JP7362630B2 - Three-dimensional auxiliary material for surgical stapler - Google Patents

Description

A three-dimensional auxiliary material and a method for manufacturing the same are provided.

Surgical staplers are used in surgical procedures to close openings in tissue, blood vessels, conduits, shunts, or other objects or body parts associated with a particular procedure. The opening may be naturally occurring, such as a passageway within a blood vessel or internal organ such as the stomach, or by forming a bypass or anastomosis with tissue or blood vessel puncture, or during a stapling procedure. It may be created by a surgeon during a surgical procedure, such as through an incision.

Some surgical staplers required the surgeon to select the appropriate staple with the appropriate staple height for the tissue being stapled. For example, a surgeon could select taller staples to use on thick tissue and shorter staples to use on thinner tissue. However, in some situations, the tissue being stapled does not have a consistent thickness and therefore the staples are unable to achieve the desired firing configuration at each staple site. As a result, it is not possible to form a desirable seal at or near all of the stapled areas, allowing blood, air, gastrointestinal fluids, and other fluids to pass through the unsealed area. It becomes possible for the fluid to ooze out.

Additionally, staples and other objects and materials that can be implanted in conjunction with procedures such as stapling generally lack some characteristics of the tissue in which they are implanted. For example, staples and other objects and materials may lack the natural flexibility of the tissue in which they are implanted, and therefore cannot withstand various intratissue pressures at the site of implantation. This can lead to undesired tearing of the tissue at or near the site of the staple, and thus leakage.

Accordingly, there remains a need for improved instruments and methods that address current problems with surgical staplers.

A three-dimensional bioabsorbable adjuvant is provided for use with stapling assemblies.

In one exemplary embodiment, a three-dimensional bioabsorbable supplement is provided and can include a plurality of elastic struts formed from a first matrix including at least one molten bioabsorbable polymer. The plurality of resilient struts can form a geometric repeating unit, and the plurality of resilient struts can be configured to deform when compressed. The auxiliary material may be configured to be releasably retained on the stapling body and to allow passage of a plurality of staples disposed within the stapling body, and the auxiliary material may be configured to so that it can be attached to tissue by staples. In one embodiment, the auxiliary material may also include at least one stop element that may be configured to limit the amount of compression of the auxiliary material.

In one aspect, voids of various sizes may be present in the supplement.

In certain embodiments, the at least one molten bioabsorbable polymer of the first matrix is a thermoplastic bioabsorbable polyurethane, a UV-curable bioabsorbable polyurethane, poly(lactic acid), polycaprolactone, polyglycolide, polydioxanone, It may be selected from the group consisting of poly(lactic-co-glycolic acid), polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, copolymers thereof, and combinations thereof.

In one aspect, the adjunct can be configured to apply a stress of at least about 3 g/mm ² to tissue stapled to the adjunct for at least 3 days when the adjunct is in a tissue-deployed state.

The plurality of resilient struts can have a variety of configurations. For example, the plurality of struts are substantially helical in shape. In some aspects, a plurality of resilient struts can be interconnected at nodes to form a truss-like structure that can be configured to flex when compressed. In one embodiment, the interconnectivity of the plurality of elastic struts and the nodes allows the auxiliary material to be compressed in a first predetermined direction and in a second direction different from the first predetermined direction. A geometric shape can be formed that can be configured to restrict movement of the. In another embodiment, the nodes may be formed from a second matrix that includes at least one molten bioabsorbable polymer that is different from the at least one molten bioabsorbable polymer of the first matrix.

In certain aspects, the plurality of struts can define a first portion, a second portion opposite the auxiliary material, and a channel therebetween, the channel configured to receive the cutting element. can be configured. The first and second portions may be selectively connected by at least one bridging member extending across the channel.

In other aspects, the plurality of struts can allow the tissue contacting surface and the body contacting surface of the supplement to compress toward each other.

In another exemplary embodiment, a three-dimensional bioabsorbable supplement can be provided that includes a plurality of elastic struts connected at joints to form a lattice structure. The lattice structure can be formed of at least one matrix comprising at least one molten bioabsorbable polymer. The interconnectivity of the plurality of struts and joints may be configured to allow the auxiliary material to compress. The lattice structure can include a tissue contacting surface and an assembly contacting surface opposite the tissue contacting surface. The lattice structure can be configured to allow passage of a plurality of staples disposed within the stapling assembly, allowing the plurality of staples to attach the supplement to the tissue. In one embodiment, the auxiliary material may also include at least one stop element that may be configured to limit the amount of compression of the auxiliary material.

In some embodiments, the plurality of elastic struts can be formed from a first matrix comprising at least one molten bioabsorbable polymer, and the joint can be formed from at least one molten bioabsorbable polymer of the first matrix. The second matrix may be formed from a second matrix comprising at least one molten bioabsorbable polymer different from the bioabsorbable polymer.

In certain embodiments, voids are present in the lattice structure. The voids can form a substantially continuous network of openings across the supplement. In other aspects, the lattice structure can have a first end, a second end, and a longitudinal axis extending therebetween. The lattice structure can also include voids extending at least partially through the lattice structure.

In one aspect, the plurality of struts can define a first side, a second side opposite the lattice structure, and a channel therebetween, the channel configured to receive the cutting element. may be configured. The first and second sides may be selectively connected by a plurality of bridging members extending across the channel.

In another aspect, the adjunct can be configured to apply a stress of at least about 3 g/mm ² to tissue stapled thereto for at least 3 days when the adjunct is in a tissue-deployed state.

The present invention will be more fully understood from the following detailed description when read in conjunction with the accompanying drawings.
1 is a perspective view of an exemplary embodiment of a conventional surgical stapling and cutting instrument; FIG. 2 is a perspective view of a wedge thread of a staple cartridge of the surgical stapling and severing instrument of FIG. 1; FIG. 2 is a perspective view of the knife and firing bar ("E-beam") of the surgical stapling and cutting instrument of FIG. 1; FIG. 2 is a longitudinal cross-sectional view of a surgical cartridge that may be placed within the stapling and cutting instrument of FIG. 1; FIG. 5 is a top view of staples in an unfired (pre-deployment) configuration that may be placed within the staple cartridge of the surgical cartridge assembly of FIG. 4; FIG. 1 is a longitudinal cross-sectional view of an exemplary embodiment of a surgical cartridge assembly having an auxiliary member attached to a cartridge deck; FIG. 7 is a schematic showing the supplement of FIG. 6 in a tissue-deployed state. FIG. 2 is a perspective view of an exemplary embodiment of an auxiliary member having multiple repeating units of interconnected struts. FIG. 8B is an enlarged view of the repeating unit of the auxiliary material shown in FIG. 8A obtained in step 8B. 8B is a schematic diagram of the repeating unit of FIG. 8B in a pre-compression state; FIG. 8B is a schematic diagram of the repeating unit of FIG. 8B in a first compressed state; FIG. 8B is a schematic diagram of the repeating unit shown in FIG. 8B in a second compressed state; FIG. FIG. 3 is a graph of the relationship between stiffness and compression of an auxiliary material. FIG. 3 is a perspective view of an exemplary embodiment of an auxiliary member having a plurality of interconnected struts and internal connecting features. FIG. 11B is a perspective cross-sectional view of the auxiliary material shown in FIG. 11A obtained in step 11B. FIG. 3 is a perspective view of another exemplary embodiment of an auxiliary member having a plurality of interconnected struts and connecting members. FIG. 12B is an enlarged view of the repeating unit of the auxiliary material shown in FIG. 12A obtained in step 12B. FIG. 3 is a perspective view of another exemplary embodiment of an auxiliary member having multiple struts of a first material interconnected at joints or nodes of a second material; FIG. 13B is an enlarged view of the repeating unit of the auxiliary material shown in FIG. 13A obtained in step 13B. FIG. 7 is a perspective view of yet another exemplary embodiment of a repeating unit of interconnected struts having an end configuration. FIG. 6 is a perspective view of an auxiliary member according to another embodiment with a plurality of struts and at least one stop element; FIG. 2 is a perspective view of an exemplary embodiment of an auxiliary member having a plurality of struts that are substantially helical in shape. FIG. 3 is a perspective view of another exemplary embodiment of an auxiliary member including a plurality of struts in the form of vertical columns with different lengths; Figure 18 is a schematic view of the auxiliary material shown in Figure 17 at its height before compression; 18 is a schematic representation of the supplementary material shown in FIG. 17 at a first compression height; FIG. 18 is a schematic representation of the supplementary material shown in FIG. 17 at a second compression height; FIG. FIG. 3 is a side view of an exemplary embodiment of an auxiliary member that includes a plurality of struts in the form of vertical columns and curved columns. 20 is a graphical representation of the mechanical behavior of the supplementary material shown in FIG. 19 over the compression range; FIG. 7 is a perspective view of another exemplary embodiment of an auxiliary material having a channel configured to receive a cutting element and having a tab for attaching the auxiliary material to a staple cartridge. 21B is an exemplary embodiment of a staple cartridge assembly having the supplement shown in FIG. 21A attached to a cartridge body; FIG. 2 is an exemplary embodiment of an auxiliary material with a bridging member.

Certain representative embodiments will now be described to provide a comprehensive understanding of the principles of structure, function, manufacture, and use of the devices and methods disclosed herein. Examples of one or more of these embodiments are illustrated in the accompanying drawings. The apparatus, systems, and methods described in detail herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the invention is defined solely by the claims. Those skilled in the art will understand. 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.

Further, in this disclosure, like referenced components of the embodiments generally have similar features, and therefore, in a particular embodiment, each of the like referenced components Features are not necessarily described in complete detail. Additionally, to the extent that linear or circular dimensions are used in describing the disclosed systems, devices, and methods, such dimensions indicate the types of shapes that can be used in combination with such systems, devices, and methods. It is not intended to be limiting. Those skilled in the art will appreciate that such linear and circular equivalent dimensions can be readily determined for any geometric shape. The size and shape of the systems and devices, and their components, will depend on at least the anatomy of the subject within which the systems and devices are used, the size and shape of the components with which the systems and devices are used, and the systems and devices. may depend on the method and treatment used.

It will be understood that the terms "proximal" and "distal" are used herein with reference to a user, such as a clinician, holding the handle of the instrument. Other spatial terms such as "anterior" and "posterior" similarly correspond to distal and proximal, respectively. It will also be appreciated that for convenience and clarity of explanation, spatial terms such as "vertical" and "horizontal" are used herein with respect to the drawings. However, surgical instruments may be used in many orientations and positions, and these spatial terms are not intended to be limiting or absolute.

Values or ranges can be expressed herein as "about" and/or "about" one particular value to another particular value. When a value or range is expressed as such, other disclosed embodiments include the particular recited value and/or from one particular value to another. Similarly, when a value is expressed in approximate form by the preceding use of "about," it is understood that a number of disclosed values are enumerated and that the particular value forms a separate embodiment. Probably. It will be further understood that there are many values disclosed, and that each value is also disclosed herein as "about" in addition to the value itself. In some embodiments, "about" can be used to mean, for example, within 10% of the recited value, within 5% of the recited value, or within 2% of the recited value.

For purposes of describing and defining the present teachings, the term "substantially" is used herein, unless otherwise specified, to refer to any quantitative comparison, value, measurement, or other expression that may be attributed to Note that it is used to express the degree of uncertainty. The term "substantially" is also utilized herein to express the extent to which a quantitative expression may vary from the stated standard without resulting in a change in the fundamental functionality of the object in question. Ru.

Surgical stapling assemblies and methods of manufacturing and stapling tissue are provided. Generally, a stapling assembly is provided that has a body (eg, a staple cartridge or an end effector body) within which a plurality of staples are disposed. The stapling assembly also includes a three-dimensional compressible supplement formed from a matrix including at least one molten bioabsorbable polymer and configured to be releasably retained on the body. The auxiliary material may be releasably retained on the body such that when the staple is deployed from the body into tissue, at least a portion of the auxiliary material may be attached to tissue captured by the staple. As discussed herein, the adjunctive material is designed to compensate for changes in tissue properties, such as changes in tissue thickness, and/or to reduce tissue ingrowth when the adjunct material is stapled to the tissue. may be configured to facilitate. For example, the adjunct may be configured to apply a stress of at least about 3 g/ ^mm to tissue for at least 3 days when in a tissue deployment state (e.g., when the adjunct is stapled to tissue in vivo). .

Exemplary stapling assemblies may include various features to facilitate application of surgical staples, as described herein and shown in the figures. However, those skilled in the art will appreciate that the stapling assembly may include only some of these features and/or may include various other features known in the art. The stapling assemblies described herein are intended to be representative of certain exemplary embodiments only. Additionally, while the auxiliary material is described in connection with a surgical staple cartridge assembly and need not be replaceable, the auxiliary material may be associated with reloading staples that are not cartridge-based or any type of surgical instrument. It can be used as

FIG. 1 depicts an exemplary surgical stapling and cutting instrument 100 suitable for use with implantable adjuncts. The illustrated surgical stapling and cutting instrument 100 includes a staple application assembly 106 or end effector having an anvil 102 pivotally coupled to an elongated staple channel 104. Staple application assembly 106 can be attached at its proximal end to elongate shaft 108 forming implementation portion 110. When staple application assembly 106 is closed, or at least substantially closed, implementation portion 110 may exhibit a sufficiently small cross-section suitable for insertion of staple application assembly 106 into a trocar. Although instrument 100 is configured to staple and cut tissue, surgical instruments configured to staple but not cut tissue are also contemplated herein.

In various situations, staple application assembly 106 may be operated by handle 112 connected to elongated shaft 108. The handle 112 is provided with user control, such as a rotation knob 114 that rotates the elongated shaft 108 and the staple application assembly 106 about the longitudinal axis of the elongated shaft 108, and a pistol grip 118 that pivots in front of the staple application assembly 106. A closure trigger 116 can be included that can close the. For example, when the closure trigger 116 is clamped, the closure release button 120 may be presented on the outside of the handle 112 such that pressing the closure release button 120 unclamps the closure trigger 116 and removes the staple application assembly 106. can be opened.

Firing trigger 122 can pivot in front of closure trigger 116, allowing staple application assembly 106 to simultaneously cut and staple tissue clamped therein. In various situations, multiple firing strokes may be used using firing trigger 122 to reduce the amount of force required to be applied by the surgeon's hand per stroke. In certain embodiments, handle 112 may include one or more rotatable indicator wheels, such as rotatable indicator wheel 124, that can display firing progress. The manual fire release lever 126 allows the firing system to be retracted, if desired, before the full firing travel is completed, and further allows the firing system to lock and/or function. When it runs out, it allows the surgeon or other clinician to retract the firing system.

Further details regarding surgical stapling and cutting instrument 100 and other surgical stapling and cutting instruments suitable for use with the present disclosure may be found, for example, in U.S. Pat. No. 9,332,984 and US Patent Application Publication No. 2009/0090763. Further, the surgical stapling and cutting instrument need not include a handle, but may instead be described by Frederick E. It includes a housing configured to couple to a surgical robot, such as that described in U.S. Patent Application Publication No. 15/689,198, filed Aug. 29, 2017, to Shelton et al.

2 and 3, for example, a firing assembly, such as firing assembly 228, may be utilized with a surgical stapling and cutting instrument, such as instrument 100 of FIG. Firing assembly 228 connects a wedge sled 230 having a plurality of wedges 232 configured to deploy staples from a staple application assembly, such as staple application assembly 106 of FIG. 1, to an anvil, such as anvil 102 of FIG. It may be configured to be advanced into tissue captured between an elongate staple channel, such as channel 104 in FIG. Additionally, an E-beam 233 on the distal portion of firing assembly 228 may fire staples from the staple application assembly and position the anvil against the elongated staple channel during firing. The E-beam 233 shown includes a pair of upper pins 234, a pair of middle pins 236 that may run along a portion 238 of the wedge thread 230, and a lower pin or foot 240. E-beam 233 can also include a sharp cutting edge 242 configured to cut captured tissue as firing assembly 228 is advanced distally. Additionally, integrally molded, proximally projecting upper and intermediate guides 244 and 246 that bracket each vertical end of cutting edge 242 may be used to sharpen tissue prior to cutting. A tissue staging area 248 may be further defined to assist in guiding the tissue to 242. The intermediate guide 246 can also be used to engage and fire the staple application assembly by abutting the stepped central member 250 of the wedge sled 230, causing formation of staples by the staple application assembly.

Referring to FIG. 4, a staple cartridge 400 can be utilized with a surgical stapling and cutting instrument, such as the surgical stapling and cutting instrument 100 of FIG. A staple cavity 404 can be included. A staple 406 may be removably disposed in each staple cavity 404. Staple 406 in an unfired (pre-deployed, unformed) configuration is shown in more detail in FIG. Staple cartridge 400 can also include a longitudinal channel that can be configured to receive a firing member and/or a cutting member, eg, an E-beam, such as E-beam 233 in FIG.

Each staple 406 can include a crown (base) _406C and one or more legs _406L extending from the crown _406C . Before the staple 406 is deployed, the crown _406C of the staple 406 can be supported by a staple driver 408 disposed within the staple cartridge 400, while the leg _406L of the staple 406 Can be at least partially housed within cavity 404. Additionally, staple legs 406 _L of staples 406 can extend beyond tissue contacting surface 410 of staple cartridge 400 when staples 406 are in an unfired position. In certain situations, as shown in FIG. 5, the tips of staple legs _406L can be sharp, which can cut and penetrate tissue.

In some embodiments, the staple can include one or more external coatings, such as a sodium stearate lubricant and/or an antimicrobial agent. The antimicrobial agent may be applied to the staple as its own coating or incorporated into another coating such as a lubricant. Non-limiting examples of suitable antimicrobial agents include 5-chloro-2-(2,4-dichlorophenoxy)phenol, chlorhexidine, silver formulations (such as nanocrystalline silver), lauric acid ethyl ester (LAE ), octenidine, polyhexamethylene biguanide (PHMB), taurolidine, lactic acid, citric acid, acetic acid, and their salts.

Staples 406 may be transformed from an unfired position to a fired position such that legs 406 _L move through staple cavity 404 and between an anvil, such as anvil 102 of FIG. 1, and staple cartridge 400. penetrate the tissue placed in the anvil and make contact with the anvil. As the legs 406 _L deform against the anvil, the legs 406 _L of each staple 406 can capture a portion of tissue within each staple 406 and apply a compressive force to the tissue. Additionally, the legs _406L of each staple 406 can be deformed downwardly toward the crown _406C of the staple 406 to form a staple acquisition region within which tissue can be acquired. In various situations, the staple capture area may be defined between the inner surface of the deformed leg and the inner surface of the staple crown. The size of the staple capture area may depend on several factors, such as, for example, leg length, leg diameter, crown width, and/or degree of leg deformation.

In use, an anvil, such as anvil 102 of FIG. 1, is closed by depressing a closure trigger, such as closure trigger 116 of FIG. 1, to advance an E-beam, such as E-beam 233 of FIG. , and can be moved to the closed position. The anvil can position tissue against the tissue contacting surface 410 of the staple cartridge 400. Once the anvil is properly positioned, staples 406 can be deployed.

As mentioned above, to deploy staples 406, a staple firing sled, such as sled 230 of FIG. 2, can be moved from proximal end 400p toward distal end 400d of staple cartridge 400. As a firing assembly, such as firing assembly 228 of FIG. 3, advances, the sled may contact staple driver 408 and lift staple driver 408 upwardly within staple cavity 404. In at least one embodiment, the sled and staple driver 408 can each include one or more ramped or diagonal surfaces that cooperate to move the staple driver 408 upwardly from the unfired position. can. As the staple drivers 408 are lifted upwardly within their respective staple cavities 404, the staples 406 are advanced upwardly, causing the staples 406 to exit the staple cavities 404 and penetrate into tissue. In various situations, the sled can move several staples upward simultaneously as part of a firing sequence.

Although auxiliary materials are shown and described below, the auxiliary materials disclosed herein can be used with other surgical instruments and do not need to be coupled to a staple cartridge as described. Those skilled in the art will understand. Furthermore, those skilled in the art will also understand that the staple cartridge need not be replaceable.

As mentioned above, some surgical staplers often require the surgeon to select an appropriate staple with an appropriate staple height for the tissue being stapled. For example, a surgeon could select taller staples to use on thick tissue and shorter staples to use on thinner tissue. However, in some situations, the tissue being stapled does not have a consistent thickness, and thus the staples may be applied to all portions of the stapled tissue (e.g., sections of thick tissue and sections of thin tissue). On the other hand, the desired firing configuration cannot be achieved. Inconsistent tissue thickness may also cause the staple site to be exposed to internal pressure at the staple site and/or along the staple row, especially when staples of the same or substantial height are used. When stapled, tissue at the site of the staple may undesirably leak and/or tear.

Thus, compensating for varying thicknesses of tissue captured within fired (deployed) staples to avoid the need to consider staple height when stapling tissue during surgical procedures. Various embodiments of three-dimensionally printed auxiliary materials are provided that can be configured to. That is, the aids described herein use a set of staples having the same or similar heights in stapling tissue of varying thickness (i.e., from thin to thick tissue). It may also be combined with adjunctive materials to provide adequate tissue compression within and between fired staples. Thus, the adjunctive materials described herein can maintain suitable compression for stapled thin or thick tissue, thereby preventing tissue leakage and/or tearing at the site of the staple. can be minimized.

Alternatively, or additionally, the three-dimensionally printed supplement may be configured to promote tissue ingrowth. In a variety of situations, implantable adjunctive materials may be incorporated into implantable adjuncts to promote healing of the tissue being treated (e.g., tissue being stapled and/or dissected) and/or to accelerate patient recovery. It is desirable to promote tissue ingrowth. More specifically, tissue ingrowth into the implantable adjunct may reduce the incidence, extent, and/or duration of inflammation at the surgical site. Tissue ingrowth into and/or around the implantable adjunct may, for example, manage the spread of infection at the surgical site. For example, ingrowth of blood vessels, particularly leukocytes, into and/or around the implantable adjunct may combat infection in and/or around the implantable adjunct and adjacent tissue. Tissue ingrowth may also assist in acceptance of foreign objects (eg, implantable supplements and staples) by the patient's body and may reduce the likelihood that the patient's body will reject the foreign object. Rejection of the foreign body may result in infection and/or inflammation at the surgical site.

Unlike traditional auxiliary materials (e.g. non-3D printed auxiliary materials, e.g. woven auxiliary materials), these 3D printed auxiliary materials have microstructures (e.g. woven auxiliaries) that are consistently reproducible. unit). That is, unlike other manufacturing methods, 3D printing significantly improves the control of microstructural features, such as the placement and connection of elements, for example. As a result, variations in both the microstructure and associated properties of the auxiliary material are reduced compared to conventional woven auxiliary materials. For example, these three-dimensionally printed aids can be structured to compress a predetermined amount of substantially uniform material. Also, fine control over the microstructure may allow the porosity of the supplement material to be tailored to enhance tissue ingrowth. Additionally, these three-dimensionally printed supplements can be adapted for use with a variety of staples and tissue types.

Generally, the auxiliary materials provided herein are designed and placed on the top of the body, such as cartridge body 402 in FIG. When the staples are fired (deployed) from the main body, the staples penetrate through the supplementary material and into the tissue. When the staple legs are deformed relative to an anvil disposed on the opposite side of the staple cartridge assembly, the deformed legs capture a portion of the auxiliary material and a portion of the tissue within each staple. That is, when the staple is fired into tissue, at least a portion of the supplemental material is disposed between the tissue and the fired staple. Although the auxiliary materials described herein may be configured to be attached to the staple cartridge body, herein the auxiliary materials may be configured to mate with other instrument components, such as the jaws of a surgical stapler. It is also contemplated that the device may be configured to do so. Those skilled in the art will appreciate that the supplements provided herein can be used in reloading replaceable cartridges or staples that are not cartridge-based.

FIG. 6 illustrates an exemplary embodiment of a staple cartridge assembly 600 that includes a staple cartridge 602 and an auxiliary material 604. Other than the differences described in detail below, staple cartridge 602 may be similar to staple cartridge 400 (FIG. 4) and therefore will not be described in detail herein. As shown, auxiliary material 604 is positioned relative to staple cartridge 602. The staple cartridge can include a cartridge body 606 and a plurality of staples 608 disposed therein, such as staples 406 shown in FIGS. 4 and 5. Staple 608 may include any suitable unformed (pre-deployment) height. For example, staples 608 can have an unformed height of about 2 mm to 4.8 mm. Prior to deployment, the crown of staple 608 can be supported by staple 610.

In the illustrated embodiment, supplementary material 604 may be fitted to an outer surface 612 of cartridge body 606, such as a tissue contacting surface. In some embodiments, the outer surface 612 of the cartridge body 606 can include one or more attachment features. The one or more attachment features are configured to engage the auxiliary material 604 to avoid undesired movement of the auxiliary material 604 relative to the cartridge body 606 and/or premature release of the auxiliary material 604 from the cartridge body 606. can be done. Exemplary attachment features can be found in US Patent Application Publication No. 2016/0106427, which is incorporated herein by reference in its entirety.

The supplemental material 604 is compressible and the supplemental material can be compressed to different heights to compensate for different tissue thicknesses captured within the deployed staples. The auxiliary material 604 has an uncompressed (undeformed) or pre-deployment height and is configured to deform to one of a plurality of compressed (deformed) or deployed heights. For example, supplemental material 604 can have an uncompressed height that is greater than the fired height of staples 608 (eg, the height (H) of fired staples 608a in FIG. 7). That is, the auxiliary material 604 can have an undeformed state in which the maximum height of the auxiliary material 604 is greater than the maximum height of the fired staples 608a (i.e., the staples in the formed configuration). In one embodiment, the uncompressed height of the auxiliary material 604 is about 10% higher, about 20% higher, about 30% higher, about 40% higher, about 50% higher than the firing height of the staples 608. It may be about 60% higher, about 70% higher, about 80% higher, about 90% higher, or about 100% higher. In certain embodiments, the uncompressed height of the auxiliary material 604 may be greater than 100% higher than the firing height of the staples 608, for example.

Auxiliary material 604 may be releasably fitted to outer surface 612 of cartridge body 606. As shown in FIG. 7, when the staple is fired, a portion of the tissue (T) and supplementary material 604 is captured by the fired (formed) staple 608a. The fired staples 608a each define an acquisition region therein, as described above, for accommodating the acquired supplemental material 604 and tissue (T). The capture area defined by fired staple 608a is limited, at least in part, by the height (H) of fired staple 608a. For example, the height of fired staples 608a can be about 0.160 inches or less. In some embodiments, the height of the first stapled 608a can be about 0.130 inches or less. In one embodiment, the height of fired staples 608a may be approximately 0.020 inches to 0.130 inches. In another embodiment, the height of fired staples 608a can be about 0.060 inches to 0.160 inches.

As described above, the auxiliary material 604 may be compressed within multiple fired staples, regardless of whether the thickness of the tissue captured within the staples is the same or different within each fired staple. . In at least one exemplary embodiment, the staples in the row of staples may be deformed to a firing height of, for example, about 2.75 mm, such that tissue (T) and supplemental material 604 are compressed within this height. can be done. In certain situations, the tissue (T) can have a compression height of about 1.0 mm and the supplemental material 604 can have a compression height of about 1.75 mm. In certain situations, the tissue (T) can have a compression height of about 1.50 mm and the supplemental material 604 can have a compression height of about 1.25 mm. In certain situations, the tissue (T) can have a compression height of about 1.75 mm and the supplemental material 604 can have a compression height of about 1.00 mm. In certain situations, the tissue (T) can have a compression height of about 2.00 mm and the supplemental material 604 can have a compression height of about 0.75 mm. In certain situations, the tissue (T) can have a compression height of about 2.25 mm and the supplemental material 604 can have a compression height of about 0.50 mm. Accordingly, the sum of the heights of compression of the captured tissue (T) and the auxiliary material 604 may be equal to, or at least substantially equal to, the height (H) of the fired staple 608a.

As discussed in more detail below, the structure of the filler material is such that the filler material resists the pressure of circulating blood through the tissue as the filler material and tissue are captured within the fired staple. The structure can be configured to apply a stress that can be applied. Hypertension is typically considered to be 210 mmHg, so it is desirable for the adjuvant to apply a stress of 210 mmHg or more (eg, 3 g/mm ² ) to the tissue for a given period of time (eg, 3 days). Accordingly, in certain embodiments, the adjunctive material may be configured to apply a stress of at least about 3 g/mm ² to the captured tissue for at least 3 days. The auxiliary material is in a tissue-deployed state when the auxiliary material is stapled to tissue in vivo. In one embodiment, the applied stress may be about 3 g/ ^mm2 . In another embodiment, the applied stress can be ^greater than 3 g/mm2. In yet another embodiment, the stress may be at least about 3 g/mm ² and may be applied to the captured tissue for more than 3 days. For example, in one embodiment, the stress can be at least about 3 g/mm ² and can be applied to the captured tissue for about 3 to 5 days.

The principle of Hooke's law (F=kD) can be used to design an adjunct configured to apply a stress of at least about 3 g/mm ² to the captured tissue for a predetermined period of time. For example, if the force (stress) applied to the captured tissue is known, the adjunct can be designed to have stiffness (k). Stiffness can be set by adjusting the geometry of the supplement (eg, the diameter of the struts and/or the interconnectivity of the struts, eg, the angle and spacing between the struts). Furthermore, the auxiliary material can be designed to have the maximum amount of compressive displacement for a minimum tissue thickness, e.g. 1 mm, and thus for a given maximum staple height. , for example 2.75 mm, the length of the displacement D may be a combination of the minimum thickness of the tissue, e.g. 1 mm, and the thickness of the auxiliary material. As an example, in one embodiment, the auxiliary material has a maximum formed stapled height of greater than 2.75 mm and 1 mm when stapled to tissue with a minimum thickness of 1 mm. It can be structured to compress up to a height of .75 mm. Therefore, the auxiliary material has a constant stiffness (k) and thickness (D) of the captured tissue and the auxiliary material such that a stress of 3 g/ ^mm2 can be applied to the captured tissue. In order to maintain the length displacement D, the compressibility may be varied. Note that those skilled in the art will appreciate that the foregoing equations may be modified to account for variations in temperature, for example, when attempting to bring the adjunct from room temperature to body temperature after implantation.

Additionally, the adjuvant can be further developed to provide substantially continuous stress to the captured tissue (eg, 3 g/mm ² ) over a predetermined period of time (eg, 3 days). To achieve this point, the rate of degradation of the material of the adjunct and the rate of tissue ingrowth within the adjunct need to be considered when designing the adjunct. In doing so, the adjunct can be designed such that the stiffness of the adjunct and/or the sum of the captured tissue and adjunct thickness varies in a manner that can result in an applied stress of less than 3 g/ ^mm2 . You can prevent it from happening.

The supplemental material is stapled to tissue under various stapling conditions (eg, tissue thickness, formed staple height, intratissue pressure). Depending on the stapling condition, an effective amount of stress can be determined that is required to allow the supplement to be applied to the tissue to prevent tearing or leaking of the tissue. For example, in one embodiment, the effective amount of stress is at least about 3 g/ ^mm2 . In order for the supplement to impart an effective amount of stress to the tissue, the supplement can be designed to effectively compensate for various stapling conditions. Accordingly, the geometry of the supplement can be adjusted to exhibit different compression heights when stapled to tissue. Because there is a finite range of intratissue pressures, tissue thicknesses, and formed staple heights, staples can be stapled for a given amount of time (e.g., at least 3 days) over a range of stapling conditions. An appropriate geometry of the adjunct can be determined that may be effective in applying the desired substantially continuous stress to the tissue (eg, 3 g/mm ² ) when applying the desired stress to the tissue (eg, 3 g/mm 2 ). That is, as described in more detail below, the present adjunct is formed of a compressible material such that when stapled to tissue the adjunct can compress to various heights in a given plane. , which is geometrically constructed. Furthermore, this variable response by the adjunct material also causes the adjunct material to react with tissue when exposed to fluctuations in intratissue pressure (e.g., sudden increases in blood pressure) that can occur when the adjunct material is stapled to tissue. It may be possible to maintain a continuous desired stress application to the tissue.

Auxiliary materials can be manufactured by additive manufacturing, also known as three-dimensional printing or 3D printing. 3D printing is a high-speed additive manufacturing technology that can deposit various types of materials in a printer-like manner. That is, 3D printing is accomplished by laying down successive layers of material to form a shape. To print, the printer reads the model design from the digital file and lays down successive layers of material to build a series of cross-sections. These layers are joined or automatically melted to create the final shape as determined by the model. This technique allows various shapes or geometric features to be created with control and precision. As a non-limiting example of a suitable 3D printing process, also known as additive manufacturing, as classified by ASTM Committee 42, a Vat liquid photopolymer is selectively cured by light-activated polymerization. VAT photopolymerization (e.g. stereolithography); material jetting, in which droplets of build material are selectively deposited; binder jetting, in which a liquid binder is selectively deposited to bind powdered materials; thermal energy Powder bed diffusion (e.g., selective laser sintering) in which areas of the powder bed are selectively melted; concentrated thermal energy is used to melt materials by melting them as they are being deposited Direct energy deposition, where concentrated thermal energy is used to melt the materials by melting them as they are being deposited; Direct energy deposition, where the materials are selectively distributed through a nozzle or orifice extrusion of materials (e.g., fused deposition modeling); and sheet stacks in which sheets of material are joined to form objects.

For example, in some embodiments, the method can include scanning the beam to melt the plurality of powder layers to form a compressible bioabsorbable adjuvant. It has an elongate structure with a tissue contacting surface, a cartridge contacting surface opposite the tissue contacting surface, and a plurality of struts forming a geometric repeating unit extending between the tissue contacting surface and the cartridge contacting surface. It has a main body. In one embodiment, the method may also include coating the adjuvant with one or more antimicrobial agents.

Auxiliary materials can be formed from one or more matrices. In certain embodiments, one or more matrices can be in the form of a particulate matrix. In such situations, each particulate matrix may be formed from molten particles (eg, molten bioabsorbable polymer particles).

Generally, each matrix may be formed from at least one molten polymer. The at least one molten polymer can be selected to impart desired compressibility to the auxiliary material. For example, in one embodiment, the matrix includes a molten polymer, but in other embodiments, the matrix can include two or more different molten polymers. Alternatively, or additionally, if the supplementary material includes two or more matrices, each matrix may be formed from the same molten polymer or from different molten polymers. For example, a first matrix can include a first molten polymer and a second matrix can include a second molten polymer that is more or less flexible than the first molten polymer. In this way, the molten polymer can impart varying degrees of flexibility to the auxiliary material. Furthermore, the molten polymer can have different rates of decomposition such that the compressibility of the auxiliary material can be adjusted to change over time as a function of the rate of decomposition.

Although various types of materials can be used, in some embodiments the at least one molten polymer is a bioabsorbable polymer. Non-limiting examples of suitable bioabsorbable polymers include thermoplastic absorbable polyurethanes, UV-curable bioabsorbable polyurethanes, poly(lactic acid) (PLA), polycaprolactone (PCL), polyglycolide, polydioxanone (PDS). , poly(lactic-co-glycolic acid) (PLGA), polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, any copolymer thereof, or any combination thereof. Further non-limiting examples of suitable bioabsorbable polymers include 3-terminal hydroxyl terminated PCL or poly(DL-lactide) with acrylate or methacrylate end group modification, PLA-PEG or poly(trimethylene carbonate), PEG dimethyl or trimethyl. acrylate or methacrylate, polypropylene fumarate, L-lactide/caprolactone copolymer, PLGA polymer infiltrated with collagen, PCL-tricalcium phosphate (TCP), PLGA-TCP copolymer coated with hyaluronic acid, PCL-PLGA-TCP, PLGA-PCL copolymers, PDS polymers and copolymers, PCL polymers and hyaluronic acid, collagen-coated PCL and beta tricalcium phosphate, polyvinyl alcohol, calcium phosphate/poly(hydroxybutyrate-co-valerate), and calcium hydroxyapatite/poly-L - Contains macromers with lactide.

For example, in some embodiments, the adjunct material can be formed from various components, each formed of a matrix that includes at least one molten bioabsorbable polymer. In some embodiments, the supplementary material comprises a first component formed from a first matrix of at least one molten bioabsorbable polymer (e.g., polyglactin or polydioxanone) and a first component formed from a first matrix of at least one molten bioabsorbable polymer (e.g., polyglactin or polydioxanone); and a second component formed from a second matrix comprising a bioabsorbable polymer (eg, a polycaprolactone copolymer). The at least one molten bioabsorbable polymer of each matrix can include at least two different bioabsorbable polymers. In one embodiment, the first component can have a first color and the second component can have a second color that is different than the first color.

In some embodiments, the adjunct material can be a drug eluting material. For example, one or more components of the adjuvant may include a composition with a pharmaceutically active agent. The composition may release a therapeutically effective amount of the pharmaceutically active agent. In various embodiments, the pharmaceutically active agent may be released upon desorption/adsorption of the adjuvant. In various embodiments, the pharmaceutically active agent can be released into a fluid (eg, blood) passing over or through the adjuvant. Non-limiting examples of pharmaceutically active agents include hemostatic agents and agents such as fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory agents (such as diclofenac, aspirin, naproxen, sulindac, and hydrocortisone); antibiotics. agents, and antibacterial agents or agents (eg, triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, and chloramphenicol); and anticancer agents (eg, cisplatin, mitomycin, and adriamycin).

Supplementary materials can also include external coatings. The coating may be part of the 3D printing process or may be applied secondarily to the auxiliary material. For example, in some embodiments, the adjunct material may be partially or fully coated with an antimicrobial agent. Non-limiting examples of suitable antimicrobial agents include triclosan, chlorhexidine, silver preparations (such as nanocrystalline silver), lauric acid alginate ethyl ester (LAE), octenidine, polyhexamethylene biguanide (PHMB), taurolidine; lactic acid, citric acid. Contains acids, acetic acid, and their salts.

The adjunct material or any component thereof may be at least partially coated with a bioabsorbable polymer different from the at least one molten bioabsorbable polymer of the adjunct material. In this way, one or more properties of the supplementary material can be varied from the properties of its base material (eg, a molten bioabsorbable polymer). For example, the adjunct material can be coated with a bioabsorbable polymer that improves structural stability. Alternatively, or additionally, the adjunct material can be coated with a bioabsorbable polymer that has a slower degradation rate compared to the degradation rate of the at least one molten bioabsorbable polymer of the adjunct material. . In this way, the lifetime of the supplemental material can be increased without sacrificing the desired compressibility of the supplemental material, which is provided at least in part by the at least one molten bioabsorbable polymer.

Auxiliary materials can have a variety of configurations. Generally, the supplemental material may include a tissue contacting surface, an opposing body contacting surface (eg, a cartridge contacting layer), and an elongate body disposed therebetween (a structural layer). The tissue contacting surface and the cartridge contacting surface can have a different structure than the structural layer, in certain embodiments, to form a tissue contacting layer and a cartridge contacting layer. In some embodiments, the elongate body is formed from a plurality of struts. The struts can have a variety of configurations, and in certain exemplary embodiments, the struts can form interconnected geometric repeating units.

In some embodiments, the tissue contacting layer engages tissue located between the adjunct and the anvil to substantially prevent sliding movement of the tissue relative to the adjunct during stapling. The surface may include a plurality of surface features configured to. These surface features may also be configured to minimize sliding movement of the adjunct relative to tissue when the adjunct is stapled. These surface features can have a variety of configurations. For example, the surface feature can extend a distance of about 0.007 inch to 0.015 inch from the tissue contacting surface.

Further, in some embodiments, these surface features extend in a direction that is substantially transverse to the longitudinal axis (L) of the body, such as cartridge body 606 of FIG. I can do it. In another embodiment, at least a portion of the surface feature can include a plurality of ridges and a plurality of grooves defined between the ridges. In yet another embodiment, the surface features include at least a plurality of surface features extending in a direction that is upwardly from the body, inwardly toward the central groove, and distally toward the second end of the body. It can include a tread. Further details of anti-slip features in the form of ridges and grooves or treads can be found in US Patent Application Publication No. 2015/0034696, which is incorporated herein by reference in its entirety.

In some embodiments, the plurality of surface features can be configured to pull tissue in opposite directions, thus providing opposing resistance ( lateral bias). For example, the tissue contacting layer may include a first plurality of surface features that can extend in a first direction and a second plurality that can extend in a second direction that is different than the first direction. surface features. As a result, the first and second plurality of surface features can create tension between the surface features that actively prevents tissue movement in at least one direction. In one embodiment, the first plurality of surface features can extend in a first direction and the second plurality of surface features can extend in an opposite second direction. . In such situations, these surface features may be configured to simultaneously pull tissue in opposite directions.

Opposing resistance can also be created by surface warping. For example, the tissue contacting layer, or alternatively, for example the entire supplementary material, may be designed to have a resilient convex shape, and the surface features may extend radially outwardly from the tissue contacting layer. During use, as the anvil of the surgical stapler moves from an open position to a closed position, the tissue contacting layer deforms (e.g., compresses to a substantially straight configuration) and the surface features, as described above, It can then extend substantially perpendicularly outward from the tissue contacting layer and engage tissue. When the anvil returns to its open position, the tissue contacting layer returns to its convex shape, creating surface tension between the surface features that simultaneously pulls the engaged tissue in opposite directions.

On the other hand, in certain embodiments it may be desirable for the tissue to slide into a predetermined plane during stapling. Thus, in some embodiments, the tissue contacting layer facilitates sliding (e.g., sliding movement) of the tissue relative to the supplement in a first predetermined direction and in a second direction different from the first direction. may include surface features that may be designed to restrict movement to. Alternatively, or additionally, the tissue contacting layer can be coated with a material to increase lubricity (eg, sodium stearate or alginate laurate ethyl ester).

As mentioned above, the auxiliary material is placed on top of the body, such as cartridge body 606 (FIG. 6). The fixation of the auxiliary material to the main body can be reinforced before and during stapling. For example, a body contact layer (eg, a cartridge contact layer) can include a surface feature configured to engage the body to substantially prevent sliding of the supplementary material relative to the body. These surface features can have a variety of configurations. For example, in embodiments where the body includes attachment features, the body contact layer can have surface features that are in the form of recesses configured to receive those attachment features. Other attachment features are described in more detail below.

As mentioned above, the elongate body may be formed from a plurality of struts. These struts can form geometric repeating units interconnected with each other. As discussed in more detail below, the array of multiple struts and/or repeating units can be structurally configured to impart varying compressibility to the auxiliary material, such that the auxiliary material has variable compressibility. It can have a stiffness profile. For example, the auxiliary material can have a first stiffness when compressed by a first amount and a second stiffness when compressed by a second amount. The second amount may be greater than the first amount, or vice versa. Therefore, the stiffness of the auxiliary material may vary as a function of compression. As described in more detail below, the greater the amount of compression, the greater the stiffness of the auxiliary material. Thus, a single supplementary material can be used under various stapling conditions (e.g., tissue thickness, formed staple height, intratissue pressure) for at least a given period of time (e.g., 3 days). , can be adjusted to provide various responses to ensure that the lowest amount of stress is applied to the tissue (eg, 3 g/mm ² ). Furthermore, this varying response by the adjunct material also makes it desirable to have a minimal amount of applied stress (e.g., 3 g/mm ² ) when the adjunct material is stapled to tissue and exposed to fluctuations in intratissue pressure. It can be maintained.

These struts can be designed in various configurations. For example, these struts can create a lattice-like or truss-like structure as shown in FIGS. 8A-9C and 11A-15. A spiral-shaped structure as shown in FIG. 16 or a column as shown in FIGS. 17-19.

The geometry of the strut itself, as well as the geometry of the repeating unit formed therefrom, can control the movement of the auxiliary material in various planes. For example, the interconnectivity of the struts may have a geometry that may be configured to allow the auxiliary material to be compressed in a first predetermined direction and restrict movement in a second direction that is different from the first direction. can create scientific units. In some embodiments, the second direction may be transverse to the first predetermined direction, as described in more detail below. Alternatively or additionally, the geometric unit may be configured to limit rotational movement of the auxiliary material about an axis perpendicular to the first predetermined direction.

In some embodiments, the struts may have a substantially uniform cross-section, while in other embodiments the struts may have varying cross-sections. Additionally, the strut material can also serve to define the movement of the auxiliary material in a given plane.

FIGS. 8A-9C and 11A-19 illustrate various embodiments including a tissue contacting surface, a cartridge contacting surface opposite the tissue contacting surface, and an elongated body formed with a strut disposed therebetween. An exemplary supplementary material is shown below. Each exemplary auxiliary material is shown in partial form (e.g., not the entire length), and thus one of ordinary skill in the art will appreciate that the auxiliary material is longer in length as specified in each embodiment. It is understood that it may be long, ie along its longitudinal axis L. The length may vary based on the length of the staple cartridge. Further, each exemplary auxiliary material is disposed on the top of the cartridge body such that the longitudinal axis L of each auxiliary material is aligned with and extends along the longitudinal axis (L _C ) of the cartridge body. configured to be used. Each of these supplements can be formed from one or more matrices that include at least one molten bioabsorbable polymer. These supplements are structured to compress when subjected to a compressive force (eg, stress or load). As discussed in more detail below, these supplements are also designed to promote both tissue and cell ingrowth.

8A-8B illustrate an exemplary embodiment of an adjunct 800 having a tissue contacting surface 802, an opposing cartridge contacting surface 804, and an elongate body 806. Although it is contemplated that tissue contacting surface 802, cartridge contacting surface 804, and elongate body 806 can each be formed from different materials, in this embodiment shown they are formed from the same molten bioabsorbable polymer. has been done. That is, supplementary material 800 is formed of the same molten bioabsorbable polymer matrix.

As shown in FIG. 8A, elongated body 806 includes a planar array 808 of repeating units 810 interconnected with each other at joints or nodes 814. Repeating unit 810 is formed from a plurality of interconnected struts 816, each having a first portion 818 and a second portion 820, respectively. Portions of struts 816 may also include third portions 821 extending from respective second portions and interconnecting each other to form joints or nodes 814 . As discussed in more detail below, the support member 800 can exhibit varying stiffness and movement based on the amount and direction of stress applied during use. Thus, the adjunct has a variable stiffness profile such that when the adjunct is stapled to tissue, the adjunct exceeds a minimum stress threshold for a predetermined period of time (e.g., a stress of 3 g/ ^mm2 in 3 days). May be configured to apply stress.

Further, as shown, the elongated body 806 includes a first planar array 808 of struts, an additional planar array 808 _N disposed parallel to each other, and a planar array 808 (e.g., extending in the x direction). including. In each array 808, _808N , the struts 816 are substantially planar and extend coplanar with one another in their respective planes. Furthermore, while each array 808, 808 _N can have a variety of configurations, in the embodiment shown, each array 808, 808 _N is substantially symmetrical about an intermediate plane. That is, each array 808, _808N has two substantially identical columns 824a, 824b of repeating units 810.

Although the struts 816 can have a variety of configurations, in this illustrated embodiment, each strut 816 has a generally elongated planar configuration such that the first portion 818 of each strut 816 overlaps the second portion 820. It has a width narrower than the width part. As a result, struts 816 are wide in the middle, preferably along most of their length, and narrower at the ends. Alternatively, first portion 818 can have a cross-section that is equal to or greater than the cross-section of second portion 820. Further, as shown in FIG. 8B, the second portion 820 of each strut 816 can have a substantially rectangular cross-sectional shape. Note that other cross-sectional shapes of struts and portions thereof are also contemplated herein. The cross-sectional shape of the struts can be used to limit movement of the auxiliary material in a particular direction.

In FIG. 8A, struts 816 are interconnected to each other at the ends of their first portions 818 to form a joint or node 822. In FIG. In the embodiment shown, struts 816 and joints or nodes 822 may be formed of the same material. Accordingly, to enhance the compression of the auxiliary material 800 under stress, the cross-section of the first portion 818, also referred to as the neck-down region, can be curved as described in more detail below. Additionally, the third portion 821 of each strut 816 is structured similarly to the first portion 818 of strut 816, and thus this third portion 821, also referred to as the neck-down area, also It can be bent, like the details.

The material of the joints or nodes 822 to the struts 816 (e.g., more or less flexible) partially controls the amount and/or direction that the support material 800 moves under stress during use. be able to. Similarly, the material of joint or node 814 can partially control the amount and/or direction that supplementary material 800 moves under stress during use. Joints or nodes 814, 822 may be of any suitable shape. For example, in certain embodiments, joints or nodes 814, 822 may be in the form of ball-shaped features. In other embodiments, the joints or nodes 814, 822 may take the form of other geometric shapes.

The struts 816 may be interconnected to each other at various angles. For example, in the embodiment shown, struts 816 intersect adjacent struts 816 at approximately 90 degree angles. In other embodiments, struts 816 can intersect at angles ranging from approximately 40 degrees to 130 degrees. In another embodiment, struts 816 can intersect at angles ranging from about 10 degrees to 90 degrees. The angles at which struts 816 connect to each other can control, at least in part, the manner and amount that supplementary material 800 responds under stress. That is, the movement and stiffness of the auxiliary member 800 may be, at least in part, a function of these angles.

As discussed above, the first portion 818 (and third portion 821, if present) of each strut 816 can function as a flexible region (e.g., a deflection point) for the auxiliary material. . A first portion 818 of each strut provides each repeating unit 812 with one or more flex zones, as shown in FIGS. 9A-9C. That is, these neck-down regions allow struts 816 to flex around or adjacent joints or nodes 822 when supplementary material 800 is under stress, so that repeating unit 810 , can partially or completely collapse on themselves. Similarly, the neck-down region forming the third portion 821 allows the repeating unit to flex around or adjacent the joint or node 814 when the auxiliary material is under stress. Accordingly, the compressibility of supplementary material 800 may vary based on different amounts and directions of applied stress. This change in compressibility may be desirable, for example, when the supplemental material is stapled to tissue and is exposed to fluctuations in intratissue pressure.

9A-9C show the compressive behavior of one repeating unit 810 of the supplementary material 800 described herein under different stresses. Specifically, iterative unit 810 is shown in a pre-compressed (undeformed) state in FIG. 9A, in a first compressed state under a first stress (S ₁ ) in FIG. 9B, and in a second compressed state in FIG. 9C. Shown in a second compressive state (C) under stress (S ₂ ). Thus, the repeating unit 810, and therefore the supplementary material 800, has a variable stiffness profile under different stresses. Those skilled in the art will appreciate that the auxiliary material may vary in deployment height over its use, and that the deployed height is at least in part a function of the particular stress applied to the auxiliary material throughout its use. Understand that.

As shown in FIGS. 9A-9B, when the repeating unit 810 of FIG. 8A, and thus the auxiliary material 800, is under a first stress S ₁ , the first portion 818 of each strut 816 (e.g., in the neck-down region ) can be bent about a joint or node 822. This allows the repeating unit 810 to be compressed from a pre-compressed state (FIG. 9A) to a first compressed state (FIG. 9B), such that the auxiliary material 800 is moved from the pre-compressed height to the first compressed state (FIG. 9B). is compressed to the height of its deployment. Further, depending on the amount of stress applied to the supplement, the second portions 820 of adjacent struts 816 may contact each other. This is shown in Figure 9B. Therefore, in such a situation, the first portion 818 of each strut 816 has reached its maximum deflection point creating a higher stiffness resistance within the repeating unit 810. This is because as the auxiliary material 800 compresses, the stiffness of the repeating unit 810 and thus the auxiliary material 800 increases. FIG. 10 is an exemplary graphical representation of the relationship between auxiliary material compression and stiffness. Therefore, any further compression of the iterations 810 and therefore the supplementary material 800 requires additional applied stress.

In situations where a larger stress (eg, a second stress, S ₂ ) is applied to the repeating unit 810 of FIG. 8A, and thus the supplementary member 800, the increase in stiffness resistance can be overcome. To accomplish this, struts 816 may be configured such that when additional stress is applied, struts 816 can bend further about joints or nodes 822. As shown in FIG. 9C, this further flexing causes the struts 816 to expand further outward in the lateral (L) direction in the direction of the applied stress, thereby causing the second of the adjacent struts 816 Portions 820 can further contact each other. As a result, repeating unit 810 may be compressed to a second compressed state (FIG. 9C), thus compressing supplementary material 800 to a second deployment height.

In some embodiments, the adjunct may include additional components that can prevent migration of tissue stapled to the adjunct. For example, FIGS. 11A-11B illustrate an exemplary supplement 1100 that includes a plurality of surface features 1128 defined within tissue contacting layer 1102. As described in more detail below, surface features 1128 can prevent slidable movement of the adjunct relative to tissue stapled to the adjunct. In one embodiment, at least a portion of surface features 1128 can prevent lateral sliding of supplement 1100 relative to tissue. Alternatively or additionally, at least a portion of surface feature 1128 can prevent longitudinal sliding of supplement 1100 relative to tissue.

The exemplary supplementary material 1100 shown includes a tissue contacting layer 1102 and an opposing cartridge contacting layer 1104. Supplementary material 1100 also includes an elongated body 1106 having a plurality of struts 1116 extending between tissue contacting layer 1102 and cartridge contacting layer 1104. As shown, tissue contacting layer 1102 includes a plurality of surface features 1128a, 1128b defined therein. These surface features 1128 include a first series 1128a extending longitudinally (e.g., parallel to the longitudinal axis of the auxiliary material) and a first series 1128a extending laterally (e.g., transverse to the longitudinal axis of the auxiliary material). The second series 1128b has a grid pattern. Each surface feature 1128a, 1128b can have a triangular profile angled relative to each other, or at least two surfaces that together are adapted to penetrate and engage tissue. form the edges. Collectively, these edges can define the outermost surface of tissue contacting layer 1102. These surface features 1128a, 1128b can engage tissue when the tissue is compressed into the tissue contacting layer 1102 as a result of the supplementary material being stapled to the tissue. The edge orientation of the first series 1128a can prevent lateral sliding of the aid against the tissue, and the edge orientation of the second series 1128b can prevent longitudinal sliding of the aid 1100 against the tissue. Sliding can be prevented. Additionally, tissue contacting layer 1102 includes a plurality of openings 1144 formed between these surface features 1128. In this manner, the plurality of openings 1144 can receive tissue when the supplementary material is stapled to the tissue, allowing the surface features 1128 to engage the tissue.

Although the plurality of struts 1116 can be interconnected to form various configurations, in this embodiment shown, the plurality of struts 1116 form a repeating X-shaped pattern. Specifically, the plurality of struts 1116 form repeating cubic units. Each cubic unit includes a top surface 1130 and an opposite bottom surface 1132. In this embodiment shown, the top and bottom surfaces 1130, 1132 are substantially identical. The quvit unit also includes four sides 1134 extending between and connecting the top and bottom surfaces 1130, 1132. In this embodiment shown, the sides 1134 are substantially identical. For clarity, not all surfaces of each illustrated cubit unit are identified in FIGS. 11A-11B. The sides 1134 can have various shapes, for example, as shown, with each side 1134 having an X-shape extending from the top surface 1130 to the bottom surface 1132. Thus, a first end of each strut 1116, 1116a terminates in tissue contact layer 1102, and a second end of each strut 1116, 1116a terminates in cartridge contact layer 1104. Each X may be formed by two elongated generally planar struts that intersect in the middle. Additionally, each repeating cube unit may also include an interior strut extending between two opposite sides 1134 of the cube unit to form an interior connecting feature 1138. As shown, the inner connecting feature 1138 can extend from the top 1134a of one side 1134 to the bottom 1134b of the opposite side 1134. As further shown, the inner connecting features 1138 can extend in alternating directions between adjacent cubic units. For example, as shown in FIG. 11B, the first inner connecting feature 1138 can have an upper end 1138a that extends from a top 1134a of one side 1134 to a lower end 1138b of a bottom 1134b of the opposite side 1134. Adjacent cubical units can have a second inner connecting feature 1138 having a lower end 1138c extending from the same bottom 1134b of the side 1134 to an upper end 1138d at the top 1134c of the opposite side 1134. The inner connecting feature 1138 can provide the auxiliary material 1100 with a geometric shape that can facilitate movement of the auxiliary material 1100 in a predetermined direction under applied stress. For example, in one embodiment, inner connecting feature 1138 can substantially prevent shearing of supplementary material 1100 under applied stress.

Although each strut, as well as interconnect feature 1138, can have a variety of configurations, in the embodiment shown, struts 1116, 1116a and interconnect feature 1138 each have a depth (D) greater than is also in the form of a beam or post with a large width (W), whereby each post/interconnection feature extends in and out of a plane extending in a given direction, i.e., along the width (W). flexion. Additionally, struts 1116, 1116a and interconnecting features 1138 can each include at least one aperture 1140 extending therethrough to facilitate bending in a predetermined direction. For clarity, not all openings 1140 extending through each post 1116 and interconnecting feature 1138 are identified in FIGS. 11A-11B. These openings 1140 can be of various shapes, for example, as shown, these openings 1140 are diamond shaped. It is also contemplated that the shape of the openings 1140 may vary from strut to strut. Openings 1140 may also be aligned across the supplement. For example, openings extending through opposing side walls that are longitudinally spaced along the length of the auxiliary members of adjacent cubic units can be longitudinally aligned, and likewise adjacent The openings extending through opposing side walls spaced laterally along the width of the auxiliary member of the cubic unit may be laterally aligned.

Alternatively or additionally, the auxiliary material may include a connecting member that connects at least a portion of the joints or nodes to each other, thereby increasing the stiffness of the auxiliary material. That is, the connecting member can be incorporated into the auxiliary member in a manner that prevents movement (eg, outward spreading) of the auxiliary member in the plane in which the connecting member extends.

For example, FIGS. 12A-12B illustrate an exemplary embodiment of an auxiliary member 1200 having a connecting member 1246. Specifically, supplementary member 1200 includes an elongated body 1206 formed from a plurality of struts 1216 interconnected at joints or nodes 1222. Elongated body 1206 has a tissue contacting surface 1202 and an opposing cartridge contacting surface 1204. As shown, at least a portion of these joints or nodes 1222 are interconnected with each other by coupling members 1246. In the embodiment shown, the coupling member 1230 extends in a first direction (e.g., the y direction shown in FIG. 12) and the strut 1216 extends in a second direction (e.g., the y direction shown in FIG. 12). Accordingly, the position of coupling member 1246 relative to post 1216 is configured to prevent movement of supplementary member 1200 in at least one direction (e.g., parallel to the direction in which coupling member 1246 extends). The resulting geometry can be provided.

In some embodiments, the joints or nodes may be formed of a different material than the material of the struts. For example, the joint or node material can be made more flexible than the strut material, thereby increasing the compressibility of the supplement. Additionally, more flexible joints or nodes may also allow the supplementary material to compress without substantially shearing. This is because the more flexible joints or nodes provide preferential bending zones for the auxiliary material, thereby reducing the stiffness of the auxiliary material. In one embodiment, the joints or nodes can be formed from polycaprolactone copolymer and the struts can be formed from polyglactin or polydioxanone.

13A-13B illustrate another exemplary embodiment of an auxiliary member 1300 that includes repeating units 1310 interconnected to each other at joints or nodes 1314. Each repeating unit 1310 is formed from a plurality of struts 1316, eg, four struts, interconnecting at joints or nodes 1322. Other than the differences described in detail below, auxiliary material 1300 may be similar to auxiliary material 800 (FIG. 8A) and therefore will not be described in detail herein. In this embodiment shown, the joints or nodes 1314, 1322 are formed of a different material than the material of the struts 1316. The material of the joints or nodes 1314, 1322 may be more flexible than the material of the struts 1316. As shown, each joint or node 1314, 1322 may be in the form of a rod 1348 extending across all arrays 1308, _1308N in a direction generally perpendicular to the plane in which the struts extend. (eg, the rod can extend in the x direction as shown in FIGS. 13A-13B). That is, when supplementary material 1300 is attached to a cartridge body, rod 1348 can extend transversely to the longitudinal axis of the cartridge body, such as cartridge body 606 in FIG.

In some embodiments, the ends of the first portions 1318 of the struts 1316 may also be directly connected to each other within joints or nodes 1322, as shown in FIGS. 13A-13B. Alternatively or additionally, the ends of the third portions 1321 of the struts 816 may also be directly connected to each other within joints or nodes 1314. This direct connection may help prevent the struts 1316 from being pulled out of the joints or nodes 1322 as the struts 1316 flex when the supplement 1300 is under stress. As a result of this direct connection, the bending of one strut can also affect the bending of another. Furthermore, compared to the joints or nodes 822 of FIG. can be more easily compressed compared to Therefore, under the same given stress, the supplement 1300 achieves a greater displacement (i.e., compression to a lower deployment height) compared to the supplement 800 of FIG. 8A.

Alternatively, the struts may not be connected to each other within joints or nodes, for example as shown in FIG. 14. For simplicity only, FIG. 14 shows a single repeating unit 1400. In this embodiment shown, struts 1416 do not directly connect to each other within joints or nodes 1422. As a result, bending of one strut can occur independently of bending of another strut. To prevent the strut 1416 from being pulled out of the joint or node 1422 as the strut 1416 bends around it, each strut 1416 has an end configured to maintain a connection to the joint or node 1422. It can have a section shape 1450. Furthermore, compared to the joint or node 1322 of FIGS. 13A-13B, this joint or node 1422 may be more flexible and therefore more conformable, and thus may be more flexible than the joint or node 1322 of FIGS. Auxiliary materials formed of can be more easily compressed under a given stress. That is, under the same given stress, the auxiliary member with this strut and joint or node configuration shown has a larger displacement (i.e., compression to lower heights) can be achieved.

In some embodiments, the auxiliary material can also include at least one stop element configured to limit the amount of compression of the auxiliary material. FIG. 15 shows an exemplary embodiment of an auxiliary member 1500 having at least one stop element 1552. Other than the differences described in detail below, auxiliary material 1500 may be similar to auxiliary material 1300 (FIGS. 13A-13B) and therefore will not be described in detail herein.

In FIG. 15, each strut 1516 can have a stop element 1552 extending from or positioned adjacent the surface of its second portion 1520. When the auxiliary material 1500 is compressed, the struts 1516 can flex about the joints or nodes 1514, 1522 until the stop elements 1552 contact each other. When these stop elements 1552 abut each other, any further bending of the strut 1516 is prevented. That is, these stop elements 1552 act as deflection stops that allow the supplementary material 1500 to compress to a first deployment height at a first stiffness under a given stress. Once the first compression height is reached, the stop element 1552 extends to the bottom and prevents further deflection of the strut 1516 and thus prevents further compression of the auxiliary material 1500. As the stop element 1552 extends to the bottom, more stress needs to be applied to cause further flexing of the struts 1516 around the joints or nodes 1514, 1522, and thus more compression of the auxiliary material 1500. .

Note that although various stop elements 1552 are shown in FIG. 15, it is contemplated herein that fewer or additional stop elements may be included throughout supplementary material 1500. Additionally, the shape, size, and location of stop element 1552 is not limited by this embodiment shown and may therefore be varied to control the desired amount of compression.

As mentioned above, the elongate body can include a plurality of struts that can have a variety of shapes. For example, FIG. 16 shows an exemplary supplement 1600 having an elongated body 1606 that includes a plurality of struts 1616 that are substantially in the shape of a helix. Each geometric repeating unit is thus in the form of a helix or coil. In this embodiment, elongated body 1606 is positioned between tissue contacting layer 1602 and cartridge contacting layer 1604. As shown, each layer 1602, 1604 is a generally planar solid layer with an opening 1626. At least a portion of these openings 1626 are aligned with openings 1615 defined by each post 1116. The thickness of each layer can vary. The struts 1616 are configured to have a predetermined compression height to limit the amount of compression of the auxiliary material. Furthermore, given their shape, these struts 1616 may be configured to function as springs. Thus, each strut 1616 can be imparted with a particular stiffness based on its shape as well as its spring constant. Therefore, the compressibility of the supplementary material 1600 may also depend on the particular stiffness of each strut 1616, which depends on both the material and shape of the strut 1616.

As shown in FIGS. 8A, 11A to 13B, and 15 to 16, each auxiliary member 800, 1100, 1200, 1300, 1500, 1600 has an opening 826, 1140, 1144, 1226, 1326, 1526, 1626. These openings can be configured to promote cell ingrowth within each supplement. The openings can define the void content of the supplement. In some embodiments, the void content may be about 15% to 95%, while in other embodiments the void content may be about 75% to 90%. As used herein, "opening" is used synonymously with "void". Additionally, the supplemental material can have a surface area to volume ratio of about 1:100 to 1:5. In some embodiments, the supplemental material can have a surface area to volume ratio of about 1:10.

Openings can also be located inside various components of the supplement. Each opening may have dimensions that extend at least partially through the component. In certain embodiments, the openings 826, 1140, 1444, 1226, 1326, 1526, 1615, 1626 are tissue contacting surfaces or layers, cartridge contacting surfaces or layers, and/or within the elongate body. In those embodiments shown, the openings extend completely through their respective components. Inside the elongate body, these openings may be defined by interconnected struts. Furthermore, these openings may also be interconnected across the supplementary material, thereby forming a substantially continuous network of openings or channels. Further, as shown in FIGS. 11A-11B, opening 1126 may also be present within inner connecting feature 1138.

The openings can have various sizes and/or shapes. For example, larger openings may allow tissue (and cells) to penetrate into the adjunct, while smaller openings may allow tissue (and cells) to penetrate within the adjunct to promote cell ingrowth. Cells can be captured. In this way, the variable size of the openings across the adjuvant can promote extracellular remodeling. That is, the variable size of the opening can facilitate revascularization and mobility of cells within the prosthesis when the prosthesis is implanted, thereby promoting tissue and cell ingrowth. You can encourage both. Furthermore, the variable size of the opening can also facilitate the extraction of by-products and cellular waste from the implanted adjuvant and therefore the implant site. In some embodiments, the opening is substantially circular in shape.

For example, in embodiments where the openings are located within the tissue contacting surface or layer and the elongated body, as in FIGS. A staple, such as staple 406 of No. 5, can have a diameter that is about 70% to 170% of the diameter of the staple leg. The openings in the tissue contacting surface and within the elongated body can have various sizes. For example, in some embodiments, the openings in the tissue contacting surface can each have a diameter in the range of about 100 μm to 1000 μm. In one embodiment, each opening in the tissue contacting surface may have a diameter of at least about 14 μm. Each opening in the elongated body can have a diameter in the range of about 200 μm to 610 μm, or about 400 μm to 1000 μm. As used herein, the "diameter" of an aperture is the maximum distance between the vertices of any pair of apertures.

Additionally, in some embodiments, the openings in the tissue contacting surface or layer allow one or more portions of tissue to penetrate or compress into the tissue contacting surface or layer (e.g., openings 1144, 1226, 1626). It may be configured to allow. This can substantially prevent slidable movement of the adjunct relative to the tissue once the adjunct is stapled to the tissue and the tissue is compressed within the opening, as described above. .

In other embodiments, the auxiliary material may be configured to enhance advancement of the staple legs through the auxiliary material. For example, the auxiliary material can have an opening that is aligned with the direction of advancement of the staple legs and partially extends through the auxiliary material. The opening can extend partially or completely through the supplement. Thus, as the staple legs advance through the auxiliary material, the openings can act as guides to minimize damage to the staples as well as the auxiliary material as the staples pass.

In some embodiments, the supplementary member can include a plurality of struts in the form of columns, as shown in FIGS. 17-19. For example, in FIG. 17, the columns are substantially vertical and may be of varying heights. Furthermore, in other embodiments, the first set of posts may be substantially vertical and the second set of posts may be curved, as shown in FIG. The struts can be made of the same or different materials. In some embodiments, the supplemental material can include a first plurality of struts formed of a first material and a second plurality of struts formed of a second material.

In FIG. 17, supplementary member 1700 includes a plurality of struts 1716 in the form of substantially vertical columns. Specifically, these struts 1716 extend from the cartridge contact layer 1704 toward the optionally opposing tissue contact layer 1702. The plurality of struts 1716 include a first plurality of vertical struts 1716a having a first height (Y) and a second plurality of vertical struts 1716a having a second height (Y ₁ ) less than the first height (Y). A plurality of struts 1716b and a third plurality of struts 1716c having a third height ( _Y3 ) less than the second height ( _Y2 ) are included. For simplicity, only a portion of the plurality of struts 1716 are shown in FIG. 17. Although not shown, those skilled in the art will appreciate that the tissue and/or cartridge contact layers 1702, 1704 may include openings as discussed herein.

The different heights of these plurality of struts 1716 can provide different compressibility of the supplement. 18A-18C show the compressive behavior of supplementary material 1700 under different stresses. Specifically, the auxiliary material 1700 is at a pre-compressed height in FIG. 18A, at a first compression height (H ₁ ) under a first stress (S 1 ) in FIG. 18B, and at a first compression height (H ₁ ) under a first stress (S 1 ) in FIG. 18C. The height of the second compression (H ₂ ) under the second stress (S ₂ ) is shown. As shown, the first compression height (H ₁ ) is higher than the second compression height (H ₂ ), so the first stress (S 1 ) is greater than the second stress (S ₁ ). S ₂ ). It is recognized that the auxiliary material may vary in the height of compression over its use, and that the height of compression is, at least in part, a function of the particular stress applied to the auxiliary material throughout its use. Businesses understand.

As shown in FIGS. 18A-18C, as the compression of the auxiliary material 1700 increases, the amount of stress required to achieve such compression increases. This is because as the auxiliary material 1700 compresses, additional struts are engaged, thereby increasing the stiffness resistance of the auxiliary material 1700. For example, at a first stress S ₁ applied to the supplement 1700, the first and second plurality of struts 1716a, 1716b are engaged, as shown in FIG. 18B. By comparison, when the auxiliary member 1700 is under the second stress _S2 , the first, second, and third plurality of struts 1716a, 1716b, 1716c are engaged, thereby providing a higher stiffness resistance. produce.

FIG. 19 shows another exemplary embodiment of an auxiliary member 1900 having a plurality of struts 1916 in the form of substantially vertical columns 1916a or curved columns 1916b. Substantially vertical columns 1916a may be configured to support the initial stress applied to the auxiliary material 1900 and then deflect or buckle as the auxiliary material compresses (e.g., at deflection point D in FIG. 20). I can do it. The curved post 1916b can be configured to provide approximately constant stiffness (ie, essentially the offset of all curves shown in FIG. 20 from the zero axis). This mechanical behavior of the struts 1916, and thus of the auxiliary members 1900, is represented graphically in FIG. 20.

In other embodiments, the supplementary material may include additional features. The following figures illustrate features that may be included in any of the supplementary materials disclosed herein; therefore, the specific configuration of the supplementary material, ie, the configuration of the repeating unit, is not shown. FIG. 21A depicts one embodiment of an auxiliary member 2100 having a channel 2108 formed therein that is configured to receive a cutting element, such as a knife.

As shown in FIG. 21A, supplementary material 2100 includes a first portion 2104 and a second portion 2106, each having an outer edge and an inner edge. Inner edges 2104a, 2106a define a channel 2108 extending between the first and second portions and along the longitudinal axis (L) of supplementary material 2100. Channel 2108 is configured to receive a cutting member, such as a knife. As shown in FIG. 121B, channel 21 does not extend completely through the height of supplementary material 2100. In particular, channel 2108 does not extend through cartridge contact surface 2110. In this manner, supplementary material 2100 is configured with sufficient structural integrity to be effectively manipulated and attached to a cartridge body, such as cartridge body 2214 of FIG. 21B. In use, when the cutting member is first fired and moves along the auxiliary material, the cutting member cuts the channel, thereby separating the first and second portions, thus separating the auxiliary material 2100 into two separate Separate into parts.

Further, as shown in FIG. 21A, the supplement 2100 includes a flange 2112 configured to mate with the cartridge body 2214 of FIG. 21B, as further described below. Although FIG. 21A shows the supplement 2100 having a flange 2112 on one side of the supplement 2100, an additional flange 2112 may be present on the opposite side of the supplement 2100. Those skilled in the art will appreciate that the number and placement of flanges 2112 is not limited to that shown in FIG. 21A. Flange 2112 can be made of a variety of materials, but in some implementations, flange 2112 can be an extension of cartridge contact surface 2110, as shown in FIG. 21A. Those skilled in the art will appreciate that the flange can be formed in-line with the auxiliary material (e.g., as part of a 3D printing process) or alternatively formed off-line and then applied secondarily to the auxiliary material. do.

FIG. 21B shows an embodiment of a staple cartridge assembly 2200. Other than the differences described in detail below, staple cartridge assembly 2200 may be similar to staple cartridge assembly 600 (FIG. 6) and therefore will not be described in detail herein. Furthermore, for the sake of brevity, certain components of staple cartridge assembly 2200 are not shown in FIG. 21B.

Staple cartridge assembly 2200 includes supplementary material 2100 of FIG. 21A attached to cartridge body 2214. Auxiliary material 2100 may be attached to cartridge body 2214 using any suitable method, as described in more detail below. In this embodiment, the cartridge body 2214 includes a recessed channel 2216 that is configured to receive the auxiliary material flange 2112 such that the flange 2112 can engage a surface of the cartridge body 2214. In this manner, the auxiliary material 2100 may be more securely attached to the cartridge body, thereby preventing undesirable movement of the auxiliary material 2100 during use.

In another embodiment, as shown in FIG. 22, the auxiliary material 3000 can have a channel 3008 with one or more openings 3010 extending therethrough (e.g., perforated); at least one bridging member 3012 is created by. Accordingly, first and second portions 3014, 3016 of supplementary material 3000 are selectively connected by at least one bridging member 3012. In use, when the cutting member is first fired and travels along the auxiliary material 3000, the cutting member cuts at least one bridging member 3012, thereby separating the first and second portions 3014, 3016. and thus separates the auxiliary material 3000 into two separate parts.

In some embodiments, a cartridge body, such as cartridge body 2214 of FIG. 21B, and an auxiliary material, such as auxiliary material 3000 of FIG. Complementary reinforcing features may be included that may be configured to prevent tearing outside the channel. For example, the reinforcing feature on the cartridge body can be a cylindrical recessed opening disposed proximate a slot in the cartridge body, and the reinforcing feature on the supplementary material can be a cylindrical recessed opening disposed proximate a slot in the cartridge body, and the reinforcing feature on the supplementary material can be a It may be a cylindrical projection disposed within the first and second portions of the supplementary material in close proximity. In this way, when the auxiliary material is placed on top of the cartridge body, these cylindrical projections of the auxiliary material extend into these recessed openings of the cartridge body. It is also contemplated that these protrusions and recessed openings can take the form of a variety of other shapes.

The scaffold can be applied to the cartridge body to form a staple cartridge assembly using any suitable method. For example, in some embodiments, the method may include attaching a compressible bioabsorbable adjuvant to a cartridge body of a surgical stapler. In one embodiment, as described above, attaching the auxiliary material to the cartridge body includes attaching the cartridge contacting surface of the auxiliary material to the surface of the cartridge body for inserting the flange of the auxiliary material into the recessed channel of the cartridge body. It may include locating against. In another embodiment, the method may also include coating a surface of the cartridge body with an adhesive prior to attaching the supplementary material to the cartridge body.

The devices disclosed herein can be designed to be discarded after a single use, or can be designed to be used multiple times. However, in any case the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of disassembling the device, followed by cleaning or replacing certain parts, and subsequent reassembly. In particular, the device can be disassembled and any number of specific parts or portions of the device can be selectively replaced or removed in any combination. After cleaning and/or replacing specific parts, the device can be reassembled for later use either at a reconditioning facility or by the surgical team immediately prior to the surgical procedure. Those skilled in the art will appreciate that reconditioning the device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. The use of such techniques, and the resulting reconditioned devices, are all within the scope of this application.

Those skilled in the art will recognize further features and advantages of the invention based on the embodiments described above. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the claims below. All publications and references cited herein are expressly incorporated by reference in their entirety. Any patent, publication, or information that is incorporated by reference in whole or in part into this specification does not indicate that the incorporated material is inconsistent with existing definitions, descriptions, or other disclosed material contained in this document. are incorporated herein only to the extent that they do not. Accordingly, the disclosure expressly set forth herein shall supersede any conflicting documents incorporated herein by reference.

[Mode of implementation]
(1) A three-dimensional bioabsorbable adjuvant for use with a stapling assembly, comprising:
a plurality of elastic struts formed of a first matrix comprising at least one molten bioabsorbable polymer, the plurality of elastic struts forming a geometrically repeating unit; , configured to deform when compressed, the auxiliary material being releasably retained on the stapling body to allow a plurality of staples disposed within the stapling body to pass through the auxiliary material. a three-dimensional bioabsorbable adjunct comprising a plurality of elastic struts configured to allow the adjunct to be attached to tissue by the plurality of staples.
2. The three-dimensional bioabsorbable supplement of embodiment 1, wherein the plurality of elastic struts are interconnected at nodes to form a truss-like structure configured to flex when compressed.
(3) the interconnectivity of the plurality of elastic struts and nodes allows the auxiliary material to be compressed in a first predetermined direction and in a second direction different from the first predetermined direction; Embodiment 3. The three-dimensional bioabsorbable adjuvant of embodiment 2, forming a geometric shape configured to restrict movement of the material.
(4) the node is formed from a second matrix comprising at least one molten bioabsorbable polymer different from the at least one molten bioabsorbable polymer of the first matrix; The three-dimensional bioabsorbable auxiliary material according to aspect 2.
(5) The three-dimensional bioabsorbable auxiliary material according to embodiment 1, wherein the plurality of struts have a substantially spiral shape.

(6) The three-dimensional bioabsorbable auxiliary material according to embodiment 1, wherein voids of various sizes are present in the auxiliary material.
(7) The at least one molten bioabsorbable polymer of the first matrix is a thermoplastic bioabsorbable polyurethane, a UV-curable bioabsorbable polyurethane, poly(lactic acid), polycaprolactone, polyglycolide, polydioxanone, The three-dimensional bioabsorbent according to embodiment 1 is selected from the group consisting of poly(lactic-co-glycolic acid), polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, copolymers thereof, and combinations thereof. Sexual aids.
(8) the plurality of struts define a first portion, a second portion opposite the auxiliary member, and a channel therebetween configured to receive a cutting element; 2. The three-dimensional bioabsorbable adjuvant of embodiment 1, wherein the first and second portions are selectively connected by at least one bridging member extending across the channel.
9. The three-dimensional bioabsorbable adjunct of embodiment 1, wherein the plurality of struts allow tissue contacting surfaces and body contacting surfaces of the adjunct to be compressed toward each other.
10. The three-dimensional bioabsorbable supplement of embodiment 1, further comprising at least one stop element configured to limit the amount of compression of the supplement.

(11) The adjunct is configured to apply ^a stress of at least about 3 g/mm to the tissue stapled to the adjunct for at least 3 days when the adjunct is in a tissue deployment state. The three-dimensional bioabsorbable auxiliary material according to embodiment 1.
(12) A three-dimensional bioabsorbable adjuvant for use with a stapling assembly, comprising:
a plurality of elastic struts connected at joints to form a lattice structure, the lattice structure being formed of at least one matrix comprising at least one molten bioabsorbable polymer; the interconnectivity of the portions is configured to allow the supplementary material to compress, the lattice structure including a tissue contacting surface and an assembly contacting surface opposite the tissue contacting surface; The structure is configured to allow a plurality of staples disposed within the stapling assembly to pass through the lattice structure such that the supplementary material is attached to tissue by the plurality of staples. A three-dimensional bioabsorbable supplement comprising a plurality of elastic struts.
(13) the plurality of elastic struts are formed from a first matrix that includes at least one molten bioabsorbable polymer; 13. The three-dimensional bioabsorbable adjuvant of embodiment 12, wherein the second matrix comprises at least one molten bioabsorbable polymer that is different from the bioabsorbable polymer.
14. The three-dimensional bioabsorbable adjuvant of claim 12, wherein voids are present in the lattice structure, the voids forming a substantially continuous network of openings throughout the adjunct.
(15) The lattice structure has a first end, a second end, and a longitudinal axis extending therebetween, the lattice structure extending at least partially through the lattice structure. 13. The three-dimensional bioabsorbable adjuvant of embodiment 12, further comprising an extending void.

(16) the plurality of struts define a first side, an opposite second side of the lattice structure, and a channel therebetween configured to receive a cutting element; 13. The three-dimensional bioabsorbable supplement of embodiment 12, wherein the first and second sides are selectively connected by a plurality of bridging members extending across the channel.
17. The three-dimensional bioabsorbable supplement of embodiment 12, further comprising at least one stop element configured to limit the amount of compression of the supplement.
(18) The ^adjunct is configured to apply a stress of at least about 3 g/mm to the tissue stapled to the adjunct for at least 3 days when the adjunct is in a tissue deployment state. 13. The three-dimensional bioabsorbable adjuvant according to embodiment 12.

Claims (12)

A three-dimensional bioabsorbable adjuvant for use with a stapling assembly comprising:
a plurality of elastic struts formed of at least one bioabsorbable polymer , the plurality of elastic struts interconnected at nodes and configured to flex when compressed; comprising a plurality of resilient struts configured to form a structure ;
the three-dimensional bioabsorbable supplement is configured to be retained on and released from the stapling body ;
The three-dimensional bioabsorbable aid is configured to allow a plurality of staples disposed within the stapling body to pass through the three-dimensional bioabsorbable aid, such that the three-dimensional bioabsorbable aid a three-dimensional bioabsorbable adjuvant may be attached to tissue by the plurality of staples;
A three-dimensional bioabsorbable supplement, wherein the nodes are formed of at least one bioabsorbable polymer that is more flexible than the at least one bioabsorbable polymer forming the plurality of elastic struts. each elastic strut has a neck-down region at least one end that is narrower than the center;
The three-dimensional bioabsorbable supplement of claim 1, wherein the nodes are formed by interconnecting the necked-down regions of each elastic strut. The three-dimensional bioabsorbable adjunct according to claim 1, wherein voids of a plurality of different sizes are present in the three-dimensional bioabsorbable adjunct. The at least one bioabsorbable polymer is a thermoplastic bioabsorbable polyurethane, a UV-curable bioabsorbable polyurethane, poly(lactic acid), polycaprolactone, polyglycolide, polydioxanone, poly(lactic-co-glycolic acid). 2. The three-dimensional bioabsorbable adjuvant of claim 1, selected from the group consisting of polyglycolic acid, trimethylene carbonate, glycolide, dioxanone, polyester, copolymers thereof, and combinations thereof. the three-dimensional bioabsorbable supplement having a channel configured to receive a cutting element of the stapling assembly , and a first portion and a second portion separated by the channel; The three-dimensional bioabsorbable adjuvant of claim 1, wherein the first and second portions are connected by at least one bridging member extending across the channel. each elastic strut comprises at least one stop element configured to project in the height direction of the three-dimensional bioabsorbable supplement and to limit the amount of compression of the three-dimensional bioabsorbable supplement;
The three-dimensional structure of claim 1, wherein the at least one stop element is configured to increase the stiffness of the three-dimensional bioabsorbable supplement when mutually contacting the at least one stop element of an adjacent resilient strut. Bioabsorbable supplement. A three-dimensional bioabsorbable adjuvant for use with a stapling assembly comprising:
a plurality of elastic struts connected at joints to form a lattice structure , the plurality of elastic struts being formed of at least one bioabsorbable polymer ;
the three-dimensional bioabsorbable adjuvant comprises a tissue contacting surface and an assembly contacting surface opposite the tissue contacting surface;
The three-dimensional bioabsorbable aid is configured to allow a plurality of staples disposed within the stapling assembly to pass through the lattice structure, such that the three-dimensional bioabsorbable aid the material may be attached to tissue by the plurality of staples;
The three-dimensional bioabsorbable supplementary material, wherein the joint portion is formed of at least one bioabsorbable polymer that is more flexible than the at least one bioabsorbable polymer forming the plurality of elastic struts. each elastic strut has a neck-down region at least one end that is narrower than the center;
8. The three-dimensional bioabsorbable supplement of claim 7, wherein the joint is formed by interconnecting the necked down regions of each elastic strut. 8. The three-dimensional bioabsorbable adjuvant of claim 7 , wherein voids are present in the lattice structure, the voids forming a continuous network of openings throughout the three-dimensional bioabsorbable adjunct. the lattice structure has a first end, a second end, and a longitudinal axis extending therebetween, the lattice structure extending at least partially through the lattice structure; The three-dimensional bioabsorbable adjuvant according to claim 7 , further comprising voids. The three-dimensional bioabsorbable supplement has a channel configured to receive a cutting element of the stapling assembly and first and second sides separated by the channel. 8. The three-dimensional bioabsorbable supplement of claim 7 , wherein the first and second sides are connected by a plurality of bridging members extending across the channel . each elastic strut comprises at least one stop element configured to project in the height direction of the three-dimensional bioabsorbable supplement and to limit the amount of compression of the three-dimensional bioabsorbable supplement;
8. The three-dimensional structure of claim 7 , wherein the at least one stop element is configured to increase the stiffness of the three-dimensional bioabsorbable supplement when mutually contacting the at least one stop element of an adjacent resilient strut. Bioabsorbable supplement.

Images