-caprolactone in the tissue thickness compensator can differ by 14 mole percent. In various embodiments, the concentration of ε-caprolactone in the pressure sensitive adhesive is, as described above, such that the concentration of ε-caprolactone in the pressure sensitive adhesive is greater than the concentration of ε-caprolactone in the tissue thickness compensator, and May be different from the concentration of ε-caprolactone in the tissue thickness compensator, such as one of the smaller.

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

  In various embodiments, the polymer composition can be processed by the composition and / or mechanical properties such as tack, resistance to aging due to light, oxygen, and heat, mechanical properties such as appearance, and other Additional optional ingredients may be included to further improve the properties. Such optional ingredients may include other copolymers that may be included in the polymer composition to achieve desirable properties, for example, to increase adhesion or compatibility with the substrate. . In various embodiments, the additional optional components include other polymers or copolymers, fillers, crosslinkers, tackifiers, plasticizers, pigments, dyes, and antioxidants. Although it may contain a coloring agent and a stabilizer, it is not limited to these. In various embodiments, the polymer composition contains a limited amount of at least 0.1, at least 2, or at least 5 to 10, 25, or 50 weight percent, based on the total weight of the polymer composition. May be included. In various embodiments, the polymer composition contains a limited amount of at least 0.1, at least 2, or at least 5 to 10, 25, or 50 weight percent, based on the total weight of the polymer composition. May contain plasticizers.

  In various embodiments, the flowable attachment portion may comprise a flowable (plastically deformable) polymer composition. In various embodiments, the flowable polymer composition is typically tacky at room temperature (eg, 20 ° C. to 25 ° C.) and is formed, for example, with finger pressure, to form a bond to adhere to the substrate. Only moderate pressures such as these may be used to releasably adhere to various substrates. In various embodiments, the flowable polymer composition may be solid up to 40 ° C, up to 45 ° C, up to 50 ° C, up to 55 ° C, and / or up to 60 ° C. In various embodiments, the flowable polymer composition has a temperature greater than 40 ° C, greater than 45 ° C, greater than 50 ° C, greater than 55 ° C, greater than 60 ° C, and / or greater than 120 ° C without degradation. May melt. In various embodiments, the flowable polymer composition may melt without degradation at up to 600 ° C, up to 500 ° C, up to 400 ° C, up to 300 ° C, up to 240 ° C, and / or up to 180 ° C. In various embodiments, the flowable polymer composition may melt without degradation at 40.1 ° C. to 600 ° C., 120 ° C. to 240 ° C., and / or 180 ° C.

  In various embodiments, the flowable polymer composition has an intrinsic viscosity of 0.6-4.0 dL / g, 0.8-3.2 g / dL, 0.1 g / dL hexafluoroisopropanol at 25 ° C., 1 May be characterized by 0.0 to 2.4 g / dL and / or 1.6 g / dL. In various embodiments, the polymer composition may be free of gel.

  In various embodiments, the flowable polymer composition has the following properties: less than about 25 percent percent crystallinity, less than about 15 percent percent crystallinity, and 15-25 percent percent crystallinity; A percent elongation greater than about 200, a percent elongation greater than about 500, and a percent elongation between about 200 and about 500, an elastic modulus less than about 276 MPa (40,000 psi), and an elasticity less than about 138 MPa (20,000 psi) May be characterized by one or more of a modulus and an elastic modulus of from about 138 MPa to about 276 MPa (20,000 to about 40,000 psi).

  In various embodiments, the flowable attachment portion may comprise one of an elongated strip, tape, tape wrap, sheet, and film attached to the surface and / or edge of the tissue thickness compensator. In various embodiments, the flowable attachment portion may comprise a pressure sensitive tape comprising an adhesive and a backing. In various embodiments, the backing may comprise one of a flexible backing material and an inflexible backing material. Examples of flexible backing materials include plastic films such as polypropylene, polyethylene, polyvinyl chloride, polyester (polyethylene terephthalate), polycarbonate, polymethyl (meth) acrylate (PMMA), cellulose acetate, cellulose triacetate, and ethyl cellulose. However, it is not limited to these. Foam backing may be used. Examples of inflexible backing materials include, but are not limited to, metals, metallized polymer films, indium tin oxide coated glass and polyester, PMMA plates, polycarbonate plates, glass, or ceramic sheet materials. In various embodiments, the pressure sensitive tape may comprise a release liner. In various embodiments, the pressure sensitive tape may be applied by removing the release liner, thereby exposing the adhesive.

  In various embodiments, the flowable attachment portion is formed using conventional coating techniques such as, for example, roller coating, flow coating, dip coating, spin coating, spray coating, knife coating, and mold coating. May be affixed to a thickness compensator. In various embodiments, the flowable attachment portion may have an initial thickness, for example, from about 1.25 mm to about 1.50 mm. In various embodiments, the flowable attachment portion may have an initial thickness, for example, from about 0.5 mm to about 0.75 mm. In various embodiments, the flowable attachment portion may have a final thickness of, for example, at least 0.25 mm when pressure is applied to the flowable attachment portion.

  In various embodiments, referring to FIG. 263, the flowable attachment portion 30000 may comprise a continuous elongate piece arranged longitudinally centrally along a portion of the central axis of the tissue thickness compensator 30010. . The width of the elongated piece may be at least 1 mm, for example. The width of the elongated piece may be, for example, about 0.5 mm to about 1.5 mm. The width of the elongate piece may be, for example, from about 1.0 mm to about 1.25 mm. The first portion of the flowable attachment portion 30000 may be spaced far from the anvil 30020, and the first cross-sectional shape of the flowable attachment portion 30000 may comprise a neutral (original) cross-sectional shape. As shown in FIG. 264, the flowable attachment portion 30000 may be aligned with a void 30025 in the anvil 30020, such as a centrally arranged slot. As shown in FIG. 265, the flowable attachment portion 30000 may flow into the slot 30025 and be in fixed engagement with the anvil 30020 when a threshold level of pressure is applied to the flowable attachment portion 30000. The flowable attachment portion 30000 may fill at least a portion of the slot 30025 such that the flowable attachment portion 30000 takes the form of the slot 30025. The second portion of the flowable attachment portion 30000 may contact the anvil 30020 and the second cross-sectional shape of the flowable attachment portion 30000 may comprise a cross-sectional shape that is complementary to the slot 30025. The flowable attachment portion 30000 may releasably attach the tissue thickness compensator 30010 to the anvil 30020.

  In various embodiments, referring to FIG. 266, the flowable attachment portion 30000 comprises two continuous elongate strips parallel to each other and arranged longitudinally along a portion of the tissue thickness compensator 30010. There is. The width of the elongated piece may be at least 1 mm, for example. The width of the elongated piece may be, for example, about 0.5 mm to about 1.5 mm. The width of the elongate piece may be, for example, from about 1.0 mm to about 1.25 mm. Two separate elongate pieces may be spaced away from the central axis and side edges of the tissue thickness compensator 30010. The width of the gap between each elongate piece may be at least 1 mm, for example, and the width of the gap between each elongate piece and the side edges may be at least 1 mm, for example. The adhesive to free space ratio can be, for example, about 1: 4 to about 1: 2. The adhesive to free space ratio may be at least about 1:10, for example. In various situations, the adhesive to free space ratio can be zero. In some situations, a constant layer that spans the entire surface may be desirable. The first portion of the flowable attachment portion 30000 may be spaced far from the anvil 30020, and the first cross-sectional shape of the flowable attachment portion 30000 may comprise a neutral (original) cross-sectional shape. As shown in FIG. 267, the flowable attachment portion 30000 may be aligned with the staple forming cavity 30330, for example. As shown in FIG. 268, the flowable attachment portion 30000 flows into the staple cavity 30030 and is fixedly engaged with the anvil 30020 when a threshold level of pressure, such as finger pressure, is applied to the flowable attachment portion 30000, for example. Sometimes. The flowable attachment portion 30000 may fill at least a portion of the staple cavity 30030 such that the flowable attachment portion 30000 takes the form of a slot 30030. At least a portion of the staple cavity 30030 may not include the flowable attachment portion 30000. The second portion of the flowable attachment portion 30000 may contact the anvil 30020 and the second cross-sectional shape of the flowable attachment portion 30000 may comprise a cross-sectional shape that is complementary to the slot 30030. The flowable attachment portion 30000 may releasably attach the tissue thickness compensator 30000 to the anvil 30020.

  In various embodiments, referring to FIGS. 269-273, a staple cartridge 30100 with a support portion 30102 and a tissue thickness compensator 30110 can be loaded into a staple cartridge channel with a staple cartridge applicator 30140, for example. In various embodiments, the applicator 30140 can be configured to position the upper tissue thickness compensator 30110 relative to the anvil 30120 in addition to positioning the staple cartridge 30100 within the staple cartridge channel. The applicator 30140 includes a locking protrusion that extends from the support portion 30102 of the staple cartridge 30100 so that the applicator 30140 can be maintained in place over the tissue thickness compensator 30110 of the staple cartridge 30100. A latch arm 30141 can be provided that can be releasably engaged. In various embodiments, the upper tissue thickness compensator 30110 is configured such that the surgical instrument anvil 30120 closes over the applicator 30140, engages the tissue thickness compensator 30110, and disconnects the tissue thickness compensator 30110 from the applicator 30140. Can be removably attached to the applicator 30140. In various embodiments, the tissue thickness compensator 30110 and / or anvil 30120 comprises one or more retention features that can be configured to releasably retain the tissue thickness compensator 30110 relative to the anvil. be able to. In various embodiments, the retention feature may comprise an adhesive sheet and / or an adhesive tab portion 30112.

  In various embodiments, the adhesive sheet and / or the adhesive tab portion may be integrally formed from a portion of the tissue thickness compensator 30110. In various embodiments, the tissue thickness compensator 30110 may comprise at least one adhesive tab portion 30112 along the edge of the tissue thickness compensator 30110. The adhesive tab 30112 may comprise a release liner 30113. Referring to FIG. 271, anvil 30120 may be moved to a closed position to engage tissue thickness compensator 30110. Release liner 30113 may be removed to expose the adhesive surface of adhesive tab portion 30112. Referring to FIGS. 272 and 273, the first end of the adhesive tab portion 30112 may be clamped to the anvil, and the second end of the adhesive tab portion 30112 may cause the tissue thickness compensator 30110 to anvil. It may be clamped to the anvil for releasable attachment. The adhesive tab portion 30112 may be pulled distally to detach the tissue thickness compensator 30110 from the applicator 30140. Thereafter, the anvil and staple cartridge 30100 can be positioned relative to the tissue to be stapled and / or dissected. The clinician may pull the adhesive tab 30112 to detach the tissue thickness compensator 30110 from the anvil.

  Referring to FIGS. 284-288, in various embodiments, the tissue thickness compensator 30210 may comprise at least one adhesive tab portion 30212 along the distal edge of the tissue thickness compensator 30210. The adhesive tab portion 30212 may include a release liner 30213. As described herein, staple cartridge applicator 30240 can be configured to position an upper tissue thickness 30210 compensator relative to anvil 30220. Release liner 30213 may be removed to expose the adhesive surface of adhesive tab portion 30212. The adhesive tab portion 30212 may be folded and clamped over the anvil 30220 to releasably attach the tissue thickness compensator 30210 to the anvil 30220. The adhesive tab portion 30212 may be pulled distally to detach the tissue thickness compensator 30210 from the applicator 30240. Thereafter, the anvil 30220 and staple cartridge 30200 can be positioned relative to the tissue to be stapled and / or dissected. Referring to FIGS. 289-290, in use, a staple deployment thread can be cut through the tissue thickness compensator 30210 to dissect at least a portion of the adhesive tab portion 30212 and gradually separate the tissue thickness compensator 30210 from the anvil 30220. The edge 30211 can be advanced distally through the staple cartridge by a firing member that can be advanced. The clinician may pull the remaining portion of the adhesive tab portion 30212 away from the anvil 30220 before reloading with a new staple cartridge 30200.

  In various embodiments, the adhesive sheet and / or the adhesive tab portion may be separated from the tissue thickness compensator. Referring to FIGS. 274-276, in at least one embodiment, an adhesive tab portion 30312 (also see FIGS. 288 and 292) may be provided between the staple cartridge 30300 and the tissue thickness compensator 30310. The tissue thickness compensator 30310 may include a notch 30311 configured and dimensioned to cooperate with the adhesive tab portion 30312 to releasably hold the tissue thickness compensator 30310 relative to the anvil 30320. is there. The first end of the adhesive tab portion 30312 may be clamped to the tissue thickness compensator 30310 adjacent to the notch portion 30311 and the second tab portion of the adhesive tab portion 30312 is clamped to the anvil 30320. Sometimes. As shown in FIG. 277, the adhesive tab portion 30312 does not engage the notch portion 30311. Thereafter, the anvil 30320 and staple cartridge 30300 can be positioned relative to the tissue T to be stapled and / or dissected.

  As described above, in use, the staple deployment sled can be advanced distally through the staple cartridge by the firing member to release the staples from the staple cartridge as outlined above. As the staples are deformed, each staple can capture a portion of the tissue thickness compensator that touches the top surface of the tissue. At the same time, the firing member can advance the knife edge through the tissue thickness compensator 30310, and in at least one embodiment, dissect the tissue thickness compensator 30310 and remove tissue from the anvil 30320 as shown in FIGS. 277-279. To cut off the thickness compensator 30310, the cutting edge can be advanced through the tissue thickness compensator 30310 to move the tissue thickness compensator 30310 distally and align the adhesive tab portion 30312 and the notch portion 30311. . In various embodiments, as described above, the tissue thickness compensator 30310 lacking a notch as the staple is moved from the unfired position of these staples to their fired position by the staple driver is shown in FIGS. As shown at 281, it may move downward to disengage the adhesive tab portion 30312 and detach the tissue thickness compensator 30310 from the anvil 30320. After the staples are deployed, the anvil 30320 can be reopened, as shown in FIG. 283, and can be moved away from the implanted tissue thickness compensator 30310. The reader will understand when comparing FIGS. 282 and 283 that the tissue thickness compensator 30310 can be fastened to the tissue T and incised by the cutting member, as described above.

  In various embodiments, the flowable attachment portion is applied by removing the first release liner from the first adhesive tab portion, thereby exposing the flowable attachment portion with, for example, a pressure sensitive adhesive. Sometimes attached. The first adhesive tab may roll onto the outer surface of the substrate or otherwise be pressed against the outer surface of the substrate. Next, the second release liner may be removed from the second adhesive tab, thereby exposing the PSA. The second adhesive tab portion may be pressed against the outer surface of the substrate and / or the first adhesive tab portion. Once the PSA is applied to the tissue thickness compensator, the PSA is placed in contact with the staple cartridge and / or anvil. The PSA may clamp the tissue thickness compensator to the substrate.

  The various embodiments described herein are described in connection with staples removably stored within a staple cartridge for use with a surgical stapling instrument. In some situations, the staples can include wires that are deformed when they come into contact with the anvil of the surgical stapler. Such wires can be composed of, for example, metals such as stainless steel, and / or other suitable materials. Such embodiments and the teachings of these embodiments may be applied to embodiments that include fasteners removably stored with a fastener cartridge for use with any suitable fastener.

  Various embodiments described herein are associated with a tissue thickness compensator attached to and / or for use with a staple cartridge and / or fastener cartridge. Explained. Such a tissue thickness compensator is capable of measuring variations in tissue thickness from one end of a staple cartridge to another, or variations in tissue thickness captured within one staple or fastener. Can be used to compensate. Such a tissue thickness compensator can also be utilized to compensate for thickness variations from one side of the staple cartridge to another. Such embodiments and the teachings of these embodiments provide a layer or group of layers of material attached to and / or for use with staple cartridges and / or fasteners. It can be applied to the embodiments including. The layer can include a buttress material amount.

  Various embodiments described herein are described in the context of a linear end effector and / or a linear fastener cartridge. Such embodiments and the teachings of these embodiments may be applied to non-linear end effectors and / or non-linear fastener cartridges such as, for example, circular and / or uneven end effectors. For example, various end effectors, including non-linear end effectors, are U.S. Patent Application No. 13 / 036,647 entitled “SURGICAL STAPLING INSTRUMENT” filed on Feb. 28, 2011, which is now US Patent application publication No. 2011/0226837, which is hereby incorporated by reference in its entirety. In addition, US patent application Ser. No. 12 / 893,461 entitled “STAPLE CARTRIDGE” filed on Sep. 29, 2012, which is hereby incorporated by reference in its entirety. Is incorporated herein by reference. US patent application Ser. No. 12 / 031,873, filed on Feb. 15, 2008, entitled “END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT”, now US Pat. No. 7,980,443, As well, the entire contents of which are hereby incorporated by reference.

  Any patent, publication, or other disclosure that is incorporated herein by reference, in whole or in part, is incorporated into the current definition, statement, or specification. To the extent that they do not conflict with other disclosures described in this document. The disclosure as expressly set forth herein shall supersede any conflicting matter incorporated herein by reference as such and, to the extent necessary. Anything that is incorporated herein by reference, but that conflicts with, or is part of, the current definitions, statements, or other disclosures contained herein, To the extent that no contradiction arises with the disclosure of

  While this invention has been described as having an exemplary design, the present invention may be further modified within the spirit and scope of the disclosure. Accordingly, this application covers any variations, uses, or adaptations of the invention that utilize the general principles of the invention. Furthermore, this application is intended to cover any deviations from the present disclosure as known or routine practiced in the technical field to which this invention pertains.

Embodiment
(1) A staple cartridge,
A cartridge body with a deck;
A plurality of staples detachably stored in the cartridge body;
An implantable layer assembly positioned on the deck;
The embeddable layer assembly comprises:
A compensation layer configured to be at least partially captured within the staple when the staple is moved from an unfired position to a fired position and having a first length;
An overlap layer extending from the compensation layer and having a second length longer than the first length and configured to overlap an adjacent embedded buried layer;
Comprising
Staple cartridge.
(2) The staple cartridge according to Embodiment 1, wherein the compensation layer is made of a compressible foam.
(3) The deck includes a distal deck end, the compensation layer includes a distal compensation end, the overlap layer includes a distal overlap end, and the distal overlap end 2. The staple cartridge of embodiment 1, wherein the staple cartridge extends beyond the distal deck end and the distal compensation end.
(4) The staple cartridge according to embodiment 1, wherein the overlap layer and the compensation layer constitute a laminated material.
(5) The staple cartridge of embodiment 1, wherein the overlap layer comprises a flexible end member extending from the compensation layer.

(6) A staple cartridge,
A cartridge body with a deck;
A plurality of staples detachably stored in the cartridge body;
An implantable layer positioned on the deck;
The embeddable layer comprises:
A compensation portion configured to be captured within the staple when the staple is moved from an unfired position to a fired position;
An overlap portion extending from the compensation portion and configured to overlap a compensation portion of an adjacent embedded embeddable layer;
Comprising
Staple cartridge.
(7) The staple cartridge according to embodiment 6, wherein the compensation portion is made of a compressible foam.
(8) The deck includes a distal deck end, the compensation portion includes a distal compensation end, the overlap portion includes a distal overlap end, and the distal overlap end Embodiment 7. The staple cartridge of embodiment 6, wherein the staple cartridge extends beyond the distal deck end and the distal compensation end.
(9) The staple cartridge according to embodiment 6, wherein the overlap portion and the compensation portion constitute a laminated material.
The staple cartridge of claim 6, wherein the overlap portion comprises a flexible end member extending from the compensation portion.

(11) A staple cartridge,
A cartridge body comprising a proximal end, a distal end, and a tissue support deck comprising a plurality of staple cavities defined between the proximal end and the distal end;
A plurality of staples detachably stored in the cartridge body;
An implantable layer positioned on the tissue support deck;
And wherein the staple is configured to capture at least a portion of the implantable layer in the staple when the staple is moved from an unfired position to a fired position, the implantable layer comprising: Comprising a tissue support portion extending beyond the distal end of the tissue support deck;
Staple cartridge.
(12) The embeddable layer comprises:
A compensation portion configured to be captured within the staple;
An overlap portion extending from the compensation portion and configured to overlap an embeddable layer of an adjacent embedded embeddable layer;
Comprising
Embodiment 12. The staple cartridge according to embodiment 11.
(13) The staple cartridge according to embodiment 12, wherein the compensation portion is made of a compressible foam.
(14) The compensation portion comprises a distal compensation end, the overlap portion comprises a distal overlap end, the distal overlap end comprising the distal deck end and the distal The staple cartridge of embodiment 12, wherein the staple cartridge extends beyond the compensating end.
(15) The staple cartridge according to embodiment 12, wherein the overlap portion and the compensation portion constitute a laminated material.

The staple cartridge of claim 12, wherein the overlap portion comprises a flexible end member extending from the compensation portion.

Claims (5)

A staple cartridge,
A cartridge body extending in the longitudinal direction and provided with a deck;
A plurality of staples detachably stored in the cartridge body;
A layer assembly positioned on the deck;
The layer assembly comprises:
A compensation layer configured to be at least partially captured within the staple when the staple is moved from an unfired position to a fired position and having a first length in the longitudinal direction ;
The compensation layer extends from the compensation layer, has a second length longer than the first length in the longitudinal direction, and overlaps the compensation layer in the entire range of the compensation layer when viewed from a direction perpendicular to the deck. An overlap layer configured to, and
Comprising
Staple cartridge.   The staple cartridge according to claim 1, wherein the compensation layer is made of a compressible foam.   The deck includes a distal deck end, the compensation layer includes a distal compensation end, the overlap layer includes a distal overlap end, and the distal overlap end includes the The staple cartridge of claim 1, extending beyond a distal deck end and the distal compensation end.   The staple cartridge according to claim 1, wherein the overlap layer and the compensation layer constitute a laminated material.   The staple cartridge according to claim 1, wherein the overlap layer comprises a flexible end member extending from the compensation layer.

Images