RU2576225C2 - Implanted cartridge with fastening elements comprising bearing retainer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions refers to medical equipment, namely to surgical incision and suturing instruments, particularly staple cartridges used therein and designed for tissue incision and stapling. The staple cartridge comprises a number of staples, a compressible cartridge body and a bearing tray. Each staple has a base and two vertical stalks extending from it. The compressible cartridge body consists of a compressible haemostatic material. The staple base and stalks are arranged inside the compressible haemostatic material of the cartridge body. The bearing tray is detachably connected to the compressible cartridge body. The cartridge with fastening elements comprises a number of bearing retainers, the compressible cartridge body and bearing tray. The compressible cartridge body consists of the compressible haemostatic material. The fastening elements are arranged inside the compressible haemostatic material of the cartridge body. The bearing tray is releasably connected to the compressible cartridge body.

EFFECT: inventions provide reducing the postoperative recovery length and the risk of complications in the patient.

7 cl, 243 dwg

Description

FIELD OF TECHNOLOGY

The present invention relates to surgical instruments and, in various embodiments, to surgical dissecting and stapling instruments and cassette staples used therein, which are designed to cut and staple tissue staples.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred over traditional open surgery devices because a smaller incision tends to shorten postoperative recovery time and reduce the risk of complications in the patient. Consequently, considerable work has been done to develop a set of endoscopic surgical instruments that allow the precise insertion of a distal working instrument into the desired surgical field through a cannula or trocar. Such distal working tools hook the tissue in a variety of ways to achieve a diagnostic or therapeutic effect (such as, for example, an endocater, a clamp, a divider, stapling tools, a clip-on applicator, an access device, a medication / gene therapy device, and an ultrasound energy supply device , RF or laser procedures, etc.).

In many applications of endoscopic surgery, it is desirable to use work tools that are minimally large enough to perform a specific surgical procedure. Smaller work tools provide better visualization of the surgical field. Smaller tools also facilitate access and handling in tight spaces. When developing small work tools, designers face many challenges. The possibility of manufacturing small working tools, and in particular small size endocaters, made with the ability to cut and stitch the fabric, is limited by the magnitude of the trigger force, which is essentially required to set the staple lines and dissect the fabric. The magnitude of such a trigger force can also vary depending on the thickness and composition of the treated fabric. For example, dissection and stitching of thick tissue usually requires a greater response force. While the magnitude of the response force required for dissection and stitching of thinner tissues is substantially less. Thus, many existing endocater designs typically use robust stop closure systems and staple feed systems that are capable of handling fabrics in a specific thickness range. However, such devices are often not optimal for processing thinner tissues.

Prior art endocaters also substantially dissect tissue during stapling and fixing them into tissue on each side of the incision. Although such devices are very effective in carrying out procedures requiring dissection and stitching of tissue, they do not allow the surgeon to install fasteners without cutting the tissue. Similarly, although various types of articulated endocaters have been developed to facilitate access to inaccessible places, the components commonly used in such devices should be large enough to allow structures to be placed inside them that can create and transmit sufficient actuation and closing forces from the handle to working tool of the device. Therefore, such working tools are often too large for effective access in the body area with limited space.

In accordance with the foregoing, there is a need to develop designs of surgical dissecting and stapling instruments and cassettes with brackets to solve many of the problems described above.

The above explanations are given solely to describe some of the disadvantages currently found in the technical field to which the invention relates, and do not limit the scope of the invention.

SUMMARY OF THE INVENTION

In at least one form, the cassette with brackets may comprise a plurality of staples, a compressible cassette body, the brackets being located inside the compressible cassette body, and a support tray that can be detached to the compressible cassette body.

In at least one form, the cassette with fasteners may comprise a plurality of fasteners, a compressible cassette body, the fasteners being located inside the compressible cassette body, and a support tray that is releasably attached to the compressible cassette body.

In at least one form, the cassette with brackets may comprise a plurality of brackets, an implantable cassette body, the brackets being at least partially located inside the implantable cassette body, a pallet, the implantable cassette body located inside the pallet, and a plurality of bracket ejectors located between the pallet and the brackets .

In at least one form, the cassette with the fasteners may comprise a plurality of fasteners, an implantable cassette body, the fasteners being at least partially located inside the implantable cassette body, a latch, the implantable cassette body located in the latch, and a plurality of ejector fasteners located between the latch and the fasteners.

BRIEF DESCRIPTION OF THE DRAWINGS

The listed and other features and advantages of the present invention and methods for their implementation will be obvious, and the essence of the invention will be more clear after reading the description of embodiments of the invention with the accompanying figures.

In FIG. 1 is a sectional view of an embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 1A is a perspective view of one embodiment of an implantable cassette with brackets, which is the subject of the present invention.

In FIG. 1B-1E illustrate parts of a working tool of various embodiments of the present invention fixing and stitching tissue using an embodiment of an implantable cassette with brackets, which is the subject of the present invention.

In FIG. 2 is an exploded perspective view of the components of an embodiment of a working instrument and part of an embodiment of a surgical stapling instrument constituting the subject of the present invention shown in cross section.

In FIG. 3 is a side elevational view of an embodiment of a stop constituting the subject of the present invention.

In FIG. 4 is a sectional view of a portion of the handle assembly shown in FIG. one.

In FIG. 5 is a partial sectional view of the handle assembly shown in FIG. 1 along line 5-5 of FIG. one.

In FIG. 6 is a perspective view of part of an embodiment of a gearing of a cutting and launching system that is the subject of the present invention.

In FIG. 7 is a partial sectional view of the handle assembly shown in FIG. 1 along line 7-7 of FIG. one.

In FIG. 8 is a partial sectional view of a portion of the handle assembly of FIG. 7, along line 8-8 of FIG. 7.

In FIG. 9 is a cross-sectional view of an embodiment of a surgical instrument constituting the subject of the present invention, after connecting the working instrument to a portion of the trunnion of the surgical instrument and before it is fixed to it.

In FIG. 9A is an enlarged view of a working tool and part of the surgical instrument shown in FIG. 10.

In FIG. 10 is a sectional view of the surgical instrument shown in FIG. 9, after fixing the working tool on the trunnion of the surgical instrument.

In FIG. 10A is an enlarged view of a working instrument and a part of the surgical instrument shown in FIG. 10.

In FIG. 11 is a sectional view of the surgical instrument shown in FIG. 9 and 10, after the first launch adapter is advanced to the beginning of the parts of the inclined fixation surfaces on the stop.

In FIG. 11A is an enlarged view of a working tool and part of the surgical instrument shown in FIG. 11, with a fabric located between its focus and the cassette with brackets.

In FIG. 12 is a sectional view of the surgical instrument shown in FIG. 9-11, after advancing the first launch adapter over parts of the inclined fixation surfaces on the stop.

In FIG. 12A is an enlarged view of a working instrument and part of the surgical instrument shown in FIG. 12.

In FIG. 13 is a sectional view of the surgical instrument shown in FIG. 9-12, after moving the first launch adapter over an inclined surface to form brackets for complete formation of brackets in the implantable cassette with brackets.

In FIG. 13A is an enlarged view of a working instrument and part of the surgical instrument shown in FIG. 13.

In FIG. 14 is a sectional view of the surgical instrument shown in FIG. 9-13, after moving the first launch adapter over the inclined surface to form the brackets for the complete formation of the brackets in the implantable cassette with brackets and after moving the scalpel holder longitudinally through the working tool.

In FIG. 14A is an enlarged view of a working instrument and part of the surgical instrument shown in FIG. fourteen.

In FIG. 15 is an exploded view of another embodiment of a working tool constituting the subject of the present invention, in which a section is shown of a trunnion of an embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 16 is a partial cross-sectional view of an embodiment of the working tool shown in FIG. 15 in an open position and attached to an embodiment of a surgical instrument.

In FIG. 17 is another partial cross-sectional view of an embodiment of the working tool shown in FIG. 15 and 16, in the fully closed position.

In FIG. 18 is another partial cross-sectional view of an embodiment of the working tool shown in FIG. 15-17, in the position with the brackets fully engaged and before advancing the distal scalpel element.

In FIG. 19 is another partial cross-sectional view of an embodiment of the working tool shown in FIG. 15-18, in the position with the brackets fully applied and after the complete advancement of the distal scalpel element.

In FIG. 20 is a sectional view of part of another embodiment of a handle assembly constituting the subject of the present invention.

In FIG. 21 is a partial sectional view of a portion of the handle assembly shown in FIG. 20 along line 21-21 of FIG. twenty.

In FIG. 22 is a partial sectional view of a portion of the handle assembly shown in FIG. 20 along line 22-22 of FIG. twenty.

In FIG. 23 is a partial sectional view of a portion of the handle assembly shown in FIG. 20 along line 23-23 of FIG. twenty.

In FIG. 24 is a sectional view of part of another embodiment of a handle assembly constituting the subject of the present invention.

In FIG. 25 is a partial cross-sectional side view of another embodiment of a working instrument constituting the subject of the present invention connected to a part of an embodiment of a surgical instrument constituting the subject of the present invention, while the working instrument supports an embodiment of a cassette with surgical staples constituting the subject of the present invention, and emphasis is in the open position.

In FIG. 26 is another partial cross-sectional side view of the working tool shown in FIG. 25, in the closed position.

In FIG. 27 is another partial cross-sectional side view of the working tool shown in FIG. 25 and 26, on which the scalpel holder begins to advance through the working tool.

In FIG. 28 is another partial cross-sectional side view of the working tool shown in FIG. 25-27, on which the scalpel holder is partially advanced through it.

In FIG. 29 is a partial cross-sectional side view of another embodiment of a working instrument constituting the subject of the present invention connected to a part of an embodiment of a surgical instrument constituting the subject of the present invention, the working instrument supporting another embodiment of a cassette with surgical staples constituting the subject of the present invention, and its emphasis is in the open position.

In FIG. 30 is another partial cross-sectional side view of the working tool shown in FIG. 29, on which the scalpel holder is partially advanced through it.

In FIG. 31 is a cross-sectional view of another embodiment of a surgical instrument constituting the subject of the present invention, with the focus of its working instrument in the open position.

In FIG. 32 is a perspective view of the spatial separation of the components of an embodiment of a working instrument and part of an embodiment of a surgical stapling instrument shown in FIG. 31 shown in cross section.

In FIG. 33 is a top view of the working tool and part of the elongated barrel assembly of the surgical instrument shown in FIG. 31, parts of which are shown in section along line 33-33 of FIG. 31.

In FIG. 34 is a top view of the working tool and part of the elongated barrel assembly of the surgical instrument shown in FIG. 31, parts of which are shown in cross section.

In FIG. 35 shows another top view of the working tool and part of the node of the elongated barrel of the surgical instrument shown in FIG. 31, while the working tool is in the swiveled orientation and in the open position.

In FIG. 36 is another top view of the working tool shown in FIG. 35, while the working tool is in a closed, or fixing fabric position.

In FIG. 37 is an enlarged view of a portion of an embodiment of a working instrument and a surgical instrument shown in FIG. 36.

In FIG. 38 is a sectional view of a portion of the handle assembly of the surgical instrument of FIG. 31.

In FIG. 39 is another cross-sectional view of a portion of the handle assembly shown in FIG. 38 along line 39-39 of FIG. 38.

In FIG. 40 is a partial exploded perspective view of the structural components of the articulated ball joint used in various embodiments of the present invention.

In FIG. 41 is a plan view of a working tool and part of an elongated stem assembly of another embodiment of a surgical instrument constituting the subject of the present invention, in an orientation not rotated by articulation.

In FIG. 42 is another top view of the working tool and part of the elongated barrel assembly shown in FIG. 41, in the articulated position.

In FIG. 43 is a cross-sectional view of another embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 44 is a partial sectional view of a portion of a hinge shaft assembly of an embodiment of the surgical instrument of FIG. 43.

In FIG. 44A is a cross-sectional view of a portion of the articulated shaft assembly of FIG. 44.

In FIG. 44B is a different sectional view of another part of the articulated barrel assembly of FIG. 44.

In FIG. 44C is another cross-sectional view of the other part of the articulated barrel assembly of FIG. 44.

In FIG. 44D is another cross-sectional view of the other part of the articulated barrel assembly of FIG. 44.

In FIG. 44E is another cross-sectional view of the other part of the articulated barrel assembly of FIG. 44.

In FIG. 44F is another cross-sectional view of the other part of the articulated barrel assembly of FIG. 44.

In FIG. 45 is a partial sectional view of the articulated barrel assembly of FIG. 44 along line 45-45 of FIG. 44.

In FIG. 46 is a partial sectional view of the articulated shaft assembly of FIG. 44 along line 46-46 of FIG. 44.

In FIG. 47 is another cross-sectional view of the surgical instrument of FIG. 43, while its working tool is shown in a fully rotated articulated position.

In FIG. 48 is a sectional view of the working tool shown in FIG. 47, with a corrugated coating on top of its articulation.

In FIG. 49 is a sectional view of a handle assembly of another embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 50 is a perspective view in cross section with a spatial separation of the components of the working tool and the distal end of the elongated barrel assembly shown in FIG. 49.

In FIG. 51 is a different sectional view of the working tool and part of the elongated barrel assembly shown in FIG. 50, while the working tool is in the open position.

In FIG. 52 is a different cross-sectional view of the working tool and part of the elongated barrel assembly, with the working tool in the closed position.

In FIG. 53 is a different cross-sectional view of the working tool and part of the elongated barrel assembly shown in FIG. 49-52, while the scalpel element is in a fully activated position.

In FIG. 54 is a perspective view of the working tool shown in FIG. 51-53, in the open position.

In FIG. 55 is a sectional view of the working tool shown in FIG. 51-54, along the line 55-55 in FIG. 51.

In FIG. 56 is a partial perspective view of an elongated barrel assembly of another embodiment of the present invention, attached to an embodiment of the working tool that is the subject of the present invention.

In FIG. 57 is a partial sectional view of the handle assembly of another embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 58 is a sectional view of a portion of an elongated barrel assembly shown in FIG. 56 and 57, along line 58-58 of FIG. 57.

In FIG. 59 is an enlarged view of a portion of the handle assembly shown in FIG. 57.

In FIG. 60 is a sectional view of the distal end portion of the elongated trunk assembly shown in FIG. 56-59.

In FIG. 61 is a partial perspective view of an elongated barrel assembly of another embodiment of the present invention, attached to an embodiment of the working tool that is the subject of the present invention.

In FIG. 62 is a cross-sectional view of a portion of a barrel segment with a tunable configuration of the elongated barrel shown in FIG. 61.

In FIG. 63 is a partial perspective view of an elongated barrel assembly of another embodiment of the present invention, attached to an embodiment of the working tool that is the subject of the present invention.

In FIG. 64 is a sectional view of a handle assembly of another embodiment of a surgical instrument constituting the subject of the present invention.

In FIG. 65 is a sectional view of a portion of the elongated barrel assembly shown in FIG. 63 and 64, along line 65-65 of FIG. 64.

In FIG. 66 is an enlarged view of a portion of the handle assembly shown in FIG. 64.

In FIG. 67 is a sectional view of a portion of a reconfigurable barrel segment shown in FIG. 63, while its parts of the tubular links are aligned essentially in a straight line.

In FIG. 68 is a cross-sectional view of a portion of a reconfigurable barrel segment shown in FIG. 63 and 67, while its parts of the tubular links are aligned essentially in a curved (non-coaxial) orientation.

In FIG. 69 is a perspective view of an alternative embodiment of a staple cartridge constituting the subject of the present invention, installed in an embodiment of a surgical dissecting and stapling apparatus constituting the subject of the present invention.

In FIG. 70 is a top view of a surgical cassette with brackets and an elongated channel of the device shown in FIG. 69.

In FIG. 71 is a top view of another embodiment of a surgical cassette with brackets constituting an object of the present invention mounted in an elongated channel of an embodiment of a working tool constituting the subject of the present invention.

In FIG. 72 is a bottom view of an embodiment of a stop constituting the subject of the present invention.

In FIG. 73 is a partial perspective view of a plurality of staples forming part of an embodiment of a staple line constituting the subject of the present invention.

In FIG. 74 is another partial perspective view of an embodiment of a staple line shown in FIG. 73, wherein its brackets are shown after forming a surgical dissecting and stapling device as a result of contact with the abutment.

In FIG. 75 is a partial perspective view of alternative staples forming part of another embodiment of a staple line constituting the subject of the present invention.

In FIG. 76 is a partial perspective view of alternative staples forming part of another embodiment of a staple line constituting the subject of the present invention.

In FIG. 77 is a partial perspective view of alternative staples forming part of another embodiment of a staple line constituting the subject of the present invention.

In FIG. 78 is a cross-sectional view of an embodiment of a working tool constituting the subject of the present invention supporting an embodiment of a cassette with brackets constituting the subject of the present invention.

In FIG. 79 is a sectional view of a portion of an elongated channel of the working tool shown in FIG. 78, after removing from it parts of the body of the implantable cassette with brackets and staples.

In FIG. 80 is a cross-sectional view of an embodiment of a working tool constituting the subject of the present invention supporting another embodiment of a cassette with brackets constituting the subject of the present invention.

In FIG. 81 is a partial cross-sectional view of an embodiment of a surgical stapling instrument constituting the subject of the present invention, the working tool supporting a cassette with brackets for moving the cassette fixation system to an open position.

In FIG. 82 is another partial cross-sectional view of the surgical stapling instrument of FIG. 81, while the cassette with brackets is removed from the working tool, and the cassette fixing system is in the closed position.

In FIG. 83A-83D is a diagram illustrating a deformation of a surgical bracket located in a compressible cassette with brackets in accordance with at least one embodiment.

In FIG. 84A is a diagram illustrating a bracket located in a collapsible cassette of the cassette with brackets.

In FIG. 84B is a diagram illustrating a process of creasing a crushable cassette body with brackets shown in FIG. 84A, focus.

In FIG. 84C is a diagram illustrating a process for further creasing a crushable cassette body with brackets shown in FIG. 84A, focus.

In FIG. 84D is a diagram illustrating a bracket shown in FIG. 84A, in a fully formed configuration, as well as a collapsible cassette case with brackets shown in FIG. 84A, in a completely crushed state.

In FIG. 85 is a diagram showing a bracket located opposite the supporting surface of the cassette with brackets and illustrating its possible relative movement.

In FIG. 86 is a cross-sectional view of a supporting surface of a cassette with brackets containing a groove or groove configured to stabilize the base of the bracket shown in FIG. 85.

In FIG. 87 is a cross-sectional view of a bracket containing a press-in head and a groove or groove configured to receive a portion of the head in accordance with at least one alternative embodiment.

In FIG. 88 is a plan view of a cassette with brackets in accordance with at least one embodiment comprising brackets mounted in a housing of a compressible cassette with brackets.

In FIG. 89 is a perspective view of a cassette with brackets shown in FIG. 88.

In FIG. 90 is a perspective view of a cassette with brackets in accordance with at least one embodiment comprising a protective layer surrounding brackets located in the housing of a compressible cassette with brackets.

In FIG. 91 is a cross-sectional view of the cassette with brackets shown in FIG. 90, along line 91-91 of FIG. 90.

In FIG. 92 is a perspective view of a cassette with brackets in accordance with at least one embodiment comprising brackets that extend at least partially outside the casing of the compressible cassette with brackets and a protective layer surrounding the cassette with brackets.

In FIG. 93 is a sectional view of the cassette with brackets shown in FIG. 92, along line 93-93 of FIG. 92.

In FIG. 94 is a partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment comprising brackets at least partially mounted in a compressible cassette casing with brackets, wherein the brackets are at least partially located in the bracket slots of the cassette case with brackets .

In FIG. 95 is a sectional view of the cassette with brackets shown in FIG. 94 along line 95-95 of FIG. 94.

In FIG. 96 is a partial sectional view of a staple cartridge in accordance with at least one embodiment.

In FIG. 97 is a partial cross-sectional view of a cassette with brackets in accordance with at least one embodiment comprising brackets at least partially mounted in the housing of a compressible cassette with brackets, and an alignment matrix connecting the brackets and the alignment brackets with respect to each other.

In FIG. 98 is a cross-sectional view of the cassette with brackets shown in FIG. 97, along line 98-98 of FIG. 97.

In FIG. 99 is a partial sectional view of the inner layer of the body of a compressible cartridge with brackets.

In FIG. 100 is a diagram illustrating that shown in FIG. 99 inner layer compressible between the transfer plate and the support plate.

In FIG. 101 is a diagram illustrating a process for inserting staples into a compressible inner layer depicted in FIG. one hundred.

In FIG. 102 is a schematic diagram of a support plate shown in FIG. 100, in the process of separation from the inner layer.

In FIG. 103 is a diagram of a subassembly containing the one shown in FIG. 99 inner layer and shown in FIG. 101 staples during insertion into the outer layer.

In FIG. 104 is a diagram illustrating the sealing process shown in FIG. 103 of the outer layer to obtain a sealed cassette with brackets.

In FIG. 105 is a cross-sectional view of a sealed cassette with brackets shown in FIG. 104.

In FIG. 106 is a cross-sectional view of a bracket cassette and a channel for a bracket cassette in accordance with at least one embodiment.

In FIG. 107 is a diagram illustrating a portion of the bracket cassette shown in FIG. 106, in a deformed state.

In FIG. 108 is a perspective view of the working tool of a surgical stapler with an emphasis in the open position and a cassette with brackets located in a channel for a cassette with brackets.

In FIG. 109 is a perspective view of the working tool shown in FIG. 108 illustrating a stop in the closed position and a cassette with brackets sandwiched between the stop and the channel for the cassette with brackets.

In FIG. 110 is a perspective view of the working tool shown in FIG. 108 illustrating the one shown in FIG. 108 cassette with brackets, located alternatively in the channel for the cassette with brackets.

In FIG. 111 is a cross-sectional view of a surgical stapling instrument containing a compressible cassette with brackets located in a channel for a cassette with brackets, as well as a fragment of the supporting material attached to the stop.

In FIG. 112 is a cross-sectional view of the working tool shown in FIG. 111 illustrating a stop in the closed position.

In FIG. 113 is a cross-sectional view of an alternative embodiment of a surgical stapler instrument containing a staple cartridge containing a waterproof layer.

In FIG. 114 is a cross-sectional view of another alternative embodiment of a surgical stapler instrument.

In FIG. 115 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing a step stop and a cassette with brackets comprising a step cassette body.

In FIG. 116 is a cross-sectional view of another alternative embodiment of a surgical stapler instrument.

In FIG. Figure 117 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing inclined tissue-contacting surfaces.

In FIG. 118 is a cross-sectional view of another alternative embodiment of a surgical stapler instrument containing inclined tissue-contacting surfaces.

In FIG. 119 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument working instrument comprising a support liner configured to support a cassette with brackets.

In FIG. 120 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing a cassette with brackets containing a plurality of compressible layers.

In FIG. 121 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing a cassette with staples comprising a stepped casing of a compressible cassette.

In FIG. 122 is a cross-sectional view of another alternative embodiment of a surgical stapling instrument containing a cassette with staples comprising a step-down compressible cassette body.

In FIG. 123 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing a cassette with brackets containing a curved tissue-contacting surface.

In FIG. 124 is a cross-sectional view of an alternative embodiment of a surgical stapling instrument containing a cassette with staples having an inclined surface in contact with the tissue.

In FIG. 125 is a sectional view of a compressible cassette with staples containing staples and at least one drug stored therein.

In FIG. 126 is a diagram illustrating a compressible cassette with brackets shown in FIG. 125, after its compression and deformation of the brackets contained in it.

In FIG. 127 is a partial sectional view of a staple cartridge in accordance with at least one embodiment.

In FIG. 128 is a sectional view of the cassette with brackets shown in FIG. 127.

In FIG. 129 is a perspective view of an implanted cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 130 is a sectional view of an implanted cassette with brackets shown in FIG. 129.

In FIG. 131 is a perspective view of an alternative embodiment of a cassette with brackets containing deformable elements extending from the outer layer of the cassette with brackets.

In FIG. 132 is a perspective view of an alternative embodiment of a cassette with brackets comprising an outer layer of a cassette with brackets attached to the inner layer.

In FIG. 133 is a cross-sectional view of an alternative embodiment of a cassette with staples comprising a plurality of staples, a compressible layer and a tampon layer.

In FIG. 134 is a perspective view of the tampon layer shown in FIG. 133.

In FIG. 135 is a perspective view of a tampon separated from the tampon layer shown in FIG. 133, and staples combined with a groove in the swab.

In FIG. 136 is a perspective view of two tampons connected to each other from the tampon layer shown in FIG. 133.

In FIG. 137 is a perspective view of a support frame for a tampon of the tampon layer shown in FIG. 133, which is removed from the divided swabs.

In FIG. 138 is a perspective view with a spatial separation of the components of an alternative embodiment of a compressible cassette with brackets containing brackets and a system for pushing the brackets to the stop.

In FIG. 138A is a partial sectional view of an alternative embodiment of a cassette with brackets shown in FIG. 138.

In FIG. 139 is a cross-sectional view of a cassette with brackets shown in FIG. 138.

In FIG. 140 is a perspective view of a slide arranged to cross a cassette with brackets shown in FIG. 138, and move the brackets in the direction of the stop.

In FIG. 141 is a diagram of a staple ejector that can be lifted in the stop direction by the slide shown in FIG. 140.

In FIG. 142 is a partial cross-sectional view of a staple cartridge in accordance with at least one alternative embodiment comprising staples located in staple ejectors.

In FIG. 143 is a sectional view of the cassette with brackets shown in FIG. 142 located in the channel for the cassette with brackets.

In FIG. 144 is a sectional view of the cassette with brackets shown in FIG. 142, illustrating the emphasis moved to the closed position, and the brackets located in the cassette with brackets, which deforms the emphasis.

In FIG. 145 is a sectional view of the cassette with brackets shown in FIG. 142 illustrating staples moved up in the direction of the stop.

In FIG. 146 is a perspective view of an alternative embodiment of a cassette with brackets comprising loops connecting the flexible side walls of the cassette with brackets.

In FIG. 147 is a perspective view of a slide assembly and a cutting member.

In FIG. 148 is a diagram of a slide assembly and a cutting member shown in FIG. 147, which is used to lift the brackets from the cassette with brackets shown in FIG. 142.

In FIG. 149 is a diagram illustrating a slide configured to engage and lift the brackets in the direction of the stop, as well as a locking system configured to selectively allow the slide to move distally.

In FIG. 150A-150C presents the sequence of steps in the process of inserting the bracket into the bracket head.

In FIG. 151 is a cross-sectional view of a cassette with brackets comprising a holder or stopper.

In FIG. 152 is a partial cross-sectional view of a compressible cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 153 is a diagram illustrating that shown in FIG. 152 cassette with brackets in the implanted state.

In FIG. 154 is a partial sectional view of a compressible cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 155 is a partial cross-sectional view of the cassette with brackets shown in FIG. 154.

In FIG. 156 is a diagram illustrating that shown in FIG. 154 cassette with brackets in the implanted state.

In FIG. 157 is a partial cross-sectional view of a collapsible cassette with brackets in accordance with at least one alternative embodiment.

In FIG. 158 is a partial sectional view of a compressible cassette with brackets in accordance with at least one embodiment comprising a plurality of compressible elements.

In FIG. 159 is a perspective view of the one shown in FIG. 158 compressible element in an uncompressed state.

In FIG. 160 is a perspective view of the one shown in FIG. 159 compressible element in a compressed state.

In FIG. 161A is a partial cross-sectional view of a surgical stapling instrument containing a jaw located opposite the jaw of the cassette with brackets and a cassette with brackets located in the channel for the cassette with brackets, the jaw containing a holding matrix attached to it.

In FIG. 161B is a partial cross-sectional view of the working tool shown in FIG. 161A illustrating a jaw moving in the direction of a channel for a cassette with brackets, wherein the cassette with brackets is compressed by the stop and the holding matrix, and the bracket passes at least partially through the fabric located between the holding matrix and the cassette with brackets.

In FIG. 161C is a partial cross-sectional view of the working tool shown in FIG. 161A illustrating the jaw in the final position and holding the matrix in mesh with the bracket depicted in FIG. 161B.

In FIG. 161D is a partial cross-sectional view of the working tool shown in FIG. 161A illustrating the jaw and channel for a cassette with brackets moved from an implanted cassette with brackets and a holding matrix.

In FIG. 162 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises a plurality of holding elements configured to engage a fastener leg passed through them.

In FIG. 163 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment that comprises six holding elements.

In FIG. 164 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment that comprises eight holding elements.

In FIG. 165 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises a plurality of holding elements configured to engage a fastener leg passed therethrough.

In FIG. 166 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises six holding elements.

In FIG. 167 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises eight holding elements.

In FIG. 168 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises a plurality of holding elements made by stamping from a metal sheet.

In FIG. 169 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, which comprises a plurality of holes located around the perimeter of the holding hole.

In FIG. 170 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 171 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 172 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 173 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 174 is a plan view of a holding hole of a holding matrix in accordance with at least one alternative embodiment.

In FIG. 175 is a plan view of a holding hole of a holding matrix comprising a holding tab extending into the holding hole in accordance with at least one embodiment.

In FIG. 176 is a plan view of a holding hole of a holding matrix comprising a holding tab extending into the holding hole in accordance with at least one alternative embodiment.

In FIG. 177 is a perspective view of a crosslinking system comprising a plurality of staples, a retention matrix engaged with the staples, and an alignment matrix configured to align the staples.

In FIG. 178 is a perspective view of a holding matrix shown in FIG. 177.

In FIG. 179 is a perspective view of the alignment matrix shown in FIG. 177.

In FIG. 180 is a partial top view of a holding matrix shown in FIG. 177, engaged with the brackets shown in FIG. 177.

In FIG. 181 is a partial bottom view of a holding matrix shown in FIG. 177, engaged with the brackets shown in FIG. 177.

In FIG. 182 is a partial elevational view of the crosslinking system shown in FIG. 177.

In FIG. 183 is a partial perspective view of the crosslinking system shown in FIG. 177.

In FIG. 184 is a partial cross-sectional view of a holding matrix shown in FIG. 177, engaged with the brackets shown in FIG. 177.

In FIG. 185 is a partial cross-sectional view of the crosslinking system shown in FIG. 177.

In FIG. 186 is a perspective view of the crosslinking system shown in FIG. 177, further containing protective caps mounted on the legs of the brackets.

In FIG. 187 is a perspective view from below of the structure of the crosslinking system shown in FIG. 186.

In FIG. 188 is a partial perspective view of the structure of the crosslinking system shown in FIG. 186.

In FIG. 189 is a partial cross-sectional view of the structure of the crosslinking system shown in FIG. 186.

In FIG. 190 is a perspective view of a working tool in accordance with at least one embodiment comprising a jaw in an open position, a holding matrix and a plurality of protective caps located in a jaw, as well as a cassette with brackets located in a channel for a cassette with brackets.

In FIG. 191 is a perspective view depicted in FIG. 190 working tools in the closed position.

In FIG. 192 is a perspective view depicted in FIG. 190 working tools in position after stapling.

In FIG. 193 is a perspective view of a holding matrix and protective caps depicted in FIG. 190 mounted on the cassette with brackets shown in FIG. 190.

In FIG. 194 is a detailed view of the structure shown in FIG. 193.

In FIG. 195 is a perspective view depicted in FIG. 190 of a working tool illustrating a jaw in an open position with a thinner tissue located between the holding matrix and the cassette with staples.

In FIG. 196 is a perspective view depicted in FIG. 190 a working tool illustrating the jaw in the closed position on the thinner fabric depicted in FIG. 195.

In FIG. 197 is a perspective view depicted in FIG. 190 a working tool illustrating the jaw in position after stapling to grasp the thinner tissue depicted in FIG. 195, between the holding matrix and the cassette with brackets.

In FIG. 198 is a perspective view of a holding matrix and shown in FIG. 190 protective caps mounted on a cassette with brackets depicted in FIG. 190, with the thin cloth disposed between them, shown in FIG. 195.

In FIG. 199 is a detailed view of the structure shown in FIG. 198.

In FIG. 200 is a cross-sectional view of a protective cap located at the end of a bracket leg in accordance with at least one alternative embodiment.

In FIG. 201 is a perspective view of a plurality of protective caps inserted in a sheet of material.

In FIG. 202 is a perspective view of a jaw containing a plurality of recesses configured to receive a plurality of protective caps.

In FIG. 203 is a detailed view of a portion of a jaw containing a sheet covering the protective caps located in the jaw shown in FIG. 202.

In FIG. 204 is a cross-sectional view of a protective cap located at the end of a bracket leg in accordance with at least one alternative embodiment, in which the protective cap comprises an inner forming surface.

In FIG. 205 is another cross-sectional view of the protective cap shown in FIG. 204 illustrating a leg of a bracket that deforms against a forming surface.

In FIG. 206 is a plan view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 207 is a top view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 208 is a top view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 209 is a plan view of an alternative embodiment of an array of holding matrices containing a plurality of related matrix elements.

In FIG. 210 is a plan view of an alternative embodiment of a holding matrix comprising a plurality of related matrix elements.

In FIG. 211 is a partial exploded view of the components of a jaw containing a holding matrix, including a compressible coating.

In FIG. 212 is a detailed view of a holding matrix shown in FIG. 211.

In FIG. 213 is a partial cross-sectional view of a cross-linking system comprising a containment matrix, including a compressible layer and a plurality of cells hermetically sealing one or more drugs.

In FIG. 214 is a diagram illustrating the legs of a bracket that pierced the ones shown in FIG. 213 cells when engaged with a holding matrix.

In FIG. 215 is a partial cross-sectional view of a crosslinking system comprising a containment matrix, including a compressible layer.

In FIG. 216 is a perspective view of a cartridge input assembly with fasteners, comprising a holder, a first cartridge with fasteners and a second cartridge with fasteners.

In FIG. 217 is a perspective view of the working instrument of a surgical stapling instrument comprising a first jaw and a second jaw, wherein the second jaw is shown in an open configuration.

In FIG. 218 is a perspective view of the working tool shown in FIG. 217, illustrating the second jaw in a closed configuration and the cartridge input assembly with fasteners shown in FIG. 216 and used to load the first cartridge into the first jaw and the second cartridge into the second jaw.

In FIG. 219 is a perspective view of a charged working tool shown in FIG. 218 illustrating a cartridge insertion assembly removed from a working tool, a second jaw in an open configuration, and tissue placed between the first jaw and the second jaw.

In FIG. 220 is a perspective view of a charged working tool shown in FIG. 219, in configuration after stapling.

In FIG. 221 is a perspective view of a first cartridge and a second cartridge in an inserted state.

In FIG. 222 is a perspective view of the working tool shown in FIG. 217 illustrating a portion of a first cartridge still engaged with the first jaw in accordance with at least one embodiment.

In FIG. 223 is a perspective view of an alternative embodiment of a cartridge input assembly with fasteners comprising a holder, a first cartridge with fasteners and a second cartridge with fasteners.

In FIG. 224 is a perspective view of a cartridge input assembly with fasteners shown in FIG. 223 and used to load the first cartridge into the first jaw of the working tool and the second cartridge into the second jaw.

In FIG. 225 is a cross-sectional view of a charged working tool shown in FIG. 224.

In FIG. 226 is a perspective view of a surgical stapling instrument comprising a lower jaw and an upper jaw in accordance with at least one embodiment in which some parts of the surgical stapling instrument are removed.

In FIG. 227 is a perspective view of the surgical stapling instrument of FIG. 226, with the upper jaw removed.

In FIG. 228 is a perspective view of a sliding stop system of the upper jaw of the surgical stapling instrument shown in FIG. 226, comprising a first sliding stop and a second sliding stop.

In FIG. 229 is an end view of the sliding stop system shown in FIG. 228.

In FIG. 230 is a plan view of the sliding stop system shown in FIG. 228.

In FIG. 231 is a diagram illustrating the one shown in FIG. 228 the system of a sliding emphasis in a state before imposing of brackets.

In FIG. 232 is a diagram illustrating a first sliding stop of the sliding stop system shown in FIG. 228, in the pre-staple condition, as well as staples located in the lower jaw in the pre-staple position.

In FIG. 233 is a diagram illustrating the brackets in the lower jaw in the staple configuration and the first stop made with the possibility of sliding and shown in FIG. 232 stretched proximally to deform the first group of staple legs.

In FIG. 234 is a diagram illustrating a first group of staples shown in FIG. 233 deformed to a completely deformed state.

In FIG. 235 is a diagram illustrating a second sliding stop of the sliding stop system shown in FIG. 228, distally pushed to deform the second group of staple legs.

In FIG. 236 is a partial perspective view of an abutment comprising in at least one embodiment a plurality of forming recesses.

In FIG. 237 is an end view in cross-section of an abutment shown in FIG. 236.

In FIG. 238 is a diagram illustrating a first step in manufacturing the forming depressions shown in FIG. 236.

In FIG. 239 is a diagram illustrating a second stage of manufacturing the forming depressions shown in FIG. 236.

In FIG. 240 is a plan view of the structure of the forming recesses of the abutment shown in FIG. 236.

In FIG. 241 is a diagram illustrating the first stage of the manufacturing process used to produce the stop.

In FIG. 242 is a diagram illustrating a second stage of the manufacturing process shown in FIG. 241.

In FIG. 243 is a diagram illustrating a third stage of the manufacturing process shown in FIG. 241.

To indicate similar elements in different images, similar numeric notations are used. The illustrations appended to this application are intended solely to demonstrate preferred embodiments of the invention and do not limit the scope of the present invention.

DETAILED DESCRIPTION

The author of this application also owns the following US patent applications, filed on the same day as this application, and fully incorporated into this application by reference:

US patent application No. _____ under the heading "Surgical stapling instrument with a movable stapling system", Attorney Dossier No. END6848USNP / 100533;

US Patent Application No. _____ under the heading “Surgical stapling instrument with interchangeable cartridge designs with brackets”, Attorney Dossier No. END6849USNP / 100534;

US Patent Application No. ____ under the heading “Surgical Dissecting and Stapling Instruments with Separate and Separate Attachment and Fabric Dissection Application Systems,” Attorney Dossier No. END6839USNP / 100524;

US patent application No. ____ under the heading "Surgical stapling instrument with a compact design of a device with articulated joint control system", dossier of the attorney No. END6847USNP / 100532;

US Patent Application No. ____, under the heading “Closure Designs for Surgical Instruments,” Attorney Dossier No. END6736USNP / 100060;

US Patent Application No. _____ under the heading “Surgical Instruments Containing Tunable Segments of the Barrel,” Attorney Dossier No. END6734USNP / 100058;

US Patent Application No. _____ under the heading “Surgical cassettes with brackets supporting non-linearly positioned staples, and surgical stapling instruments with common grooves to form braces,” Attorney Dossier No. END6735USNP / 100059;

US Patent Application No. _____ under the heading “Surgical cassettes with staples with detachable load-bearing structures and surgical stapling instruments with systems to prevent starting movements in the absence of a cassette”, Attorney dossier No. END6855USNP / 100540;

US patent application No. _____ under the heading "Implantable cartridge with fasteners with a heterogeneous arrangement of elements", dossier of the attorney No. END6840USNP / 100525;

US Patent Application No. _____ under the heading “Implantable Cartridge with Fasteners Containing Multiple Layers,” Attorney Dossier No. END6842USNP / 100527;

US Patent Application No. ____ under the heading “Selectively Oriented Implantable Cassette with Fasteners,” Attorney Dossier No. END6843USNP / 100528;

US patent application No. _____ under the heading "Implantable cartridge with fasteners containing bioabsorbable layers", dossier of the attorney No. END6856USNP / 100541;

US Patent Application No. _____ under the heading “Compressible Cassette with Fasteners,” Attorney Dossier No. END6857USNP / 100542;

US Patent Application No. _____ under the heading “Fasteners Supported by the Carrier of the Cassette with Fasteners”, Attorney Dossier No. END6858USNP / 100543;

US Patent Application No. _____ under the heading “Compressible Cassette with Fasteners,” Attorney Dossier No. END6859USNP / 100544;

US patent application No. _____ under the heading “A crosslinking system containing a plurality of related elements of the retaining matrix”, Attorney dossier No. END6860USNP / 100546;

US Patent Application No. _____ under the heading “Crosslinking System Containing a Retention Matrix and Alignment Matrix,” Attorney Dossier No. END6861USNP / 100547;

US Patent Application No. _____ under the heading “Crosslinking System Containing the Retention Matrix,” Attorney Dossier No. END6862USNP / 100548;

US Patent Application No. _____ under the heading “Stapling Tool for Using a Stapling System Containing a Retention Matrix,” Attorney Dossier No. END6863USNP / 100549;

US Patent Application No. _____ under the heading “Crosslinking System Containing the Retention Matrix and Coating,” Attorney Dossier No. END6864USNP / 100550; and

US Patent Application No. _____ under the heading “Staple System Containing Multiple Cassettes with Fasteners,” Attorney Dossier No. END6865USNP / 100551.

For a general understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual embodiments of the present invention. One or more examples of such embodiments are presented in the accompanying figures. Those skilled in the art will understand that the devices and methods described in detail herein and shown in the accompanying figures are non-limiting examples of implementation, and the scope of various embodiments of the present invention is determined solely by the claims. Features illustrated or described with reference to one embodiment may be combined with features of other embodiments. The scope of the present invention is intended to cover all such modifications and changes.

Throughout this document, reference is made to “various embodiments”, “certain embodiments”, “one embodiment”, “one embodiment”, and the like. means that a particular design feature, structural element or characteristic described in connection with this embodiment is included in at least one embodiment of the present invention. Thus, the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” “in one embodiment,” and the like, as used herein, do not necessarily refer to the same same embodiment. In addition, specific design features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, specific design features, structures, or characteristics shown or described in connection with one embodiment may, without limitation, be combined, in whole or in part, with the design features, structures, or characteristics of one or more other embodiments. The scope of the present invention is intended to cover all such modifications and changes.

The terms "proximal" and "distal" in this document are defined with respect to the physician managing the handle of the surgical instrument. The term "proximal" refers to the part closer to the doctor, and the term "distal" refers to the part removed from the doctor. It is also proposed for convenience and clarity in relation to the figures to use in this document such spatial terms as “vertical”, “horizontal”, “top” and “bottom”. However, surgical instruments can be used in many orientations and positions, therefore, these terms are not absolute and / or do not limit the present invention.

Various examples of devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided herein. However, it will be understood by those skilled in the art that the various methods and devices described herein can be used to perform a variety of surgical procedures, as well as in many fields of application, including, for example, those associated with open surgical procedures. As you describe the following detailed description, it will become apparent to those skilled in the art that the various instruments described herein can be inserted into the body by any means, such as insertion through natural openings, through an incision or puncture made in the tissue, etc. The working parts or parts of the working tools of the described devices can be inserted directly into the patient’s body or through an access device that has a working channel through which the working tool and the elongated trunk of the surgical instrument can be advanced.

Turning to the figures in which similar numerals are used to indicate similar elements in different images, in FIG. 1 shows a surgical instrument 10 in which a number of unique advantages of the present invention are realized. The surgical stapling instrument 10 is configured to adjust and / or actuate the operatively mounted working instruments 12 of various shapes and sizes. For example, in the embodiments depicted in FIG. 1 and 2, the working tool 12 includes an elongated channel 14 forming the lower jaw 13 of the working tool 12. The elongated channel 14 is configured to support the implantable cassette with brackets 30, and also to support the stop 20, which performs the function of the upper jaw 15 working tool 12.

In various embodiments, the elongated channel 14 can be made, for example, of stainless steel type 300 and 400 grades 17-4 and 17-7, titanium, etc. and can be formed by spaced side walls 16. The stop 20 can be made, for example, of stainless steel type 300 and 400 grades 17-4 and 17-7, titanium, etc. and may have a brace-forming bottom surface substantially labeled as element 22, which has a plurality of recesses formed therein to form brackets 23. See FIG. 1B-1E. In addition, the stop 20 has a node forked inclined surface 24, protruding from it proximally. On each side of the assembly of the inclined surface 24, a stop pin 26 protrudes into the corresponding groove or hole 18 in the side walls 16 of the elongated channel 14 to facilitate its fastening on the channel with the possibility of movement or articulation.

With various embodiments of the surgical instruments described herein, various forms of implantable staple cassettes can be used. Specific configurations and designs of cassettes with brackets are described in detail below. However, in the embodiment depicted in FIG. 1A and 9-14, an implantable cassette with brackets 30 is depicted. In at least one embodiment, the cassette with brackets 30 has a body portion 31 that consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam , in which are placed in line undeformed metal staples 32. In at least some embodiments, in order to prevent exposure to staples and activation of hemostatic material in During insertion and placement of the cassette, the entire cassette can be coated with a layer or wrapped in a film of bioabsorbable material 38, such as a polydioxanone film sold under the brand PDS®, or polyglycerol sebacinate (PGS) film or other absorbable films made from PGA (polyglycolic acid available on the market under the Vicryl trademark), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglycaprone 25, commercially available under the Monocryl trademark), or a mixture of PGA, PCL PLA, PDS, impervious to tearing the film. The housing 31 of the cassette with brackets 30 has dimensions that can be removably supported in the elongated channel 14, as shown in the figures, so that each bracket 32 located in it is aligned with the corresponding recesses to form the brackets 23 in the stop when the stop 20 is brought into forming contact with cassette with staples 30.

When used after placing the working tool 12 near the target fabric, the working tool 12 is manipulated to grab or fix the target fabric between the upper side 36 of the cassette 30 and the staple forming surface 22 of the stop 20. The staples 32 are formed by moving the stop 20 along a path that is essentially parallel to the elongated channel 14, to bring the staple-forming surface 22 and, more specifically, the recesses therein to form the staples 23 into substantially simultaneous contact with the upper side 36 of the cassettes with brackets 30. While continuing to move the stop 20 to the cassette with brackets 30, the legs 34 of the brackets 32 are in contact with the corresponding recess to form the brackets 23 in the stop 20, which serves to bend the legs of the bracket 34 to give the brackets 32 the shape of the letter B. Further movement of the stop 20 into the direction of the elongated channel 14 leads to additional compression and the formation of staples 32 to the desired final height of the formed staples FH.

The above process of forming the staples is essentially depicted in FIG. 1B-1E. For example, in FIG. 1B shows a working tool 12 with a target tissue T between the abutment 20 and the upper side 36 of the implantable cassette with brackets 30. FIG. 1C shows an initial locking position of an abutment 20 in which an abutment 20 is closed on the target tissue T to fix the target tissue T between the abutment 20 and the upper side 36 of the cassette with brackets 30. FIG. 1D, the first step of forming the bracket is shown, in which the stop 20 began to compress the cassette with the brackets 30 so that the formation of legs 34 of the brackets 32 with recesses begins to form the brackets 23 of the stop 20. In FIG. 1E, a bracket 32 is shown in a final formed state passing through the target fabric T, with the stop 20 removed for clarity. After the formation of the staples 32 and fixing them in the target tissue T, the surgeon puts the emphasis 20 in the open position to allow the cassette body 31 and the staples 32 to remain in the target tissue T when removing the working tool 12 from the patient’s body. The working tool 12 forms all the brackets simultaneously when two jaws 13 and 15 are compressed together. The remaining materials of the “crumpled” case of the cartridge 31 serve as hemostatic means (ORC) and reinforce a number of superimposed braces (PGA, PDS or a film of any other composition from the above 38 ) In addition, since the brackets 32 do not need to leave the cassette 31 during formation, the likelihood of incorrect formation of the brackets 32 during the formation is minimized. As used herein, the term “implantable” means that, in addition to the staples, there are also bracket-bearing materials of the cassette body in the patient’s body, which are then resorbed in the patient’s body. Such implantable cassettes with brackets differ from the designs of the cassettes of the prior art, which remain in the working tool and are removed from the body with it. Such “removable” staple cassettes typically include staple ejector components and therefore can be significantly larger than the work tools that make up the subject of the present invention, which are adapted to use unique innovative implantable staple cassettes with specific staples of the present invention.

In various embodiments, the working tool 12 is configured to connect to an elongated barrel assembly 40 that protrudes from the handle assembly 100. The working tool 12 (in the closed state) and the elongated barrel assembly 40 may have similar cross-sectional shapes and sizes that allow functional passage through the tube trocar or working channel of another form of access instrument. As used herein, the term “pass through functionally” means that a working tool and at least a portion of an elongated stem assembly can be inserted through a channel or opening of a tube and can be manipulated within them in a manner that is necessary to conduct a surgical tissue stitching procedure. In some embodiments, when the jaws 13 and 15 of the working tool 12 are in a closed position, they can give the working tool an approximately circular cross-sectional shape, which facilitates its passage through a circular hole or channel. However, the working tools of various embodiments of the present invention, as well as embodiments of an elongated barrel assembly, may have other cross-sectional shapes that can be differently drawn through access channels and openings having a non-circular cross-sectional shape. Thus, the total cross-sectional dimension of the working tool in the closed position is related to the size of the channel or hole through which it is intended to be introduced. Thus, for example, a work tool can be designated as a work tool “5 mm in size”, which means that it can be functionally passed through an opening that has a diameter of at least about 5 mm.

In various embodiments of the present invention, the elongated barrel assembly 40 may have an external diameter substantially matching the external diameter of the working tool 12 in the closed position. For example, a 5 mm working tool can be connected to an elongated barrel assembly 40 with a cross-sectional diameter of 5 mm. However, as the following detailed description is presented, it will become clear that various embodiments of the present invention can be effectively used in connection with different sized tools. For example, a 10 mm working tool can be attached to an elongated barrel with a cross-sectional diameter of 5 mm. Conversely, for applications in which there is a channel or access hole of 10 mm or more in size, the elongated barrel assembly 40 may have a cross-sectional diameter of 10 mm (or more), but can also drive a working tool of 5 mm or 10 mm in size. Accordingly, the outer barrel 40 may have an outer diameter equal to or different from the outer diameter of the working tool 12 mounted thereon in the closed position.

As shown in the figures, the elongated barrel assembly 40 extends distally from the handle assembly 100 in a substantially straight line and forms a longitudinal axis A-A. For example, in various embodiments, the elongated barrel assembly 40 may have a length of approximately 229-406 mm (9-16 inches). However, the elongated barrel assembly 40 may have a different length and, in other embodiments, may be articulated or otherwise configured to facilitate pivoting of the working tool 12 relative to other parts of the barrel assembly or handle, as described in more detail below. In various embodiments, the implementation of the elongated shaft assembly 40 includes a pin 50 that extends from the handle assembly 100 to the working tool 12. At the proximal end of the elongated channel 14 of the working tool 12 there are a pair of protruding locking supports 17, the size of which allows them to enter appropriate receiving holes or sockets 52 at the distal end of the pin 50 to enable removable connection of the working tool 12 with the node of the elongated barrel 40. The pin 50 can be made, for example, of 6061 or 7075 aluminum alloy, stainless steel, titanium, etc.

In various embodiments, the handle assembly 100 comprises a pistol-type housing that, for ease of assembly, may be made of two or more parts. For example, the handle assembly 100 shown in the figures includes the right side of the body 102 and the left side of the body 104 (FIGS. 5, 7 and 8) cast or otherwise made of a polymer or plastic material and made to mate together. Such parts of the housing 102 and 104 can be attached to each other using latches, pins and sockets, molded or otherwise formed in them, and / or glue, screws, etc. The pin 50 has a proximal end 54 on which a flange 56 is formed. The flange 56 is rotatably mounted in a groove 106 formed by mating ribs 108 that protrude inwardly from each of the parts of the housing 102 and 104. This design facilitates the fastening of the pin 50 on the handle assembly. 100, allowing the trunnion 50 to rotate relative to the handle assembly 100 around the longitudinal axis AA by 360 °.

As further shown in FIG. 1 and 4, the trunnion 50 extends through and is supported by a mounting sleeve 60, which is rotatably mounted on the handle assembly 100. The mounting sleeve 60 has a proximal flange 62 and a distal flange 64, which form a groove for rotation 65, configured to receive the nose 101 knot assembly 100 rotatably. This design allows the mounting sleeve 60 to rotate around the longitudinal axis AA relative to the handle assembly 100. The pin 50 is fixedly mounted to the mounting sleeve 60 using a pin of the pin 66. In addition, a rotary handle 70 is also mounted on the mounting sleeve 60. For example, in one embodiment, the rotary handle the handle 70 has a hollow portion of the mounting flange 72, the size of which allows the portion of the mounting sleeve 60 to be received. In various embodiments, the rotary handle 70 may be made, for example, of nylon, poly of carbonate, Ultem® material, etc., reinforced with fiberglass or carbon fiber, and is also fixed to the mounting sleeve 60 with a pin pin 66. In addition, a forward projecting restriction flange 74 formed with the possibility of passage into the radial a groove 68 formed on the mounting sleeve 60. Thus, the surgeon can rotate the pin 50 (and the working tool 12 mounted thereon) around the longitudinal axis AA by 360 ° by gripping the rotary handle 70 and rotating it relative to the handle assembly 100.

In various embodiments, the stop 20 is held open by the spring of the stop 21 or other biasing structure, as shown in FIG. 1, 9A, 10A and 11A. The stop 20 is adapted to be selectively moved from an open position to various closed or locking and working positions by a cutting-stitching system essentially referred to as element 109. The cutting-stitching system 109 includes a “working element” 110, which in various embodiments represents a hollow working tube 110. The hollow working tube 110 is made with the possibility of axial movement along the axle 50 and thus forms the outer part of the elongated barrel assembly 40. The working tube 110 can be It is made from a polymer or other suitable material and can have a proximal end 112 attached to the shutter crosspiece 114 cutting-crosslinking system 109. See. FIG. 4. For example, in various embodiments, the trigger beam 114 may be fabricated using multi-component molding at the proximal end 112 of the working tube 110. However, other fastener structures may be used.

As shown in FIG. 1 and 4, the trigger beam 114 can be rotatably supported in a support sleeve 120 configured to axially move in the handle assembly 100. In various embodiments, the support sleeve 120 has a pair of laterally projecting ribs 122 thereof, the size of which allows them to slide in in the grooves under the ribs 103 and 105 formed on the right and left parts of the housing 102 and 104, respectively. See FIG. 7. Thus, the support sleeve 120 can axially slide in the housing of the handle 100, allowing the trigger beam 114 and the working tube 110 to rotate about it about the longitudinal axis A-A. As shown in FIG. 4, in the working tube 110 there is a longitudinal groove 111, allowing the pin of the pin 66 to pass through it into the pin 50, facilitating the axial movement of the working tube 110 along the pin 50.

The cutting-crosslinking system 109 further comprises a trigger 130, which controls the axial movement of the working tube 110 along the spigot 50. See FIG. 1. Such axial movement of the working tube 110 in the distal direction to the working interaction with the stop 20 in this document is called the "starting movement". As shown in FIG. 1, the trigger 130 is connected by a pivot pin 132 to the handle assembly 100 for displacement or pivoting. A torsion spring 135 is used to bias the trigger 130 away from a portion of the pistol grip 107 of the handle assembly 100 to an inactive “open”, or initial, position. As shown in FIG. 1 and 4, the trigger 130 has an upper portion 134 that is movably attached (with a pin) to the trigger rods 136, which are movably attached (with pins) to the support sleeve 120. Thus, the trigger 130 is moved from its initial position (FIG. . 1 and 9) in the direction of the final position near the part of the pistol grip 107 of the handle assembly 100 (FIG. 14) will cause the trigger beam 114 and the working tube 110 to move in the distal direction DD. Moving the trigger 130 in the direction from the pistol grip part 107 of the handle assembly 100 (under the action of the biasing force of the torsion spring 135) will move the trigger beam 114 and the working tube 110 in the proximal direction PD along the axle 50.

You can use various embodiments of the present invention with implantable cassettes with brackets of various sizes and configurations. For example, the surgical instrument 10, when used in combination with the first trigger adapter 140, can be used with a working tool 12 of size 5 mm and a length of approximately 20 mm (or another length) that supports an implantable cassette with brackets 30. This size of the working tool may be particularly suitable , for example, to perform relatively thin dissecting and vascular operations. However, as described in more detail below, surgical instrument 10 can also be used, for example, in combination with working tools and cassettes with brackets of other sizes when replacing the first launch adapter 140 with the second launch adapter 150. In other embodiments, the elongated barrel assembly 40 may be made with the possibility of attaching to the working tool only one shape or size. In such embodiments, for example, the pressing surfaces 146 or 158 (typically located on the starting adapters 140 and 150, respectively) can be integral with the distal end of the working tube 110, depending on the particular size of the working tool for which it is intended to be used. .

As shown in FIG. 2, the first trigger adapter 140 is substantially hollow and has a first spring portion 142 that is configured to extend into the open distal end 116 of the working tube 110. A first protrusion of the retainer 144 is formed on the first spring portion 142, the size of which allows it to fit into the existing the distal end of the working tube 110, the hole of the retainer 117. See FIG. 1 and 2. Thus, to disconnect the first start adapter 140 from the working tube 110, the user simply presses the tab of the latch 144 until it comes out of the hole of the latch 117 and pulls the first start adapter 140 out of the working tube 110. As also shown in FIG. 2, the first starting adapter 140 has an internal pressing surface 146 that is configured to interact with the assembly of the forked inclined surface 24 of the stop 20.

In various embodiments, the implementation of the node forked inclined surface 24 on the abutment 20 contains a pair of teeth 45, separated by a groove for receiving the blade (not shown). Each tooth 45 has a proximal surface 27 that is substantially parallel to the bottom of the elongated channel 14 when the stop 20 is in the closed position. Then, the proximal surface 27 passes into the inclined surface of the fixation 28, distal with respect to the proximal surface 27. See FIG. 3. The inclined surface of the fixation 28 is oriented at an angle of fixation A relative to the proximal surface 27. For example, in various embodiments, the angle of fixation A can be in the range from about 15 to 30 degrees. As described in more detail below, when the first pressing surface 146 of the first starting adapter 140 is in contact with the inclined fixing surface 28, the stop 20 moves in the direction of the elongated channel 14, and more specifically in the direction of the cassette with brackets 30 located therein. When the first starting adapter is further moved 140 distally the first pressing surface 146 is in contact with the inclined surface to form brackets 29 on each of the teeth of the stop 45 to further push the stop 20 towards the cassette with brackets 30 to form the brackets 32 contained therein. As also shown in FIG. 3, the inclined surface for forming the staples 29 is oriented at an angle of the surface of the formation B relative to the inclined surface of the fixation 27. For example, in various embodiments, the angle of the surface of the formation of B can be in the range of about 5 to 20 degrees. The inclined surface assembly 24 of the stop 20 may further comprise a lower inclined surface 25 (for example, the angle C may be in the range of about 5 to 40 degrees), so that when the stop 20 is in the open position, the lower inclined surface 25 allows the stop 20 to rotate to the limit angle open state 15 ° (angle β in FIG. 11A).

The method of removable connection of the working tool 12 with the trunnion 50 will be described below. The connection process begins with the insertion of the fixing supports 17 on the elongated channel 14 into the receiving sockets 52 in the trunnion 50. Then, the surgeon moves the trigger 130 to the pistol grip 107 of the handle assembly 100 to advance the working tube 110 and the first start adapter 140 distally along the proximal end portion 47 of the elongated channel 14 so as to fix the supports 17 in the corresponding sockets 52. See FIG. 10 and 10A. This position of the first start adapter 140 above the supports 17 is referred to herein as the “connected position”. In various embodiments of the present invention, it is also possible to use the lock of the working tool 160 to lock the trigger 130 in the desired position after attaching the working tool 12 to the pin 50.

More specifically and taking into account FIG. 5, 7, and 8, one embodiment of the fixation assembly of the working tool 160 includes a locking pin 162 supported to move in the upper portion 134 of the trigger 130. The locking pin 162 is pressed against the left side of the housing 104 by a locking spring 166. When the trigger 130 is in the inactive (initial) position, the locking pin 162 is shifted all the way to the stopper of the initial position 163, which protrudes inward from the left side of the housing 104. See FIG. 7 and 8. As described above, the working tube 110 must first be moved distally to the connected position, in which the first trigger 140 holds the fixing supports 17 of the working tool 12 in the receiving sockets 52 in the pin 50. The surgeon pushes the trigger adapter 140 distally to the connected position by pulling the trigger 130 from the initial position in the direction of the pistol grip 107. When the trigger 130 is initially activated, the locking pin 162 slides against the stopper of the initial position 163, until Static preparation tube 110 does not advance the first starting adapter 140 to the connected position, at which point the locking pin 162 moves into the cavity retainer 164 formed in the left housing portion 104. See. FIG. 8. In various embodiments, when the locking pin 162 enters the cavity of the latch 164, the pin 162 may make a distinctive “click” or other sound, as well as provide the surgeon with a tactile signal that the working tool 12 is fixed to the trunnion 50. In addition, the surgeon does not may inadvertently continue activating the trigger 130 to start forming the brackets 32 in the working tool 12 without deliberately displacing the locking pin 162 from the cavity of the retainer 164. Similarly, if the surgeon releases the trigger 130 in the connected position, it is held in this position by the locking pin 162, not allowing the trigger 130 to return to its original state and thereby disconnect the working tool 12 from the pin 50.

In various embodiments, on the left side of the housing 104 of the handle assembly 100 there is a release button for the trigger hook 167, allowing the surgeon to purposefully release the locking pin 162 and to provide either further activation of the trigger hook 130 or its return to its original position. See FIG. 5, 7 and 8. The release button of the trigger 167 is mounted to move in the cavity of the latch 164 and spring loaded to an inactive position (FIG. 8). When you press the release button of the trigger 167 inward, it is in contact with the locking pin 162 and removes it from the cavity of the latch 163, allowing further activation of the trigger 130.

As described, surgical instrument 10 can be used as a gripping device for regulating / placing tissue. Further movement of the trigger 130 in the direction of the pistol grip part 107 after releasing the hook 130 from the lock (by pressing the release button of the trigger 167) will cause the trigger adapter 140 to come into contact with the inclined surface of the lock 28 on the stop 20. When the portion of the pressing surface 146 of the first trigger adapter on the inclined surface of the fixation 28, the emphasis moves in the elongated channel 14 in the direction of the cartridge with brackets 30. Thus, the surgeon can move the emphasis 20 in the direction of the cartridge with brackets 30 and away from e to capture and release captured between them tissue without the formation of staples.

Various embodiments of the present invention may further include a locking button for the cutting-stapling system 137, which is pivotally mounted on the handle assembly 100. See FIG. 1 and 4. In one form, the lock button of the cutting-stapling system 137 has a retainer 138 formed at the distal end and oriented to engage the trigger beam 114 when the release button of the trigger is in the first locking position. As shown in FIG. 1 and 4, the locking spring 139 is used to shift the lock button of the cutting-stapling system 137 to the first locking position (FIGS. 11 and 12). As will be described in more detail below, the latch 138 is used to engage the trigger beam 114 at a point where the position of the trigger beam 114 on the pin 50 corresponds to the point at which the pressing surface 146 of the first trigger adapter 140 is ready to begin to move distally up the inclined surface of the locking 28 of the stop 20. It should be understood that when the first start adapter 140 moves axially upward along the inclined surface of the fixation 28, the stop 20 moves along such a path that part of the forming bracket ti 22 remains substantially parallel to the upper side 36 of the staple cartridge 30.

After connecting the working tool 12 with the pin 50, the process of forming the brackets begins, the first stage of which is pressing the lock button of the cutting-stapling system 137 to ensure further movement of the trigger beam 114 distally along the pin 50 and ultimately pressing the stop 20 into the cassette with brackets 30. See FIG. 13. After pressing the lock button of the cutting-stapling system 137, the surgeon continues to press the trigger 130 in the direction of the pistol grip 107, feeding the pressing surface 146 of the first trigger adapter 140 upward along the corresponding inclined surface to form the brackets 29 to bring the stop 20 into forming contact with staples 32 in the cassette with staples 30. The fixation button of the cutting-stapling system 137 protects against inadvertent formation of staples 32 until the surgeon is ready to begin this process. In this embodiment, the surgeon must press the lock button of the cutting-stapling system 137 to enable further activation of the trigger 130 to start the stapling process.

If desired, the surgical instrument 10 can be used exclusively as a device for stitching tissue. However, various embodiments of the present invention may also include a tissue dissection system substantially designated as element 170. In at least one form, tissue dissection system 170 includes a scalpel 172 that can be selectively advanced from an inactive position near the proximal end of the working tool 12 (FIGS. 1 and 9-13) to the activated position (FIG. 14) by pressing the trigger to advance the scalpel 200. The scalpel 172 is supported with the ability to move in the journal 50 and beyond replay on a rod 180 of a scalpel or otherwise protrudes therefrom. The scalpel 172 can be made, for example, of stainless steel type 420 or 440 with a hardness higher than 38 HRC (Rockwell hardness, scale C) and can have an edge for cutting tissue 176 at its distal end 174, and can also be made with the possibility of sliding passing through the groove 31 at the stop 20 and the centrally located groove 33 in the cassette with brackets 30 for dissecting the tissue, clamped in the working tool 12. See FIG. 14A. As shown in FIG. 4, the scalpel shaft 180 passes through the trunnion 50 and has a proximal end portion 182. The proximal end portion 182 interacts with the possibility of transmitting a drive force with a gear drive of the scalpel 190, which is functionally attached to the trigger mechanism for moving the scalpel 200. In various embodiments, the trigger mechanism the scalpel 200 is attached to the pivot pin 132 so that it can rotate or otherwise be activated without pressing the trigger 130. In various versions for implementation, the first gear drive of the scalpel 192 is also fixed on the hinge pin 132, so that activation of the trigger mechanism for moving the scalpel 200 also rotates the first gear drive of the scalpel 192. Between the first gear of the scalpel 192 and the handle housing 100, a trigger return spring 20 is fixed, biasing trigger for moving the scalpel 200 to its initial, or inactive, position. See FIG. 1 and 4.

As shown in FIG. 5 and 6, various embodiments of the gear transmission of the scalpel drive 190 also include a second scalpel drive gear 194 that is rotatably mounted on the spindle of the second gear 193 and engaged with the first scalpel drive gear 192. The second scalpel drive gear 194 is in meshing with the third gear drive of the scalpel 196, which is mounted on the spindle of the third gear 195. Also on the spindle of the third gear 195, the fourth gear of the scalpel drive 198 is installed. The fourth gear the scalpel drive 198 is adapted to engage with the transmission of a driving force to a series of ring teeth or rings 184 at the proximal end of the scalpel shaft 180. Thus, this design allows the fourth gear of the scalpel drive 198 to axially push the scalpel shaft 180 in the distal direction DD or the proximal direction PD, allowing the scalpel 180 to rotate around the longitudinal axis AA relative to the fourth gear of the scalpel drive 198. Accordingly, the surgeon can axially advance the trigger rod 180 and ultimately the scalpel 172 distally by pulling the trigger to advance the scalpel 200 towards the pistol grip 107 of the handle assembly 100.

Various embodiments of the present invention further include a scalpel fixation system 210 that prevents the scalpel 72 from advancing until the trigger 130 is fully engaged (FIGS. 13 and 14). Thus, this design feature prevents the scalpel advancement system 170 from triggering until the braces are first applied or formed in the tissue. As shown in FIG. 1, various embodiments of a scalpel fixing system 210 comprise a scalpel retainer 211 that is pivotally mounted in a portion of the pistol grip 107 of the handle assembly 100. The scalpel retainer 211 has an activating end 212 that is engageable with a trigger 130 when the trigger 130 is in the fully activated position. In addition, at the other end, the scalpel retainer 211 has a locking hook 214 adapted to engage the retainer shaft 216 on the first gear of the scalpel 192. The scalpel 218 fixation spring is designed to bias the scalpel 211 into a fixed position in which the fixing hook 214 is in engages with the latch pin 216 and prevents the trigger of the scalpel 200 from being actuated until the trigger 130 is fully engaged . See FIG. 9.

Further with reference to FIG. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14, and 14A, various methods are described for working with at least one embodiment of a surgical instrument of the present invention. How can it become clear after studying FIG. 1, 9 and 9A, when the scalpel holder 172 is in the “starting” position shown in the figure (before stapling), the edge for dissecting the tissue 176 is located proximally to the distal end of the first trigger adapter 140, so that the sharp edge for dissecting the tissue 176 closed by user. In alternative embodiments in which an elongated stem assembly is made for use with a working tool of only one shape or size (for example, when trigger adapters 140 and 150 are not used), the edge for dissecting tissue 176 of scalpel holder 172 may be proximal to the distal the end of the working tube, so that in such embodiments, the edge for cutting tissue 176 is also closed from the user.

In FIG. 9 and 9A, the working tool 12 is shown after it is attached to the pin 50 by inserting the fixing supports 17 on the working tool 12 into the receiving sockets 52 on the pin 50. In FIG. 9 shows that the trigger 130 is in the initial position, or in the position before stapling, and the working tool 12 is not yet attached to the pin 50 with the first trigger adapter 140. Arc P _O shows the distance that the trigger 130 can go as the first trigger adapter 140 begins to rise along a portion of the inclined surface of the fixation 28 of the abutment 20. The trigger mechanism for advancing the scalpel 200 is also in a locked position until the brackets are applied.

In FIG. 10 and 10A show the position of the trigger 130 after moving it to a position where the working tool 12 is fixed to the pin 50 by the first trigger adapter 40. This position is referred to herein as a connected position. When moving to the connected position, the locking pin 162 clicks into the cavity of the latch 164 (FIG. 8), thereby creating a sound and tactile confirmation for the surgeon that the working tool 12 is fixed on the pin 50. Further trigger release 130 is not possible until then until the surgeon purposefully presses the release button of the trigger 167 (FIGS. 5, 7 and 8) to withdraw the locking pin 62 from the cavity of the retainer 164. The distance traveled by the distal end 141 of the first trigger adapter 140 is shown as the distance l (FIG. 10A), and the corresponding distance traveled by the trigger beam 114 in the spigot 50 is shown as the distance l '. In FIG. 11 and 11A show the position of the trigger 130 after pressing the release button (not shown) and the surgeon activates the trigger 130 to move the first trigger adapter 140 to the beginning of the inclined surfaces of the locking 28 on the stop 20. As shown in these figures, the spring of the stop 21 has shifted emphasis 20 in the open position. The distance traveled by the distal end of the first trigger adapter 140 is shown as the distance l ₁ , and the corresponding distance traveled by the trigger beam 114 on the pin 50 is shown as the distance l ' _1. In FIG. 12 and 12A show the position of the first start adapter 140 after it moves to the beginning of the inclined surface to form the staples 29 of the stop 20. This position corresponds to the maximum degree of tissue fixation that can be achieved before the staples are formed. This position is referred to herein as the “maximum hold position”. As shown in FIG. 12, the yoke 114 contacts the latch 138 on the release button of the trigger 137 and therefore cannot be further distally advanced until the release button of the trigger 137 is pressed. As shown in FIG. 12A, the staple-forming surface 22 of the stop 20 is substantially parallel to the upper side 31 of the cassette 30 with brackets 30. The distance between the part for forming the staples 22 of the stop 20 and the upper bounding surface of the elongated channel 14 is shown as C _max . In various embodiments, the implementation of the distance C _max can be, for example, from 2.15 to 3.65 mm (approximately from 0.085 to 0.144 inches) for cassettes with brackets 30 with parts of the housing 31, which have a substantially equivalent thickness. For example, in at least one embodiment, the thickness of the cartridge may be approximately 0.25-0.76 mm (approximately 0.01-0.03 inches) larger than the size of the bracket. The total distance traveled by the first trigger adapter 140 when moving from the starting position to the maximum latched position is shown as the distance l ₂ , and the corresponding distance traveled by the trigger beam 114 on the pin 50 is shown as the distance l ' _2. In FIG. 13 and 13A show the position of the trigger beam 114 in the fully activated position after the brackets 32 are completely formed in the cassette with the brackets 30. In this position, the distance between the part for forming the brackets 22 of the stop 20 and the upper bounding surface of the elongated channel 14 is shown as C _min . In various embodiments C _min, the distance can be, e.g., from about 0.38 mm to 0.76 mm (from about 0.015 to 0.030 inches) for cassettes with brackets, supporting brackets, which have legs unshaped condition a length n from about 1.90 mm to 3.40 mm (from about 0.075 to 0.134 inches) (UF distance in FIG. 1A), and in a fully formed state, have a height, for example, from about 0.63 mm to 1.01 mm ( from approximately 0.025 inches to 0.04 inches), which is the FF distance in FIG. 1D. The total distance traveled by the first trigger adapter 140 when moving from the starting position to this fully activated position is shown as the distance l ₃ , and the corresponding distance traveled by the trigger beam 114 on the pin 50 is shown as the distance l ' _3. As also shown in FIG. 13, the trigger 130 is in the fully activated position and is in contact with the activating end 212 of the scalpel retainer 211 to disengage the retaining hook 214 with the retainer rod 216 on the first gear gear of the scalpel 192.

Dissection, in particular vascular dissection, may be one of the most stressful stages of any surgical procedure. During a laparoscopic operation, the voltage may be even greater, since in case of failure it may be necessary to transfer the entire procedure almost immediately to an open operation to prevent catastrophic consequences. Thus, it may be desirable to use a surgical stapling instrument that has the optional ability to dissect tissue after stapling. Various embodiments of the present invention satisfy such needs.

After applying (forming) staples in the target tissue, the surgeon can press the release button of the trigger 167 to allow the trigger 130 to return to its original position under the action of the torsion spring 135, which allows the stop 20 to move to the open position under the action of the spring 21. When the tool is in the open position, the surgeon can remove the working tool 12 from the patient’s body, leaving an implantable cassette with brackets 30 and brackets 32 in it. In those applications where the working tool was inserted into the patient’s body through the opening, working channel, etc., the surgeon needs to abutment 20 back into the closed position by pressing the trigger 130, to allow removal of the tool through hole 12 or the working channel. However, if the surgeon wants to dissect the target tissue after stapling, the surgeon activates the trigger to advance the scalpel 200 as described above to push the scalpel holder 72 through the target tissue to the end of the working tool, as shown in FIG. 14 and 14A. In FIG. 14 shows the degree of movement of the trigger for moving the scalpel 200 in various embodiments when using working tools / cartridges with brackets of different lengths, while the holder of the scalpel 72 is advanced in the working tool 12 to a fully activated position. After that, the surgeon can release the trigger mechanism for advancing the scalpel 200, which will allow the return spring of the trigger mechanism 202 through the gear system to return the holder of the scalpel 72 to its original (before stapling) position (FIGS. 13 and 13A). After the scalpel holder 72 returns to its original position, the surgeon can open the jaws of the working tool 13 and 15 to release the implantable cartridge 30 in the patient’s body, and then remove the working tool 12 from the patient’s body. Thus, such surgical instruments that are the subject of the present invention facilitate the use of small implantable cassettes with brackets that can be inserted through the working channels and openings of a relatively small size, while allowing the surgeon to lay staples without dissecting the tissue or, if necessary, also dissecting the tissue after stapling.

As indicated above, the surgical tool 10 can be used in combination with other working tools that allow the use of cassettes with brackets of other sizes containing staples of a different size and quantity. In FIG. 15-19 show the process of using the working tool 12 ', which functionally supports a cassette with brackets 30', which contains larger brackets 32 'than brackets 32 in a cassette with brackets 30. For example, the brackets 32 in a cassette with brackets 30 may have a size approximately 2.03 to 2.15 mm (staples approximately 0.080-0.085 in.), while staples 32 'in the cassette with staples 30' can be approximately 1.90 mm (approximately 0.075 in). In various embodiments, the cassette with brackets 30 'is longer than the cassette with brackets 30. For example, the cassette with brackets 30 may have a length of approximately 20 mm (approximately 0.78 inches), while the cassette with brackets 30' may have a length of approximately 40 mm (approximately 1.57 inches). In FIG. 15 is an exploded view of the components of the working tool 12 ′, the second starting adapter 150, and the distal end 55 of the pin 50. As shown in FIG. 15, the elongated channel 14 'has a pair of lateral walls 16' spaced apart from each other, each of which has a groove or hole 18 ', the size of which allows the corresponding stop pin 26' to be received. The stop 20 'and the elongated channel 14' can together form a working tool 12 ', which has a common diameter that allows the working tool 12' to be guided through an opening that has a diameter of at least about 5.0 mm (about 0.20 inches). The stop 20 'also has a part for forming the staples 22', in which there are many recesses for forming the staples, as well as a node of the forked inclined surface 24 ', which protrudes proximally from it. At the proximal end 15 'of the elongated channel 14' there is a pair of protruding locking supports 17 ', the size of which allows them to enter the corresponding receiving sockets 52 at the distal end of the pin 50.

As shown in FIG. 15, the second start adapter 150 has a part of the substantially hollow body 151 and a part of the proximal sleeve 152, in which there is a protrusion of the latch 154 protruding inwardly. Between the body part 151 and the part of the proximal sleeve 152 there is a groove 156 that allows to move the part of the sleeve 152 relative to the body part 151 to facilitate the insertion of the protrusion of the latch 154 into the hole of the latch 117 of the working tube 110. To disconnect the second starting adapter 150 from the working tube 110, the surgeon presses a part of the proximal sleeve 152 to withdraw the protrusion of the latch 154 from the fixation hole torus 117, allowing you to pull the second starting adapter 150 distally from the working tube 110.

In various embodiments, the stop 20 ′ has a bifurcated inclined surface 24 ′ assembly that comprises a pair of teeth 45 ′, each of which has a proximal surface 27 ′ that extends into an inclined fixation surface 28 ′ distal to the proximal surface 27 ′. See FIG. 15. The inclined surface of the fixation 28 'is oriented at an angle A' relative to the proximal surface 27 '. For example, in various embodiments, the angle A ′ may be in the range of about 50 to 30 degrees. As described in more detail below, when the second pressing surface 158 of the second starting adapter 150 is in contact with the inclined fixing surfaces 28 ', the stop 20' moves in the direction of the elongated channel 14 ', more specifically in the direction of the cassette with brackets 30' therein. See FIG. 17. With further movement of the second starting adapter 150 distally, the second pressing surface 158 contacts the inclined surfaces to form the staples 29 'on each of the teeth of the stop 45 to further push the stop 20' in the direction of the cartridge with staples 30 'to form the staples 32' . See FIG. 18. The inclined surface for forming the staples 29 'is oriented at an angle B' with respect to the inclined fixation surface 27 '. For example, in various embodiments, the angle B ′ may range from about 5 to 20 degrees. Between the node of the inclined surface 24 'and the bottom of the elongated channel 14', a spring (not shown) can be provided to move the stop 20 'to the open position.

In FIG. 16 shows the position of the second trigger adapter 150 after the surgeon advanced the second trigger adapter 150 distally to the beginning of the portion of the inclined fixation surface 28 '. The operation of the second trigger adapter 150 is controlled by the trigger 130 in the manner described above with respect to the first trigger adapter 140. In FIG. 17 shows the position of the second trigger adapter 150 in the fully locked position. In FIG. 18 shows the position of the second start adapter 150 in the fully activated position after the brackets 32 'are fully formed in the cassette with brackets 30' through a fixed tissue (not shown in the figure).

As indicated above, the length of the implantable cassette with brackets 30 'exceeds the length of the implantable cassette with brackets 30. Thus, as shown in FIG. 15, the working tool 12 'also includes a distal scalpel 124, which is supported to move in the elongated channel 14'. The distal scalpel 124 has an edge for dissecting tissue 125 and a proximal portion 126 capable of engaging with the scalpel holder 72. Thus, if the surgeon needs to dissect the tissue after stapling, the surgeon activates the trigger 200, as described above, to eject the scalpel holder 172 distally until contact with the distal scalpel 124 and expulsion of the distal scalpel 124 through the tissue, as shown in FIG. 19. The distal scalpel 124 may have at least one fixing part, made with the possibility of sliding along the groove of the corresponding shape (not shown in the figure) in the elongated channel 14 '. This design allows you to open the working tool 12 'after applying staples and dissection of the fabric. The distal scalpel 124 remains in the abutment 20 'and is removed together with the working tool 12' from the patient’s body.

Thus, in various embodiments of the surgical instrument 10, there are separate mechanisms for stitching and dissecting the tissue, so that the surgeon can stitch the tissue without having to dissect it. Various embodiments of the stapling tool, which is the subject of the present invention, can be successfully used with working tools of various sizes, made with the possibility of applying staples of different sizes and in different quantities. Surgical instruments can be supplied in the form of a kit, which includes an instrument 10, a first starting adapter 140 and a second starting adapter 150, which allows the tool to be used for applying staples from implantable cassettes of different sizes.

In various unique and innovative embodiments of the present invention, a compressible cassette with brackets is used in which the brackets are supported in a substantially stationary position to form contact with the stop. Unlike prior art surgical suturing instrument designs that use ejector staples, staples in cassettes of various embodiments of the present invention are not ejected toward the stop. In various embodiments, the emphasis is on unformed braces. The degree of staple formation achieved in this case depends on how far the stop is brought into contact with the staples. Such constructions allow the surgeon to adjust the forming or imposing force applied to the brackets and thereby change the final height of the formed braces.

In various embodiments, the trigger movement applied to the emphasis made with the possibility of movement depends on the force of pressing the trigger. For example, if the surgeon wants to receive only partially formed staples, the trigger is only partially fed inward towards the pistol grip 107. To achieve the formation of staples, the surgeon simply additionally presses the trigger, which leads to a more advanced movement of the stop into forming contact with the brackets . As used herein, the term “forming contact” means that the staple-forming surface or recesses for forming the staples are in contact with the ends of the staple legs and the legs begin to form or bend to bring them into the formed position. The term "degree of formation of staples" means the extent to which the legs of the staples are bent, and ultimately refers to the height of the formed staples, as described above. It will also be clear to those skilled in the art that, since the stop 20 moves substantially parallel to the cassette with the brackets when starting forces are applied to it, the brackets are formed substantially simultaneously with the substantially equal height of the formed brackets.

In FIG. 20-23, an alternative surgical instrument 10 is provided in which a bracket height indicator assembly 220 is used. In various embodiments, the bracket height indicator assembly 220 includes an indicator pointer 222 that is pivotally mounted to the top of trigger 134 130 with it. When the trigger 130 is turned in the direction of the pistol grip part 107 of the handle assembly 100 to press the stop 20 against the cassette with the brackets 30, as indicated above, the indicator pointer 222 can be seen through the window 223 on the left side of the housing 104. In this embodiment, the bracket height indicator assembly 220 also includes a series of locking recesses 24, 26 and 28, made on the left side of the housing 104 and corresponding to the three stages of the formation of brackets. In particular, after the initial activation of the trigger 130, the locking pin 162 slides against the stopper of the initial position 163 until the working tube 110 moves the trigger adapter 140 or 150 to the above locking position, and at this moment the locking pin 162 goes into the cavity of the latch 164 provided on the left side of the housing 104. When the surgeon needs to close the jaws 13 and 35 of the working tool 12, he presses the release button of the trigger 167, providing further activation of the trigger 130. When pressed and on the release button of the trigger 167 inward, it contacts the locking pin 162 and leads it out of the cavity of the lock 163, providing activation of the trigger 130. As described above, then the surgeon can use the upper and lower branches 13 and 15 of the working tool 12, respectively for gripping and working with fabric. When the surgeon needs to start the process of forming the staples, he presses the release button of the trigger 167, providing advancement of the trigger beam 114 distally with further pressing the trigger 130.

Further advancement of the trigger 130 brings the stop 20 into forming contact with the brackets 32 of the cassette with the brackets 30. When the trigger 130 is pressed further, the flat end 165 of the locking pin 162 slides off from the stopper of the initial position 163 and contacts the first stopper 224, which corresponds to the first degree of formation brackets, which is represented by the first symbol of the height of the brackets 230 on the left side of the housing 104. See FIG. 20. As shown in the figure, the first symbol of the height of the staples 230 contains the image of the bracket at the beginning of the formation. Other symbols or scales can be used to indicate this stage of staple formation. When the first stopper 224 is engaged, the locking pin 162 may make a click that is heard by the surgeon. The engagement of the first stopper 224 with the fixing pin 162 can also be accompanied by the formation of some tactile feedback to the surgeon using the trigger 130. In addition, the indicator of the height indicator of the bracket 222 can be seen in the viewing window 223 next to the first symbol of the height of the bracket 230. If the surgeon needs to continue forming staples 32 in the cassette with staples, it disengages the locking pin 162 from the first stop 224 using the release button 240 provided on the second part of the handle 104. For example, in various embodiments In implementation, the release button 240 may be integral with the left side of the housing 104, while its hinge portion 242 is part of the left side of the housing 104. This design allows the release button 240 to be pressed all the way to the end 165 of the locking pin 162 to engage it from any from the first, second and third stoppers 224, 226 and 228. After the locking pin 162 is pulled out of the first stopper 224, the trigger 130 can be pushed further until the locking pin 162 engages the second stopper to form the brackets 226. This The e position of the trigger 130 will further move the stop 20 into the staple contact with the brackets 32 in the cassette with the brackets 30. The locking pin 162 again clicks into the second stopper to form the brackets 226, giving the surgeon a sound and tactile feedback that the trigger 130 is in the second position of the formation of the staples. In this position, the bracket height indicator 222 can be seen in the viewing window 223 and can be located next to the second bracket height symbol 232. If the surgeon needs to continue forming brackets 32 in the cassette with brackets 30, he removes the locking pin 162 from the second stopper 226 using release buttons 240. Then, the trigger 130 can be pushed further until the locking pin 162 engages a third stop to form the brackets 228 corresponding to the last stage of the formation of the brackets. The locking pin 162 again clicks into the third stop to form the brackets 228, giving the surgeon an audible and tactile feedback that the trigger 130 is in the third position of the brace formation. In this position, the bracket height indicator 222 can be seen in the viewing window 223 and can be located next to the bracket height symbol 234. After the brackets are formed, the surgeon can slide the locking pin 162 from the third stop to the required extent to form the brackets 228 to allow the trigger to return 130 in the starting position. Or, if necessary, the surgeon can begin dissecting the tissue, as described above, before returning the trigger 130 to its original position.

In FIG. 24 illustrates an alternative embodiment in which the bracket-height indicator assembly, essentially shown as element 220 ', does not include a series of stoppers that correspond to different degrees of staple formation. However, such an embodiment includes a bracket height indicator 222 and a viewing window 223. Thus, the surgeon can monitor the degree of staple formation achieved by observing the position of the bracket height indicator 222 through the viewing window 223. Such an embodiment includes height indicating symbols staples 230, 232 and 234 as described above. In addition, such an embodiment may also include the symbol of the unformed bracket 229, which corresponds to the initial position in which the formation of the brackets 32 with the stop 20 has not yet begun. Otherwise, such an embodiment works in the same way as described above.

In FIG. 25 and 26, an alternative working tool 12 ″ is provided, similar to the working tool 12 ′ described above, except for the following differences, which are able to accommodate the scalpel holder 172 ′. The scalpel holder 172 'is connected to or protrudes from the stem of the scalpel 180 and otherwise functions in the manner described above with respect to the scalpel holder 172. However, in this embodiment, the scalpel holder 172' has a length sufficient to intersect the entire length of the working tool 12 ”, therefore a separate distal scalpel is not used in the 12 ”working tool. The scalpel holder 172 'has an upper transverse element 173' formed thereon and a lower transverse element 175 '. The upper transverse element 173 'is oriented so as to intersect with sliding the corresponding elongated groove 250 at the stop 20 ", and the lower transverse element 175' is oriented so as to intersect the elongated groove 252 in the elongated channel 14" of the working tool 12 ". A stop for a disengagement (not shown) is also provided in the stop 20 ”, so that when the scalpel holder 172 'is brought to its final position with a thin working tool 12”, the upper transverse element 173' falls out through the corresponding groove, allowing the stop to move 20 ”into the open position for the release of stitched and dissected tissue. Otherwise, the stop 20 ”may be identical to the stop 20 described above, and the elongated channel 14” may otherwise be identical to the elongated channel 14 described above.

In these embodiments, the stop 20 ”is shifted to the fully open position (FIG. 25) by a spring or other opening structure (not shown in the figure). The stop 20 ”is moved between the open and fully locking position by axial movement of the trigger adapter 150 as described above. After moving the trigger adapter 150 to the fully locking position (FIG. 26), the surgeon can advance the scalpel holder 172 ”distally as described above. If the surgeon needs to use the working tool as a gripping device for working with tissue, he can move the trigger adapter proximally to allow movement of the stop 20 "from the elongated channel 14", as shown by the dotted line in FIG. 27. In this embodiment, when moving the scalpel holder 172 ”distally, the upper transverse element 173 ′ and the lower transverse element 175 ′ bring the stop 20” and the elongated channel 14 ”together to achieve the desired staple formation as the scalpel 172” moves distally through the working tool 12 ". See FIG. 28. Thus, in this embodiment, the formation of the staples is carried out simultaneously with the dissection of the tissue, but the staples themselves can be formed sequentially as the holder of the scalpel 172 ”is distally extruded.

In FIG. 29 and 30 show the process of using a 12 ”tool with a 20” stop, which is made of, for example, stainless steel, titanium, PGA (polyglycolic acid) or other absorbable plastic, which has some flexibility. These figures also show the process of using the holding matrix 6250 and the alignment matrix 6206, which are described in detail below. As shown in FIG. 29, when pushing the scalpel holder 172 ”distally through the stop 20”, it bends to a fully formed position.

In many surgical applications, it is advisable or preferable to use a surgical dissecting and stapling instrument having a working instrument that can be pivotally rotated relative to the elongated stem assembly. However, for prior art articulated tools, access to hard to reach areas was often limited by the size and design of the elements used to articulate the working tool. In FIG. 31-40 show another embodiment of a surgical instrument constituting the subject of the present invention, which is capable of articulating rotation of a working instrument relative to an elongated barrel and has a relatively compact design of a control device for articulating articulation in the handle assembly.

The surgical instrument 310 of this embodiment is substantially similar to the various embodiments of the surgical instrument 10 described above, except that in this embodiment, the articulated barrel assembly 312 is used to facilitate the selective positioning of the working instrument 12 with respect to the elongated longitudinal axis AA. Although surgical is used herein tool 310 will be described for use with the working tool 12 of the above type, those skilled in the art will It is understood that the surgical instrument 310 can also be used with the second trigger adapter 150 to actuate the working tool 12 ' or other designs of the working tool. As shown in FIG. 31 and 32, the hinge barrel assembly 312 includes a distal portion of the barrel assembly 314 that is articulated to a proximal portion of the barrel assembly 316 that is operatively connected to the handle assembly 100. For example, in various embodiments, the distal portion of the barrel assembly 314 includes the distal element of the pin 320, which provides a pair of receiving sockets 322 for receiving the fixing supports 17. See FIG. 32. The distal member of the pin 320 has a proximal end 324, which includes a base of the hinge 326, from which the hinge pin 328 protrudes.

As shown in FIG. 32, the proximal portion of the stem assembly 316 includes a proximal segment of the pin 330 to which the proximal base of the hinge and a scalpel guide 332 are attached. The guide of the scalpel 332 can, for example, be welded to or attached to the proximal segment of the pin 330 with an adhesive or other fixation method. A hinge hole 334 is provided in the scalpel guide of the proximal base of the hinge 332, adapted to receive the hinge pin 328 rotatably, allowing the distal segment of the pin 320 to pivotally rotate relative to the proximal segment of the pin 330 around the first axis of the FA-FA hinge, which is essentially perpendicular to the longitudinal axis AA. Surgical instrument 310 further includes a distal segment of the working tube 370, which is pivotally coupled to a pair of rods of the working tube 380 and 382 for articulating movement about a second axis SA-SA. The distal segment of the working tube 370 has a latch hole 372 for receiving the protrusion of the latch 144 of the first starting adapter 140. A pair of rods of the working tube 380 and 382 are pivotally connected with the proximal working tube 390 for articulating movement about it about the third axis of the TA-TA hinge. See FIG. 32.

In various embodiments, the proximal working tube 390 is attached to a rotary handle 400, which is rotatably attached to the handle assembly 100. See FIG. 31, 38 and 39. The rotary handle 400 may be molded from a plastic or plastic material and may include a part of the coupling 402 and a part of the flange 404, which is located at some distance from the part of the coupling 402. The nose portion 101 of the handle assembly 100 is received between the part of the coupling 402 and part of the flange 404 and allows rotation of the rotary handle 400 relative to the handle assembly 100 around the longitudinal axis AA. In other embodiments, the rotary knob 400 may be made of other suitable materials. In the embodiment shown in the figures, both the proximal working tube 390 and the proximal segment of the journal 330 are fixed to the rotary handle 400 without being movable. As shown in FIG. 38 and 39, the proximal segment of the trunnion 330 and the proximal working tube 390 are fixed to the rotary handle 400 by a pin 406. Thus, the surgeon can rotate the working tool 12 relative to the handle body 100 360 ° around the longitudinal axis A-A by rotating the rotary handle 400.

As shown in FIG. 37, 38 and 40, in various embodiments, the working tool 12 can be selectively rotated about the longitudinal axis AA with a pair of hinge elements 420 and 430 attached to the distal base of the hinge 326 and the ball element of the hinge 440, which is rotatably supported in the socket 408 pivoting arm 400. In various embodiments, the hinge elements 420 and 430 may comprise, for example, rods made of stranded wire, nitinol, titanium, etc. The first, or right, hinge element 420 has a distal end 422 on which an eyelet 424 is formed, the size of which provides a snug fit in the hole for attaching the first rod 327, which is made in the distal base of the hinge 326. In a similar way, the second, or left, hinge the element 430 has a distal end 432, on which an eyelet 434 is made, the size of which ensures its tight fit into the hole for attaching the second rod 329, which is made in the distal base of the hinge 326. See FIG. 37. Thus, the working tool 12 can be pivotally rotated to the right around the first axis FA-FA (FIGS. 35 and 36) by pulling the first or right hinge element 420, and the working tool 12 can be pivotally rotated to the left around the first axis FA- FA by pulling on the second or left hinge element 430. In various embodiments, the right hinge element 420 can slide into the channel of the right thrust 336 formed in the proximal segment of the axle 330, and the left hinge element 430 can slide into the channel left channel Ki 338 in the proximal segment of the axle 330.

As shown in FIG. 38-40, the first hinge element 420 has a proximal end 426 with a pressed or otherwise secured locking ball 428, which is adapted to enter the first locking groove 442 in the ball element of the hinge 440, which is rotatably supported in the socket 401 of the pivot arm 400. Similarly, the second hinge element 430 has a proximal end 436 with a clamping ball 438 pressed or otherwise attached to it, which is adapted to enter the second locking ball a groove 444 in the ball element of the hinge 440. As most accurately shown in FIG. 40, a groove for driving device 446 extending through it is further provided in the ball joint member 440, which facilitates the unhindered passage of the proximal segment of the working tube 390 through it. As shown in FIG. 38, the groove of the actuator 446 may taper from the wider open portions 448 and 450 to the channel 452 in the center of the ball joint of the hinge 440, which provides a sliding passage of the proximal segment of the working tube 390. As described in more detail below, the ball element of the hinge 440 is rotatably supported or articulated rotation in the socket 401 and is configured to selectively move from a neutral position (shown in FIG. 38 by solid lines) to the first and second articulation control positions ( rendered in FIG. 38 in phantom). The ball element of the hinge 440 is also made with the possibility of axial movement in the socket 401.

As shown in FIG. 40, the surgical instrument 310 may include a locking structure, essentially referred to as element 453, for securing the ball joint of the hinge 440 in any of the neutral, first and second articulation control positions. In various embodiments, the locking structure 453 comprises a series of segments of locking stoppers 454 provided on the surface of the spherical hinge element 440 and configured to mate with locking ribs 410 formed in a recess 408 formed in a portion of the sleeve 402 and oriented in the region of the socket 401 of the rotary handle 400 A channel for the drive unit 412, which is aligned with the groove for the drive unit 446 of the ball joint element 440, passes through part of the sleeve 402 to ensure through them proximal segment of the working tube 390. As shown in FIG. 38 and 39, the spring of the ball joint member 456 rests on a portion of the spring retaining sleeve 414 of the rotary handle 400 to bias the ball joint member 440 proximally so that the locking stops 454 engage in locking engagement with the locking ribs 410 in the portion of the coupling 402.

To facilitate the application of pivoting movements to the spherical element of the hinge 440, a pair of laterally extending rotary arms 458 and 460 protrude from the spherical element of the hinge 440 in diametrically opposite directions. Ultem® material not reinforced or reinforced with fiberglass, carbon fiber, mineral fiber, etc., and may have 454 locking stoppers made by casting or machining running. The rotary arms 458 and 460 can be attached to the spherical element of the hinge 440 by tight fit, welding, etc. Such a locking structure allows the ball element of the hinge 440 to be fixed in any of the neutral, first and second positions of the hinge joint. After moving the ball joint element 440 to achieve the desired position of the articulation of the working tool, the surgeon can release the ball joint 440, thereby allowing the spring of the ball joint 456 to move the ball joint 440 proximally so that the locking stops 454 engage in locking engagement with the locking ribs 410 in part of the sleeve 402. In various embodiments, the spring size of the ball joint member 456 may be selected such that the ball joint member 440 may return to the neutral position by the action of the spring when the working tool rotated in the articulation is pulled with force through a trocar or similar hole. In addition, the use of rotary handles 458 and 460 allows you to adjust the degree of bending in the articulation in accordance with a specific surgical task.

As shown in FIG. 38, the first or right rotary handle 458 protrudes through the right groove 416 in the rotary handle 400, and the second, or left, rotary handle 460 protrudes through the left groove 418 in the rotary handle 400. To rotate the working tool 12 in the articulation relative to the longitudinal axis AA, the surgeon first axially moves the right and left rotary arms 458 and 460 in the distal direction DD to disengage the locking stops 454 and the locking ribs 410 on the part of the sleeve 402 of the rotary handle 400. The surgeon can then rotate the ball joint of the hinge 440 m moving the rotary arms 458 and 460 in the desired direction for applying rotary movements to the hinge elements 420 and 430. For example, the working tool 12 can be pivoted to the right by moving the right rotary handle 458 in the proximal direction PD and the left rotary handle 460 in the distal direction DD for applying a pulling movement (pivoting movement) to the right hinge element 420 and pushing motion to the left hinge element 430. Similarly, the working tool 12 can be return to the hinge to the left by moving the left pivot handle 460 in the proximal direction PD and the right pivot handle 458 in the distal direction DD to apply a pulling movement (pivoting movement) to the left hinge element 430 and pushing movement to the right hinge element 420. In FIG. 38, the dashed lines show different ranges of movements of the right and left hinge arms 458 and 460. Thus, the working tool 12 can be optimally positioned in various bent positions, for example, by bending clockwise or counterclockwise, without requiring rotation or other movement of the assembly the elongated barrel 40. In FIG. 35 shows an angle α, which in various embodiments can range from 0 ° to 45 °.

Various embodiments of a surgical instrument 310 include a scalpel holder 472, which is supported to move in the hollow proximal segment of the journal 330 and along the support groove of the scalpel 333, which extends from the narrow proximal portion 335 to the wide distal portion 337, allowing bending of the scalpel holder 472 to provide articulation of the working tool 12 around the longitudinal axis AA. See FIG. 37. In various embodiments, the implementation of the scalpel holder 472 may be made, for example, of stainless steel grade 300 or 400 and may have an edge for dissecting tissue 476 at its distal end. As further shown in FIG. 37, the holder of the scalpel 472 is slidable along the groove for the scalpel 473 in the distal base of the hinge 326. The proximal end 478 of the holder of the scalpel 472 is attached to the shaft of the scalpel 480, which passes through the proximal segment of the axle 330 until it engages with the possibility of transmitting drive force with a gear drive of the drive scalpel 190, as described above. See FIG. 31. The locking pin 406 enters the longitudinal groove 392 (FIG. 38) in the proximal segment of the working tube 390 and passes through the hole 339 in the proximal segment of the pin 330 (FIG. 39) into the longitudinal groove 482 in the shaft of the scalpel 480, allowing the proximal segment of the working tube 390 and the scalpel shaft 480 move axially relative to the proximal segment of the trunnion 330 and the handle assembly 100. Thus, the surgeon can selectively work with the scalpel holder 472 to dissect the tissue by actuating the trigger for moving the scalpel 200 as described above.

Various articulation designs are described in US Patent Application No. 12 / 775,809 (Attorney Dossier No. END6755USNP) under the heading “Laparoscopic Articulated Devices” by Frederick E. Shelton IV, filed May 7, 2010, and US Patent Application No. 12 / 775,699 (Attorney Dossier No. END6756USNP) under the heading “Bendable Barrel for Arm Grip,” by Frederick E. Shelton IV et al., Filed May 7, 2010, descriptions of each of which are incorporated herein by reference in their entirety. In FIG. 41 and 42 show an alternative joint assembly 490 that is substantially identical to the joint assembly 340 and is driven in substantially the same way, except that the intermediate segment of the working tube 492 replaces the thrust of the working tube 380 used in the joint shaft 340 As shown in FIG. 41 and 42, the intermediate segment of the working tube 492 extends from the distal segment of the working tube 370 to the proximal segment of the working tube 390. In various embodiments, the intermediate segment of the working tube 492 may be made of nylon, Isoplast® material or other flexible plastics. In various embodiments, the intermediate segment of the working tube 492 has two longitudinally extending compressible parts of the journal 494, from which a plurality of spaced apart segments of the ribs 496 separated by distances 498 depart to create a substantially hollow tubular segment through which others can functionally pass trunnion assembly components and scalpel holder. Parts of the spigot 494 are capable of transmitting compressive movements from the proximal segment of the working tube 390 to the distal segment of the working tube 370, the amplitude of which is sufficient to move the stop 20 to the position with the brackets fully mounted, while allowing the tool 12 to be rotated selectively to swivel relative to the longitudinal axis AA. The intermediate segment of the working tube 492 has a distal end portion 491 attached to the distal segment of the working tube using, for example, pins, grooves, latches, etc., as well as the proximal part 493 attached to the proximal segment of the working tube 390 with the same or similar methods. In this embodiment, the working tool 12 can be optimally placed in various bent positions, for example, by bending clockwise or counterclockwise, without the need for rotation or other movement of the elongated barrel assembly 490. In FIG. 42 shows an angle α, which in various embodiments can range from 0 ° to 45 °.

In FIG. 43-47, another embodiment of a surgical instrument constituting the subject of the present invention is presented. The surgical instrument 510 of this embodiment is substantially similar to the above-described embodiment of the surgical instrument 310, with the exception of the differences discussed below. Although a surgical tool 510 is described herein for use with a working tool 12 of the type described above, those skilled in the art will understand that the surgical tool can also be used with a second trigger adapter 150 to actuate the working tool 12 'or with other working tool designs . Various embodiments of a surgical instrument 510 include an articulated barrel assembly 512 to facilitate the selective positioning of the surgical instrument 12 relative to the longitudinal axis A-A. As shown in FIG. 43 and 44, the hinge shaft assembly 512 includes a distal member of the trunnion 520, which has a pair of receiving sockets 522 for receiving fixing supports 17. The distal element of the trunnion 520 has a proximal end 521, which is pivotally connected to the distal end 531 of the proximal segment of the trunnion 530. In particular, the proximal end 521 of the distal segment of the pin 520 has a pair of spaced apart teeth of the distal pin 523 that support the hinge pin 524 passing through the distal end 531 proximal of segment pins 530 to form a rotation axis of the hinge AA-AA, which is substantially perpendicular to the longitudinal axis AA. See FIG. 46.

In various embodiments of the present invention, the working tool 12 is rotatable in a hinge to obtain many different orientations relative to the longitudinal axis A-A. For example, the angle α 'in FIG. 47 may range from 180 ° to 90 °. The working tool 12 is articulated with at least one hinge element 550, which is connected to the pivot rod 540. The pivot rod 540 is pivotally connected to the distal end 521 of the distal segment of the pin 520 via the distal pin 542. See FIG. 43. As shown in FIG. 46, the pivot rod 540 is pivotally connected to the distal end 552 of the pivot rod 550 via a pin of the articulated shaft 554. As shown in FIG. 43, the hinge member 550 extends through the hinge shaft assembly 512 and has a proximal end 556 extending into a pivot handle 560 that is rotatably connected to the handle assembly 100. The proximal end 556 of the hinge member 550 is connected to the articulated control element, or button, 558 which is slidably coupled to a rotary handle 560 for selective axial movement relative to it. Thus, the axial shift of the control button of the articulation 558 in the distal direction DD will lead to the rotation of the working element 12 in the articulation relative to the longitudinal axis A-A in the manner shown in FIG. 47. To return the working tool to its original straight position, when the working tool is aligned in a coaxial direction with the longitudinal axis A-A, the surgeon simply slides the articulation control button 558 on the rotary handle 560 in the proximal direction PD.

As in the series of embodiments described above, the rotary handle 560 is rotatably connected to a mounting sleeve 570, which is rotatably connected to the handle assembly 100. See FIG. 43 and 47. The mounting sleeve 570 has a proximal flange 572 and a distal flange 574, which form a groove for rotation 575, adapted to rotate the nose 101 of the handle assembly 100. This design allows the mounting sleeve 570 to rotate around the longitudinal axis AA relative to the handle assembly 100. The proximal segment of the trunnion 530 is fixed without rotation by a pin or otherwise (welding, adhesive bonding, etc.) on the mounting sleeve 570 so that the rotation of the rotary handle 560 around the longitudinal axis A-A leads to the rotation of the working tool 12 relative to the longitudinal axis A-A. You must understand that this design can facilitate the rotation of the working tool 12 through 360 ° around the longitudinal axis A-A.

In this embodiment, a distal segment of the working tube 580 is also provided, which is connected to the first trigger adapter 140 and configured to axially move along the distal segment of the pin 520. In particular, the protrusion of the latch 144 on the first trigger adapter 140 enters the hole of the latch 581 on the distal segment work tube 580 as described above. The distal segment of the working tube 580 is driven by at least one working element attached to it. In a preferred embodiment, the distal segment of the working tube 580 is driven by a pair of starting strips 582 and 584 fixed thereon. The starting strips 582 and 584 are attached to the holder of the strips 585 connected to the proximal segment of the working tube 590, which is attached to the trigger beam 114 in the manner described above . In addition, the closure tube 592 connected to the rotary handle 560 for rotation with it also rests on the proximal segment of the pin 530. The proximal work tube 590 and the strip holder 585 are axially movable relative to the closure tube 592. As shown in FIG. 44C, the starter strips 582 and 584 are slidably inserted into the side channels for the strips 526 of the distal member of the journal 520. In various embodiments, each of the starter strips 582 and 584 is a thin flexible element that can be made of, for example, stainless steel. Each strip can push the distal segment of the working tube 580 to actuate or close the stop 20 in the manner described above to form the brackets 32 in the implantable cassette with the brackets 30. The trigger strips 582 and 584 are actuated by depressing the trigger 130 in the manner described above. Returning the trigger 130 to its original position will pull the trigger strips 582 and 584 out and cause the first trigger adapter 140 to either extend the stop 20 to the open position or move to a position in which the spring (not shown) biases the stop 20 to the open position.

Surgical instrument 510 may further include a scalpel 534, which is supported to move into the support groove of the scalpel 528 of the distal segment of the pin 520. See FIG. 44B. In various embodiments, the implementation of the scalpel holder 534 may be made, for example, of stainless steel grade 300 or 400, etc. and may have an edge for dissecting tissue 535 at its distal end. The scalpel holder 534 is attached to the strip of the scalpel 536, which can be made of stainless steel 300 or 400. The strip of the scalpel can be made, for example, of sheet stainless steel with a thickness of 0.178 to 0.305 mm (0.007 to 0.012 inches) with a higher degree of hardening than the rod. The thrust of the scalpel 536 passes through the distal member of the trunnion 520 and the proximal segment of the trunnion 530 and is attached to the shaft of the scalpel 480, which is engaged with the possibility of transmission of the drive force with gear transmission of the drive of the scalpel 190, as described above. Thus, the surgeon can selectively work with the scalpel holder 534 to dissect the tissue by actuating the trigger for moving the scalpel 200 in the manner described above. In various embodiments, to protect the articulation from dirt, tissue fragments, etc. corrugated coating element 594 may also be used. See FIG. 48.

In FIG. 49-53 show another embodiment of a surgical instrument constituting the subject of the present invention. The surgical instrument 610 of the present embodiment is substantially similar to the above-described embodiment of the surgical instrument 10, with the exception of the differences described below. Surgical instrument 610 is configured to actuate a working instrument 612 having two branches 613 and 615 that are movable. In various embodiments, a working tool 612 is coupled to an elongated barrel assembly 655 protruding from a handle assembly 100. See FIG. 49. The elongated barrel assembly 655 includes an elongated trunnion assembly 658 and an elongated closure tube assembly 680, which is configured to axially move along the trunnion assembly 658 in the proximal and distal directions. As shown in the figure, the elongated barrel assembly 655 extends distally from the handle assembly 100 in a substantially straight line along the longitudinal axis A-A. In various embodiments, the elongated barrel assembly 655 may have a length of about 228.8 mm to 406.4 mm (about 9 to 16 inches). However, the elongated barrel assembly 655 may have a different length.

As shown in FIG. 50 and 51, in various embodiments, the lower jaw 613 of the working tool 612 contains an elongated channel 614, and the upper jaw 615 contains an abutment 620. The elongated channel 614 has a pair of spaced side walls 616, each of which ends with a protruding closing end, or protrusion, 618. The elongated channel 614 can be made, for example, of stainless steel grade 17-4 or 400, and its size can be selected with the possibility of functional support cassettes with brackets 630 or other forms of cassettes with brackets. The stop 620 can be made, for example, of stainless steel grade 416, 17-4, 17-7, etc. In at least one embodiment, for example, each of the working tool 612 (in the closed position) and the elongated barrel assembly 655 have a maximum outer diameter allowing the device to be functionally passed through an opening with a diameter of at least about 8-12 mm (about 0.31 -0.47 inches). However, the working tool 612 and the elongated barrel assembly 655 may have other diameters and shapes. Work tool 612 further includes a distal segment of a trunnion 660 configured to detachably connect to a distal end of a proximal segment of a trunnion 670, as described in more detail below.

The stop 620 has a part for forming the staples 622, which has a plurality of recesses formed therein for forming the staples. In addition, the stop 620 has a bifurcated closing portion 624, which includes at least one and preferably a pair of protruding downward closing ends 625. As shown in FIG. 50-53, in at least one embodiment, the closing ends 625 and the corresponding closing ends 618 of the elongated channel 614 are pivotally mounted in the ears of the trunnion 663 of the bifurcated distal end 662 of the distal segment of the trunnion 660 (FIG. 55) of the trunnion 658 using a hinge pin 626 such so that when viewed from the side, the closing ends 625 and the closing ends 618 form a movable scissor-type closure structure, generally designated as element 628. In other embodiments, the stop 620 may be interchangeably connected tions with the elongated channel 614.

Various embodiments of the working tool 612 also include an axially displaceable scalpel assembly 640, which includes a scalpel plate 642 having a pair of distal scalpel holders 644 spaced apart from each other and protruding axially therebetween the ears of the trunnion 663 of the distal segment of the trunnion 660. See FIG. 55. A scalpel 646 is attached or otherwise formed to the distal ends of the scalpel holders 644. In various embodiments, the scalpel holders 644 and the scalpel 646 can be made, for example, of 300 or 400 stainless steel. An edge for dissecting the tissue is formed at the distal end of the scalpel 646. 648. The lower portion 649 of the scalpel 646 is configured to engage with the slide to eject the brackets 650, which are supported in the elongated channel 614 with the possibility of movement. The slide for pushing the brackets 650 can be held in a groove or groove system (not shown) in an elongated channel 614 to facilitate axial movement of the slide for pushing the brackets 650 from the initial position (FIG. 50-52) to the final position (FIG. 53), while maintaining contact with the elongated channel 614. The rails for ejecting the brackets 650 have a surface or surfaces for ejecting the brackets 652, oriented with the possibility of transmitting force to engage the brackets 632 in the cassette with brackets 630 and pushing the brackets 632 up in the direction of the part for the formation of brackets 622 of the stop 620 while advancing the scalpel 646 distally along the working tool 612.

In addition, in various embodiments, a distal cam sleeve of a trunnion 668 is also provided that is rotatably coupled to a proximal end 664 of a distal segment of a trunnion 660 to rotate relative thereto around a longitudinal axis A-A. The distal cam sleeve of the pin 668 has a pair of inwardly extending locking legs 669, the size of which ensures their entry into the corresponding receiving holes 674 at the distal end 672 of the proximal segment of the pin 670 protruding from the handle assembly 100 to allow rotation of the distal segment of the pin 660 relative to the proximal segment of the pin 670. As shown in FIG. 49, the proximal segment of the trunnion 670 is fixed to the rotary handle 70 (pin 66), which is mounted to rotate on the handle assembly 100 in the manner described above to facilitate 360 ° rotation of the working tool 612 around the longitudinal axis A-A.

As also shown in FIG. 49, a flange 676 is formed at the proximal end 671 of the proximal segment of the trunnion 670. The flange 676 is rotatably mounted in a groove 106 formed by mating ribs 108 that extend inwardly from each part of the housing 102 and 104. This design simplifies the fastening of the proximal segment of the trunnion 670 to the handle assembly 100, allowing the proximal segment of the pin 670 to rotate 360 ° about the handle assembly 100 around the longitudinal axis AA. The proximal segment of the closure tube 682 may be made of polymer or other suitable material and may have a proximal end 683 attached to the trigger beam 114, which is made and mounted to move in the handle assembly 100 in various ways described above. For example, in various embodiments, the trigger beam 114 may be fabricated using multi-component molding at the proximal end 683 of the proximal segment of the closure tube 682. However, other fastener structures may be used. As described above, the trigger beam 114 can be rotatably supported in a support sleeve 120 configured to axially move in the handle assembly 100. As shown in FIG. 49, a longitudinal groove 681 is provided in the proximal segment of the closure tube 682, allowing the pin of the trunnion 66 to pass through it into the proximal segment of the trunnion 670, facilitating the axial movement of the proximal segment of the closure tube 682 along the distal segment of the trunnion 670.

As shown in FIG. 49, the trigger 130 has an upper portion 134 pivotally attached (pins) to the trigger rods 636 and 638, which are pivotally attached (pins) to the support sleeve 120. Thus, the trigger 130 is moved toward the pistol portion the handle 107 of the handle assembly 100 will cause the trigger beam 114 and the proximal segment of the closure tube 682 to move in the proximal direction PD (shown by a dotted line in FIG. 49). Moving the latch and the trigger 130 in the direction from part of the pistol grip 107 of the handle assembly 100 will move the trigger beam 114 and the working tube 110 in the distal direction DD along the proximal segment of the pin 670.

As shown in FIG. 50-53, the proximal segment of the closure tube 682 has a distal end 684 adapted to attach to the proximal end 692 of the distal segment of the closure tube 690. In the embodiment shown in the figures, the distal segment of the closure tube 690 is threadedly attached to the distal end 684 of the proximal segment cover tube 682. At the distal end 694 of the distal segment of the cover tube 690, a cone-shaped drive element 696 is provided, configured to interconnect action with a closing scissor structure 628 so that when the distal closure tube segment 690 is in the position shown in FIG. 51, the spring or springs 617 of the working tool, located between the elongated channel 614 and the stop 620, move the stop 620 to the open position shown in this figure. However, when the distal segment of the closure tube 690 extends in the proximal direction PD, the cone-shaped drive member 696 contacts the shear-type closure 628 to articulate the jaws 613 (elongated channel 614) and 615 (stop 620) towards each other. See FIG. 52 and 53.

Surgical instrument 610 may further include a scalpel advancement system 639, including a scalpel shaft 700 that extends through the proximal segment of trunnion 670 and has a proximal end portion 702 that interacts with the ability to transmit drive force to the gear transmission of scalpel advancement 190, which is functionally attached to the trigger mechanism for advancing the scalpel 200 as described above. Thus, the surgeon can advance the shaft of the scalpel 700 distally by pulling the trigger to advance the scalpel 200, as described above. As shown in FIG. 52 and 53, the scalpel shaft 700 has a bifurcated distal end 704 that includes an upper segment of the scalpel shaft 706 and a lower segment of the scalpel shaft 708 adapted to engage the scalpel plate 642. As shown in FIG. 51-54, the upper segment of the scalpel shaft 706 is slidable through the upper groove 773 in the cam clutch of the pin 668, and the lower segment of the scalpel shaft 708 is slideable through the lower groove 775 in the cam clutch of the pin 668.

To use the surgical instrument 610, a working instrument 612 is attached to the distal end 672 of the proximal segment of the axle 670 by inserting the fixing supports 669 of the cam sleeve of the axle 668 into the corresponding receiving slots 674 of the proximal segment of the axle 670. See FIG. 50. Then the surgeon or medical worker can rotate the working tool 612 relative to the node of the elongated barrel 655 to screw the distal segment of the closure tube 690 onto the proximal segment of the closure tube 682 to form the node of the closure tube 680. In the working tool 612 there may be a cassette with brackets 630, or a medical the worker can install the cassette with brackets in the elongated channel 614 at this or a subsequent stage. After attaching the working tool 612 to the node of the elongated barrel 655 of the surgical instrument 610, the surgeon can insert the working tool 612 and the node of the elongated barrel 655 through the access hole into the patient’s body (for example, through a trocar or endoscope, etc., or, in the case of open surgery, through the cut) to capture the target tissue between the jaws of the working tool 613 and 615. As in the various embodiments described above, the jaws 613 and 615 are closed by moving the trigger 130 relative to the pistol grip 107 of the handle assembly 10 0. After capturing the target tissue between the jaws of the working tool 613 and 615, the surgeon can start the device or form staples 632 in the target tissue by pressing the stop 620 against the cassette with staples 630 as described above. If the procedure does not require dissection of the target tissue, the surgeon can then release the trigger 130 to move the stop 620 to the open position (under the influence of biasing force from the spring 617) and thus release the implantable cassette with brackets 630 from the working tool 612. Then the surgeon can again close the branches of the working tool 613 and 615 to bring the working tool 612 through the access hole or working channel. However, if the surgeon needs to cut the target tissue between the staple lines 632, he can advance the scalpel 640 by pulling the trigger to advance the scalpel 200 in the manner described above to push the scalpel 648 distally through the target tissue. When the scalpel 648 is moved distally through the working tool 612, it is in contact with the slide to eject the brackets 650, which further push the brackets 632 into forming contact with the bracket-forming surface 622 of the stop 620 to further form the brackets 632. See FIG. 53. Then the surgeon can open the working tool 612 to release the dissected / stapled target tissue and the implantable cassette with staples 630 from it.

Thus, the unique and innovative design of the closure tube, which closes the jaws of the working tool by moving the closure tube distally, allows the use of smaller closure structures and saves the possibility of applying significant closure force to form the staples. In addition, this embodiment of the present invention provides the surgeon with the ability to stitch tissue without dissection in applications that do not require tissue dissection.

In FIG. 56-60 show an alternative embodiment of a surgical instrument 810 that is substantially identical to the surgical instrument 610 described above, except for the differences described below. For example, a surgical instrument 810 includes a flexible trunnion assembly 820 having a proximal end with a flange 822 that rotates into a groove 106 formed by mating ribs 108 that protrude inwardly from each of the parts of the body 102 and 104 forming the handle assembly 100 See FIG. 57 and 58. This mounting design facilitates the rotational movement of the flexible pin assembly 820 relative to the handle assembly 100. In various embodiments, the flexible pin assembly 820 may be made, for example, of nylon, acrylonitrile butadiene styrene copolymer (ABS), polycarbonate, liquid crystal polymer, stainless steel, titanium etc. and can be configured to be used with the working tool 612 of the type described above.

Surgical instrument 810 further includes an elongated stem assembly, essentially shown as element 830. For example, in various embodiments, the elongated stem assembly 830 includes a tunable trunk segment 840 and a proximal trunk segment 844. As shown in FIG. 56, for example, a segment of the barrel with a tunable configuration 840 may have a distal support ring 842 secured without being able to move to a part of the flexible pin assembly 820 using, for example, adhesive bonding, welding, fasteners, etc. The tunable trunk segment 840 is configured to selectively change configuration between a linear configuration in which all portions of the tunable configuration segment 840 are aligned substantially in a coaxial direction with respect to each other (i.e., they form a substantially straight hollow tubular structure), and configurations, in which at least one of the parts is not aligned in a coaxial or linear direction with the rest of the segment with a tunable configuration 840. In an embodiment, ticipate, as shown in FIG. 56, the tunable barrel segment 840 may be made, for example, of nylon, acrylonitrile butadiene styrene copolymer (ABS), polycarbonate, etc. and has many ribs 846 that facilitate changing the configuration of segment 840 from orientations with linear or coaxial alignment to non-linear or non-coaxial orientations (e.g., serpentine, curved, etc.), and remains in such orientations until the user changes the configuration barrel segment 840 manually or by using other surgical instruments, such as gripping devices or the like. Thus, the tunable barrel segment 840 is “passively articulated”, which means that the device is not equipped with articulated rotation means for actively controlling the articulation of segment 840.

In various embodiments, the proximal segment of the barrel 844 is connected to the segment of the barrel with a tunable configuration 840 using, for example, tongue-and-groove or pin joints and is intended to facilitate the rotation-fastening of the segment of the barrel with a tunable configuration 840 on the handle assembly 100. For example, at least in one embodiment, the proximal segment of the barrel 844 is connected to a mounting sleeve 60, which is rotatably connected to the handle assembly 100, as described above. See FIG. 57 and 59.

In addition, in various embodiments, a portion of the flexible trunnion assembly 820 is movably mounted with a segment of the closure tube 832 for selectively moving the flexible trunnion assembly. See FIG. 56 and 60. As shown in FIG. 60, in at least one embodiment, the closure tube segment 832 and the trunnion assembly 820 are configured with opposed portions of the flanges 833 and 821, respectively, so that the closure tube segment 832 is protected from slipping from the trunnion assembly 820 while being able to move along it. In various embodiments, the flexible closure member 848 is connected to or includes a portion of the traverse 114. See FIG. 57 and 59. The flexible closure element 848 may be made, for example, of stainless steel, etc. and has a distal end portion 849 that extends through an elongated groove 834 in the trunnion assembly 820 to connect to the closure tube segment 832. This design facilitates the movement of the closure tube segment 832 in the distal direction DD and the proximal direction PD along the trunnion assembly 820 when trigger 130 is activated as described above.

As shown in FIG. 56, a surgical instrument 810 can be used with a working instrument 612, which has been described in detail above. In particular, the working tool 612 may be removably coupled to the flexible pin assembly 820 by inserting the locking bearings 669 of the cam sleeve of the pin 668 into the respective receiving holes 825 at the distal end 825 of the pin assembly 820. See FIG. 60. The distal end 835 of the segment of the closure tube 832 is configured to threadedly attach to the proximal end 692 of the distal segment of the closure tube 690 in the manner described above.

In at least one embodiment, the surgical instrument 810 further includes a scalpel advancement system 639 including a scalpel shaft 700 that extends through a pin assembly 820 and has a proximal end portion 702 that cooperates with transmitting drive force to the drive gear a scalpel 190, which is functionally attached to the trigger mechanism for advancing the scalpel 200 in the manner described above. Thus, the surgeon can advance the shaft of the scalpel 700 distally by pulling the trigger to advance the scalpel 200, as described above. The scalpel shaft 700 has a bifurcated distal end 704, which includes an upper segment of the scalpel shaft 706 and a lower segment of the scalpel shaft 708, adapted to engage the scalpel plate 642 of the working tool 612. See FIG. 60.

To use the surgical instrument 810, the working tool 612 is attached to the distal end 823 of the trunnion assembly 820 by inserting the fixing supports 669 of the cam clutch of the trunnion 668 into the respective receiving sockets 825. The surgeon or medical professional can then rotate the working tool 612 to screw the distal segment of the closure tube 690 onto the segment closing tube 832. In the working tool 612 there may be a cassette with brackets 630, or a medical professional can install a cassette with brackets in an elongated channel 614 on this adii. After attaching the working tool 612 to the node of the elongated closure tube 830 of the surgical tool 810, the surgeon can reconfigure the trunk segment with a tunable configuration 840 so that parts of the extension of the barrel are aligned in a coaxial direction for insertion through an opening or working channel into the patient’s body (e.g. through a trocar or endoscope, etc., or, in the case of open surgery, through an incision). Then, the surgeon can reconfigure the segment of the trunk with a tunable configuration 840 so that its parts are not coaxial to each other to orient the attached tool 612 in the desired position relative to the target tissue. As in the various embodiments described above, the jaws 613 and 615 are closed by moving the trigger 130 relative to the pistol grip 107 of the handle assembly 100. After grabbing the target tissue between the jaws of the working tool 613 and 615, the surgeon can start the device or form staples 632 in the target tissue by pressing the stop 620 against the cassette with brackets 630 as described above. If the procedure does not require dissection of the target tissue, the surgeon can then release the trigger 130 to move the stop 620 to the open position (under the influence of biasing force from the spring 617) and thus release the implantable cassette with brackets 630 from the working tool 612. Then the surgeon can again close the branches of the working tool 613 and 615 and change the configuration of the barrel segment with a tunable configuration 840 to bring the working tool 612 through the access hole or working channel. However, if the surgeon needs to cut the target tissue between the staple lines 632, he can advance the scalpel 640 by pulling the trigger to advance the scalpel 200 in the manner described above to push the scalpel 648 distally through the target tissue. When the scalpel 648 is moved distally through the working tool 612, it contacts the slider to eject the staples 650, which further push the staples 632 into forming contact with the staple forming surface 622 of the stop 620 to further form the staples 632. The surgeon can then open the working tool 612 to release it dissected / stapled target tissue and implantable cassette with staples 630.

In FIG. 61 and 62, another embodiment of a surgical instrument 810 'is shown, which is substantially identical to the above-described embodiment of a surgical instrument 810, with the exception of a segment of a tunable trunk 850, which comprises a portion of an elongated shaft assembly 830' operatively connected to a handle assembly 100 for driving operational tool 612. In various embodiments, the tunable trunk segment 850 comprises a plurality of mutually interconnected the lengths of the tubular units 852. Each tubular unit 852 may be made, for example, of nylon, acrylonitrile butadiene styrene copolymer (ABS), polycarbonate reinforced or not reinforced with fiberglass or carbon fiber, etc., and may have a tubular body 854. The tubular part of the housing 854 may have a spherical or spherical connecting portion 856 formed therethrough, through which a channel for receiving the trunnion 858 passes. In addition, a tubular channel for receiving the trunnion 858 passes into the formed in the tubular part of the housing 8 54 a hollow socket 860, the size of which allows the spherical connecting part 856 of the adjacent tubular link 852 to be movably movable. The size of the spherical connecting parts 856 relative to the sockets 860 is selected with the possibility of the spherical connecting part 856 getting into it and fixing in the desired configuration when the trunk segment has a substantially rectilinear configuration or when the barrel 850 may be curved (FIG. 62) or serpentine (FIG. 61) configuration.

Although the spherical connecting parts 856 and the sockets 860 can be dimensioned relative to each other so as to create a small friction force between them, sufficient to hold the segment 850 in the desired orientation until external force is applied, in the embodiment shown in FIG. 60 and 61, a locking system 862 is applied to hold with the possibility of release or fixation without the possibility of moving the tubular links 852 in the desired configuration. As shown in these figures, the locking elements 862 are at least one, and preferably a plurality of flexible locking knots, or elements 864, made along the perimeter of the tubular link 852 near its one end 853. In a preferred embodiment, four locking knots 864 are used Other embodiments may have 1, 2, 3, or more than four fixing knots 864. Each tubular link 852 further comprises a fixing element 866 corresponding to each fixing knot 864, adjacent to the other end 865 of link 852. Each locking element 866 has a recess for receiving a latch 868 configured to receive with the possibility of releasing a portion of a corresponding locking knot 864 made on an adjacent tubular link 852.

To use the surgical instrument 810 ', a working instrument 612 is attached to the distal end 823 of the trunnion assembly 820 as described above. The distal segment of the closure tube 690 of the working tool 612 is screwed onto the segment of the closure tube 832. After attaching the work tool 612 to the node of the elongated closure tube 830 of the surgical instrument 810 ', the surgeon can reconfigure the trunk segment with a tunable configuration 850 so that the parts of the elongated trunk assembly are aligned in the coaxial direction for insertion through an opening or a working channel into the patient’s body (for example, through a trocar or endoscope, etc., or, in the case of open surgery, through the cut). After that, the surgeon can use, for example, a gripping tool 869 to give the movable links 852 a segment of the trunk with the tunable configuration 850 of the desired orientation and then press the corresponding locking knots 864 of each link 852 into the corresponding recesses to receive the latch 868 to fix the links 852 in the desired orientation. See FIG. 62. As in the various embodiments described above, the jaws 613 and 615 are closed by moving the trigger 130 relative to the pistol grip 107 of the handle assembly 100. After grabbing the target tissue between the jaws of the working tool 613 and 615, the surgeon can start the device or form staples 632 in the target tissue by pressing the stop 620 against the cassette with staples 630 as described above. If the procedure does not require dissection of the target tissue, the surgeon can then release the trigger 130 to move the stop 620 to the open position (under the influence of biasing force from the spring 617) and thus release the implantable cassette with brackets 630 from the working tool 612. Then the surgeon can again close the jaws of the working tool 613 and 615 and use the gripping tool 869 to bring the locking knots 864 out of the corresponding recesses to receive the clips 868 so that the links 852 can be aligned in this way m to allow the output device through an access channel or a traffic channel. However, if the surgeon needs to cut the target tissue between the staple lines 632, he can advance the scalpel 640 by pulling the trigger to advance the scalpel 200 in the manner described above to push the scalpel 648 distally through the target tissue. When the scalpel 648 is moved distally through the working tool 612, it contacts the slider to eject the staples 650, which further push the staples 632 into forming contact with the staple forming surface 622 of the stop 620 to further form the staples 632. The surgeon can then open the working tool 612 to release it dissected / stapled target tissue and implantable cassette with staples 630.

In FIG. 63-68, another embodiment of a surgical instrument 810 ”is shown, which is substantially identical to the above-described embodiments of a surgical instrument 810 and 810 ', with the exception of a segment of a tunable trunk 870 and its associated fixation system 882 of an elongated trunk. In various embodiments, the tunable barrel segment 870 comprises a plurality of movably interconnected tubular links 872 and is connected to a proximal segment of the barrel 871 that is connected to a mounting sleeve 60 rotatably held within the handle assembly 100, as described above in detail. Each tubular unit 872 can be made, for example, of nylon, acrylonitrile butadiene styrene copolymer (ABS), polycarbonate, etc. and has a tubular portion of a housing 874. See FIG. 67. The tubular part of the housing 874 may have a spherical or spherical connecting part 876 formed on it, through which the channel for receiving the trunnion 878 passes. In addition, the tubular channel for receiving the trunnion 878 passes into the hollow socket 880 formed in the tubular part of the housing 854, the size of which allows you to accept with the ability to move the spherical connecting part 876 of the adjacent tubular link 872. The size of the spherical connecting parts 876 relative to the sockets 880 is selected with the possibility of getting into it a spherical connecting part part 876 and fixation in the desired configuration when the segment of the barrel with the tunable configuration 870 has a substantially straight configuration (FIG. 67) or when the barrel 870 may have a curved (FIG. 68) or serpentine configuration.

Whereas spherical connecting parts 876 and sockets 880 in at least one embodiment can be dimensioned relative to each other so as to create a small friction force between them that can hold the tubular links 872 of the barrel segment with the tunable configuration 870 in the necessary orientations until external force, in the embodiment shown in FIG. 63-68, a locking system 882 is used to hold with the possibility of release or fixation without the possibility of moving the tubular links 872 in the desired configuration. As shown in FIG. 67 and 68, the fixing device 882 comprises at least one and preferably two selectively expandable fixing elastic containers 884 that extend through the tubular links 872 in diametrically opposite positions. In various embodiments, the implementation of the elastic elastic cylinders 884 can be made, for example, of nylon film and the like, and they can be adapted to receive fluid under pressure from a fluid source under pressure 886. In the embodiment shown in FIG. 64, the pressurized fluid source 886 comprises a fluid pump structure 888 configured to supply pressurized air to the fixing elastic cylinders 884. In particular, in at least one embodiment, the fluid pump structure 888 includes a cylinder 889, inside which is the piston 890. The piston 890 has a perimeter o-ring or other sealing structure 891 and is attached to the threaded handle of the pump 892, which engages with part of the handle assembly 100 in the middle threaded connection. Thus, when the pump handle 892 is screwed into the handle assembly 100, air is supplied from the cylinder 890 under pressure through the supply pipe 893, which departs from the cylinder 890 to the manifold assembly 894, which receives the spigot assembly 820. The air pressure in the fixing elastic cylinders 884 can be reduced by rotating the handle of the pump 894 in the opposite direction.

As shown in FIG. 65, the manifold assembly 894 comprises an annular zone of the manifold 895, on each side of which there are o-rings or other seals 896. The annular region of the manifold 895 communicates with the supply line 897, which passes through the proximal segment of the barrel 871 and enters the fixing elastic cylinders 884. Such a design serves to supply pressurized air to the fixing elastic cylinders 884 with the possibility of rotational movement of the pin assembly 820 along the longitudinal axis AA relative to the handle assembly 100. In this document, under t Pmin "fluid under pressure" is understood, for example, air, saline or, preferably, glycerin. In alternative embodiments, the tubular elements may be filled with very low hardness rubber or elastomer. When pressure is applied to the rubber material, it deforms, filling the voids and fixing the barrel in much the same way as the method in embodiments using a fluid.

To use the surgical instrument 810 ”, a working instrument 612 is attached to the distal end 823 of the trunnion assembly 820 ′ in the manner described above. The distal segment of the closure tube 690 of the working tool 612 is screwed onto the segment of the closure tube 832. After attaching the work tool 612 to the node of the elongated barrel 830 "of the surgical instrument 810", the surgeon can reconfigure the barrel segment with a tunable configuration 870 so that parts of the node of the elongated barrel 830 " were aligned in a coaxial direction for insertion through an opening or a working channel passing into the patient’s body (for example, through a trocar or endoscope, etc., or through an incision - in the case of open surgery). After that, the surgeon can use, for example, a gripping tool to bring the links 872, made with the possibility of movement, of the barrel segment with a tunable configuration 870 in the desired position. After the segment of the barrel with the tunable configuration 870 is oriented as necessary, the surgeon can rotate the handle of the pump 892 into the body of the handle 100 to create pressure in the elastic holding cylinders 884 to fix the links 872, made with the possibility of movement, as shown in FIG. 68. As in the various embodiments described above, the jaws 613 and 615 are closed by moving the trigger hook 130 relative to the pistol grip 107 of the handle assembly 100. After grabbing the target tissue between the jaws of the working tool 613 and 615, the surgeon can start the device or form staples 632 in the target tissue by pressing the stop 620 against the cassette with staples 630 as described above. If the procedure does not require dissection of the target tissue, the surgeon can then release the trigger 130 to move the stop 620 to the open position (under the influence of biasing force from the spring 617) and thus release the implantable cassette with brackets 630 from the working tool 612. Then, the surgeon can repeatedly close the jaws of the working tool 613, 615 and reduce the pressure in the fixing elastic cylinders 884 by rotating the handle of the pump 892 in the opposite direction. To control the links 872 configured to move, to achieve an orientation aligned in a substantially coaxial direction (FIG. 67), or other orientation necessary to enable the device to be removed from the patient’s body, a gripping tool can be used. However, if the surgeon needs to cut the target tissue between the staple lines 632, he can advance the scalpel 640 by pulling the trigger to advance the scalpel 200 in the manner described above to push the scalpel 648 distally through the target tissue. When the scalpel 648 is moved distally through the working tool 612, it contacts the slider to eject the staples 650, which further push the staples 632 into forming contact with the staple forming surface 622 of the stop 620 to further form the staples 632. The surgeon can then open the working tool 612 to release it dissected / stapled target tissue and implantable cassette with staples 630.

The various embodiments described herein, which include a customizable trunk segment, represent a significant improvement over traditional articulated surgical instrument designs that utilize articulated fixings. Such surgical instruments, as a rule, are limited to 1 or 2 degrees of freedom when placing the working tool in the place of the incision. Various embodiments of the present invention provide a wider range of possible positions of the working tool and, therefore, offer the surgeon much more options when using a device inserted through a single access hole.

Unique and new features of various surgical cassettes with brackets and surgical instruments of the present invention allow staples to be placed in these cassettes in the form of one or more linear or non-linear rows. Many of these staple lines can be made on each side of the elongated groove that extends through the center of the cassette with staples to allow the cutting element to enter. In one embodiment, for example, the brackets in one line can be substantially parallel to the staples in the adjacent staple line (s), but offset from them. In other embodiments, one or more lines of staples may be non-linear. This means that the base of at least one bracket in the staple line can extend along an axis that substantially intersects the bases of other staples located in the same staple line. For example, as described in more detail below, in alternative embodiments, the staple lines on each side of the elongated groove may be zigzag. This non-linear arrangement of staples can be created due to the fact that the brackets are not pushed up in the direction of the stop. Instead, in these various embodiments, the emphasis is brought into forming contact with the ends of the fixed brackets. Such a non-linear arrangement of staples can lead to better stitching of the fabric when using fewer staples compared to various linear arrangements of staples used in cassettes with staples of the prior art, in which the brackets are actually pushed up to form contact with the stop.

In FIG. 69 shows the use of an embodiment of a surgical cassette with staples 900 in an embodiment of a working tool 612 'of the present invention. The working tool 612 'can be used in combination with the surgical tool 610 in various ways described above. Work tool 612 'may be identical to work tool 612, as described above, except for the differences described below. As shown in FIG. 69 and 70, an embodiment of a surgical cassette with brackets 900 has a cassette body 902 that has a central elongated groove 904 extending through the proximal end 903 to an area near the distal end 605. The elongated groove 904 is configured to move the scalpel body 646 of the surgical instrument through it 610 in the axial direction during the operation of dissecting tissue as described above. In at least one embodiment, the cassette body 902 consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC), or a bioabsorbable foam made, for example, of PGA (polyglycolic acid, commercially available under the trademark Vicryl ), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, commercially available under the brand name Monocryl) or from a mixture of PGA, PCL, PLA and PDS, where held lin and 920, 930 of unformed brackets 922. However, the cassette body 902 can be made of other materials that maintain the unformed brackets 922 in the required position so that they can be compressed under the influence of the stop 910 in contact with it. As in the various other embodiments described above, the cassette with brackets 900 is implantable and remains attached to the stitched tissue after completion of the stitching procedure. In at least some embodiments, in order to prevent exposure of the staples 922 and activation of the hemostatic material during insertion and placement of the cartridge, the entire cartridge 900 can be coated or wrapped in a biodegradable film 906, such as a commercially available polydioxanone film under the brand name PDS®, or polyglycerin sebacinate (PGS) film, or other biodegradable films made, for example, of PGA (polyglycolic acid, commercially available under the trademark Vicry l), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, commercially available under the Monocryl trademark) or a mixture of PGA, PCL, PLA, PDS, impervious to tearing . The cartridge case 902 with brackets 900 has a size that allows it to be disposed of within the elongated channel 614 of the working tool 612 '.

In the embodiment shown in FIG. 69, 73, and 74, the surgical cassette with brackets 900 comprises a first line 920 of brackets 922 in the working position on one side 907 of the elongated groove 904 and a second line 930 of brackets 922 on the other side 909 of the elongated groove 904. In various embodiments, the brackets 922 can be made of a metal material such as, for example, titanium, titanium alloys (for example, titanium of class 6AI-4V, 3al-2,5V), stainless steel and the like, and they have a base bracket 924 and two protruding from it vertical legs of the bracket 926. Each leg of the bracket 926 may have formed on it the end for piercing the fabric 928. In the first line 920 of the brackets 922, the base 924 of at least one bracket 922 overlaps the base of the other bracket 922. In a preferred embodiment, the base 924 of each bracket 922 overlaps the base 924 of two adjacent brackets 922, except for the base 924 of the extreme bracket 922 at each end of the first line of staples 920. See FIG. 73. Thus, the first line of staples 920 has a substantially non-linear shape. In particular, in a plan view, the first line of staples 920 has a substantially zigzag appearance.

As shown in FIG. 72, the stop 90 has two successive longitudinally located recesses for forming the brackets 912, each of which has a substantially zigzag shape corresponding to the shape of the first line 920 of the brackets 922, so that when the stop 910 is brought into forming contact with the brackets 922, formation legs 926, as shown in FIG. 74. Thus, the distal leg of one bracket falls into the same recess as the proximal leg of the bracket following it in the longitudinal direction. This design allows you to provide a more dense arrangement of the recesses, up to the position at which the brackets act on each other (for example, nested one into the other). In previous embodiments, the location of the recesses for the brackets, as a rule, was from 0.127 to 0.381 mm (0.005 to 0.015 inches) of metal / free space from one set of recesses to another. However, in this embodiment of the present invention, the arrangement provides from 0 to 0.51 mm (0 to 0.02 inches) of the impact / overlap portions (substantially -0.51 mm (0.020 ”)) since, for example, one bracket mates with the next bracket. Such location options allow you to place 15-30% more staples in the same space. Moreover, when the brackets engage each other, the need for a plurality of transverse rows of staples is reduced. Previous layouts typically included three rows of staples on each side of the tissue incision line to prevent the possibility of open areas that could leak blood. When using lines of interconnected staples, the preservation of open areas that can let blood through is less likely. Another notable advantage when using various arrangements of interlocking brackets constituting the subject of the present invention relates to an increase in “tensile strength”, which refers to the amount of force required to break the seam formed by the brace line.

Another arrangement of the recesses for forming the brackets, which is the subject of the present invention, may comprise a common recess for forming the braces. As used herein, the term “general recess for forming brackets” means that one forming recess can arrange all brackets on the same line of brackets, in contrast to prior art emphasis designs that provide a separate forming recess for each leg of each bracket.

In FIG. 75 shows yet another embodiment of the brackets 922 ', in which the base 924' has an offset portion 928 to provide a closer overlap of the bases 924 '. As indicated above, the cassette with brackets 900 has a second line 930 of brackets 922 located on the second side 909 of the elongated groove 904. The second line 930 of brackets 922 is substantially identical to the first line 920 of brackets 922. Thus, the stop 910 has a second common recess for forming staples 912, which corresponds to the second line of staples 930 and is intended to form staples upon contact with them. However, in alternative embodiments, the second staple line 930 of the staples 922 may differ from the first staple line 920 of the shape and possibly the number of staples.

In FIG. 71 shows a surgical cassette with brackets 900 ', which is essentially identical to the cassette with brackets 900 described above, with the exception of lines 920', 930 'of brackets 922. For example, in this embodiment, the line 920' of brackets 922 is positioned relative to another so that the axis of the base SS of at least one base of the bracket 924 substantially intersects the axis SS of the base 924 of the at least one other adjacent bracket 922. Such a predetermined arrangement of staples in a plan view has a substantially zigzag shape. In the embodiment shown in FIG. 76, the respective bases 924 of the brackets 922 may further have a base support element 927 molded over the bracket as shown in the figure. In various embodiments, the base support member 927 may be made, for example, of non-absorbable plastic, such as polyetheretherketone (PEEK), or absorbable plastic, such as polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone ( PDS), PCL (polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polyglexaprone 25, commercially available under the trademark Monocryl) or various composite mixtures of PGS, PDS, PLA, PGA and PCL. The support elements of the base 927 provide engagement between the brackets without overlapping brackets. Thus, such arrangement patterns may contribute to the formation of a bracket in the form of a letter B or an inverted letter W without overlapping the legs of the brackets. However, the heads are connected by supporting elements of the base, thus, they function as overlapping staples. This arrangement allows the use of combined recesses to obtain two separate paths for each leg.

The embodiment shown in FIG. 77 includes a line of brackets 920 ”, in which the legs 926 of adjacent brackets 922 are connected to each other by a connecting part 929 attached to them by molding or in another way. Each connecting part 929 can be made, for example, from non-absorbable plastic, such as polyetheretherketone (PEEK), or absorbable plastic, such as, for example, polyglycolic acid (PG), polylactic acid (PLA or PLLA), polydioxanone (PDS), PCL ( polycaprolactone), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, commercially available under the brand name Monocryl) or various composite mixtures of PGS, PDS, PLA, PGA and PCL. Such a staple line 920 ”in a plan view has a substantially zigzag appearance. Although various embodiments of the surgical cassette with staples 900, 900 'have been described in combination with the use of working tools 612' and the surgical stapling tool 610, it is contemplated that cassettes with staples 900, 900 'can be effectively used with various other working tools and surgical instruments, described in this document if appropriately located recesses for forming staples to form the required CTBA staples forming contact with the staple stop.

In FIG. 78 and 79 show another embodiment of a surgical cassette with brackets 940 located in an elongated channel 14 of a surgical instrument 10 constituting the subject of the present invention. In at least one embodiment, the surgical cassette with brackets 940 includes a cassette body 942 that has a central elongated groove 944 at least partially extending through the cassette body. The elongated groove 944 is configured to allow axial movement of the scalpel body of the surgical instrument 10 through the tissue dissection operation as described above. In various embodiments, the cassette body 942 consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam of the above or below types, in which there are lines 946, 948, 950, 952 of undeformed staples 922. At least in some embodiments, in order to prevent exposure to the brackets 922 and activation of the hemostatic material during insertion and placement of the cartridge, the entire cartridge 940 can be coated or wrapped l in a biodegradable film 954, such as a film of polydioxanone commercially available under the brand name PDS®, or a film of polyglycerin sebacinate (PGS), or other biodegradable film made, for example, of PGA (polyglycolic acid, commercially available under trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (polyglecaprone 25, commercially available under the trademark Monocryl) or a mixture of PGA, PCL, PLA, PDS, impervious to the moment tearing film.

In the embodiment shown in FIG. 78, the cartridge 940 further includes a cartridge support member 960 attached to the cartridge case 942. In various embodiments, the cartridge support member 960 may be made of rigid material, such as, for example, titanium, stainless steel, aluminum, or an alloy of any of the above above metals and the like, and it can be partially integrated into the cassette 942. In various embodiments, the support element of the cassette 960 can be held in place by, for example, film 954. In other embodiments, where necessary using a limited bond, cyanoacrylate can be used to “glue” the two components together. In other embodiments, the cassette body 942 can be heated and “welded” or “fused” with the cassette support member 960. In various embodiments, the cassette support member 960 forms at least a portion of the bottom surface of the cassette 942 for connection to an elongated channel 14. In a preferred an embodiment, the support element of the cartridge 960 has one or more clamping elements 962 protruding from it and intended for removable connection of the support element of the cartridge 960 and the elongated channel 14. For removable connection Other forms of clamping elements / stitching structures can be used to support the cassette support element 960 and the elongated channel 14.

In various embodiments, the support element of the cartridge 960 has a series of support ribs 964, 966, 968, 970, 972, 974, 976 formed to provide some lateral support to the bases 924 of the brackets 922 in the lines of the brackets 946, 948, 950, 952, as shown in FIG. 78. Thus, in at least some embodiments, the support ribs are substantially the same in length with the staple lines. In FIG. 80 shows an alternative embodiment of a cassette with brackets 940 ', which is essentially identical to the cassette 940, except for the inclusion of the vertical parts of the ribs 978, 979, 980, 981, 982, 983, which protrude from the supporting ribs 964, 966, 968, 970, 972 976, respectively, to provide additional lateral support for the brackets 922. In various embodiments, parts of the ribs may be integral with the support member of the cartridge 960, and their height may be approximately ½ or less of the height of the cartridge. Thus, in preferred embodiments, for example, the height of any vertical elements supporting the foam cannot be greater than the maximum height of the compressed foam. Thus, if the cartridge is designed, for example, to compress 1/3 of the original height, the height of the ribs can be from 66% of the height to compression to 10% of the height before compression.

When used after forming the staples 922 in contact with the abutment 20 as described above, the abutment 20 goes into the open position, and the working tool 12 is pulled from the stitched fabric. When the working tool 12 is pulled from the stitched fabric, the cassette 942 body remains attached to the stitched fabric and then disconnected from the support element of the cartridge 960, which remains connected to the elongated channel 14. In various embodiments, the support element of the cartridge 960 has a color different from the color of the material, from which the cassette body 942 is made, as well as the color of the elongated channel 14. This design allows the surgeon to clearly see that there is no cassette with brackets inside the working tool. Thus, this frees the surgeon from accidental attempts to re-introduce / use the working tool until the cassettes with brackets are previously inserted into it. To do this, the surgeon simply disconnects the clamping elements of the supporting element of the cassette 960 from the elongated channel 14 to enable the insertion of a new cassette with brackets 940 into the supporting element of the cassette 960. Although the use of cassettes with brackets 940, 940 'in combination with the surgical instrument 10 is described in this document it is contemplated that these cassettes can be effectively used with many other surgical instrument embodiments described herein without departing from the spirit and scope of the present Bretenoux.

In FIG. 81 and 82 show the use of an embodiment of a surgical instrument 10 in conjunction with a working instrument 990, which is substantially identical to the working instrument 12 described above, except for the closure lock 991 attached to the elongated channel 14 movably or otherwise located within it. In various embodiments, the closure locking structure 991 includes a locking arm 992 that has a distal end 993 and a proximal end 994. The locking arm 992 is pivotally coupled to the elongated channel to pivotally rotate around the pivot member or pin 995. The distal end portion has a leaf spring 996 or another biasing element attached thereto to bias the locking shoulder 992 into the working or closed position, while the proximal end portion 994 engages the distal the second end 141 of the first trigger release clutch 141 to prevent the distal advance of the first release trigger coupling 140 to a position after activation. However, when the cassette with the brackets 30 is installed in the elongated channel 14, it moves the blocking arm 992 to the idle or open position so that the trigger clutch 140 can be distally past the blocking arm 992 to complete the stapling process. See FIG. 81.

In the closed position, the trigger clutch 140 cannot be distally advanced to complete the stapling process. In addition, the trigger 130 cannot be advanced to a fully “lowered” position in which the scalpel retainer 210 is moved to the open position, allowing the surgeon to advance the scalpel holder 172. Thus, in the absence of a cassette in the working tool 990, the closure lock 991 is in the closed position , which makes it completely impossible to advance the holder of the scalpel 172. Thus, the surgeon cannot advance the holder of the scalpel 172 to cut tissue if inside the working tool 990 is missing 30. The cassette is assumed that the structure of lock closure 991, described above, can efficiently incorporate into many embodiments of the surgical instrument described herein without departing from the spirit and scope of the present invention.

In various embodiments, the staple cartridge may comprise a cartridge case and a plurality of brackets located inside the cartridge case. When using the cartridge with brackets can be placed in the surgical field and placed on one side of the treated tissue. In addition, on the opposite side of the fabric, a staple-forming stop can be arranged. In various embodiments, the emphasis can be positioned on the first jaw, and the cassette with brackets can be positioned on the second jaw, wherein the first jaw and / or the second jaw can move toward each other. After positioning the cassette with brackets and stop relative to the fabric, the brackets can be removed from the cassette body with brackets so that the staples can pierce the fabric and interact with the forming bracket. After installing the brackets from the cassette with brackets, it can be removed from the surgical field. In various embodiments described herein, a cassette with brackets or at least a portion of the cassette with brackets can be implanted together with braces. In at least one such embodiment, which is described in more detail below, the cassette with brackets may include a cassette body that can be compressed, destroyed and / or wrinkled when interacting with the stop when moving from an open position to a closed position. When compressing, destroying and / or creasing the cassette body, the emphasis may deform the brackets located in the cassette body. In an alternative embodiment, the jaw carrying the cassette with brackets can be moved in the direction of the stop in the closed position. In any case, in various embodiments, the brackets may be deformed when they are at least partially located in the cassette body. In certain embodiments, the staples may not be removed from the cassette with staples, while in some embodiments, the staples can be removed from the cassette with staples along with part of the cassette body.

As shown in FIG. 83A-83D, a compressible cassette with brackets, such as, for example, a cassette with brackets 1000, may include a compressible implantable cassette 1010 and, in addition, a plurality of brackets 1020 located inside the compressible cassette 1010, although in FIG. 83A-83D, only one bracket 1020 is shown. FIG. 83A shows a cassette with brackets 1000 supported by a support element of a cassette with brackets or a channel for a cassette with brackets 1030, the cassette with brackets 1000 being shown in an uncompressed state. In such an uncompressed state, the abutment 1040 may or may not come in contact with tissue T. In use, the abutment 1040 may be moved from the open position to engage the tissue T, as shown in FIG. 83B and the placement of the fabric T relative to the cassette body 1010. Although the emphasis 1040 can provide the necessary location of the fabric T relative to the tissue-contacting surface 1019 of the cassette body with brackets 1010, as shown in FIG. 83B, the cassette case with brackets 1010 in this position may experience slight compressive action or pressure (if applicable), and the brackets 1020 may remain in an unformed, or unbent, state. As shown in FIG. 83A and 83B, the cassette case with brackets 1010 may comprise one or more layers, and the legs 1021 of the brackets 1020 may extend upward through these layers. In various embodiments, the cassette body 1010 may include a first layer 1011, a second layer 1012, a third layer 1013, the second layer 1012 may be located between the first layer 1011, the third layer 1013 and the fourth layer 1014, and the third layer 1013 may be located between the second layer 1012 and a fourth layer 1014. In at least one embodiment, the bases 1022 of the brackets 1020 may be located in the cavities 1015 in the fourth layer 1014, and the legs of the brackets 1021 may extend upward from the bases 1022 and, for example, through the fourth layer 1014, the third layer 1013 and second loi 1012. In various embodiments, each leg 1021, configured to deformation, can comprise an end, such as, for example, sharp end 1023 which, for example, may be disposed in the second layer 1012, when the staple cartridge 1000 is in an uncompressed state. In at least one such embodiment, the ends 1023 may not extend into and / or through the first layer 1011, and in at least one embodiment, the ends 1023 may not protrude through a tissue contacting surface 1019 when the cassette with brackets 1000 is uncompressed condition. In other specific embodiments, the sharp ends 1023 may be located in the third layer 1013 and / or any other appropriate layer when the cassette with brackets is in an uncompressed state. In various alternative embodiments, the cassette case with brackets may have any suitable number of layers, such as, for example, less than four layers or more than four layers.

In various embodiments, which are described in more detail below, the first layer 1011 may consist of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), and the second layer 1012 may consist of bioabsorbable foam and / or compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC). In various embodiments, one or more of the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 can hold the brackets 1020 inside the cassette body with brackets 1010 and, in addition, provide the necessary location of the brackets 1020 relative to each other. In various embodiments, the third layer 1013 may consist of a supporting material or a completely incompressible or inelastic material, which may be configured to hold the legs 1021 of the brackets 1020 in position relative to each other. Moreover, the second layer 1012 and the fourth layer 1014, which are located on opposite sides of the third layer 1013, can stabilize or reduce the movement of the staples 1020, even if the second layer 1012 and the fourth layer 1014 can consist of compressible foam or elastic material. In certain embodiments, the ends 1023 of the legs of the brackets 1021 can be at least partially inserted into the first layer 1011. At least in one such embodiment, the first layer 1011 and the third layer 1013 can be made to hold the legs of the brackets 1021 together and tightly in place . In at least one embodiment, the first layer 1011 and the third layer 1013 may be bioabsorbable plastic sheets, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL, and each of the second layer 1012 and fourth layer 1014 may consist of at least one hemostatic whom material or agent.

Although the first layer 1011 may be compressible, the second layer 1012 may be substantially more compressible than the first layer 1011. For example, the second layer 1012 may be, for example, approximately two times more compressible, approximately three times more compressible, approximately four times more compressible, about five times more compressible and / or about ten times more compressible than the first layer 1011. In other words, with this force, the second layer 1012 can be compressed about two times, about three times, about four e times, about five times and / or about ten times stronger than the first layer 1011. In certain embodiments, the second layer 1012 can be, for example, about two to ten times more compressible than the first layer 1011. At least in one embodiment, the second layer 1012 may contain a plurality of air voids formed therein, the number and / or dimensions of air voids in the second layer 1012 can be controlled to provide the necessary compressibility of the second layer 1012. Similar to the above, although the third layer 1013 may be compressible, the fourth layer 1014 may be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 may be, for example, approximately two times more compressible, approximately three times more compressible, approximately four times more compressible, about five times more compressible and / or about ten times more compressible than the third layer 1013. In other words, with this force, the fourth layer 1014 can be compressed approximately two times, approximately three times, approximately four times, about five times and / or about ten times stronger than the third layer 1013. In certain embodiments, the fourth layer 1014 can be, for example, about two to ten times more compressible than the third layer 1013. At least in one embodiment, the fourth layer 1014 may contain a plurality of voids formed therein, the number and sizes of air voids in the fourth layer 1014 can be controlled to provide the necessary compressibility of the fourth layer 1014. In various situations s compressibility of the cassette case of the cassette case or the layer can be described as a compression ratio, i.e. the distance that the layer compresses when a certain force is applied. For example, a layer with a higher compression ratio will compress over a greater distance when a certain compressive force is applied to it, compared to a layer with a lower compression ratio. This means that the second layer 1012 can have a higher compression ratio than the first layer 1011, and the fourth layer 1014 can likewise have a higher compression ratio than the third layer 1013. In various embodiments, the second layer 1012 and the fourth layer 1014 can consist from the same material and can have the same compression ratio. In various embodiments, the second layer 1012 and the fourth layer 1014 may consist of materials with different compression ratios. The first layer 1011 and the third layer 1013 can similarly consist of the same material and can have the same compression ratio. In certain embodiments, the first layer 1011 and the third layer 1013 may consist of materials with different compression ratios.

When the emphasis 1040 moves to the closed position, it can come in contact with fabric T and apply a compressive force to fabric T and cassette with staples 1000, as shown in FIG. 83C. In such situations, the abutment 1040 may push the upper surface, or tissue-contacting surface 1019, of the cartridge case 1010 down towards the support element of the cartridge with brackets 1030. In various embodiments, the support element of the cartridge with brackets 1030 may comprise a surface for supporting the cartridge 1031, which may be made with the possibility of supporting the cartridge with brackets 1000, when the cartridge with brackets 1000 is compressed between the surface for the support of the cartridge 1031 and the contact surface 1041 of the support 1040. Due to the pressure, p Depicted by the stop 1040, the cartridge case 1010 can be compressed, and the stop 1040 can interact with the brackets 1020. More specifically, in various embodiments, compressing the cartridge case 1010 and moving the fabric contacting surface 1019 downward can pierce the ends of the legs 1023 of the staples 1021 of the first layer 1011 of the cartridge case 1010, piercing the fabric T and their entry into the forming recesses 1042 on the stop 1040. Upon further compression of the cartridge case 1010 under the action of the stop 1040, the ends 1023 can come into contact with the walls forming forming recesses 1042, and thus legs 1021 can, for example, deform or bend inward, as shown in FIG. 83C. After deformation of the legs of the staples 1021, as shown in FIG. 83C, the bases 1022 of the brackets 1020 may contact or support the cassette support member with brackets 1030. In various embodiments, as described in more detail below, the support element of the cassette with brackets 1030 may comprise a plurality of support elements, such as, for example, support grooves, grooves or grooves 1032, which may be configured to support the brackets 1020 or at least the bases 1022 staples 1020 after deformation of staples 1020. As shown in FIG. 83C, the cavities 1015 in the fourth layer 1014 may collapse upon applying compressive force to the cassette body with brackets 1010. In addition to the cavities 1015, the cassette body with brackets 1010 may additionally contain one or more voids, such as, for example, voids 1016, which may contain or not contain part of the staples located in them and which can be arranged to crush the cassette 1010. In various embodiments, the cavities 1015 and / or voids 1016 can be crushed so that the walls forming olosti, deflected downwards and contacted with the surface of the cassette support 1031 and / or in contact with the layer of the cartridge housing 1010, located below the cavities and / or voids.

When comparing FIG. 83B and FIG. 83C, it can be seen that the second layer 1012 and the fourth layer 1014 were substantially compressed by the compressive force from the stop 1040. It can also be noted that the first layer 1011 and the third layer 1013 were also compressed. When the stop 1040 is moved to the closed position, it can continue to squeeze the cassette 1010, pushing the fabric contacting surface 1019 down in the direction of the cassette support element 1030. When the cassette 1010 is further compressed, the stop 1040 can deform the brackets 1020, giving them the final shape, as shown in FIG. 83D. As shown in FIG. 83D, legs 1021 of each bracket 1020 may be deformed downward toward the base 1022 of each bracket 1020 to grip at least a portion of fabric T, the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 between the deformable legs 1021 , and base 1022. When comparing FIG. 83C and 83D, it can also be seen that the second layer 1012 and the fourth layer 1014 were essentially further compressed by a compressive force from the stop 1040. When comparing FIG. 83C and 83D, it can also be noted that the first layer 1011 and the third layer 1013 were also further compressed. After the staples 1020 are completely or at least sufficiently formed, the abutment 1040 can be lifted from the fabric T, and the cassette support element with staples 1030 can be removed and / or detached from the cassette with staples 1000. As shown in FIG. 83D, and follows from the above, the cassette 1010 can be implanted with brackets 1020. In various situations, the implanted cassette 1010 can support tissue along the line of staples. In some situations, a hemostatic agent and / or any other appropriate therapeutic drug contained in the implanted cassette 1010 body can act on the tissue for some time. A hemostatic agent, as described above, can reduce bleeding of stitched and / or cut tissue, while a binding agent or tissue adhesive can provide tissue strength over time. The implanted cassette 1010 housing may consist of materials such as, for example, ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PGA), commercially available under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain situations, the cartridge case 1010 may contain an antibiotic and / or antimicrobial material, such as, for example, colloidal silver and / or triclosan, which can reduce the risk of infection in the surgical field.

In various embodiments, the layers of the cassette 1010 can be connected to each other. In at least one embodiment, the second layer 1012 can be attached to the first layer 1011, the third layer 1013 can be attached to the second layer 1012, and the fourth layer 1014 can be attached to the third layer 1013 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In certain embodiments, although not shown in the figures, the layers of the cassette 1010 can be connected to each other by interconnected mechanical elements. In at least one such embodiment, each of the first layer 1011 and the second layer 1012 may comprise corresponding interconnected elements, such as, for example, a tongue and groove structure and / or dovetail type connecting elements. Each of the second layer 1012 and the third layer 1013 may similarly contain corresponding interconnected elements, while each of the third layer 1013 and the fourth layer 1014 may contain corresponding interconnected elements. In certain embodiments, although not shown, the cassette with brackets 1000 may comprise one or more rivets, which, for example, may pass through one or more layers of the cassette 1010. In at least one such embodiment, each rivet may comprise a first end, or a head, located next to the first layer 1011, and a second head, located next to the fourth layer 1014, which can be formed by the second end of the rivet or attached to it. Due to the compressibility of the cartridge case 1010, in at least one embodiment, rivets can compress the cartridge case 1010 so that the rivet heads can be recessed, for example, relative to the fabric contacting surface 1019 and / or the bottom surface 1018 of the cartridge case 1010. At least in one such embodiment, the rivets may be composed of bioabsorbable materials such as, for example, polyglycolic acid (PGA), commercially available under the trademark Vicryl, polylactic acid (PLA or PLLA), polydiox Anone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain embodiments, the layers of the cassette 1010 can be connected to each other only by the brackets 1020 included in them. At least in one such embodiment, friction force coupling between the legs of the brackets 1021 and the cassette 1010, for example, can hold the layers of the cassette 1010 together. and after the formation of the staples, the layers can be captured by the staples 1020. In certain embodiments, at least a portion of the legs of the staples 1021 may comprise a rough surface or a rough coating that can increase the force t rhenium between the brackets 1020 and the cassette 1010.

As described above, the surgical instrument may comprise a first jaw including a cassette support member with brackets 1030 and a second jaw including a stop 1040. In various embodiments, which are described in more detail below, a cassette with brackets 1000 may comprise one or more retaining elements that can be adapted to engage the support element of the cartridge with brackets 1030 and, thus, can provide a removable connection of the cartridge with brackets 1000 with the supporting element of the cartridge with brackets 1030. certain embodiments, the staple cartridge 1000 can be connected to the support member staple cartridge 1030 using at least one adhesive, such as, e.g., fibrin and / or protein hydrogel. When used in at least one situation, especially in laparoscopic and / or endoscopic surgery, the second jaw can be moved to the closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through the trocar into the surgical field. In at least one such embodiment, the trocar may form a lumen, or cannula, of approximately 5 mm in size, into which the first and second branches can be inserted. In certain embodiments, the second jaw can be moved to a partially closed position between the open and closed positions so that the first and second jaws can be inserted through the trocar without deformation of the staples 1020 contained in the cassette body with staples 1010. In at least one such embodiment the emphasis 1040 may not exert a compressive force on the cassette body with brackets 1010 when the second jaw is in a partially closed intermediate position, while in other certain embodiments Lenia stop 1040 may compress the staple cartridge housing 1010, as the second jaws are in a partially closed intermediate position. Even if the emphasis 1040 can compress the cartridge case with brackets 1010 when it is in such an intermediate position, the emphasis 1040 may not sufficiently compress the cartridge case with brackets 1010 so that the emphasis 1040 can contact the brackets 1020, and / or so that the brackets 1020 deformed under the influence of an emphasis 1040. After the first and second branches are inserted through the trocar into the surgical field, the second branch can be opened again, and the emphasis 1040 and the cassette with brackets 1000 can be positioned in the required position relative to the tissue, as described neck.

In various embodiments, as shown in FIG. 84A-84D, the surgical stapling instrument's working tool may include an implantable cassette with brackets 1100 located between the abutment 1140 and the support element of the cassette with brackets 1130. Like the abutment 1140 described above, may include tissue contacting surface 1141, the cassette with brackets 1100 may include fabric surface 1119, and the supporting element of the cassette with brackets 1130 may contain a supporting surface 1131, which can be configured to support the cassette with brackets 1100. As shown in FIG. 84A, an abutment 1140 can be used to position the fabric T relative to the tissue surface 1119 of the cassette with brackets 1100 without deforming the cassette with the brackets 1100, and when the abutment 1140 is in this position, the fabric contacting surface 1141 can be spaced 1101a from the abutment surface for a cassette with brackets 1131, and the fabric contacting surface 1119 can be spaced 1102a from the supporting surface for the cassette with brackets 1131. After that, when the stop 1140 is moved towards the supporting element of the box s clevis 1130 as shown in FIG. 84B, the abutment 1140 may push the upper surface, or the fabric contacting surface 1119, the cassettes with the brackets 1100 down, and squeeze the first layer 1111 and the second layer 1112 of the cassette 1110. When the layers 1111 and 1112 are compressed, as shown in FIG. 84B, the second layer 1112 may be destroyed, and the legs 1121 of the brackets 1120 may pierce the first layer 1111 and enter tissue T. In at least one such embodiment, the brackets 1120 may be at least partially located in the cavities, or voids, for the brackets 1115 in the second layer 1112, and when the second layer 1112 is compressed, the cavities for the brackets 1115 can be wrinkled, thereby allowing the second layer 1112 to wrinkle around the brackets 1120. In various embodiments, the second layer 1112 may include cover portions 1116 that may pass over the cavities for staples 1115 and h kryvat or at least partially close the staple cavity 1115. In FIG. 84B shows cover portions 1116 that, when broken, fall down into the cavity for the brackets 1115. In certain embodiments, the second layer 1112 may include one or more weakened parts that can crease the second layer 1112. In various embodiments, such weakened parts may contain, for example, notches, perforations, and / or thin sections that can provide controlled creasing of the cassette 1110. In at least one embodiment, the first layer 1111 may comprise one or more weakened parts that can allow the legs of the staples 1121 to pass through the first layer 1111. In various embodiments, such weakened parts may include, for example, notches, perforations, and / or thin sections that can be combined or at least substantially combine with the legs of the staples 1121.

When the stop 1140 is in a partially closed, inactive position, as shown in FIG. 84A, it may be located at a distance 1101a from the supporting surface for the cartridge 1131 so that a space is formed between them. This space may be occupied by a cassette with brackets 1100 with a height of the cassette with brackets 1102a and fabric T. When the stop 1140 is moved down to compress the cassette with brackets 1100, as shown in FIG. 84B, the distance between the tissue-contacting surface 1141 and the supporting surface for the cartridge 1131 can be determined by a distance 1101b, which is less than the distance 1101a. In various situations, the space between the fabric contacting surface 1141 of the abutment 1140 and the supporting surface for the cartridge 1131, indicated by the distance 1101b, may be greater than the initial height of the undeformed cartridge with brackets 1102a. When the emphasis 1140 is moved closer to the supporting surface for the cartridge 1131, as shown in FIG. 84C, the second layer 1112 may continue to wrinkle, and the distance between the legs of the bracket 1121 and the forming recesses 1142 may decrease. Similarly, the distance between the tissue-contacting surface 1141 and the supporting surface for the cassette 1131 may decrease to a distance 1101c, which in various embodiments may be greater, less than, or equal to the original height of the undeformed cassette 1102a. As shown in FIG. 84D, the abutment 1140 can be moved to a final, activated position in which the brackets 1120 are fully formed or at least formed to the desired height. In this position, the fabric contacting surface 1141 of the abutment 1140 may be at a distance 1101d from the supporting surface for the cartridge 1131, the distance 1101d being less than the original height of the undeformed cartridge 1102a. As shown in FIG. 84D, the cavities for the brackets 1115 may be completely or at least substantially wrinkled, and the brackets 1120 may be completely or at least substantially surrounded by a crumpled second layer 1112. In various situations, thereafter, the stop 1140 may be removed from the cartridge with brackets 1100. After releasing the stop 1140 from the cassette with brackets 1100, the cassette 1110 can at least partially experience backward expansion in different sections, that is, for example, in the sections between adjacent brackets 1120. In at least one embodiment, the crumpled cassette 1110 can experience inelastic reverse extension. In various embodiments, the formed braces 1120, as well as the cassette 1110 located between adjacent brackets 1120, can exert pressure or compressive force on tissue T, which can provide various therapeutic effects.

As described above, in the embodiment shown in FIG. 84A, each bracket 1120 may comprise the legs of the bracket 1121 protruding therefrom. Although the brackets 1120 shown in the figures comprise two legs 1121, various brackets may be used that may comprise one leg or, in an alternative embodiment, more than two legs, such as , three legs or four legs. As shown in FIG. 84A, each leg of the bracket 1121 can be inserted into the second layer 1112 of the cassette 1110 so as to secure the brackets 1120 in the second layer 1112. In various embodiments, the brackets 1120 can be inserted into the cavity for the brackets 1115 in the cassette 1110 so that the ends 1123 of the legs of the bracket 1121 entered the cavity 1115 before the bases 1122. After inserting the ends 1123 into the cavity 1115 in various embodiments, the ends 1123 can be pressed into the covering portions 1116 and the second layer 1112 can be cut. In various embodiments, the brackets 1120 can be inserted into the second layer 1112 to a sufficient depth so that the brackets 1120 are stationary or at least substantially stationary relative to the second layer 1112. In certain embodiments, the brackets 1120 can be inserted into the second layer 1112 to a sufficient depth so that the base bases 1122 are located or mounted in the cavity for the brackets 1115. In other various embodiments, the bases 1122 may not be located or mounted in the second layer 1112. In certain embodiments, as shown in FIG. 84A, the bases 1122 may extend beneath the lower surface 1118 of the cartridge case 1110. In certain embodiments, the bases 1122 may lie on the supporting surface for the cartridge 1130 or may be located directly opposite it. In various embodiments, the support surface for the cassette 1130 may comprise support elements extending from and / or formed therefrom, and in at least one such embodiment of the base 1122, the brackets 1120 may be supported, for example, by one or more supporting grooves, grooves, or grooves 1132 on the support element of the cassette with brackets 1130, as described in more detail below.

In addition to the above, as shown in FIG. 85, the bases 1122 of the brackets 1120 can be positioned directly opposite the supporting surface 1131 of the cassette support element with the brackets 1130. In various embodiments, including embodiments where the bases of the brackets 1122, for example, contain circular or curved lower surfaces 1124, the bases of the brackets 1122 can move or slide along the supporting surface for the cassette with brackets 1131. Such sliding can occur when the stop 1140 puts pressure on the ends 1123 of the legs of the bracket 1121 during the formation of the brackets. In certain embodiments, as described above and as shown in FIG. 86, the support element of the cassette with brackets 1130 may include one or more support grooves 1132, which can be configured to eliminate or at least reduce the relative movement between the bases of the brackets 1122 and the supporting surface for the cartridge 1131. In at least one such embodiment each abutment groove 1132 can be formed by a surface contour that matches or at least substantially coincides with the contour of the bottom surface of the bracket located on it. For example, the lower surface 1124 of the base 1122 shown in FIG. 86 may comprise a circular or at least substantially circular surface, and the support groove 1132 may also comprise a circular or at least substantially circular surface. In at least one such embodiment, the radius of curvature of the surface forming the groove 1132 may be greater than or equal to the radius of curvature of the lower surface 1124. Although the grooves 1132 can help prevent or reduce relative sliding movement between the brackets 1120 and the support element of the cassette with brackets 1130, the grooves 1132 can also be configured to prevent or reduce relative rotational movement between the brackets 1120 and the supporting element of the cassette with brackets 1130. In particular, at least is, in one embodiment, the slots 1132 may be configured to introduce therein a dense bases 1122 to prevent or reduce rotation of the staple 1120, for example, around the axes 1129 so that the bracket 1120 can not rotate or twist during the deformation process.

In various embodiments, in addition to the above, each bracket 1120 can be made of round or at least substantially circular cross-section of the wire. In certain embodiments, the legs and base of each bracket can be made of wire with a non-circular cross section, such as, for example, a rectangular cross section. In at least one such embodiment, the support element of the cassette with brackets 1130 may include corresponding non-circular grooves, such as, for example, rectangular grooves configured to receive the bases of such brackets. In various embodiments, as shown in FIG. 87, each bracket 1120 may include a head, such as, for example, a head 1125, which is a broadening of the base 1122, each head 1125 can be positioned inside the support groove in the support element of the cassette with brackets 1130. In at least one such embodiment, each head 1125 may have, for example, a square and / or rectangular section that can be adapted to enter, for example, square and / or rectangular grooves 1134 in the support element of the cassette with brackets 1130. In various embodiments 1125 heads may consist of a bioabsorbable plastic such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL) ), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL, and it can be formed around the bases 1122 of the brackets 1120, for example, by injection molding . Various heads and methods for producing various heads are disclosed in US Patent Application No. 11 / 541,123 entitled "SURGICAL STAPLES WITH COMPRESSIBLE OR MOLDED ELEMENTS FOR FASTENING TISSUES, AND SEWING INSTRUMENTS FOR INSTALLING THESE SEPTEMBER 29, 2007, such as fully incorporated herein by reference. As shown in FIG. 87, the grooves 1134 may further comprise guides, or chamfers, 1135, which may be configured to allow inserting the heads 1125 into the grooves 1134. In various embodiments, the base and / or head of the brackets 1120 may be located within the grooves 1134 when the cassette with the brackets 1100 installed in the support element of the cartridge with brackets 1130. In certain embodiments of the head 1125, the brackets 1120 can be combined with the grooves 1134 when the cartridge with the brackets 1100 is installed in the support element of the cartridge with the brackets 1130. In at least one such shaft In the embodiment, the heads 1125 may not enter the grooves 1134 until a compressive force is applied to the legs of the brackets 1121 and the bases and / or heads of the brackets 1120 are pushed down into the grooves 1134.

In various embodiments, as shown in FIG. 88 and 89, a cassette with brackets, such as, for example, a cassette with brackets 1200, may include a compressible implantable cassette 1210 containing an outer layer 1211 and an inner layer 1212. Similar to the above, the cassette with brackets 1200 may contain many brackets 1220 located inside cassette cases 1210. In various embodiments, each bracket 1220 may include a base 1222 and one or more legs of the bracket 1221 extending from it. In at least one such embodiment, the legs of the bracket 1221 can be inserted into the inner layer 1212 and to the depth at which, for example, the bases 1222 of the brackets 1220 are adjacent and / or are located next to the lower surface 1218 of the inner layer 1212. In the embodiment shown in FIG. 88 and 89, the inner layer 1212 does not contain a cavity for the brackets, configured to receive part of the brackets 1220, while in other embodiments, the implementation of the inner layer 1212 may contain such cavity for the brackets. In various embodiments, in addition to the above, the inner layer 1212 may consist of a compressible material, such as, for example, bioabsorbable foam and / or oxidized regenerated cellulose (ORC), which can be configured to wrinkle the cassette 1210 upon application compressive load to it. In various embodiments, the inner layer 1212 may consist of lyophilized foam containing, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA). ORC may be commercially available under the trade name Surgicel and may be a loose woven fabric (like a surgical sponge), loose fibers (like cotton balls) and / or foam. In at least one embodiment, the inner layer 1212 may consist of a material including drugs, such as, for example, lyophilized thrombin and / or fibrin, contained therein and / or applied thereto, which can, for example, be activated with water and / or activate the fluid in the patient. In at least one such embodiment, lyophilized thrombin and / or fibrin may be located, for example, on a matrix of Vicryl material (PGA). However, in certain circumstances, activated drugs can be inadvertently activated, for example, by inserting a cassette with brackets 1200 into the surgical field in a patient. In various embodiments, as shown in FIG. 88 and 89, the outer layer 1211 may consist of a waterproof or at least substantially waterproof material so that liquids cannot come into contact or at least essentially cannot come into contact with the inner layer 1212 until the cassette 1210 is compressed and penetration of the legs of the staples through the outer layer 1211 and / or until the cutting of the outer layer 1211 in one way or another. In various embodiments, the outer layer 1211 may consist of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In certain embodiments, the outer layer 1211 may comprise a wrapper surrounding the inner layer 1212 and the brackets 1220. In particular, in at least one embodiment, the brackets 1220 can be inserted into the inner layer 1212, and the outer layer 1211 can be wrapped around a subunit containing the inner layer 1212 and staples 1220, and then seal.

In various embodiments, as shown in FIG. 90 and 91, a cassette with brackets, such as, for example, a cassette with brackets 1300, may comprise a compressible implantable cassette 1310 including an outer layer 1311 and an inner layer 1312. Similar to the above, the cassette with brackets 1300 may further comprise staples 1320, cassettes 1310 located inside the casing, each bracket 1320 may include a base 1322 and one or more legs 1321 extending from it. Similarly to a cassette with brackets 1200 of the base 1322, the brackets 1320 can extend under the lower surface 1318 of the inner layer 1312, and the outer layer 13 11 may surround the bases 1322. In at least one such embodiment, the outer layer 1311 may be flexible enough to surround the base of each bracket 1322 so that the outer layer 1311 matches the outline of the bases 1322. In at least one alternative embodiment, as shown in FIG. 89, the outer layer 1211 may be stiff enough to extend around the bases 1222 without matching the contour of each base 1222. In any case, in various embodiments, the outer layer 1311 may be located between the bases 1322 of the brackets 1320 and the supporting surface for the cassette with brackets, such as, for example, supporting surfaces 1031 or 1131 supporting a cassette with brackets 1300. In at least one such embodiment, the outer layer 1311 may be located between the bases 1322 and supporting grooves, such as, for example, grooves 1032 Whether 1132 formed in the support surface for the staple cartridge. In at least one such embodiment, in addition to the above, the outer layer 1311 may be configured to limit the movement of the bases 1322 and / or increase the coefficient of friction between the bases 1322 and the supporting surface for the cassette with brackets and / or supporting grooves to reduce their movements relative to each other. In various alternative embodiments, as shown in FIG. 92 and 93, the outer layer of the cassette with brackets, such as, for example, the cassette with brackets 1400, may not completely surround the brackets located therein. In at least one such embodiment, the outer layer 1411 of the compressible implantable cartridge case 1410 can be attached to the inner layer 1412 before the legs 1421 of the brackets 1420 are inserted into the cartridge case 1410. As a result of the base 1422 described above, the brackets 1420 may protrude outward from the outer layer 1411, and in at least one such embodiment, the bases 1422 may be located, for example, directly in the supporting grooves 1032 or 1132 of the supporting surfaces for the cartridge with brackets 1031 or 1131. In various embodiments, the legs of the brackets S 1421 can cut the outer layer 1411 during insertion. In various situations, the holes created by the legs of the brackets 1421 can tightly surround the legs of the brackets 1421 so that the fluid leak between the legs of the brackets 1421 and the outer layer 1411 is very small or absent, which can reduce or eliminate the risk of premature activation and / or leakage of the drug means contained inside the cassette with brackets 1410.

As described above and shown in FIG. 88 and 89, the legs 1221 of the brackets 1220 can be installed in the cassette 1210, and the bases 1222 of the brackets 1220 can protrude outward from the lower surface 1218 of the inner layer 1212. In various embodiments, in addition to the above, the inner layer 1212 may not contain a cavity for staples, configured to receive staples 1220. In other various embodiments, as shown in FIG. 94 and 95, a cassette with brackets, such as, for example, a cassette with brackets 1500, may comprise a compressible implantable cassette 1510 housing containing cavities for brackets 1515 that can be configured to receive at least a portion of the brackets 1520. At least one such embodiment, the upper part of the legs 1521 of the brackets 1520 can be installed in the inner layer 1512, while the lower part of the legs of the brackets 1521 and the base 1522 can be located in the cavities for the brackets 1515. In certain embodiments, the bases 1522 can completely rely in the cavities for the brackets 1515, while in some embodiments, the bases 1522 may at least partially extend under the lower surface 1518 of the inner layer 1512. Similar to the above, the outer layer 1511 may include an inner layer 1512 and brackets 1520 located therein. other specific embodiments, as shown in FIG. 96, the cassette with brackets 1600 may include brackets 1620 located in the cavity for brackets 1615 in a compressible implantable cassette 1610, with at least a portion of the brackets 1620 not surrounded by an outer layer 1611. In at least one such embodiment, each bracket 1620 may comprise legs of the bracket 1621, which are at least partially installed in the inner layer 1612, as well as the base 1622, which protrude outward around the outer layer 1611.

In various embodiments, as shown in FIG. 97 and 98, a cassette with brackets, such as, for example, a cassette with brackets 1700, may comprise a compressible implantable cassette 1710 and a plurality of brackets 1720 at least partially located inside the cassette 1710. The cassette 1710 may include an outer layer 1711, an inner a layer 1712, as well as a leveling matrix 1740, which can be arranged to align and / or hold the brackets 1720 in the required position inside the cassette 1710. In at least one embodiment, the inner layer 1712 may include a recess 1741, which may be configured to receive the alignment matrix 1740. In various embodiments, the alignment matrix 1140 may be secured to the recess 1741 by pressing and / or otherwise appropriately secured to the inner layer 1712 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In at least one embodiment, the recess 1741 may be configured so that the bottom surface 1742 of the alignment matrix 1740 aligns or at least substantially aligns with the bottom surface 1718 of the inner layer 1712. In certain embodiments, the bottom surface 1742 of the alignment matrix may be recessed in the lower surface 1718 of the second layer 1712 and / or may depart from it. In various embodiments, each bracket 1720 may comprise a base 1722 and one or more legs 1721 extending from the base 1722, wherein at least a portion of the legs of the bracket 1721 may extend through the alignment matrix 1740. The alignment matrix 1740 may further comprise a plurality of holes passing therethrough and / or grooves that can be configured to receive the legs of the staples 1721. In at least one such embodiment, each hole can be configured to tightly insert the legs of the bracket 1 721 so that the relative movement between the leg of the bracket 1721 and the side walls of the hole is negligible or absent. In certain embodiments, the holes of the alignment matrix may not completely extend through the alignment matrix 1740, and it may be necessary to cut the alignment matrix 1740 with the legs of the bracket 1721 while pushing the legs of the bracket 1721 through it.

In various embodiments, the alignment matrix 1740 may consist of a molded plastic housing, which in at least one embodiment may be more rigid and less compressible than the inner layer 1712 and / or the outer layer 1711. In at least one such embodiment, the alignment matrix 1740 may consist of a plastic material and / or any other suitable material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In certain embodiments, the alignment matrix 1740 can be attached to the inner layer 1712, and then the legs of the bracket 1721 can be inserted through the alignment matrix 1740 and installed in the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment matrix 1740 may comprise, for example, one or more grooves, grooves or grooves that can be configured to at least partially receive the bases 1722 of the brackets 1720. Similar to the above, the outer layer 1711 can then be positioned in the circle of the subassembly containing the inner layer 1712, the alignment matrix 1740 and the brackets 1720. In an alternative embodiment, the outer layer 1711 can be positioned around the subassembly containing the inner layer 1712 and the alignment matrix 1740, after which the brackets 1720 can be inserted through the outer layer 1711, the alignment matrix 1740 and the inner layer 1712. In any case, as a result of the above, the inner layer 1712, the alignment matrix 1740 and / or the outer layer 1711 can be configured to hold the brackets 1720 in the required position until and / or after their deformation under the influence of stops, as described above. In at least one such embodiment, the alignment matrix 1740 can serve to hold the brackets 1720 in position until the cassette with brackets 1700 is implanted in the patient’s body, as well as to fix tissue along the line of braces after implantation of the cassette with brackets 1700. In at least one the embodiment, the brackets 1720 can be fixed, for example, in the alignment matrix 1740 without being installed in the inner layer 1712 and / or the outer layer 1711.

In various embodiments, as shown in FIG. 99-105, a cassette with brackets, such as, for example, a cassette with brackets 1800, can be installed by compressing the inner layer 1812, inserting brackets, such as, for example, staples 1820, into the inner layer 1812, and also wrapping the inner layer 1812 with the outer layer 1811. As mainly shown in FIG. 99, the compressible inner layer 1812 contains a plurality of brackets 1815 formed therein, although other embodiments are possible in which the inner layer 1812 does not contain a hollow as described above. As shown in FIG. 100, a compressible inner layer 1812 can be positioned between the transfer plate 1850 and the support plate 1860 and compressed between the compression surfaces of the plates 1852 and 1862, respectively. As shown in FIG. 100, the upper and lower surfaces of the inner layer 1812 can be pressed against each other, and thus, the inner layer 1812 can protrude outward in the transverse directions. In certain embodiments, the inner layer 1812 can be compressed, for example, to a height of about one third of its original height, and its height or thickness can be, for example, from about 1.52 mm (0.06 ") to about 2.03 mm (0.08 ”) in a compressed state. As shown in FIG. 100, the transfer plate 1850 may further comprise a plurality of brackets, such as, for example, brackets 1820 arranged in a plurality of recesses for the brackets 1853. In addition, the transfer plate 1850 may further comprise a plurality of ejectors 1851, which may be configured to push the brackets 1820 up and out of the recesses for the brackets 1853. As shown in FIG. 101, the pushers 1851 can be used to push the legs 1821 of the brackets 1820 in and through the compressed inner layer 1812. In various embodiments, the pushers 1851 can be configured so that their upper surfaces are at the same level or at least almost at the same level with the surface compressing 1852 the transfer plate 1850 when the brackets 1820 are completely installed from the recesses for the brackets 1853 of the transfer plate 1850. In certain embodiments, as shown in FIG. 101, the support plate 1860 may comprise a plurality of receiving holes 1861, which may be configured to receive the legs of the brackets 1821 or at least the ends of the legs of the brackets 1821 after pushing them through the inner layer 1812. The receiving holes 1861 or the like. may be necessary in embodiments where the inner layer 1812 is compressed to a height that is less than the height of the brackets 1820, and thus, when the brackets 1820 are completely removed from the grooves for the brackets 1853, the legs of the brackets 1821 may protrude from the upper surface of the compressed inner layer 1812. B In other specific embodiments, the inner layer 1812 can be compressed to a height that is greater than the height of the brackets 1820, and thus receiving holes 1861 in the support plate 1860 may not be necessary.

After inserting the brackets 1820 into the inner layer 1812, as shown in FIG. 102, the support plate 1860 can be diverted from the transfer plate 1850 to decompress the inner layer 1812. In such situations, the inner layer 1812 may experience elastic back expansion to its original or at least close to its original height before compression. When the inner layer 1812 undergoes back expansion, the height of the inner layer 1812 can increase so that it becomes larger than the height of the brackets 1820 and that the legs 1821 of the brackets 1820 will no longer protrude from the upper surface of the inner layer 1812. In various situations, the receiving holes 1861 can be made with the possibility of holding the legs of the staples 1821 in the required position at least until the moment when the support plate 1860 will be taken away to a sufficient distance so that the legs 1821 are no longer located in the receiving x holes 1861. In such situations, the receiving holes 1861 can help maintain the mutual alignment of the brackets 1820 in the inner layer 1812 after its back expansion. In various situations, the inner layer 1812 and the brackets 1820 located therein may comprise a subassembly 1801, which, as shown in FIG. 103, it is possible to insert, for example, into the outer layer 1811. In at least one such embodiment, the outer layer 1811 may comprise a cavity 1802, which may be adapted to receive a subnode 1801. In various situations, a tool such as, for example, tongs 1855, to pull the outer layer 1811 onto the subassembly 1801. After the subassembly 1801 is sufficiently positioned inside the outer layer 1811, as shown in FIG. 104, the outer layer 1811 can be sealed. In various embodiments, the outer layer 1811 may be sealed by applying thermal energy to a portion thereof. In particular, in at least one embodiment, the outer layer 1811 may consist of a plastic material, the open end of the outer layer 1811 can be heat-sealed using one or more heating elements, or heat-sealing devices, 1856 for bonding and / or sealing the perimeter of the open the end of the outer layer 1811. In at least one such embodiment, as shown in FIG. 105, the excess portion 1857 of the outer layer 1811 can be removed, and then the cassette with brackets 1800 can be used as described herein.

As described above, the cassette with brackets can be placed inside the part for fixing the cassette with brackets and / or fixed on it. In various embodiments, as shown in FIG. 106 and 107, the bracket mounting portion of the cassette may comprise a channel for a cassette with brackets, such as, for example, a channel for a cassette with brackets 1930, which may be configured to receive at least a portion of the cassette with brackets, such as, for example, cassette with brackets 1900. In at least one embodiment, the channel for the cassette with brackets 1930 may comprise a lower abutment surface 1931, a first transverse abutment wall 1940 and a second transverse abutment wall 1941. In use, the cassette with brackets 1900 can be positioned the inside of the channel for the cassette with brackets 1930 so that the cassette with the brackets 1900 is located on and / or adjacent to the lower supporting surface 1931, and also between the first transverse supporting wall 1940 and the second transverse supporting wall 1941. In certain embodiments, between the first transverse the supporting wall 1940 and the second transverse supporting wall 1941 may be a transverse space. In at least one such embodiment, the cassette with brackets 1900 may have a width in the transverse direction 1903 that is equal to and / or greater than the width of the transverse space formed between the support walls 1940 and 1941 so that a compressible implantable cassette body 1910 with brackets 1900 could fit tightly between walls 1940 and 1941. In other specific embodiments, the width in the transverse direction 1903 of the cassette with brackets 1900 may be less than the width of the space formed between the first and second side walls 1940 and 1941. In various embodiments, at least a portion of walls 1940 and 1941 and a lower abutment surface 1931 may be formed by a stamped metal channel, while in at least one embodiment, at least a portion of the transverse abutment wall 1940 and / or the transverse support wall 1941 may consist of a flexible material, such as, for example, an elastomeric material. As mainly shown in FIG. 106, each of the first side wall 1940 and the second side wall 1941 of the cassette channel 1930 can consist of a rigid portion 1933 extending upward from a lower abutment surface 1931 and a flexible portion 1934 extending upwardly from the rigid portions 1933.

In various embodiments, in addition to the above, the cassette body 1910 with brackets 1900 may consist of one or more compressible layers, such as, for example, the first layer 1911 and the second layer 1912. When the cassette body 1910 is compressed to a lower abutment surface 1931 the impact of the stop, as described above, the side parts of the cassette 1910 can expand in the transverse direction. In embodiments where the cassette with brackets 1930 consists of rigid side walls, lateral expansion of the cassette 1910 can be prevented or at least limited by the hard side walls, and thus significant internal pressure can occur within the cassette 1910, or voltage. In embodiments where at least a portion of the cassette with brackets 1930 consists of flexible side walls, the flexible side walls can be configured to extend in the transverse direction, which helps to expand the lateral parts of the cassette body 1910 in the transverse direction and reduces internal pressure, or voltage arising inside the cassette body 1910. In embodiments where the channel for the cassette does not contain transverse side walls or comprises transverse side walls that are relative to Shorter than the cassettes with brackets, the lateral parts of the cassette with brackets can expand unlimitedly or at least essentially unlimitedly in the transverse direction. In any case, as shown in FIG. 107, the channel for the cassette with brackets 2030 may contain transverse side walls 2040 and 2041, which may consist entirely of flexible material, such as, for example, elastomeric material. The cassette channel with brackets 2030 may further comprise transverse grooves 2033 extending along the sides of the lower supporting surface 2031 of the cassette channel with brackets 2030, which may be configured to receive and secure at least a portion of the transverse side walls 2040 and 2041. In certain embodiments the transverse side walls 2040 and 2041 can be secured in the grooves 2033 using snap and / or pressing mechanisms, while in at least some embodiments, the transverse side walls 2040 and 20 41 may be secured in slots 2033 using one or more adhesives. In at least one embodiment, the side walls 2040 and 2041 may be detached from the lower abutment surface 2031 during use. In any case, the compressible implantable cartridge case 2010 can be disconnected and / or freed from the transverse side walls 2040 and 2041 after implantation of the cartridge case 2010 with brackets 2020.

In various embodiments, as shown in FIG. 108, the surgical tool may include a barrel 2150 and a working tool extending from the distal end of the barrel 2150. Similar to the above-described working tool may include a channel for a cassette with brackets 2130, an emphasis 2140 configured to move between the open position and the closed position, and the cassette with staples 2100 located between the channel for the cassette with brackets 2130 and emphasis 2140. Also similar to the above, the cassette with brackets 2100 may include a compressible implantable cassette 2110 and a plurality of brackets 2120, position married in the housing of the cartridge 2110. In various embodiments, the channel for the cartridge with brackets 2130 may contain, firstly, a lower supporting surface 2131, on which the cartridge with brackets 2100 can be located, secondly, the distal end 2135 and, thirdly, proximal end 2136. In at least one embodiment, as shown in FIG. 108, the cassette with brackets 2100 may include a first end 2105 that can be configured to install a channel for the cassette with brackets 2130 at the distal end 2135, and a second end 2106 that can be configured to install a channel for the cassette at the proximal end 2136 brackets 2130. In various embodiments, the distal end 2135 of the cassette channel with brackets 2130 may comprise at least one distal retaining element, such as, for example, a retaining wall 2137, and the proximal end 2136 may likewise hold at least one proximal retaining element, such as, for example, a retaining wall 2138. In at least one such embodiment, a space may be formed between the distal retaining wall 2137 and the proximal retaining wall 2138, which may be equal to or less than the length of the cassette with staples 2100 so that the cassette with staples 2100 can be held tightly inside the channel for the cassette with staples 2130 after inserting the cassette with staples 2100 into it.

In various embodiments, as shown in FIG. 88 and 89, a cassette with brackets, such as, for example, a cassette with brackets 1200, may comprise a flat or at least substantially flat tissue-contacting surface 1219. In at least one such embodiment, the cassette body 1210 with brackets 1200 may comprise a first end 1205, which may be determined by a first height, or thickness, 1207, and a second end 1206, which may be determined by a second height, or thickness, 1208, where the first height 1207 may be equal to or less than substantially equal to the second height 1208. In certain option In an embodiment, the cartridge case 1210 may comprise a constant or at least substantially constant height, or thickness, between the first end 1205 and the second end 1206. In at least one such embodiment, the tissue-contacting surface 1219 may be parallel or at least at least substantially parallel to the bottom surface 1218 of the cassette 1210. In various embodiments, as shown in FIG. 108, the first end 2105 of the cassette body 2110 with brackets 2100 may be defined by a first height 2107 that is different from the second height 2108 of the second end 2106. In the illustrated embodiment, the first height 2107 is greater than the second height 2108, although in alternative embodiments, the second height 2108 may be greater than the first height 2107. In various embodiments, the height of the cassette 2110 may decrease linearly and / or exponentially between the first end 2105 and the second end 2106. In at least one such embodiment, The fabric contacting surface 2119 extending between the first end 2105 and the second end 2106 can be oriented along an angle formed between them. In at least one such embodiment, the tissue-contacting surface 2119 may not be parallel to the bottom surface 2118 of the cassette 2110 and / or parallel to the supporting surface 2131 of the cassette channel with brackets 2130.

In various embodiments, as shown in FIG. 108 and 109, the stop 2140 may comprise a fabric contacting surface 2141, which may be parallel or at least substantially parallel to the support surface 2131 of the cassette channel with brackets 2130, when the stop 2140 is in the closed position, as shown in FIG. 109. When the stop 2140 is in the closed position, it can be configured to compress the first end 2105 of the cassette with brackets 2100 to a greater extent than the second end 2106 due to the higher height of the first end 2105 and the lower height of the second end 2106. In some situations , including situations where the tissue T located between the tissue contacting surfaces 2119 and 2141 has a constant or at least substantially constant thickness, the pressure generated inside the tissue T and the cassette 2100 may be greater at the distal end of the working tool, than at the proximal end of the working tool. More specifically, when the fabric T located between the emphasis 2140 and the cassette with the brackets 2100 has a substantially constant thickness, the fabric T located between the distal end 2145 of the emphasis 2140 and the first end 2105 of the cassette 2100 can be compressed more than tissue T located between the proximal end 2146 of the abutment 2140 and the second end 2106 of the cassette with brackets 2100. In various embodiments, a pressure gradient can be created within the tissue T between the proximal end and the distal end of the working tool. More specifically, in at least one embodiment, when the tissue T located between the abutment 2140 and the cassette with brackets 2100 has a substantially constant thickness and the height of the cassette with brackets 2100 decreases linearly from the distal end to the proximal end of the working tool, the pressure inside the tissue T can linearly decrease from the distal end of the working tool to the proximal end of the working tool. Similarly, in at least one embodiment, when the tissue T located between the abutment 2140 and the cassette with brackets 2100 has a substantially constant thickness and the height of the cassette with brackets 2100 decreases exponentially from the distal end to the proximal end of the working tool, the pressure inside tissue T can decrease exponentially from the distal end of the working tool to the proximal end of the working tool.

In various embodiments, as shown in FIG. 108, the fabric T located between the cassette with the brackets 2100 and the abutment 2140 may not have a constant thickness over its entire length. In at least one such situation, the tissue T located between the proximal end 2146 of the stop 2140 and the second end 2106 of the cassette 2100 may be thicker than the tissue T located between the distal end 2145 of the stop 2140 and the first end 2105 of the cassette 2100. Thus , in such situations, a thicker tissue T can essentially be located above the shorter proximal end 2106 of the cassette with brackets 2100, and a thinner tissue T can essentially be located above the higher distal end 2105. In use, the trigger of barrel 2150 mechanism 2152 can be advanced distally along the barrel pins 2151 such that the clutch release mechanism 2152 engages the cam portion 2143 and abutment 2140 abutment 2140 turned toward the staple cartridge 2100 as shown in FIG. 109. After the stop 2140 is rotated to the fully closed position, the fabric T can be compressed between the surfaces 2119 and 2141 in contact with the fabric, and the pressure or compressive force applied to the fabric T can be constant or at least substantially constant over the entire thickness even with taking into account that the height of the cassette with brackets 2100 between the proximal and distal ends of the working tool may be unstable. More specifically, since a thicker fabric T can be connected to a higher cassette with brackets 2100, and a thinner fabric T can be connected to a lower cassette to brackets 2100, the total or total height of fabric T and cassettes with brackets 2100 can be constant or at least substantially constant between the proximal and distal ends of the working tool, and thus the compression of a given total height by the abutment 2140 may be constant or at least substantially constant over its entire thickness.

In various embodiments, as shown in FIG. 108 and 109, the cassette with brackets 2100 may have an asymmetric configuration. In at least one such embodiment, the height of the cartridge with brackets 2100 at its first end 2105 may, for example, be greater than the height of the cartridge with brackets 2100 at its second end 2106. In certain embodiments, the cartridge with brackets 2100 and / or the channel for the cartridge with the brackets 2130 may contain one or more leveling and / or retaining elements, which can be configured to ensure that the cartridge with brackets 2100 can be located inside the channel for the cartridge with brackets 2130 in only one orientation, i.e. in an orientation in which the first end 2105 is located on the distal end 2135 of the cassette channel with brackets 2130 and the second end 2106 is located on the proximal end of 2136. In various alternative embodiments, the cassette with brackets 2100 and / or the channel for the cassette with brackets 2130 may comprise one or more alignment and / or holding elements, which can be arranged to arrange the cartridge with brackets 2100 in the channel for the cartridge with brackets 2130 in more than one orientation. As shown in FIG. 110, for example, the cassette with brackets 2100 can be located inside the channel for the cassette with brackets 2130 so that the first end 2105 of the cassette with brackets 2100 can be located at the proximal end 2136 of the channel for the cassette with brackets 2130, and the second end 2106 can be located at the distal end 2135. Thus, in various embodiments, a lower height of the cassette with brackets 2100 can be located in close proximity to the distal retaining wall 2137, and a large height of the cassette with brackets 2100 can be located in the immediate proximity to the proximal retaining wall 2138. In at least one such embodiment, the cassette with brackets 2100 may be appropriately positioned to apply a constant or at least substantially constant fixing pressure to tissue T so that the thicker portion is located inside the distal end the working tool, and the more accurate part is inside the proximal end of the working tool. In various embodiments, the cassette with brackets 2100, for example, can be selectively oriented within the channel for the cassette with brackets 2130. In at least one such embodiment, the alignment and / or holding elements of the cassette with brackets 2100 can be symmetrical, and the surgeon can selectively position a cassette with brackets 2100 inside the channel for a cassette with brackets 2130 in the orientations shown, for example, in FIG. 108 and FIG. 110.

In addition to the above, the implantable cartridge case 2110 may include a longitudinal axis 2109 that can extend between the proximal and distal ends of the working tool when the cartridge with brackets 2100 is located in the channel for the cartridge with brackets 2130. In various embodiments, the thickness of the cartridge case 2110 may substantially decrease and / or substantially increase between the first end 2105 and the second end 2106 along the longitudinal axis 2109. In at least one such embodiment, the distance, or height, between surface 2118 and a fabric contacting surface 2119 can substantially decrease and / or substantially increase between the first end 2105 and the second end 2106. In certain embodiments, the thickness of the cassette 2110 can both increase or decrease along the longitudinal axis 2109. At least in at least one such embodiment, the thickness of the cassette 2110 may comprise one or more parts whose thickness increases, and one or more parts whose thickness may decrease. In various embodiments, as shown in FIG. Z, the cassette with brackets 2100 may comprise a plurality of brackets 2120 located therein. During use, as described above, the brackets 2120 can become deformed when the stop 2140 moves to the closed position. In certain embodiments, each bracket 2120 may have the same or at least substantially the same height. In at least one such embodiment, the height of the bracket can be measured, for example, from the bottom of the base to the top, or end, of the highest leg of the bracket.

In various embodiments, the staples inside the cassette with brackets may have different heights. In at least one such embodiment, the cassette with brackets may comprise a first group of staples having a first staple height that is located in the first part of the compressible cassette body, and a second group of staples having a second staple height that is located in the second part of the compressible cassette body. In at least one embodiment, the first bracket height may be greater than the second bracket height, and the first bracket group may be located on the first end 2105 of the cassette 2100, and the second bracket group may be located on the second end 2106. In an alternative embodiment, the higher first a group of brackets may be located on the second end 2106 of the cartridge with brackets 2100, and a lower second group of brackets may be located on the first end 2105. In certain embodiments, a plurality of bracket groups may be used, each giving of which has different height staples. In at least one such embodiment, a third group having an intermediate height of staples may be located in the cassette 2110 between the first group of staples and the second group of staples. In various embodiments, each bracket in a row of brackets in a bracket cassette may have a different height. In at least one embodiment, the highest bracket in a row may be located at the first end of the row of brackets, and the shortest bracket may be located at the opposite end of the row of brackets. In at least one such embodiment, the brackets located between the highest bracket and the shortest bracket can, for example, be positioned so that the height of the brackets decreases between the highest bracket and the shortest bracket.

In various embodiments, as shown in FIG. 111, the surgical stapling instrument's working tool may include a stop 2240, a cassette channel with brackets 2230 and a cassette with brackets 2200 supported by a channel for a cassette with brackets 2230. The cassette with brackets 2200 may include a compressible implantable cassette 2210 and a plurality of brackets located therein, such as, for example, staples 2220a and 2220b. In various embodiments, the channel for the cassette with brackets 2230 may include a supporting surface for the cartridge 2231 and a plurality of support grooves formed therein for the brackets, such as, for example, the support grooves 2232a and 2232b. In at least one such embodiment, the cassette with brackets 2200 may comprise two outer rows of brackets 2220a and two inner rows of brackets 2220b, wherein the support grooves 2232a may be configured to support the brackets 2220a and the support grooves 2232b may be configured to support the brackets 2220b. As shown in FIG. 111 and 112, the emphasis 2240 may comprise a plurality of recesses formed therein to form brackets 2242, which may be adapted to receive and deform the brackets 2220a and 2220b when the emphasis 2240 moves toward the cassette with brackets 2200. In at least one such embodiment the lower surfaces of the support grooves 2232a may be located at a first distance 2201a from the upper surfaces of the recesses to form the brackets 2242, and the lower surfaces of the support grooves 2232b may be located at a second distance 2201b from the upper surfaces of the corner stitches for forming brackets 2242. In at least one such embodiment, the support grooves 2232b are located closer to the abutment 2240 due to the raised step on the supporting surface 2231 in which they are formed. Due to the different distances 2201a and 2201b in various embodiments, the outer rows of brackets 2220a and the inner rows of brackets 2220b may acquire different heights during deformation. In various situations, the brackets, which, when deformed, have acquired different heights, can exert a different fixing pressure or force on the stitched fabric T. In addition to the above, at the beginning of the bracket, they can have different heights. In at least one such embodiment, as shown in FIG. 111, the outer brackets 2220a may have an initial height prior to forming that is greater than the original height before the formation of the inner brackets 2220b. As shown in FIG. 111 and 112, the inner brackets 2220b having a lower height before forming than the outer brackets 2220a can also have a lower height after forming than the outer braces 2220a. In various alternative embodiments, the inner brackets 2220b may have a greater height before forming than the outer brackets 2220a, while still having a lower height after formation than the outer brackets 2220a.

In various embodiments, in addition to the above, the emphasis 2240 can be moved to the closed position, as shown in FIG. 112, for compressing the cartridge case 2210 and deforming the brackets 2220a and 2220b. In certain embodiments, a surgical stapling instrument comprising the working tool shown in FIG. 111 and 112, may, for example, further comprise a cutting element that can be adapted to dissect the tissue T located between the stop 2240 and the cassette with brackets 2200. In at least one such embodiment, the stop 2240, the channel for the cassette with brackets 2230 and / or the cassette with brackets 2200 can form a groove made with the possibility of sliding introduction of a cutting element into it. More specifically, the stop 2240 may comprise a portion of a groove 2249, the channel for a cassette with brackets 2230 may comprise a portion of a groove 2239, and the cartridge with brackets 2200 may comprise a portion of a groove 2203 that may be aligned or at least substantially aligned relative to each other when emphasis 2240 is in a closed or at least substantially closed position. In various embodiments, the cutting element can be moved from the proximal end of the working tool to the distal end of the working tool after closing the stop 2240 and deforming the staples 2220a, 2220b. In at least one embodiment, the cutting element can be moved independently of the staple deformation process. In certain embodiments, the cutting element can be advanced simultaneously with the deformation of the staples. In any case, in at least one embodiment, the cutting element may be configured to cut tissue along a path extending between the inner rows of staples 2220b.

In various embodiments, as shown in FIG. 112, the inner braces 2220b may receive a lower height after forming than the outer braces 2220a, the inner braces 2220b may exert a higher fixing pressure or force on the fabric near the cut line created by the cutting element. In at least one such embodiment, a higher fixation pressure or force exerted by the inner brackets 2220b may provide various therapeutic effects, such as reducing bleeding from the cut tissue T, while a lower fixation pressure created by the outer brackets 2220a can provide flexibility inside stitched fabric. In various embodiments, as shown in FIG. 111 and 112, the abutment 2240 may further comprise at least one portion of the supporting material attached thereto, such as, for example, the supporting material 2260. In at least one such embodiment, the legs of the staples 2220a, 2220b may be configured to cut the supporting material 2260 and / or passing through holes in the supporting material 2260 when the cassette with brackets 2200 is compressed by the stop 2240, followed by interaction with the recesses to form the brackets 2242 in the stop 2240. When the legs of the staples 2220a are deformed, The legs 2220b may again contact and / or cut the supporting material 2260. In various embodiments, support material 2260 may improve bleeding arrest and / or provide additional strength to the stitched fabric.

In various embodiments, as shown in FIG. 111 and 112, the bottom surface of the cassette 2210 may have a step contour that matches or at least substantially coincides with the step contour of the support surface for the cassette 2231. In certain embodiments, the bottom surface of the cassette 2210 can be deformed to fit, or at least substantially matching the contour of the abutment surface for the cartridge 2231. In various embodiments, as shown in FIG. 113, a working tool, for example, similar to the working tool shown in FIG. 111 may comprise a cassette with brackets 2300 located therein. The cassette with brackets 2300 may have a compressible implantable housing 2310 comprising an inner layer 2312 and an outer layer 2311, moreover, in addition to the above, in at least one embodiment, the outer layer 2311 can be made of waterproof material. In various embodiments, the outer layer 2311 may extend around the brackets 2220a, 2220b and may be located between the brackets 2220a, 2220b and the support grooves 2232a, 2232b, respectively. In various embodiments, as shown in FIG. 114, a working tool, for example, similar to the working tool shown in FIG. 111 may comprise a cassette with brackets 2400 located therein. Like a cassette with brackets 2300, a compressible implantable casing 2410 of a cassette with brackets 2400 may include an inner layer 2412 and an outer layer 2411; however, in at least one embodiment, the cartridge case 2410 may not contain a groove for the cutting element. In at least one such embodiment, a cutting element may be necessary, for example, to cut the inner layer 2412 and / or the outer layer 2411 while advancing through the cassette with brackets.

In various embodiments, as shown in FIG. 115, the surgical stapling instrument's working tool may include an abutment 2540, a cassette channel with brackets 2530 and a cassette with brackets 2500 located in the channel for the cassette with brackets 2530. Similar to the above, the cassette with brackets 2500 may contain a compressible implantable cassette 2510, the outer rows of staples 2220a and inner rows of staples 2220b. The channel for the cassette with brackets 2530 may contain a flat or at least essentially flat supporting surface for the cartridge 2531 and the supporting grooves for brackets 2532 formed therein. The stop 2540 may include a stepped surface 2541 and many recesses for forming brackets, such as, for example, the forming recesses 2542a and 2542b formed therein. Similar to the above, the distance formed between the forming recesses 2542a and the support grooves 2532 may be greater than the distance between the forming recesses 2452b and the support grooves 2532. In various embodiments, the stop 2540 may further comprise a portion of the supporting material 2560 attached to the stepped surface 2541 of the stop 2540. In at least one such embodiment, the supporting material 2560 may abut, or at least substantially abut, the stepped surface 2541. In various ways Ianthe of the supporting material 2560 can be attached removably to the surface 2541 by means of at least one adhesive, such as, e.g., fibrin and / or protein hydrogel. In certain embodiments, the cassette housing 2510 may also have a step profile that in at least one embodiment is parallel or at least substantially parallel to the step surface 2541 of the stop 2540. More specifically, in at least one embodiment, the stop 2540 may include steps 2548 protruding toward the cassette with brackets 2500, said steps 2548 may have a height equal to or at least substantially equal to the height of the steps 2508 protruding from the cassette 2510. By enshey least one such embodiment, as a result of the above, the quantity of compressed cassette housing 2510 that can be captured in the first bracket 2220a may, for example, differ from the values compressible cassette housing 2510 which may be captured during the second bracket 2220b.

In various embodiments, as shown in FIG. 116, the working tool may include a stop 2640, a cassette channel with brackets 2530, and a cassette with brackets 2600 located between them. The cassette with brackets 2600 may include a compressible implantable cassette 2610 housing including an inner layer 2612, an outer layer 2611, and a plurality of inside staples, such as, for example, staples 2220a and 2200b. In various embodiments, the emphasis 2640 may comprise a plurality of recesses for forming the brackets 2642 in the surface 2641, and the channel for the cassette with the brackets 2530 may contain many grooves for forming the brackets 2532 formed in the supporting surface 2531. As shown in FIG. 116, the surface of the abutment 2641 may be parallel or at least substantially parallel to the supporting surface for the cartridge 2531, in which each forming recess 2642 may be located at an equal or at least substantially equal distance from the opposite and corresponding supporting groove for the brackets 2532. B various embodiments of the cassette with brackets 2600 may contain staples having the same or at least substantially the same initial, prior to formation, height, as well as the same or at least the same height of staples after formation. In other specific embodiments, the outer rows of staples may comprise staples 2220a and the inner rows of staples may comprise staples 2220b, wherein, as described above, the staples 2220a and 2220b may have different heights before being formed. When the emphasis 2640 is moved toward the cassette with the brackets 2600 in the closed position, the brackets 2220a and 2220b can be molded so that they have the same or at least substantially the same height after deformation. In at least one such embodiment, as a result of the above, the formed outer brackets 2220a and inner brackets 2220b may have the same or at least substantially the same size of the compressible cartridge case 2610 contained therein; however, since the outer brackets 2220a have a higher height before forming than the inner brackets 2220b, and yet can have the same height after forming, for example, greater fixing pressure can be created in the outer brackets 2220a than in the inner brackets 2220b.

In various embodiments, as shown in FIG. 117, the working tool of the surgical stapling instrument may include an abutment 2740, a cassette channel with brackets 2530 and a cassette with brackets 2700 located inside the channel for the cassette with brackets 2530. Similar to the above, the cassette with brackets 2700 may include a compressible implantable cassette 2710 containing an internal layer 2712, outer layer 2711, and a plurality of brackets located therein, such as, for example, staples 2220a and 2220b. In at least one embodiment, the thickness of the cassette body 2710 may vary across its width. In at least one such embodiment, the cartridge case 2710 may include a central portion 2708 and side portions 2709, the central portion 2708 may have a thickness that is greater than the thickness of the side portions 2709. In various embodiments, the highest portion of the cartridge case 2710 may be housed in the central part 2708, and the lowest part of the cassette body 2710 may be located in the side parts 2709. In at least one such embodiment, the thickness of the cassette body 2710 may gradually decrease between the center part 2708 and side parts 2709. In certain embodiments, the thickness of the cassette body 2710 may decrease linearly and / or exponentially between the central part 2708 and side parts 2709. In at least one such embodiment, the fabric contacting surface 2719 of the cassette 2710 may comprise two deviated, or inclined, surfaces, beveled downward in a direction from the central part 2708 to the lateral parts 2709. In various embodiments, the abutment 2740 may comprise two rejected, and whether inclined, surfaces parallel or at least substantially parallel to the deflected tissue-contacting surfaces 2719. In at least one embodiment, the abutment 2740 may further comprise at least one portion of support material 2760 attached to the deflected surfaces of the abutment 2740.

In various embodiments, in addition to the above, the inner rows of staples in the cassette with brackets 2700 may contain higher staples 2220a, and the outer rows of staples can contain shorter staples 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or adjacent to the higher central portion 2708, while the brackets 2220b may be located inside and / or adjacent to the side portions 2709. In at least one such embodiment, as a result of the above, the taller staples 2220a can capture more material from the implantable cassette body 2710 than the shorter staples 2220b. Such situations can cause the staples 2220a to apply more fixing pressure to the tissue T than the staples 2220b. In certain embodiments, although taller staples 2220a can capture more cassette body material 2710 than shorter staples 2220b, taller staples 2220a may have greater height after formation than shorter staples 2220b due to the inclined arrangement of the recesses to form the staples 2742a and 2742b. Such considerations can be used to achieve the necessary fixing pressure inside the fabric captured by the brackets 2220a and 2220b, and thus, the fixing pressure in the brackets 2220a can be, for example, higher, lower, or equal to the fixing pressure applied to the fabric by the brackets 2220b. In various alternative embodiments of the working tool shown in FIG. 117, shorter brackets 2220b may be located inside and / or adjacent to the higher central portion 2708 of the cassette 2710, and higher brackets 2220a may be located inside and / or adjacent to the lower side portions 2709. Moreover, although the cassette is brackets 2700 contains the inner and outer rows of brackets, the cassette with brackets 2700 may contain additional rows of brackets, such as, for example, rows of brackets located between the inner and outer rows of brackets. In at least one such embodiment, the intermediate rows of staples may comprise staples having, for example, a height after formation that is intermediate between the heights of the brackets 2220a and 2220b before formation, and a height after formation that is intermediate between the heights of the brackets 2220a and 2220b after formation.

In various embodiments, as shown in FIG. 118, the surgical stapling instrument's working tool may include a stop 2840, a cassette channel with brackets 2530 and a cassette with brackets 2800 located inside the cassette channel 2530. Similar to the above, the cassette with brackets 2800 may include a compressible implantable cassette 2810 containing an internal layer 2812, outer layer 2811, and a plurality of brackets located therein, such as, for example, staples 2220a and 2220b. In at least one embodiment, the thickness of the cassette body 2810 may vary across its width. In at least one such embodiment, the cartridge case 2810 may include a central portion 2808 and side portions 2809, the central portion 2808 may have a thickness that is less than the thickness of the side portions 2809. In various embodiments, the lowest portion of the cartridge case 2810 may be housed in the center portion 2810, and the highest portion of the cartridge case 2808 may be located in the side portions 2809. In at least one such embodiment, the thickness of the cartridge case 2810 may gradually increase between cent the other part 2808 and the side parts 2809. In certain embodiments, the thickness of the cartridge case 2810 may increase linearly and / or exponentially between the central part 2808 and the side parts 2809. In at least one such embodiment, the fabric-contacting surface 2819 of the cartridge case 2810 may contain two deviated, or inclined, surfaces, peeling upward in the direction from the Central part 2808 to the side parts 2809. In various embodiments, the implementation of the emphasis 2840 may contain ve deviated, or inclined, surfaces parallel or at least substantially parallel to the deflected tissue-contacting surfaces 2819. In at least one embodiment, the abutment 2840 may further comprise at least one portion of support material 2860 attached to the deflected surfaces of the abutment 2840 In various embodiments, in addition to the above, the outer rows of staples in the cassette with brackets 2800 may contain higher staples 2220a, and the inner rows of staples may contain b shorter staples 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or adjacent to the higher side portions 2809, while the brackets 2220b may be located inside and / or adjacent to the central portion 2808. In at least one such embodiment, as a result of the above, the taller staples 2220a can capture more material from the implantable cassette body 2810 than the shorter staples 2220b.

As described above with respect to the embodiment shown in FIG. 111, for example, the channel for the cassette with brackets 2230 may include a stepped support surface 2231, which can be configured to support the brackets 2220a and 2220b at different heights relative to the stop 2240. In various embodiments, the channel for the cartridge with brackets 2230 may consist of metal, and the steps of the supporting surface 2231 can be formed on the supporting surface 2231, for example, by grinding. In various embodiments, as shown in FIG. 119, the surgical instrument's working tool may include a cassette channel with brackets 2930 containing a supporting insert 2935 located therein. More specifically, in at least one embodiment, the cassette channel with brackets 2930 may be formed so that it has a flat or at least a substantially flat abutment surface 2931, for example, configured to support an insert 2935 containing stepped surfaces to support the brackets 2220a and 2220b in the cassette with brackets 2200 at different heights. In at least one such embodiment, insert 2935 may comprise a flat or at least substantially flat bottom surface that may be located opposite the abutment surface 2931. Insert 2935 may further comprise abutment grooves, grooves, or grooves 2932a and 2932b that may be formed with the possibility of supporting brackets 2220a and 2220b, respectively, at different heights. Similarly to the above, insert 2935 may comprise a groove for scalpel 2939 configured to pass a cutting member through it. In various embodiments, the channel for the cassette with brackets 2930 may consist of the same material as the support insert 2935, or of another material. In at least one embodiment, both the cassette channel with brackets 2930 and the support insert 2935 may, for example, consist of metal, while in other embodiments, the cassette channel with brackets 2930 may, for example, consist of metal, and the support insert 2935 may, for example, consist of plastic. In various embodiments, the support insert 2935 may be attached and / or welded to the channel for the cassette with brackets 2930. In certain embodiments, the support insert 2935 may be installed in the channel for the cassette with brackets 2930 with snap and / or interference fit. In at least one embodiment, the support insert 2935 may be secured to the cassette channel with brackets 2930 using adhesive.

In various embodiments, as shown in FIG. 120, the surgical stapling instrument's working tool may include an abutment 3040, a cassette channel with brackets 3030, and a compressible implantable cassette with brackets 3000 located in the cassette channel with brackets 3030. Similar to the above, the abutment 3040 may contain many recesses formed therein for forming the staples 3042 and a groove for the scalpel 3049, which can be made with the possibility of sliding insertion of a cutting element into it. Also, similarly to the above-described channel for a cassette with brackets 3030 may contain many formed in it support grooves for brackets 3032 and a groove for the scalpel 3039, which can also be made with the possibility of sliding insertion of a cutting element into it. In various embodiments, the cassette with brackets 3000 may comprise a first layer 3011, a second layer 3012, and a plurality of brackets located therein, such as, for example, staples 3020a and 3020b. In at least one embodiment, the height of the staples 3020a prior to formation may be greater than the height of the staples 3020b prior to formation. In various embodiments, the first layer 3011 may consist of a first compressible material, and the second layer 3012 may consist of a second compressible material. In certain embodiments, the first compressible material may be compressed with greater force than the second compressible material, while in other specific embodiments, the first compressible material may be compressed with less force than the second compressible material. In at least one embodiment, the first compressible material may consist of an elastic material with a first coefficient of elasticity, and the second compressible material may consist of an elastic material with a second coefficient of elasticity different from the first coefficient of elasticity. In various embodiments, the first compressible material may have a higher coefficient of elasticity than the second compressible material. In other specific embodiments, the first compressible material may have a lower coefficient of elasticity than the second compressible material. In various embodiments, the first compressible layer may have a first stiffness and the second compressible layer may have a second stiffness, the first stiffness being different from the second stiffness. In various embodiments, the first compressible layer may have a higher stiffness than the second compressible layer. In other specific embodiments, the first compressible layer may have lower stiffness than the second compressible layer.

In various embodiments, as shown in FIG. 120, the second cassette layer 3012 of the staples 3000 may have a constant or at least substantially constant thickness across the entire width. In at least one embodiment, the first layer 3011 may have a thickness varying in width. In at least one such embodiment, the first layer 3011 may comprise one or more steps 3008 that can increase the thickness of the cassette case 3010 in certain parts of the cassette case 3010, such as, for example, a central part. As shown in FIG. 120, shorter staples 3020b may be placed in or aligned with steps 3008, i.e. higher parts of the cassette 3010 and higher staples 3020a may be located inside the lower parts of the cassette 3010 or can be combined with them. In various embodiments, as a result of having higher and lower portions of the cassette 3010, the stiffness of the cassette 3010 may be greater along the inner rows of staples 3020b than along the outer rows of staples 3020a. In various embodiments, the first layer 3011 may be in contact with the second layer 3012. In at least one such embodiment, the first layer 3011 and the second layer 3012 may contain interconnected elements that can hold layers 3011 and 3012 together. In certain embodiments, the first layer 3011 may be a first laminate and the second layer 3012 may be a second laminate, wherein the first laminate may be adhered to the second laminate using one or more adhesives. In various embodiments, the cassette with brackets 3000 may include a groove for the scalpel 3003, which can be made with the possibility of sliding insertion of a cutting element into it.

In various embodiments, as shown in FIG. 121, the cassette with brackets 3100 may include a compressible implantable casing of the cassette 3110, containing one layer of compressible material, as well as many brackets located therein, such as, for example, staples 3020b. In at least one embodiment, the thickness of the cassette 3110 may vary across its width. In at least one such embodiment, the cassette body 3110 may include steps 3108 extending along its side portions. In various embodiments, as shown in FIG. 122, the cassette with brackets 3200 may comprise a compressible implantable casing of the cassette 3210 containing one layer of compressible material, as well as a plurality of brackets located therein, such as, for example, staples 3020b. In at least one embodiment, the thickness of the cassette 3210 may vary across its width. In at least one such embodiment, the cassette housing 3210 may include steps 3208 extending along its central portion. In various embodiments, as shown in FIG. 123, the cassette with brackets 3300 may include a compressible implantable casing of the cassette 3310, and the thickness of the cassette 3310, as described above, may vary in width. In at least one embodiment, the thickness of the cartridge case 3310 may increase exponentially between the side portions and the central part of the cartridge case 3310. In at least one such embodiment, the thickness of the cartridge case 3310 may be defined by an arcuate or curved profile and may include an arcuate or curved fabric contacting surface 3319. In certain embodiments, the thickness of the cassette 3310 and the contour of fabric contacting surface 3319 may determine a single radius of curvature or, in an alternative embodiment, for example, several radii of curvature. In various embodiments, as shown in FIG. 124, the cassette with brackets 3400 may comprise a compressible implantable cassette 3410, the thickness of the cassette 3410 may increase linearly or at least substantially linearly between the side portions and the central part of the cassette 3410.

In various embodiments, as shown in FIG. 125, the cassette with brackets 3500 may comprise a compressible implantable cassette 3510 and a plurality of clips 3520 located therein. The implantable cassette 3510 may include a first inner layer 3512, a second inner layer 3513 and an outer layer 3511. In at least one embodiment, the first inner layer 3512 may have a first thickness and the second inner layer 3513 may have a second thickness, the second inner layer 3513 may be thicker than the first inner layer 3512. In at least one alternative embodiment the first inner layer 3512 may be thicker than the second inner layer 3513. In another alternative embodiment, the first inner layer 3512 may have the same or at least substantially the same thickness as the second inner layer 3513. In certain embodiments, each bracket 3520 may comprise a base 3522 and one or more deformable legs 3521 extending from the base 3522. In various embodiments, each leg 3521 may include an end 3523 inserted in the first inner layer 3511, as well as each base 3522 staples 3520 may be inserted into the second inner layer 3512. In at least one embodiment, the first inner layer 3512 and / or the second inner layer 3513 may contain at least one drug stored therein, and in various embodiments, the outer layer 3511 can encapsulate and isolate the first inner layer 3512 and the second inner layer 3513 so that the drug does not flow out of the cassette with brackets 3510 until the brackets 3520 pierce the outer layer 3511. More to Specifically, in addition to the above, the emphasis can be pressed downward on the fabric opposite the tissue contacting surface 3519 of the cassette with the brackets 3500 so that the cassette 3510 is compressed and the surface 3519 is moved down and at least partially below the ends of the brackets 3523 so so that the ends of the brackets 3523 break through or puncture the outer layer 3511. After piercing the outer layer 3511 with the legs of the brackets 3521, at least one drug M can flow out of the cassette 3510 around the legs of the brackets 3521. In various situations Rep additional compression of the cartridge housing 3510 could result in the expulsion of an additional amount of M medicament cartridge housing 3510, as shown in FIG. 126.

In various embodiments, as shown in FIG. 125, the outer layer 3511 may comprise a waterproof or at least substantially waterproof shell, which may be configured to, firstly, prevent the drug from leaking prematurely from the cassette with brackets 3500 and, secondly, to prevent premature fluid from entering inside the surgical field into a cassette with brackets 3500. In certain embodiments, the first inner layer 3512 may comprise a first drug stored or absorbable in the layer, and the second inner layer 3513 may contain a second drug stored or absorbable in the layer, the second drug may be different from the first drug. In at least one embodiment, the initial compression of the cartridge case 3510, leading to the breakthrough of the outer layer 3511, can essentially lead to the release of the first drug from the first inner layer 3512, and further compression of the cartridge case 3510 can essentially lead to the release of the second drug from the second inner layer 3513. However, in such embodiments, portions of the first drug and the second drug may be released simultaneously, although most of the first drug to be released can consist of the first drug, and most of the drug released after this can consist of the second drug. In certain embodiments, in addition to the above, the first inner layer 3512 may consist of more compressible material than the second inner layer 3513, so that the initial compressive force or pressure, which may be weaker than the subsequent compressive force or pressure, can lead to more strong initial deformation in the first inner layer 3512 than in the second inner layer 3513. A stronger initial deformation inside the first inner layer 3512 can lead to the release of most the first drug from the first inner layer 3512 than the second drug from the second inner layer 3513. In at least one embodiment, the first inner layer 3512 may be more porous and / or more flexible than the second inner layer 3513. At least one such embodiment, the first inner layer 3512 may comprise a plurality of pores or voids formed therein, 3508, and the second inner layer 3513 may comprise a plurality of pores or voids formed therein, 3509, wherein In these embodiments, the pores 3508 can be configured to store the first drug in the first inner layer 3512, and the pores 3509 can be configured to store the second drug in the second inner layer 3513. In certain embodiments, the size and density of the pores 3508 inside the first inner layer 3512 and pores 3509 inside the second inner layer 3513 can be selected so as to provide the desired result described herein.

In various embodiments, as shown in FIG. 125 and 126, the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513 may consist of bioabsorbable material. In at least one embodiment, the first inner layer 3512 may consist of a first bioabsorbable material, the second inner layer 3513 may consist of a second bioabsorbable material, and the outer layer 3511 may consist of a third bioabsorbable material, the first bioabsorbable material, the second bioabsorbable material and / or the third bioabsorbable material may be different materials. In certain embodiments, the first bioabsorbable material may be bioabsorbable at a first speed, the second bioabsorbable material may bioabsorb at a second speed, and the third bioabsorbable material may bioabsorb at a third speed, the first speed, second speed and / or third speed may be different. In at least one such embodiment, when the material is biologically absorbed at a certain rate, that rate can be defined as the mass of material absorbed by the patient’s body per unit time. As you know, the organisms of different patients can absorb different materials at different speeds, and thus, to take into account such variability, such speeds can be described as average speeds. In any case, there may be a higher speed at which a larger mass of material is biologically absorbed per unit time than at a lower speed. In various embodiments, as shown in FIG. 125 and 126, the first inner layer 3512 and / or the second inner layer 3513 may consist of a material that is biologically absorbable faster than the material that the outer layer 3511 consists of. In at least one such embodiment, the first inner layer 3512 and / or the second inner layer 3513 may consist of bioabsorbable foam, tissue sealant and / or hemostatic material, such as, for example, oxidized regenerated cellulose (ORC), the outer layer 3511 may consist of a supporting material and / or pl asthmatic material such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under by trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can have an immediate effect on the tissue, for example, reducing bleeding from the tissue, and the outer layer 3514 can provide long-term structural support and bioabsorb at a lower rate.

Due to the lower bioabsorption rate of the outer layer 3511, in addition to the one described above, the outer layer 3511 can support or strengthen the tissue structure within the staple line during healing. In certain embodiments, one of the first inner layer 3512 and the second inner layer 3513 may consist of a material that can biologically absorb faster than the other material, so that in at least one embodiment, one of the layers can provide an initial release of therapeutic material, and another layer may provide a sustained release of the same therapeutic material and / or other therapeutic material. In at least one such embodiment, the rate of release of therapeutic material from layer 3512, 3513 may be a function of the bioabsorption of the substrate layer in which the drug is resorbed or dispersed. For example, in at least one embodiment, the substrate containing the first inner layer 3512 can biologically absorb faster than the substrate containing the second inner layer 3513, and thus, the drug can, for example, be released from the first inner layer 3512 faster, than from the second inner layer 3513. In various embodiments, as described herein, one or more layers 3511, 3512 and 3513 of the cassette housing 3510 can be glued to each other using at least one adhesive VA, such as, for example, fibrin and / or protein hydrogel. In certain embodiments, the adhesive may be water soluble and may be configured to break the bond between the layers upon implantation of the cassette with brackets 3500 and / or after some time. In at least one such embodiment, the adhesive may be bioabsorbable at a faster rate than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

In various embodiments, as shown in FIG. 127 and 128, a cassette with brackets, such as, for example, a cassette with brackets 3600, may comprise a cassette body 3610 including a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a compressible layer 3613 configured to removal and attached to the second layer 3612. In at least one such embodiment, the first layer 3611 may consist of compressible foam, the second layer 3612 may consist of a laminate adhered to the first layer 3611 using one or more adhesives, and the third layer 3613 my it may consist of a compressible foam adhered removably to the second layer 3612, for example, using one or more adhesives. In various embodiments, the cassette with brackets 3600 may further comprise a plurality of brackets, such as, for example, brackets 3620 located inside the cassette 3610. In at least one such embodiment, each bracket 3620 may, for example, comprise a base 3622 located in a third layer 3613, and one or more deformable legs 3621, protruding upward from the base 3622 through the second layer 3612 and into the first layer 3611. In use, in addition to the above, the upper surface 3619 of the cassette body with a bracket MI 3610 can be pressed down with the stop until the legs of the staples 3621 pass through the upper surface 3619 and the target fabric until they contact the stop. After sufficient deformation of the legs of the staples 3621, the emphasis can be moved away from the cassette with staples 3600 so that its compressible layers can at least partially experience reverse expansion. In various situations, inserting staples through tissue can cause bleeding in the tissue. In at least one embodiment, the third layer 3613 may consist of an absorbent material, such as, for example, a protein hydrogel, which can drain blood from stitched tissue. In addition to or in place of the above, the third layer 3613 may consist of a hemostatic material and / or tissue sealant, such as, for example, lyophilized thrombin and / or fibrin, which may be configured to reduce bleeding from the tissue. In certain embodiments, the third layer 3613 may serve as structural support for the first layer 3611 and the second layer 3612, wherein the third layer 3613 may consist of bioabsorbable and / or non-bioabsorbable material. In any case, in various embodiments, the third layer 3613 may be separated from the second layer 3612 after implantation of the cassette 3610. In embodiments where the third layer 3613 contains implantable quality material, the surgeon may choose whether to remove the third layer 3613 with cartridge cases 3610. In at least one embodiment, the third layer 3613 may be configured to separate from the second layer 3612 as a whole.

In various embodiments, the first layer 3611 may consist of a first foam, and the third layer 3613 may consist of a second foam, which may be different from the first foam. In at least one embodiment, the first foam may have a first density and the second foam may have a second density, wherein the first density may be different from the second density. In at least one such embodiment, the second density may be higher than the first density, and thus, the third layer 3613 may be less compressible or have a lower compression ratio than the first layer 3611. In at least one alternative embodiment, the first density may be higher than the second density, and thus, the first layer 3611 may be less compressible or have a lower compression ratio than the third layer 3613. In various embodiments, as shown in FIG. 129 and 130, a cassette with brackets 3700, similar to a cassette with brackets 3600, may comprise a cassette body 3710 containing a first compressible layer of foam 3711, a second layer 3712 attached to the first layer 3711, and a third compressible layer of foam 3713 configured to separating and removably attached to the second layer 3712. In at least one such embodiment, the third layer 3713 may comprise a plurality of receiving grooves or recesses for the brackets 3709, each of which may be configured to receive at least a portion of the bracket 3620, such as, for example, the base of the bracket 3622. In certain embodiments, the brackets 3620 can be slidably inserted into the receiving slots for the brackets 3709 or, in other words, the third layer 3713 can be slidably movement relative to the staples 3620, when, for example, the cassette with staples 3700 is located opposite the target fabric and is compressed by the stop. In at least one embodiment, the receiving grooves 3709 may be configured so that there is a gap between the brackets 3620 and the side walls of the receiving grooves 3709. In at least one such embodiment, as a result of the above, the brackets 3620 may not capture part of the third layer 3713 when the brackets 3620 undergo deformation, as shown in FIG. 129 and 130. In other specific embodiments, the ends of the receiving grooves for the brackets 3709 next to the second layer 3712 can be covered by part of the third layer 3713, and thus at least part of the third layer 3713 can be caught by the brackets 3620 when they are deformed. In any case, the third layer 3713 may contain, for example, one or more perforations and / or notches 3708, which can be performed to ensure separation of the third layer 3713 from the second layer 3712 into two or more parts, as shown in FIG. 129. In FIG. 129 shows the separation of one of the parts of the third layer 3713 using a tool 3755. In various embodiments, perforations 3708 can be located along a line running between the first row of staples and the second row of staples.

In various embodiments, as shown in FIG. 129 and 130, the bases 3622 of the brackets 3620 can be located inside the receiving grooves 3709, and in at least one embodiment, the side walls of the receiving grooves 3709 can be made to engage and detachably hold the legs of the brackets 3621 in the required position. In certain embodiments, although not shown in the figures, the third layer 3713 may comprise an elongated groove surrounding all of the brackets in the staple line. In at least one such embodiment, the staple cartridge containing, for example, four rows of staples, may comprise an elongated groove aligned with each row of staples in the bottom layer of the cassette with staples. In addition to the above, at least a portion of the cassette with brackets 3600 and / or a cassette with brackets 3700 can be implanted into the patient’s body, and at least a portion of the cassette with brackets can be removable from the patient’s body. In at least one embodiment, as shown in FIG. 129 and 130, the first layer 3711 and the second layer 3712 can be grasped with brackets 3620 and implanted with brackets 3620, while the third layer 3713 can optionally be removed or separated from the cassette with brackets 3700. In various situations, removing part of the implanted cassette with brackets can reduce the amount of material that the patient must absorb, which can provide various therapeutic effects. In the case of separating or removing part of the cassette with brackets using a tool such as, for example, a laparoscopic instrument 3755, the separated part of the cassette with brackets can be removed from the surgical field through a trocar, such as, for example, a trocar with a 5 mm hole. In certain embodiments, the cartridge case may comprise more than one layer that can be removed. For example, the cassette body 3710 may comprise a fourth layer, the third layer 3713 of the cassette body 3710 may consist of hemostatic material, and the fourth layer may consist of a support layer. In at least one such embodiment, the surgeon may remove the backing layer and then, for example, decide whether to remove the hemostatic layer.

In various embodiments, as shown in FIG. 131, a cassette with brackets, such as, for example, a cassette with brackets 3800, may comprise a cassette body 3810 including an outer layer 3811 and an inner layer 3812. The inner layer 3812 may consist of compressible foam, and the outer layer 3811 may be at least partially surround the inner layer 3812. In at least one embodiment, the outer layer 3811 may comprise a first portion 3811a arranged to be located on the first side of the inner layer 3812 and a second portion 3811b arranged to be located on the second st the inner layer 3812, the first part 3811a and the second part 3811b can be connected by a flexible hinge, such as, for example, hinge 3809. In at least one such embodiment, at least one adhesive, such as, for example, fibrin and / or a protein hydrogel may be applied to the first side and / or second side of the inner layer 3812 to secure portions of the outer layer 3811 thereon. In various embodiments, the outer layer 3811 may comprise one or more protruding fasteners. In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3821 protruding from one side of the outer layer 3811 that can be installed in the compressible inner layer 3812. In at least one such embodiment, the legs 3821 may not protrude the second side of the inner layer 3812, while in at least one alternative embodiment, the legs 3821 may at least partially protrude from the inner layer 3812. The legs 3821 may be configured to tilting of the inner layer 3812 and the second part 3811b of the outer layer 3811, if during use the compressible cassette 3810 is compressed. In certain embodiments, the second portion 3811b of the outer layer 3811 may comprise holes, such as, for example, holes 3808, which may be configured to receive the legs of brackets 3821. In certain embodiments, at least portions of the cassette with brackets 3800 may comprise a scalpel groove 3803, which can be made with the possibility of sliding introduction of a cutting element into it. In at least one such embodiment, the groove for the scalpel 3803 may not completely extend through the thickness of the cassette 3810, and thus the cutting element may cut through the cassette 3810 when moving relative to it.

In various embodiments, as shown in FIG. 132, the cassette with brackets 3900, like the cassette with brackets 3800, may comprise a cassette body 3910 including an inner layer 3812 and an outer layer 3811, the outer layer 3811 may include a first part 3811a located next to the first side of the inner layer 3812 and a second part 3811b located adjacent to the second side of the inner layer 3812. In at least one embodiment, similar to that described above, the outer layer 3811 may contain one or more protruding fasteners. In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3921 protruding from one side of the outer layer 3811 that may be installed in the compressible inner layer 3812. In certain embodiments, each deformable leg 3921 may comprise at least one the hook protruding from it, or notch, 3923, which can be adapted to engage the second part 3811b of the outer layer 3811 and, thus, hold the outer layer 3811 with the inner layer 3812. At least in at least one such embodiment, the notches 3923 can be configured to protrude from the second side of the inner layer 3812 and pass through the holes 3808 in the second part 3811b of the outer layer 3811 so that the notches 3923 can engage on the outer surface of the outer layer 3811 and fix the outer a layer 3811 with an inner layer 3812. For the manufacture of a cassette with brackets 3900, the inner layer 3812 can be at least partially compressed so that the notches can protrude from it and enter the holes 3808. At least in one such embodiment, the cassette with brackets 3900 may, for example, be at least partially pre-compressed when inserted into the cassette with brackets. In certain embodiments, in addition to the above, at least a portion of the legs 3921 may be inserted into the first portion 3811a of the outer layer 3811, wherein in at least one embodiment, the outer layer 3811 may consist of a plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), and a plastic material may be formed around at least a portion of the legs 3921.

In various embodiments, as shown in FIG. 133-137, a cassette with brackets, such as, for example, a cassette with brackets 4000, may comprise a cassette body 4010 including a compressible first layer 4011 and a second layer 4012, as well as a plurality of brackets 4020 located inside the cassette 4010. In certain embodiments as shown in FIG. 135, each bracket 4020 may include a base 4022 and at least one deformable leg 4023 extending from the base 4022. In at least one embodiment, as shown in FIG. 133, a cassette with brackets 4000 may be located between the channel for the cassette with brackets 4030 and the stop 4040 of the working tool of the surgical stapler, the second layer 4012 of the cassette 4010 and / or the base 4022 of the brackets 4020 may be located opposite the channel for the cassette with brackets 4030. In different embodiments as shown in FIG. 134, the second layer 4012 may comprise a layer of tampons 4060 that are connected to each other by means of a support frame for tampons 4061. In at least one such embodiment, the tampons 4060 and the support frame for tampons 4061 may consist of molded plastic material such as for example polyglycolic acid (PGA). Each tampon 4060 may contain one or more holes or slots 4062, which may be configured to receive the leg of the bracket 4021 passing through them, as shown in FIG. 135 and 136. Each swab 4060 may further comprise a receiving groove 4063 formed therein, which may be configured to receive the base 4022 of the bracket 4020. In various embodiments, as shown in FIG. 134, tampons 4060 and / or the support frame for tampons 4061 may comprise a plurality of notches, perforations, or the like, which may be configured to separate tampons 4060 from the support frame for tampons 4061 at the desired location. Similarly, as shown in FIG. 136, one or more swabs 4060 may be connected to each other along a line containing, for example, perforations and / or notches 4064. During use, the compressible foam layer 4011 may be located opposite the target fabric T, and the cassette body 4010 may be compressed by a stop 4040 such so that the stop 4040 can deform the staples 4020. When the staples 4020 are deformed, the legs 4021 of each staple 4020 can grab the fabric T, part of the first layer 4011 and the tampon 4060 inside the deformed staple. When the cassette channel with brackets 4030 is diverted, for example, from the implanted cassette with brackets 4060, the support frame for tampons 4061 can be separated from tampons 4060, and / or tampons 4060 can be separated from each other. In certain situations, the tampons 4060 may be separated from the frame 4061 and / or from each other during the deformation of the staples 4020 with the emphasis 4040, as described above.

In the various embodiments described herein, staples from a cassette with brackets are completely formed by the stop when it is moved to the closed position. In other various embodiments, as shown in FIG. 138-141, staples from a cassette with brackets, such as, for example, a cassette with brackets 4100, can be deformed by the stop when it is moved to the closed position, as well as by a system of ejector brackets that moves the staples in the direction of the closed stop. The cassette with brackets 4100 may comprise a compressible cassette 4110, which may consist of, for example, foam, as well as a plurality of brackets 4120 at least partially located inside the compressible cassette 4110. In various embodiments, the bracket ejector system may include an ejector holder 4160, a plurality of ejector brackets 4162 located inside the holder of the ejector 4160, and a tray for a cartridge with brackets 4180, which can be made with the possibility of holding the ejector brackets 4162 in the holder ytalkivateley 4160. In at least one such embodiment, the staple pushers 4162 may be located within one or more slots 4163 in holder 4160 ejectors, wherein the side walls of the grooves 4163 may help guide brackets pushers 4162 upwardly in the direction of the stop. In various embodiments, the brackets 4120 can be supported in the grooves 4163 using the ejector brackets 4162, in at least one embodiment, the brackets 4120 can be completely inside the grooves 4163 when the brackets 4120 and the ejector brackets 4162 are in the inactive positions. In other specific embodiments, at least a portion of the brackets 4120 may protrude upwardly through the open ends 4161 of the grooves 4163 when the brackets 4120 and the ejectors of the brackets 4162 are in non-activated positions. In at least one such embodiment, as mainly shown in FIG. 139, the bases of the brackets 4120 can be located inside the holder of the ejectors 4160, and the ends of the brackets 4120 can be inserted inside the compressible housing of the cartridge 4110. In certain embodiments, approximately one third of the height of the brackets 4120 can be located inside the holder of the ejectors 4160, and approximately two-thirds of the height of the brackets 4120 can located inside the cassette 4110. In at least one embodiment, as shown in FIG. 138A, the cassette with brackets 4100 may further comprise, for example, a waterproof casing or membrane 4111 surrounding the cassette 4110, and an ejector holder 4160.

In use, the cassette with brackets 4100 can be located, for example, inside the channel for the cassette with brackets, and the emphasis can be moved towards the cassette with brackets 4100 in the closed position. In various embodiments, the emphasis may come into contact and compress the compressible housing of the cartridge 4110 as it moves to the closed position. In certain embodiments, the emphasis may not be in contact with the brackets 4120 when it is in the closed position. In other specific embodiments, the implementation of the emphasis may be in contact with the legs of the staples 4120 and at least partially deform the brackets 4120 when it moves to the closed position. In any case, the cassette with brackets 4100 may additionally contain one or more slides 4170, which can be advanced longitudinally inside the cassette with brackets 4100 so that the slide 4170 can sequentially engage the ejectors of the brackets 4162 and move the ejectors of the brackets 4162 and brackets 4120 to the stop. In various embodiments, the slide 4170 may slide between the cassette tray with brackets 4180 and the ejectors of the brackets 4162. In embodiments where closing the stop starts the process of forming the brackets 4120, moving the brackets 4120 up to the stop may complete the forming process and deform the brackets 4120 to their final heights after forming or at least the necessary height. In embodiments where closing the stop does not deform the brackets 4120, moving the brackets 4120 up to the stop can start and complete the formation process and deform the brackets 4120 to their final height after forming or at least the required height. In various embodiments, the slide 4170 can be advanced from the proximal end of the cassette with brackets 4100 to the distal end of the cassette with brackets 4100 so that the brackets 4120 located on the proximal end of the cassette with brackets 4100 are fully formed before the brackets are fully formed 4120 located at the distal end of the cassette with brackets 4100. In at least one embodiment, as shown in FIG. 140, each of the slides 4170 may comprise at least one inclined, or deviated, surface 4711, which may be configured to slip under the ejectors of the brackets 4162 and raise the ejectors of the brackets 4162, as shown in FIG. 141.

In various embodiments, in addition to the above, the brackets 4120 may be formed so as to capture at least a portion of the fabric T and at least a portion of the compressible cassette body 4110 with the brackets 4100. After the brackets 4120 are formed, the stop and channel for the cassette with the staples of the surgical stapling instrument 4130 can be retracted from the implanted cassette with the staples 4100. In various situations, the tray for the cassette 4180 can be fixedly engaged with the channel for the cassette with the staples 4130, and thus the tray for cassette 4180 may be separated by a compressible body 4110 by pulling the tape cassette channel 4130 of the staple cartridge housing implanted 4110. In various embodiments, as shown in FIG. 138, the cassette tray 4180 may include opposing side walls 4181, between which the cassette body 4110 can be removably disposed. In at least one such embodiment, the compressible cassette 4110 can be compressed between the side walls 4181 so that during in use, the cassette body 4110 could be fixed between them with the possibility of removal, and when pulling the tray for the cassette 4180 could be detached with the possibility of removal from the pallet for the cartridge 4180. In at least one such case Rianta of the ejector holder 4160 may be attached to the cassette tray 4180 so that the ejector holder 4160, the pushers 4162 and / or 4170 can slide a pallet to remain in the cassette 4180 while removing the tray for cassette 4180 of the surgical field. In other specific embodiments, ejectors 4162 can be removed from ejector holder 4160 and left in the operative field. In at least one such embodiment, the ejectors 4162 may consist of a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate ( PHA), polyglecaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the pushers 4162 can be attached to the brackets 4120 so that the pushers 4162 are mounted together with the brackets 4120. In at least one such embodiment, each pusher 4162 may include a groove configured to receive, for example, the bases of the brackets 4120, moreover, in at least one embodiment, the grooves can be made with the possibility of accepting the base of the brackets by pressing or snapping.

In certain embodiments, in addition to the above, the ejector holder 4160 and / or the slide 4170 can be removed from the tray for the cartridge 4180. In at least one such embodiment, the carrier 4170 can slide between the cartridge tray 4180 and the ejector holder 4160 thus so that the slide 4170 can move the holder of the ejectors 4160 upward from the tray for the cartridge 4180, when the slide 4170 is advanced to push the ejectors staples 4162 and staples 4120 up. In at least one such embodiment, the ejector holder 4160 and / or the slide 4170 may consist of a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (CL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the slide 4170 may be integral and / or attached to a push rod or cutting element that pushes the slide 4170 through the cassette 4100. In such embodiments, the slide 4170 may not be removed from the tray 4180 and may be left on a surgical stapling instrument, while in other embodiments in which the slide 4170 is not attached to the push rod, the slide 4170 can be left in the surgical field. In any case, in addition to the above, the compressibility of the cassette 4110 allows the use of wider cassettes with staples inside the surgical stapler's instrument since the cassette 4110 can be compressed when the stop of the stapler is closed. In certain embodiments, as a result of at least partial deformation of the brackets, when closing the stop, higher brackets can be used, such as, for example, brackets with a height of approximately 4.57 mm (0.18 ”), with approximately 3.05 mm (0, 12 ”) from the height of the staples may be located inside the compressible layer 4110, and wherein the compressible layer 4110 in uncompressed form may have a height of, for example, approximately 3.56 mm (0.14”).

In various embodiments, as shown in FIG. 142-145, a cassette with brackets, such as, for example, a cassette with brackets 4200, may comprise a compressible cassette 4210, a plurality of brackets 4220 located therein and a plurality of flexible transverse support elements 4234. In various embodiments, as shown in FIG. 143, a cassette with brackets 4200 may be located between the stop 4240 and the channel for the cassette with brackets 4230, and in at least one embodiment, transverse support elements 4234 may be attached to the cassette channel with brackets 4230. When moving downward, the stop 4240 compresses the cassette 4210 and at least partially deforms the brackets 4220, as shown in FIG. 144, the side portions of the cassette 4210 can be pulled out in the transverse directions and push the transverse support elements 4234 out. In at least one such embodiment, the transverse support elements 4234 may be attached to the cassette body 4210, and the transverse support elements 4234 may be separated from the cassette 4210, as shown in FIG. 144 when the cartridge case 4210 is distributed in the transverse directions, as described above. In at least one embodiment, the transverse support elements 4234 may be adhered to the cassette body 4210 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. Similarly to the above, the closure of the stop 4240 can only partially deform the brackets 4220, and the formation of the brackets 4220 can result in the movement of one or more slides 4270 through the cassette with brackets 4200, as shown in FIG. 145. In various embodiments, as shown in FIG. 147 and 148, the slide 4270 may advance from the proximal end of the cassette with brackets 4200 to the distal end of the cassette with brackets 4200 using a cutting element 4280. In at least one such embodiment, the cutting element 4280 may be a cutting element, or a scalpel, 4283, which can advance through fabric T and / or the compressible housing of the cartridge 4210. In certain embodiments, the cutting element 4280 may comprise cam elements 4282 that can move along the outer surfaces of the branches 4230 and 4240 and move or keep the branches in position. In various embodiments, as a result of the foregoing, the final shape may be attached to the brackets 4220 at the same time or at least substantially simultaneously with the cutting of the tissue T. In at least one such embodiment, the slide 4270 may be located distally relative to the scalpel 4283 so that the fabric T, for example, was cut only when the previous part of the fabric was completely stapled.

In various embodiments, as shown in FIG. 147 and 148, the slide 4270 may comprise individual sliding members that are advanced together by the cutting member 4280. In at least one such embodiment, the slide 4270 may be inside the cassette with brackets 4200, and the cutting member 4280 may advance into cassette with brackets 4200 using the trigger rod 4281 so that the cutting element 4280 engages the slide 4270 and moves them distally. In certain embodiments, the slide 4270 may be coupled to each other. In any case, each slide 4270 may comprise an inclined surface, or cam, 4271, which may be configured to lift the brackets 4220 aligned within a row of staples. In certain embodiments, the inclined surfaces 4271 may be integral with the cutting element 4280. In at least one embodiment, as shown in FIG. 147 and 148, each bracket 4200 may include a base, at least one deformable element extending from the base, and a head 4229 formed on top and / or located around at least a portion of the base and / or deformable elements of the bracket 4200. In various embodiments such heads 4229 may be capable of being directly ejected, for example, by a slide 4270. More specifically, in at least one embodiment, heads 4229 of brackets 4220 may be configured so that inclined surfaces The rails 4271 of the slide 4270 could slip under the heads 4229 and directly contact with them without placing between them the ejector brackets. In such embodiments, each head 4229 may comprise at least one interacting inclined, or deviated, surface that can engage with the inclined surface 4271 of the slide 4270 so that the interacting inclined surfaces can push the brackets 4220 upward when the slide 4270 slides under the brackets 4220.

In various embodiments, as shown in FIG. 146, a cassette with brackets, such as, for example, a cassette with brackets 4300, may comprise a compressible housing 4310 and a plurality of brackets 4320 located inside the compressible housing 4310. Similar to the above, the cassette with brackets 4300 may comprise flexible transverse support elements 4334, which may be attached to the cassette channel with brackets and / or glued to a compressible housing 4310. In addition to the above, the flexible transverse support elements 4334 can be connected to each other using one or more beams, or connecting elements, 4335 which can be arranged to hold the transverse support elements 4334 together. In use, the connecting elements 4335 may be configured to prevent or at least prevent the transverse support elements 4334 from being prematurely separated from the cassette body 4310. In certain embodiments, the connecting elements 4335 may be able to hold the transverse support elements 4334 together after the cassette is compressed with staples 4300 focusing. In such embodiments, the transverse support elements 4334 may resist lateral bending or displacement of the transverse parts of the cartridge case 4310. In certain embodiments, a cutting element, such as, for example, a cutting element 4280, may be able to cross-cut the connecting elements 4335 while moving the cutting element 4280 distally inside the cartridge case 4310. In at least one such embodiment, the cutting element 4280 may be configured to push one them or more sleds, such as, for example, sled 4270, distally to form staples 4320 focus. The slide 4270 can guide the cutting edge 4283 so that the cutting element 4280 does not cut the connecting element 4335 until the brackets 4320 adjacent to this connecting element 4335 will not be given the final height after formation or at least the necessary height. In various situations, the connecting elements 4335 together with the transverse support elements 4334 can prevent or at least reduce the lateral movement of the compressible cassette 4310 and at the same time prevent or at least reduce the lateral movement of the staples 4320 located inside the cassette 4310. In such situations, the connecting elements 4335 can hold the brackets 4320 in the required position until they are deformed, after which the connecting elements 4335 can be dissected to release waiting for the transverse parts of the cassette case 4310. As indicated above, the transverse support elements 4334 can be connected to the cassette channel with brackets and, thus, can be removed from the surgical field with the cassette channel with brackets after implantation of the cassette with brackets 4300. In certain embodiments, the transverse support elements 4334 may consist of an implantable material and remain in the surgical field. In at least one embodiment, the connecting elements 4335 may be located between the cassette body 4310 and the tissue T, and after separating the connecting elements 4335 from the transverse support elements 4334, the connecting elements 4335 may remain implanted in the patient. In at least one such embodiment, the connecting elements 4335 may consist of implantable material, and in certain embodiments, the connecting elements 4335 may consist, for example, of the same material as the transverse support elements 4334. In various embodiments, the connecting elements 4335 and / or transverse support elements 4334 may consist of a flexible bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, from limolactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the connecting element may comprise a sheet of material connecting to the transverse support elements 4334. In certain embodiments, the cassette with brackets may include connecting elements passing through the upper surface of the cassette 4310, as well as connecting elements passing around the lower surface of the cassette 4310 .

In various embodiments, as shown in FIG. 149, the cassette with brackets may comprise staples, such as, for example, staples 4420, which may include a wire portion inserted in a portion of the head. In at least one embodiment, the wire portion may consist of a metal, such as, for example, titanium and / or stainless steel, and / or plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In at least one embodiment, the head portion may consist of metal, such as, for example, titanium and / or stainless steel, and / or plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In certain embodiments, the wire portion of each bracket 4420 may comprise a base 4422 and deformable legs 4421 protruding from the base 4422, the portion of the head of each bracket 4420 may comprise a head 4429, which may be configured to receive at least a portion of the base 4422. To assemble together parts of each bracket 4420, as shown in FIG. 150A-150C, the legs 4421 of the wire portion can be inserted into the hole 4426 in the head 4429, and the hole 4426 can be configured to guide the legs 4421 into the chamber for the base 4427. The wire portion can be further inserted into the head 4429 so that the legs 4421 left the chamber for the base 4427, and the base 4422 of the wire portion entered the chamber for the base 4427. In at least one such embodiment, the chamber for the base 4427 may be configured to rotate the wire part inside the head 44 29 when entering the base 4422 into the chamber for the base 4427 so that the legs of the bracket 4421 are directed upward or at least substantially upward. In various embodiments, as shown in FIG. 149, the head 4429 may include outlet openings 4425, which may be configured to receive the legs of the brackets 4421.

In various embodiments, in addition to the above, the surgical stapling instrument may include a slide 4470 configured to extend laterally through the cassette with brackets 4400 and the channel for the cassette with brackets 4430 and move the brackets 4420 located inside the cassette 4410 in the direction emphasis. In various situations, the slide 4470 can move from the proximal end of the cassette channel with brackets 4430 to the distal end of the channel for the cassette 4430 for implantation of the cassette 4410 and the brackets 4420. In certain situations, the slide 4470 can be retracted or returned to the proximal end of the channel for the cassette 4430, and another cassette with brackets 4400 can be inserted into the channel for cassette 4430. After placing a new cassette with brackets 4400 inside the channel for cassette 4430, the slide 4470 can be distally advanced again. In various embodiments, the surgical stapling instrument may include one or more blocking elements that can prevent re-advancement of the slide 4470 distally without placing a new cassette with brackets 4400 inside the channel for the cassette 4430. In at least one such embodiment, as shown in FIG. 149, the channel for the cassette with brackets 4430 may include a locking arm 4439, which can be configured to prevent or at least restrict the distal movement of the slide 4470. More specifically, the slide 4470 can be abutted against the shoulder 4439 if the slide 4470 is not will be at least partially raised up above shoulder 4439 using, for example, a lifting member 4428 extending between the most proximal staples 4420 inside the cassette with staples 4400. In other words, the slide 4470 cannot be advanced units in the absence of the most proximal staples 4420 in the new cassette with staples 4400. Thus, if the used cassette with staples 4400 is in the channel for the cassette 4430, or if the cassette with staples 4400 is completely missing in the channel for the cassette 4430, slide the rails 4470 with staples into channel for cassette 4430.

In addition to the above, as shown in FIG. 151, a cassette with brackets, such as, for example, a cassette with brackets 4500, may be located within the channel for the cassette with brackets 4530 and may include a compressible cassette 4510, a plurality of brackets 4520 located inside the cassette 4510, and a cassette tray, or latch , 4580. In various embodiments, the compressible cartridge case 4510 may include an outer layer 4511 and an inner layer 4512, wherein in at least one embodiment, the outer layer 4511 can hermetically enclose the inner layer 4512. In at least one such embodiment In this embodiment, the outer layer 4511 may extend between the inner layer 4512 and the cassette tray 4580. In other specific embodiments, the outer layer 4511 can only partially surround the inner layer 4512, and in at least one such embodiment, the outer layer 4511 and the cassette tray 4580 may together comprise, or at least substantially enclose, an inner layer 4512. In various embodiments, in addition to the above, the brackets 4520 may be supported by a cassette tray 4580, whereby for cassette 4580 may comprise one or more staple support channels configured to support brackets 4520. In certain embodiments, cassette tray 4580 may be attached to cassette body 4510, wherein in at least one such embodiment, cassette body 4510 may be clamped in the transverse direction between opposite side walls of the cassette tray 4580. In various embodiments, the side walls of the cassette tray 4580 may support the cassette body 4510 transversely direction, and in at least one such embodiment, the cassette tray 4580 may comprise one or more walls, or ribs, 4582 extending upward from a lower support member 4583 into the cassette body 4510. In at least one such embodiment, the cassette body 4510 may comprise one or more grooves, or channels, which may be configured to receive and / or engage walls 4582. In various embodiments, walls 4582 may extend partially or nearly the entire length of the cassette body 45 10. In at least one such embodiment, walls 4582 may extend longitudinally between cassette 4500 between a first row of staples 4520 and a second row of staples 4520.

In various embodiments, the cassette body 4510 and / or the cassette tray 4580 may include interacting holding elements that can provide a snap connection between the cassette tray 4580 and the cassette body 4510. In certain embodiments, the cassette with brackets 4500 may be inside the channel for the cassette 4530 so that the tray for the cartridge 4580 was located close to the channel for the cartridge 4530 and / or was attached to it. In at least one embodiment, the cassette tray 4580 can be detachably connected to the cassette channel 4530 so that after compressing the cassette with the brackets 4500 with an emphasis 4540 and deforming the brackets 4520, the cassette pallet 4580 can be separated from the channel for the cassette 4530 and implanted into the cassette case 4510. In at least one such embodiment, the cassette tray 4580 may consist of a bioabsorbable material, such as, for example, polyglycolic acid (PGA), commercially available under the trade name Vicryl, poly lactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGCL), commercially available under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In certain embodiments, the surgical stapler may further comprise a trigger and / or an ejector that can slide between the cassette channel with brackets 4530 and the lower moving surface on the cassette tray 4580, which may be configured to lift or remove the cassette tray 4580 from the channel for the cartridge 4530. In certain embodiments, the housing of the cartridge 4510 can be detachably connected to the tray for the cartridge 4580 so that after compression of the cartridge with 4500 with a stop 4540 and deformations of the staples 4520, the cartridge case 4510 could be separated from the tray for the cartridge 4580. In at least one such embodiment, the tray for the cartridge 4580 can remain stationary in engagement with the channel for the cartridge 4530 so that the tray for the cartridge 4580 was removed from the surgical field along with the cassette channel 4530. In certain embodiments, the surgical stapler may further comprise a trigger and / or an ejector that can slide between the pallet for I have a cartridge with brackets 4580 and a lower moving surface of the cartridge case 4510, which can be adapted to lift or remove the cartridge case 4510 from the tray for the cartridge 4580. In at least one such embodiment, the cartridge with brackets 4500 may further comprise staple ejectors located between the cassette tray 4580 and the brackets 4520 so that when the trigger is sliding, the distal ejectors of the brackets and staples 4520 can be pushed up towards the stop. In at least one such embodiment, the ejector brackets may be at least partially inserted into the compressible housing of the cartridge 4510.

In various embodiments similar to those described above, the cassette with brackets 4500 may include a blocking element that can be configured to prevent or at least limit the distal movement of the cutting element until an inactive cassette with brackets is located inside the channel for the cassette with brackets 4530 4500. In certain embodiments, the cassette tray with brackets 4580 may comprise a surface that lifts the cutting element up and above the blocking surface inside, for example, a cassette channel with brackets 4530. If there is no cassette with brackets 4500 in the channel for cassette 4530 containing a tray for cassette 4580, the cutting element cannot be advanced. In at least one embodiment, the most proximal staples and / or any other suitable staples inside the cassette with brackets 4500 may include a lifting surface capable of sufficiently raising the cutting element above the blocking surface. In addition to or instead of the above, the various parts of the cassette with brackets 4500 may consist of materials having different colors. In such embodiments, the surgeon may be able to visually identify the presence of an unactivated and / or activated cassette with brackets in the channel for the cassette with brackets 4530. In at least one such embodiment, the outer layer 4511 of the cassette body 4510 may have a first color cassette tray 4580 may have a second color, and the channel for the cassette with brackets 4530 may have a third color. When the surgeon sees the first color, he can determine that the inactive cassette 4500 is in the channel for the cassette with brackets 4530. When the surgeon sees the second color, he can determine that the activated cassette 4500 is in the channel for the cassette with brackets 4530 and that the remaining tray for cartridge 4580. When the surgeon sees the third color, he can determine that there are no parts of the cartridge with brackets 4500 in the channel for the cartridge with brackets 4530.

In various embodiments, as shown in FIG. 152, a cassette with brackets, such as, for example, a cassette with brackets 4600, may comprise a compressible implantable cassette 4610 and a plurality of brackets 4620 located therein. Cassette 4610 may include an outer layer 4611 and an inner layer 4612. In certain embodiments, the inner layer 4612 may comprise a plurality of recesses formed therein, such as, for example, recesses or cavities, 4615, which may cause creasing of the cassette 4610. In at least one such embodiment, the inner layer 4612 may contain to press a folded, or honeycomb, frame, which can be configured to withstand the compressive force, or pressure, until the compressive force, or pressure, exceeds a certain threshold value. If the threshold value is not exceeded, the inner layer 4612 may be deformed with a linear or at least substantially linear relationship with respect to the applied compressive force or pressure. If the compressive force, or pressure, exceeds a threshold value, the inner layer 4612 can abruptly give in to the compressive load and become very bent or wrinkled. In various embodiments, the implementation of the frame of the inner layer 4612 may consist of many sublayers 4612a that can be connected to each other. In at least one embodiment, each sublayer 4612a may comprise a plurality of interleaved grooves and ribs, or waves, which can be aligned with the alternating grooves and ribs of an adjacent sublayer 4612a. In at least one such embodiment, the grooves of the first sublayer 4612a can be located adjacent to the ribs of the second sublayer 4612a, and the edges of the first sublayer 4612a can be similarly located adjacent to the grooves of the second sublayer 4612a. In various embodiments, adjacent sublayers 4612a may be adhered to each other and / or to the outer layer 4611 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In FIG. 153 shows a cassette with brackets 4600 after crushing the cassette 4610 and deforming the staples 4620 to fix and hold the fabric T close to the cassette 4610.

In various embodiments, as shown in FIG. 154-156, a cassette with brackets, such as, for example, a cassette with brackets 4700, may comprise a compressible implantable cassette 4710 and a plurality of brackets 4720 located inside the cassette 4710. Similar to the above, the cassette 4710 may include an outer layer 4711 and an inner layer 4712, the inner layer 4712 may contain many sublayers 4712a. Also similar to the above, each sublayer 4712a may comprise intermittent grooves 4717 and ribs 4718, which can be aligned with each other to form recesses, or cavities, 4715 between them. In at least one such embodiment, grooves 4717 and / or ribs 4718 may extend along axes that are parallel to each other and / or parallel to the longitudinal axis 4709. In various embodiments, the brackets 4720 may be aligned in a plurality of rows of staples that may extend along axes that are parallel to each other and / or arallelny longitudinal axis 4709. In various alternative embodiments, as shown in FIG. 152 and 153, the brackets 4620 contained in the cassette 4600 can extend along axes that are transverse or perpendicular to the axes formed by the grooves and ribs of the sublayers 4612a. As shown in FIG. 154-156, the brackets 4720 may extend through grooves 4717 and ribs 4718, and the frictional force between the brackets 4720 and the sub-layers 4712a can hold the brackets 4720 inside the cassette 4710. In certain embodiments, the plurality of sub-layers 4712a may consist of supporting material and / or plastic material such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), which can be arranged to hold the brackets 4720, for example, in a standing position and / or to keep the brackets 4720 aligned with each other, as shown in FIG G. 154 and 155. In FIG. 156 shows a cassette with brackets 4700 after folding the cassette 4710 and deforming the brackets 4720 to fix and hold the fabric T against the cassette 4710

In various embodiments, as shown in FIG. 154-156, the cassette body 4710 can elastically or elastically wrinkle under compression. In at least one such embodiment, waves generated in each sublayer 4712a by grooves 4717 and ribs 4718 can become flat or at least substantially flat when the cassette 4710 is compressed, resulting in wrinkled or at least substantially crushed formed between they are cavities 4715. In various situations, the cassette body 4710 or at least part of the cassette body 4710 may experience elastic or elastic backward expansion after the compressive force or pressure is removed from the cassette body 4710. In at least one such embodiment, the engagement between the grooves 4717 and the ribs 4718 of adjacent sublayers 4712a can remain intact or at least substantially intact when compressing the cassette body 4710 so that, after releasing the compressive force from the cassette body 4710, the sublayers 4712a can move relative to each other, and thus at least partially again expand the cassette body 4710. In certain embodiments, the cassette body 4710 may undergo plastic deformation or creasing at Atia, and thus the cartridge body 4710 may not experience despreading after removing from it a compressive force, or pressure. In certain embodiments, as shown in FIG. 157, a cassette with brackets, such as, for example, a cassette with brackets 4800, may comprise a crease cartridge case 4810 comprising an outer layer 4811 and an inner layer 4812, wherein the inner layer 4812 may comprise a folded, honeycomb, frame having a plurality of recesses formed therein , or cavities, 4815. In various embodiments, the walls forming the frame of the inner layer 4812 may contain one or more weakened, or thin, sections 4819, which can be designed so that the walls forming the frame break when compressed uu cassette housing 4810. In such situations, the cassette housing 4810 may be crushed when the staple cartridge 4800 of implantation.

In various embodiments, as shown in FIG. 158-160, a cassette with brackets, such as, for example, a cassette with brackets 4900, may comprise a cassette body 4910 comprising an outer layer 4911 and a plurality of crease elements 4912 located, for example, between the upper and lower parts of the outer layer 4911. As is mainly shown in FIG. 158 and 159, the cassette with brackets 4900 may further comprise a plurality of brackets 4920, each bracket 4920 may be located inside the crease element 4912. More specifically, each crease element 4912 may include a first part 4912a, a second part 4012b and a third part 4012c, which together form a cavity 4915 configured to receive the bracket 4920. In addition to the above, in use, the cassette with brackets 4900 can be located inside the channel for the cassette with brackets, and to the surface 4919 in contact with the fabric It is applied compressive force for compressing the cassette body 4910. When moving tissue contacting surface 4919 downwards collapsible elements 4912 may wrinkle. In such situations, the second part 4912b of each crease element 4912 can be wrinkled into the corresponding first part 4912a, and similarly, the third part 4912c of each crease element 4912 can be wrinkled into the corresponding second part 4912b. By compressing the cassette body 4910 and creasing the crease elements 4912, the brackets 4920 located inside the crease elements 4912 can become deformed, as shown in FIG. 160. In various embodiments, the second part 4912b of each crease member 4912 can be engaged by friction and / or pressed into the corresponding first part 4912a so that the first part 4912a and the second part 4912b can begin to slide relative to each other as soon as the compressive force applied to the crease member 4912 exceeds the restraining force holding the first part 4912a and the second part 4912b in the extended position (FIG. 159). Likewise, the third part 4912c of each crease member 4912 can be engaged by friction and / or pressed into the corresponding second part 4912b so that the second part 4912b and the third part 4912c can begin to slide relative to each other as soon as the compressive force applied to the crease member 4912 exceeds the restraining force holding the second part 4912b and the third part 4912c in the extended position (FIG. 159).

In many of the embodiments described herein, a staple cartridge may comprise a plurality of staples. In various embodiments, the implementation of such brackets may consist of a metal wire deformed into a configuration essentially U-shaped with two legs. Other embodiments are possible in which the brackets may have different configurations, such as two or more wires connected together containing three or more legs. In various embodiments, the wire or wires used to form the brackets may have a circular or at least substantially circular cross-section. In at least one embodiment, the staple wires may have any other suitable cross-section, such as, for example, square and / or rectangular cross-sections. In certain embodiments, the staples may consist of plastic wire. In at least one embodiment, the staples may consist of plastic coated metal wire. In various embodiments, the cartridge may comprise any type of fastener in addition to or instead of staples. In at least one such embodiment, such a fastener may comprise pivotable arms that fold when engaged with the stop. In certain embodiments, two-part fasteners may be used. In at least one such embodiment, the cassette with brackets may comprise a plurality of first parts of the fastener, and the stop may comprise a plurality of second parts of the fastener that connect to the first parts of the fastener when the stop is pressed against the cassette with brackets. In certain embodiments, as described above, the slide or ejector can advance inside the staple cassette to complete the staple formation process. In certain embodiments, the slide or ejector can advance inside the abutment to move one or more forming elements down to engage them with the opposite cassette and with staples or fasteners located inside the cassette.

In various embodiments described herein, a cassette with brackets may comprise four rows of brackets located therein. In at least one embodiment, four rows of brackets may be located in two inner rows of brackets and two outer rows of brackets. In at least one such embodiment, the inner row of brackets and the outer row of brackets can be located on the first side of the groove for the cutting element, or the scalpel, inside the cassette with brackets, and the inner row of brackets and the outer row of brackets can likewise be located on the second side of the groove for cutting element, or scalpel. In certain embodiments, the cassette with brackets may not contain a groove for the cutting element; however, instead of the groove for the cassette with brackets, such a cassette with brackets may contain a special part adapted to be cut by the cutting element. In various embodiments, the implementation of the inner rows of staples can be located inside the cassette with staples so that they are at equal or at least substantially equal distance from the groove for the cutting element. Similarly, the outer rows of staples can be located inside the cassette with staples so that they are at equal or at least substantially equal distance from the groove for the cutting element. In various embodiments, the cassette with brackets may contain more or less than four rows of brackets located therein. In at least one embodiment, the staple cartridge may comprise six rows of staples. In at least one such embodiment, the staple cartridge may comprise three rows of staples on the first side of the groove for the cutting element and three rows of staples on the second side of the groove for the cutting element. In certain embodiments, the staple cartridge may contain an odd number of rows of staples. For example, a cassette with brackets may contain two rows of brackets on the first side of the groove for the cutting element and three rows of brackets on the second side of the groove for the cutting element. In various embodiments, the rows of staples may comprise staples of the same or at least substantially the same height prior to formation. In other specific embodiments, the implementation of one or more rows of staples may contain staples with a height prior to formation other than the height of the other staples. In at least one such embodiment, the brackets on the first side of the groove for the cutting element can have a first height before forming, and the brackets on the second side of the groove for the cutting element can have a second height before forming, which, for example, differs from the first height.

In various embodiments, as shown in FIG. 161A-161D, a surgical stapling instrument's working tool may include a cassette holding portion, such as, for example, a cassette channel with brackets 5030, a cassette with fasteners disposed removably in a cassette channel with brackets 5030, such as, for example a cassette with brackets 5000 and a jaw 5040 located opposite the cassette with brackets 5000 and the channel for the cassette with brackets 5030. The cassette with brackets 5000 may comprise a compressible housing 5010 and a plurality of brackets 5020 and / or any other fasteners for at least an hour otherwise located in a compressible housing 5010. In at least one such embodiment, each bracket 5020 may comprise a base 5022 as well as legs 5021 extending upward from the base 5022, at least a portion of the legs 5021 may be inserted into the housing of the cartridge 5010. B In various embodiments, the compressible housing 5010 may comprise an upper or fabric contacting surface 5019 and a lower surface 5018, the lower surface 5018 being adjacent to the supporting surface 5031 of the cassette with brackets 5030 and below erzhivatsya it. Similarly to the aforementioned, the supporting surface 5031 may contain, for example, a plurality of support grooves 5032 formed therein (FIG. 161D), which can be adapted to receive and support the bases 5022 of the staples 5020. In various embodiments, the surgical stapling instrument may further comprise a holding matrix, such as, for example, a holding matrix 5050, which can be adapted to engage the staples 5020 and trap tissue between the matrix and the staples. In at least one such embodiment, the retaining matrix 5050 may be removably mounted on the jaw 5040. During use, after the cartridge with the brackets 5000 is located in the channel for the cartridge with the brackets 5030, the jaw 5040 and the holding matrix 5050 attached thereto can move in the direction cassettes with brackets 5000 and a channel for a cassette with brackets 5030. In at least one embodiment, the jaw 5040 can move down along the axis 5099 so that the jaw 5040 and the channel for the cassette with brackets 503 0 remained parallel or at least substantially parallel to each other when the jaw 5040 was closed. More specifically, in at least one such embodiment, the jaw 5040 can be closed so that the tissue-contacting surface 5051 of the holding matrix 5050 remains parallel or at least substantially parallel to the tissue-contacting surface 5019 of the cassette with brackets 5000 while moving the jaw 5040 to direction of the cassette with brackets 5000.

In various embodiments, as shown in FIG. 161A, the holding matrix 5050 can be detachably fixed to the jaw 5040 so that the relative movement between the holding matrix 5050 and the jaw 5040 when the matrix 5050 is attached to the jaw 5040 is small or absent. In at least one embodiment, the jaw 5040 may comprise one or more retaining elements, which may be configured to hold the retaining matrix 5050 in position. In at least one such embodiment, the retaining matrix 5050 may be snap-fit and / or tightened into the jaw 5040. In certain embodiments, the holding matrix 5050 may be adhered to the jaw 5040 using at least one adhesive. In any case, the jaw 5040 can be moved to a position where the holding matrix 5050 is in contact with the fabric T, and the fabric T is located close to the fabric contact surface 5019 of the cassette with brackets 5000. When the tissue T is located close to the cassette with brackets 5000 using the jaw 5040, the compressible cassette body 5010 with the brackets 5000 may or may not be compressed by the jaw 5040. In any situation, in various embodiments, the legs 5021 of the brackets 5200 may not protrude through the fabric contacting surface 5019 of the cartridge with brackets 5000, as shown in FIG. 161A. Moreover, as shown in FIG. 161A, the jaw 5040 can hold tissue T close to the compressible body 5010 without engaging the holding matrix 5050 with brackets 5020. Such embodiments allow the surgeon to repeatedly open and close the jaw 5040, for example, to achieve the desired position of the working tool in the surgical field without damaging the tissue T. However other embodiments are possible, where the ends of the staples 5023 can protrude from the tissue-contacting surface 5019 until the cassette 5010 is compressed by the stop 5040. After the working tool is positioned appropriately as shown in FIG. 161B, the jaw 5040 can be moved down in the direction of the cassette channel with brackets 5030 so that the compressible body 5010 is pressed by the stop 5040 and that the tissue-contacting surface 5019 is moved downward relative to the brackets 5020. When pushing the tissue-contacting surface 5019 down, the ends 5023 legs of staples 5021 can puncture the tissue contact surface 5019 and puncture at least a portion of the fabric T. In such situations, the holding matrix 5050 can be positioned above the staples 5020 so that the holding holes I 5052 retaining matrix 5050 are aligned or at least substantially aligned with the ends of the legs 5023 of staples 5021.

By pushing down the holding matrix 5050 along the axis 5099, as shown in FIG. 161C, the legs 5021 of the brackets 5020 may fit into the holding holes 5052. In various embodiments, the legs of the brackets 5021 may engage the side walls of the holding holes 5052. In certain embodiments, as described in more detail below, the holding matrix 5050 may comprise one or more holding elements, protruding inwardly and / or around the holding holes 5052, which can engage the legs of the brackets 5021. In any case, the legs of the brackets 5021 can be held in the holding holes 5052. In various situations, the ends 5023 of the legs of the brackets 50 21 may fit into the holding holes 5052 and engage the holding elements and / or side walls of the holes 5052 by friction. When pushing the holding matrix 5050 toward the bases 5022 of the brackets 5020, the legs of the brackets 5021 can slide relative to the side walls and / or the holding elements. As a result of the above, a sliding friction force can be generated between the legs of the brackets 5021 and the holding matrix 5050, and such a sliding friction force can create resistance when the retaining matrix 5050 is mounted on the brackets 5020. In various embodiments, when the holding matrix 5050 slides down along the legs 5021 of the brackets 5020 the sliding friction force between the holding matrix 5050 and the brackets 5020 may be constant or at least substantially constant. In certain embodiments, the sliding friction force may increase and / or decrease during the sliding of the holding matrix 5050 down along the legs of the brackets 5021 due to variations in the geometric shape of the legs of the brackets 5021, the holding holes 5052 and / or the holding elements protruding inward and / or around, for example, retaining holes 5052. In various embodiments, the compressible cartridge case 5010 with brackets 5000 may also resist when the retaining matrix 5050 is pushed onto the brackets 5020. More specifically, we compress The 5th housing 5010 may consist, for example, of an elastic material that can exert a counteracting force on the holding matrix 5050, which increases as the distance by which the compressible housing 5010 is compressed increases. In at least one such embodiment, the increase in the opposing force created by the housing cassettes 5010 may be linearly proportional or at least substantially linearly proportional to the distance the cassette 5010 is compressed. In certain embodiments, velichenie reaction force generated cartridge housing 5010 may be proportional to or at least substantially exponentially proportional to the distance at which the cassette case 5010 is compressed.

In various embodiments, in addition to the above, a trigger force sufficient to overcome the counteracting and frictional forces described above can be applied to the jaw 5040 and the holding matrix 5050. In use, the holding matrix 5050 can be set to any appropriate depth with respect to the brackets 5020. In at least one embodiment, the holding matrix 5050 can be set at such a depth with respect to the bases 5022 of the brackets 5020 to secure two or more layers of fabric together and create inside tissue compressive force, or pressure. In various situations, a system comprising a holding matrix 5050 and staples 5020 may allow the surgeon to select the amount of compressive force or pressure applied to the tissue, choosing the depth at which the holding matrix 5050 is set. For example, the holding matrix 5050 can be pushed down in the direction of the bases 5022 brackets 5020 until the holding matrix 5050 is installed at a certain depth 5011 from the bottom of the support grooves 5032, and with a smaller depth 5011 compressive force, or pressure, butt applied to the fabric T may be greater than at a larger depth 5011, at which the compressive force or pressure applied to the fabric T may be less. In various embodiments, the compressive forces or pressures applied to the fabric T may be linearly proportional or at least substantially linearly proportional to the depth 5011 onto which the holding matrix 5050 is mounted. In various situations, compressive forces or pressures applied to the fabric T , may depend on the thickness of the fabric T located between the holding matrix 5050 and the cassette with brackets 5020. More specifically, at a given distance 5011 compressive forces, or pressures, with a thicker layer of fabric T can be more than with a thinner layer of tissue T.

In various situations, in addition to the one described above, the surgeon can adjust the depth at which the retaining matrix 5050 is installed to take into account the thicker and / or thinner tissue located in the working tool, as well as to apply a certain or predetermined pressure to the tissue T regardless of its thickness. For example, the surgeon may set the holding matrix 5050 to a shallower depth 5011 when stitching a thinner tissue T or to a greater depth 5011 when stitching a thicker tissue T to obtain the same or at least substantially the same compressive pressure within the tissue. In certain embodiments, in addition to the one described above, the surgeon can selectively determine the amount of compressive pressure applied to the tissue T located between the retaining matrix 5050 and the cassette with brackets 5010. In various situations, the surgeon can engage the holding matrix 5050 with brackets 5020 and place it on a first distance from the bases 5022 of the staples 5020 to apply a first compressive pressure to the fabric. In an alternative embodiment, the surgeon may position the holding matrix 5050 at a second distance from the bases 5022, which is less than the first distance, to apply a second compressive pressure to the tissue that is greater than the first pressure. In an alternative embodiment, the surgeon may position the holding matrix 5050 at a third distance from the bases 5022, which is less than the second distance, to apply a third compressive pressure to the tissue that is greater than the second pressure. In various embodiments, a crosslinking system comprising a holding matrix 5050 and staples 5020 may be configured so that the surgeon is able to apply a wide range of compressive pressures to the target tissue.

In various embodiments, as shown in FIG. 161D, the legs of the brackets 5021 can be inserted through the holding matrix 5050 so that the ends of the legs of the brackets 5023 extend above the upper surface of the holding matrix 5050. In at least one embodiment, as shown in FIG. 161C, the jaw 5040 may further comprise separating holes 5042 formed therein, which may be configured to receive the ends of the legs of the brackets 5023 as they pass through the retaining holes 5052 in the holding matrix 5050. In at least one such embodiment, the separating holes 5042 may be aligned with the retaining holes 5052 so that the legs 5021 do not touch the jaw 5040. In various embodiments, the separation holes 5042 may have a depth sufficient to allow the legs of the brackets 5021 were not in contact with the jaw 5040, regardless of the depth to which the holding matrix 5050 is installed. After the holding matrix 5050 is hooked with brackets 5020 and set in the required position, as shown in FIG. 161D, the cassette channel with brackets 5030 and jaw 5040 can be pulled away from tissue T. More specifically, the cassette channel with brackets 5030 can be disconnected from the implanted cassette with brackets 5000, and the stop 5040 can be disconnected from the implanted holding matrix 5050. When when the jaw 5040 is removed from the holding matrix 5050 and the supporting elements of the brackets 5032 are removed from the bases of the brackets 5022, the distance 5011 between the holding matrix 5050 and the bottom of the bases 5022 can be maintained even if the jaw 5040 and the cassette channel with brackets 5030 no longer provide so their support. In various embodiments, the static friction force between the legs of the brackets 5021 and the holding matrix 5050 may be sufficient to maintain the holding matrix 5050 in the desired position, despite the biasing force exerted on the holding matrix 5050 by the compressed cassette body 5010 and / or the compressed tissue T. in at least one such embodiment, the cassette body 5010 may consist of an elastic material, which in a compressed state can exert an elastic biasing force on the holding matrix 5050 and the brackets 5020 in such a way way that the retaining matrix 5050 and braces 5020 sought to repel each other, although such movement is opposed to the friction between the legs of the brackets 5021 and 5050 hold the matrix.

In various embodiments, as described above, the holding matrix may comprise a plurality of holding holes, with each holding hole being able to receive a leg of the fastener. In at least one embodiment, as shown in FIG. 162, a portion of the holding matrix 5150 may include a holding hole 5152, which is defined by the perimeter 5156. In various embodiments, the perimeter 5156 of the hole 5152 may have a circular or at least substantially circular profile and / or any other corresponding profile. In certain embodiments, the holding matrix 5150 may include one or more holding elements, such as, for example, holding elements 5153, which may protrude inside the hole 5152 and may be able to engage the legs of the fastener when it is inserted into the hole. In at least one such embodiment, each holding member 5153 may comprise a cantilever protruding inwardly in the direction of the central axis 5159, i.e. toward the center of the hole 5152. In various embodiments, each cantilever may comprise a first end attached to the housing of the holding matrix 5158 and a second end forming the perimeter 5156 of the holding hole 5152. In certain embodiments, the perimeter 5156 of the holding hole 5152 may be defined by a first diameter, or width, and the leg of the fastener may be determined by a second diameter or width, the second diameter being larger than the first diameter. In at least one such embodiment, the leg of the fastener may be configured to come into contact and deflect one or more retaining elements 5153 to increase the diameter of the retaining hole 5152 when the legs of the fastener are inserted through it. In certain embodiments, in addition to the above, the leg of the fastener may be defined by a perimeter that is larger than the perimeter 5156 of the holding hole 5152 so that the leg of the fastener can expand the perimeter 5156 when it is inserted into the holding hole.

In various embodiments, as shown in FIG. 162, the hole 5152 can be defined by deformable elements 5153, each deformable element 5153 can be deflectable relative to or independent of other deformable elements 5153. In at least one such embodiment, adjacent deformable elements 5153 can be separated by grooves 5154, which can be made in such a way as to allow each deformable element 5153 to expand relative to other elements. In certain embodiments, each groove 5154 may include a first end 5155 located in the housing of the holding matrix 5158, a second end opening inside the holding hole 5152, and a constant or at least substantially constant width between the first end 5155 and the second end. In other various embodiments, the width of each groove 5154 may be unstable, and the width of each groove 5154 may increase and / or decrease between the first and second ends. In certain embodiments, the first ends 5155 of the grooves 5154 may include an expanded part, such as an annular part, which can, firstly, reduce the stress of the bases of deformable elements 5153 attached to the housing of the holding matrix 5158, and, secondly, a method of increasing flexibility deformable elements 5153. In various embodiments, the geometric shape of the deformable elements 5153 and / or grooves 5154 can be selected so as to provide the deformable elements 5153 with the necessary flexibility . In certain embodiments, the grooves 5154, for example, can be extended to create longer deformable elements 5153, which can be more flexible than deformable elements 5153 of shorter length. In at least one embodiment, the width of each deformable member 5153 may be selected so as to provide the necessary flexibility. More specifically, deformable elements with a smaller width may be more flexible than deformable elements with a larger width. In certain embodiments, as shown in FIG. 162, the first ends of the cantilevers of deformable elements 5153 attached to the housing of the holding matrix 5158 may be wider than the second ends of the cantilevers. In at least one such embodiment, the cantilevers can linearly or at least substantially linearly narrow between the first and second ends.

In various embodiments, as shown in FIG. 162, the housing of the retaining matrix 5158 may comprise a flat or at least substantially flat sheet of material having a fabric contacting surface 5151 and an upper surface 5157. In at least one such embodiment, the fabric contacting surface 5151 and the upper surface 5157 may be parallel or at least substantially parallel to each other. In various embodiments, each deformable member 5153 may comprise a first part 5153a and a second part 5153b, with the first part 5153a extending in the first direction and the second part 5153b extending in the other or second direction. In at least one such embodiment, the housing of the holding matrix 5158 may form a plane, and the first parts 5153a of the deformable elements 5153 may lie in such a plane. In various embodiments, the second parts 5153b of the deformable elements 5153 can extend at an angle to the first parts 5153a. In at least one such embodiment, the second parts 5153b may extend in directions extending from the upper surface 5157 of the holding matrix housing 5158, and in certain embodiments, the second parts 5153b may converge to the central axis 5159 of the holding hole 5152. In any case, in various embodiments the implementation of the second parts 5153b can be configured to deviate from the Central axis 5159 when inserting the legs of the fastener through the hole. In embodiments where the leg 5021 of the bracket 5020 is inserted into the holding hole 5152, the deformable elements 5153 can be deformed in a direction substantially from the bases 5122 of the brackets 5120. Thus, in certain embodiments, the deformable elements 5153 can deviate in a general direction that is the same or at least measure essentially coinciding with the direction in which the legs of the staples 5021 are inserted.

In various embodiments, as shown in FIG. BD, each of the second parts 5153b of the deformable elements 5153 may include a sharp end, which, for example, can be slidable relative to the legs of the bracket 5021 when inserting the legs of the bracket 5021. The sharp ends of the second parts 5153b can also be made to abut against the leg of the bracket 5021, if the leg of the bracket 5021 should extend in the opposite direction, i.e. in the direction of extraction of the leg of the bracket 5021 from the holding hole 5052. In certain situations, the second parts 5153b may be deflected relative to the side surface of the legs of the bracket 5021 at an angle exceeding 90 degrees, and thus, the second parts 5153b may deepen, or penetrate, into the side surface the legs of the bracket 5021 when a force acts on the leg of the bracket 5021 to extend the leg of the bracket 5021 from the holding hole 5052. In certain embodiments, the surfaces of the legs of the bracket 5021 may include cutouts and / or recesses, such as, for example, microcuts, which, for example, can be configured to receive the ends of deformable elements 5053. In at least one such embodiment, the ends of deformable elements 5053 can be caught and embedded in the cutouts in the legs of the bracket 5021 when the brackets 5021 are attached to the legs pulling force. In various embodiments, as a result of the second parts 5153b being inserted into the legs of the bracket 5021, forces striving to remove the legs of the bracket 5021 from the holding holes 5022 can only insert the second parts 5153b deeper into the legs of the bracket 5021 and increase the force required to remove the legs of the bracket 5021. Moreover , due to the upward movement of the second parts 5153b in at least one embodiment, the second parts 5153b may be more pliable to insert the legs of the bracket 5021 into the holding hole 5152 and have greater resistance to pulling the legs of the staples 5021. Thus, in at least one embodiment, the force required to insert the legs of the bracket 5021 into the holding hole 5022 may be less than the force required to remove the legs of the bracket 5021 from the holding hole 5022. In various embodiments, the force required to extract the legs of the bracket 5021 from the holding hole 5022 may, for example, be about 50 percent more than the force required to insert the legs of the bracket 5021 into the holding hole 5022. In various other embodiments, the force is required for extracting the legs of the bracket 5021 may, for example, be from about 10 to about 100 percent more force required to insert the legs of the bracket 5021. In certain embodiments, the force required to remove the legs of the bracket 5021 can be, for example, about 100 percent, about 150 percent, about 200 percent and / or more than about 200 percent more than the force required to insert the legs of the bracket 5021.

In some embodiments, implementation, as shown in FIG. 162, the second portions 5153b may be arranged in a circle around the hole 5152, and a recess may be formed between them. More specifically, the second parts 5153b may form a recess 5160, which may be configured to receive the end of the leg of the fastener when it is inserted into the holding hole 5152. In various embodiments, the second parts 5153b of the deformable elements 5153 may comprise annular or at least substantially annular contours that can together form, for example, an annular or at least substantially annular profile of a recess 1560. In at least one such embodiment, the second Asti 5153b may form a recess in the form of a cone or truncated cone. In various embodiments, the recess may be formed by an appropriate number of deformable elements, such as, for example, four deformable elements 5153 (FIG. 162), six deformable elements 5153 (FIG. 163), or eight deformable elements 5153 (FIG. 164). In certain embodiments, as shown in FIG. 165, deformable elements of a holding matrix, such as, for example, a holding matrix 5250, can form a pyramidal contour or at least a substantially pyramidal contour. In various embodiments, the holding matrix 5250 may comprise a plurality of holding holes, such as, for example, a holding hole 5252, which may be formed by a perimeter 5256. In various embodiments, the perimeter 5256 may have a polygonal or at least substantially polygonal profile and / or any another relevant profile. In certain embodiments, the holding matrix 5250 may include one or more holding elements, such as, for example, holding elements 5253 that protrude inside the hole 5252 and can be adapted to engage the legs of the fastener when it is inserted through the hole. In at least one such embodiment, each holding member 5253 may comprise a cantilever protruding inwardly towards the central axis 5259, i.e. toward the center of the hole 5252. In various embodiments, each cantilever may comprise a first end attached to the housing of the holding matrix 5258 and a second end forming the perimeter 5256 of the holding hole 5252. In certain embodiments, the perimeter 5256 of the holding hole 5252 may be defined by a first diameter, or width, and the leg of the fastener may be determined by a second diameter or width, the second diameter being larger than the first diameter. In at least one such embodiment, the leg of the fastener may be configured to contact and deflect one or more retaining elements 5253 to increase the diameter of the retaining hole 5252 when the legs of the fastener are inserted through it. In certain embodiments, in addition to the above, the leg of the fastener may be defined by a perimeter that is larger than the perimeter 5256 of the holding hole 5252 so that the leg of the fastener can expand the perimeter 5256 when inserted into the holding hole.

In various embodiments, as shown in FIG. 165, hole 5252 may be defined by deformable elements 5253, each deformable element 5253 may be deflectable relative to or independently of other deformable elements 5253. In at least one such embodiment, adjacent deformable elements 5253 may be separated by grooves 5254, which can be made in such a way as to allow each deformable element 5253 to expand relative to other elements. In various embodiments, the implementation of the housing of the retaining matrix 5258 may comprise a flat or at least substantially flat sheet of material having a fabric contacting surface 5251 and an upper surface 5257. In at least one such embodiment, the tissue contacting surface 5251 and the upper surface 5257 may be parallel or at least substantially parallel to each other. In various embodiments, each deformable member 5253 may comprise a first part 5253a and a second part 5253b, with the first part 5253a extending in the first direction and the second part 5253b extending in the other or second direction. In at least one such embodiment, the housing of the holding matrix 5258 may form a plane, and the first parts 5253a of the deformable elements 5253 may lie in such a plane. In various embodiments, the second parts 5253b of the deformable members 5253 may extend at an angle to the first parts 5253a. In at least one such embodiment, the second parts 5253b may extend in directions extending from the upper surface 5257 of the housing of the holding matrix 5258, and in certain embodiments, the second parts 5253b may converge to the central axis 5259 of the holding hole 5252. In any case, in various embodiments the implementation of the second parts 5253b can be configured to deviate from the Central axis 5259 when inserting the legs of the fastener through the hole. In some embodiments, implementation, as shown in FIG. 165, the second parts 5253b may be circumferentially around the hole 5252, and a recess may be formed between them. More specifically, the second parts 5253b can form a recess that can be adapted to receive the end of the leg of the fastener when it is inserted into the holding hole 5252. In various embodiments, the second parts 5253b of the deformable elements 5253 can form, for example, polygonal or at least essentially a polygonal recess. In various embodiments, the recess may be formed by an appropriate number of deformable elements, such as, for example, four deformable elements 5253 (FIG. 165), which can form a square, six deformable elements 5253 (FIG. 166), which can form a hexagon, or eight deformable elements 5253 (FIG. 167), which can form an octagon.

In various embodiments, as shown in FIG. 168, a retention matrix, such as, for example, a retention matrix 5350, may be formed from a flat or at least substantially flat sheet of material, such as, for example, titanium and / or stainless steel. In at least one such embodiment, a plurality of holes 5352 may be formed in the housing 5358 of the holding matrix 5350 using one or more stamping processes. The sheet of material can be placed in a stamping die, which, when activated, can punch certain parts of the material to form, for example, grooves 5354, holes 5355 of grooves 5354 and / or perimeter 5356 of the holding hole 5352. The stamping can also be configured to bend deformable elements 5353 into the appropriate configuration. In at least one such embodiment, the embossing stamp may deform the second parts 5353b by bending them upward relative to the first parts 5353a along the crease line 5353c. In various embodiments, as shown in FIG. 169, a holding matrix, such as, for example, a holding matrix 5450, may comprise a plurality of holding holes 5452. As described above, the perimeter 5456 of each holding hole 5452 may be formed by a plurality of deformable elements 5453 separated by grooves or slots, 5454. At least in one such embodiment, each deformable element 5453 can be completely bent upward, and the free ends of the cantilevers containing deformable elements 5453 can form a perimeter 5456. In various In embodiments, the holding matrix 5450 may comprise a plurality of holes 5455 surrounding or at least substantially surrounding the holding hole 5452. In at least one such embodiment, the holes 5455 may be arranged in a concentric circle surrounding or enclosing a perimeter formed by fixed ends cantilevers of deformable elements 5453. In certain embodiments, each hole 5455 may have a circular or at least substantially circular perimeter and / or l Any other appropriate perimeter. In the process of using the holes 5455 can, firstly, reduce the stress of the bases of the deformable elements 5453 attached to the housing of the holding matrix 5458, and secondly, a method of increasing the flexibility of the deformable elements 5453. In various embodiments, the larger holes 5455 can provide a larger flexibility to deformable elements 5453 than smaller holes 5455. Moreover, holes 5455 located closer to deformable elements 5453 can provide greater flexibility than holes 5455 located further from deformable elements.

In various embodiments, as shown in FIG. 170, a holding matrix, such as, for example, a holding matrix 5550, may comprise a plurality of holding holes 5552. Each holding hole 5552 may comprise an elongated groove 5554 with enlarged circular or at least substantially circular ends 5555. In at least one such embodiment the ends 5555 may be determined by a diameter that is larger than the groove 5554. In certain embodiments, the elongated groove 5554 and the ends 5555 may be located and / or centered along the longitudinal axis 5559. In various embodiments the implementation of the groove 5554 and the ends 5555 can form two opposite tongues 5553, which can be made with the possibility of engagement of the legs of the fastener and deviation when it is inserted through the groove. In at least one embodiment, ends 5555 with a larger perimeter or diameter may form longer tongues 5553, which may be more flexible than tongues 5553 formed by ends 5555 with a smaller perimeter, or diameter. In various embodiments, ends 5555 may have the same perimeter and diameter, and in at least one such embodiment, each tongue 5553 may be symmetrical about an axis perpendicular or at least substantially perpendicular to longitudinal axis 5559. In an alternative embodiment, ends 5555 may have other perimeters and / or diameters, in at least one embodiment, each tongue 5553 may not be symmetrical about its axis. In at least one such alternative embodiment, the tabs 5553 can rotate about their axis when inserting the legs of the fastener through the retaining hole 5552. In various embodiments, as shown in FIG. 171, a holding matrix, such as, for example, a holding matrix 5650, may comprise a plurality of holding holes 5652. Each holding hole 5652 may comprise an elongated groove 5654 with circular or at least substantially circular ends 5655. In at least one such embodiment the elongated groove 5654 and the ends 5655 may be located and / or centered along the longitudinal axis 5659. In various embodiments, each end 5655 may be determined by a diameter matching or at least substantially matching m with a groove width of 5654.

In various embodiments, as shown in FIG. 172, a holding matrix, such as, for example, a holding matrix 5750, may comprise a plurality of holding holes 5752. Each holding hole 5752 may comprise a plurality of grooves, such as, for example, grooves 5754, with extended ends 5755. In at least one such embodiment of the implementation, the grooves 5754 and the ends 5755 may be located and / or centered along the longitudinal axis 5759. In various embodiments, the axes 5759 may extend in directions perpendicular or intersecting each other. In certain embodiments, the grooves 5754 and the ends 5755 can form, for example, four tongues 5753, which can be adapted to engage the legs of the fastener and deflect when inserted through the retaining hole 5752. In at least one embodiment, each tongue 5753 may have a triangular or at least substantially triangular configuration, such as, for example, an equilateral triangle. In various embodiments, as shown in FIG. 173, a holding matrix, such as, for example, a holding matrix 5850, may comprise a plurality of holding holes 5852. Each holding hole 5852 may comprise a plurality of grooves, such as, for example, grooves 5854 having ends 5855, wherein grooves 5854 and ends 5855 may be located and / or centered along the longitudinal axes 5859. In various embodiments, the axles 5859 may extend in directions perpendicular or intersecting each other. In certain embodiments, the grooves 5854 and the ends 5855 can form tongues 5853, which can be adapted to engage the legs of the fastener and deflect when inserted through the retaining hole 5852. In at least one embodiment, each tongue 5853 may have an arcuate profile. More specifically, each tongue 5853 may comprise a curved end compared with the pointed end shown in FIG. 170, which may be configured to come into contact with the leg of the fastener.

In various embodiments, as shown in FIG. 174, a holding matrix, such as, for example, a holding matrix 5950, may comprise a plurality of holding holes 5952. Each holding hole 5952 may comprise a plurality of grooves, such as, for example, grooves 5954, each groove 5954 may extend and / or be centered along axles 5959. In various embodiments, axles 5959 can intersect with each other, and in at least one such embodiment, axles 5959 can be positioned so that all axes 5959 pass through the center of the retaining hole 5952 and galis at the same or at least substantially equidistant from each other. In at least one embodiment, each groove 5954 may include an open end directed toward the center of the retaining hole 5952, and a second, closed, end 5955 at the opposite end of the groove 5954. As described above, the grooves 5954 and the ends 5955 can form, for example, three tongue 5953, which can be adapted to engage the legs of the fastener and deflect when inserted through the retaining hole 5952. In various embodiments, each tongue 5953 may have an arcuate configuration between a neighbor the ends 5955 of the slots 5954. In various embodiments, as shown in FIG. 175, a holding matrix, such as, for example, a holding matrix 6050, may comprise a plurality of holding holes 6052. Each holding hole 6052 may include a tongue 6053, which may be adapted to engage the legs of the fastener and deflect when inserted through the holding hole 6052. In at least one such embodiment, the tongue 6053 may include a base attached to the housing of the retaining matrix 6058, and a free end having an arcuate or curved profile 6056, which can It can be configured to contact the leg of the fastener. In certain embodiments, the leg of the fastener may be a staple leg consisting of a round wire, wherein the curved profile 6056 can be configured to fit or at least substantially match the curved outer surface of the round wire.

In various embodiments, as shown in FIG. 175, the housing of the holding matrix 6058 may comprise a plurality of grooves 6054 and holes 6055, which may be configured to form a tongue 6053 and various parts of the holding hole 6052. In at least one embodiment, the tongue 6053 may have a rectangular configuration with parallel or at least essentially parallel sides. In various embodiments, as shown in FIG. 176, a holding matrix, such as, for example, a holding matrix 6150, may comprise a plurality of holding holes 6152. Each holding hole 6152 may include a tongue 6153, which may be adapted to engage the legs of the fastener and deflect when inserted through the holding hole 6152. In at least one such embodiment, the tongue 6153 may include a base attached to the housing of the holding matrix 6158, and a free end having an arcuate or curved profile 6156, which can It can be configured to contact the leg of the fastener. In various embodiments, the housing of the retaining matrix 6158 may comprise a plurality of grooves 6154 and holes 6155, which may be configured to form a tongue 6153 and various parts of the retaining hole 6152. In at least one embodiment, the tongue 6153 may have a cone configuration with arched sides. In at least one such embodiment, the tongue 6153, for example, may taper exponentially, the base being wider than the free end.

In various embodiments, as described above, the crosslinking system may comprise a plurality of staples containing legs that are inserted through the plurality of holding holes in the holding matrix. In certain embodiments, as described in more detail below, the brackets can be held in the first jaw, and the holding matrix can be held in the second jaw, at least one of the first jaw and the second jaw can move to the other. In various situations, the brackets located inside the first jaw can be fixed in it so that the legs of the brackets are aligned with the retaining holes when the retaining matrix is engaged by the legs of the brackets. In certain embodiments, as shown in FIG. 177 and 178, the stapling system may include, for example, a cassette with brackets 6200 located in the first jaw of the surgical stapling instrument, and, for example, a holding matrix 6250 located in the second jaw of the surgical stapling instrument. As shown in FIG. 184 and 185, in addition to the above, the holding matrix 6250 may comprise a plurality of holding holes 6252, each holding hole 6252 may have a perimeter 6256 formed by one or more bendable elements 6253. In at least one such embodiment, in addition to as described above, the bendable elements 6253 forming each hole 6252 may form a recess 6201. In various embodiments, each recess 6201 may have, for example, a curved and / or concave surface that can It can be adapted to guide the end of the staple leg into the hole 6252 if the staple leg is offset relative to the retaining hole 6252 and will initially come into contact, for example, with the bending elements 6253 and / or the surface 6251 in contact with the fabric.

In various embodiments, in addition to the above, the crosslinking system may further comprise a plurality of staples 6220 containing legs 6221 that can be inserted through the holding holes 6252 in the holding matrix 6250. In at least one such embodiment, each staple 6220 may have for example, a substantially U-shaped configuration comprising a base 6222 from which legs 6221 may protrude upward. In various embodiments, as shown in FIG. 180 and 181, the holding holes 6252 in the holding matrix 6250 can be arranged, for example, in two parallel or at least substantially parallel longitudinal rows that can extend along or parallel to the longitudinal axis of the holding matrix. In certain embodiments, the holding holes 6252 in the first row can be offset, or staggered, relative to the holding holes 6252 in the second row. In at least one such embodiment, each bracket 6220 may include a first leg 6221 located in the holding hole 6252 in the first row, and a second leg 6221 located in the holding hole 6252 in the second row, and thus, the bases 6222 can extend into a direction crossing the longitudinal axis of the holding matrix 6250. In at least one such embodiment, the brackets 6220 may be parallel or at least substantially parallel to each other. More specifically, the base 6222a of the bracket 6220a, for example, may be parallel or at least substantially parallel to the base 6222b of the bracket 6220b, which may be parallel or at least substantially parallel to the base 6222c of the bracket 6220c. In at least one embodiment, the legs 6221a of the bracket 6220a, for example, may form a plane parallel or at least substantially parallel to the plane formed by the legs 6221b of the bracket 6220b, which may be parallel or at least substantially parallel to the plane formed by the legs 6221 staples 6220c.

In various embodiments, as shown in FIG. 177 and 179, the cassette with brackets 6200 may comprise a plurality of brackets 6220, as well as an alignment matrix 6260 containing a plurality of alignment guides, such as, for example, grooves, grooves and / or holes that can be adapted to align the brackets 6220. B In various situations, the alignment matrix 6260 may be configured such that the legs 6221 of the brackets 6220 align with the holding holes 6252 in the holding matrix 6250 before engaging the holding matrix 6250 in mesh with the legs of brackets 6221. In various embodiments, as shown in FIG. 182 and 183, the alignment matrix 6260 may comprise a plurality of alignment holes 6262, which can be more accurately adapted to receive the legs 6221 of the brackets 6220. In at least one such embodiment, each bracket 6220 may include a base 6222 and two legs 6221 extending from the base 6222, the base 6222 of the brackets 6220 may extend around the bottom surface 6264 of the retaining matrix 6260, and the legs of the brackets 6221 may protrude upward through the alignment holes 6262. In certain embodiments, each alignment the bore hole 6262 may be circular or at least substantially circular and may be determined by a diameter that is equal to or slightly larger than the diameter of the legs of the bracket 6221 passing through it. In various embodiments, the alignment matrix 6260 may further comprise a plurality of convex elements 6263 that may protrude upward from the upper surface 6261 of the alignment matrix 6260 and surround or at least partially surround the alignment holes 6262. In certain embodiments, the convex elements 6263 of the position olyayut get longer aligns the hole 6262, and in different situations over the long holes 6262 allow for better control the alignment of the legs of staples 6221 than shorter holes 6262.

During use in various embodiments, the first jaw supporting the cassette with brackets 6200 may be located on one side of the stitched fabric, and the second jaw supporting the holding matrix 6250 may be located on the other side of the fabric. In certain embodiments, after the jaws are properly positioned relative to the fabric, the second jaw and the holding matrix 6250 can be moved toward the cassette with brackets 6200. In various embodiments, during insertion of the legs, the brackets 6221 through the holding holes 6252 in the holding matrix 6250 are in contact with the fabric, or the lower, surface 6251 of the holding matrix 6250 can contact the fabric and press it against the fabric in contact with the fabric, or the upper surface 6261 of the alignment matrix 6260. In other cases In other embodiments, as described in more detail below, the cassette with brackets 6200 may further comprise a compressible cassette housing located, for example, above the upper surface 6261 of the alignment matrix 6260, which may come into contact with the fabric. In certain embodiments, as shown in FIG. 179 and 183, the alignment matrix 6260 may further comprise one or more openings 6203 formed therein, which may be configured to receive a portion of the fabric when the alignment matrix 6260 is placed adjacent to the fabric. In embodiments where the compressible cartridge case is located above and / or adjacent to the alignment matrix 6260, a portion of the compressible cartridge case may enter holes 6203 when the cartridge case is compressed. The holding matrix 6250 may likewise comprise a plurality of holes 6202, which may be configured to receive at least a portion of the fabric when the holding matrix 6250 is placed adjacent to the fabric.

In addition to the above, when inserting the legs 6221 of the brackets 6220 through the holding holes 6252 of the holding matrix 6250, the ends of the legs of the brackets 6221 may protrude upward from the upper surface 6257 of the holding matrix 6250. In various situations, as described above, the ends of the legs of the brackets 6221 may remain unbent after inserts through retaining holes 6252. In certain embodiments, as shown in FIG. 186-189, a crosslinking system comprising a cassette with brackets 6200 and a holding matrix 6250, may further comprise a plurality of protective caps or covers, such as, for example, caps 6270, which can be attached to the legs of the brackets 6221 protruding above the holding matrix 6250. B in various embodiments, each cap 6270 may completely or at least partially cover the sharp end of the leg of the bracket 6221 so that the sharp end does not come in contact with adjacent tissue. In at least one embodiment, as shown in FIG. 189, each cap 6270 may include an opening 6271 that can be more accurately adapted to receive the end of the leg of the bracket 6221. In various embodiments, the caps 6270 may consist of an elastomeric material, such as, for example, silicone, polyisoprene, sanoprene and / or natural rubber. In at least one embodiment, the opening 6271 may have a perimeter or diameter that is smaller than the perimeter or diameter of the bracket leg 6221 inserted into it. In at least one such embodiment, the hole 6271 in the protective cap 6270 may expand to receive the bracket leg 6221. B various alternative embodiments of the caps 6270 may not contain holes, and the ends of the legs of the staples 6221 can be made with the possibility of cutting the caps 6270 when inserting the legs 6221 in them. In each case, each cap 6270 can be mounted on the leg of the bracket 6221 until the base 6272 of the cap 6270 abuts or is located next to the upper surface 6257 of the holding matrix 6250. In various situations, the caps 6270 can be made so that they can be tight to install brackets 6221 on the ends of the legs and it was not easy to remove them. In certain embodiments, each cap 6270 may have, for example, a conical or at least substantially conical outer surface. In various embodiments, caps 6270 may have any suitable contour, such as, for example, contours containing a parabolic or at least substantially parabolic outer surface.

In various embodiments, the crosslinking system described above can be installed, for example, using the surgical crosslinking tool shown in FIG. 190-192. In various embodiments, the implementation of the working tool may include a first jaw, or channel for a cassette with brackets, 6230, which can be arranged to hold the cassette with brackets 6200, and a second jaw 6240, which can be configured to support the holding matrix 6250 and many protective caps 6270. As mainly shown in FIG. 190, where the second jaw 6240 is shown in an open configuration, the jaws 6230 and 6240 can be positioned relative to the fabric T so that the fabric T is located between the holding matrix 6250 and the cassette with brackets 6200. In various embodiments, as described above, the cassette with brackets The 6200 may further comprise a compressible cartridge case, such as, for example, a cartridge case 6210, in which the brackets 6220 and the alignment matrix 6260 can be housed. In at least one such embodiment, the fabric T can be flush to the upper surface of the cartridge case 6210. In certain embodiments, the second jaw 6240 may comprise a plurality of recesses, or holes, 6245 configured to receive a plurality of protective caps 6270, as well as one or more retaining elements, or clips, which may be configured to holding the holding matrix 6250 in position above the caps 6270. In at least one such embodiment, the holding matrix 6250 may be configured to hold the caps 6270 in the hole x 6245. In various embodiments, as shown in FIG. 202, each orifice 6245 may be configured to receive part or all of the cap 6270. In certain embodiments, the orifices 6245 may be large enough to be configured such that caps 6270 can be secured to them using, for example, at least one of pressed and / or snap-in connections. In some embodiments, at least one adhesive may be used to secure caps 6270 in openings 6245. In at least one such embodiment, the adhesive may be selected so that the caps 6270 can separate from the second jaw 6240 after the caps 62 62 are engaged by the legs of the brackets 6221 and the second jaw 6240 is withdrawn from the implanted fastener assembly. In certain embodiments, as shown in FIG. 203, the second jaw 6240 may further comprise at least one cover sheet 6246 that can be attached to the second jaw 6240 and can cover and hold the caps 6270 in the openings 6245. In at least one such embodiment, at least a portion of the cover sheet 6246 may be attached to jaw 6240, for example, using at least one adhesive. In at least one embodiment, during use, the cover sheet 6246 may be at least partially detached from jaw 6240 before insertion of the working instrument into the surgical field. In certain embodiments, the cover sheet 6246 may consist of an implantable material, such as, for example, PDS and / or PGA, which can cut through the legs of the brackets 6221 protruding from the holding matrix 6250. In at least one such embodiment, the cover sheet 6246 may be fixed in a crosslinking system between covers 6270 and holding matrix 6250.

In addition to the above, as shown in FIG. 191, the jaw 6240 may move from an open position to a closed position in which the fabric T is located opposite the holding matrix 6250 and the cassette 6210. In this position, the holding matrix 6250 may not yet engage with the brackets 6220. In various embodiments, the jaw 6240 may move between the open position and the closed position using the actuator 6235. In at least one such embodiment, the jaw 6240 may include a distal pin 6243 and a proximal pin 6244 extending from it, and the pin 6243 can slide vertically or at least substantially vertically in the distal groove 6233 formed in the channel for the cassette 6230, and the proximal pin 6244 can slide vertically or at least substantially vertically in the proximal groove 6234 also formed in the cassette channel about brackets 6230. During use, the drive 6235 can be retracted proximally to push the pins 6243 and 6244 into the upper ends of the corresponding grooves 6233 and 6234, as shown in FIG. 191. In at least one such embodiment, the drive 6235 may include a distal drive groove 6236 and a proximal drive groove 6237, the side walls of the drive grooves 6236 and 6237 can be configured to contact the distal pin 6243 and the proximal pin 6244, respectively, and push the pins 6243 and 6244 upward when moving the 6235 actuator proximally. More specifically, when moving the actuator 6235, the proximal distal pin 6243 can slide upward along the inclined first portion 6236a of the distal drive groove 6236 into the intermediate, or second, part 6236b, and the proximal pin 6244 can similarly slide upward along the inclined first part 6237a of the distal drive groove 6237 in the intermediate, or second, part 6237b. When both pins 6243 and 6244 move up, the jaw 6240 can rotate down toward the tissue T to the closed position.

In addition to the above, as shown in FIG. 192, the actuator 6235 can be further extended proximally to push the second jaw 6240 down toward the first jaw 6230, compress the cassette 6210 and engage the holding matrix 6250 and the plurality of protective caps 6270 with legs of brackets 6220. In at least one such embodiment, additional proximal movement drive 6235 may cause the side walls of the drive slots 6236 and 6237 to contact the pins 6243 and 6244, respectively, and push the pins 6243 and 6244 down toward the lower ends of the slots 6233 and 6234, respectively. In such situations, the drive 6235 can be extended proximally so that, firstly, the distal pin 6243 exits the second part 6236b of the drive groove 6236 and enters the inclined third part 6236c, and the proximal pin 6244 likewise exits the second part 6237b of the drive groove 6237 and entered the inclined third part 6237c. By moving both pins 6243 and 6244 down, the second jaw 6240 can move down toward the first jaw 6230 to the activated position. In at least one such embodiment, the second jaw 6240 can be moved downward so that the holding matrix 6250 remains parallel or at least substantially parallel to the upper surface of the cassette 6210 and / or parallel or at least substantially parallel to the alignment matrix 6260. In any case, after the retaining matrix 6250 and the protective caps 6270 enter into engagement with the legs 6221 of the brackets 6220, as shown in FIG. 194, the second jaw 6240 can be returned to the open or at least substantially open position. In at least one such embodiment, the actuator 6235 can be distally pushed to move the pins 6243 and 6244 into the upper ends of the slots 6233 and 6234, respectively, and then down to the lower ends of the slots 6233 and 6234 as soon as the pins pass through the intermediate parts 6236b and 6237b of the respective drive slots 6236 and 6237. After opening the second jaw 6240, the first jaw 6230 can be disconnected from the implanted cassette with brackets 6200, and the first and second jaws 6230, 6240 can be removed from the implanted fastener assembly, as shown in FIG. 193.

Turning to FIG. 192, it can be noted that the pins 6243 and 6244 are shown not reaching the very end of the corresponding grooves 6233 and 6234, although the retaining matrix 6250 and the caps 6270 are already engaged with the legs of the brackets 6221. This situation may occur when between the holding matrix 6250 and the housing cassette 6210 is a thick fabric T. As shown in FIG. 195, in situations where a thinner fabric T is located between the holding matrix 6250 and the cassette 6210, the pins 6243 and 6244 can be pushed down into the corresponding slots 6233 and 6234, as shown in FIG. 197. In general, in at least one such embodiment, the actuator 6235 can be pulled proximally to push the pins 6243 and 6244 up and down as described above and shown in FIG. 195-197 in a series of movements, and due to the smaller thickness of the fabric T, the holding matrix 6250 and the protective caps 6270 can extend further onto the legs 6221 of the brackets 6220, as shown in FIG. 198 and 199. In various embodiments, due to the adjustment possibilities provided by the holding matrix 6250, it is possible to obtain the same or substantially the same compressive force in the fixed fabric, regardless of the thickness of the tissue captured by the working tool. In a number of embodiments, the adjustment possibilities provided by the holding matrix 6250 may allow the surgeon to select a larger compressive force or a lower compressive force applied to the tissue by selecting the depth to which the holding matrix 6250 lowers. In at least one such embodiment, the lowering range holding matrix 6250 on the legs of the brackets 6221 can be determined, for example, by the length or range of lengths of the grooves 6233 and 6234.

In various embodiments, as described above, the protective caps 6270 may be made, for example, of soft or flexible material, which may be capable of gripping the ends of the legs of the brackets 6221. In some embodiments, the protective caps 6270 may be made of a bioabsorbable polymer, polyglycolic acid (PGA), commercially available under the Vicryl trademark, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglycaprone 25 (PGCL), commercially available under the Monocr trademark yl, polycaprolactone (PCL) and / or, for example, a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL, and / or a biocompatible metal, such as, for example, titanium and / or stainless steel. As shown in FIG. 189, in at least one embodiment, each cap 6270 may not be connected to other caps 6270. In a number of other embodiments, one or more caps 6270 may be mounted on a holding matrix 6250. In at least one such embodiment, caps 6270 may be connected to the holding matrix 6250 using, for example, at least one adhesive, the holes 6271 in the caps 6270 can be aligned or at least substantially aligned with the holding holes 6252 in the hold vayuschey matrix 6270. As shown in FIG. 200, in various embodiments, a protective cap, such as, for example, cap 6370, may form an internal cavity, or dome, 6374, which may be configured to receive, for example, the end of the leg of the bracket 6221. In at least one such embodiment cap 6370 may comprise a bottom 6372 and an opening 6371 extending through the bottom 6372. In various embodiments, the opening 6371 may be formed by one or more deflectable elements 6373, which may be deflectable in a moment t passing through them the legs of the bracket 6221. In a number of embodiments, for example, two or more caps 6370 may be joined together to form a matrix of caps 6370. As shown in FIG. 201, in at least one such embodiment, the plurality of caps 6370 may be joined by a sheet of material 6375. In some embodiments, the sheet 6375 may be rigid enough to maintain the desired relative positioning and / or alignment of the caps 6370. In at least one embodiment, the caps 6370 can be made from a biocompatible metal, such as titanium and / or stainless steel, and sheet 6375 can be made from a bioabsorbable polymer, polyglycolic acid (PGA), available in also under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or, for example, a mixture of PGA , PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, sheet 6375 may be made from a bioabsorbable polymer comprising an antimicrobial agent, such as, for example, colloidal silver and / or triclosan embedded and / or dispersed, for example, in sheet 6375 and released upon bioabsorption.

In addition to the above, in various embodiments, the sheet 6375 may be formed around the caps 6370, for example, by injection molding, so that the caps 6370 are embedded in the material of the sheet 6375. In a number of other embodiments, the sheet 6375 may be formed, for example, by molding under pressure, with holes 6376 can be formed on sheet 6375 during injection molding and / or after completion of the injection molding process, for example, by stamping. In any case, the caps 6370 can be inserted into the holes 6376 and secured to them using pressing and / or snapping, and / or at least one adhesive. In a number of embodiments, each cap 6370 may comprise an annular groove that completely or at least partially surrounds the perimeter of cap 6370 and which may be configured to receive the perimeter of aperture 6376. In some embodiments, sheet 6375 may be made of flexible and / or ductile material allowing relative movement between the caps 6370. In at least one such embodiment, the flexible sheet 6375 may be made, for example, of rubber, plastic or silicone mat iala and caps 6370 may be made from a rigid material such as, for example, metal. In at least one such embodiment, similar to the above, the flexible material may be cast around the caps 6370. In a number of embodiments, the caps 6370 may, for example, be pressed into a pre-molded sheet 6375. In various embodiments, the hardness index of the flexible used can be selected. material to obtain the desired stiffness of the sheet 6375. In some embodiments, the sheet 6375 may be configured to contain a flexible strip. In any case, the sheet 6375 can facilitate the installation of the caps 6370 in the working tool, since in this case, many caps 6370 can be located and / or combined in the working tool at the same time. In addition, after implantation, the sheet 6375 connecting the caps 6370 can, for example, act as a reinforcing or supporting element for tissue along the line of staples. In addition to or instead of using a sheet to connect the caps 6370, the caps 6370 can be connected together by many links. In at least one such embodiment, such links may be flexible and may allow relative movement between caps 6370.

As shown in FIG. 204 and 205, in various embodiments, a protective cap, such as, for example, cap 6470, may comprise a forming surface that can be configured to deform the end of the leg of the bracket. In at least one such embodiment, cap 6470 may include a base 6472, which may include a hole 6471 extending through it. In various embodiments, the hole 6471 may be more accurately able to receive a bracket leg, such as, for example, a bracket leg 6221. In at least one embodiment, the aperture 6471 may be formed by a diameter or perimeter, which may be equal to or greater than the diameter or perimeter of the leg of the bracket 6221. In various embodiments, The cap 6470 may further comprise a cavity, or dome, 6474, which may be configured to receive the end of the leg of the bracket 6221 during insertion into the cap 6470. As shown primarily in FIG. 205, cap 6470 may further comprise an abutment, or forming surface, 6473, which may be configured to deflect and deform the legs of the bracket 6221. In various circumstances, forming surface 6473 may be, for example, curved and / or concave, and may be formed with the possibility of bending the legs of the bracket 6221 during insertion into the cap 6470. In some embodiments, the leg of the bracket 6221 can be deformed so that it cannot be pulled back through hole 6471, and thus, cap 6470 may be is encoded on the leg of the bracket 6221. In at least one such embodiment, the base 6472 of the cap 6470 may form a rim around the hole 6471, which may prevent the deformed leg of the bracket 6221 from being pulled out of the cavity 6474. In various circumstances, as a result of the above, one or more caps 6470 may or may not allow the retention of the retention matrix, such as, for example, the retention matrix 6250, or its disengagement from the brackets 6220. Although not shown in the figures, in various embodiments, the number of achok 6470 may be symmetrical or at least substantially symmetrical and the opening 6471 can be located on the central axis 6479 through the cap 6470. As also shown in FIG. 204, in various alternative embodiments, the hole 6471 may be offset relative to the central axis 6479. In at least one such embodiment, the offset hole 6471 may allow the leg of the bracket 6221 to contact the side of the forming surface 6473 and bend toward the other side of the forming surface 6473 instead contact with the center of the forming surface 6473, which may occur in embodiments with the above centered holes 6471.

As indicated above, in various embodiments, the holding matrix, such as, for example, the holding matrix 6250, can be made of a sheet of material and a plurality of holding holes 6252 passing through it. In at least some embodiments, the sheet of material containing the holding matrix 6250 may be rigid or substantially inflexible. In a number of other embodiments, the holding matrix may consist of an array of elements of the holding matrix and a plurality of flexible connectors, or links connecting the elements of the holding matrix. As shown in FIG. 206, in various embodiments, the holding matrix, or part of the holding matrix, 6550 may comprise a plurality of element bodies 6505, which may be joined together by one or more connecting links 6507. In at least one embodiment, each element body 6505 may comprise a plurality of deformable elements 6553, which form a holding hole 6552. In a number of embodiments, the housing of elements 6505 and the connecting links 6507 of the holding matrix 6550 may be integral and may dstavlyat a single fragment of material. In various embodiments, the holding matrix 6550 may be, for example, stamped or cast and made of a metal material, such as, for example, titanium and / or stainless steel. In at least one embodiment, the holding matrix 6550 may consist of a synthetic material, such as, for example, polyetheretherketone (PEEK), polypropylene, commercially available under the trademark Prolene, polyester, polyethylene terephthalate, commercially available under the trademarks Ethibond and Mersilene, polyvinylidene fluoride, a copolymer of polyvinylidene fluoride and hexafluoropropylene, polyhexafluoropropylene-VDF, commercially available under the brand name Pronova, and / or long chain aliphatic polymers Nylon 6 and Nylon 6,6, commercially available under Ethilon govymi marks and Nurolon, and can be made, e.g., by injection molding. In some embodiments, the element housings 6505 may not be integral with the connecting links 6507. In various embodiments, it is possible to produce a plurality of individual element housings 6505, which are then joined together and embedded in a holding matrix. In at least one such embodiment, the element bodies 6505 can be stamped from a metal material, such as, for example, titanium and / or stainless steel, and placed in a plastic injection mold, wherein the plastic material can be injected into the mold to create, firstly, a rim 6506 of material surrounding or at least partially surrounding the housing of elements 6505, and, secondly, connecting links 6507 emerging from the rims 6506. In a number of other embodiments, can be made one or more connecting grids comprising openings formed in a plurality of rims 6506, each such opening being able to receive an element casing 6505. In at least one embodiment, each casing of an element 6505 may comprise an annular or at least substantially an annular outer perimeter, and in a similar manner, each rim 6506 may form a circular or at least substantially circular hole within itself, wherein the diameter of the hole may be equal to or be m nshe diameter casing member 6505. In at least one such embodiment, the housing members 6505 may be pressed or embedded in the hole rims 6505. In some embodiments, the housing element 6505 may be fixed in the holes by means of at least one adhesive.

In addition to the above, in various embodiments, the holding matrix may comprise a plurality of element housings 6505 and a plurality of connecting links 6507 that can connect the element housings 6505 to any array of suitable topology, for example, as shown in FIG. 207-210. Regardless of the topology of the array, in various embodiments, the connecting links 6507 may be capable of relative movement of the element housings 6505 and the holding holes 6552. In at least one such embodiment, the lattice of the element housings 6505 and the connecting links 6507 forming the holding matrix 6550 after adhesion to the fabric can be stretched, twisted, compressed and / or otherwise deformed to provide at least some mobility in the fabric, but at the same time prevent raschat its significant displacement. In various embodiments, each link 6507 may include a flexible member configured to stretch, twist and / or compress to allow deformation of the holding matrix 6550, for example, between the holding elements of the matrix 6505. As shown in FIG. 206, each link 6507 exiting the rim 6506 may have a width that is less than the width of the element body 6505 and / or rim 6506. As shown in FIG. 207-210, in some embodiments, one or more links 6507 may comprise straight sections that, for example, extend along a line connecting adjacent enclosures of elements 6506. In at least one such embodiment, each link 6507 may comprise a first end attached to a first rim 6506, and a second end attached to the second rim 6506. As also shown in FIG. 206, in a number of embodiments, two or more links 6507 may be connected to each other. In at least one such embodiment, two or more links 6507 may be connected, for example, in an intermediate hinge 6509. In various embodiments, the hinge 6509 may comprise a narrowing in the cross section in one or more directions compared to the thickness in the cross section of the links 6507 that can provide, for example, the ability to move the connected links 6507 relative to each other. In a number of embodiments, the holding matrix 6550 may further comprise hinges 6508 that can connect the links 6507 to the rims 6506 and allow relative movement of the links 6507 and the rims 6506. Like hinges 6509, the hinges 6508 may include, for example, one or more narrowing of the cross section more directions compared to the thickness of the 6507 units in cross section.

In addition to the above, in various embodiments, the connected links 6507 may extend in different directions. In at least one such embodiment, the first link 6507 may extend in a first direction, and the second link 6507 may extend in a second direction, wherein the first direction may be different from the second direction. In a number of embodiments, the first link 6507 may extend along the first line, and the second link 6507 may extend along the second line, wherein the first line and the second line may intersect at an angle, such as, for example, approximately 30 degrees, approximately 45 degrees, approximately 60 degrees and / or approximately 90 degrees. In various embodiments, the hinges 6508 and / or hinges 6509 may be flexible hinges that allow links 6507 to move relative to each other several times without breaking the hinge. In some embodiments, hinges 6508 and / or hinges 6509 may contain brittle or easily collapsing parts that can be destroyed if the deformation is strong enough or too many. In at least one such embodiment, such fragile parts may allow one or more parts of the holding matrix 6550 to separate from another part of the holding matrix 6550. In various embodiments, hinges 6508 and / or hinges 6509 may, for example, comprise sections of the holding matrix 6550, which easier to cut than other parts of the holding matrix 6550. More specifically, the often implanted holding matrix and tissue fixed by the implanted holding matrix can be cut with a cutting element for I have various purposes, and to facilitate such a transverse dissection, for example, tracks or thin sections can be provided in hinges 6508 and / or hinges 6509, through which it will be easier for the cutting element to pass through the holding matrix 6550. In addition to the foregoing, in various embodiments the implementation of the connecting links 6507 may contain, for example, made on them one or more stamped or flattened sections to facilitate bending, tearing and / or incision of the connecting links 6507.

In various embodiments, the holding matrix may comprise a plurality of holding matrix elements, such as, for example, matrix element housings 6505 that can be embedded in a flexible sheet or strip of material. In at least one embodiment, the flexible sheet of material may be made of a bioabsorbable elastomeric material, such as, for example, silicone, and the flexible sheet may be made with a plurality of holes formed therein. In at least one such embodiment, a continuous flexible sheet may be cast first, and then a plurality of holes may be punched in the flexible sheet. In various alternative embodiments, a flexible sheet may be molded and holes formed therein during the casting process. In any case, for example, the elements of the holding matrix 6505 can be inserted and fixed in a flexible sheet. Similarly to the foregoing, in a number of other embodiments, a flexible sheet may be formed around the elements of the matrix 6505. In at least one embodiment, the flexible sheet may be, for example, a woven mesh and / or any other suitable material. In addition to the above, such a woven mesh can be easily cut.

As shown in FIG. 211 and 212, in various embodiments, a crosslinking system comprising a retention matrix, such as, for example, a retention matrix 6250, may further comprise a coating, such as, for example, a coating 6670, which can cover the ends of the legs of the brackets 6221 when they protrude above the upper the surface 6257 of the holding matrix 6250. In various embodiments, the coating 6670 may be attached to the holding matrix 6250. In some embodiments, the coating 6670 and / or the holding matrix 6250 may include holding elements which can be configured to hold the coating 6670 on the holding matrix 6250. At least in one embodiment, at least one adhesive can be used to fix the coating 6670 on the holding matrix 6250. In at least one embodiment, the coating 6670 may consist of one layer, although the coating 6670 shown in the figure contains two layers, as described in more detail below. As shown primarily in FIG. 212, in various embodiments, the ends of the legs of the brackets 6221 may extend through the lower surface 6673 of the coating 6670, however, the coating 6670 may be sufficiently thick so that the ends of the legs of the brackets do not extend through the upper surface 6675 of the coating 6670. As a result, in at least one such embodiment the implementation of the ends of the legs of the brackets 6221 may not protrude from the coating 6670. In various embodiments, the implementation of the coating 6670 may contain many layers. In at least one such embodiment, the coating 6670 may comprise a first layer 6671 and a second layer 6672. In at least one embodiment, the first layer 6671 and the second layer 6672 may be bonded to each other, in at least one embodiment the second layer 6672 may comprise a lower surface 6676 adhered to the first layer 6671. In various embodiments, the first layer 6671 and the second layer 6672 may have different thicknesses, although in some embodiments they may be the same thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 may have substantially the same width and / or length. In alternative embodiments, layers 6671 and 6672 may have different widths and / or lengths.

In addition to the above, in various embodiments, the first layer 6671 may consist, for example, of compressible foam, mesh material and / or hydrogel, which can be cut by the legs of the brackets 6211. In at least one embodiment, the second layer 6672 may consist of a stronger material, or shell, such as, for example, PGA and / or PDS, and / or any suitable support material. In at least one such embodiment, the legs of the brackets 6221 may be capable of piercing the first layer 6671, however, in various embodiments, the legs of the brackets 6221 may not be able to pierce the second layer 6672. In some embodiments, the second layer 6672 may consist of material, possessing sufficient elasticity and / or strength for contact and displacement of the second layer 6672 with the leg of the bracket 6221, but without a notch or with a minimum notch, the end of the leg of the bracket 6221. Although not shown in the figures, the coating may consist more than two layers, wherein one or more of these layers may be puncture resistant. During use in at least one such embodiment, the holding matrix 6250 can be positioned on the tissue to be fixed and fed down so that the legs 6221 of the brackets 6220 pass through the fabric T and the holding holes 6252 in the holding matrix 6250 and enter the first layer 6271 coatings 6270. In various embodiments, the ends of the legs of the brackets 6221 may not be included or at least substantially not included in the second layer 6272 of the cover 6270. After the retaining matrix 6250 is properly positioned, the jaw 6240 may yt is open, so that the cover 6670 and 6250 holding the matrix can be separated from the jaws 6240, as shown in FIG. 211. As shown in FIG. 211, jaw 6640 may be configured to hold more than one holding matrix 6250 and cover 6670. In at least one such embodiment, jaw 6640 may comprise two channels 6679, each of which may be configured to receive cover 6670 and located below holding matrix 6250 such that the tissue-contacting surface 6251 of each holding matrix 6250 will face down from the base of jaw 6240. In at least one such embodiment, the holding matrix 6250 and Generic 6270 can be placed in jaw 6640 on each side of the groove of the scalpel 6678. In use, the holding matrices 6250 and coatings 6670 can be located simultaneously and / or at the same depth with respect to the cassettes with brackets located opposite them, such as for example, cassettes 6200. Then, in various embodiments, the fixed tissue can be dissected along the cut line by a cutting element moving along the groove of the scalpel 6678, while the jaw 6640 can be opened again. In some embodiments, the coatings 6670 may not be attached to the holding matrix 6250. In at least one such embodiment, the coatings 6670 may be located in channels 6679 and may be held in channels 6679 by holding matrices 6250, which may be secured in a jaw 6640. B in various embodiments, each holding matrix 6250 may have a larger width and / or length compared to respective coatings 6670, so that the holding matrices 6250 can completely hold the corresponding coatings 667 0 in the desired position. In a number of embodiments, each holding matrix 6250 may have, for example, the same length and / or width as the corresponding coating 6670.

In various embodiments, as described above, the crosslinking system may comprise a layer of material that can be attached to a holding matrix, such as, for example, a holding matrix 6250. As shown in FIG. 215, in at least one embodiment, a layer of material 6870 may be attached to the bottom surface 6251 of the retaining matrix 6250. In some embodiments, the layer 6870 and / or the holding matrix 6250 may include holding elements configured to hold the layer 6870 on the holding matrix 6250 In at least one embodiment, at least one adhesive may be used to adhere layer 6870 to retention matrix 6250. In any case, the layer 6870 may comprise a lower or fabric-facing surface 6873 that can be made to contact the fabric T by moving the holding matrix 6250 down in the direction of the brackets 6220 to engage the holding holes 6252 with the legs of the brackets 6221. At least in One such embodiment, layer 6870 may consist of a compressible material, such as, for example, bioabsorbable foam, which can be compressed between the bottom surface 6251 of the holding matrix 6250 and the fabric T. In various embodiments, the The layer 6870 may further comprise at least one drug stored and / or absorbed therein, which may be released from layer 6870 by compressing layer 6870. In at least one embodiment, the drug may contain at least one hemostatic tissue sealant an agent and / or antimicrobial material, such as, for example, silver ions and / or triclosan. In various embodiments, the compression of layer 6870 can cause the drug to extrude from layer 6870, so that all or at least a significant portion of the surface of tissue T will be coated with the drug. In addition, as the layer 6870 is compressed and the tissue T and layer 6870 are punctured by the legs of the staples 6221, the drug can flow along the legs of the staples 6221 and, for example, process the tissue just cut by the legs of the staples 6221. In various embodiments, the housing of the holding matrix 6250 may include a first layer consisting of a biocompatible material, such as, for example, titanium and / or stainless steel, and a lower layer 6870 may comprise a second layer containing a bioabsorbable material, such as oxidized regenerated cellulose (ORC), a biological cally active substances, such as fibrin and / or thrombin (in liquid or lyophilized form), glycerol, absorbable porcine gelatin in the form of a gas, or a foam and / or antimicrobial agents such as, for example, silver ions and / or triclosan. Additional bioabsorbable materials may contain, for example, Surgicel Nu-Knit, Surgicel Fibrillar, collagen / ORC, which is a hybrid material with an integrated collagen matrix and is commercially available under the trademark Promogran, polyglycolic acid (PGA), commercially available under the trade Vicryl brand, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGCL), commercially available under the trademark Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. Although in FIG. 215 shows only one layer 6870, any appropriate number of layers can be used. In at least one embodiment, the first layer containing the first drug may be attached to the holding matrix 6250, and the second layer containing the second or other drug may be attached to the first layer. In at least one such embodiment, multiple layers may be used, with each layer containing its own drug and / or combination of drugs.

As shown in FIG. 213, in various embodiments, the crosslinking system may comprise a layer of material 6770 attached to the bottom surface 6251 of the holding matrix 6250. In some embodiments, the layer 6770 and / or holding matrix 6250 may include holding elements configured to hold the layer 6770 on the holding matrix 6250 In at least one embodiment, at least one adhesive may be used to adhere layer 6770 to retention matrix 6250. In any case, the layer 6770 may contain a lower or fabric-facing surface 6773 that can be made to contact the fabric T by moving the holding matrix 6250 down in the direction of the brackets 6220 to engage the holding holes 6252 with the legs of the brackets 6221. At least in One such embodiment, layer 6770 may consist of a compressible material, such as, for example, bioabsorbable foam, which can be compressed between the surface 6251 of the holding matrix 6250 and the fabric T. In various embodiments, eniya layer 6770 may further comprise one or more capsules or cells 6774 that can be configured to store therein at least one drug. As shown in FIG. 214, in a number of embodiments, the capsules 6774 can be aligned or at least substantially aligned with the holding holes 6252 so that when pushing the legs of the staples 6221 through the fabric T and the layer 6770, the legs of the staples 6221 can puncture and / or otherwise violate the integrity of the capsules 6774 After the integrity of the capsules 6774 is compromised, at least one drug M located in the capsules 6774 may leak onto tissue T. In at least one such embodiment, the drug M may contain a fluid that may Flow or drip down the legs of the brackets 6221 and treat the fabric T, just cut by the legs of the brackets. As a result, the drug in capsules 6774 can provide local treatment of tissue. In a number of embodiments, capsules 6774 in sheet 6770 may contain various drugs. For example, the first group of capsules 6774 may contain a first drug or a first combination of drugs, and the second group of capsules may contain another drug or a different combination of drugs. In various embodiments, the implementation of the layer 6770 may consist of a flexible silicone sheet, and the capsule 6774 may represent voids in the silicone sheet. In at least one such embodiment, the silicone sheet may comprise two layers that can be attached to each other, wherein capsules 6774 may be formed between the two layers. In various embodiments, the implementation of the layer 6770 may contain one or more thin or weakened parts, for example, in the form of partially perforated sections, which can facilitate incision of the layer 6770 and the violation of the integrity of the capsules 6774 legs 6221. In some embodiments, at least a portion of the capsules 6774 may located in domes 6777, while domes 6777 may protrude upward from sheet 6770. In at least one such embodiment, domes 6777 and / or at least a portion of capsules 6774 may be located in recesses 6201 formed h retention matrix 6250. In some embodiments, the capsule 6774 may comprise individual cells, are not related to each other. In a number of other embodiments, one or more capsules 6774 may be in fluid communication with each other, for example, through one or more channels, passages and / or ducts passing through layer 6770. US Pat. ELEMENT ”, issued on August 24, 2010, is fully incorporated into this application by reference.

In addition to the above, in various embodiments, a cassette with brackets comprising a cassette body, staples and / or leveling matrix can be loaded into the first jaw of the working tool, and, similarly, a holding matrix and / or one or more coatings can be loaded into the second branch of the working tool. As shown in FIG. 216, in a number of embodiments, a special tool, such as, for example, a cassette loader 6990, can be used to insert two or more cassettes with fasteners simultaneously into a working tool. In at least one embodiment, the cassette loader 6990 may include a handle 6991 and a cassette holder 6992, while the cartridge holder 6992 may include a first holding part configured to hold the cassette body 6210 with brackets 6200, as well as an additional second holding part made with the possibility of the retention capacity of the cassette body 6980, which supports, for example, firstly, a plurality of protective caps 6270 and, secondly, a holding matrix 6250 along its lower surface. In various embodiments, each of the first and second holding parts may comprise one or more holding elements configured to detachably engage the cartridge cases 6210 and 6980. In use, as shown in FIG. 217 and 218, the working tool may comprise a first or lower jaw 6230 and a second or upper jaw 6940, the cassette with brackets 6200 can be loaded into the first jaw 6230 and the cassette body 6980 can be loaded into the second jaw 6940. B in various circumstances, the upper jaw 6940 can be rotated from the open position (FIG. 217) to the closed position (FIG. 218) using the drive 6235, while the operation of the drive 6235 is described above and is not repeated for brevity. After moving the upper jaw 6940 to the closed position, as shown in FIG. 218, the distal end 6993 of the cassette holder 6992 can be inserted into the working tool so that the cassette with brackets 6200 slides through the distal end 6938 of the first jaw 6930 into the first connecting part, or channel, 6939, of the first jaw 6230. Similarly, the distal end 6993 the cartridge holder 6992 can be inserted into the working tool so that the cartridge case 6980 slides through the distal end 6948 of the second jaw 6940 into the second connecting part, or channel, 6949, of the second jaw 6940. A surgeon or other medical professional, while holding the handle 6991 of the cassette loader 6990, it can push the cassette with brackets 6200 and the cassette body 6980 through channels 6939 and 6949, respectively, until the cassette with brackets 6200 and the cassette body 6980 are completely installed in the channels.

When the cassette with the brackets 6200 and the cassette body 6980 is installed in place, each of the cassette with the brackets 6200 and the body of the cassette 6980 can engage with one or more holding parts of the respective branches 6230 and 6940, as described in more detail below. In any case, after installing the cassette with the brackets 6200 and the cassette body 6980 in place, as shown in FIG. 219, the cassette loader 6990 can be disconnected from the cassette with the brackets 6200 and the cassette body 6980 and removed from the working tool. In at least one such embodiment, the holding force fixing the cassette with brackets 6200 in the first jaw 6230 may exceed the holding force fixing the cassette with brackets 6200 on the cassette holder 6992, so that when pulling the cassette holder 6992 distally from the working tool, the cassette with brackets 6200 may remain in the first jaw 6230. Likewise, the holding force fixing the cassette 6980 in the second jaw 6940 may exceed the holding force fixing the cassette 6940 on the cartridge holder 6992, so that when pulling the cassette holder 6992 distally from the working tool, the cassette body 6940 can remain in the second jaw 6940. After removing the cassette loader 6990 from the working tool, the first loaded jaw 6230 and the second loaded jaw 6940 can be located relative to the stitched fabric T. As shown in FIG. 220, the second jaw 6940 can be moved from the open position (FIG. 219) to the position with the brackets fully engaged (FIG. 220) to insert the retaining matrix 6250 and the plurality of protective caps 6270 that are on the cassette body 6980 into engagement with the brackets 6220 located in the cassette with brackets 6200.

As shown in FIG. 221 and 222, the second jaw 6940 can be opened again, and the plurality of protective caps 6270 and the holding matrix 6250 can be detached from the cassette body 6980, so that the caps 6270 and holding matrix 6250 can remain engaged with the T fabric and the cassette with brackets 6200. In at least one embodiment, the cassette body 6980 may comprise a plurality of recesses in which a plurality of caps 6270 can be placed to remove, as well as one or more retaining grooves configured to hold the retaining mat Ritsa 6250 with a possibility of removal. In various embodiments, the holding elements of the second jaw 6940, engaged with the cassette body 6980, can hold the cassette body 6980 in the second jaw 6940 after moving the second jaw 6940 to the open position. In some embodiments, the cassette body 6980 can be torn apart when the second jaw 6940 is moved to the open position, so that part of the cassette body 6980 is implanted with caps 6270 and holding matrix 6250, and part of the cassette body 6980 remains in the second jaw 6940. Similarly, as shown in FIG. 221 and 222, holding elements of the first jaw 6230, engaged with the cassette 6210, can hold the cassette 6210 in the first jaw 6230 after the second jaw 6940 is in the open position. In a number of embodiments, the cassette 6210 can be torn apart at the moment of removal of the first jaw 6230 from the implanted cassette 6200, so that part of the cassette 6210 is implanted with brackets 6220 and alignment matrix 6260, and part of the cassette 6210 remains in the first jaw 6230 As shown in FIG. 223-225, in various embodiments, a cassette with brackets, such as, for example, a cassette with brackets 6900, may comprise one or more longitudinal retaining grooves 6913 extending along the length of the cassette 6910, which may be configured to receive one or more longitudinal retaining rails 6916 protruding from jaw 6930, for example, when inserting the cartridge with brackets 6900 into the jaw 6930. In at least one embodiment, during use, before slipping the cartridge with brackets 6900 through the distal end of 6938 beats the holding channel 6939 the end of the retaining grooves 6913 can be aligned, for example, with the distal ends of the holding rails 6916.

As shown in FIG. 225, in various embodiments, the jaw 6940 may include two holding channels 6949, each holding channel 6949 may be configured to receive a cartridge case 6980 containing a plurality of caps 6270 and a holding matrix 6250. In some embodiments, each cartridge case 6980 may comprise one or more longitudinal retaining flanges 6917, which can be slidable along one or more longitudinal retaining rails 6918 of the second jaw 6940 with the introduction of the cartridge cases 6980 into the respective holding channels 6949 of the jaw 6940. In various embodiments, the holding ribs 6918 and the holding flanges 6917 can together hold the cassette body 6980 in the second jaw 6940 while detaching the cassette bodies 6980 from the caps 6270 and holding matrix 6250 contained therein. As shown in FIG. . 224, in various embodiments, the second jaw 6940 may further comprise one or more distal protrusions or retaining elements 6915 protruding therefrom, which may be removably fixed to remove the cassette body 6980 in respective holding channels. In at least one such embodiment, the second jaw 6940 may comprise a distal protrusion 6915 configured and disposed relative to each holding channel 6949 so that each cartridge case 6980 can bend from the protrusions 6915 when inserting the cartridge cases 6980 into the channels 6949, wherein when the cases of the cassettes 6915 fully reach the end position in the channels 6949, the distal ends of the cases of the cassettes 6980 can come off the tabs 6915 and click on them. To remove the cartridge cases 6980 after use, as described above, the cartridge bodies 6980 can be pulled back over the protrusions 6915 and removed from the holding channels 6949. Similar to the above, the first jaw 6930 may contain one or more protruding distal locking protrusions 6914 which can be configured to fit into one or more locking grooves, or grooves, 6912 (FIG. 223) in the cassette body 6910 when the cassette with brackets 6900 fully reaches its final position.

In addition to the above, in various embodiments, a first cassette with fasteners containing a plurality of first fasteners housed therein may be located in a first branch of a surgical stapler, and a second cassette with fasteners containing a plurality of second fasteners housed therein , can be placed in the second branch of the surgical stapler. In use, the first jaw and / or second jaw can be moved toward each other to engage the first fasteners with the second fasteners and fix the fabric between them. In some embodiments, the first cassette with fasteners and the second cassette with fasteners may come into contact with each other when the first fasteners engage with the second fasteners. In at least one embodiment, the housing of the first cartridge with fasteners can be made of a first compressible material, and the housing of the second cartridge with fasteners can be made of a second compressible material, while the first housing and / or second housing can be pressed into a fixed the cloth. After tissue is fixed, the first jaw can be retracted from the implanted first cassette with fasteners, and the second jaw can be retracted from the implanted second cassette with fasteners. Then, the first jaw can be recharged with another first cassette with fasteners and the like, the second jaw can be recharged with another second cassette with fasteners and the like, and the surgical stapler can be used again. Although brackets may be used in a number of embodiments, other embodiments are provided using other types of fasteners, such as, for example, two-piece fasteners that lock together when engaged. In at least one such embodiment, the first cassette with fasteners may comprise a first storage part for accommodating the first parts of the fasteners, and the second cassette with fasteners may comprise a second storage part for accommodating the second parts of the fasteners. In various embodiments, fasteners of any applicable shape and / or made of any applicable material may be used in the crosslinking systems described herein. In some embodiments, fasteners may include piercing elements. Such piercing elements can be made, for example, of a polymer or composite material and / or of a multilayer carrier. An example of a multilayer carrier is a wire or sheet carrier with an elastomeric or polymer coating. It can be a thin sheet formed so that the piercing elements are oriented perpendicularly or at least substantially perpendicularly to the connecting element. The piercing elements may have a rectangular profile, a semicircular profile and / or the profile of any beam. In various embodiments, the fasteners described herein may be fabricated using any suitable method, such as, for example, a wire extrusion method. Another possibility is to use microprocessing to create hollow piercing elements. Such piercing elements may be made in a manner different from the method of extruding the wire, and may include a combination of materials.

As indicated above, the ends of the legs of the brackets passing through the holding matrix can be closed with one or more caps and / or caps. In a number of embodiments, the ends of the staple legs can be deformed after being held through the holding matrix. In at least one embodiment, the jaw supporting the holding matrix may further comprise stop recesses located above and / or aligned with the holding holes, which may be able to deform the legs of the brackets protruding above the holding matrix. In various embodiments, the legs of each bracket may be folded inward, for example, toward each other and / or toward the center of the bracket. In a number of other embodiments, one or more legs of the bracket can be bent outward in the direction from the other legs of the bracket and / or from the center of the bracket. In various embodiments, regardless of the direction of curvature of the legs of the staples, the ends of the legs of the staples may come in contact with the housing of the holding matrix and may not go into the stapled fabric. In at least one embodiment, deformation of the legs of the staples after they are held through the holding matrix can lock the holding matrix in place.

As shown in FIG. 226 and 227, in various embodiments, a surgical stapling instrument, such as, for example, a surgical stapling instrument 7000, may comprise a first jaw 7030 and a second jaw 7040, while the second jaw 7040 can move toward and away from the first jaw 7030 drive 6235. The operation of drive 6235 is described above and is not repeated for brevity. In various embodiments, the first jaw 7030 may comprise a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 may form a channel extending between the distal end 7031 and the proximal end 7032, which is configured to receive a cassette with brackets. To illustrate the case of such a cassette with brackets in FIG. 226 is not shown, however, such a cassette with brackets may comprise a cassette body located in the cassette cassette bracket 6220 and placed under the brackets 6220 ejector brackets 7012. In some embodiments, although in FIG. 226 this is not shown for clarity, the second jaw 7040 can be arranged to place a holding matrix, such as, for example, a holding matrix 6250, over the brackets 6220 and / or moving the holding matrix until it engages with the legs of the brackets 6220, as described above . In at least one embodiment, the surgical stapling instrument 7000 may further comprise a slide 7010 located in the first jaw 7030 that can slide, for example, from the distal end 7031 of the first jaw 7030 to the proximal end 7032 and lift the ejectors of brackets 7012 and the brackets 6220 in the direction of the holding matrix and the second jaw 7040. In other various embodiments, for mounting the staples 6020, the sled 7010 can move, for example, from the proximal end 7032 to the distal end 7031. M nshey least one embodiment, slide 7010 can comprise one or more ramps or cams, surfaces 7011 that can be configured to slip under the ejectors staples 7012 and staple pushers 7012 lifting upwards. In various embodiments, the surgical stapling instrument 7000 may further comprise a pulling or pushing rod operably connected to the slide 7010, which can be moved proximally and / or distally by means of a drive located, for example, on the handle and / or trunk of the surgical stapling instrument 7000.

As also shown in FIG. 226, in various embodiments, the second jaw 7040 of the surgical suturing instrument 7000 may comprise a frame 7041, a distal end 7048, and a proximal end 7049 opposite the distal end 7048. In some embodiments, the second jaw 7040 may further comprise a guide system comprising one or more guides such as, for example, guides 7045 and 7046 extending along the longitudinal axis of the frame 7041, which, as described in more detail below, can be configured to direct one or more e abutments or cam members that can engage and deform the staple legs 6220 6221 feet after passing through the retaining clamps 6220 matrix. In at least one such embodiment, the guides 7045 and 7046 may include a guide wire or rod extending, for example, along the upper part or surface of the frame 7041, around the distal shaft 7047 and back along the upper part or surface of the frame 7041. In various embodiments, as indicated above and shown mainly in FIG. 228 and 230, the second jaw 7040 may further comprise one or more stops, or cam elements, such as, for example, the first stop 7050 and the second stop 7060, which can move longitudinally along the second jaw 7040 to deform the legs of the brackets 6220 after passing through the retaining matrix. In at least one embodiment, the surgical stapling instrument 7000 may further comprise a pusher, or drive, of a first stop 7051, coupled and / or functionally connected to a first stop 7050, which may be configured to extend the first stop 7050 proximally and / or push the first stop 7050 distally. Similarly, in at least one embodiment, the surgical stapling instrument 7000 may further comprise a pusher, or actuator, of a second stop connected and / or functionally connected to a second stop 7060, which may be configured to push the second stop 7060 distally and / or pulling the second stop 7060 proximally. In various embodiments, the first stop 7050 may include guide grooves 7052, and the second stop 7060 may include guide grooves 7062, each of which may be adapted to receive a guide 7045 or a slide 7046. In at least one such embodiment, the guides 7045 and 7046 can be tightly received in the guide grooves 7052 and 7062 so as to prevent or at least minimize lateral or lateral movement between them.

In addition to the above, in a number of embodiments, the first stop 7050 can be pulled proximally, and the second stop 7060 can be pulled distally. As shown in FIG. 226, in at least one embodiment, the rails 7045 and 7046 and the distal shaft 7047 may comprise a block system configured to extend the second stop 7060 distally and / or to extend the first stop 7060 proximally. In at least one such embodiment, the guide 7045 and the guide 7046 may comprise a continuous wire or rod extending around the distal rod 7047, while a portion of the continuous wire can be extended to guide the wire rod around the distal rod 7047. In various embodiments, the guide 7046, for example can be fixed on the second stop 7060 in such a way that when pulling a continuous pull in the first direction, the second stop 7060 can be pulled distally to the distal end of the 7048 sc 7040 Shea, and when pulling the continuous rod in the second, or opposite, direction of the second stop 7060 can be pulled proximally to the proximal end 7049. As shown in FIG. 228, in at least one embodiment, the guide 7046 may be secured to the guide groove 7062 so that it can transmit a pulling force. In at least one such embodiment, the guide 7045 can be slidable in another guide groove 7062. In various embodiments, the first stop 7050 can operate independently of the second stop 7060 and the block system, and the guide grooves 7052 provided in the first stop 7050 can be made with the possibility of receiving rails 7045 and 7046 with the possibility of sliding so as to ensure the possibility of their relative movement. In various embodiments, continuous traction, which is guides 7045 and 7046, can be flexible enough to allow opening and closing of the upper jaw 7040. Continuous traction can also be flexible enough to allow vertical movement of the second stop 7060 toward the lower jaw 7030 and from her, as described in more detail below.

As also shown in FIG. 228 and 230, in various embodiments, the first stop 7050 may comprise support rollers 7055 protruding from it, which may be movable in one or more cam grooves, or guide grooves, such as, for example, a cam groove 7070 (FIG. 231 ) formed in the frame 7041 of the second jaw 7040. More specifically, in at least one embodiment, the frame 7041 may comprise a first cam groove 7070 extending longitudinally along the first side of the frame 7041, and a second cam groove 7070 extending longitudinally along the second or the opposite side of the frame 7041, wherein the support rollers 7055 protruding from the first side of the first stop 7050 can move along the first cam groove 7070, and the support rollers 7055 protruding from the second side of the first stop 7050 can move along the second cam groove 7070 In at least one such embodiment, the contours of each cam groove 7070 may be identical or at least substantially identical, and the grooves may be aligned or at least substantially aligned with each other. Similarly, in various embodiments, the second stop 7060 may include support rollers 7065 protruding from it, which can be movable in the cam grooves 7070 (FIG. 231) provided in the frame 7041 of the second jaw 7040. More specifically, at least in one embodiment, the support rollers 7065 protruding from the first side of the second stop 7060 can move along the first cam groove 7070, and the support rollers 7065 protruding from the second side of the second stop 7060 can move along the second cam a groove 7070. During use, the support rollers 7055 of the first stop 7050 and the support rollers 7065 of the second stop 7060 can slide in the cam grooves 7070 so that when extending proximally and / or pushing the first stop 7050 and the second stop 7060, the first stop 7050 and the second the stop 7060 will follow the contours of the cam grooves 7070. In various embodiments, each cam groove 7070 may comprise a plurality of retaining or upper parts 7071 and a plurality of guides or lower parts 7072 that may be configured zhnosti movement stops 7050 and 7060 vertically, i.e. in a direction towards the lower jaws 7030 and from it, during longitudinal displacement of the stops 7050 and 7060, i.e. between the distal end 7048 and proximal end 7049 of the frame 7041, as described more fully below.

As shown in FIG. 231, when the surgical stapler 7000 is in a pre-staple state, the first stop 7050 can be located at the distal end 7048 of the frame 7041, and the second stop 7060 can be located at the proximal end 7049 of the frame 7041. In addition, as shown in FIG. 232, when the surgical stapling instrument 7000 is in a pre-stapled state, the brackets 6220 located in the first jaw 7030 may not yet be inserted into the tissue T and / or the retaining matrix located above it. In use, as shown in FIG. 233, the brackets 6220 can be pushed upward in the bracket slots 7033 of the cassette with the brackets using ejectors 7012. In addition, the first stop 7050 can move proximally from the distal end 7048 of the frame 7041 to the proximal end 7049 to engage the legs 6221 of the brackets 6220. In at least one embodiment, the brackets 6220 can be pushed upward until the first stop 7050 engages with their legs 6221. In various embodiments, all brackets 6220 can be stacked in the upward direction of the slide 7010 before the first p 7050 will be moved before contact with the legs of the brackets 6221, or, in an alternative embodiment, the slide 7010 can move proximally simultaneously with the proximal movement of the first stop 7050, although the slide 7010 can be well ahead of the first stop 7050 to push the brackets 6220 until they come in contact with first emphasis 7050. As shown in FIG. 233, in various embodiments, cam grooves 7070 may be formed and positioned so that forming surfaces, such as, for example, forming, or cam, surfaces 7053 and 7054 of first stop 7050 can contact at least a portion of the legs of brackets 6221 when first stop 7050 through the stop position, or the upper position. In various circumstances, each of the support rollers 7055 of the first stop 7050 can be placed in the locking part 7071 of the cam grooves 7070 so that the forming surfaces 7053 and 7054 are in the raised position and when the stop 7050 is in the stop position, only the legs of the brackets 6221 are partially formed. As shown in FIG. 234, upon further movement of the first stop 7050 along the cam grooves 7070, the support rollers 7055 of the first stop 7050 can be guided into the guides or lower parts 7072 of the cam grooves 7070 so that the forming surfaces 7053 and 7054 move vertically downward to the legs of the staples 6021 to bring legs of brackets 6021 in their finally formed configurations. Then, with further movement of the first stop 7050 along the cam grooves 7070, the first stop 7050 can be fed vertically upward into another set of locking parts 7071 of the cam grooves 7070. As shown in FIG. 233 and 234, the reader may notice that the first stop 7050 can engage only with part of the legs of the brackets, without engaging the remaining legs of the brackets. In at least one such embodiment, the first stop 7050 can be configured to deform only a group of staple legs, for example, containing distal legs 6221 staples 6220. In at least one such embodiment, the first stop 7050 can be made to deform distal legs staples 6221 toward the center of staples 6220. In various embodiments, a first abutment 7050 can contact each proximal leg of the staple 6221 twice, that is, the first forming surface 7053 and the second forming surface 7054, which is aligned with the first forming surface 7053. In at least one such embodiment, the first forming surfaces 7053 can deform the distal legs of the brackets 6221 into a partially deformed configuration when the first stop 7050 is in the stop position, or the upper position, and the second forming surfaces 7054 can deform the distal legs of the brackets 6221 into a fully deformed configuration when the first stop 7050 moves to an excited, or lower, position. As shown in FIG. 228 and 229, in various embodiments, the first stop 7050 may comprise a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 for deforming the distal legs 6221 of the brackets 6220 when the legs of the brackets 6221 are arranged in more than one row or line. In various embodiments, as described in more detail below, deformation of the proximal legs 6221 of the brackets 6020 may be performed, for example, by a second stop 7060.

In addition to the above, in various embodiments, the first stop 7050 can move from the distal end 7048 of the frame 7041 to the proximal end 7049 to deform all the distal legs 6221 of the bracket 6220. As the reader may note, the first stop 7050 can move up and down relative to undeformed proximal legs of brackets 6221, and for the possibility of such relative movement in various embodiments, the first stop 7050 may contain one or more transmissive grooves 7057 (FIG. 230), which can be performed with the possibility of receiving the non-curved proximal legs of the brackets 6221 when the first stop 7050 bends the distal legs of the bracket 6221. In the same way, as also shown in FIG. 228, the second stop 7060 may include a transmission groove 7067, which may be configured to vertically move the drive of the first stop 7051, which moves up and down when the first stop 7050 moves between the stop positions and the drive positions, as described above. After all the distal legs are folded, the brackets 6221 in at least one embodiment, the second stop 7060 can be moved from the proximal end 7049 of the frame 7041 to the distal end 7048 by means of the stop 7061. As shown above, as shown in FIG. 235, the support rollers 7065 of the second stop 7060 can slide in the cam grooves 7070 so that the second stop 7060 moves between the stop positions, or the upper positions, and the drive positions, or the lower positions, to deform the proximal legs of the brackets 6221, for example, inward to the centers brackets 6220. Similar to the above, the second emphasis 7060 may contain many of the first forming, or cam, surfaces 7063 and many of the second forming, or cam, surfaces 7064, each of which can be made with possible the ability to at least partially deform and / or completely deform one or more proximal legs of the bracket 6021. As also shown in FIG. 229, the second stop 7060 may comprise a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064, which may be able to deform the proximal legs 6221 of the brackets 6220 arranged, for example, in the form of a plurality of rows or lines. As also shown in FIG. 229, the first forming surfaces 7063 and the second forming surfaces 7064 of the second stop 7060 may not be aligned with the first forming surfaces 7053 and the second forming surfaces 7054 of the first stop 7050, so that as a result, the proximal legs 6221 of the brackets 6220 may be arranged in other rows or lines, compared to the distal legs 6221 of the brackets 6220. As the reader may also note, the second stop 7060 can push the first stop 7050 while moving the second stop 7060 distally. In at least one such embodiment, the second abutment 7060 may push the first abutment 7050 back to the distal end 7048 of the frame 7041 so that the first abutment 7050 can be returned to its original position before stapling. After deformation of all proximal legs 6221, brackets 6220, the second stop 7060 can be extended proximally and returned to its original position before the braces were applied. Thus, the surgical stapling instrument 7000 can be returned to its initial position, so that a new cassette with brackets can be located in the first jaw 7030, and a new holding matrix can be located in the second jaw 7040 for reusing the surgical stapler 7000.

In various embodiments, as described above, a surgical stapling instrument may comprise two or more stops that can be moved longitudinally to engage multiple staples in the transverse direction with the legs. In some embodiments, the surgical stapling instrument may include an abutment that moves, for example, proximal to deform the first group of staple legs and, for example, distally to deform the second group of staple legs. In at least one such embodiment, such an abutment may comprise, for example, proximal facing forming surfaces and distally facing forming surfaces.

As shown in FIG. 236, in various embodiments, an abutment, such as, for example, an abutment 7140, may include a lower or fabric contacting surface 7141 and a plurality of forming recesses 7142 formed therein. At least in one embodiment, the abutment 7140 may comprise more than one plate such as, for example, a plate with recesses 7143 that can be welded to the frame 7144. In at least one such embodiment, each plate with recesses 7143 can be placed in the channel for the plate 7145 in the frame 7144 and welded to the frame 7144 h a cut through the frame 7144 of the weld groove 7146 to obtain a longitudinal weld 7147. In various circumstances, the longitudinal weld 7147 may be a continuous weld extending along the entire length of the weld groove 7146, or, for example, a series of spaced apart welds distributed throughout its length. In various embodiments, each recessed plate 7143 may comprise two or more parts of the plate welded together. In at least one such embodiment, each plate with recesses 7143 may include a first part of the plate 7143a and a second part of the plate 7143b, which can be welded together along the seam 7148. In various embodiments, the first part of the plate 7143a and the second part of the plate 7143b of each plate 7143 can be welded to each other before welding the plates 7143 to the channels for the plates 7145 in the frame 7144. In at least one such embodiment, the first part of the plate 7143a and the second part of the plate 7143b may have mating profiles such as shown in FIG. 236 zigzag profiles that can fit together to form a tight seam 7148. In at least one embodiment, each plate 7143 may have a height of, for example, approximately 0.51 mm (0.02 ”), which may exceed the depth of the channels for the plates 7145, so that their surfaces 7141 in contact with the fabric extend from the frame 7044 of the stop 7040. As shown in FIG. 237, in a number of embodiments, plates 7143 can be joined together, for example, using at least one weld 7149 at the distal ends of plates 7143.

As shown in FIG. 236 and 237, each plate with recesses 7143 may comprise a plurality of forming recesses 7142 formed therein. In various embodiments, forming recesses 7142 can be made in plates 7143 using any suitable manufacturing process, such as, for example, grinding and / or electrode burning . As shown in FIG. 238 and 239, in at least one such embodiment, each forming recess 7142 can be made, for example, by first forming a deep hole 7150, then forming an arched or curved surface 7151 around a deep hole 7150, and then forming a guide groove for the legs of the bracket 7152 in a curved surface 7151. In other various embodiments, the implementation of these stages can be performed in any applicable order. As shown in FIG. 240, in various embodiments, recesses for forming the brackets 7142 can be formed in such a way that the inner edges 7153 of the forming recesses are separated by a constant or at least substantially constant space 7154. In at least one such embodiment, the space 7154 can be, for example, approximately 0.20 mm (0.008 ”). In addition, in at least one such embodiment, the forming recesses 7142 may be arranged in two or more rows, or lines, the center lines of which may be separated by a constant or at least substantially constant interval 7155. In at least one such embodiment the implementation interval 7155 between the center lines can be, for example, approximately 0.89 mm (0.035 ”). As also shown in FIG. 240, in various embodiments, each forming recess 7142 can smoothly taper from a smaller width 7156 to a larger width 7157. In at least one such embodiment, a smaller width 7156 can be, for example, approximately 1.14 mm (0.045 ”) and a larger a width of 7157 may be approximately 1.91 mm (0.075 ”). In various embodiments, plates 7143 may be made of the same material as frame 7144. In at least one such embodiment, both plates 7143 and frame 7144 may be made of stainless steel, such as, for example, 300 grade stainless steel or 400, and / or, for example, from titanium. In various other embodiments, the plates 7143 and the frame 7144 may be made of different materials. In at least one such embodiment, plates 7143 may be made, for example, of ceramic material, and frame 7144 may be made, for example, of stainless steel and / or titanium. In various circumstances, depending on the materials used, for fixing the plates 7143 in the frame 7144, for example, at least one soldering process can be used in addition to or instead of the welding processes described above.

As shown in FIG. 241-243, in various embodiments, the abutment 7240 may comprise a frame 7244 and a plurality of plates with recesses 7243 that can be inserted into the frame 7244. Similarly to the above, each plate with recesses 7243 may comprise a plurality of forming recesses 7242 formed therein. At least in one embodiment, the stop frame 7244 may comprise retaining grooves 7246 formed therein, each of which may be configured to receive a retaining rail 7247 protruding from a plate with recesses 7243. and plates with recesses 7243 to the frame 7244 abutment 7245 abutment sidewalls 7244 of the frame may be bent or moved apart, as shown in FIG. 242, to increase the width of the retaining grooves 7246 so that each retaining groove 7246 can receive the retaining rail 7247 of the plate with recesses 7243. After placing the retaining rails 7247 in the retaining grooves 7246, the side walls 7245 can be released, as shown in FIG. 243, thereby allowing the frame 7244 to elastically contract and / or return to its expanded state. In such circumstances, the retaining grooves 7246 may be compressed and thereby gripping the retaining rails 7247. In a number of embodiments, the retaining rails 7247 and / or the retaining grooves 7246 may contain one or more mating conical surfaces that, after releasing the curved retaining grooves 7246, may form a conical lock, which can fix the holding rails 7247 in the holding grooves 7246. Similar to the above, the plates with recesses 7243 can be made of the same material la as the frame 7244, or from another material. In at least one such embodiment, plates 7243 may be made, for example, of ceramic material, and frame 7244 may be made, for example, of stainless steel and / or titanium. In various circumstances, depending on the materials used, for fixing the plates 7243 in the frame 7244, for example, at least one soldering process and / or at least one welding process can be used.

The devices described in this application may be configured to be disposed of after a single use, or may be configured to be used multiple times. However, in each case, after at least one use, the device can be reused after recovery. Recovery may include any combination of the steps of disassembling the device, then cleaning or replacing individual items and then reassembling. In particular, it is possible to disassemble the device and selectively replace or remove in any combination any number of individual elements or parts of the device. After cleaning and / or replacing individual parts, the device can be reassembled in repair centers or in the operating unit immediately before surgery for subsequent use. Those skilled in the art will appreciate that various methods of disassembling, cleaning / replacing, and reassembling can be used in rebuilding a device. The use of such methods, as well as the resulting reconditioned device, are within the scope of the present invention.

Preferably, the present invention described in this application undergoes processing before use in a surgical operation. First, a new or used tool is obtained and, if necessary, cleaned. Then the instrument can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, such as a plastic bag or a Tyvek bag (TYVEK). The container and instrument are then placed in a field of exposure to radiation that can penetrate into the container, such as gamma radiation, X-rays or high energy electrons. Radiation kills bacteria on the surface of the instrument and in the container. The sterilized instrument can then be stored in a sterile container. A sealed container keeps the instrument in a sterile condition until it is opened in a medical facility.

Any patent, publication, or other information that is fully or partially incorporated herein by reference is an integral part of this document to the extent that it does not contradict the definitions, provisions or other information presented in this document. In this regard, the description provided in this document, to the extent necessary, prevails over any information contrary to the provisions of this document, which was incorporated into this document by reference. Any material or part thereof that is incorporated herein by reference and which contradicts the definitions, provisions or other information presented herein is included in this document to the extent that there is no conflict between the material incorporated by reference and this document .

Although examples of industrial designs are presented in the description of the present invention, the present invention can be further modified within the spirit and scope of the present description. Thus, it is intended that the present application cover all possible variations, methods of use, or modifications of the present invention using its basic principles. Moreover, it is intended that the present application cover such deviations from the present description as are included in known or accepted practice in the field to which the present invention relates.

Claims (7)

1. A cassette with brackets containing:
many brackets, each of which has a bracket base and two vertical legs of the bracket protruding from it;
a compressible cassette case consisting of a compressible hemostatic material, wherein said staple bases and staple legs are located inside said compressible hemostatic material of said cassette body; and
a support tray connected with the possibility of detachment to the specified housing of the compressible cartridge. 2. A cassette with brackets according to claim 1, wherein said support tray comprises a plurality of grooves, and wherein said brackets are at least partially located within said grooves. 3. A cassette with brackets according to claim 1, wherein said plurality of brackets are located in the first row of brackets and the second row of brackets, and wherein said support pallet comprises a wall at least partially extending between said first row of brackets and said second row of brackets. 4. A cassette with brackets according to claim 3, wherein said brackets are installed inside said compressible cassette body, and wherein said compressible cassette body comprises a channel, and said wall of the support pallet is located inside said channel. 5. A cassette with brackets according to claim 1, wherein said compressible cassette body comprises a fabric contacting surface, said fabric contacting surface having a first color, and said support tray having a second color that differs from said first color. 6. A cassette with brackets according to claim 1, wherein said support tray comprises a moving surface configured to contact a trigger mechanism of a surgical stapling instrument. 7. A cassette with fasteners, comprising:
many fasteners;
a compressible cartridge case consisting of a compressible styptic material, said fastening elements being located inside said compressible styptic material of said cartridge case; and
a support tray that is releasably coupled to said compressible cartridge case.

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