RU2587940C2 - Crumpled staple unit for stapling apparatus - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: group of inventions relates to medical devices, namely surgical devices, and more particularly to the surgical instruments for dissection and suturing with staples and staple blocks. Staple block includes a collapsable housing of the staple block and the set of staples inserted in the collapsable housing of the staple block. Collapsable housing of the staple block comprises a top, a bottom opposite to the top, the first side and the second side. First side extends between the top and the bottom. Second side extends between the top and the bottom, the staple block additionally includes a flexible support. Collapsable housing of the staple block is detachable from the flexible support. Flexible support includes a lower support side, the first bearing side, the second support side, and upper surface. Lower support surface extends around the bottom of the collapsable housing of the staple block. First bearing side extends around the first side of the collapsable housing of the staple block. Second bearing side extends around the second side of the collapsable housing of the staple block. Top surface extends between the first support side and the second bearing side, the upper surface may be configured to be separated from the first support side and the second support part. Flexible support comprises retainers designed to retain the bottom bearing side, the first support side and the second bearing side in the groove of the staple block of the suturing apparatus after separation of the collapsable housing of the staple block from the flexible support. In the second version, the staple block additionally includes an adhesive gluing at least one first bearing side, the second support side and the bottom bearing side to the collapsable housing of the staple block.

EFFECT: inventions provide optimum actuation force.

17 cl, 243 dwg

Description

BACKGROUND OF THE INVENTION

TECHNICAL AREA

The present invention relates to surgical devices, in various embodiments, to surgical devices for dissecting and suturing with brackets and corresponding blocks of brackets for cutting and stitching tissues using brackets.

BACKGROUND OF THE INVENTION

Often, endoscopic surgical devices are preferred over traditional devices for performing open operations, since a smaller incision usually reduces the recovery period after surgery and the risk of complications. In this regard, a significant amount of development was carried out in the field of endoscopic surgical devices suitable for the precise placement of the distal end clamp in the surgical field through the cannula of the trocar. These distal end clamps capture tissue in various ways to achieve a diagnostic or therapeutic effect (for example, an endocutter dissecting and bracketing apparatus, clamp, cutter, staplers, clip-on device, access device, drug delivery / gene therapy device, and devices energy delivery using ultrasound, RF, laser, etc.).

When carrying out endoscopic surgical interventions in many cases, it is desirable to use end clamps, the size of which does not exceed the size necessary for a certain surgical procedure. Smaller end clamps provide a higher degree of visualization in the surgical field. Smaller end clamps also provide easier access to and handling of narrow spaces. Designers of such clamps face numerous problems trying to develop small end clamps. The possibilities for producing small end clamps and, in particular, endoscopic cutting devices for dissecting and stitching tissue using brackets are limited by the amount of force for actuation, which is usually necessary for forming rows of brackets and dissecting tissues. The magnitude of such efforts for actuation may also vary depending on the thickness and composition of the tissue being exposed. For example, for dissection and stapling by stapling larger tissue thicknesses, more force is usually required to actuate. Whereas when cutting and stapling brackets of smaller thicknesses, less force is usually required to activate. Thus, many existing endoscopic cutting devices usually use strong clamping systems with a stop element and a bracket drive system designed for a certain range of tissue thicknesses. Such devices, however, are often not suitable for working with thin fabrics.

Previous devices such as endoscopic cutting devices also usually dissect tissue, and brackets are pushed out and fasten tissue on each side of the incision. Such devices are very effective for procedures that require cutting and stitching the tissue, but they do not provide the surgeon with the possibility of suturing without cutting the tissue. Similarly, although various types of flexible endoscopic cutting devices have been developed to improve access, such devices typically require massive enough components to fit structures capable of generating and transmitting significant forces to the end clamp from the handle of the actuating and compressing device. Thus, the size of such end clamps is often too large for efficient access to the narrow spaces of the body.

Accordingly, surgical devices are needed for dissection and stapling with brackets, as well as constructions containing blocks of brackets that will help solve many of the problems described above.

The explanations above are provided solely to reveal 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 bracket block may include a collapsible bracket block body and a plurality of brackets placed in a crushable bracket block body.

In at least one form, the implantable brace unit may include a crushable bracket block body and a plurality of brackets nested in the crushable bracket block housing.

In at least one form, the implantable bracket unit may include a bracket unit housing having a thickness, means for reducing the thickness of the bracket unit housing, and

a set of brackets placed inside the body of the bracket block.

BRIEF DESCRIPTION OF THE DRAWINGS

These 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 drawings, in particular:

FIG. 1 is a sectional view of an embodiment of a surgical apparatus of the present invention;

FIG. 1A is a perspective view of one embodiment of an implantable bracket unit of the present invention;

FIG. 1B-1E are an image of end clamp parts in various embodiments of the present invention clamping and stitching tissue using an embodiment of an implantable bracket unit of the present invention;

FIG. 2 is a cross-sectional exploded view of an embodiment of an end clamp and a fragment of an embodiment of a surgical stapler of the present invention;

FIG. 3 is a vertical projection of an embodiment of a thrust member of the present invention.

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

FIG. 5 is a partial cross-sectional view of the handle assembly of FIG. 1 along line 5-5 of FIG. one;

FIG. 6 is a perspective view of part of an embodiment of a transmission mechanism of the present invention;

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

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

FIG. 9 is a sectional view of an embodiment of the surgical apparatus of the present invention after connecting the end clamp to the central longitudinal portion of the surgical apparatus, but before being fixed thereto.

FIG. 9A is an enlarged view of the end clamp and part of the surgical apparatus of FIG. 10;

FIG. 10 is a sectional view of the surgical apparatus shown in FIG. 9, after fixing the end clamp on the axial part of the surgical apparatus;

FIG. 10A is an enlarged view of the end clamp and part of the surgical apparatus shown in FIG. 10;

FIG. 11 is a cross-sectional view of the surgical apparatus shown in FIG. 9 and 10, after the first starting adapter is extended to the beginning of the pressing beveled planks of the thrust element;

FIG. 11A is an enlarged view of the end clamp and part of the surgical apparatus shown in FIG. 11 with a fabric nested between the thrust member and the corresponding block of brackets;

FIG. 12 is a sectional view of the surgical apparatus shown in FIG. 9-11, after the first starting adapter is extended over the clamping tapered parts of the thrust member;

FIG. 12A is an enlarged view of the end clamp and part of the surgical apparatus shown in FIG. 12.

FIG. 13 is a sectional view of the surgical apparatus shown in FIG. 9-12, after the first start adapter is extended above the inclined bracket forming bracket for the complete formation of the brackets in the implantable bracket unit.

FIG. 13A is an enlarged view of the end clamp and part of the surgical apparatus shown in FIG. 13;

FIG. 14 is a sectional view of the surgical apparatus shown in FIG. 9-13, after the first start adapter is extended over the inclined bar to form the brackets in order to completely form the brackets in the implantable brace block, and after the scalpel is extended in the longitudinal direction through the end clamp;

FIG. 14A is an enlarged view of the end clamp and part of the surgical apparatus shown in FIG. fourteen;

FIG. 15 is an exploded view of another embodiment of an end clamp of the present invention with a portion of an axial member in an embodiment of a surgical apparatus of the present invention shown in cross section;

FIG. 16 is a partial sectional view of an embodiment of an end clamp of the present invention shown in FIG. 15 in an open position attached to a surgical apparatus according to one embodiment;

FIG. 17 is another partial cross-sectional view of an embodiment of the end clamp of FIG. 15 and 16 in a fully closed position;

FIG. 18 is another partial cross-sectional view of an embodiment of the end clamp of FIG. 15-17 in the fully operational position and before extending the distal cutting element;

FIG. 19 is another partial cross-sectional view of an embodiment of the end clamp of FIG. 15-18, in the fully operational position and after the full extension of the distal cutting element;

FIG. 20 is a sectional view of a part according to another embodiment of a handle assembly of the present invention;

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

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

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

FIG. 24 is a sectional view of a part according to another embodiment of a handle assembly of the present invention;

FIG. 25 is a partial cross-sectional side view of another embodiment of an end clamp of the present invention connected to a part of a surgical apparatus according to an embodiment of the present invention, with an end clamp supporting a block of surgical brackets in accordance with an embodiment of the present invention and with a corresponding stop member in the open position;

FIG. 26 is another partial cross-sectional side view of the end clamp of FIG. 25 in the closed position;

FIG. 27 is another partial cross-sectional side view of the end clamp of FIG. 25 and 26, when the cutting element begins to extend through the end clip;

FIG. 28 is another partial cross-sectional side view of the end clamp of FIG. 25-27, with a cutting element partially extended through it;

FIG. 29 is a partial side sectional view of another embodiment of an end clamp of the present invention connected to a portion of a surgical apparatus according to an embodiment of the present invention with an end clamp supporting a surgical brace unit in accordance with an embodiment of the present invention and with a corresponding stop member open position;

FIG. 30 is another partial cross-sectional side view of the end clamp of FIG. 29, with a cutting element partially extended through it;

FIG. 31 is a sectional view according to another embodiment of a surgical apparatus of the present invention with a thrust member of a corresponding end clip in an open position;

FIG. 32 is an exploded view of an embodiment of an end clamp and part of an embodiment of a surgical stapler shown in FIG. 31, in a section;

FIG. 33 is a top view of the end clamp and part of the elongated trunk of the surgical apparatus assembly of FIG. 31, with its parts shown in section along the line 33-33 of FIG. 31;

FIG. 34 is a top view of the end clamp and part of the elongated trunk of the surgical apparatus assembly of FIG. 31, with its parts shown in cross section;

FIG. 35 is another top view of the end clamp and part of the elongated trunk of the surgical apparatus assembly of FIG. 31, with the end clamp in a rotational orientation, and with the end clamp in the open position;

FIG. 36 is another top view of the end clip shown in FIG. 35, with the end clamp in the closed or closed position;

FIG. 37 is an enlarged view of a portion of the end clamp and the embodiment of the surgical apparatus shown in FIG. 36;

FIG. 38 is a sectional view of the handle assembly of the surgical apparatus of FIG. 31;

FIG. 39 is another partial cross-sectional view of a portion of the handle assembly of FIG. 38 along line 39-39 of FIG. 38;

FIG. 40 is a partial exploded perspective view of a design of a universal ball joint in various embodiments of the present invention;

FIG. 41 is a plan view of an end clip and a portion of an elongated trunk assembly according to another embodiment of a surgical apparatus of the present invention in a direct orientation;

FIG. 42 is another top view of the end clamp and the elongated barrel assembly assembly shown in FIG. 41, in a curved position;

FIG. 43 is a sectional view according to another embodiment of a surgical apparatus of the present invention;

FIG. 44 is a partial sectional view of a portion of an articulated barrel assembly in accordance with an embodiment of the surgical apparatus shown in FIG. 43;

FIG. 44A is a cross-sectional view of a portion of an articulated barrel assembly in accordance with an embodiment of the surgical apparatus of FIG. 44;

FIG. 44B is another cross-sectional view of another part of the articulated barrel assembly of FIG. 44;

FIG. 44C is another sectional view of another part of the articulated barrel assembly of FIG. 44;

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

FIG. 44E is another sectional view of another part of the articulated barrel assembly of FIG. 44;

FIG. 44F is another cross-sectional view of another part of the articulated barrel assembly shown in FIG. 44;

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

FIG. 46 is a partial cross-sectional view of a portion of the articulated barrel assembly of FIG. 44 along line 46-46 of FIG. 44;

FIG. 47 is another sectional view of the surgical apparatus shown in FIG. 43, with its end clip shown in a fully bent position;

FIG. 48 is a sectional view of the end clamp of FIG. 47 with a corrugated casing covering the hinge;

FIG. 49 is a sectional view of the handle assembly according to another embodiment of the surgical apparatus of the present invention;

FIG. 50 is an exploded cross-sectional view of an end clip and a distal end of an elongated barrel assembly shown in FIG. 49;

FIG. 51 is another sectional view of the end clamp and the elongated barrel assembly assembly shown in FIG. 50, with the end clamp in the open position;

FIG. 52 is another sectional view of the end clamp and the portion of the elongated barrel assembly with the end clamp in the closed position;

FIG. 53 is another cross-sectional view of an end clip and a portion of an elongated trunk shown in FIG. 49-52 with the cutting element in the fully operational position;

FIG. 54 is a perspective view of the end clip of FIG. 51-53, and in the open position;

FIG. 55 is a sectional view of the end clamp of FIG. 51-54, along line 55-55 of FIG. 51.

FIG. 56 is a partial perspective view of an elongated barrel assembly according to another embodiment of the present invention attached to an end clip according to an embodiment of the present invention;

FIG. 57 is a partial sectional view of the handle assembly according to another embodiment of the surgical apparatus of the present invention;

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

FIG. 59 is an enlarged view of a part of the handle assembly shown in FIG. 57;

60 is a cross-sectional view of a portion of the distal end of an elongated stem assembly shown in FIG. 56-59;

FIG. 61 is a partial perspective view of an elongated barrel assembly according to another embodiment of the present invention attached to an end clip according to an embodiment of the present invention;

FIG. 62 is a sectional view of a portion of a reconfigurable segment of an elongated trunk shown in FIG. 61;

FIG. 63 is a partial perspective view of an elongated barrel assembly according to another embodiment of the present invention attached to an end clip according to an embodiment of the present invention;

FIG. 64 is a sectional view of the handle assembly according to another embodiment of the surgical apparatus of the present invention;

FIG. 65 is a sectional view of a portion of the oblong stem assembly shown in FIG. 63 and 64, along line 65-65 of FIG. 64;

FIG. 66 is an enlarged view of a part of the handle assembly shown in FIG. 64;

FIG. 67 is a sectional view of a portion of a reconfigurable segment shown in FIG. 63, with portions of respective tubular units aligned substantially in a straight line;

FIG. 68 is a sectional view of a portion of a reconfigurable barrel segment shown in FIG. 63 and 67, with portions of respective tubular links arranged substantially in a curved (non-coaxial) orientation;

FIG. 69 is a perspective view of an alternative embodiment of a bracket block of the present invention mounted in a surgical cutting-stapler according to an embodiment of the present invention;

FIG. 70 is a plan view of a surgical brace block and an elongated groove of the device of FIG. 69;

FIG. 71 is a top view according to another embodiment of a surgical brace unit of the present invention mounted in an elongated end channel groove according to an embodiment of the present invention;

FIG. 72 is a bottom view of an embodiment of a thrust member of the present invention;

FIG. 73 is a partial perspective view of a plurality of brackets forming part of a line of brackets according to an embodiment of the present invention;

FIG. 74 is another partial perspective view of an embodiment of a line of brackets shown in FIG. 73, wherein the brackets are formed after contact with the thrust element of the surgical cutting-stapler;

FIG. 75 is a partial perspective view of alternative brackets forming part of another line of brackets according to an embodiment of the present invention;

FIG. 76 is a partial perspective view of alternative brackets forming part of a line of brackets according to an embodiment of the present invention;

FIG. 77 is a perspective view of alternative brackets forming part of a line of brackets according to an embodiment of the present invention;

FIG. 78 is a sectional view of an embodiment of end clips of the present invention holding a bracket unit according to an embodiment of the present invention;

FIG. 79 is a sectional view of a portion of an elongated end channel groove depicted in FIG. 78, after removing from it part of the body of the implantable block of brackets and brackets;

FIG. 80 is a sectional view of an embodiment of end clips of the present invention holding a bracket unit according to another embodiment of the present invention;

FIG. 81 is a partial cross-sectional view of an embodiment of the surgical stapler of the present invention with a block of brackets held in an end clip to move the blocking system of the block to an unlocked position;

FIG. 82 is another partial cross-sectional view of the surgical stapler shown in FIG. 81, with the block of brackets removed from the end clamp, with the blocking system of the block in the locked position;

FIG. 83A-83D is a deformation diagram of a surgical brace placed inside a crushable case of the brace block in accordance with at least one embodiment;

FIG. 84A is a diagram illustrating a position of a bracket in a crushable case of a bracket unit;

FIG. 84B is a diagram illustrating a collapsible bracket block body shown in FIG. 84A squeezed by a thrust member;

FIG. 84C is a diagram illustrating a collapsible bracket block body shown in FIG. 84A, further compressed by a thrust member;

FIG. 84D is a diagram illustrating a bracket shown in FIG. 84A, in a fully enclosed configuration, and a collapsible bracket unit shown in FIG. 84A, in a fully compressed state;

FIG. 85 is a diagram depicting a bracket located at the same level as the bearing surface of a block of brackets, and illustrating a possible relative movement between them;

FIG. 86 is a cross-sectional view of a support surface of a block of brackets including a groove or recess for securing the base of the bracket shown in FIG. 85;

FIG. 87 is a sectional view of a bracket consisting of a molded ridge, groove, or groove configured to insert part of the ridge, in accordance with at least one alternative embodiment;

FIG. 88 is a top view of a bracket block in accordance with at least one embodiment, comprising brackets nested in a crushable housing of the bracket block;

FIG. 89 is a vertical sectional view of a block of brackets shown in FIG. 88;

FIG. 90 is a vertical sectional view of a bracket block in accordance with at least one embodiment including a protective layer around the brackets inside the crumple block body of the bracket;

FIG. 91 is a sectional view of a block of brackets shown in FIG. 90, along line 91-91 of FIG. 90;

FIG. 92 is a vertical sectional view of a bracket block in accordance with at least one embodiment comprising brackets at least partially protruding outwardly from a crumpled bracket block body, and a protective layer around the bracket block body;

FIG. 93 is a sectional view of a block of brackets shown in FIG. 92, along line 93-93 of FIG. 92;

FIG. 94 is a partial partial view of a bracket block in accordance with at least one embodiment, comprising brackets at least partially enclosed in a crushable bracket block body, brackets at least partially located in a bracket recess cavity in a bracket block housing;

FIG. 95 is a sectional view of a block of brackets shown in FIG. 94 along line 95-95 of FIG. 94;

FIG. 96 is a partial partial view of a block of brackets in accordance with at least one embodiment;

FIG. 97 is a partial partial view of a block of brackets, in accordance with at least one embodiment, comprising brackets at least partially enclosed in a crushable bracket block body, and an alignment matrix connecting brackets and alignment brackets with respect to each other;

FIG. 98 is a sectional view of a block of brackets shown in FIG. 97, along line 98-98 of FIG. 97;

FIG. 99 is a partial partial view of the inner layer of a crushable case of the bracket unit;

FIG. 100 is a diagram illustrating an inner layer depicted in FIG. 99, compressed between the transfer plate and the support plate;

FIG. 101 is a diagram illustrating brackets nested in a compressed inner layer depicted in FIG. one hundred;

FIG. 102 is a diagram of a support plate shown in FIG. 100 removed from the inner layer;

FIG. 103 is a diagram of an assembly including an inner layer depicted in FIG. 99, and the brackets shown in FIG. 101 nested in the outer layer;

FIG. 104 is a diagram illustrating an outer layer depicted in FIG. 103, sealed to obtain a tight block of brackets;

FIG. 105 is a sectional view of the sealed unit of brackets shown in FIG. 104;

FIG. 106 is a cross-sectional view of a bracket block and a trough of a bracket block, in accordance with at least one embodiment;

FIG. 107 is a diagram illustrating a portion of a bracket block shown in FIG. 106 in a deformed state;

FIG. 108 is a vertical sectional view of an end clamp of a surgical stapler including a stop member in an open position and a bracket block inside a gutter of a bracket block;

FIG. 109 is a vertical sectional view of an end clip shown in FIG. 108, with the stop element in the closed position and the bracket block compressed between the stop element and the groove of the bracket block;

FIG. 110 is a vertical sectional view of an end clip shown in FIG. 108, with the bracket block shown in FIG. 108 located inside the gutter of the bracket block in an alternative manner;

FIG. 111 is a cross-sectional view of an end clamp of a surgical stapler including a crease block of brackets inside a groove of a bracket block and a portion of a support material attached to a stop member;

FIG. 112 is a cross-sectional view of an end clip shown in FIG. 111, with a stop element in the closed position;

FIG. 113 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a bracket block with a waterproof layer;

FIG. 114 is a cross-sectional view of another alternative embodiment of an end clamp of a surgical stapler;

FIG. 115 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a stepped stop member and a bracket block including a stepped block body;

FIG. 116 is a cross-sectional view of another alternative embodiment of an end clamp of a surgical stapler;

FIG. 117 is a sectional view of an alternative embodiment of an end clamp of a surgical stapler including beveled surfaces in contact with tissue;

FIG. 118 is a sectional view of another alternative embodiment of an end clamp of a surgical stapler, including beveled surfaces in contact with tissue;

FIG. 119 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a support liner for supporting a block of brackets;

FIG. 120 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a bracket unit with a plurality of crease layers;

FIG. 121 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a bracket unit with a step-down crease body;

FIG. 122 is a cross-sectional view of another alternative embodiment of an end clamp of a surgical stapler including a brace unit comprising a stepped crease block body of the brace unit;

FIG. 123 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a brace unit having a curved surface in contact with tissue;

FIG. 124 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler including a block of brackets with a beveled surface in contact with tissue;

FIG. 125 is a sectional view of a crushable block of brackets including brackets and at least one drug enclosed therein;

FIG. 126 is a diagram showing a collapsible block of brackets shown in FIG. 125, after compression and deformation of the suture brackets contained therein;

FIG. 127 is a partial sectional view of a block of brackets in accordance with at least one embodiment;

FIG. 128 is a sectional view of a block of brackets shown in FIG. 127;

FIG. 129 is a perspective view of an implantable bracket unit in accordance with at least one alternative embodiment;

FIG. 130 is a sectional view of an implantable block of brackets shown in FIG. 129;

FIG. 131 is a perspective view of an alternative embodiment of a block of brackets, including deformable elements extending from the outer layer of the block of brackets;

FIG. 132 is a perspective view of an alternative embodiment of a bracket block including an outer layer of a bracket block assembly with an inner layer;

FIG. 133 is a sectional view of an alternative embodiment of a block of brackets comprising a plurality of brackets, a crease layer and a layer of gaskets;

FIG. 134 is a perspective view of the gasket layer depicted in FIG. 133;

FIG. 135 is a perspective view of one gasket isolated from the gasket layer shown in FIG. 133, and a bracket aligned with a groove in the gasket;

FIG. 136 is a perspective view of two interconnected gaskets from the gasket layer of FIG. 133;

FIG. 137 is a perspective view of a support frame of the gasket layer depicted in FIG. 133, after removal of individual gaskets;

FIG. 138 is a detailed perspective view of an alternative embodiment of a crushable bracket block containing brackets and a system for pushing brackets relative to the stop member;

FIG. 138A is a partial sectional view of an alternative embodiment of a block of brackets shown in FIG. 138;

FIG. 139 is a sectional view of a block of brackets shown in FIG. 138;

FIG. 140 is a vertical sectional view of a slide made to move the bracket block shown in FIG. 138, and moving the brackets in the direction of the thrust member;

FIG. 141 is a diagram of a bracket pusher that can be lifted in the direction of the thrust member using the slide shown in FIG. 140;

FIG. 142 is a partially opened block of brackets, in accordance with at least one alternative embodiment, comprising brackets located inside the pushers of the brackets;

FIG. 143 is a sectional view of a block of brackets shown in FIG. 142 located in the groove of the bracket block;

FIG. 144 is a sectional view of a block of brackets shown in FIG. 142, showing the stop element moved to the closed position and the brackets contained in the bracket block deformed by the stop element;

FIG. 145 is a sectional view of a block of brackets shown in FIG. 142 showing the brackets moved upward towards the stop member;

FIG. 146 is a perspective view of an alternative embodiment of a block of brackets, including jumpers connecting the flexible sides of the block of brackets;

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

FIG. 148 is a diagram of a slide and a cutting member assembly shown in FIG. 147 used to raise the brackets of the bracket block shown in FIG. 142;

FIG. 149 is a diagram showing a slide made to engage and raise the brackets in the direction of the stop member, and a locking system made to selectively provide distal slide movement;

FIG. 150A-150C show the progress of the bracket inserted in the crest of the bracket;

FIG. 151 is a sectional view of a bracket block including a support tray or emphasis;

FIG. 152 is a partial sectional view of a crease block of brackets in accordance with at least one alternative embodiment;

FIG. 153 is a diagram showing a block of brackets shown in FIG. 152, in the implanted position;

FIG. 154 is a partial sectional view of a crease block of brackets in accordance with at least one alternative embodiment;

FIG. 155 is a partial sectional view of a block of brackets shown in FIG. 154;

FIG. 156 is a diagram showing a block of brackets shown in FIG. 154, in the implanted position;

FIG. 157 is a partial sectional view of a crease block of brackets in accordance with at least one alternative embodiment;

FIG. 158 is a partial cross-sectional view of a crease block of brackets in accordance with at least one embodiment including a plurality of destructible elements;

FIG. 159 is a perspective view of a crease member shown in FIG. 158, in an uncompressed state;

FIG. 160 is a perspective view of a crease member shown in FIG. 159, in a compressed state;

FIG. 161A is a partial cross-sectional view of an end clamp of a surgical stapler including a jaw, a brace block chute located opposite the jaw, and a brace block located inside the brace of the brace block, the jaw including a holding matrix attached thereto;

FIG. 161B is a partial cross-sectional view of the end clamp of FIG. 161A, showing a jaw moved in the direction of the groove of the bracket block, the bracket block compressed by the stop element and the holding matrix, and the bracket at least partially protruding through the fabric located between the holding matrix and the bracket block;

FIG. 161C is a partial cross-sectional view of the end clamp shown in FIG. 161A showing the jaw in the final position and holding the matrix in mesh with the bracket shown in FIG. 161B;

FIG. 161D is a partial cross-sectional view of the end clamp of FIG. 161A showing the jaw and gutter of the bracket block removed from the implanted bracket block and the holding matrix;

FIG. 162 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a plurality of holding elements configured to engage with a leg of a stapling element protruding through it;

FIG. 163 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, comprising a combination of six holding elements;

FIG. 164 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a collection of eight holding elements;

FIG. 165 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, comprising a plurality of holding elements configured to engage a leg of a stapling element protruding through it;

FIG. 166 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a combination of six holding elements;

FIG. 167 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment comprising a combination of eight holding elements;

FIG. 168 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, comprising a plurality of holding elements stamped from sheet metal;

FIG. 169 is a perspective view of a holding hole of a holding matrix in accordance with at least one alternative embodiment, comprising a plurality of holes protruding around the perimeter of the holding hole;

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

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

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

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

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

FIG. 175 is a plan view of a holding hole of a holding matrix including a stopper extending into a holding hole in accordance with at least one embodiment;

FIG. 176 is a plan view of a holding hole of a holding matrix including a stopper extending into a holding hole in accordance with at least one alternative embodiment;

FIG. 177 is a perspective view of a crosslinking system including a plurality of brackets holding the matrix in mesh with brackets and a leveling matrix made to align the brackets;

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

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

FIG. 180 is a partial top view of a holding matrix shown in FIG. 177, in engagement with the brackets depicted in FIG. 177;

FIG. 181 is a partial bottom view of a holding matrix shown in FIG. 177, in engagement with the brackets depicted in FIG. 177;

FIG. 182 is a partial view of the crosslinking system shown in FIG. 177, in vertical section;

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

FIG. 184 is a partial view of a holding matrix shown in FIG. 177, in section, connected to the brackets shown in FIG. 177;

FIG. 185 is a partial sectional view of the surgical stapling system shown in FIG. 177;

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

FIG. 187 is a bottom perspective view of the structure of the crosslinking system shown in FIG. 186;

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

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

FIG. 190 is a vertical sectional view of an end clip in accordance with at least one embodiment, comprising a jaw in an open position, holding a matrix and a plurality of protective caps located in a jaw, and a block of brackets located in the groove of the bracket block;

FIG. 191 is a vertical sectional view of the end clip shown in FIG. 190, in the closed position;

FIG. 192 is a vertical sectional view of an end clip shown in FIG. 190, in working position;

FIG. 193 is a vertical sectional view of a holding matrix and protective caps shown in FIG. 190 mounted on a bracket block shown in FIG. 190;

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

FIG. 195 is a vertical sectional view of the end clamp shown in FIG. 190 showing the jaw in the open position with a thin cloth located between the holding matrix and the bracket unit

FIG. 196 is a vertical sectional view of the end clip shown in FIG. 190 showing the jaw in the closed position on the small thickness fabric shown in FIG. 195;

FIG. 197 is a vertical sectional view of an end clip shown in FIG. 190, showing the jaw in the working position when gripping the small thickness fabric shown in FIG. 195;

FIG. 198 is a vertical sectional view of a holding matrix and protective caps in FIG. 190 mounted on the bracket block shown in FIG. 190, with the small thickness fabric depicted in FIG. 195 located between;

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

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

FIG. 201 is a perspective view of a plurality of protective caps enclosed in a sheet of material;

FIG. 202 is a perspective view of a jaw including a plurality of recesses configured to embed a plurality of protective caps therein;

FIG. 203 is a detailed view of a portion of a jaw including a sheet covering protective caps placed inside a jaw shown in FIG. 202;

FIG. 204 is a cross-sectional view of a protective cap located on the tip of a bracket leg in accordance with at least one alternative embodiment, wherein the protective cap includes an inner forming surface;

FIG. 205 is another cross-sectional view of the protective cap shown in FIG. 204 showing a bracket leg bent relative to a forming surface;

FIG. 206 is a top view of an alternative embodiment of a holding matrix including a plurality of attached matrix elements;

FIG. 207 is a top view of an alternative embodiment of a holding matrix including a plurality of attached matrix elements;

FIG. 208 is a top view of an alternative embodiment of a holding matrix including a plurality of connected matrix elements;

FIG. 209 is a top view of an alternative embodiment of a plurality of holding matrices including a plurality of connected matrix elements;

FIG. 210 is a top view of an alternative embodiment of a holding matrix including a plurality of connected matrix elements;

FIG. 211 is a partial expanded view of a jaw including a holding matrix, including a crease coating;

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

FIG. 213 is a partial cross-sectional view of a crosslinking system comprising a containment matrix, including a crease layer and a plurality of cells in which one or more drugs are encapsulated;

FIG. 214 is a diagram showing the brace legs that puncture the cells depicted in FIG. 213 as they engage with the holding matrix;

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

FIG. 216 is a vertical sectional view of a device for inserting a bracket block including a holder, a first bracket block and a second bracket block;

FIG. 217 is a vertical sectional view of an end clamp of a surgical stapler including a first jaw and a second jaw, the second jaw shown in the open position;

FIG. 218 is a vertical sectional view of the end clip shown in FIG. 217, showing the second jaw in the closed position and the apparatus for inserting the bracket block shown in FIG. 216 used to load the first block into the first jaw and the second block into the second jaw;

FIG. 219 is a vertical sectional view of a charged end clip of FIG. 218 showing a device for inserting a block of brackets removed from an end clamp, a second jaw in an open configuration again, and a tissue placed between the first jaw and the second jaw;

FIG. 220 is a vertical sectional view of a charged end clip of FIG. 219, in a working configuration;

FIG. 221 is a vertical sectional view of a first block of brackets and a second block of brackets in an implanted position;

FIG. 222 is a vertical sectional view of the end clip shown in FIG. 217 showing a fragment of a first block still engaged with a first jaw, in accordance with at least one embodiment;

FIG. 223 is a vertical sectional view of an alternative embodiment of a device for inserting a bracket block including a holder, a first bracket block and a second bracket block;

FIG. 224 is a vertical sectional view of an apparatus for inserting a block of brackets shown in FIG. 223 used to insert the first block into the first jaw of the end clamp and the second block into the second jaw;

FIG. 225 is a cross-sectional view of a charged end clip of FIG. 224;

FIG. 226 is a perspective view of a surgical stapler including a lower jaw and an upper jaw in accordance with at least one embodiment, showing fragments of a removed surgical stapler;

FIG. 227 is a perspective view of the surgical stapler shown in FIG. 226, with the upper jaw removed;

FIG. 228 is a perspective view of a sliding stop system of the upper jaw of a surgical stapler shown in FIG. 226 including a first sliding stop element and a second sliding stop element;

FIG. 229 is an end view of a sliding stop system depicted in FIG. 228;

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

FIG. 231 is a diagram showing a sliding stop system depicted in FIG. 228, inoperative;

FIG. 232 is a diagram showing a first sliding stop element of the sliding stop system shown in FIG. 228, inoperative and brackets located in the lower jaw in an unexpanded position;

FIG. 233 is a diagram showing suture brackets in the lower jaw in the expanded state and the first sliding stop member shown in FIG. 232 extended proximally to bend the first group of brace legs;

FIG. 234 is a diagram showing a first group of brackets shown in FIG. 233 deformed to a completely closed state;

FIG. 235 is a diagram showing a second sliding stop element of the sliding stop system shown in FIG. 228, distally pushed to bend a second group of staple legs;

FIG. 236 is a partial perspective view of a thrust member including a plurality of forming recesses in at least one embodiment;

FIG. 237 is a view of a thrust member shown in FIG. 236, from the end in cross section;

FIG. 238 is a diagram showing a first production step of the forming depressions shown in FIG. 236;

FIG. 239 is a diagram showing a second production step of the forming depressions shown in FIG. 236;

FIG. 240 is a plan view of the structure of the forming recess of the thrust member shown in FIG. 236;

FIG. 241 is a diagram showing a first step of a manufacturing process for manufacturing a stop member;

FIG. 242 is a diagram showing a second step of the manufacturing process shown in FIG. 241; and

FIG. 243 is a diagram showing a third step of the manufacturing process shown in FIG. 241.

Corresponding details in different images are indicated by the corresponding conventional signs. The examples attached to this application are intended solely to illustrate preferred embodiments of the invention, such examples should not be construed as limiting in any way the scope of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

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

US Patent Application Serial No. ____, under the heading “Surgical Stapler with Variable Bracket Molding System,” Dossier of Patent Attorney No. END6848USNP / 100533;

US Patent Application Serial No. ____, under the heading “Surgical Stapler with Interchangeable Cassette Devices,” Patent Attorney No. END6849USNP / 100534;

US Patent Application Serial No. ____, under the heading “Surgical Cutting-Staplers with Separate and Individual Deployment of the Stapling System and Tissue Dissection Systems,” Patent Attorney No. END6839USNP / 100524;

US Patent Application Serial No. ____, under the heading “Surgical Stapler with Compact Bending Control,” Patent Attorney No. END6847USNP / 100532;

US Patent Application Serial No. ____, under the heading “Jaw Closure Device for Surgical Apparatus,” Patent Attorney No. END6736USNP / 100060;

US Patent Application Serial No. ____, under the heading “Surgical apparatus with reconfigurable shaft,” patent dossier No. END6734USNP / 100058;

US Patent Application Serial No. ____, under the heading “Surgical staple blocks supporting non-linear arrangement of staples, and surgical staplers with common recesses forming staples”, Patent Attorney No. END6735USNP / 100059;

US Patent Application Serial No. ____, under the heading “Surgical brace blocks with removable support structures and surgical staplers with systems to prevent tripping in the absence of a brace block”, Dossier Patent No. END6855USNP / 100540;

US Patent Application Serial No. ____, under the heading “Implantable Bracket Block That Has a Heterogeneous Arrangement,” Patent Attorney No. END6840USNP / 100525;

US Patent Application Serial No. ____, under the heading “Implantable Bracket Block Including Support Bracket”, Patent Proxy Dossier No. END6841USNP / 100526;

US Patent Application Serial No. ____, under the heading “Implantable Bracket Unit Including Multiple Layers,” Patent Attorney No. END6842USNP / 100527;

US Patent Application Serial No. ____, under the heading “Selectively Oriented Implantable Bracket Unit,” Patent Attorney No. END6843USNP / 100528;

US Patent Application Serial No. ____, under the heading “Implantable Brace Unit Including Bioabsorbable Layers”, Proxy File No. END6856USNP / 100541;

US Patent Application Serial No. ____, under the heading “Pull-out Bracket,” Patent Attorney No. END6857USNP / 100542;

US Patent Application Serial No. ____, under the heading “Staples Supported by the Bracket Lock”, Proxy File No. END6858USNP / 100543;

US Patent Application Serial No. ____, under the heading “Stitching system including a plurality of connected elements of a retaining matrix”, Patent Attorney No. END6860USNP / 100546;

US Patent Application Serial No. ____, under the heading “Crosslinking System Including Retention Matrix and Alignment Matrix”, Patent File No. END6861USNP / 100547;

US Patent Application Serial No. ____, under the heading “Stitching System Including a Retention Matrix,” Patent Attorney No. END6862USNP / 100548;

US Patent Application Serial No. ____, under the heading “Stapler for actuating a stapling system including a retaining matrix”, Patent File No. END6863USNP / 100549;

US Patent Application Serial No. ____, under the heading “Crosslinking System Including a Retention Matrix and Coating,” Patent Attorney No. END6864USNP / 100550; and

US Patent Application Serial No. ____, under the heading “Stitching system including a plurality of bracket blocks”, Patent Proxy No. END6865USNP / 100551.

For a more complete understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual examples of embodiments. One or more examples of such embodiments are presented in the accompanying drawings. Those skilled in the art will understand that the devices and methods described in detail herein and shown in the accompanying drawings are non-limiting examples of embodiments, 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. It is intended that the scope of the present invention covers all modifications and changes.

References in the specification to “various embodiments”, “certain embodiments”, “one embodiment” or “embodiment”, or similar expressions, mean that a particular feature, structure, or characteristic described in connection with the embodiment is included although would be in one embodiment. Thus, the phrases “various embodiments”, “certain embodiments”, “one embodiment” or “embodiment” or similar expressions contained in the specification do not necessarily refer to the same embodiment. Moreover, it is possible to combine certain properties, structures or characteristics in any suitable manner in one or more embodiments. Thus, it is possible to combine certain properties, structures or characteristics, illustrated or described in connection with one embodiment, in whole or in part, with the properties, structures or characteristics of one or more other embodiments without limitation. The scope of the present invention is intended to cover all of these modifications and changes.

The terms "proximal" and "distal" in this document are defined with respect to the physician managing the handle of the surgical device. The term "proximal" refers to the part lying closer to the doctor, and the term "distal" refers to the part removed from the doctor. In addition, it should be understood that for convenience and clarity in the document such spatial terms as “vertical”, “horizontal”, “up” and “down” can be used in relation to the drawings. However, surgical devices are used in different directions and positions, therefore, these terms are not restrictive and / or are not absolute.

To perform laparoscopic and minimally invasive surgical procedures, various, exemplary devices and methods are provided. However, it will be understood by those skilled in the art that the various methods and devices disclosed in this document can be used in various surgical procedures and actions, for example, in connection with open operations. During the presentation of this detailed description, it will also be clear to those skilled in the art that various apparatuses disclosed in this document can be introduced into the body by any means, for example, through a natural opening, through an incision or puncture in a tissue, etc. . The working parts or parts of the end clamp of the devices can be directly inserted into the patient’s body or inserted through an access device having a working channel through which the end clamp or the elongated trunk of the surgical apparatus can be advanced.

Returning to the drawings in this document, the same numbers denote the same components in several images, in FIG. 1 depicts a surgical apparatus 10 that enables the practice of several unique advantages of the present invention. Surgical stapler 10 is designed to control and / or actuate the end clamps 12 of various shapes and sizes that are associated with it in the working position. In the embodiment depicted in FIG. 1 and 2, for example, the end clamp 12 includes an elongated groove 14, which forms the lower jaw 13 of the end clamp 12. The elongated groove 14 is made to support the “implantable” block of brackets 30 and also to support the movable stop element 20, which functions as the upper jaw 15 of the end clamp 12.

In various embodiments, the elongated groove 14 may be made, for example, of 300 and 400 series stainless steel, 17-4 and 17-7, titanium, etc., and formed by side walls spaced apart from each other 16. Resistant element 20 can be made, for example, of stainless steel of the series 300 and 400, 17-4 and 17-7, titanium, etc., and have a lower surface forming brackets, generally marked 22, which includes depressions forming brackets 23 formed therein. See FIG 1B. 1E. In addition, the thrust member 20 comprises a fork-shaped beveled portion 24 protruding proximally. A pin 26 of the thrust member protrudes from each side of the beveled portion 24 to align with a corresponding slot or hole 18 in the side walls 16 of the elongated groove 14 to allow it to be rotatably mounted to them.

In various embodiments of the surgical apparatus disclosed herein, various forms of implantable brace blocks may be used. The following is a description of specific configurations and designs of brace blocks. However, in the embodiment depicted in FIG. 1A and 9-14, an implantable bracket block 30 is shown. In at least one embodiment of the bracket block 30, there is a fragment of the housing 31, which consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or bioabsorbable foam , in which there are rows of unformed metal brackets 32. In at least some embodiments, to protect the brackets from affecting it, and the hemostatic material from activation during the After placement and placement, the block can be completely coated or wrapped in a biodegradable film 38, such as a polydioxanone film sold on the market under the brand name PDS®, or a polyglycerol sebacinate (PGS) film or other biodegradable film consisting of PGC (polyglycolic acid sold under the trademark Vikril), PCL (polycaprolactone), PMA (polylactic acid), PHA (polyhydroxyalkanate), PGKL (polyglecapron 25 sold on the market under the Monocryl brand) or a composite including PHC, PCL, PMK, PDS, which is not onitsaemym rupture. The size of the housing 31 of the block of brackets 30 is selected so as to be fixed inside the elongated groove 14 with the possibility of movement, as shown, each bracket 32 in it coincides with a corresponding recess 23 forming suture brackets in the stop element when the stop element 20 comes into forming contact with the block brackets 30.

In operation, as soon as the end clamp 12 is near the target tissue, the end clamp 12 is controlled so as to capture or clamp the target tissue between the upper surface 36 of the bracket block 30 and the surface 22 forming the suture bracket, the stop member 20. The formation of suture brackets 32 is carried out by moving the stop element 20 along a path substantially parallel to the elongated groove 14, in order to achieve substantially simultaneous contact of the surface 22 forming the suture bracket y, and more specifically, the recesses 23 forming a suture bracket, with the upper surface 36 of the block of brackets 30. As the stop element 20 continues to move in the direction of the block of brackets 30, the legs 34 of the suture brackets 32 come into contact with the corresponding recess 23, forming a suture bracket, in the abutment element 20, which serves to bend the legs 34 of the bracket 32 into a “B-shaped”. With further movement of the thrust element 20 in the direction of the elongated groove 14, further compression and bending of the suture brackets 32 occurs until the desired final formed height “FH” is reached.

The above-described process for folding a suture brace is outlined in FIG. 1B-1E. For example, in FIG. 1B shows an end clip 12 with a target tissue “T” between the abutment member 20 and the upper surface 36 of the implantable bracket unit 30. In FIG. 1C shows the initial clamping position of the abutment member 20 at which the abutment member 20 closes on the target fabric “T” to grip the target tissue “T” between the abutment member 20 and the upper surface 36 of the bracket block 30. FIG. 1D illustrates the start of suture brace formation when the stop member 20 begins to compress the brace block 30 so that the legs 34 of the suture brackets 32 begin to form with recesses 23B in the stop member 20. In FIG. 1E shows the suture bracket 32 in the final formed position, after stitching the target tissue “T”, the stop member 20 is removed for clarity. Once the brackets 32 have formed and stitched the target tissue “T”, the surgeon moves the stop element 20 to the open position to detach the bracket block body 31 and suture brackets 32 from the target tissue while removing the end clamp 12 from the patient’s body. The end clamp 12 bends all suture brackets at the same time as soon as the two jaws 13,15 are closed. The remaining “crushed” materials of the housing 31 serve as a hemostatic agent (ORC), as well as to strengthen the staple seam (PHC, PDS or any film-forming compositions mentioned above 38). In addition, since during the formation of the brackets 32 there is no need to go beyond the body of the block of brackets 31, the probability of deformation of the brackets 32 during their formation is minimized. As used herein, the term “implantable” means that not only the brackets, but also the body materials of the bracket block that support the brackets also remain inside the patient’s body and, ultimately, are absorbed into the patient’s body. Such implantable brace blocks are different from previous brace block designs that remain attached to the end clamp and are removed with it. Such “removable” brace blocks typically include brace pusher components, and therefore their size can significantly exceed the size of the end clamps of the present invention, which are intended to be used in connection with certain embodiments of the innovative implantable brace block of the present invention.

In a different design, the end clamp 12 is designed to correspond to an elongated barrel 40 that protrudes from the handle assembly 100. The cross-sectional shapes of the end clamp 12 (in the closed position) and the elongated barrel assembly 40 may be similar, and their size selected so that in working condition they pass through the tube of a trocar or the working channel of an access device of another shape. In this document, the term “passes in working condition” means that the end clamp and at least part of the elongated barrel assembly can be inserted into the channel or hole of the tube and can pass through them, and it will also be possible to carry out the necessary manipulations in this place to complete surgical stapling procedure. In some embodiments, when the jaws 13 and 15 of the end clamp 12 are in the closed position, the end clamp in cross section may take an approximately circular shape, which facilitates its passage through the round channel / hole. However, end clamps of various embodiments of the present invention, as well as embodiments of an elongated barrel, can potentially be provided with other cross-sectional shapes that can otherwise pass through access channels and openings whose cross-sectional shape is not circular. Thus, the total size of the closed end clamp in cross-section is related to the size of the channel or hole, the passage through which is assumed. Thus, one end clamp, for example, can be referred to as a “5 mm” end clamp, which means that it can pass in the working position through an opening with a diameter of approximately at least 5 mm.

In various embodiments of the present invention, the outer diameter of the elongated barrel assembly 40 may not substantially differ from the outer diameter of the end clamp 12 in the closed position. For example, a 5 mm end clip can be aligned with an elongated barrel 40, the diameter of which is 5 mm in cross section. However, further in the present detailed description, it will become apparent that various embodiments of the present invention can be effectively used in connection with end clamps of various sizes. For example, a 10 mm end clamp can be attached to an elongated barrel assembly, the diameter of which is 5 mm in cross section. Conversely, in the practical use of the device with an opening or access channel of 10 mm or more, the diameter of the elongated barrel assembly 40 may be 10 mm (or more) in cross section, but may also actuate an end clip with a diameter of 5 mm or 10 mm. Accordingly, the outer diameter of the outer barrel 40 may be the same or different from the outer diameter of the end clamp 12 in the closed position attached thereto.

As described, the elongated barrel assembly 40 extends distally from the handle assembly 100, generally in a straight line, denoting the longitudinal axis A-A. In various embodiments, for example, the elongated barrel assembly 40 may be approximately 229-406 mm (9-16 inches) long. However, an elongated barrel 40 of a different length may be provided, and in other embodiments it may be hinged or configured to rotate the end clip 12 relative to other parts of the barrel or handle assembly, which will be described in detail below. In various embodiments, the elongated barrel assembly 40 includes an axial member 50 that extends from the handle assembly 100 to the end clamp 12. At the proximal end of the elongated channel 14 of the end clamp 12 there is a pair of retaining trunnions 17 that protrude from it, their size is selected so as to align with the corresponding trunnion openings or sockets 52 that are provided at the distal end of the axial member 50 for disassembling the end clamp 12 to the elongated barrel 40. phenomenon axial member 50 of, e.g., 6061 or 7075 aluminum, stainless steel, titanium, etc.

In various embodiments, the handle assembly 100 includes a pistol-type handle housing that may be made of two or more parts for ease of assembly. For example, the grip assembly 100, as shown, comprises a right grip element 102 and a left grip element 104 (FIGS. 5, 7, and 8) molded or otherwise made of a polymer or plastic material designed to fit together . Such housing elements 102 and 104 can be attached to each other using snap parts, pins, and sockets molded thereon or otherwise and / or using glue, screws, and the like. The axial member 50 has a proximal end 54 with a flange 56 formed thereon. The flange 56 is configured to rotatably be positioned within the groove 106 formed by mating ribs 108 that protrude inwardly from each member 102,104 of the housing 102, 104. This design facilitates the attachment of the axial member 50 to the handle assembly 100, allowing the axial member 50 rotate relative to the handle assembly 100 around the longitudinal axis AA through 360 °.

As can be further seen in FIG. 1 and 4, the axial member 50 passes through and is supported by a mounting insert 60 that is attached to the handle assembly 100. Mounting insert 60 has a proximal flange 62 and a distal flange 64 that define a rotating groove 65 that is configured so that the nose part 101 of the handle assembly 100 fell between them. This design makes it possible to rotate the mounting insert around the longitudinal axis AA relative to the handle assembly 100. The axial member 50 is mounted to the mounting insert 60 without rotation by an axial pin 66. In addition, a rotary coupling 70 is attached to the mounting insert 60. In one embodiment, for example, in the rotary coupling 70 there is a part of the hollow mounting flange 72, the size of which is selected so as to accommodate part of the mounting insert 60. In various embodiments, it is possible to manufacture A rotary coupling 70, for example of glass or carbon-filled nylon, polycarbonate, Ultem®, etc., is also attached to the mounting insert 60 by an axial pin 66. In addition, an inwardly extending holding flange 74 is formed on the part of the mounting flange 72, which is designed to passing into the radial groove 68 formed in the mounting insert 60. Thus, the surgeon can rotate the axial element 50 (and the end clamp 12 attached thereto) around the longitudinal axis AA by 360 °, capturing the rotary sleeve 70 and rotating it relative to the handles and assembled 100.

In various embodiments, the thrust member 20 is held open by the spring 21 of the thrust member or other retaining structure, as shown in FIG. 1, 9A, 10A and 11A. The thrust member 20 selectively moves from an open position to various closed or closed and operating positions using a trigger system, commonly referred to as 109. The trigger system 109 includes a “trigger element” 110, which, in various embodiments, includes a hollow trigger tube 110. A hollow trigger tube 110, axially displaceable on the axial member 50, thus forms the outer part of the elongated barrel assembly 40. The launch tube 110 may be made of polymer or other suitable material ala, it has a proximal end 112 that is attached to the trigger 114 launcher yoke 109. See. FIG. 4. In various embodiments, for example, the launch collar 114 may be formed at the proximal end 112 of the launch tube 110. However, a different attachment structure may be used.

As can be seen in FIG. 1 and 4, the launch collar 114 may be rotatably supported by a support collar 120 that is configured to axially move within the handle assembly 100. In various embodiments, the support collar 120 has a pair of laterally projecting ribs 122, size which are selected so as to fit, with the possibility of sliding, in the grooves of the ribs 103 and 105 formed in the right and left elements 102, 104 of the handle housing, respectively. See FIG. 7. Thus, the support collar 120 can axially slide inside the handle housing 100, while the launch collar 114 and the launch tube 110 rotate there about the longitudinal axis A-A. As seen in FIG. 4, a longitudinal groove 111 extends along the launch tube 110 to allow the axial pin 66 to enter through it into the axial element 50, while facilitating the axial movement of the launch tube 110 on the axial element 50.

In addition, the cutting-crosslinking system 109 includes a trigger device 130, which serves to control the axial movement of the trigger tube 110 on the axial element 50. See FIG. 1. Such axial movement in the distal direction of the launch tube 110 to achieve working interaction with the thrust element 20 is hereinafter referred to as the “starting motion”. As can be seen in FIG. 1, the trigger device 130 is connected to the handle assembly 100 with the possibility of movement or articulated movement using a pivot pin 132. A torsion spring 135 is used to divert the trigger device 130 from a part of the pistol grip 107 of the handle assembly 100 to an inactive “open” or initial position . As seen in FIG. 1 and 4, the trigger device 130 has an upper portion 134 that is movably connected (attached) to the trigger links 136, which are coupled (attached), to be movably connected to the support collar 120. Thus, the movement of the trigger device 130 from the original position (FIGS. 1 and 9) in the direction of the end position next to the pistol grip part 107 of the handle assembly 100 (FIG. 14) causes the trigger clamp 114 and the trigger tube 110 to move “DD” in the distal direction. The movement of the trigger device 130 from the pistol grip 107 of the handle assembly 100 (when the torsion spring 135 deviates) causes the trigger clamp 114 and the trigger tube 110 to move in the proximal direction “PD” on the axial member 50.

In various embodiments of the present invention, it is possible to use implantable brace blocks of different sizes and configurations. For example, the surgical apparatus 10, when used in connection with the first trigger adapter 140, can be used with a 5 mm end clamp 12, which is approximately 20 mm long (or other length), that supports the implantable bracket unit 30. This size of the end clamp may in particular, suitable, for example, for dissection of relatively small tissue and vascular surgery. However, as will be described in more detail below, it is also possible to use a surgical apparatus 10, for example, with end clamps and bracket blocks of other sizes when replacing the first trigger adapter 140 with the second trigger adapter 150. In other embodiments, it is possible to configure the elongated barrel assembly 40 for connecting to the end clamp only one shape or size. In such embodiments, for example, the pressing surfaces 146 or 158 (typically provided on the trigger adapters 140, 150, respectively) are formed as a unit at the distal end of the trigger tube 110, depending on the particular size of the end clamp with which it is intended to be used.

As seen in FIG. 2, the first trigger adapter 140 is substantially hollow, and has a first spring portion 142 that is configured to protrude into the open distal end 116 of the trigger tube 110. A first locking button 144 is formed on the first spring portion 142 so sized so as to align with the fixing hole 117 located on the part of the distal end of the launch tube 110. See FIG. 1 and 2. Thus, in order to disconnect the first trigger adapter 140 of the trigger tube 110, it is sufficient for the user to simply press the lock button 144 out of the lock hole 117 and remove the first trigger adapter 140 from the trigger tube 110. As can also be seen in FIG. 2, the first trigger adapter 140 has an internal clamping surface 146 that is designed to align with the assembly of the forked beveled bar 24 of the stop member 20.

In various implementations, the bifurcated beveled bar 24 on the abutment member 20 includes a pair of fingers 45 separated by a groove for receiving a blade (not shown). On each of the fingers 45 there is a proximal surface 27, which is substantially parallel to the bottom of the elongated channel 14 when the stop member 20 is in the closed position. Then, the proximal surface 27 passes into the pressing beveled bar 28, which is located distally to the proximal surface 27. See FIG. 3. The tapered beveled bar 28 is oriented at a clamping angle “A” relative to the proximal surface 27. In various embodiments, for example, the clamping angle “A” may be approximately 15-30 degrees. As will be described in more detail below, when the first pressing surface 146 of the first start adapter 140 comes into contact with the beveled clamping bar 28, the abutment member 20 advances along the elongated channel 14, and more specifically, in the direction of the bracket block 30 therein. As the first trigger adapter 140 further extends distally, the first clamping surface 146 contacts the brace forming beveled bar 29 on each finger 45 of the stop member to further push the stop member 20 into the bracket block 30 to form the brackets. As also shown in FIG. 3, the brace-forming beveled bar 29 is oriented at a forming angle “B” with respect to the clamping beveled bar 27. In various embodiments, for example, the forming angle “B” may be about 5-20 degrees. The tilt angle of the assembly of the beveled plank 24 of the abutment member 20 can be further increased below its surface 25 (for example, the angle “C” is approximately 5-40 degrees) so that when the abutment member 20 is in the open position, the inclined bottom surface 25 provides maximum opening when lifting the stop element 20, comprising 15 ° (angle “β” in FIG. 11A).

The following is a description of one of the connection methods, with the possibility of rotation, of the end clamp 12 to the axial element 50. The connection process begins by inserting the holding pins 17 on the elongated groove 14 into the openings 52 for the pins in the axial element 50. Then, the surgeon advances the trigger device 130 in the direction pistol grip 107 of the housing 100 in order to distally advance the launch tube 110 and the first launch adapter 140 along the proximal end 47 of the elongated groove 14 so as to hold the trunnions 17 in the corresponding openings 52. See FIG. 10 and 10A. This position of the first trigger adapter 140 relative to the pins 17 is hereinafter referred to as the “connected position”. Various embodiments of the present invention may also include a locking mechanism 160 of the end clamp 160 to lock the trigger 130 in place after attaching the end clamp 12 to the axial member 50.

More specifically, and the example of FIG. 5, 7 and 8, in one embodiment of the end clamp locking mechanism 160, there is a holding pin 162 that is rotatably fixed to the upper portion 134 of the trigger 130. The holding pin 162 is spring-loaded in the direction of the left-side housing element 104 with a holding spring 166. When the release device 130 is in the inactive (initial) position, the stop pin 162 is displaced into adjacent contact with the stopper of the initial position 163, which protrudes inward from the left-side element of the core Pusa 104. See FIG. 7 and 8. As already described above, it is first necessary to extend the trigger tube 110 distally to the attached position, in which, using the first trigger adapter 140, the retaining pins 17 of the end clamp 12 are locked in the pin holes 52 in the axial member 50. The surgeon advances the trigger adapter 140 distally to the attached position, pressing the trigger 130, moving it from its original position in the direction of the pistol grip 107. After the trigger is initially activated, the holding pin 162 slides in adjacent contact with the stopper rest position 163 until the first start-up adapter 140 moves through tube 110 starter in the connected position, wherein the retaining pin 162 is displaced in the locking cavity 164 formed in the left-hand member 104 of the housing. See FIG. 8. In various embodiments, when the retaining pin 162 enters the retaining cavity 164, the pin 162 makes an audible “click” or other sound, in addition, the surgeon senses by touch that the end clip 12 is “latched” on the axial member 50. In addition unless the surgeon intentionally removes the retention pin 162 from the retaining cavity 164, he cannot accidentally move the trigger device 130 to start folding the brackets 32 in the end clamp 12. Similarly, if the surgeon releases the trigger device 130 at Connections position, it is held in the same position by the retarding pin 162 that prevents the release device 130 from returning to its original position, and thereby disconnecting terminal 12 from the clamp member 50 axially.

In various embodiments, the release button 67 of the trigger device is mounted in the left-side member 104 of the handle housing assembly 100 so that the surgeon can intentionally pull out the retention pin 162 to further activate the trigger device 130 or return to its original position. See FIG. 7, 5 and 8. The release button 167 of the trigger device is movably mounted in the locking cavity 164 and spring-loaded to translate into an inactive position (FIG. 8). When the release button 167 of the release device is pressed inward, it touches the holding pin 162 and pushes it out of the locking cavity 163 to further activate the release device 130.

As described previously, the surgical apparatus 10 can be used as a gripping device for manipulating the tissue / placing it in a specific position. Further movement of the trigger device 130 in the direction of the pistol grip part 107 after unlocking the trigger device 130 (by depressing the unlock key 167) will cause the trigger adapter 140 to contact the tapered bevel bar 28 of the stop member 20. As part of the pressure surface 146 of the first trigger adapter moves up the clamped beveled bar 28, the stop element moves towards the bracket block 30 in the elongated channel 14. Thus, the surgeon can control the stop element ntom 20, moving in the direction of block brackets 30 or from it for gripping and releasing the tissue therebetween without forming seaming brackets.

In various embodiments, the implementation of the present invention may also include a locking button for the cutting-stapling system 137, which is pivotally attached to the handle assembly 100. See FIG. 1 and 4. In one form, in the blocking button 137 of the cutting-cross-linking system, there is a latch 138 formed on the corresponding distal end, the position of which is oriented so as to engage with the trigger clamp 114, when the release button of the release device is in the first locking position. As seen in FIG. 1 and 4, the locking spring 139 serves to move the locking button 137 of the cutting-stitching system to the first locking position (FIGS. 11 and 12). As described in more detail below, the latch 138 serves to engage the trigger clamp 114 at a point where the position of the trigger clamp 114 on the axial member 50 corresponds to the point at which the pressure surface 146 of the first trigger adapter 140 is close to extend distally up the beveled clip the bar 28 on the stop element 20. It will become clear that the first starting adapter 140 moves axially towards the pressure beveled plate 28, the stop element 20 will move along such a path that part of the forming kobki surface 22 is substantially parallel to the upper surface 36 of block 30 parentheses.

After attaching the end clamp 12 to the axial element 50, the process of forming a suture bracket begins with the first release of the locking button 137 of the cutting-stitching system in order to ensure further distal advancement of the trigger clamp 114 on the axial element 50 and the final pressing of the stop element 20 into the block of brackets 30 See FIG. 13. After depressing the lock button 137 of the cutting and stapling system, the surgeon continues to move the trigger 130 towards the pistol grip 107, thereby advancing the pressing surface 146 of the first stitching sleeve 140 to the corresponding forming brace, beveled bar 29 to push the stop member 20 to making contact with the suture brackets 32 in the block of braces 30. The blocking button 137 of the cutting-stitching system prevents accidental folding of the brackets 32 until the surgeon is ready to begin this process. In this embodiment, the surgeon needs to press the blocking button 137 of the cutting-stapling system before it becomes possible to move the trigger device 130 further to begin the brace formation process.

If desired, it is possible to separately use the surgical apparatus 10 as a tissue stitching device. However, various embodiments of the present invention may also include a tissue dissection system, generally referred to as 170. In at least one form, the tissue dissection system 170 includes a cutting element 172 that can selectively extend from an inactive position bordering the proximal end end clamp 12 (FIG. 1 and 9-13), in the active position (FIG. 14) when the trigger is activated 200 to extend the surgical knife. The cutting element 172 is movably supported within the axial element 50 and is attached or otherwise protrudes outward from the knife shaft 180. The cutting element 172 can be made, for example, of stainless steel 420 or 440, the hardness of which exceeds 38HRC (on the Rockwell hardness scale C) with a blade 176 for cutting tissue formed at its distal end 174, it can be made so as to protrude sliding through a groove 31 in the abutment member 20 and a centrally located groove 33 in the bracket unit 30 for dissecting tissue captured by the end clamp 12. See FIG. 14A. As seen in FIG. 4, the surgical knife blade 180 projects through the axial member 50 and has a proximal end portion 182. The proximal end portion 182 is coupled, with the possibility of transmitting a driving force, to a surgical knife drive 190, which is attached in working position to the trigger mechanism 200 to extend the surgical knife. In various embodiments, the surgical knife advancement mechanism 200 is attached to the hinge axis 132 so that it can be rotated or otherwise moved without activating the trigger device 130. In various embodiments, the first surgical knife gear 192 is also attached to the hinge axis 132 so that the activation of the trigger 200 to extend the surgical knife also causes the first gear 192 of the surgical knife to rotate. A trigger return spring 202 is attached between the first gear wheel 192 of the surgical knife and the handle body to move the trigger 200 to extend the surgical knife to the starting or inoperative position. See FIG. 1 and 4.

Turning to FIG. 5 and 6, various embodiments of a surgical knife drive 190 also include a second surgical knife gear 194, which is rotatably supported by a second gear spindle 193 193 and is engaged with the first surgical knife gear 192. The second gear wheel 194 of the surgical knife is engaged with the third gear wheel 196 of the surgical knife, which is mounted on the spindle 195 of the third gear. A fourth gear wheel 198 of a surgical knife is also attached to spindle 195. The fourth gear wheel 198 of the knife is adapted to engage, with the possibility of transmitting drive force, with a series of teeth or rings 184 of gears with internal gearing at the proximal end of the shaft 180 of the knife. Thus, this design allows the fourth knife gear 198 to move along the axis of the knife bar 180 in the distal direction “DD” or the proximal direction “PD”, causing the trigger bar 180 to rotate about the longitudinal axis A-A relative to the fourth gear wheel 198 of the knife. Accordingly, the surgeon can advance along the axis of the trigger bar 180 and ultimately the cutting element 172, distally, pushing the trigger 200 to extend the knife toward the pistol grip 107 of the handle assembly 100.

Various embodiments of the present invention also include a knife locking system 210 that prevents the cutting element 172 from being pulled out until the release lever 130 reaches its fully operational position (FIGS. 13 and 14). This characteristic, therefore, prevents the activation of the knife extension system 170 before activating the suture braces or forming them in the tissue. As seen in FIG. 1, various embodiments of a knife blocking system 210 comprise a knife blocking bar 211 that is pivotally supported within a pistol grip portion 107 of the handle 100. The knife blocking bar 211 has an activating end 212 that is adapted to engage the trigger lever 130 when trigger lever 130 is in the fully trigger position. In addition, at the other end of the knife blocking bar 211 there is a locking hook 214 that is adapted to engage with the locking pin 216 on the first gear wheel 192 of the knife. The knife retaining spring 218 is used to move the knife blocking bar 211 to the “blocking” position in which the locking hook 214 is held in engagement with the locking pin 216, thereby preventing the activation of the knife extension trigger 200 until the trigger lever 130 is fully starting position. See FIG. 9.

The following is a description of various operating methods of at least one embodiment of the surgical apparatus of the present invention when referring to FIG. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A. As can be understood when referring to FIG. 1, 9 and 9A, when the cutting element 172 is in the depicted “initial” or inactive position, the tissue cutting blade 176 is proximal to the distal end of the first trigger adapter 140, so that the sharp tissue cutting blade 176 does not face the user. In alternative embodiments in which an elongated barrel is made for use with an end clamp of the same shape or size (for example, which do not use trigger adapters 140, 150), the cutting blade 176 of the cutting element 172 is located proximal to the distal end of the launch tube so that the sharp blade 176 for cutting tissue was also not addressed to the user in these embodiments.

In FIG. 9 and 9A show the end clamp 12 after attaching it to the axial member 50 by inserting the retaining pins 17 on the end clamp 12 into the trunnion openings 52 in the axial member 50. As shown in FIG. 9, the release lever 130 is in an inactive or initial position, and the end clamp 12 is not yet fixed to the axial member 50 with the first trigger adapter 140. “P _O ” represents the distance that the trigger 130 can be moved before the first trigger the adapter 140 will begin to move in the direction of the pressing beveled plate 28 of the stop element 20. The trigger mechanism 200 for extending the knife is also locked in the inactive position.

In FIG. 10 and 10A show the position of the release lever 130 after it has been moved to a position where the end clamp 12 is fixed in the axial member 50 by the first trigger adapter 40. This position is hereinafter referred to as the “attached position.” In the attached position, the holding pin 162 latches in the fixing cavity 164 (FIG. 8), thereby the surgeon receives a sound and tactile confirmation that the end clamp 12 is currently attached to the axial element 50. The trigger lever 130 cannot be actuated while the surgeon deliberately does not release the release button 167 of the trigger (FIGS. 5, 7 and 8) to release the retention pin 62 from the retaining cavity 164. The distance by which the distal end 141 of the first trigger adapter 140 moves is represented as the distance “l” (FIG. 10A ), and the corresponding distance over which the trigger clamp 114 moves on the axial member 50 is represented as the distance “l.” FIGS. 11 and 11A show the position of the trigger lever 130 after the release button (not shown) is depressed, and the surgeon drives cn an acceleration lever 130 for moving the first starting adapter 140 to the beginning of the beveled clamping strips 28 on the stop element 20. As can be seen in these figures, the spring 21 of the stop element moves the stop element 20 to the open position. The movement of the distal end of the first trigger adapter 140 is represented as the distance “l ₁ ”, and the corresponding distance by which the trigger clamp 114 moves on the axial member 50 is represented as the distance “l ' ₁ ”. In FIG. 12 and 12A show the position of the first trigger adapter 140 after it has been extended to the beginning of the beveled forming bar 29 of the stop member 20. In this position, the compression ratio reaches the maximum level that is possible before the formation of the suture brace begins. This position is hereinafter referred to as the “maximum compression position”. As can be seen in FIG. 12, the trigger collar 114 makes contact with the latch 138 on the lock button 137 of the trigger, and therefore cannot move further distally until the lock button 137 of the trigger is depressed. As can be seen in FIG. 12A, the suture-forming surface 22 of the abutment member 20 is substantially parallel to the upper surface 31 of the bracket unit 30. The distance between the staple-forming part 22 of the abutment member 20 and the upper holding surface of the elongated channel 14 is represented as “C _max ." In various embodiments, C _max. may be, for example, 2.15-3.65 mm (approximately 0.085-0.144 inches) for blocks of brackets 30 with parts of the housing 31 having substantially the same thickness. In at least one embodiment, for example, the thickness of the block of brackets may exceed approximately 0.25 mm to 0.76 mm (approximately 0.01-0.03 inches) the size of the suture bracket. The total distance that the first start adapter 140 moves from the starting position to the maximum compression position is represented by “l ₂ ”, and the corresponding distance by which the start clamp 114 moves on the axial member 50 is represented as “l ' ₂ ”. In FIG. 13 and 13A show the position of the trigger clamp 114 in the fully operational position when the brackets 32 in the bracket block 30 are fully formed. In this position, the distance between the forming bracket portion 22 of the abutment member 20 and the holding surface of the elongated groove 14 is represented as “C _min ”. In various embodiments, “C _min. ”Can be, for example, approximately 0.38 mm to 0.76 mm (approximately 0.015-0.030 inches) for bracket blocks supporting brackets in which the legs are in the open state approximately 1.90 mm to 3.40 mm ( approximately 0.075-0.134 inches) (“UF” distance in FIG. 1A), and when fully closed, the total formed height is, for example, approximately 0.63 mm to 1.01 mm (approximately 0.025 inches to 0.04 inches) that amounts to the distance “FF" in FIG. 1D. The total distance that the first start adapter 140 travels from the starting position to the fully operational position is represented as “l ₃ ”, and the corresponding distance that the start clamp 114 travels along the axial member 50 is represented as “l ' ₃ ”. As can also be seen in FIG. 13, the trigger device 130 is in the fully operational position and comes into contact with the drive end 212 of the locking bar of the knife 211 to disengage the locking hook 214 with the locking pin 216 on the first gear wheel 192 of the cutting element.

Dissection, especially of vessels, can be considered as one of the most intense stages of any surgical procedure. When carrying out laparoscopic surgery, this stage is even more stressful, since in case of failure, a transition to an open operation may be needed almost immediately in order to prevent the onset of catastrophic events. Thus, it may be desirable to use a surgical stapler with the additional possibility of excising tissue after the installation of suture staples. Various embodiments of the present invention meet such requirements.

After the suture brackets “sew” the target tissue (are formed), the surgeon is able to press the release button 167 of the trigger device to return the trigger device 130 to its original position under the influence of the torsion spring 135, which ensures that the stop element 20 is in the open position under the action springs 21. In the open position, the surgeon can remove the end clamp 12, leaving the implantable block of brackets 30 and brackets 32. In cases where the end clamp is inserted through the passage, the working channel, etc., the surgeon returns schaet stop element 20 in the closed position, acting on the trigger device 130 to display the terminal connector 12 through the passageway or working channel. However, if the surgeon needs to cut the target tissue after stitching with brackets, the surgeon activates the trigger 200 to extend the surgical knife in the manner described above, so that the cutting element 72 cuts the target tissue towards the end of the end clamp, as shown in FIG. 14, 14A. In FIG. 14 shows the travel distance of the trigger 200 to extend the surgical knife in various embodiments for the end clamps / bracket blocks of different lengths, at which the cutting element 72 extends to the fully operational position inside the end clamp 12. After that, the surgeon can release the trigger 200 to extend the surgical knife, so that the cutting element 72 returns to its original (inactive) position under the influence of the transmission of the cutting-stitching system, driven by the starting return spring another 202 (FIG. 13, 13A). As soon as the cutting element 72 returns to its original position, the surgeon can open the jaws 13, 15 of the end clamp to release the implantable block of brackets 30 inside the patient’s body and remove the end clamp 12 from the patient’s body. Thus, such surgical devices of the present invention facilitate the use of small implantable staple blocks that can be inserted through the working channels and passages of a relatively small size, while at the same time allowing the surgeon to stitch with staples without cutting the fabric, or if necessary, dissection of the tissue after stitching with staples will be required .

As indicated above, the surgical device 10 can be used with other end clamps that support blocks of brackets of other sizes containing brackets of a different size and quantity. In FIG. 15-19 illustrate the use of an end clamp 12 ', which in the working position supports the bracket block 30', which contains brackets 32 'larger than the brackets 32 in the bracket block 30. For example, the size of the brackets 32 in the bracket block 30 can be approximately 2 , 03-2.15 mm (approximately 0.080-0.08 inch brackets, while the size of the brackets 32 'in the bracket block 30' may be approximately 1.90 mm (approximately 0.075 inches). In various embodiments, the length of the block brackets 30 'exceeds the length of the block of brackets 30. For example, the length of the block of brackets 30 mo it can be approximately 20 mm (approximately 0.78 inches); while the length of the bracket block 30 ′ can be approximately 40 mm (approximately 1.57 inches). FIG. 15 is an exploded view of the end clip 12 ′, the second the start adapter 150 and the distal end 55 of the axial element 50. As can be seen in FIG. 15, in the elongated groove 14 'there is a pair of side walls 16' located at a distance from each other, each of which has a slot or hole 18 ', the size of which tailored to suit the appropriate the pin 26 'of the thrust element. The stop member 20 'and the elongated groove 14' together can form an end clamp 12 ', the total diameter of which allows the end clamp 12' to pass through an opening whose diameter is at least 5.0 mm (about 0.20 inches). The stop member 20 'also has a brace forming part 22', in which a plurality of recesses forming the brackets are located, and a forked beveled plate 24 'that protrudes proximally from it. At the proximal end 15 'of the elongated groove 14' there is a pair of retaining pins 17 that protrude from it, their size is selected so as to fit with the corresponding openings 52 located on the axial element 50.

As can be seen in FIG. 15, the second start adapter 150 has a substantially hollow body portion 151 and a proximal cuff portion 152 that has an inwardly extending retaining protrusion 154. There is a groove 156 between the body portion 151 and the proximal cuff portion 151 that allows movement of the cuff portion 152 relative to parts of the body 151 to facilitate insertion of the holding protrusion 154 into the holding hole 117 in the launch tube 110. To detach the second launch adapter 150 from the launch tube 110, the surgeon squeezes the proximal part cuffs 152 for removing the holding protrusion 154 from the holding hole 117, thereby distally removing the second starting adapter 150 from the starting tube 110.

In various embodiments, the abutment member 20 ′ utilizes a forked beveled plate 24, which includes a pair of fingers 45 ′, each of which has a proximal surface 27 ′ that extends into a pressing beveled bar 28 ′ distal to the proximal surface 27 ′. See FIG. 15. The tapered beveled bar 28 ′ is oriented at an angle “A ′” with respect to the proximal surface 27 ′. In various embodiments, for example, the pressure angle “A ′” may be approximately 50-30 degrees. As will be described in more detail below, when the second pressing surface 158 of the second starting adapter 150 comes into contact with the beveled clamping strips 28 ′, the thrust plate 20 ′ moves forward along the elongated groove 14 ′, and more specifically, in the direction of the bracket block 30 ′ therein . See FIG. 17. As the second start adapter 150 further extends distally, the second clamping surface 158 contacts the brace forming beveled bar 29 ′ on each finger 45 of the stop member to further push the stop member 20 ′ into the bracket block 30 ′ to form in it suture brackets 32 '. See FIG. 18. The staple forming beveled plate 29 ′ is oriented at an angle “B” with respect to the pressed beveled plate 27 ′. In various embodiments, for example, the angle "B" may be approximately 5-20 degrees. Between the assembly of the beveled plate 24 ′ and the bottom of the elongated groove 14 ′, a spring (not shown) may be provided to move the thrust member 20 ′ to the open position.

In FIG. 16 shows the position of the second trigger adapter 150 after the surgeon distally advances the second trigger adapter 150 to the beginning of the beveled pressing plates 28 ′. The operation of the second trigger adapter 150 is controlled by the trigger lever 130 in the manner described above with respect to the first trigger adapter 140. In FIG. 17 shows the position of the second start adapter 150 in a fully locked position. In FIG. Figure 18 shows the position of the second trigger adapter 150 in the fully operational position, in which the suture braces 32 'in the block of braces 30' are formed by stitching a clamped tissue (not shown).

As shown above, the length of the implantable block of brackets 30 'exceeds the length of the implantable block of brackets 30. Thus, as shown in FIG. 15, the end clamp 12 ′ also includes a distal cutting element 124 that is movably supported in the elongated groove 14 ′. The distal cutting member 124 has a blade 125 that cuts the tissue, and a proximal portion 126 designed to engage the cutting member 72. Thus, if the surgeon needs to cut the tissue after stitching with brackets, the surgeon activates the trigger device 200, as described above, for extending the cutting element 172 distally until it contacts the distal cutting element 124 so that the distal cutting element 124 cuts through the fabric, as shown in FIG. 19. The distal cutting element 124 may have at least one holding part thereon, which is adapted to extend through a slot of a corresponding shape (not shown) in an elongated groove 14 '. This design allows the end clamp 12 'to open after stitching with brackets and dissection of the fabric. The distal cutting element 124 remains in the abutment element 20 ′ and is removed along with the end clip 12 ′ when it is removed from the patient’s body.

Thus, in various embodiments of the surgical apparatus 10, there are separate mechanisms for suturing and dissecting tissue, so that the surgeon is able to stitch the tissue without dissecting the tissue. Various embodiments of the stapler of the present invention can be successfully applied with end clamps of various sizes, which are adapted to suture brackets of various sizes and in different quantities. Surgical devices can be supplied in the form of a kit including an apparatus 10 and a first starting adapter 140, as well as a second starting adapter 150, which allows the use of the device with implantable brace blocks of different sizes.

Various unique, innovative embodiments of the present invention utilize a collapsible brace block that maintains the suture braces in a substantially stable position to form contact with the stop member. Unlike previous surgical staplers that used pushers of suture staples, the staples in various embodiments of the present invention do not move until they come into contact with the stop member. In various embodiments of the present invention, the thrust member moves until it comes into contact with open brackets. The degree of formation of the suture brackets depends on how far the stop member moves into the suture braces. This design allows the surgeon to adjust the degree of forming or starting pressure applied to the suture brackets, thereby changing the final height of the brackets in the formed state.

In various embodiments, the degree of movement of the movable thrust element during start-up depends on the degree of depression of the trigger. For example, if the surgeon needs to get only partially closed braces, the trigger is moved by pressing only partially in the direction of the pistol grip 107. To obtain a more tight bending of the suture bracket, the surgeon simply presses the trigger further, which leads to further contact of the stop element with the suture brackets to bend them. When used in this document, the term “forming contact” means that the forming surface of the suture brace or the forming recesses for the suture braces come into contact with the legs of the suture brace and begin to form or bend the legs into the closed position. The degree of formation of the suture brace indicates the degree of bending of the legs of the suture brace and is ultimately related to the height of the suture brace in the closed state, as described above. It will also be quite clear to those skilled in the art that since the stop element 20 moves substantially parallel to the block of brackets as the force is applied to it through the trigger mechanism, suture brackets are formed, to a significant extent, simultaneously, their height, the resulting formation is substantially the same.

In FIG. 20-23, an alternative surgical apparatus 10 is shown in which the suture bracket height indicator assembly 220 is used. In various embodiments, the suture bracket height indicator assembly includes a display panel 222 attached to the upper portion 134 of the release lever 130 to rotate with it. As the trigger lever 130 moves toward the pistol grip 107 of the handle assembly 100 to push the stop member 20 into the bracket block 30, as described above, the display panel 222 becomes visible through the window 223 in the left-side housing element 104. In this embodiment, the suture height indicator unit 220 also includes a series of stoppers 24, 26, 28 made in the left-side member of the body 104, which correspond to the three stages of suture stitch bending. In particular, after the trigger is initially activated, the stop pin 162 slides in adjacent contact with the stopper of the initial position 163, while the start tube 110 pushes the trigger adapter 140 or 150 in the attached position described above, in which the stop pin 162 is displaced into the locking cavity 164 made in the left-side housing element 104. When the surgeon needs to close the jaws 13, 35 of the end clamp 12, the release button 167 is pressed so that it becomes possible to further activate the release lever. When the release button 167 of the release lever is pressed inward, it comes into contact with the holding pin 162 and is pulled out of the blocking cavity 163 to provide further activation of the release lever 130. As described above, the surgeon is able to use the lower and upper jaws 13, 15, respectively, end clamp 12 for gripping tissue and manipulating it. When the surgeon needs to start the process of forming the suture, he presses the release button 167 of the trigger lever, which allows the trigger clamp 114 to move distally as the surgeon continues to press the trigger lever 130.

Further advancement of the release lever 30 moves the stop member 20 into forming contact with the suture brackets 32 in the bracket unit 30. When the release lever 130 is further pressed, the flat end 165 of the holding pin 162 slides away from the original latch 163 and makes contact with the first latch 224, which corresponds to the first value of the formation of the brackets, which is indicated by the first symbol 230 of the height of the suture bracket on the left-side body element 104. See FIG. 20. As shown, the first suture height symbol 230 is an image of a bracket that has just begun to form. Other symbols / notations may be used to indicate the stage of formation of the bracket. As the holding pin 162 hits the first latch 224, the surgeon may hear a click. When the retaining pin 162 enters the first latch 224, the surgeon can also feel tactile feedback through the release lever 130. In addition, the suture bracket display panel 222 can be seen through the inspection window next to the suture bracket symbol 230. If the surgeon needs to further bend the brackets 32 in the brace block, the holding pin 162 is disengaged from the first latch 224 using the release button 240, which is formed in the second element of the handle body 104. In various embodiments, for example, the release button 240 can be integrated into the left member 104 of the handle body with a hinge portion 242 that is part of the left member 104 of the handle housing. This design allows you to press the release button 240 to the end 165 of the holding pin 162 in order to release it from engagement with the first, second or third latch 224, 226, 228. As soon as the holding pin 162 is released from the first latch 224, you can press further on the trigger a lever 130 until the holding pin 162 engages with the second suture brace 226. This position of the trigger lever 130 leads to a further movement of the stop element 20 into contact with the brackets 32 in the block of brackets 30, as a result of which the brackets are bent. And again, the holding pin 162 snaps into the second latch 226 to form the suture brackets 226, while the surgeon receives a sound and tactile confirmation that the trigger lever 130 is in the second position to form the suture brace. In this position, the bracket height indicator panel 222 can be seen through the inspection window 223 next to the second suture bracket height symbol 232. If the surgeon needs to further bend the brackets 32 in the bracket block, the holding pin 162 is disengaged from the second latch 226 by pressing the release button 240. Following this, the release lever 130 can be further pressed until the holding pin 162 engages with the third latch 228 the formation of the suture bracket corresponding to the final stage of formation of the suture bracket. And again, the holding pin 162 snaps into the third latch 228 to form the suture brackets 226, while the surgeon receives a sound and tactile confirmation that the trigger lever 130 is in the third position to form the suture brace. In this position, the bracket height indicator panel 222 can be seen through the inspection window 223 next to the suture bracket height symbol 234. After the suture brackets are bent to the desired shape, the surgeon can release the holding pin 162 from the retainer pin 228 of the third height of the suture bracket to return the trigger lever 130 to its original position. Or, if necessary, the surgeon can begin the tissue dissection procedure as described above before returning the trigger lever 130 to its original position.

FIG. 24 shows an alternative embodiment in which the suture bracket height indicator assembly, usually designated 220, does not include a series of clips that correspond to different stages of suture brace formation. This embodiment also includes a suture height indicator panel 222 and a viewing window 223. Thus, the surgeon can track the degree of suture formation formed by monitoring the position of the suture height indicator panel 222 through the inspection window 223. This embodiment does not include characters 230 , 232, 234 to indicate the height of the suture bracket as described above. Furthermore, this embodiment may also include an open bracket symbol 229, which corresponds to the initial position at which the suture brackets 32 have not yet begun to be bent by the stop member 20. This embodiment otherwise works the same as described above.

In FIG. 25 and 26 show an end clamp 12 ”that is similar to the end clamp 12 ′ described above, except for the following differences, which are made to correspond to the cutting element 172 ′. The cutting element 172 'is attached to or protrudes from the knife shaft 180, and otherwise operates as described above with respect to the cutting element 172. However, in this embodiment, the cutting element 172' is long enough to move along the entire length of the end clip 12 ”, Therefore, a separate distal cutting element is not used on the 12” end clip. The cutting element 172 'has an upper transverse element 173' and a lower transverse element 175 'made on it. The upper transverse element 173 'is oriented with the possibility of sliding along the corresponding elongated groove 250 in the stop element 20 ", the lower transverse element 175' is oriented with the possibility of moving along the elongated groove 252 of the elongated channel 14" of the end clamp 12 ". The release groove (not shown) extends into the stop element 20 ”so that when the cutting element 172 ′ extends to the end position within the end clamp 12”, the upper transverse element 173 ′ can move along the corresponding groove to move the stop element 20 ”into the open position for separation from stitched and dissected tissue. The stop element 20 ”may otherwise be identical to the stop element 20 described above, and the elongated groove 14” may otherwise be identical to the elongated groove 14 described above.

In these embodiments, the stop member 20 ”is moved to the fully open position (FIG. 25) by means of a spring or other opening structure (not shown). The stop member 20 ″ is moved between the open position and the full clamp position by axially moving the trigger adapter 150 in the manner described above. As soon as the trigger adapter 150 extends to the fully clamped position (FIG. 26), the surgeon can extend the cutting element 172 ”distally in the manner described above. If the surgeon needs to use the end clamp as a gripping device for manipulating the tissue, he can advance the trigger adapter proximally so that the stop member 20 ”extends from the elongated groove 14” as shown in FIG. 27 dotted line. In this embodiment, as the cutting element 172 ″ extends distally, the upper transverse element 173 ′ and the lower transverse element 175 ′ extend the stop element 20 ″ and the elongated groove 14 ″ together to achieve the desired level of suture brace formation as as the cutting element 172 "extends distally through the end clamp 12". See FIG. 28. Thus, in this embodiment, the formation of the brace occurs simultaneously with the dissection of the tissue, but it is possible to sequentially form the brackets themselves as the cutting element 172 ”extends distally.

FIG. 29 and 30 show the use of a 12 ”end clamp having a 20” thrust member made of, for example, stainless steel, titanium, PGA (polyglycolic acid) or other absorbent plastic having some flexibility. The drawings show the use of a holding matrix 6250 and a leveling matrix 6206, which will be described in more detail below. As can be seen in FIG. 29, the abutment member 20 ″ bends to a fully formed position as the cutting member 172 ″ extends distally through it.

Often during surgical interventions, it is desirable or convenient to use a surgical cutting and stapling apparatus, the end clamp of which can be rotated relative to the elongated barrel assembly. The ability to penetrate hard-to-reach areas using previous articulated devices, however, was often limited by the size and design of the elements used to rotate the end clamp. In FIG. 31 to 40 show another embodiment of the surgical apparatus of the present invention, which is capable of pivoting an end clip relative to an elongated shaft, using a relatively compact articulated steering structure in the handle assembly.

The surgical apparatus 310 of this embodiment is substantially similar to the various embodiments 10 of the surgical apparatus described above, except that this embodiment uses a hinged assembly of the stem 312 to facilitate the selective selection of the location of the end clamp 12 relative to the elongated longitudinal axis A-A. While the surgical apparatus 310 will be described herein when used with the end clamp type 12 described above, those skilled in the art will understand that the surgical apparatus 310 can also be used with a second trigger adapter 150 to drive the end clamp 12 ′ or end clamp of another design. As can be seen in FIG. 31 and 32, the hinge assembly of the barrel 312 includes a distal assembly 314 that is articulated to the proximal part 316 of the assembly, which in working position is connected to the handle assembly 100. In various embodiments, for example, the distal part of the barrel 314 includes a distal axial element 320, in which there is a pair of openings 322 for pins in it, made for engagement with pins 17. See FIG. 32. The distal axial member 320 has a proximal end 324, which includes a hinge support 326, including a hinge pin 328 protruding from it.

As can be seen in FIG. 32, the proximal stem assembly 316 includes a proximal axial segment 330 having a proximal articulated support and a cutting guide 332 attached thereto. The cutting guide 332 may, for example, be welded or attached to the proximal axial segment 330 with glue or other bonding method. In the cutting guide 332 of the proximal articulated support there is a hinge hole 334 for insertion into it, with the possibility of rotation, of the hinge pin 328, to provide rotation of the distal axial segment 320 relative to the proximal axial segment 330 about the first axis of rotation FA-FA, which is substantially perpendicular to the longitudinal AA axis. The surgical device 310 further includes a distal segment 370 of the launch tube, which is pivotally connected to a pair of links 380, 382 of the launch tube to move, rotatably, around the second axis SA-SA. In the distal segment 370 of the launch tube there is a holding hole 372 for receiving the holding button 144 of the first trigger adapter 140. A pair of links 380, 382 of the trigger tube are rotatably connected to the proximal trigger tube 390 to rotate about it, rotatably, around the third rotary axles TA-TA. See FIG. 32.

In various embodiments, the proximal trigger tube 390 is attached to a rotary sleeve 400, which is rotatably attached to a handle assembly 100. See FIGS. 31, 38 and 39. The rotary sleeve 400 may be molded from a polymer or plastic material and include part of the hub 402 and part of the flange 404, which is located at a distance from the part of the hub 402. The nose portion 101 of the handle assembly 100 is inserted between the part of the hub 402 and the part of the flange 404 to allow rotation of the rotary sleeve 400 relative to the handle assembly 100 around the longitudinal axis A-A. In other embodiments, the rotary coupling 400 may be made of other suitable materials. In the described embodiment, both the proximal trigger tube 390 and the proximal axial segment 330 are rigidly attached to the rotary sleeve 400. As can be seen in FIG. 38 and 39, the proximal axial segment 330 and the proximal trigger tube 390 are attached to the rotary sleeve 400 with a pin 406. Thus, the surgeon can rotate the end clip 12 relative to the handle body 100 360 ° about the longitudinal axis A-A by rotating the rotary sleeve 400.

Turning to FIG. 37, 38, and 40, in various embodiments, the end clamp 12 can selectively rotate about the longitudinal axis AA with a pair of hinge controls 420, 430 that are attached to the distal hinge support 326, and a universal ball joint 440 that is supported, rotation, in the socket 408 of the rotary coupling 400. In other embodiments, the control elements of the hinge 420, 430 may include, for example, cables made of cable bundle, nitinol, titanium, etc. The first or right hinge control 420 has a distal end 422, with a tip 424 formed thereon, sized to fit into the first hole for attaching the cable 327, made in the distal hinge support 326. Similarly, the second or left controls the hinge 430 has a distal end 432 with a tip 434 formed on it, the size of which is selected for pressing into a second hole for attaching the cable 329, made in the distal hinge support 326. See FIG. 37. Thus, the end clamp 12 can be rotated to the right side around the first axis FA-FA (FIGS. 35 and 36) by pulling the first or right control element of the hinge 420, and the end clamp 12 can be rotated to the left side around the first axis FA-FA by pushing the second or left hinge control 430. In various embodiments, the right hinge control 420 can slide along the right channel 336 of the cable formed in the proximal axial segment 330, and the left right hinge control 430 can slide inside left th channel 338 of the cable in the proximal axial segment 330.

Turning to FIG. 38-40, the first right hinge control 420 has a proximal end 426 with a locking ball 428, molded or otherwise attached, adapted to be inserted into the first retaining groove 442 in a ball joint 440, which is rotatably supported in a rotating socket 401 couplings 400. Similarly, the second right hinge control 430 has a proximal end 436 with a locking ball 438, crimped therein, or otherwise attached, adapted to be inserted into the second retainer shrinking groove 444 in ball joint 440. As can be seen, in particular, in FIG. 40, a drive groove 446 is made in the ball joint 440, which facilitates the unhindered passage of the proximal segment of the launch tube 390 therein. As shown in FIG. 38, the drive groove 446 may taper from the wider portions 448, 450 of the opening to the passage 452 in the center of the ball joint 440, which provides a sliding passage for the proximal segment 390 of the launch tube. As will be described later, the ball joint 440 is rotatably or pivotally supported in the socket 401 and selectively moves from the neutral position (shown in FIG. 38 by a solid line) to the first or second rotation control position (shown by a dotted line in FIG. 38). The ball joint 440 is also able to axially move in socket 401.

As can be seen in FIG. 40, the surgical instrument 310 may include a locking device, generally designated 453, for locking the ball joint 440 in one of the neutral, first and second rotated positions. In various embodiments, the locking device 453 includes a series of locking locking segments 454 formed on a ball joint 440 to align with locking ribs 410 formed in a recess 408 formed in a portion of the hub 402 oriented in the region of the socket 401 of the rotary coupling 400. Drive passage 412 passes through part of the hub 402 and aligns with the groove 446 of the actuator in the ball joint 440 to align with the proximal segment 390 of the launch tube passing through it. As can be seen in FIG. 38 and 39, the ball joint spring 456 rests on the retaining spring of the hub portion 414 of the rotary coupling 400, the ball joint 440 moves proximally so that the retaining clips 454 engage in retaining engagement with the retaining ribs 410 in the hub portion 402.

To facilitate the application of rotary movements to the ball joint 440, a pair of swivel arms 458, 460 extending to the sides protrude from the ball joint 440 in diametrically opposite directions. In various embodiments, it is possible to make a ball joint 440, for example, of polycarbonate, nylon, Ultem®, without filling, with glass filling, carbon filling, mineral filling, etc., it may have locking tabs 454 cut or cast On him. Rotary handles 458, 460 can be attached to the ball joint 440 by means of a press fitting, a welded joint, etc. This locking design allows you to fix the ball joint 440 in any of the positions - neutral or first and second rotation position. Once the surgeon moves the ball joint 440 to the desired end position of the end clamp, the surgeon can release the ball joint 440 so that the ball joint spring 456 moves the ball joint 440 proximally so that the locking tabs 454 engage in retaining engagement with the locking ribs 410 in the part of the hub 402. In various embodiments, the size of the ball joint spring 456 may be selected so that the ball joint 440 can spring back to the neutral position when the end bar is articulated forcibly retracted through a trocar or similar opening. Moreover, the use of rotary handles 458, 460 allows you to "configure" the degree of rotation for use in specific surgical purposes.

As can be seen in FIG. 38, the first or right rotary handle 458 protrudes through the right slot 416 in the rotary sleeve 400, and the second or left rotary handle 460 protrudes through the left slot 418 in the rotary sleeve 400. To rotate the end clamp 12 relative to the longitudinal axis AA, the surgeon first moves the right and left distal rotation handles 458, 460 of the “DD” direction for disengaging the locking clips 454 from engaging with the locking ribs 410 in the hub portion 402 of the rotary coupling 400. After that, the surgeon can rotate the ball joint 440 by moving I turn the rotary knobs 458, 460 in the desired direction for applying rotary movements to the rotational adjustment elements 420, 430. For example, the end clamp 12 can be rotated to the right by moving the right rotary knob 458 in the proximal direction “PD”, and the left rotary knob 460 in the distal direction “DD” for applying a pulling movement (pivoting movement) to the right pivoting member 420 and pushing motion to the left pivoting member 430. In the same way, the end clamp 12 can be turned to the left by moving the left rotary knob 460 in the proximal direction “PD”, and the right rotary knob 458 in the distal direction “DD” for applying a pulling movement (rotation motion) to the left rotary element 430 and the ejection movement to the left rotary element 420. Various ranges of movements the right and left rotary knobs 458, 460 are shown in broken lines in FIG. 38. In this way, it is possible to optimally position the end clamp 12 in different angular positions, for example, tilting it clockwise or counterclockwise, without the need for rotation or movement of another kind of elongated barrel assembly 40. In FIG. 35 shows an angle α, which in various embodiments can range from 0 ° to 45 °.

Various embodiments of the surgical apparatus 310 include a cutting member 472 that is movably supported within the hollow proximal axial segment 330, and through a supporting cutting member, a slot 333, the width of which is cone-shaped from a narrow proximal portion 335 to a wide distal portion 337 to provide bending the cutting element 472 to facilitate rotation of the end clamp 12 about the longitudinal axis AA. See FIG. 37. In various embodiments, it is possible to manufacture a cutting member 472, for example, from 300 or 400 series stainless steel with a blade 476 for cutting tissue made at its distal end. As can also be seen in FIG. 37, the cutting element 472 slides through the knife slot 473 into the distal rotary base 326. The proximal end 478 of the cutting element 472 is attached to the knife shaft 480, which protrudes through the proximal axial segment 330 to engage, with the possibility of transmitting drive force, with a starting gear 190 as described above. See FIG. 31. The holding pin 406 protrudes into the longitudinal slot 392 (FIG. 38) in the proximal segment 390 of the launch tube and through the hole 339 in the proximal axial segment 330 (FIG. 39), as well as into the longitudinal slot 482 in the knife shaft 480 to allow movement the proximal segment 390 and the knife shaft 480 axially relative to the proximal axial segment 330 and the handle assembly 100. Thus, the surgeon is able to selectively use the cutting element 472 to dissect the tissue using the knife extension trigger 200 ohm described above.

Various articulated designs are disclosed in US Patent Application Serial No. 12 / 775,809, (Dossier of Patent Attorney No. END6755USNP), under the heading “Laparoscopic devices with hinged end clamps,” to Frederick E. Shelton IV, filed May 7, 2010, and in US Patent Application Serial No. 12 / 775,699, (patent dossier No. END6756USNP), under the heading “Bendable barrel for positioning the handle” to Frederick E. Shelton IV et al., Filed May 7, 2010, fully disclosed information about each incorporated herein by reference. In FIG. 41 and 42 show alternative rotary barrel assemblies 490, which are substantially identical to the rotary barrel assembly 340, are used in a substantially similar manner, with the exception of only the intermediate launch tube segment 492, which replaced the starting tube segment 380 used in the rotary barrel assembly 340 . As can be seen in FIG. 41 and 42, the intermediate segment of the launch tube 492 extends from the distal segment 370 of the launch tube to the proximal segment 390 of the launch tube. In various embodiments, it is possible to manufacture an intermediate segment 492 of the launch tube from nylon, isoplast®, or other flexible plastic. In various embodiments, in the intermediate segment 492 of the launch tube there are two longitudinally compressive axial portions 494, of which a plurality of rib segments 496, spaced apart from each other, separated by gaps 498, form a substantially hollow segment of the tube, through which other components of the axial assembly and the cutting element can pass in the working position. Axial parts 494 are configured to transmit compression movement from the proximal trigger tube segment 390 to the distal trigger tube segment 370, of sufficient force to bring the stop member 20 to its fully operational position, while at the same time facilitating the selective rotation of the end clamp 12 relative to the longitudinal axis A-A. The intermediate segment 492 of the launch tube has a distal end portion 491 attached to the distal segment of the launch tube using, for example, pins, cut-out protrusions, latches, etc., as well as the proximal part 493 attached to the proximal segment 390 of the launch tube by similar means . In this embodiment, it is possible to provide an optimal arrangement of the end clamp 12 in different angular positions, for example, by tilting it clockwise or counterclockwise, without the need for rotation or movement of another kind of 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 show another embodiment of the surgical apparatus of the present invention. The surgical apparatus 510 in this embodiment is substantially similar to the embodiment of the surgical apparatus 310 described above, with the exception of some differences that are described below. Although the surgical apparatus 510 is described herein for use with the end clamp type 12 described above, those skilled in the art will understand that the surgical apparatus can also be used with the second trigger adapter 150 to actuate the end clamp 12 ', or can be used with other end clamp designs. Various embodiments of the surgical apparatus 510 include an articulated assembly of the barrel 512 to facilitate the selective location of the end clamp 12 relative to the longitudinal axis A-A. As can be seen in FIG. 43 and 44, the hinge assembly of the barrel 512 includes a distal axial element 520, in which a pair of trunnion openings 522 are provided for inserting the trunnions 17. The distal axial element 520 has a proximal end 521 that is rotatably connected to the distal end 531 the proximal axial segment 530. In particular, at the proximal end 521 of the distal axial segment 520, a pair of spaced distal axial teeth 523 are made that support the hinge pin 524 protruding through the distal end 531 of the pr the maximum axial segment 530, to indicate the axis of rotation AA-AA, which is substantially perpendicular to the longitudinal axis A-A. See FIG. 46.

In various embodiments of the present invention, the end clamp 12 rotates in different directions about the longitudinal axis A-A. For example,

angle α 'in FIG. 47 may vary from 180 ° to 90 °. The end clip 12 is rotated by at least one hinge element 550 that is attached to the hinge link 540. The hinge link 540 is rotatably attached to the distal end 521 of the distal axial segment 520 using the distal pin 542. See FIG. 43. The articulated link 540 is rotatably attached to the distal end 552 of the articulated rod 550 with a pin 554 of the articulated rod, as shown in FIG. 46. As can be seen in FIG. 43, the hinge member 550 protrudes through the hinge assembly of the barrel 512, it has a proximal end 556 that protrudes into a rotary clutch 560 that is rotatably attached to the handle assembly 100. The proximal end 556 of the hinge member 550 is attached to the rotation control or button 558 which is attached, with the possibility of sliding, to the rotary coupling 560 for selective movement in it in the axial direction. Thus, sliding along the axis of the pivot button 558 in the distal direction “DD” will cause the end clamp 12 to rotate about the longitudinal axis A-A in the order shown in FIG. 47. To return the end clamp to its original, non-rotated position, in which the end clamp is coaxially aligned with the longitudinal axis A-A, the surgeon should simply move the drive button 558 in the proximal direction “PD” on the rotary sleeve 560.

As in some of the embodiments described above, the rotary clutch 560 is rotatably attached to a mounting sleeve 570, which is rotatably mounted to the handle assembly 100. See FIG. 43 and 47. A proximal flange 572 and a distal flange 574 are formed on the mounting insert 570, which define a rotating groove 575 that is configured to insert, rotatably, the nose assembly 101 of the handle assembly 100 between them. This design makes it possible to rotate the mounting insert 570 around the longitudinal axis AA relative to the handle assembly 100. The proximal axial segment 530 is rigidly attached with pins or other means (welded, glued, etc.) to the mounting insert 570 so that the rotation of the rotary sleeve 560 around the longitudinal axis AA caused the rotation of the end clamp 12 about the longitudinal axis AA. It is understandable that such a design can facilitate the rotation of the end clamp 12 360 ° around the longitudinal axis A-A.

This embodiment also includes a distal starting tube segment 580 attached to the first starting adapter 140 and axially movable on the distal axial segment 520. In particular, a holding button 144 on the first starting adapter 140 is inserted into the holding hole 581 in the distal starting tube segment 580 in the order described above. The distal trigger tube segment 580 is driven by at least one trigger element attached to it. In a preferred embodiment, the distal trigger tube segment 580 is driven by a pair of trigger strips 582, 584 attached thereto. Trigger tapes 582, 584 are attached to the ribbon support 585 attached to the proximal segment 590 of the trigger tube attached to the trigger clamp 114 in the manner described above. The cover tube 592 also rests on the proximal axial segment 530 and is attached to the rotary sleeve 560 to rotate with it. The proximal trigger tube 590 and the tape support 585 are capable of axial movement relative to the cover tube 592. The trigger strips 582, 584 are slidably inserted into the side ducts 526 for the tapes in the distal axial member 520, as shown in FIG. 44C. In various embodiments, each of the starter tapes 582, 584 includes a thin flexible member that can be made of, for example, stainless steel, and each can push the distal segment 580 of the starter tube to actuate or close the stop member 20 in order, described above, to form the brackets 32 in the implantable block of brackets 30. Actuation of the trigger cables 582, 584 is performed by pressing the trigger lever 130 in the manner described above. When the trigger lever 130 returns to its initial position, the trigger cables 582, 584 are pulled, which causes the first trigger adapter 140 to either pull the stop element 20 to the open position or move it to the position where the spring (not shown) moves the stop element 20 to open position.

The surgical device 510 may also include a surgical knife 534, which is supported, with the possibility of movement, in the supporting slot 528 for the knife in the distal axial segment 520. See FIG 44B. In various embodiments, it is possible to produce a cutting element 534, for example, from stainless steel of a series 300 or 400, etc. with a blade 535 for cutting tissue made at its distal end. The cutting element 534 is attached to the strip 536 of the cutting element, which can be made of stainless steel series 300 or 400. The strip of the cutting element can, for example, be made of stainless steel with a thickness of 0.178-0.3005 mm (0.007-0.012 inches), more hardened, than the material the rod is made of. The cable 536 of the cutting element passes through the distal axial element 520 and the proximal axial segment 530, it is attached to the shaft 480 of the knife, which engages, with the possibility of driving, with the starting gear 190, as described above. Thus, the surgeon is able to selectively use the cutting element 534 to dissect the tissue using the trigger mechanism 200 to extend the knife in the manner described above. In various embodiments, it is also possible to use a corrugated security element 594 to prevent the ingress of dirt, fabric, foreign particles, etc. swivel. See FIG. 48.

In FIG. 49-53 show another embodiment of the surgical apparatus of the present invention. The surgical apparatus 610 in this embodiment is substantially similar to the embodiment of the surgical apparatus 10 described above, with the exception of some of the differences that are described below. Surgical apparatus 610 is configured to actuate an end clamp 612 having two movable branches 613, 615. In various embodiments, the end clamp 612 is attached to an elongated barrel assembly 655 that protrudes from the handle assembly 100. See FIG. 49. The elongated barrel assembly 655 includes an elongated axial portion 658 and an elongated covering tube 680, which is capable of axial movement along the axial portion 658 in the proximal and distal directions. As shown, the elongated barrel 655 protrudes distally from the handle assembly 100, generally in a straight line along the longitudinal axis A-A. In various embodiments, the elongated barrel assembly 655 may be approximately 228.8 mm to 406.4 mm (approximately 9 to 16 inches) long. However, it is possible to use the elongated barrel assembly 655 of a different length.

Turning to FIG. 50 and 51, in various embodiments, the lower jaw 613 of the end clamp 612 includes an elongated groove 614, and the upper jaw 615 includes a stop member 620. The elongated gutter 614 has a pair of side walls 616 spaced apart from each other, each of which ends protruding upward by pressing ends or tips 618. It is possible to manufacture an elongated groove 614, for example, of stainless steel 17-4 or 400 series, its size is selected in order to maintain in it in position the bracket block 630 or the bracket block another ormy. The stop element 620 may be made of stainless steel 416, 17-4, 17-7, etc. In at least one embodiment, for example, both the end clamp 612 (in the closed position) and the oblong barrel assembly 655 have a maximum outer diameter that allows the device to pass through an opening in working position whose diameter is at least about 8-12 mm (approximately 0.31-0.47 inches). However, it is possible to use end clamp 612 and elongated barrel assembly 655 of a different diameter and shape. The end clamp 612 also includes a distal axial segment 660, which is adapted to releasably attach to the distal end of the proximal axial segment 670, as will be described below.

The stop member 620 has a suture-forming part 622 in which the recesses forming the staple are made. In addition, the thrust member 620 has a bifurcated locking portion 624 including at least one, and preferably a pair of downwardly pressing compression tips 625. As can be seen in FIG. 50-53, in at least one embodiment, the compression ends 625 and the corresponding compression ends or ends 618 of the elongated groove 614 are pivotally mounted on the axial protrusions 663 of the bifurcated distal end 662 of the distal axial segment 660 (FIG. 55) of the axial assembly 658 with a finger The hinge 626 so that when viewed from the side, the compression tips 625 and the compression tips 618 form a movable, scissor-like compressive structure, generally designated 628. In other embodiments, movable attachment is possible the thrust element 620 to the elongated groove 614.

Various embodiments of end clamp 612 also include an axially movable cutting element assembly 640, which includes a knife plate 642 having a pair of knife holders 644 spaced apart from each other and protruding from it and configured to slide axially between axial protrusions 663 distal axial segment 660. See FIG. 55. The cutting element 646 is attached to the distal ends of the knife holders 644, or is formed on them in another way. In various embodiments, it is possible to manufacture knife holders 644 and a cutting member 646, for example, of a 300 or 400 series stainless steel. A fabric cutting blade 648 is formed at the distal end of the cutting member 646. The lower portion 649 of the cutting member 646 is configured to engage with a slide 650 leading the suture brackets 650, located within the elongated barrel 614 with the possibility of movement. The slide 650 driving the brackets can be fixed in a groove or group of grooves (not shown) in the elongated groove 614 to facilitate axial movement of the slide 650, moving the suture brackets from the starting position (FIG. 50-52) to the final position (FIG .53), remaining attached to the elongated groove 614. On the slide 650, which drives the brackets, there is a surface or surfaces 652 that move the brackets, which are oriented to contact the brackets 632 in the block of brackets 630 and move the brackets 632 to Before forming the bracket in the direction of portion 622 of anvil member 620, to the extent that the cutting element 646 extends distally through a terminal connector 612.

Also, in various embodiments, the distal axial nut 668 is rotatably attached to the proximal end 664 of the distal axial segment 660 for rotational movement about it about the longitudinal axis A-A. The distal axial nut 668 has a pair of inwardly directed pins 669, the size of which is selected to fit into the corresponding grooves 674 for the pins 674 at the distal end 672 of the proximal axial segment 670, which protrudes from the handle assembly 100 to allow rotation of the distal axial segment 660 relative to the proximal axial segment 670. As can be seen in FIG. 49, the proximal axial segment 670 is attached to a rotary sleeve 70 (via a pin 66) that is mounted rotatably to the handle 100 in the manner described above to facilitate 360 ° rotation of the end clamp 612 about the longitudinal axis A-A.

As can be seen in FIG. 49, a flange 676 is formed at the proximal end 671 of the proximal axial segment 670. The flange 676 is configured to lean, rotatably, within a groove 106 formed by mating ribs 108 that protrude inwardly from each housing member 102,104. This design facilitates the attachment of the proximal axial segment 670 to the handle 100, while allowing the proximal axial element 670 to rotate relative to the handle 100 around the longitudinal axis A-A by 360 °. The proximal segment 682 of the closure tube may be made of polymer or other suitable material, it has a proximal end 683, which is attached to the trigger collar 114, which is designed and movably mounted in the Assembly of the handle 100 in various ways described above. In various embodiments, for example, the launch collar 114 may be formed on the proximal segment 683 of the closure tube 682. However, a different attachment structure may be used. As described above, the launch collar 114 may be rotatably supported by a support collar 120, which is configured to axially move within the handle 100. As shown in FIG. 49, a longitudinal groove 681 extends through the proximal segment 682 of the closure tube to allow the axial pin 66 to exit through it to the proximal axial segment 670, while facilitating the axial movement of the proximal segment 682 of the closure tube on the distal axial segment 670.

As can be seen in FIG. 49, the trigger portion 130 has an upper portion 134 that is pivotally attached to the trigger links 636, 638 pivotally attached to the support collar 120. Thus, moving the trigger lever 130 toward the pistol grip portion 107 of the handle 100 causes the trigger clip 114 to move proximal segment 682 of the closure tube in the proximal direction “PD” (shown by the dotted line in FIG. 49). Thus, moving the clamping and release lever 130 away from the pistol grip part 107 of the handle 100 causes the trigger clamp 114 and the trigger tube 110 to move in the proximal direction “DD” on the proximal axial segment 670.

As seen in FIG. 50-53, the proximal segment 682 of the closure tube has a distal end 684 configured to attach to the proximal end 692 of the distal segment 690 of the closure tube. In the illustrated embodiment, the distal closure tube segment 690 is configured to threadedly connect to the distal end 684 of the proximal closure tube segment 682. At the distal end 694 of the distal segment 690 of the closure tube, there is a tapering drive member 696 configured to interface with the scissor-like clamping structure 628 so that the distal segment 690 of the closure tube occupies the position shown in FIG. 51, a spring or spring clips 617 located between the elongated groove 614 and the stop member 620 serve to move the stop member 620 to the open position shown in this figure. However, when the distal segment 690 of the closure tube is pulled in the proximal “PD” direction, the tapering drive member 696 comes into contact with the scissor-like clamping structure 628 to move the jaws 613 (longitudinal groove 614) and 615 (thrust member 620) towards each other. See FIG. 52 and 53.

The surgical device 610 may also include a surgical knife extension system 639, including a knife shaft 700 protruding through the proximal axial segment 670, and a proximal end portion 702 that is coupled, with the possibility of transmitting drive force, to the starting gear 190, which is connected in working position to the trigger mechanism 200 of the extension of the knife in the manner described above. Thus, the surgeon can extend the knife shaft 700 distally by pressing the trigger mechanism 200 to extend the knife, as described above. As can be seen in FIG. 52 and 53, the distal end 704 of the knife bar 700 is bifurcated and includes an upper segment of the knife bar 706 and a lower bar segment 708 made for bonding with the knife plate 642. As can be seen in FIG. 51-54, the upper knife shaft segment 706 is slidable through the upper groove 773 of the axial washer 668, and the lower knife shaft segment 708 is slidable through the lower groove 775 of the axial washer 668.

To use the surgical device 610, an end clamp 612 is attached to the distal end 672 of the proximal axial segment 670 by inserting the pins 669 on the axial nut 668 into the corresponding openings 674 for the pins in the proximal axial segment 670. See FIG. 50. Thereafter, the surgeon or clinician can rotate the end clamp 612 relative to the elongated barrel assembly 655 to threadedly connect the distal segment 690 of the closure tube to the proximal segment 682 of the closure tube to form the assembly of the closure tube 680. An end bracket 630 may have a bracket block 630 , or the clinician can install the bracket unit in the elongated groove 614 at this time or later. As soon as the end clamp 612 is attached to the elongated barrel 655 of the surgical device 610, the surgeon can insert the end clamp 612 and the elongated barrel 655 through the passage to access the patient’s body (for example, through a trocar or endoscope, etc., or through an incision - in case of open surgical intervention) to capture tissue between the jaws 613, 615 of the end clamp. In the various embodiments described above, the jaws 613, 615 are closed by moving the trigger lever 130 relative to the pistol grip 107 of the handle 100. After grabbing the target tissue between the jaws 613, 615 of the end clamp, the surgeon can “actuate” or form brackets 632 in the target tissue by pressing the stop element 620 into the block of brackets 630 in the manner described above. If the procedure does not require dissection of the target tissue, the surgeon can release the trigger lever 130 to allow the thrust element 620 to move to the open position (under the action of the spring 617), and thereby release the implantable block of brackets 630 from the end clamp 612. The surgeon can then re- close the jaws 613, 615 of the end clamp to allow removal of the end clamp 612 through the access hole or working channel. If, however, the surgeon needs to cut the target tissue between the rows of brackets 632, the surgeon can actuate the scalpel assembly 640 using the trigger lever 200 in the manner described above to distally insert the cutting element 648 through the target tissue. As the cutting element 648 moves distally through the end clamp 612, it comes in contact with the slide 650, which drives the brackets, which serve to further advance the brackets 632 to achieve forming contact with the bracket-forming surface 622 of the stop member 620 for further folding brackets 632. See FIG. 53. Following this, the surgeon can open the end clamp 612 to release the dissected / stapled target tissue and the implantable block of brackets 630 from it.

Thus, the unique and innovative design of the closure tube, which closes the jaws of the end clamp by distal movement of the closure tube, allows the use of smaller closure structures while maintaining the ability to create significant closure force required to bend surgical braces. In addition, this embodiment of the present invention provides the surgeon with the ability to stitch the tissue with brackets without dissecting it in cases where the intervention does not require excision of the tissue.

In FIG. 56-60 show an alternative embodiment of a surgical device 810, which is substantially identical to the surgical device 610 described above, except for the differences disclosed below. Surgical apparatus 810, for example, includes a flexible axial component 820 having a proximal end with a flange 822 on it, which is inserted, rotatably, into a groove 106 formed by adjacent ribs 108 protruding inwardly from each body member 102, 104 forming a handle 100 See FIG. 57 and 58. This mounting structure facilitates rotational movement of the flexible axial component 820 relative to the handle 100. In various embodiments, the flexible axial component 820 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, liquid crystalline polymer, stainless steel, titanium , etc., and can be performed for use with the end clamp 612 of the type described above.

Surgical apparatus 810 also includes an elongated trunk assembly, generally designated 830. In various embodiments, for example, an elongated trunk 830 includes a variable configuration segment 840 of the trunk and a proximal segment of the trunk 844. As can be seen in FIG. 56, for example, a reconfigurable barrel segment 840 may have a distal mounting sleeve 842 that is rigidly attached to a portion of the movable axial component 820 using, for example, glue, welding, fasteners, and the like. The segment of the variable configuration 840 of the barrel can selectively take a linear configuration in which all parts of the segment of the variable configuration 840 are substantially coaxially aligned with each other (i.e., they form a substantially direct hollow tubular structure), and configurations in which at least one of the parts is not aligned coaxially or linearly with the other part of the reconfigurable segment 840. In the embodiment depicted in FIG. 56, for example, a reconfigurable barrel segment 840 may be made of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, and the like. and have a set of ribs 846 that facilitate changing the configuration of segment 840 from orientation in a linear direction, or along axes, to a non-linear orientation or non-coaxial orientation (e.g., spiral, curvilinear, etc.) and maintaining that orientation until the user reconfigures barrel segment 840 manually or through the use of other surgical devices, such as gripping devices and the like. Thus, the reconfigurable barrel segment 840 is “passively rotatable”, which means that the device is not equipped with hinge means for actively controlling the rotation of segment 840.

In various embodiments, the proximal trunk segment 844 is attached to the reconfigurable trunk segment 840, for example, using interlocking components or pins, and serves to facilitate the rotatable reconfiguration of the trunk segment 840 to the handle 100. In at least one embodiment, for example, the proximal trunk segment 844 is attached to a mounting insert 60, which is rotatably attached to the handle 100, as described above. See FIG. 57 and 59.

Also in various embodiments, the closure tube segment 832 is movably mounted on a portion of the flexible axial assembly 820 to selectively move thereon. See FIG. 56 and 60. As can be seen in FIG. 60, in at least one embodiment, the closure tube segment 832 and the axial component 820 are formed with parts 833, 821 flanked on opposite sides, respectively, so as to prevent the closure of the closure tube segment 832 from the axial component 820, which remains movable mounted on it. In various embodiments, a flexible closure member 848 is attached to, or forms part of, a mounting flange 114. See FIG. 57 and 59. The flexible clamping member 848 may be made of, for example, stainless steel, etc., and have a distal end portion 849 that extends through an elongated groove 834 in the axial assembly 820 to join 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” on the axial component 820 by actuating the release lever 130 in the manner described previously.

As can be seen in FIG. 56, surgical device 810 can be used with end clamp 612, which has been described in detail previously. In particular, the end clamp 612 may be removably attached to the flexible axial member 820 by inserting the trunnions 669 on the axle nut 668 into the corresponding trunnion openings 825 at the distal end 825 of the axial member 820. See FIG. 60. The distal end 835 of the distal closure tube segment 832 is threadedly connected to the proximal end 692 of the distal closure tube segment 690 in the manner described above.

In at least one embodiment, the surgical apparatus 810 may also include a surgical knife extension system 639, comprising a knife shaft 700 protruding through the proximal axial component 820, and a proximal end portion 702 that is coupled, with the possibility of transmitting drive force, to the starting gear 190, attached in working position to the trigger mechanism 200 extension of the scalpel in the manner described above. Thus, the surgeon can extend the scalpel shaft 700 distally by pressing the scalpel extension trigger 200, as described above. The distal end 704 of the scalpel shaft 700 is bifurcated and includes an upper segment of the scalpel shaft 706 and a lower shaft segment 708 made for bonding with the scalpel plate 642. See FIG. 60.

To use the surgical apparatus 810, an end clamp 612 is attached to the distal end 823 of the axial component 820 by inserting the trunnions 669 on the axial nut 668 into the corresponding trunnion openings 825. After that, the surgeon or the clinician can rotate the end clamp to screw the distal segment 690 of the closure tube to the segment 832 of the closure tube. An end brace 630 may be included in the end clamp 612, or the clinician may install the brace block in the elongated groove 614 at this time. As soon as the end clamp 612 is attached to the elongated closure tube 830 of the surgical device 810, the surgeon can configure the reconfigurable trunk segment 840 so so that the parts of the elongated trunk are aligned coaxially for insertion through an opening or working channel into the patient’s body (for example, through a trocar or endoscope, etc., or through an incision in case of open surgery). After that, the surgeon can reconfigure the reconfigurable segment 840 of the trunk so that its parts are not coaxial relative to each other to orient the end clamp 612 attached to it in the desired position relative to the target tissue. As in the various embodiments described above, the jaws 613, 615 are closed by moving the trigger lever 130 relative to the pistol grip 107 of the handle 100. After grabbing the target tissue between the jaws 613, 615 of the end clamp, the surgeon can “start” or bend the brackets 632 in the target tissue by pressing the stop member 620 into the bracket block 630 in the manner described above. If the procedure does not require dissection of the target tissue, the surgeon can release the trigger lever 130 to allow the thrust element 620 to move to the open position (under the action of the movement of the spring 617), and thereby release the implantable block of brackets 630 from the end clamp 612. The surgeon has the opportunity then re-close the end clamp jaws 613, 615 and reconfigure the reconfigurable barrel segment 840 to allow extraction of the end clamp 612 through the access hole or working channel. If, however, the surgeon needs to cut the target tissue between the rows of suture staples 632, the surgeon can trigger the scalpel assembly 640 using the trigger lever 200 in the manner described above to distally insert the cutting element 648 through the target tissue. As the cutting element 648 moves distally through the end clamp 612, it comes in contact with the slide 650, which drives the brackets, which serve to further advance the brackets 632 to achieve forming contact with the bracket-forming surface 622 of the stop member 620 for further folding brackets 632. Following this, the surgeon can open the end clamp 612 to release the dissected / stapled target tissue and the implantable block of brackets 630 from it.

In FIG. 61 and 62, another embodiment of a surgical apparatus 810 'is shown, which is substantially identical to the surgical apparatus 810 of the embodiment described above, with the exception of a reconfigurable trunk segment 850, which includes a portion of the elongated trunk 830', attached in working position to the handle 100 for operation with end clamp. In various embodiments, the reconfigurable barrel segment 850 includes a plurality of tubular links 852 movably connected to each other. Each tubular unit 852 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate filled with glass or carbon, etc., and have a part of the tubular body 854. On the part 854 of the tubular body can be made spherical or spherical connecting part 856, in which there is a passage 858 for inserting an axial element. In addition, the tubular passage 858 for inserting the axial element extends into a concave seat 860 formed on the tubular body part 854, the size of which allows the spherical connecting part 856 of the adjacent tubular link 852 to be movably inserted. The size of the spherical connecting parts 856 is selected relative to the sockets 860 so that the spherical the connecting part 856 could snap into it and remain in the desired configuration, in which the barrel segment is located essentially in a straight line, or configurations in which par 850 may have a curved (FIG. 62) or a spiral shape (FIG. 61).

While the sizes of the spherical connecting parts 856 and the sockets 860 can be selected relative to each other to create a slight frictional force between them, which can keep the segment 850 in the desired orientation until an external force is applied to it, in the embodiment shown in FIG. . 60 and 61, a locking system 862 is used to hold, with the possibility of releasing or immobilizing the tubular links 852, together in the desired configuration. As can be seen in these figures, the locking means 862 include at least one, and preferably several flexible locking tabs or elements 864 formed around the perimeter of one end 853 on the adjacent tubular link 852. In the preferred embodiment, four locking tabs 864 are used. In others embodiments, it is possible to use 1, 2, 3 or more than four locking protrusions 864. Each tubular link 852 also includes a locking element 866 corresponding to each locking protrusion 864 adjacent to another at the end 865 of link 852. On each locking element 866 there is a recess 868 for inserting a locking protrusion into it, configured to insert, with the possibility of releasing, part of the corresponding locking protrusion 864 formed on the adjacent tubular link 852.

For the use of surgical apparatus 810 ', an end clamp 612 is attached to the distal end 823 of the axial component 820 in the manner described above. The distal closure tube segment 690 of the end clamp 612 is screwed onto the closure tube segment 832. Once the end clamp 612 is attached to the elongated closure tube 830 of the surgical device 810 ′, the surgeon can continue to configure the reconfigurable trunk segment 850 so that parts of the oblong trunk are coaxially aligned for insertion through the opening or working channel into the patient’s body (for example, through a trocar or endoscope and etc., or through an incision - in case of open surgery). After that, the surgeon can use, for example, a gripping tool 869 to configure the movable links 852 of the reconfigurable trunk segment 850 in the desired orientation, and then press the corresponding locking protrusions 864 on each link 852 into their corresponding recesses 868 to insert the locking protrusions to block the links 852 in the desired orientation. See FIG. 62. In the various embodiments described above, the jaws 613, 615 are closed by moving the trigger lever 130 relative to the pistol grip 107 of the handle 100. After grabbing the target tissue between the jaws 613, 615 of the end clamp, the surgeon can “trigger” or bend the brackets 632 to the target tissue by pressing the stop element 620 into the block of brackets 630 in the manner described above. If the procedure does not require dissection of the target tissue, the surgeon can release the trigger lever 130 to allow the stop element 620 to move to the open position (under the action of the movement of the spring 617), and thereby release the implantable block of brackets 630 from the end clamp 612. The surgeon can then re-close the end clamp jaws 613, 615 and use the grasping tool 869 to release the locking protrusions 864 from the respective recesses 868 for inserting the protrusions to ensure alignment of the links 852 and so that the device can be removed through the access hole or the working channel. If, however, the surgeon needs to cut the target tissue between the rows of suture staples 632, the surgeon can actuate the scalpel assembly 640 by pressing the release lever 200 in the manner described above to distally insert the cutting element 648 through the target tissue. As the cutting element 648 moves distally through the end clamp 612, it makes contact with the slide 650, which drives the brackets, which serve to further advance the brackets 632 to achieve forming contact with the bracket-forming surface 622 of the stop member 620 to further bend the brackets 632. Following this, the surgeon can open the end clamp 612 to release the dissected / stapled target tissue and the implantable bracket block 630 from it.

In FIG. 63-68, an embodiment of a surgical apparatus 810 ”is shown, which is substantially identical to the embodiments of the surgical apparatus 810, 810 'described above, with the exception of the reconfigurable trunk segment 870 and the corresponding oblong stem assembly blocking system 882. In various embodiments, the reconfigurable trunk segment 870 includes a plurality of tubular links 872 movably connected to each other, and is attached to the proximal trunk segment 871 attached to the mounting insert 60 to provide support for rotation within the handle 100, as disclosed in detail above. Each tubular unit 872 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate filled with glass or coal, etc., and have part of the tubular body 874. See FIG. 67. On the part 874 of the tubular body, a sphere-shaped or spherical connecting part 876 may be provided, in which there is a passage 878. In addition, the tubular passage 878 for inserting the axial element extends into a concave socket 880 formed on the part 854 of the tubular body, the size of which allows movable insert the spherical connecting part 876 of the adjacent tubular link 872. The size of the spherical connecting parts 876 is selected relative to the sockets 880 so that the spherical connecting part 876 can snap into place vatsya in a desired configuration in which the reconfigurable segment 870 of the barrel is located substantially on a straight line (FIG. 67) with respect to the configurations at 870 which may be curved (FIG. 68) or a spiral shape configuration.

While the sizes of the spherical connecting parts 876 and the sockets 880 can in at least one embodiment be selected relative to each other to create a slight frictional force between them, which can hold the tubular links 872 of the reconfigurable barrel segment 870 in the desired orientation, while no external force will be applied to it, in the embodiment depicted in FIG. 63 and 68, a locking system 882 is used to hold, with the possibility of release, or still locking the tubular links 872 together in the desired configuration. As can be seen in FIG. 67 and 68, the blocking means 882 include at least one, and preferably two, selectively expanding blocking diaphragms 884 that extend through the tubular links 872 in diametrically opposite positions. In various embodiments, the blocking diaphragms 884 can be made, for example, of a nylon film and the like, and are adapted to receive fluid under pressure from a fluid source under pressure 886. In the embodiment shown in FIG. 64, the pressure source fluid 886 includes a fluid pump unit 888 adapted to supply pressurized air to the orifice plates 884. In particular, in at least one embodiment, the fluid pump unit 888 includes a cylinder 889 with a piston 890 inside . On the piston 890 there is a sealing ring or other sealing device 891 around the perimeter, it is attached to a threaded pump handle 892, which is screwed onto a part of the handle 100. Thus, when the pump handle 892 is screwed onto the handle 100, air in the cylinder 890 is supplied under pressure to a supply pipe 893 that extends from the cylinder 890 to the manifold system 894 connected to the axial component 820. The air pressure in the blocking orifices 884 can be weakened by unscrewing the pump handle 894 in the opposite direction.

As can be seen in FIG. 65, the collector system 894 includes a collector circular region 895, which is sealed on each side by o-rings or other gaskets 896. The collector circular region 895 communicates with a feed line 897 that passes through the proximal segment 871 of the barrel and which is connected to the holding chambers for release 884. This design serves to supply pressurized air to the holding chambers 884, while simultaneously facilitating the rotational movement of the axial component 820 around the longitudinal axis AA relative to the ru Ojať 100. As used herein, the term pressurized fluid may imply, for example, air, saline or, preferably, glycerin. In alternative embodiments, the tubular elements may be filled with very soft rubber or elastomer. When pressure is applied to the rubber material, it deforms, filling voids and blocking the barrel to a large extent, as in the embodiment using a fluid.

For the use of the surgical apparatus 810 ”, the end clamp 612 is attached to the distal end 823 of the axial component 820 ′ in the manner described above. The distal closure tube segment 690 of the end clamp 612 is screwed onto the closure tube segment 832. As soon as the end clamp 612 is attached to the elongated shaft 830 "of the apparatus 810", the surgeon can configure the reconfigurable segment of the barrel 870 so that the parts 830 "of the elongated trunk are aligned coaxially for insertion through the opening or working channel into the patient’s body (for example, through a trocar or endoscope and etc., or through an incision - in case of open surgery.) After this, the surgeon can use, for example, a gripping tool to configure the movable links 872 of the reconfigurable seg enth of the barrel 870 in the desired orientation: After orienting the reconfigurable barrel segment 870 in the desired direction, the surgeon can then twist the pump handle 892 on the handle body 100 to pressurize the holding chambers 884 to lock the movable links 872 in place, as shown in FIG. 68. In the various embodiments described above, the jaws 613, 615 are closed by moving the trigger lever 130 relative to the pistol grip 107 of the handle 100. After capturing the target tissue between the end jaws 613, 615 The surgeon may “actuate” or bend the brackets 632 in the target tissue by pressing the abutment element 620 into the bracket block 630 in the manner described above. If the procedure does not require dissection of the target tissue, the surgeon can then release the trigger lever 130 to allow the thrust element 620 to move to the open position (under the action of the movement of the spring 617), and thereby release the implantable block of brackets 630 from the end clamp 612. The surgeon can then re-close the end clamp jaws 613, 615 to relieve pressure in the holding chambers 884 by unscrewing the pump handle 892 in the opposite direction. You can use a gripping tool to give the movable links 872 essentially coaxial orientation (FIG. 67) or other orientation necessary to remove the device from the patient’s body. If, however, the surgeon needs to cut the target tissue between the rows of suture staples 632, the surgeon can actuate the scalpel assembly 640 by pressing the release lever 200 in the manner described above to distally insert the cutting element 648 through the target tissue. As the cutting element 648 moves distally through the end clamp 612, it makes contact with the slide 650, which drives the brackets, which serve to further advance the brackets 632 to achieve forming contact with the bracket-forming surface 622 of the stop member 620 for further folding brackets 632. Following this, the surgeon can open the end clamp 612 to release the dissected / stapled target tissue and the implantable block of brackets 630 from it.

The various embodiments disclosed herein, including a reconfigurable trunk segment, represent a significant improvement over traditional articulated surgical apparatus designs that utilize lockable articulated joints. Such surgical devices usually have a limitation of 1 or 2 degrees in the freedom to place the end clamp in the dissection field. Various embodiments of the present invention allow the use of a wider range of possible positions of the end clamp, and, therefore, provide the surgeon with a much greater degree of flexibility when using a device inserted through a single laparoscopic access.

The unique and innovative properties of various surgical brace blocks and surgical devices of the present invention allow brackets to be placed in these blocks in one or more linear and non-linear rows. Many of these rows of suture brackets can be located on each side of the elongated groove, which is located inside the block of brackets for passing through it a cutting element that dissects the tissue. In one design, for example, surgical braces in the same row can be located substantially parallel with the brackets in the adjacent row (s) of braces, but with an offset from them. In still other embodiments, one or more rows of brackets may be nonlinear. In other words, the base of at least one suture bracket in a row of brackets may be located along an axis that is substantially transverse to the bases of other brackets in the same row of brackets. For example, as will be described in more detail below, in alternative embodiments, the rows of brackets on each side of the elongated groove may have a zigzag shape. Such a non-linear arrangement of the brackets was probably made possible due to the fact that the brackets do not extend upward into the stop element. Instead, in these various embodiments, the thrust member extends to enter forming contact with the tips of the fixed brackets. Such a non-linear arrangement of suture brackets can help achieve better stitching results using fewer staples compared to the different types of linear staples used in previous brace blocks, in which the brackets are pushed up to enter forming contact with the stop element.

In FIG. 69 shows an embodiment of a surgical block of brackets 900 in an embodiment of an end clamp 612 ′ of the present invention. The end clamp 612 'can be used when attached to the surgical device 610 in various ways described above. End clamp 612 'may be identical to end clamp 612, as described above, except for the differences described below. As can be seen in FIG. 69 and 70, an embodiment of a surgical block of brackets 900 includes a block body 902 located in the center of an elongated groove 904 passing through the proximal end 903 to an area adjacent to the distal end 605. The elongated groove 904 is configured to facilitate axial movement through it scalpel canvases 646 of the surgical device 610 during tissue dissection in the manner described above. In at least one embodiment, the bracket block body 902 is made of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or bioabsorbable foam made, for example, of PGA (polyglycolic acid sold under the brand name Vicryl ), PCL (polycaprolactone), PMA (polylactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanate), PHCL (polyglecapron 25 sold under the trade name monocryl) or various composite mixtures of PGC, PCL, PMC and PDS, in which rows 920, 930 of unformed brackets 922 are laid. However, the case of the bracket block 902 can be made of other materials that serve to support the unformed brackets 922 in the desired orientation so that they bend when they come in contact with the stop element 910. As with various other options of the implementation described above, the bracket unit 900 is implantable and remains attached to the stitched tissue after completion of the stapling procedure. In at least some embodiments, to prevent the suture brackets 922 from being exposed and the hemostatic material to be activated during the insertion and positioning process, the bracket block 900 can be completely coated or wrapped in a biodegradable film 906, such as a polydioxanone film, marketed under the brand name PDS®, or a polyglycerol sebacinate film (PGS) or other biodegradable films made, for example, from PGC (polyglycolic acid sold under trade Vicryl brand name), PCL (polycaprolactone), PMA (polylactic acid), PHA (polyhydroxyalkanate), PHCL (polyglecapron 25 sold on the market under the brand name monocryl) or composite materials PGK, PKL, PMK, PDS, which remain impermeable to them the gap. The size of the housing 902 of the bracket unit 900 is selected so as to be positioned in an elongated groove 614 of the end clamp 612 '.

In the embodiment depicted in FIG. 69, 73 and 74, the suture block 900 holds the first row 920 of brackets 922 on one side 907 of the elongated groove 904 and the second row 930 of brackets 922 on the other side 909 of the elongated groove 904. 922 from a metal material such as, for example, titanium, titanium alloys (for example, grade 5 titanium (6AI-4V), grade 9 titanium (3Al-2.5V), stainless steel, etc., the bracket has a base 924 brackets and two legs 926 protruding from it upward. Each bracket leg 926 may have a piercing the fabric tip 928 formed on it. In the first row 920 of brackets 922, the base of the suture bracket 924 of at least one suture bracket 922 overlaps the base of the other suture bracket 922. In a preferred embodiment, the base 924 of the bracket of each of the brackets 922 overlaps the base 924 two adjacent brackets 922, with the exception of the base 924 of the last suture bracket 922 at each end of the first row of brackets 920. See FIG. 73. Thus, the shape of the first row of 920 suture brackets is substantially non-linear. More specifically, when viewed from above, the appearance of the first row 920 of brackets is essentially zigzag.

As can be seen in FIG. 72, the stop member 90 has two successive longitudinal brace-forming recesses 912, each of which has a substantially zigzag shape corresponding to the shape of the first row 920 of brackets 922 so that when the stop member 910 extends into forming contact with the brackets 922, legs 926 were formed in accordance with the image in FIG. 74. Thus, the distal leg of one bracket falls into the same recess as the proximal leg of the next bracket in the longitudinal direction. This design provides a denser arrangement of the recesses, even at the point where the brackets themselves act on each other (for example, bending one above the other). In previous designs of recesses for brackets, in General, it was required to provide from 0.127 to 0.381 mm (0.005 and 0.015 inches) of metal / distance from one set of recesses to another. In this embodiment of the present invention, however, the spatial gaps are from 0 to 0.51 mm (0 to 0.02 inches) of the joint / overlap (essentially -0.051 cm (-0.020 ”)) since one bracket joins the next bracket . This design allows you to use 15-30% more brackets in one area. Moreover, when brackets are attached to each other, the need for multiple side rows of brackets is reduced. Previous designs typically used three rows on each side of the tissue dissection line to prevent the formation of an open area through which bleeding could begin. If the brackets in the rows are linked to each other, the likelihood of a section through which bleeding can begin is reduced. Another clear advantage obtained by varying the placement of brackets interlocking with each other according to the present invention is the increase in “tensile strength” associated with the level of force required to break a number of brackets.

Another design of the suture-forming cavity in the present invention may include a single bracket-forming cavity. As used herein, the term “single brace-forming recess” means that a single brace-forming groove can form all brackets in the same row of brackets, as opposed to the previous stop element designs in which a separate bracing is provided for each leg of each bracket to be formed.

In FIG. 75 shows yet another embodiment of the suture bracket 922 ′ in which there is a curved portion 928 at the base 924 ′ to allow for a more tight fit of the bases 924 ′ on top of each other. As indicated above, in the bracket block 900 there is a second row 930 of brackets 922 supported by a second lateral side 909 of the elongated groove 904. The second row 930 of brackets 922 is substantially identical to the first row 920 of brackets 922. Thus, a second single forming element is formed in the stop element 910 brackets recess 912, which corresponds to the second row of brackets 930, to form a contact between them. In alternative embodiments, however, the second row 930 of brackets 922 may differ from the first row 920 of brackets in shape and possibly in the number of brackets.

In FIG. 71 shows the surgical brace block 900 ′, which is substantially identical to the brace block 900 described above, with the exception of the rows of brackets 922 ′ therein 922. For example, in this embodiment, the row 920 ′ of braces 922 is positioned relative to each other so that the SS axis of at least one bracket base 924 is substantially transverse to the SS axis of the base 924 of at least one other adjacent bracket 922. Such a predetermined arrangement of the brackets, when viewed from above, has a substantially zigzag shape. In the embodiment depicted in FIG. 76, the respective bases 924 of the brackets 922 may further have a base supporting member 927 molded from above, as shown. In various embodiments, the base support member 927 may be made, for example, of non-absorbable plastic, such as PEEK polyetheretherketone or absorbable plastic, such as, for example, polyglycolic acid “PHC”, polylactic acid “PMA”, polydioxanone “PDS” , PCL (polycaprolactone), PHA (polyhydroxyalkanate), PGCL (polyglecapron 25 sold under the trade name monocryl) or various composite mixtures of PGS, PDS, PMK, PGK and PKL. The base supporting elements 927 facilitate the engagement of the brackets with each other without brackets overlapping. Thus, such constructions allow bending the bracket into a “B” -shaped shape or an inverted “W” -shaped form without superimposing the legs of the brackets on top of each other. However, the ridges are connected by supporting the base elements, therefore, they act as overlapping brackets. This design provides two separate paths for each leg in combined recesses.

In the embodiment depicted in FIG. 77, a row of 920 ”brackets is used in which the legs 926 of adjacent brackets 922 are joined together by a connecting portion 929 that is molded or otherwise attached to them. Each connecting part 929 can be made, for example, from PEEK polyetheretherketone or absorbable plastic, such as, for example, polyglycolic acid “PHC”, polylactic acid “PMK”, polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkanate), PGKL (polyglecapron 25 sold under the trade name monocryl) or various composite mixtures of PGS, PDS PMK, PGK and PKL. Each row of 920 ”brackets is substantially zigzag when viewed from above. Although various embodiments of the surgical brace unit 900, 900 'have been disclosed regarding the use of end clamps 612' and the surgical stapler 610, it is understood that the brace blocks 900, 900 'can be effectively used in the various types of other end clamps and surgical apparatus described in this document above, with suitable designs of the brackets forming the recesses formed in the abutment plates of these apparatuses in order to achieve the desired degree of formation of the suture brace during Movement, refractory plates in contact forming a bracket.

In FIG. 78 and 79 show another embodiment of a surgical block of brackets 940 supported in an elongated groove 14 of the surgical apparatus 10 of the present invention. In at least one embodiment, the surgical brace unit 940 includes a brace unit case 942 in which there is a centrally located elongated groove 944 extending through it at least partially. The elongated groove 944 is designed so as to facilitate movement along the axis of the blade of the scalpel of the surgical apparatus 10 through it during dissection of the tissue in the manner described above. In various embodiments, the brace block housing 942 consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or a bioabsorbable foam of the type described above or below, in which rows 946, 948, 950, 952 are located unformed brackets 922. In at least some embodiments, to prevent the brackets 922 from being exposed and the hemostatic material to be activated during the insertion and positioning process, the block of brackets 940 can be fully cover or wrap in a biodegradable film 954, such as a polydioxanone film sold on the market under the brand name PDS®, or a polyglycerol sebacinate film (PGS), or other biodegradable films made, for example, from PGC (polyglycolic acid sold under the trademark Vikril brand), PCL (polycaprolactone), PMA (polylactic acid), PHA (polyhydroxyalkanate), PGKL (polyglecapron 25 sold on the market under the Monocryl brand) or composite materials PGK, PKL, PMK, PDS, which are impermeable to their size discontinuity.

In the embodiment depicted in FIG. 78, the bracket block 940 also includes a support member 960 that is connected to the body of the block 942. In various embodiments, the support member 960 may be made of rigid material, such as, for example, titanium, stainless steel, aluminum, or any alloy of the above materials and etc. and can be partially inserted into the body of the bracket unit 942. In various embodiments, the support member 960 can be held in place by, for example, film 954. In yet another embodiment, when a limited connection is required, it is possible to occasionally use cyanoacrylate to “glue” the two components together. In yet another embodiment, the bracket block body 942 may heat up and “weld” or “weld” to the support member 960. In various embodiments, the support member 960 forms at least a portion of the bottom surface of the bracket assembly 942 to interface with an elongated groove 14. In a preferred embodiment, the supporting member 960 has one or more locking devices 962 protruding from it for attachment, with the possibility of releasing the supporting member 960 to elongated groove 14. Other forms of locking devices / fasteners may be used to attach, with the possibility of release, the supporting element 960 to the elongated groove 14.

In various embodiments, the support member 960 has a series of support tabs 964, 966, 968, 970, 972, 974, 976 formed thereon to provide some lateral support to the bases 924 of the brackets 922 in rows 946, 948, 950, 952 of suture braces shown in FIG. 78. Thus, in at least some embodiments, the supporting protrusions are substantially the same in length with the rows of suture brackets. In FIG. 80 shows an alternative embodiment of the bracket block 940 ', which is essentially identical to block 940, except for the inclusion of upwardly protruding portions 978, 979, 980, 981, 982, 983 of the ribs that extend upward from the supporting protrusions 964, 966, 968, 970, 972, 976, respectively, to provide additional lateral support for the brackets 922. In various embodiments, portions of the ribs can be formed as an integral part of the supporting element 960, their length may be about ½ or less than the height of the bracket block. Thus, in preferred embodiments, for example, any fixed means supporting the foam cannot rise above the height of the foam in a compressed state. Thus, if the block of brackets is made, for example, for compression up to 1/3 of its original height in the working position, the ribs will be from 66% of the height in an uncompressed state to 10% of the height before compression.

In use, as soon as the brackets 922 come into forming contact with the abutment member 20 in the manner described above, the abutment member 20 opens and the end clip 12 is removed from the stapled fabric. As soon as the end clamp 12 is removed from the stapled fabric, the bracket block body 942 remains attached to the stitched fabric, and is then separated from the support member 960, which remains attached to the elongated groove 14. In various embodiments, the color of the bracket-supporting member 960 is different from the color the material of the case of the bracket block 942, as well as the color of the elongated trough 14. Due to this design, the surgeon can easily understand that there is no bracket block in the end clamp. This prevents the surgeon from accidentally trying to re-insert / use the end clamp without first installing a new block of brackets. To do this, it is enough for the surgeon to simply disconnect the clamps of the supporting element 960 from the elongated groove 14 to enable the insertion of a new new block of brackets 940 into the supporting element 960. Although the blocks of brackets 940, 940 'have been described regarding the use of the surgical device 10, it is clear that effective use is possible of this block of brackets in many other embodiments of the surgical apparatus disclosed herein, without departing from the spirit and scope of the present invention.

In FIG. 81 and 82 show the use of an embodiment of a surgical apparatus 10 with an end clip 990, which is essentially identical to the end clip 12 described above, except for the locking blocking device 991 that is movably attached to or otherwise supported in the elongated groove 14. In various embodiments, the closure locking device 991 includes a locking arm 992 having a distal end 993 and a proximal end 994. The locking arm 992 is rotatably connected to an elongated groove around a hinge member or pin 995. A leaf spring 996 is formed on a portion of the distal end. or another biasing element attached thereto to move the locking arm 992 to a working or locked position in which part of the proximal end 994 engages with the distal end 141 of the first launching cuff 141 to prevent the distal extension of the first starting cuff 140 to the “working” position. However, when the bracket block 30 is inserted into the elongated groove 14, the bracket block 30 causes the locking arm 992 to move to the idle or unlocked position, so that it is possible to distally launch the trigger collar 140 behind the locking arm 992 to complete the stapling process. See FIG. 81.

In the locked position, it is not possible to distally extend the start-up sleeve 140 to complete the crosslinking process. In addition, it is not possible to extend the trigger lever 130 to the fully operational position when the locking block 210 of the cutting element is moved to the unlocked position so that the surgeon can extend the cutting element 172. Thus, if there is no bracket block in the end clamp 990, the closing blocking device 991 is in the locking position, which ultimately prevents the extension of the cutting element 172. In this position, the surgeon cannot extend the cutting element 172 to dissect the tissue, if in The brace block 30 will not be inserted in the front clamp 990. It is understood that the closure blocking device 991, as described above, can be effectively used in many of the surgical apparatus embodiments disclosed herein without departing from the spirit and scope of the present invention.

In various embodiments, the bracket block may include a bracket block housing and a plurality of brackets located in the housing. During operation, it is possible to introduce a block of brackets into the surgical field and place it on one side of the tissue that undergoes surgical intervention. In addition, the stop element forming the brackets can be placed on the opposite side of the fabric. In various embodiments, the thrust member may rest on the first jaw, and the block of brackets may rest on the second jaw, wherein the first jaw and / or second jaw may move toward each other. As soon as the brace block and the stop element are positioned relative to the fabric, the brackets can be pushed out of the bracket block body so as to pierce the fabric and come into contact with the brace forming element. Once the brackets are pushed out of the bracket block housing, the bracket block housing can be removed from the surgical field. In various embodiments disclosed herein, a block of brackets, or at least a portion of a block of brackets, can be implanted together with brackets. In at least one such embodiment, as described in more detail below, the bracket unit may include a housing that can be compressed, crushed, and / or flattened by the stop member when the stop member moves from the open position to the closed position. When the case of the block of brackets is crushed, crushed and / or flattened, the brackets placed inside the case of the block of brackets can be deformed by a stop element. In another way, the jaw holding the block of brackets can be moved towards the thrust element in the closed position. In any case, in various embodiments, the brackets may be deformed while they are at least partially placed in the bracket block body. In some embodiments, the brackets may not be pushed out of the bracket block, while in some embodiments, the brackets may be pushed out of the bracket block together with a part of the body of the bracket block.

Turning now to FIG. 83A-83D, a crushable brace block, for example, a brace block 1000, may include a crushable implantable housing 1010 and, in addition, a plurality of brackets 1020 housed in a crushable brace block body 1010, although in FIG. 83A-83D, only one suture brace 1020 is shown. FIG. 83A, a bracket block 1000 is shown, supported by a bracket block support, or a gutter of a bracket block, 1030, in which the bracket block 1000 is shown in an unbroken state. In such an unclasped state, the abutment 1040 may or may not be in contact with the fabric T. In use, the abutment 1040 may move from the open position to the contact with the fabric T, as shown in FIG. 83B, and place the fabric T relative to the bracket block body 1010. Even provided that the abutment member 1040 can accommodate fabric T opposite the tissue-contacting surface 1019 of the bracket block body 1010, referring again to FIG. 83B, the bracket block body 1010 may be subjected to a slight (if any) compression force or pressure at such a point, and the brackets 1020 may remain unformed or inoperative. As shown in FIG. 83A and 83B, the bracket block body 1010 may include one layer or several layers, and the legs 1021 of the suture brackets 1020 may extend upward through these layers. In various embodiments, the bracket block body 1010 may include a first layer 1011, a second layer 1012, a third layer 1013, wherein a second layer 1012 may be located between the first layer 1011 and the third layer 1013, and the fourth layer 1014, while the third layer 1013 may placed between the second layer 1012 and the fourth layer 1014. In at least one embodiment, for example, the bases 1022 of the brackets 1020 can be placed in the recesses 1015 in the fourth layer 1014, and the legs of the brackets 1021 can protrude upward from the bases 1022 and pass through the fourth layer 1014 , third a layer 1013 and a second layer 1012. In various embodiments, each deformable leg 1021 may include a tip, such as a pointed tip 1023, for example, which can be placed in the second layer 1012, for example, when the bracket block 1000 is in an uncompressed state . In at least one such embodiment, the tips 1023 may not protrude into and / or through the first layer 1011, while in at least one embodiment, the tips 1023 may not protrude through the tissue-contacting surface 1019 when the bracket block 1000 is in an uncompressed state. In some other embodiments, the sharp tips 1023 may be located in the third layer 1013, and / or in any other suitable layer, when the block of brackets is in an unbroken state. In various alternative embodiments, the bracket block housing may comprise any suitable number of layers, for example, four layers or more than four layers.

In various embodiments, as described in more detail below, the first layer 1011 may consist of a refractory material and / or plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example, and the second layer 1012 may consist, for example , from bioabsorbable foam and / or compressible hemostatic material, such as oxidized regenerated cellulose (ORC). In various embodiments, one or more of the following: the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 can hold the brackets 1020 inside the bracket block body 1010 and, in addition, maintain the orientation of the brackets 1020 relative to each other. In various embodiments, the third layer 1013 may consist of a refractory material, or unconditionally incompressible or inelastic material, which can be configured to hold the legs 1021 of the suture brackets 1020 in a certain 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 bracket 1020 even through the second layer 1012 and the fourth layer 1014, and can be made of compressible foam or elastic material. In some embodiments, the brace tips 1023 of the brace legs 1021 can be at least partially embedded in the first layer 1011. In at least one such embodiment, the first layer 1011 and the third layer 1013 can be configured to jointly and firmly hold the brace legs 1021 in a certain position. In at least one embodiment, the first layer 1011 and the third layer 1013 can be made from a bioabsorbable plastic sheet such as polyglycolic acid (PGA) marketed under the trade name Vicryl, Polylactic Acid (PMA), Polydioxanone (PDS), Polyhydroxyalkanate (PHA), polyglecaprone 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone (PCL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example, and the second layer is 1012 and the fourth layer 1014 may be made at least at least one hemostatic material or substance.

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 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 compared to, for example, the first layer 1011. In other words, the second layer 1012 can be compressed about two times, about three times, with lizitelno four times, about five times, and / or about ten times stronger as compared with the first layer 1011, while applying a given force. In some embodiments, the second layer 1012 can compress from about two times stronger to about ten times larger than, for example, the first layer 1011. In at least one embodiment, the second layer 1012 may include a plurality of air voids formed therein, in this case, the number and / or size of air voids in the second layer 1012 can be controlled in order to provide the required compressibility of the second layer 1012. Similar to the above, although the third layer 1013 can be compressible, h the hardened layer 1014 can be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 can be approximately two times more compressible, approximately three times more compressible, approximately four times more compressible, approximately five times more compressible and / or about ten times more compressible compared to, for example, the third layer 1013. In other words, the fourth layer 1014 can be compressed approximately two times, approximately three times, approximately four times, lizitelno five Razi / or about ten times stronger as compared with the third layer 1013, while applying a given force. In some embodiments, the fourth layer 1014 may compress from about two times stronger to about ten times stronger than, for example, the third layer 1013. In at least one embodiment, the fourth layer 1014 may include a plurality of air cavities formed in it, in which the number and / or size of the air cavities in the fourth layer 1014 can be controlled in order to provide the required compressibility of the fourth layer 1014. In various circumstances, the compressibility of the block body parentheses or brackets casing layer unit can be expressed as the compression ratio, i.e. the distance over which the layer is compressed when a given force value is applied. For example, a layer with a high compression ratio is compressed over a greater distance when a predetermined amount of compression force is applied to the layer compared to a layer with a lower compression ratio. In this case, the second layer 1012 may have a higher compression ratio than the first layer 1011 and, likewise, the fourth layer 1014 may have a higher compression ratio compared to the third layer 1013. In various embodiments, the second layer 1012 and the fourth layer 1014 can be made of the same material and can have the same compression ratio. In various embodiments, the second layer 1012 and the fourth layer 1014 may be made of materials having different compression ratios. Similarly, the first layer 1011 and the third layer 1013 can be made of the same material and can have the same compression ratio. In some embodiments, the first layer 1011 and the third layer 1013 may be made of materials having different compression ratios.

As the stop member 1040 moves toward the closed position, the stop member 1040 can come into contact with the fabric T and apply a compressive force to the fabric T and the bracket block 1000, as shown in FIG. 83C. In such circumstances, the abutment element 1040 may push the top surface or the fabric-contacting surface 1019 of the bracket block body 1010 down towards the bracket block support 1030. In various embodiments, the bracket block support 1030 may include a bearing surface 1031, which may be configured to support the bracket block 1000 as the bracket block 1000 is compressed between the bearing surface 1031 and the fabric contacting surface 1041 of the stop member 1040. Due to pressure attached to the stop member 1040, the bracket block body 1010 may be compressed, and the stop member 1040 may come into contact with the brackets 1020. More specifically, in various embodiments, the compression of the bracket block body 1010 and the downward movement of the tissue-contacting surface 1019 can cause the tips 1023 of the legs 1021 to pierce the first layer 1011 of the bracket block body 1010, pierce the fabric T and enter the forming recesses 1042 in the abutment element 1040. As the bracket block body 1010 further is compressed by the stop element 1040, the tips 1023 can come into contact with the forming recesses 1042 and, as a result, the legs 1021 can be deformed or bent inward, for example, as shown in FIG. 83C. With the deformation of the legs 1021 brackets, as also shown in FIG. 83C, the bases 1022 of the brackets 1020 may come into contact with or supported by a bracket block support 1030. In various embodiments, as described in more detail below, the bracket block bracket 1030 may include a plurality of supporting means, such as supporting brackets, grooves, grooves or grooves 1032 , for example, configured to support brackets 1020, or at least bases 1022 of brackets 1020, as brackets 1020 deform. As also shown in FIG. 83C, cavities 1015 in the fourth layer 1014 may collapse as a result of the compression force applied to the bracket block body 1010. In addition to the cavities 1015, the bracket block housing 1010 may also include one or more voids, such as voids 1016, for example, including or not including a portion of the brackets located therein, which may be configured to facilitate flattening of the block housing 1010 brackets. In various embodiments, the cavities 1015 and / or voids 1016 may be slidable so that the walls defining the cavities and / or walls bend down and come into contact with the bracket block surface 1031 and / or come in contact with a layer of the housing 1010 block brackets located under the cavities and / or voids.

When comparing FIG. 83B and FIG. 83C, it is understood that the second layer 1012 and the fourth layer 1014 are substantially compressed as a result of applying compression pressure to the abutment member 1040. It can also be noted that the first layer 1011 and the third layer 1013 are also compressed. As the stop element 1040 moves to the closed position, the stop element 1040 can continue to further compress the bracket block body 1010 by pushing the tissue contact surface 1019 down toward the bracket block support 1030. As the brackets block body 1010 is further compressed, the abutment element 1040 can deform the brackets 1020 into a fully formed configuration, as shown in FIG. 83D. Turning to FIG. 83D, the legs 1021 of each suture brace 1020 can be folded downward toward the base 1022 of each staple 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 the base 1022 When comparing FIG 83C and 83D, it is also clear that the second layer 1012 and the fourth layer 1014 are substantially compressed further by applying compression pressure to the stop element 1040. It can also be noted when comparing FIG. 83C and 83D, that the first layer 1011 and the third layer 1013 are also compressed further. After the brackets 1020 are completely, or at least substantially formed, it is possible to lift the stop element 1040 from the fabric T and remove the bracket block support 1030 and / or disconnect it from the bracket block 1000. As shown in FIG. 83D, and as a result of the foregoing, the bracket block body 1010 may be implanted with brackets 1020. In various circumstances, the implantable bracket block body 1010 may support tissue along a series of brackets. In some circumstances, a hemostatic agent and / or any other suitable therapeutic drug contained in the implantable bracket block body 1010 may have a therapeutic effect on the tissue for some time. A hemostatic substance, as described above, can reduce bleeding from stitched and / or dissected tissue, while a bonding agent or tissue adhesive can give the fabric strength for some time. The implantable case 1010 of the block of brackets can be made of materials such as ORC (oxidized regenerated cellulose), protein matrix, polyglycolic acid (PHA), which is sold under the trade name Vicryl, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA) polyglecapron 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone (PKL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example. In some circumstances, the bracket block body 1010 1010 may include an antibiotic and / or antimicrobial material, such as colloidal silver and / or triclosan, for example, which reduce the possibility of infection of the surgical field.

In various embodiments, the layers of the bracket block body 1010 may be connected to each other. In at least one embodiment, the second layer 1012 may be glued to the first layer 1011, the third layer 1013 may be glued to the second layer 1012, and the fourth layer 1014 may be glued to the third layer 1013 using at least one adhesive, for example, such as fibrin and / or protein hydrogel. In some embodiments, although not shown, the layers of the bracket block body 1010 may be joined together using locking mechanical devices. In at least one such embodiment, both the first layer 1011 and the second layer 1012 may include appropriate locking devices, such as, for example, a groove mount and / or dovetail joint. Similarly, both the second layer 1012 and the third layer 1013 may include respective locking devices, while the third layer 1013 and the fourth layer 1014 each may include respective locking devices. In some embodiments, although not shown, the bracket block 1000 may include one or more rivets, for example, which may protrude through one or more layers of the bracket block body 1010. In at least one such embodiment, each rivet may include a first end, or a head adjacent to the first layer 1011, and a second head adjacent to the fourth layer 1014, which can either be assembled or formed by the second end of the rivet. Due to the collapsible nature of the bracket block housing 1010, in at least one embodiment, rivets can compress the bracket block housing 1010 so that the rivet heads can recess relative to the fabric contacting surface 1019 and / or bottom surface 1018 of the bracket 1010. At least in One such embodiment, rivets can be made from bioabsorbable materials, such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, Polylactic Acid (PMA), and Polydioxanone (PDS) ), polyhydroxyalkanate (PHA, polyglecapron 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone PKL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example. In some embodiments, implementation, the layers of the bracket block body 1010 can only be connected to each other with the brackets 1020 contained therein. In at least one such embodiment, friction engagement between the brace legs 1021 and the brace block housing 1010, for example, can hold the layers of the brace block housing 1010 together and, once the brackets are formed, the layers can be gripped inside the brackets 1020. In some embodiments, at least a portion of the legs 1021 of the brackets may have a rough surface or a rough coating that can increase the frictional force between the brackets 1020 and the body 1010 of the bracket block 1010.

As described above, the surgical apparatus may comprise a first jaw including a bracket block support 1030 and a second jaw including a stop member 1040. In various embodiments, as will be described in more detail, the bracket block 1000 may include one or more restraining devices that may be provided so as to engage the bracket block support 1030 and, as a result, the bracket block 1000 can be detachably fixed to the bracket block support 1030. In some embodiments, the bracket block 1000 may be glued to the bracket block support 1030 with at least one adhesive, such as, for example, fibrin and / or protein hydrogel. When used in at least one circumstance, especially during laparoscopic and / or endoscopic surgery, the second jaw can be advanced 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 have an opening of approximately 5 mm, or a cannula through which the first or second branches can be inserted. In some embodiments, the second jaw can be moved to a partially closed position intermediate between the closed and open position, which can allow the first and second jaws to be inserted through the trocar without deforming the brackets 1020 contained in the bracket block body 1010. In at least one such embodiment, the thrust member 1040 may not exert a compressive force on the bracket block body 1010 when the second jaw is in a partially closed intermediate position, while at the same time, in some other embodiments, the thrust member 1040 may compress the housing 1010 block brackets when the second jaw is in a partially closed intermediate position. Even if the stop element 1040 can compress the bracket block body 1010 when it is in such an intermediate position, the stop element 1040 cannot significantly compress the bracket block body 1010 so that the stop element 1040 comes into contact with the brackets 1020 and / or so that the brackets 1020 are deformed by the stop element 1040. Once the first and second branches are inserted through the trocar into the surgical field, the second branch can be re-opened and the stop element 1040 and the block of brackets 1000 relative to the target tissue can be placed as described above.

In various embodiments, referring to FIG. 84A-84D, the end clamp of the surgical stapler may include an implantable brace block 1100 located between the abutment element 1140 and the bracket block support 1130. Similar to the foregoing, the abutment member 1140 may include a fabric contacting surface 1141, the bracket assembly may include a tissue contacting surface 1119, and the bracket assembly support 1130 may include a support surface 1131 that may be intended to support the bracket assembly 1100. Referring to FIG. 84A, the abutment member 1140 can be used to position the fabric T relative to the fabric contact surface 1119 of the bracket block 1100 without deforming the bracket assembly 1100, and when the abutment member 1140 is in this position, the tissue contact surface 1141 can be located at a distance of 1101a from surface 1131 the brackets block support, and the fabric contacting surface 1119 may be spaced 1102a from the brackets block support surface 1131. After that, as the thrust member 1140 moves toward the bracket block support 1130, referring now to FIG. 84B, the abutment member 1140 may push the top surface or fabric contacting surface 1119 of the bracket block 1100 down and compress the first layer 1111 and the second layer 1112 of the bracket block housing 1110. As the layers 1111 and 1112 are compressed, referring again to FIG. 84B, the second layer 1112 can be crushed, and the legs 1121 of the brackets 1120 can pierce the first layer 1111 and penetrate the fabric T. In at least one embodiment, the brackets 1120 can be at least partially placed inside the cavities or voids 1115 of the brackets in the second layer 1112 and, when the second layer 1112 is compressed, the bracket cavities 1115 may collapse and, as a result, contribute to the destruction of the second layer 1112 around the brackets 1120. In various embodiments, the second layer 1112 may include coating portions 1116 that may extend over the cavities and 1115 brackets and to cover or at least partially cover the cavity 1115 brackets. In FIG. 84B shows cover portions 1116 that are wrinkled down in the bracket cavity 1115. In some embodiments, implementation, the second layer 1112 may include one or more parts with weakened strength, which can enhance the subsidence of the second layer 1112. In various embodiments, such parts with weakened strength may include risks, perforated holes and / or thin cross-sections, to for example, which can enhance the controlled compression of the housing 1110 block brackets. In at least one embodiment, the first layer 1111 may include one or more parts of weakened strength, which may facilitate the more rapid penetration of the staple legs 1121 through the first layer. In various embodiments, implementation, such parts with weakened strength may include risks, perforated holes and / or tonic cross sections, for example, which can be aligned, or at least essentially aligned, with legs 1121 brackets.

When the abutment member 1140 is in a partially closed, inoperative position, referring to FIG. 84A, the abutment member 1140 can be placed at a distance 1101a from the bracket support surface 1131 so as to fix a gap between them. This gap may be filled with a bracket block 1100 having a bracket block height 1102a and a fabric T. As the stop member 1140 moves downward to compress the bracket block 1100, referring again to FIG. 84B, the distance between the tissue contacting surface 1141 and the bracket surface 1131 of the bracket block may be determined by a distance 1101b that is shorter than the distance 1101a. Under various circumstances, the gap between the tissue contacting surface 1141 of the abutment member 1140 and the bracket block support surface 1131, determined by the distance 1101b, may be longer than the initial bracket block height 1102a before deformation. As the stop member 1140 moves closer to the bracket surface 1131 of the bracket block, now referring to FIG. 84C, compression of the second layer 1112 may continue, and the distance between the bracket legs 1121 and the forming recesses 1142 may decrease. Similarly, the distance between the tissue contacting surface 1141 and the bracket block support surface 1131 may be reduced to a distance 1101c, which in various embodiments may exceed, be equal to, or be less than the original bracket height 1102a before it deforms. Turning now to FIG. 84D, the thrust member 1140 can be moved to the final, working position in which the brackets 1120 are already fully formed or at least formed to the desired height. In this position, the fabric contacting surface 1141 of the abutment member 1140 may be at a distance 1101d from the bracket block support surface 1131, while the distance 1101d may be shorter than the initial bracket block height 1102a before deformation. As also shown in FIG. 84D, the bracket cavities 1115 may be completely or at least substantially collapsed, and the brackets 1120 may be completely or at least substantially surrounded by a compressed second layer 1112. In various circumstances, the stop member 1140 may then be removed from bracket block 1100. As soon as the stop element 1140 disengages from the bracket block 1100, the bracket block housing 1110 can at least partially re-expand in different sections, that is, for example, in the sections between adjacent brackets 1120. At least at least one wa Ianthe of destroyed housing unit 1110 staples can resiliently straightened. In various embodiments, the formed brackets 1120 and, in addition, the bracket block body 1110 located between adjacent brackets 1120 can exert pressure, or compressive force, on tissue T, which can provide various therapeutic benefits.

As previously discussed, referring again to the embodiment shown in FIG. 84A, each bracket 1120 may include brace legs 1121 extending from it. Although the brackets 1120 can be described as having two legs 1121, you can use different brackets having one leg or, alternatively, more than two legs, for example, three legs or four legs. As shown in FIG. 84A, each bracket leg 1121 can be embedded in the second layer 1112 of the bracket block body 1110, so that the brackets 1120 are secured in the second layer 1112. In various embodiments, the brackets 1120 can be embedded in the bracket cavities 1115 in the bracket block housing 1110, so that the ends 1123 of the brace legs 1121 fit into the cavities 1115 in front of the bases 1122. After the ends 1123 are inserted into the cavities 1115, in various embodiments, the ends 1123 can be pressed into the coating part 1116 and dissect the second layer 1112. In various embodiments parentheses 1120 can be placed at a substantial depth in the second layer 1112 so that the brackets 1120 do not move, or at least substantially do not move, relative to the second layer 1112. In some embodiments, the brackets 1120 can be placed at a significant depth in the second layer 1112 so so that the base 1122 are located or nested in the cavity 1115 of the brackets. In various other embodiments, the bases 1122 may not be located or enclosed in a second layer 1112. In some embodiments, referring to FIG. 84A, the bases 1122 may be located below the bottom surface 1118 of the bracket block body 1110. In some embodiments, the bases 1122 may be supported, or directly positioned, relative to the supporting surface 1130 of the bracket block. In various embodiments, the implementation, the supporting surface 1130 of the block of brackets may include supporting devices that come out of it and / or formed in it, while in at least one such embodiment, the base 1122 of the brackets 1120 can be located and supported by one or more holding grooves, grooves or grooves, 1132, for example, in the bracket block support 1130, as described in more detail below.

In addition to the foregoing, referring now to FIG. 85, the brackets 1122 of the brackets 1120 may be located directly opposite the bearing surface 1131 of the brace block support 1130. In various embodiments, including embodiments in which the brackets 1122 include round or curved surfaces 1124, for example, the brackets 1122 can move or slide along the support surface 1131 block brackets. Such sliding can occur when the abutment element 1140 is pressed at the level of the tips 1123 of the legs 1121 of the bracket in the process of forming the bracket. In some embodiments, implementation, as described above, and referring to FIG. 86, the bracket block support 1130 may include one or more support grooves 1132 therein, which may be configured to eliminate or at least reduce the relative movement between the bracket bases 1122 and the bracket block bearing surface 1131. In at least one such embodiment, each abutment groove 1132 may be defined by a surface contour that matches or at least substantially coincides with the contour of the bottom surface of the bracket located therein. For example, the lower surface 1124 of the base 1122 shown in FIG. 86 may include a circular or at least substantially circular, surface and a support groove 1132, which may also include a circular, or at least substantially circular, surface. In at least one such embodiment, the surface delineating the groove 1132 may be defined by a curve with a radius that is greater than or equal to the radius of the curve that delineates the bottom surface 1124. Although the grooves 1132 can help prevent or reduce relative sliding movement between the brackets 1120 and the bracket block support 1130, the grooves 1132 can also be configured to prevent or reduce relative rotational movement between the brackets 1120 and the bracket block support 1130. More specifically, in at least one embodiment, the grooves 1132 can also be made to fit the bases 1122 tightly into them to prevent or reduce the rotation of the brackets 1120 around the axles 1129, for example, so that the brackets 1120 do not rotate or rotate when they deformation.

In various embodiments, in addition to the foregoing, each bracket 1120 may be made of round or at least substantially round wire. In some embodiments, the legs and base of each bracket may be made of wire with a non-circular cross section, for example, a rectangular shape. In at least one such embodiment, the bracket block support 1130 may comprise corresponding non-circular grooves, such as rectangular grooves, for example, designed to fit the bases of such brackets. In various embodiments, referring now to FIG. 87, each suture brace 1120 may include a ridge, for example, a ridge 1125, molded on the base 1122, with each ridge 1125 can be placed in the abutment groove in the bracket block support 1130. In at least one such embodiment, each ridge 1125 may have a square and / or rectangular cross-section, such as to be inserted into square and / or rectangular grooves 1134, for example, in a support 1130 of a bracket block 1130. In various embodiments of implementation, ridges 1125 can be made of bioabsorbable plastic, such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 ( GCR), which is sold under the trade name Monocryl, Polycaprolactone (PCL) and / or composite mixtures of PGK, PMK, PDS, PHA, PGKL and / or PKL, for example, and can be formed around the bases 1122 of brackets 1120 by injection molding, to for example. Various combs and methods for making various combs are disclosed in US Patent Application Serial No. 11 / 541,123, under the heading "SURGICAL BRACKETS WITH REMOVABLE OR DESTROYABLE ELEMENTS FOR PROTECTING FABRIC IN THEM AND SEWING TOOLS FOR THEIR USE, September 29, 2006 and fully incorporated herein by reference. Turning again to FIG. 87, the grooves 1134 may also include bevels or sections 1135 that can be made to facilitate insertion of the ridges 1125 into the grooves 1134. In various embodiments, the bases and / or ridges of the brackets 1120 can be placed in the grooves 1134 when the bracket block 1100 is mounted to the support 1130 block brackets. In some embodiments, the ridges 1125 of the brackets 1120 may align with the grooves 1134 when the block of brackets 1100 is mounted to the bracket block support 1130. In at least one such embodiment, ridges 1125 may not be inserted into the grooves 1134 until a compressive force is applied to the legs 1121, and the bases and / or ridges of the brackets 1120 are pushed down into the grooves 1134.

In various embodiments, referring now to FIG. 88 and 89, a bracket block, for example, a bracket block 1200, may include a crushable, implantable bracket block housing 1210 including an outer layer 1211 and an inner layer 1212. Similarly to the foregoing, the bracket block 1200 may include a plurality of brackets 1220 located inside the bracket block body 1210 In various embodiments, each bracket 1220 may include a base 1222 and one or more legs 1221 extending from it. In at least one such embodiment, for example, the legs 1221 of the brackets can be embedded in the inner layer 1212 and fixed at a depth at which the bases 1222 of the brackets 1220 are joined and / or placed next to the lower surface 1218 of the inner layer 1212. In an embodiment, depicted in FIG. 88 and 89, the inner layer 1212 does not include parenthesis cavities configured to insert part of the brackets 1220, while in other embodiments, the inner layer 1212 may include such parent cavities. In various embodiments, in addition to the foregoing, the inner layer 1212 may be made of a compressible material, such as, for example, bioabsorbable foam and / or oxidized regenerated cellulose (ORC), which is designed to flatten the bracket body 1210 when attached compression load. In various embodiments, the inner layer 1212 may be made of lyophilized foam containing, for example, polylactic acid (PMA) and / or polyglycolic acid (PHA). ORC can be marketed under the trade name Surgicel and may include loose woven material (such as a surgical sponge), loose fibers (such as a cotton swab), and / or foam. In at least one embodiment, the inner layer 1212 may be made of a material with the inclusion of drugs, for example, such as lyophilized thrombin and / or fibrin contained in and / or coating the layer, which can be activated by water and / or liquids in the patient’s body. In at least one such embodiment, lyophilized thrombin and / or fibrin may be located, for example, on a Vicryl (PGC) matrix. In some circumstances, however, activated drugs may undergo accidental activation when a block of brackets 1200 is inserted into the surgical field in the patient. In various embodiments, referring again to FIG. 88 and 89, the outer layer 1211 may include a waterproof or at least substantially waterproof material so that liquids cannot penetrate the inner layer or at least substantially penetrate the inner layer 1212 until the bracket block body 1210 is compressed and the legs of the brackets do not penetrate into the outer layer 1211 and / or after the outer layer 1211 is not dissected in any way. In various embodiments, the outer layer 1211 may comprise a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In some embodiments, the outer layer 1211 may include a shell that surrounds the inner layer 1212 and brackets 1220. More specifically, in at least one embodiment, the brackets 1220 can be embedded in the inner layer 1212, and the outer layer 1211 can wrap around a subsystem including the inner layer 1212 and the brackets 1220, and then sealed.

In various embodiments, referring now to FIG. 90 and 91, a bracket block, such as a bracket block 1300, for example, may include a crushable, implantable housing 1310 including an upper layer 1311 and an inner layer 1312. Similarly to the foregoing, the bracket block 1300 may also include brackets 1320 located inside the housing 1310, each suture bracket 1320 may include a base 1322 and one or more legs 1321 extending from it. Like the bracket block 1200, the bases 1322 of the brackets 1320 may be lower than the lower surface 1318 of the inner layer 1312, and the outer layer 1311 may surround the bases 1322. In at least one embodiment, the outer layer 1311 can be substantially flexible so as to cover on all sides, each base 1322 of the bracket so that the outer layer 1311 matches the contour of the bases 1322. In at least one alternative embodiment, referring again to FIG. 89, the outer layer 1211 can be substantially rigid to cover on all sides of the base 1222 without coincidence with each base 1222. In any case, in various embodiments, the outer layer 1311 can be located between the bases 1322 of the brackets 1320 and the block support surface brackets, such as bearing surfaces 1031 or 1131, for example, supporting a bracket block 1300. In at least one embodiment, the outer layer 1311 may be located between the bases 1322 and the support grooves, such as grooves 1032 or 1132, for example, weeding neny in the surface of the block brackets. In at least one such embodiment, in addition to the foregoing, 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 bearing surface of the bracket block and / or the bearing grooves to reduce the relative movement between them. In various alternative embodiments, referring again to FIG. 92 and 93, the outer layer of the bracket block, such as the bracket block 1400, for example, may not completely surround the brackets located therein. In at least one such embodiment, the outer layer 1411 of the collapsible, implantable bracket block body 1410 may be mounted to the inner layer 1412 before the bracket legs 1421 of the brackets 1420 enter the bracket block body 1410. As a result of the foregoing, the bases 1422 of the brackets 1420 may extend beyond the outer layer 1411, and in at least one such embodiment, the bases 1422 may be located directly in the support grooves 1032 or 1132 on the surfaces 1031 or 1131 of the bracket block support. In various embodiments, the brace legs 1421 can cut through the outer layer 1411 when they enter it. In various circumstances, the holes made by the legs of the brackets 1421 can tightly surround the legs of the brackets 1421 so that a small, if any, amount of liquid can penetrate between the legs of the brackets 1421 and the outer layer 1411, which can reduce or prevent the possibility of activation the drug contained in the bracket block body 1410, and / or premature leakage from the bracket block body 1410.

As described previously, referring again to FIG. 88 and 89, the legs 1221 of the brackets 1220 can be inserted into the body 1210 of the bracket block, and the bases 1222 of the brackets 1220 can protrude upward from the bottom surface 1218 of the inner layer 1212. In various embodiments, in addition to the foregoing, the inner layer 1212 may include cavity brackets, configured to insert brackets 1220. In various other embodiments, referring again to FIG. 94 and 95, a bracket block, such as a bracket block 1500, for example, may include a collapsible implantable housing 1510 comprising brace cavities 1515 that can be configured to fit at least a portion of the brackets 1520 into them. In at least one such embodiment, the upper part of the legs 1521 of the brackets 1520 can be embedded in the inner layer 1512, while the lower part of the legs 1521 of the brackets and the base 1522 can be located in the cavity 1515 for brackets. In some embodiments, the bases 1522 can be fully placed in the brackets 1515, while in some embodiments, the bases 1522 can be at least partially below the bottom surface 1518 of the inner layer 1512. Similarly to the foregoing, the outer layer 1511 can cover all sides, the inner layer 1512 and the brackets 1520 located therein. In some other embodiments, referring again to FIG. 96, the bracket block 1600 may include brackets 1620 located in the brackets 1615 for the brackets in the crushable implantable bracket block body 1610, wherein at least a portion of the brackets 1620 is not covered on all sides by the outer layer 1611. In at least one such embodiment , each suture brace 1620 may include brace legs 1621 that are at least partially embedded in the inner layer 1612, and, in addition, bases 1622 that protrude up the outer layer 1611.

In various embodiments, referring again to FIG. 97 and 98, a bracket block, such as a bracket block 1700, for example, may include a crushable, implantable bracket block body 1710 and a plurality of brackets 1720 at least partially located in the bracket block body 1710. The bracket block body 1710 may include an outer layer 1711, an inner layer 1712, and, in addition, an alignment matrix 1740 that can be made to align and / or hold the brackets 1720 in place inside the bracket block body 1710. In at least one embodiment, the inner layer 1712 may include a recess 1741, which may be configured to insert the alignment matrix 1740 into it. In various embodiments, the alignment matrix 1140 may be pressed into the recess 1741 and / or fixed in another suitable manner in the inner layer 1712 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In at least one embodiment, recesses 1741 may be configured so that the bottom surface 1742 of the alignment matrix 1740 can be aligned, or at least substantially aligned, with the bottom surface 1718 of the inner layer 1712. In some embodiments, the lower surface 1742 of the alignment matrix may be deepened relative to the lower surface 1718 and / or extend from the lower surface 1718 of the second layer 1712. In various embodiments, each suture brace 1720 may turn on the base 1722 and one go several legs 1721 coming out of the base 1722, while at least part of the legs 1721 brackets can pass through the alignment matrix 1740. The alignment matrix 1740 may also include a set of holes and / or cutouts, for example, passing through it configured for nesting the legs of 1721 brackets. In at least one such embodiment, such an opening may be configured to fit the bracket leg 1721 so that movement between the bracket leg 1721 and the side walls of the hole, if any, is small. In some embodiments, the holes of the alignment matrix may not extend completely through the alignment matrix 1740 as the brace legs 1721 push through it.

In various embodiments, the alignment matrix 1740 may include a molded plastic housing that, in at least one embodiment, may be more rigid or less compressible compared to the inner layer 1712 and / or the outer layer 1711. In at least one embodiment , the alignment matrix 1740 may be made of plastic material and / or other suitable material, such as polydioxanone (PDS) and / or polyglycolic acid (PGC) for example. In some embodiments, the alignment matrix 1740 may be mounted to the inner layer 1712, and the brace legs 1721 may then pass through the alignment matrix 1740 and be enclosed in the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment matrix 1740 may include one or more grooves, grooves or grooves, for example, with such a configuration that, at least partially, the bases 1722 of the brackets 1720 are embedded in them. Similarly to the above, the outer layer 1711 can be placed around d of the part of the system including the inner layer 1712, the alignment matrix 1740 and the brackets 1720. Alternatively, the outer layer 1711 can be placed around the part of the system, including the inner layer 1712 and the alignment matrix 1740, while the brackets 1720 can then pass through the outer layer 1711, the alignment matrix 1740 and the inner layer 1712. In any case, as a result of the foregoing, the inner layer 1712, the alignment matrix 1740 and / or the outer layer 1711 can be configured to hold the brackets 1720 in place while they are deformed and / or after deformation ii abutment member as described above. In at least one such embodiment, the alignment matrix 1740 may serve to hold the brackets 1720 in place before the brace block 1700 is implanted into the patient’s body and, in addition, to secure tissue along a series of braces after implantation of the brace block 1700. At least in one embodiment, the brackets 1720 can be fixed in the alignment matrix 1740 without being inserted into the inner layer 1712 and / or the outer layer 1711, for example.

In various embodiments, referring now to FIG. 99-105, a bracket block, such as a bracket block 1800, for example, can be mounted by compressing the inner layer 1812, inserting brackets such as brackets 1820, for example, into the inner layer 1812, and wrapping the inner layer 1812 with the outer layer 1811. Turning primarily to FIG. 99, the compressible inner layer 1812 is shown as a layer including a plurality of cavities 1815 for the brackets indicated therein, although other embodiments are provided in which the inner layer 1812 does not contain cavities for the brackets, as described above. Turning now to FIG. 100, a compressible inner layer 1812 may be sandwiched between the transfer plate 1850 and the support plate 1860 and compressed between their compression surfaces 1852 and 1862, respectively. As shown in FIG. 100, the upper and lower surfaces of the inner layer 1812 can be compressed towards each other and, in response to this, the inner layer 1812 can be squeezed outward in the lateral directions. In some embodiments, for example, the inner layer 1812 can be compressed to a height that is about one third of the original height, and its height or thickness can be, for example, from about 0.15 cm (0.06 ”) to about 0 , 20 cm (0.08 ”) in a compressed state. As also shown in FIG. 100, the transfer plate 1850 may also include a plurality of brackets, such as brackets 1820, for example, located within a plurality of bracket holes 1853. In addition, the transfer plate 1850 may also include a plurality of pushers 1851 that can be configured to push the brackets 1820 forward and out of the bracket holes 1853. Turning now to FIG. 101, pushers 1851 can be used to push the legs 1821 of the brackets 1820 into and through the compressed inner layer 1812. In various embodiments, the pushers 1851 may be configured so that their upper surfaces are flush or at least almost flush with the compression surface 1852 of the transfer plate 1850 when the brackets 1820 are fully operational from the holes 1853 of the brackets of the transfer plate 1850. In some embodiments, implementation, as also shown in FIG. 101, the support plate 1860 may include a plurality of receiving holes 1861 that can be configured to insert the legs of the brackets 1821 or at least the ends of the legs of the brackets 1821 after being pushed 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 less than the height of the brackets 1820 and, thus, when the brackets 1820 are completely out of the holes 1853 of the brackets, the legs 1821 of the brackets may come out of the upper surface the compressed inner layer 1812. In some embodiments, the inner layer 1812 can be compressed to a height exceeding the height of the brackets 1820 and, as a result, there is no need for receiving holes 1861 in the support plate 1860.

After the brackets 1820 enter the inner layer 1812, now referring to FIG. 102, the support plate 1860 can be moved away from the transfer plate 1850 in order to reduce compression in the inner layer 1812. In such circumstances, the inner layer 1812 can elastically expand to its original or at least close to the original height before it is compressed. As the inner layer 1812 expands, the height of the inner layer 1812 can increase so that it exceeds the height of the brackets 1820, and so that the legs 1821 of the brackets 1820 no longer protrude from the upper surface of the inner layer 1812. Under various circumstances, the receiving holes 1861 can be configured to hold the legs 1821 of the brackets in place, at least until the base plate 1860 moves away, so that the legs 1821 are no longer located in the receiving holes 1861. In such circumstances, taking about Holes 1861 can help maintain the relative alignment of the brackets 1820 in the inner layer 1812 as it expands. Under various circumstances, the inner layer 1812 and the brackets 1820 located therein may include a subsystem 1801, which, now referring to FIG. 103 may extend into the outer layer 1811, for example. In at least one such embodiment, the outer layer 1811 may include a cavity 1802, designated therein, which may be configured to insert a subsystem 1801 into it. Under various circumstances, a tool, such as tongs 1855, may be used to pull the outer layer 1811 over subsystem 1801. Once the subsystem 1801 is substantially located inside the outer layer 1811, see FIG. 104, the outer layer 1811 may be sealed. In various embodiments, the outer layer 1811 may be sealed by applying thermal energy to a portion thereof. More specifically, in at least one embodiment, the outer layer 1811 may be made of plastic material, while the open end of the outer layer 1811 may be sealed with one or more heating elements or a heat seal apparatus, 1856 for bonding and / or sealing the perimeter of the open end of the outer layer 1811 together. In at least one such embodiment, referring now to FIG. 105, the excess portion 1857 of the outer layer 1811 can be removed, and the bracket block 1800 can now be used as described in this document.

As described above, the block of brackets can be positioned and / or fixed in the mounting part for the block of brackets. In various other embodiments, referring again to FIG. 106 and 107, the mounting portion for the bracket block may include a bracket channel chute, such as a bracket bracket chute 1930, for example, which can be configured to fit at least a portion of the bracket block, such as a bracket block 1900, for example In at least one embodiment, the gutter block groove 1930 may include a lower abutment surface 1931, a first side abutment wall 1940 and a second side abutment wall 1941. In use, the brace unit 1900 may be located in the groove 1930 for the brace unit so that block ck 1900 side was located opposite and / or adjacent to the bottom support surface 1931 and between the first lateral support wall 1940 and a second lateral support wall 1941. In some embodiments, the first lateral support wall 1940 and a second lateral support wall 1941 may denote transverse gap therebetween. In at least one such embodiment, the block of brackets 1900 may have a transverse width 1903 that is equal to and / or greater than the transverse gap defined between the support walls 1940 and 1941 so that the crushable, implantable body 1910 of the block of brackets 1900 can be tightly fixed between the walls 1940 and 1941. In some other embodiments, the transverse width 1903 of the bracket block 1900 may be less than the gap defined between the first and second side walls 1940 and 1941. In various embodiments, at least a portion of the walls 1940 and 1941 and the lower abutment surface 1931 may be defined by a stamped metal trough, while in at least one embodiment, at least a portion of the lateral abutment wall 1940 and / or the lateral abutment wall 1941 may be made of a flexible material such such as elastomeric material. Turning primarily to FIG. 106, the first side wall 1940 and the second side wall 1941 of the gutter 1930 of the bracket block may each include 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 foregoing, the bracket block body 1910 1900 may include one or more compressible layers, such as, for example, the first layer 1911 and the second layer 1912. When the bracket block body 1910 is compressed relative to the lower abutment surface 1931 by a stop member, as described above, the side parts of the bracket block body 1910 may expand laterally. In embodiments where the bracket block 1930 includes rigid side walls, lateral expansion of the housing 1910 can be prevented or at least limited by the rigid side walls and, as a result, significant pressure or internal stress can be generated within the housing 1910. In embodiments in which at least a portion of the bracket block 1930 includes flexible side walls, the flexible side walls may be configured to bend laterally and allow the lateral parts of the bracket block housing 1910 to expand laterally, thereby reducing internal pressure or stress generated inside the bracket block body 1910. In embodiments in which the gutter of the bracket block does not include side walls, or includes side walls that are relatively shorter than the bracket block, the side portions of the bracket block can expand to the sides unlimited or at least essentially unlimited. In any case, referring now to FIG. 107, the chute 2030 of the bracket block may include side walls 2040 and 2041, which can be completely made of a flexible material, such as, for example, an elastomeric material. The bracket block groove 2030 may also include lateral grooves 2033 extending along the sides of the lower abutment surface 2031 of the bracket block groove 2030 that can be inserted and secured to at least a portion of the side walls 2040 and 2041. In some embodiments, the side walls 2040 and 2041 can be fixed in grooves 2033 with a snap and / or press-fit tool, while at least in some embodiments, side walls 2040 and 2041 can be fixed in grooves 2033 with one or more gezivami. In at least one embodiment, the side walls 2040 and 2041 may separate from the lower abutment surface 2031 during use. In any case, the crushable implantable bracket block body 2010 can be detached and / or detached from the side walls 2040 and 2041 when the bracket block body 2010 is implanted with brackets 2020.

In various embodiments, referring now to FIG. 108, the surgical device may include a barrel 2150 and an end clip protruding from the distal end of the barrel 2150. The end clip may include, like the above, a chute 2130 for the bracket block, a stop member 2140 that moves between the open position and the closed position, and the bracket block 2100 located between the chute 2140 for the bracket block and the stop element 2140. Also similar to the above, the bracket block 2100 may include a crushable, implantable bracket block body 2110 and a plurality of brackets 2120 located in the housing 2110 block brackets. In various embodiments, the bracket block chute 2130 may include, firstly, a lower abutment surface 2131, against which a bracket block 2100 may be located, secondly, a distal end 2135, and thirdly, a proximal end 2136. At least in at least one embodiment, as shown in FIG. 108, the bracket block 2100 may include a first end 2105, which may be located at the distal end 2135 of the bracket block groove 2130, and a second end 2106, which may be located at the proximal end 2136 of the bracket block groove 2130. In various embodiments, the distal end 2135 of the bracket block chute 2130 may include at least one distal retainer, such as, for example, a retaining wall 2137, and similarly, the proximal end 2136 may include at least one proximal retainer such as, for example, the retaining wall 2138. In at least one such embodiment, the distal retaining wall 2137 and the proximal retaining wall 2138 may define a gap between them, which This may be equal to or shorter than the length of the bracket block 2100, so that the bracket block 2100 can be tightly mounted in the groove 2130 for the bracket block when the bracket block 2100 is inserted into it.

In various embodiments, referring again to FIG. 88 and 89, a bracket block, such as a bracket block 1200, for example, may include a flat, or at least substantially flat, tissue-contacting surface 1219. In at least one such embodiment, the housing 1210 of the bracket block 1200 may include a first end 1205, which may be designated a first height or thickness 1207, and a second end 1206, which may be designated a second height or thickness 1208, wherein the first height 1207 may be equal to, or at least substantially equal, the second height 1208. In some embodiments, the implementation The height or thickness of the bracket block body 1210 may be constant or at least substantially constant 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 substantially parallel to the bottom surface 1218 of the bracket block body 1210. In various embodiments, referring again to FIG. 108, the first end 2105 of the body 2110 of the bracket block 2100 may be designated 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 exceeds the second height 2108, although the second height 2108 may exceed the first height 2107 in an alternative an embodiment. In various embodiments, the height of the bracket block body 2110 may decrease linearly and / or geometrically between the first end 2105 and the second end 2106. In at least one such embodiment, the tissue-contacting surface 2119 that extends between the first end 2105 and the second end 2106, can be oriented along the angle marked between them. In at least one such embodiment, the fabric contacting surface 2119 may not be parallel to the bottom surface 2118 of the bracket block body 2110 and / or parallel to the supporting surface 2131 of the bracket block groove 2130.

In various embodiments, referring again to FIG. 108 and 109, the abutment member 2140 may include a fabric contacting surface 2141, which may be parallel or at least substantially parallel to the abutment surface 2131 of the bracket block groove 2130 when the abutment member 2140 is in the closed position, as shown in FIG. 109. When the stop member 2140 is in the closed position, the stop member 2140 may be configured to compress the first end 2105 of the bracket block 2100 more 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 circumstances, including circumstances where the thickness of the fabric T located between the tissue-contacting surfaces 2119 and 2141 is constant or at least substantially constant, the pressure created between the fabric T and the block of staples approx. 2100 at the distal end of the end clamp may exceed this pressure at the proximal end of the end clamp. More specifically, when the thickness of the fabric T between the abutment member 2140 and the block of brackets 2100 is substantially constant, the tissue T located between the distal end 2145 of the abutment element 2140 and the first end 2105 of the block of brackets 2100 can compress more than the fabric T located between the proximal end 2146 of the abutment member 2140 and the second end 2106 of the bracket block 2100. In various embodiments, pressure can occur in tissue T between the proximal end and the distal end of the end clip. More specifically, in at least one embodiment, when the thickness of the fabric T between the abutment member 2140 and the block of brackets 2100 is substantially constant, and the height of the block of brackets 2100 decreases linearly from the distal end to the proximal end of the end clamp, the pressure inside the fabric T can decrease linearly from the distal end of the end clamp to the proximal end of the end clamp. Similarly, in at least one embodiment, when the thickness of the fabric T between the abutment member 2140 and the block of brackets 2100 is substantially constant, and the height of the block of brackets 2100 decreases geometrically from the distal end to the proximal end of the end clamp, the pressure inside the fabric T may decrease geometrically from the distal end of the end clamp to the proximal end of the end clamp.

In various embodiments, referring again to FIG. 108, the thickness of the fabric T located between the bracket block 2100 and the abutment member 2140 may not be constant everywhere. In at least one such circumstance, the thickness of the tissue T located between the proximal end 2146 of the stop member 2140 and the second end 2106 of the bracket block 2100 may exceed the thickness of the tissue T located between the distal end 2145 of the stop member 2140 and the first end 2105 of the bracket block 2100 Under such circumstances, as a result, tissue T of greater thickness can, in most cases, be located above the shorter proximal end 2106 of the bracket block 2100, and tissue T of smaller thickness can, in most cases, be located above more the other distal end 2105. In use, the trigger sleeve 2152 of the barrel 2150 can extend distally along the axis 2151 of the barrel so that the trigger sleeve 2152 engages with the cam portion 2143 of the stop element 2140 and rotates the stop element 2140 in the direction of the bracket block 2100, as shown in FIG. 109. Once the abutment member 2140 is rotated to the fully closed position, the tissue T may be compressed between the tissue-contacting surfaces 2119 and 2141 and, although the height of the bracket block 2100 may not be constant between the proximal and distal ends of the end clamp, pressure or compression force applied to tissue T may be constant or at least substantially constant over its entire area. More specifically, since a fabric T of smaller thickness can interact with a larger height of the block of brackets 2100, and fabric T of larger thickness can interact with a lower height of the block of brackets 2100, in total, or in total, the height of the fabric T and the block of brackets 2100 can be constant or, at least substantially constant between the proximal and distal ends of the end clamp and, as a result, the compression of this combined height by the abutment member 2140 may be constant, or at least substantially constant, over the entire area.

In various embodiments, referring again to FIG. 108 and 109, the bracket block 2100 may have an asymmetric configuration. In at least one such embodiment, for example, the height of the bracket block 2100 at its first end 2105 may exceed the height of the bracket block 2100 at its second end 2106. In some embodiments, the bracket block 2100 and / or the trough of the bracket block 2130 may include one or several leveling and / or holding devices that can be designed to ensure that the bracket block 2100 is placed exclusively in the bracket block groove 2130 in one orientation, i.e., in an orientation in which the first end 2105 is located at the distal end 2135, the brackets block grooves 2130, and the second end 2106 is located at the proximal end 2136. In various alternative embodiments, the brackets block 2100 and / or the brackets block groove 2130 may include one or more leveling and / or restraining devices, which may be used to accommodate the block brackets 2100 in the groove 2130 block brackets in more than one orientation. Turning now to FIG. 110, for example, the bracket block 2100 may be located in the bracket block groove 2130 such that the first end 2105 of the bracket block 2100 may be located at the proximal end 2136 of the bracket block groove 2130, and the second end 2106 may be located at the distal end 2135. In various embodiments, as a result, a lower height of the brackets 2100 may be located close to the distal retaining wall 2137, and a larger height of the brackets 2100 may be located close to the proximal retaining wall 2138. In at least one such embodiment, In addition, the block of brackets 2100 can be made in an acceptable way for applying a constant, or at least substantially constant, compression pressure to the tissue T, a part of which, having a greater thickness, is located inside the distal end of the end clamp, and a part having a smaller thickness, located inside the proximal end of the end clamp. In various embodiments, the bracket block 2100, for example, may be selectively oriented in the groove 2130 for the bracket block. In at least one such embodiment, the leveling and / or holding devices of the bracket block 2100 may be symmetrical, and the surgeon may selectively orient the bracket block 2100 in the groove block 2130 in the orientations depicted, for example, in FIG. 108 and FIG. 110.

In addition to the foregoing, the implantable bracket block body 2110 may include a longitudinal axis 2109, which, when the bracket block 2100 is located in the groove of the bracket block 2130, may extend between the proximal and distal ends of the end clamp. In various embodiments, the thickness of the bracket block body 2110 may generally increase and / or generally decrease 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 the bottom surface 2118 and fabric contacting surface 2119 may generally decrease and / or generally increase between the first end 2105 and the second end 2106. In some embodiments, the thickness of the bracket block body 2110 can both increase or decrease along the longitudinal axis 2109. In at least one such embodiment, the thickness of the bracket block body 2110 may include one or more parts whose thickness increases, and one or more parts whose thickness may decrease. In various embodiments, referring again to FIG. Z, the block of brackets 2100 may include a plurality of brackets 2120 located therein. In use, as described above, the brackets 2120 may be deformed when the stop member 2140 moves to the closed position. In some 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 brace can be measured, for example, from the bottom of the base of the brace to the top, or the tip, of the longest leg of the suture brace.

In various embodiments, the height of the brackets in the bracket block may be different. In at least one such embodiment, the bracket block may include a first group of brackets having a first height of brackets located in the first part of the crumpled brace block body, and a second group of brackets having a second height of brackets located in the second part of the crumpled brace block body. In at least one embodiment, the first height of the suture bracket may exceed the second height of the suture bracket, and the first group of brackets may be located at the first end 2105 of the bracket block 2100, while the second group of brackets may be located at the second end 2106. Alternatively, the first group of brackets of greater height may be located at the first end 2106 of the block of brackets 2100, while the second group of brackets of lower height may be located at the first end of 2105. In some embodiments, it is possible to use another set of parenthesis groups when each group contains brackets of different heights. In at least one such embodiment, a third group including brackets of intermediate height may be located in the bracket block body 2110 between the first group of brackets and the second group of brackets. In various embodiments, each suture bracket in a row of brackets in a bracket block may have a different height. In at least one embodiment, the longest suture bracket in the row of brackets 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 longest bracket and the shortest bracket can be positioned so that the height of the brackets decreases from the height of the longest bracket to the height of the shortest bracket.

In various embodiments, referring to FIG. 111, the end clamp of the surgical stapler may include an abutment member 2240, a chute for the brace block 2230, and a brace block 2200 supported in the chute 2230 for the brace block. The block of brackets 2200 may include a crushable implantable case 2210 of a block of brackets and a set of brackets, for example, a set of brackets 2220a and brackets 2220d located therein. In various embodiments, the brace block chute 2230 may include a brace block support surface 2231 and a plurality of brace support grooves, such as for example, the support grooves 2232a and 2232b indicated therein. In at least one such embodiment, the bracket block 2200 may include two outer rows of brackets 2220a and two inner rows of brackets 2220b, while the support grooves 2232a may be configured to support the brackets 2220b. Turning to FIG. 111 and 112, the stop member 2240 may include a plurality of brace-forming recesses 2242 marked thereon, which can be configured to insert and deform the brackets 2220a and 2220b when the stop member 2240 moves toward the block of brackets 2200. In at least one such embodiment of implementation, the lower surfaces of the support grooves 2232a may be at a first distance 2201a from the upper surfaces of the bracket-forming recesses 2242, while the lower surfaces of the support grooves 2232b may be at a second distance 2201b from rhnih surfaces forming brackets recesses 2242. In at least one such embodiment, the supporting grooves 2232b are closer to the abutment member 2240, because of a raised bearing surface in step 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 can be deformed to various heights in the closed state. In various circumstances, the brackets deformed to different heights in a closed state may apply different pressures or compressive forces to the stitched fabric T. In addition to the above, the height of the brackets before they are formed may be different. In at least one such embodiment, refer again to FIG. 111, the initial height of the outer brackets 2220a before they are formed may exceed the initial height of the inner brackets 2220b before they are formed. As shown in FIG. 111 and 112, the inner brackets 2220b having a shorter height before forming compared to the outer brackets 2220a may also be shorter in the formed length compared to the height of the outer brackets 2220b. In various alternative embodiments, the height of the inner brackets 2220b prior to their formation may exceed the height of the outer brackets 2220a, but the brackets may be lower in shape than the outer brackets 2220a.

In various embodiments, in addition to the foregoing, the abutment member 2240 may move to the closed position, as shown in FIG. 112, for compressing the bracket block body 2210 and deforming the brackets 2220a and 2220b. In some embodiments, a surgical stapler including an end clip depicted in FIG. 111 and 112, for example, may also include a cutting element with a configuration for dissecting the tissue T located between the stop element 2240 and the block of brackets 2200. In at least one such embodiment, the stop element 2240, the groove 2230 of the bracket block and / or the block of brackets 2200 can form a groove configured to insert, with the possibility of sliding, the cutting element. More specifically, the stop member 2240 may include a groove portion 2249, the chute 2230 for the bracket block 2230 may include a groove portion 2239, and the bracket block 2200 may include a groove portion 2203 that are aligned, or at least substantially aligned, with respect to each other to a friend when the thrust member 2240 is in a closed, or at least substantially closed, position. In various embodiments, the cutting member may move from the proximal end of the end clamp toward the distal end of the end clamp after the stop member 2240 is closed and the brackets 2220a, 2220b are deformed. In at least one embodiment, the cutting element can be moved independently of the deformation process of the brackets. In some embodiments, the cutting element may extend at the same time as the deformation of the brackets. In any case, in at least one embodiment, the cutting element may be configured to cut the fabric along a line located between the inner rows of brackets 2220b.

In various embodiments, as shown in FIG. 112, the height of the inner brackets 2220b in the formed state may be shorter than the outer brackets 2220a, while the inner brackets 2220b can exert a higher pressure or compressive force on the fabric next to the cut line made by the cutting element. In at least one such embodiment, the higher pressure or compression force created by the inner brackets 2220b may provide various therapeutic benefits, such as reducing bleeding from dissected tissue T, while the less intense pressure or compression force created by the outer brackets 2220a may provide flexibility in stitched fabric. In various embodiments, referring again to FIG. 111 and 112, the abutment member 2240 may also include at least one piece of support material, such as support material 2260 attached to it. In at least one such embodiment, the legs of the brackets 2220a, 2220b may be configured to pierce the support material 2260 and / or to pass through the holes in the support material 2260 when the bracket unit 2200 is compressed by the stop member 2240 and then contact with the brackets forming the recesses 2242 in the abutment element 2240. As the legs of the brackets 2220a, 2220b deform, the legs can come into contact and / or pierce the supporting material 2260 again. In various embodiments, support material 2260 may improve hemostasis and / or strength of stitched tissue.

In various embodiments, referring again to FIG. 111 and 112, the lower surface of the bracket block body 2210 may have a stepped contour matching, or at least substantially matching, a stepped contour of the brace block supporting surface 2231. In some embodiments, the bottom surface of the bracket block body 2210 may be deformed to match, or at least substantially match, the outline of the bracket block bearing surface 2231. In various embodiments, referring now to FIG. 113, an end clip similar to the end clip shown in FIG. 111, for example, may include a bracket block 2300 located therein. The bracket block 2300 may include a crushable implantable housing 2310 including an inner layer 2312 and an outer layer 2311, wherein, in addition to the foregoing, the outer layer 2311 may be made of a waterproof material in at least one embodiment. 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, referring now to FIG. 114, an end clip similar to the end clip shown in FIG. 111, for example, may include a bracket block 2400 located therein. Similar to the bracket block 2300, the crushable, implantable housing 2410 of the bracket block 2400 may include an inner layer 2412 and an outer layer 2411; however, in at least one embodiment, the bracket block body 2410 may not include a groove for the cutting element. In at least one such embodiment, the cutting element must cut through the inner layer 2412 and / or the outer layer 2411 as it extends through the block of brackets.

In various embodiments, referring now to FIG. 115, the end clamp of the surgical stapler may include a stop member 2540, a gutter 2530 for the bracket unit and a bracket unit 2500 located in the gutter 2530 of the bracket unit. Similar to the foregoing, the bracket block 2500 may include a crushable, implantable bracket block housing 2510, outer rows of brackets 2220a, and inner rows of brackets 2220b. The bracket block chute 2530 may include a flat, or at least substantially flat, bracket surface 2531 of the bracket block and support brackets of the bracket block 2532 indicated therein. The thrust member 2540 may include a stepped surface 2541 and a plurality of bracket forming recesses, such as, for example, forming recesses 2542a and 2542b formed therein. Similar to the above, the forming recesses 2542a and the support grooves 2532 may indicate a distance between them that exceeds the distance between the forming recesses 2452b and the support grooves 2532. In various embodiments, the stop member 2540 may also include a piece of support material 2560 attached to the stepped surface 2541 thrust member 2540. In at least one such embodiment, the supporting material 2560 may correspond, or at least substantially correspond to step, surface 2541. In various embodiments, the support material 2560 may be removably attached to surface 2541 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. In some embodiments, the bracket block housing 2510 may also include a stepped profile, which, in at least one embodiment, is arranged parallel or at least substantially parallel to the stepped surface 2541 of the stop member 2540. More specifically, at least in one embodiment, the thrust member 2540 may include steps 2548 protruding in the direction of the bracket block 2500, wherein steps 2548 may have a height that is equal to, or at least substantially equal to, the height of the step th 2508 protruding from the housing 2510 block brackets. In at least one such embodiment, as a result of the foregoing, for example, the size of the crumpled bracket block body 2510, which may be covered by the first brackets 2220a, may differ from the size of the crumpled bracket block body 2510 that may be covered by the second brackets 2220b.

In various embodiments, referring now to FIG. 116, the end clamp may include a stop member 2640, a gutter of the bracket block and a bracket block 2600, a bracket block 2600 located between them may include a crushable implantable housing 2610 including an inner layer 2612, an outer layer 2611 and a plurality of brackets, such as, for example, brackets 2220a and 2200b located therein. In various embodiments, the abutment member 2640 may include a plurality of brace-forming recesses 2642 in the surface 2641, and the gutter block groove 2530 may include brace-forming grooves 2532 defined in the support surface 2531. As shown in FIG. 116, the surface 2641 of the thrust member may be parallel, or at least substantially parallel, to the supporting surface 2531 of the bracket block, wherein each forming recess 2642 may be located at the same or at least substantially the same distance from opposite and corresponding support grooves 2532 of the bracket block. In various embodiments, the bracket block 2600 may include brackets with the same, or at least substantially the same, original parenthesis height in an unformed form, and, in addition, with the same, or at least substantially the same parenthesis height in formed form. In some other embodiments, the outer rows of brackets may include brackets 2220a and the inner rows of brackets may include brackets 2220b, while, as described above, the height of brackets 2220a and 2220b in an unformed form may vary. When the stop member 2640 moves toward the block of brackets 2600 in the closed position, the brackets 2220a and 2220b can be formed so that their height in the formed form is the same, or at least substantially the same. In at least one such embodiment, as a result of the foregoing, the formed outer brackets 2220a and inner brackets 2220b may occupy the same or at least substantially the same part of the crumpled bracket block body 2610 in which they are contained; However, since the outer brackets 2220a their height in an unformed form exceeds this height of the inner brackets 2220b, but they can nevertheless have the same height in the formed form, a higher compression pressure may occur in the outer brackets 2220a compared to the inner brackets 2220b.

In various embodiments, referring now to FIG. 117, the end clamp of the surgical stapler may include a stop member 2740, a groove 2530 for the bracket block and a bracket block 2700 located in the groove 2530 for the bracket block. Similar to the above, the bracket block 2700 may include a crushable implantable bracket block housing 2710 including an inner layer 2712, an outer layer 2711, and a plurality of brackets, such as, for example, brackets 2220a located 2220b therein. In at least one embodiment, the thickness of the bracket block body 2710 may vary across its entire width. In at least one such embodiment, the bracket block body 2710 may include a central portion 2708 and side portions 2709, the central portion 2708 may have a thickness greater than the thickness of the side portions 2709. In various embodiments, the bracket portion of the bracket block body 2710 having the largest thickness may be located in the central part 2708, while the part of the bracket unit body 2710 having the smallest thickness may be located in the side parts 2709. In at least one such embodiment, then the thickness of the bracket block body 2710 may gradually decrease between the center portion 2708 and the side portions 2709. In some embodiments, the thickness of the bracket block body 2710 may decrease linearly and / or geometrically between the center portion 2708 and the side portions 2709. In at least one such embodiment the fabric contacting surface 2719 of the bracket block body 2710 may include two inclined or angled surfaces that are beveled downward from the central portion 2708 towards the side portions 2709. In various embodiments The implementation of the thrust element 2740 may include two inclined or angular surfaces that are parallel, or at least substantially parallel, the inclined tissue-contacting surfaces 2719. In at least one embodiment, the thrust element 2740 may also include, at least one fragment of the supporting material 2760 attached to the inclined surfaces of the thrust element 2740.

In various embodiments, in addition to the foregoing, the inner rows of brackets in the bracket block 2700 may include longer brackets 2220a, and the outer rows of brackets may include shorter brackets 2220b. In at least one embodiment, longer brackets 2220a may be located in and / or adjacent to the central portion 2708 having a greater thickness, while brackets 2220b may be located in and / or adjacent to the side portions. In at least one such embodiment, as a result of the foregoing, longer brackets 2220a can capture more material of the implantable bracket block body 2710 compared to shorter brackets 2220b. Such circumstances may cause the brackets 2220a to exert more pressure on the fabric T than the brackets 2220b. In some embodiments, even if longer brackets 2220a can capture more material of the bracket block body 2710 than shorter brackets 2220b, the height of the longer brackets 2220a in the formed form can exceed the height of the shorter brackets 2220b due to the inclined design of the bracket-forming recesses 2742a and 2742b. Such aspects can be used to achieve the desired level of compression pressure in the tissue gripped by the brackets 2220a and 2220b, with the result that the compression pressure in the brackets 2220a may, for example, exceed, be less than, or equal to the compression pressure applied to the fabric by the brackets 2220b. In various alternative embodiments, the end clamp shown in FIG. 117, the shorter brackets 2220b may be located in and / or adjacent to the greater thickness central portion 2708 of the bracket unit bodies 2710, and the longer brackets 2220a may be located in and / or adjacent to the smaller thickness side portions 2709. Moreover, although the bracket block 2700 is shown as including the inner and outer layers of brackets, the bracket block 2700 may include additional rows of brackets, for example, rows of brackets located between the inner and outer rows of brackets. In at least one such embodiment, the intermediate rows of brackets may include brackets whose height in an unformed form is intermediate between the height of the brackets 2220a and 2220b in the unformed form and the height of the brackets in the formed form intermediate with the height of the brackets 2220a and 2220b in the formed form.

In various embodiments, referring now to FIG. 118, the end clamp of the surgical stapler may include a stop member 2840, a groove 2530 for the bracket block and a bracket block 2800 located in the groove 2530 for the bracket block. Similar to the above, the bracket block 2800 may include a crushable implantable housing 2810, for example, comprising an inner layer 2812, an outer layer 2811 and a plurality of brackets, such as the brackets 2220a and 2220b located therein. In at least one embodiment, the thickness of the bracket block body 2810 may vary across its entire width. In at least one such embodiment, the bracket block body 2810 may include a central portion 2808 and side portions 2809, while the central portion 2808 may have a thickness less than the thickness of the side portions 2809. In various embodiments, a portion of the bracket block housing 2810, having the smallest thickness may be located in the central part 2808, while the part of the bracket block body 2810 having the greatest thickness may be located in the side parts 2809. In at least one such embodiment, the thickness of the bracket block body 2810 may gradually increase between the central portion 2808 and the side portions 2809. In some embodiments, the thickness of the bracket block body 2810 may increase in arithmetic and / or geometric progression between the central portion 2808 and the side portions 2809. In at least one such an embodiment, the fabric contacting surface 2819 of the bracket block body 2810 may include two inclined or angled surfaces that are inclined upward from a central portion 2808 in a lateral direction parts 2809. In various embodiments, the abutment element 2840 may include two inclined or angled surfaces that are parallel or at least substantially parallel to the inclined fabric contact surfaces 2819. In at least one embodiment, the abutment element 2840 may also include at least one piece of support material 2860 attached to the inclined surfaces of the abutment member 2840. In various embodiments, in addition to the foregoing above, the outer rows of brackets in the bracket block 2800 may include longer brackets 2220a and inner rows of brackets that include shorter brackets 2220b. In at least one embodiment, longer brackets 2220a may be located in and / or adjacent to the larger side portions 2809, while brackets 2220b may be located in and / or adjacent to the central portion 2808. At least in one such embodiment, as a result of the foregoing, longer brackets 2220a can capture more material of the implantable bracket block body 2810 compared to shorter brackets 2220b.

As described above with respect to the embodiment of FIG. 111, for example, the chute 2230 for the bracket block may include a stepped support surface 2231, which can be designed to support brackets 2220a and 2220b with different heights relative to the stop element 2240. In various embodiments, the chute 2230 for the bracket block can be made of metal, and the steps in the supporting surface 2231 can be formed in the supporting surface 2231, for example, by grinding. In various embodiments, referring now to FIG. 119, the end clamp of the surgical device may include a gutter 2930 for a block of brackets, including a support insert 2935 located therein. More specifically, in at least one embodiment, the bracket block chute 2930 may be formed so as to have a flat, or at least substantially flat, support surface 2931, for example, which may be configured so that support the liner 2935, including stepped surfaces to support the brackets 2220a and 2220b of the block of brackets 2200 at various heights. In at least one such embodiment, the liner 2935 may include a flat, or at least substantially flat, lower surface that may lie opposite the abutment surface 2931. The liner 2935 may also include abutment grooves, grooves, or grooves 2932a and 2932b, which may be configured to support brackets 2220a and 2220b, respectively, at different heights. Similar to the above, the insert 2935 may include a knife slot 2939 made in it, with such a configuration to allow the passage of the cutting element through it. In various embodiments, the brace block chute 2930 may be made of the same material as the material of the support liner 2935, or another material. In at least one embodiment, both the chute 2930 for the bracket block and the support liner 2935 can be made, for example, of metal, while in other embodiments, the chute 2930 for the bracket block can be made, for example, of metal, and the support shell 2935 may be made, for example, of plastic. In various embodiments, the support liner 2935 may be attached and / or welded to the groove 2930 for a block of brackets. In some embodiments, the implementation of the support liner 2935 may snap and / or be pressed into the groove 2930 for block brackets. In at least one embodiment, the support liner 2935 may be secured to the bracket block groove 2930 using an adhesive.

In various embodiments, referring now to FIG. 120, the end clamp of the surgical stapler may include a stop member 3040, a groove 3030 for the brace block and a crushable, implantable brace block 3000 located in the groove 3030 for the brace block. Similar to the foregoing, the thrust member 3040 may include a plurality of brace-forming recesses 3042 indicated therein and a knife slot 3049 to receive, with the possibility of sliding, the cutting element. Also similar to the above, the gutter 3030 for the bracket block may include a plurality of support grooves 3032 for the brackets made therein, and a knife slot 3039 to receive, with the possibility of sliding, the cutting element. In various embodiments, the block of brackets 3000 may include a first layer 3011, a second layer 3012, and a plurality of brackets, such as, for example, brackets 3020a and 3020b, for example, located therein. In at least one embodiment, the height of the brackets 3020a in unformed form may exceed the height of the brackets 3020b in unformed form. In various embodiments, the first layer 3011 may be made of a first compressible material, and the second layer 3012 may be made of a second compressible material. In some embodiments, the first compressible material can be compressed to a higher degree than the second compressible material, while in some other embodiments, the first compressible material can be compressed to a lower degree than the second compressible material. In at least one embodiment, the first compressible material may be made of elastic material having a first coefficient of elasticity, and the second compressible material may be made of elastic material having a second coefficient of elasticity other than the first coefficient of elasticity. In various embodiments, the first compressible material may have a higher coefficient of elasticity than the coefficient of elasticity of the second compressible material. In some other embodiments, the first compressible material may have a lower coefficient of elasticity than the coefficient of elasticity of 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, wherein the first stiffness is different from the second stiffness. In various embodiments, the first compressible layer may have a stiffness exceeding that of the second compressible layer. In some other embodiments, the first compressible layer may have a stiffness lower than that of the second compressible layer.

In various embodiments, referring again to FIG. 120, the second layer 3012 of the bracket block 3000 may have a constant, or at least substantially constant, thickness across its entire width. In at least one embodiment, the thickness of the first layer 3011 may vary across its entire width. In at least one such embodiment, the first layer 3011 may include one or more steps 3008 that can increase the thickness of the bracket block housing 3010 in some parts of the bracket block housing 3010, such as, for example, a central portion. Turning again to FIG. 120, shorter brackets 3020b may be located in or aligned with steps 3008, i.e. parts of the bracket block body 3010 having a larger thickness, and longer brackets 3020a may be positioned in or aligned with the bracket portion housing parts 3010 having a smaller thickness. In various embodiments, due to parts of the bracket block body 3010 with greater or lesser thickness, the stiffness of the bracket block housing 3010 along the inner rows of brackets 3020b may exceed this figure along the outer rows of brackets 3020a. In various embodiments, the first layer 3011 may be connected to the second layer 3012. In at least one such embodiment, the first layer 3011 and the second layer 3012 may include locking devices that can hold layers 3011 and 3012 together. In some embodiments, the first layer 3011 may include a first laminate and the second layer 3012 may include a second laminate, wherein the first laminate may adhere to the second laminate with one or more adhesives. In various embodiments, the block of brackets 3000 may include a knife slot 3003 with such a configuration to receive a cutting element with the possibility of sliding.

In various embodiments, referring now to FIG. 121, the bracket block 3100 may include a crushable, implantable bracket block housing 3110 containing one layer of crushable material and, in addition, a plurality of brackets, such as, for example, brackets 3020b located therein. In at least one embodiment, the thickness of the bracket block body 3110 may vary across its entire width. To at least one embodiment, the bracket unit housing 3110 may include steps 3108 located along its side portions. In various embodiments, referring now to FIG. 122, the bracket block 3200 may include a crushable, implantable bracket block housing 3210 containing one layer of compressible material and, in addition, a plurality of brackets, such as, for example, brackets 3020b located therein. In at least one embodiment, the thickness of the bracket block housing 3210 may vary across its entire width. To at least one embodiment, the bracket block housing 3210 may include steps 3208 located along its central portion. In various embodiments, referring now to FIG. 123, the bracket block 3300 may include a crushable, implantable bracket block housing 3310 similar to the above, the thickness of the bracket block housing 3310 may vary across its entire width. In at least one such embodiment, the thickness of the bracket block body 3310 may increase exponentially between the side portions and the central portion of the bracket block body 3310. In at least one such embodiment, the thickness of the bracket block body 3310 may be defined by an arcuate or curved profile and may include an arched or curved surface 3319 in contact with the fabric. In some embodiments, the thickness of the body 3310 of the bracket block and the contour of the fabric contacting surface 3319 may be outlined by a single radius or curved line or, alternatively, several radii or curved lines, for example. In various embodiments, referring now to FIG. 124, the bracket block 3400 may include a crushable, implantable bracket block housing 3410, wherein the thickness of the bracket block housing 3410 may increase linearly, or at least substantially linearly, between the side portions and the central portion of the bracket block body 3410 .

In various embodiments, referring now to FIG. 125, the brace block 3500 may include a crushable, implantable bracket block case 3510 and a plurality of brackets 3520 located therein. The implantable bracket block body 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 may have a second thickness, with the second inner layer 3513 may have a greater thickness than the first inner layer 3512. In at least one alternative embodiment, the first inner layer 3512 may have a greater thickness than the second inner layer 3513. In other in an 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 some embodiments, each bracket 3520 may include a base 3522 and one or more deformable legs 3521 extending from the base 3522. In various embodiments, each leg 3521 may include a tip 3523 that is embedded in the first inner layer 3511 and, in addition, each base 3522 of the brackets 3520 can be embedded in a second the inner layer 3512. In at least one embodiment, the first inner layer 3512 and / or the second inner layer 3513 may include at least one drug contained therein and, in various embodiments, the outer layer 3511 may be wrapped and seal the first inner layer 3512 and the second inner layer 3513 so as to prevent leakage of the drug from the bracket block body 3510 until the outer layer 3511 is pierced by the brackets 3520. More specifically, in addition to the foregoing ohm, the thrust element can be pushed down relative to the fabric opposite the surface 3519 of the bracket block 3500 in contact with the fabric so that the bracket block body 3510 is compressed and the surface 3519 moves down towards and at least partially below the ends of the brackets 3523 so so that the ends 3523 tear or puncture the outer layer 3511. After the brace legs 3521 pierce the outer layer 3511, at least one drug M can flow out of the bracket block body 3510 around the brace legs 3521. In various circumstances, additional compression of the bracket block body 3510 may squeeze an additional portion of the drug M from the bracket block body 3510, as shown in FIG. 126.

In various embodiments, referring again to FIG. 125, the outer layer 3511 may include a waterproof, or at least substantially waterproof, shell configured to, first, prevent accidental leakage of the drug from the bracket unit 3500 and, second, prevent accidental ingress of fluids from the surgical field, for example, in a bracket block 3500. In some embodiments, the first inner layer 3512 may include a first drug that is stored in an accumulated or absorbed form, wherein the second inner the th layer 3513 may include the second drug in accumulated or absorbed form, while the second drug may be different from the first drug. In at least one embodiment, the initial compression of the bracket block body 3510 causing a rupture of the outer layer 3511 may generally cause the first drug to extrude from the first inner layer 3512, and the subsequent compression of the bracket block body 3510 may generally cause the second drug to extrude from the second inner layer 3513. In such embodiments, however, portions of the first drug and the second drug can be extruded simultaneously, although more the first part of the drug squeezed out can be the first drug, and the second drug can be the most squeezed out after that. In some embodiments, in addition to the foregoing, the first inner layer 3512 may be made of a more compressible material than the second inner layer 3513 so that the initial compression forces or pressures, which may be weaker than subsequent compression forces or pressures, can cause a larger initial offset in the first inner layer 3512 compared to the second inner layer 3513. Such a larger initial offset in the first inner layer 3512 can squeeze out most of the first o drug from the first inner layer 3512 compared to the second drug from the second inner layer 3513. In at least one embodiment, the first inner layer 3512 may have greater porosity and / or flexibility compared to the second inner layer 3513. By in at least one such embodiment, the first inner layer 3512 may include a collection of pores or voids 3508 indicated therein, the second inner layer 3513 may include a collection of pores or voids 3509 indicated in in this, in various embodiments, the pores 3508 can be configured to contain the first drug in the first inner layer 3512, and the pores 3509 can be configured to contain the second drug in the second inner layer 3513. In some embodiments, the size and the density of pores 3508 in the first inner layer 3512 and pores 3509 in the second inner layer 3513 can be chosen to provide the desired result described in this document.

In various embodiments, referring again to FIG. 125 and 126, the outer layer 3511, the first inner layer 3512, and / or the second inner layer 3513 may be made of bioabsorbable material. In at least one embodiment, the first inner layer 3512 may be made of a first bioabsorbable material, the second inner layer 3513 may be made of a second bioabsorbable material, and the outer layer 3511 may be made of a third bioabsorbable material, wherein the first bioabsorbable material, the second bioabsorbable material and / or the third bioabsorbable material may be various materials. In some embodiments, the first bioabsorbable material may undergo bioabsorption at a first speed, the second bioabsorbable material may undergo bioabsorption at a second speed, and the third bioabsorbable material may undergo bioabsorption at a third speed, wherein the first speed, second speed and / or third speed may differ apart from each other. In at least one such embodiment, when the material is bioabsorbable at a certain rate, this rate can be defined as the amount of mass of material that can be absorbed in the patient’s body per unit time. As you know, the organisms of different patients can absorb different materials at different speeds, and thus, such speeds can be expressed as average speeds to account for such variability. In any case, the speed at which a large mass is bioabsorbable per unit time compared to a lower speed can be considered a higher speed. In various embodiments, referring again to FIG. 125 and 126, the first inner layer 3512 and / or the second inner layer 3513 can be made of a material that undergoes bioabsorption at a faster rate than the material of which the outer layer 3511 is made. In at least one such embodiment, the first inner layer 3512 and / or the second inner layer 3511 can be made of bioabsorbable foam, fabric sealant and / or hemostatic material, such as, for example, oxidized regenerated cellulose (ORC), and the outer layer 3511 can be made from holding a material and / or plastic material, such as polyglycolic acid (PGA) sold on the market under the trade name Vicryl, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PHCL), which is sold under trade name monocryl, polycaprolactone (PCL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can, for example, immediately have a therapeutic effect on the tissue and reduce bleeding from the tissue, while the outer layer 3514 can provide long-term structural support and undergo bioabsorption at a lower rate.

Due to the lower bioabsorption rate of the outer layer 3511, in addition to the foregoing, the outer layer 3511 can support or structurally strengthen the fabric in the suture line during its healing. In some embodiments, one of the first inner layer 3512 and the second inner layer 3513 may be made of a material that is bioabsorbable faster than the others, so that in at least one embodiment, one of the layers can provide initial release of the therapeutic material and the outer the layer could provide a sustained release of the same therapeutic material and / or other therapeutic material. In at least one such embodiment, the rate at which therapeutic material can be released from layer 3512, 3513 may be a function of the bioabsorption of the substrate layer in which the drug is absorbed or dispersed. For example, in at least one embodiment, the substrate constituting the first inner layer 3512 can undergo bioabsorption faster than the substrate constituting the second inner layer 3513 and, as a result, the drug can be released from the first inner layer 3512 faster than from the second inner layer 3513, for example. In various embodiments, as described herein, one or more layers 3511, 3512, and 3513 of the bracket block body 3510 may adhere to each other using at least one adhesive, such as, for example, fibrin and / or protein hydrogel . In some embodiments, the adhesive may be water soluble and made to break the connection between the layers as the block of brackets 3500 is implanted and / or some time later. In at least one such embodiment, the adhesive can be made for faster bioabsorption than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

In various embodiments, referring to FIG. 127 and 128, a bracket block, for example, such as a bracket block 3600, may include a bracket block housing 3610 including a compressible first layer 3611, a second layer 3612 attached to the first layer 3611 and a removable compressible layer 3613 attached to the second layer 3612. In at least one such embodiment, the first layer 3611 may be made of compressible foam material, the second layer 3612 may be made of laminate glued to the first layer 3611 using one or more adhesives, and the third layer 3613 may be made of compress emogo foam bonded, removably, to the second layer 3612 using one or more adhesives, for example. In various embodiments, the bracket block 3600 may also include a plurality of brackets, such as, for example, brackets 3620 located in the bracket block body 3610. In at least one such embodiment, each suture bracket 3620 may include a base 3622 located in the 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, for example. In use, in addition to the foregoing, the upper surface 3619 of the bracket block body 3610 may be pushed down by the stop element until the bracket legs 3621 penetrate through the upper surface 3619 and the target fabric and come into contact with the stop element. After a significant degree of deformation of the bracket legs 3621, the thrust element can be moved away from the bracket block 3600 so that the compressible layers in it can at least partially straighten. Under various circumstances, the penetration of brackets through the tissue can cause bleeding from the tissue. In at least one embodiment, the third layer 3613 may be made of a suction material, such as, for example, a protein hydrogel, which can drain the stitched tissue from the blood. In addition to or in place of the foregoing, the third layer 3613 may be made of hemostatic material and / or tissue sealant, such as, for example, lyophilized thrombin and / or fibrin, which may be designed to reduce bleeding from the tissue. In some embodiments, the third layer 3613 may provide structural support for the first layer 3611 and the second layer 3612, while the third layer 3613 may be made of bioabsorbable material and / or non-bioabsorbable material. In any case, in various embodiments, the third layer 3613 may separate from the second layer 3612 after implantation of the bracket block 3610. In embodiments where the third layer 3613 is made of material of suitable quality for implantation, the surgeon is able to choose whether to remove the third layer 3613 housing 3610 block brackets. In at least one embodiment, the third layer 3613 may be configured to separate completely from the second layer 3612.

In various embodiments, the first layer 3611 may be made of a first foam and the third layer 3613 may be made of a second foam that may be different from the first foam. In at least one embodiment, the first foam may have a first density, the second foam may have a second density, and the first density may differ from the second density. In at least one such embodiment, the second density may exceed the first density, with the result that the third layer 3613 may have lower compressibility or lower compression ratio compared to the first layer 3611. In at least one in an alternative embodiment, the first density may exceed the second density, with the result that the first layer 3611 may have a lower crushability or lower compression ratio compared to the third layer 3613. In various embodiments implementation, referring now to FIG. 129 and 130, the bracket block 3700, similar to the bracket block 3600, may include a bracket block housing 3710 comprising a first compressible foam layer 3711, a second layer 3712 attached to the first layer 3711, and a detachable third compressible foam layer 3713 attached, removably to the second layer 3712. In at least one such embodiment, the third layer 3713 may include a plurality of grooves or slots 3709 for inserting brackets, each of which is designed to insert at least part of a suture bracket 3620, such as a base 3622 parentheses, for example. In some embodiments, the brackets 3620 can be made to slide in the brackets 3709 for inserting the brackets or, in other words, the third layer 3713 can be made to slide relative to the brackets 3620 when the block of brackets 3700 is located opposite the target fabric and is compressed by a stop element, for example . In at least one embodiment, the insertion grooves 3709 may be configured so that a gap is maintained between the brackets 3620 and the side walls of the insertion grooves 3709. In at least one such embodiment, as a result of the foregoing, the brackets 3620 may not capture part of the third layer 3713 when the brackets 3620 are deformed, as shown in FIG. 129 and 130. In some other embodiments, the ends of the parenthesis grooves 3709 next to the second layer 3712 may be covered by part of the third layer 3713 and, as a result, at least part of the third layer 3713 may be gripped by brackets 3620 in a deformed form. In any case, the third layer 3713 may include one or more perforated holes and / or transverse sections 3708, for example, which can be configured to ensure that the third layer 3713 is removed from the second layer 3712 in two or more parts, as shown in FIG. 129. In FIG. 129, one of the parts of the third layer 3713 removed by the tool 3755 is shown. In various embodiments, perforated holes 3708 may be positioned along a line between the first row of brackets and the second row of brackets.

In various embodiments, referring again to FIG. 129 and 130, the bases 3622 of the brackets 3620 can be placed in the grooves 3709 for insertion, while in at least one embodiment, the side walls of the grooves 3709 for insertion can be made to enter into contact and hold, with the possibility of release, the legs 3621 brackets on location. In some embodiments, although not shown, the third layer 3713 may include an elongated groove surrounding all the brackets within the line of brackets. In at least one such embodiment, a bracket block containing four rows of brackets, for example, may include an elongated groove aligned with each row of brackets in the bottom layer of the bracket block. In addition to the foregoing, at least a portion of the bracket block 3600 and / or the bracket block 3700 can be implanted in the patient’s body, and at least a portion of the bracket block can be removed from the patient’s body. In at least one embodiment, referring again to FIG. 129 and 130, the first layer 3711 and the second layer 3712 can be gripped by brackets 3620 and can be implanted with brackets 3620, while the third layer 3713 can be further removed or separated from the bracket block 3700. Under various circumstances, removing a portion of the implanted bracket block may reduce the amount of material to be absorbed in the patient, which can provide various therapeutic benefits. In the event that a portion of the bracket block is separated and removed, using, in particular, a laparoscopic instrument 3755, for example, the separated portion of the bracket block can be removed from the surgical field through a trocar, such as, for example, a trocar with a 5 mm hole. In some embodiments, the implementation of the bracket block body may include more than one layer that may be removed. For example, the bracket block body 3710 may include a fourth layer, wherein the third layer 3713 of the bracket block housing 3710 may be made of hemostatic material, and the fourth layer may be made of a support layer. In at least one such embodiment, the surgeon may remove the support layer, and then choose whether to remove the hemostatic layer, for example.

In various embodiments, referring now to FIG. 131, a bracket block, such as a bracket block 3800, for example, may include a bracket block housing 3810 including an outer layer 3811 and an inner layer 3812. The inner layer 3812 may be made of compressible foam material, and the outer layer 3811 may at least partially wrap the inner layer 3812. In at least one embodiment, the outer layer 3811 may include a first portion 3811a configured to be located on the first side of the inner layer 3812, and a second portion 3811b configured to be located on the second side of the inner the backing layer 3812, wherein the first part 3811a and the second part 3811b may be connected by a flexible loop, such as, for example, loop 3809. In at least one such embodiment, at least one adhesive, such as, for example, fibrin and / or protein hydrogel, can be applied to the first side and / or second side of the inner layer 3812 to fix parts of the outer layer 3811 to them. In various embodiments, the outer layer 3811 may include one or more fastening elements emerging from it. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3821 extending from one side of the outer layer 3811 that can be placed in the compressible inner layer 3812. In at least one such embodiment, the legs 3821 may extend from the second side the inner layer 3812, while in at least one alternative embodiment, the legs 3821 may at least partially protrude from the inner layer 3812. When the compressible bracket block body 3810 is compressed in use, legs 3821 may be configured to puncture the inner layer 3812 and the second portion 3811b of the outer layer 3811. In some embodiments, the second portion 3811b of the outer layer 3811 may include holes, such as, for example, holes 3808 indicated therein, which can be used to insert legs 3821 brackets. In some embodiments, the implementation of at least part of the block of brackets 3800 may include a slot 3803 for a scalpel capable of receiving a cutting element with the possibility of sliding. In at least one such embodiment, the scalpel slot 3803 may not extend completely through the thickness of the bracket block body 3810 and, as a result, the cutting element may dissect the bracket block body 3810 as it extends relative to it.

In various embodiments, referring now to FIG. 132, the bracket block 3900 may include, like the bracket block 3800, the bracket block body 3910 including the inner layer 3812 and the outer layer 3811, while the outer layer 3811 may include a first portion 3811a adjacent to the first side of the inner layer 3812 and a second portion 3811b located adjacent to the second side of the inner layer 3812. In at least one embodiment, similar to the above, the outer layer 3811 may include one or more fastening elements protruding from it. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3921 extending from one side of the outer layer 3811 that can be accommodated in the compressible inner layer 3812. In some embodiments, each deformable leg 3921 may include. at least one hook or tooth 3923 exiting therefrom intended to engage the second part 3811b of the outer layer 3811 and, as a result, fix the outer layer 3811 to the inner layer 3812. In at least one such embodiment, the teeth 3923 may be to exit the second part of the inner layer 3812 and pass through the holes 3808 of the second part 3811b of the outer layer 3811 so that the teeth 3923 can engage in the outer surface of the outer layer 3811 and attach the outer layer 3811 to the inner layer 3812. For of forming the bracket block 3900, the inner layer 3812 may be compressed at least partially in order to allow the teeth to protrude from it and enter the holes 3808. In at least one such embodiment, the bracket block 3900 may be at least partially pre-compressed when installed in the block brackets. In some embodiments, in addition to the foregoing, at least a portion of the legs 3921 may be inserted into the first portion 3811a of the outer layer 3811, while in at least one embodiment, the outer layer 3811 may be made of plastic material, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example, and at least a portion of the legs 3921 can be molded into a plastic material.

In various embodiments, referring to FIG. 133- and 137, a block of brackets, such as a block of brackets 4000, for example, may include a bracket block body 4010 including a compressible first layer, a second 4012 and, in addition, a plurality of brackets 4020 housed in the bracket block body 4010. In some embodiments, referring to FIG. 135, each suture bracket 4020 may include a base 4022 and at least one deformable leg 4023 extending from the base 4022. In at least one embodiment, referring to FIG. 133, a bracket block 4000 may be located between the bracket block groove 4030 and the surgical stapler end clamp member 4040, wherein the second layer 4012 of the bracket block body 4010 and / or the base 4022 of the brackets 4020 may be located opposite the bracket groove 4030. In various embodiments, referring now to FIG. 134, the second layer 4012 may include a layer of gaskets 4060 interconnected by a support frame 4061 for gaskets. In at least one such embodiment, the gaskets 4060 and the support frame 4061 for the gaskets can be made of molded plastic material, such as, for example, polyglycolic acid (PGA). Each gasket 4060 may include one or more holes or grooves 4062, designed to insert legs 4021 brackets passing through them, as shown in FIG. 135 and 136. Each spacer 4060 may also include an insertion groove 4063 formed therein, which may be used to insert the base 4022 of the suture stitch 4020. In various embodiments, referring again to FIG. 134, gaskets 4060 and / or gasket support frame 4061 may include a plurality of grooves, perforated holes, and the like, which may be configured to separate gaskets 4060 from gasket support frame 4061 at a desired location. Similarly, referring to FIG. 136, one or more gaskets 4060 may be interconnected along a line formed by perforated holes and / or risks 4064, for example. In use, the compressible foam layer 4011 can be positioned opposite the target fabric T, and the bracket block body 4010 can be compressed by the stop member 4040 so that the stop member 4040 can deform the brackets 4020. After the brackets 4020 are deformed, the legs 4021 of each suture bracket 4020 can grab the fabric T, part the first layer 4011 and the gasket 4060 in the deformed bracket. When the gutter 4030 for the bracket block moves away from the implanted bracket block 4060, for example, the gasket support frame 4061 can be separated from the gaskets 4060 and / or the gaskets 4060 can be separated from each other. In some circumstances, the gaskets 4060 may separate from the frame 4061 and / or from each other when the brackets 4020 are deformed by the stop member 4040 in the manner described above.

In the various embodiments described herein, the brackets in the bracket block can be fully formed by the stop element when the stop element is moved to the open position. In various other embodiments, referring now to FIG. 138-141, the brackets in the brace block, such as, for example, the brace block 4100, can be deformed by the stop element when the stop element is moved to the closed position and, in addition, with the help of the bracket pusher system, which moves the brackets in the direction of the closed stop element . The block of brackets 4100 may include a crease block 4110 of the bracket block, which may be made of foam material, for example, and a set of brackets 4120 at least partially located in the crumple block 4110 of the bracket block. In various embodiments, the bracket pusher system may include a drive holder 4160, a plurality of bracket pushers 4162 located in the pusher holder 4160, and a bracket block tray 4180 that may be configured to hold the bracket pushers 4162 in the pusher holder 4160. In at least one such embodiment, the pushers 4162 of the brackets can be located in one or more grooves 4163 of the holder 4160 of the pushers, while the side walls of the grooves 4163 can contribute in the direction of the pushers 4162 of the brackets up to the stop element. In various embodiments, the brackets 4120 can be held in the grooves 4163 using the bracket pushers 4162, in at least one embodiment, the brackets 4120 can be completely placed in the grooves 4163 when the brackets 4120 and the bracket pushers 4162 are inoperative. In some other embodiments, at least a portion of the brackets 4120 may extend upwardly through the open ends 4161 of the grooves 4163 when the brackets 4120 and the bracket pushers 4162 are inoperative. In at least one such embodiment, now turning first to FIG. 139, the bracket bases 4120 may be located in the pusher holder 4160, and the ends of the brackets 4120 may be inserted into the body of the crumpled bracket body 4110 of the bracket assembly. In some embodiments, approximately one-third of the height of the brackets 4120 may be located in the pusher holder 4160, and approximately two-thirds of the height of the brackets 4120 may be located in the bracket unit body 4110. In at least one embodiment, referring to FIG. 138A, the bracket block 4100 may also include a waterproof shell or membrane 4111 around the bracket block housing 4110 and the pusher holder 4160, for example.

In use, the block of brackets 4100 may be located in the groove of the block of brackets, for example, and the stop element may move in the direction of the block of brackets 4100 in the closed position. In various embodiments, the abutment member may come into contact and compress the crushable bracket block body 4110 when the abutment element moves to its closed position. In some embodiments, the implementation of the stop element may come into contact with the brackets 4120 when the stop element is in the closed position. In some other embodiments, implementation, the stop element may come into contact with the legs of the brackets 4120 and at least partially deform the brackets 4120 when the stop element is moved to the closed position. In any case, the bracket block 4100 can also include one or more slides 4170, which can be extended longitudinally in the bracket block 4100 so that the slide 4170 can sequentially engage with the bracket pushers 4162 and move the bracket pushers 4162 and the brackets 4120 in the direction thrust element. In various embodiments, the slide 4170 can slide between the bracket block tray 4180 and the suture bracket drive 4162. In embodiments in which the opening of the stop element begins the process of forming the brackets 4120, the upward movement of the brackets 4120 in the direction of the stop element can complete the forming process and deform the brackets 4120 to their full or at least the desired height in the formed form. In embodiments in which the closure of the stop member does not form the brackets 4120, the upward movement of the brackets 4120 in the direction of the stop member can begin and complete the forming process and deform the brackets 4120 to their full or at least the desired height in the formed form. In various embodiments, the slide 4170 may extend from the proximal end of the bracket block 4100 to the distal end of the bracket block 4100 so that the brackets 4120 located at the proximal end of the bracket block 4100 are fully formed until the brackets 4120 located at the distal end of the bracket block 4100 are fully formed. In at least one embodiment, referring to FIG. 140, the slide 4170 may include at least one inclined or beveled surface 4711, which can be made to slide under the bracket drives 4162 and raise the bracket pushers 4162, as shown in FIG. 141.

In various embodiments, in addition to the foregoing, brackets 4120 may be formed to grab at least a portion of fabric T and at least a portion of the crease body 4110 of the bracket block 4100 here. After forming the brackets 4120, the abutment element and the groove 4130 of the brace block of the surgical stapler can move away from the implanted brace block 4100. Under various circumstances, the tray 4180 of the brace block can be rigidly attached to the groove 4130 of the brace block, and, as a result, the tray 4180 of the brace block can be separated from the crumpled bracket block body 4110 as the bracket block chute 4130 is removed from the implanted bracket block body 4110. In various embodiments, referring again to FIG. 138, the bracket block tray 4180 may include opposed side walls 4181, between which the bracket block housing 4110 can be disposed, with the possibility of removal. In at least one such embodiment, the staple block casing 4110 can be compressed between the side walls 4181 so that the cramp block body 4110 can be held therebetween so that it can be removed during use and can be removed from the tray 4180 of the brace block as the tray 4180 brackets are pushed out. In at least one such embodiment, the pusher holders 4160 can be connected to the bracket block tray 4180 so that the pusher holder 4160, pushers 4162 and / or the slide 4170 can remain in the bracket block tray 4180 when the bracket block tray 4180 is removed from the surgical field . In some other embodiments, the pushers 4162 may be removed from the pusher holder 4160 and remain in the operative field. In at least one such embodiment, the pushers 4162 can be made from bioabsorbable materials, such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA, polyglexaprone 25 (PHCL) ), which is sold under the trade name monocryl, polycaprolactone PKL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example. In various embodiments, the pushers 4162 may be attached to the brackets 4120 so that the pushers 4162 are actuated together with the brackets 4120. In at least one such embodiment, each pusher 4162 may include a groove for inserting the bases of the brackets 4120, for example however, in at least one embodiment, the gutters can be made to insert the bases of the brackets by pressing and / or snapping.

In some embodiments, in addition to the foregoing, the pusher holder 4160 and / or the slide 4170 may be removed from the bracket block tray 4180 thereof. In at least one such embodiment, the slide 4170 can slide between the bracket block tray 4180 and the pusher holder 4160 so that the slide 4170 can be extended to drive the bracket pushers 4162 and the brackets 4120 forward, and the slide 4170 can also move the pusher holder 4160 up from tray 4180 of the bracket block. In at least one such embodiment, the pusher holder 4160 and / or the slide 4170 may be made from bioabsorbable materials such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, Polylactic Acid (PMA), Polydioxanone (PDS), Polyhydroxyalkanate ( PHA, polyglecapron 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone PKL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example. In various embodiments, the slide may be an integral part and / or attached to a drive rod or cutting element that pushes the slide 4170 through the bracket block 4100. In such embodiments, the slide 4170 may not be removed from the bracket block tray 4180 and may remain in the surgical a stapler, while in other embodiments in which the slide 4170 is not attached to the cutting element, the slide 4170 may remain in the surgical field. In any case, in addition to the foregoing, the creaseability of the bracket block body 4110 may allow the use of larger thickness bracket brackets in the end clamp of the surgical stapler, since the bracket block body 4110 can compress or contract when the stop element of the stapler is closed. In some embodiments, as a result of the brackets being at least partially deformed when the stop element is closed, longer brackets, such as brackets with a height of about 0.46 cm (0.18 ”), can be used, for example, approximately 0.30 cm (0.12 ”) of the height of the bracket can be located in the compressible layer 4110 and, thus, the height of the compressible layer 4110 in an uncompressed form is approximately 0.36 cm (0.14”), for example.

In various embodiments, referring now to FIG. 142-145, a bracket block, such as a bracket block 4200, for example, may include a crush, bracket block housing 4210 and a plurality of brackets 4220 disposed therein, a plurality of flexible side support elements 4234. In various embodiments, referring now to FIG. 143, the bracket block 4200 may be placed between the abutment member 4240 and the bracket block groove 4230, wherein in at least one embodiment, the side support members 4234 may be attached to the bracket block groove 4230. When the abutment member 4240 moves downward to compress the bracket block body 4210 and at least partially deform the brackets 4220, as shown in FIG. 144, the side portions of the bracket block housing 4210 may extend outwardly and push the side support members 4234 out. In at least one such embodiment, the side support elements 4234 may be attached to the bracket block body 4210 and, when the bracket block body 4210 is extended to the sides as described above, the side support elements 4234 may be separated from the bracket block body 4210, as shown in FIG. . 144. In at least one embodiment, the side support members 4234 may adhere to the bracket block body 4210 using at least one adhesive, such as fibrin and / or protein hydrogel, for example. Similarly to the above, when closing the stop element 4240, only partial deformation of the brackets 4220 can occur, while the completion of the formation of the brackets 4220 can occur when one or more slides 4270 are pulled out through the block of brackets 4200, as shown in FIG. 145. In various embodiments, referring now to FIG. 147 and 148, the slide 4270 may extend from the proximal end of the bracket block 4200 to the distal end of the bracket block 4200 using a cutting member 4280. In at least one such embodiment, the cutting member 4280 may include a cutting member, or knife, 4283, which may extend through the fabric T and / or the crumple case 4210 bracket block. In some embodiments, the implementation of the cutting element 4280 may include cam elements 4282, which can move along the outer surfaces of the jaws 4230 and 4240 or to move or hold the jaws in place. In various embodiments, as a result of the foregoing, the brackets 4220 can be bent to their final shape in one, or at least substantially one, time with the moment of dissection of the tissue. In at least one embodiment, the slide 4270 can be placed distally from the knife 4283 so that tissue T is cut only after the previous part of the fabric has been stitched, for example.

In various embodiments, referring again to FIGS. 147 and 148, the slide 4270 may include separate slide elements that extend with the cutting element 4280. In at least one such embodiment, the slide 4270 may be in the bracket block 4200 and the cutting element The 4280 can be extended into the bracket block 4200 using the trigger bar 4281 so that the cutting element 4280 engages with the slide 4270 and extends the slide 4270 distally. In some embodiments, implementation, the slide 4270 can be connected to each other. In any case, each slide 4270 can enclose an inclined surface, or cam, 4271, designed to lift the brackets 4220 aligned in a row of brackets. In some embodiments, the implementation, the inclined surfaces 4271 may be integral with the cutting element 4280. At least in one embodiment, referring again to FIGS. 147 and 148, each bracket 4200 may include a base, at least one deformable element extending from the base and a ridge 4229 molded onto and / or located around at least a portion of the base and / or deformable elements of the bracket 4200. In various embodiments, such ridges 4229 may be configured to directly drive for example, by a slide 4270. More specifically, in at least one embodiment, the ridges 4229 of the brackets 4220 can be configured so that the inclined surfaces 4271 of the slide 4270 can slide from below and come into contact with the ridges 4 229 without a bracket drive located between them. In such embodiments, each ridge 4229 may include at least one interacting inclined or beveled surface that can engage with the inclined surface 4271 of the slide 4270 so that the interacting inclined surfaces can move the brackets 4220 upward when the slide 4270 slide under brackets 4220.

In various embodiments, referring again to FIG. 146, a bracket block, such as a bracket block 4300, for example, may include a crushable, implantable bracket block housing 4310 and a plurality of brackets 4320 at least partially located in the crushable housing 4310. Similar to the above, the bracket block 4300 may include flexible side supports 4334 attached to the chute of the bracket block and / or glued to the collapsible housing 4310. In addition to the above, the flexible side supports 4334 can be joined together by one or more spacers, or connecting elements, 4335, which can be performed to hold the lateral supports 4334 together. In use, the connecting elements 4335 may be designed to prevent or at least slow down the accidental separation of the side supports 4334 from the case 4310 bracket unit. In some embodiments, the connecting members 4335 may be designed to hold the side supports 4334 together after the brace block 4300 is compressed by the stop member. In such embodiments, the side supports 4334 may resist lateral abrasion or displacement of the side portions of the bracket block body 4310. In some embodiments, a cutting element such as cutting element 4280, for example, may be configured to cut through connecting elements 4335 as the cutting element 4280 moves distally in the bracket block body 4310. In at least one such embodiment, the cutting element 4280 may be configured to push one or more slides, such as the slide 4270, for example, distally to form brackets 4320 relative to the thrust element. The slide 4270 can guide the cutting blade 4283 so that the cutting element 4280 does not cut the connecting element 4335 until the brackets 4320 adjacent to the connecting element 4335 are fully formed or at least are not formed to the desired height. Under various circumstances, the connecting elements 4335, in conjunction with the side supports 4334, can prevent, or at least limit, the lateral movement of the wrinkled case 4310 of the bracket block and, at the same time, prevent, or at least limit, the lateral movement of the brackets 4320 located in the housing 4310 block brackets. In such circumstances, the connecting elements 4335 can hold the brackets 4320 in place until they are deformed, after which the connecting elements 4335 can be cut to release the side parts of the housing 4310 of the bracket block. As mentioned above, the side supports 4334 can be connected to the groove of the bracket block and, as a result, can be removed from the surgical field with the groove of the bracket block after implantation of the bracket block 4300. In some embodiments, the side supports 4334 may be made of implantable material and may remain in the surgical field. In at least one embodiment, the connecting elements 4335 can be placed between the bracket block body 4310 and the tissue T, and after the connecting elements 4335 are detached from the side supports 4334, the connecting elements 4335 can remain implanted in the patient’s body. In at least one such embodiment, the connecting elements 4335 may be made of implantable material, and, in some embodiments, the connecting elements 4335 may be made of the same material as the side supports 4334, for example. In various embodiments, the connecting elements 4335 and / or side supports 4334 may be made from flexible bioabsorbable materials such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, Polylactic Acid (PMA), Polydioxanone (PDS), Polyhydroxyalkanate (PHA, polyglecapron 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone PKL) and / or composite material PGK, PMK, PDS, PHA PGKL and / or PKL, for example. In various embodiments, the connecting element may be made of a sheet of material connecting the side supports 4334. In some embodiments, the bracket unit may include connecting elements extending across the upper surface of the housing 4310 of the bracket unit, and, in addition, connecting elements extending along the lower the surface of the housing 4310 block brackets.

In various embodiments, referring now to FIG. 149, the bracket block may include brackets, such as brackets 4420, for example, which may include a wire portion inserted in a portion of the ridge. In at least one embodiment, the wire portion may be made of metal, such as titanium and / or stainless steel, for example, and / or plastic, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example. In at least one embodiment, a portion of the ridge may be made of metal, such as titanium and / or stainless steel, for example, and / or plastic, such as polydioxanone (PDS) and / or polyglycolic acid (PGC), for example. In some embodiments, the wire portion of each brace 4420 may include a base 4422 and deformable legs 4421 originating from the base 4422, wherein a portion of the crest of each suture bracket 4420 may include a crest 4429 designed to insert at least a portion thereof foundations 4422. In order to assemble parts of each bracket 4420, referring now to FIG. 150A-150C, the legs 4421 of the wire part can be inserted into the hole 4426 in the comb 4429, while the hole 4426 can be made to guide the legs 4421 into the compartment 4427 of the base. The wire portion can then be inserted into the comb 4429 so that the legs 4421 exit from the base compartment 4427, and the base 4422 of the wire portion enters the base compartment 4427. In at least one such embodiment, the base compartment 4427 may be configured so that the wire portion can rotate within the ridge 4429 as the base 4422 enters the base compartment 44 so that the brace legs 4421 are directed upward, or at least substantially up. In various embodiments, referring again to FIG. 149, ridge 4429 may include outlet openings 4425 that are configured to insert bracket legs 4421 into them.

In various embodiments, in addition to the foregoing, the surgical stapler may include a slide 4470 designed to extend the bracket block 4400 therethrough and the bracket groove 4430 and move the brackets 4420 contained in the bracket block body 4410 toward the stop member . Under various circumstances, the slide 4470 can move from the proximal end of the bracket block groove 4430 to the distal end of the bracket block groove 4430 in order to implant the bracket block body 4410 and the brackets 4420. In some circumstances, the slide 4470 may retract or return to the proximal end of the groove 4430 block brackets, and another block of brackets 4400 can be inserted into the groove 4430 block brackets. As soon as a new bracket block 4400 is inserted into the groove 4430 of the bracket block, the slide 4470 can again extend distally. In various embodiments, the surgical stapler may include one or more locking devices that prevent the distal slider 4470 from re-extending if a new bracket block 4400 is not installed in the groove 4430 of the bracket block. In at least one such embodiment, referring again to FIG. 149, the bracket block chute 4430 may include a blocking arm 4439 that can be configured to prevent, or at least limit, the distal movement of the slide 4470. More specifically, the slide 4470 can be abutted against the shoulder 4439 as long as the slide 4470 at least partially, they will not rise above the shoulder 4439 with the help of a lifting device 4428, for example, passing between the brackets 4420 located at the maximum proximal position in the bracket block 4400. In other words, in the absence of brackets 4420, located In the maximum proximal position in the new block of brackets 4400, the slide 4470 cannot be extended. Thus, if the used bracket block 4400 is in the groove 4430 of the brackets or there is no bracket block 4400 in the groove 4430 of the brackets, the rails 4470 cannot be pulled out gutter 4430 block brackets.

In addition to the foregoing, referring now to FIG. 151, a bracket block, such as a bracket block 4500, for example, may be located in the groove of the bracket block 4530 and may include a staple bracket assembly 4510, a plurality of brackets 4520 located in the bracket block body 4510 and a tray, or an emphasis, 4580 bracket block. In various embodiments, the wraparound bracket block body 4510 may include an outer layer 4511 and an inner layer 4512, in at least one embodiment, the outer layer 4511 can hermetically seal the inner layer 4512. In at least one such embodiment implementation, the outer layer 4511 may extend between the inner layer 4512 and the tray 4580 bracket unit. In some other 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 bracket block tray 4580 can interact to encompass, or at least substantially encompass, the inner layer 4512. In various embodiments, in addition to the foregoing, the brackets 4520 may be supported by the bracket block tray 4580, wherein the bracket block tray 4580 may include one or more support channels for the brackets, brackets to support brackets 4520. In some embodiments, the bracket block tray 4580 may be attached to the bracket block body 4510, wherein in at least one such embodiment, the bracket block housing 4510 may be compressed from the sides between opposite side sides of the block tray 4580. brackets. In various embodiments, the side walls of the bracket block tray 4580 may support the bracket block body 4510 from the sides, and in at least one such embodiment, the bracket block tray 4580 may comprise one or more walls, or ribs, 4582, protruding upward from the lower support 4583 to the housing 4510 bracket block. In at least one such embodiment, the bracket block body 4510 may enclose one or more grooves or channels that may be inserted and / or locked with walls 4582. In various embodiments, walls 4582 may partially extend. or almost completely, through the bracket block body 4510. In at least one such embodiment, the walls 4582 may extend longitudinally through a block of brackets 4500 between the first row of brackets 4520 and the second row of brackets 4520.

In various embodiments, the implementation of the bracket block body 4510 and / or the bracket block tray 4580 may include interacting holding devices that can snap into place between the bracket block tray 4580 and the bracket block housing 4510. In some embodiments, the bracket block 4500 may be located in the bracket block groove 4530 so that the bracket block tray 4580 is opposite and / or attached to the bracket bracket groove 4530. In at least one embodiment, the bracket block tray 4580 can be detachably connected to the bracket block groove 4530 so that, after compressing the bracket block 4500 with the stop member 4540 and deforming the brackets 452, it becomes possible to detach the bracket block tray 4580 from the groove 4530 and implant with the body 4510 block brackets. In at least one such embodiment, the bracket block tray 4580 may be made from bioabsorbable materials such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, Polylactic Acid (PMA), Polydioxanone (PDS), Polyhydroxyalkanate (PHA) polyglecapron 25 (PGKL), which is sold under the trade name monocryl, polycaprolactone PKL) and / or composite material PGK, PMK, PDS, PHA PGKL and / or PKL, for example. In some embodiments, the surgical stapler may also include a trigger and / or drive that can slide between the bracket block groove 4530 and the bottom surface of the drive on the bracket block tray 4580, which can be configured to raise or eject the bracket block tray 4580 from the groove 4530 for block brackets. In some embodiments, the bracket block body 4510 can be detachably connected to the bracket block tray so that after compressing the bracket block 4500 with the stop member 4540 and deforming the brackets 4520, it becomes possible to detach the bracket block housing 4510 from the bracket block 4580 . In at least one such embodiment, the bracket block tray 4580 may remain rigidly attached to the bracket block groove 4530 so that the bracket block tray 4580 is removed from the operative field with the bracket block groove 4530. In some embodiments, the surgical stapler may also include a trigger and / or drive that can slide between the bracket block tray 4580 and the bottom surface of the drive on the bracket block groove 4510, which may be used to lift or pop the bracket block body 4510 from the tray 4580 block brackets. In at least one such embodiment, the brace block 4500 may also include brace pushers located between the brace block tray 4580 and the brackets 4520 so that as the trigger starts distally sliding, the brace pushers and brackets 4520 can extend up towards the stop element. In at least one such embodiment, the pushers of the brackets may be at least partially enclosed in a crushable case 4510 bracket block.

In various embodiments, similar to the above, the block of brackets 4500 may include a locking device that can be designed to prevent, or at least limit, the distal movement of the cutting element, while the block of brackets 4500 in the idle position is located in the groove 4530 for the block of brackets . In some embodiments, the implementation of the bracket block tray 4580 may include a surface that lifts the cutting element up and above the blocking surface in the bracket block groove 4530, for example. If there is no bracket block 4500 in the groove 4530, including the bracket block tray 4580, the cutting element cannot be extended. In at least one embodiment, the brackets located at the maximum proximal position and / or any other suitable brackets in the bracket block 4500 may include a lifting surface that can substantially raise the cutting element above the locking surface. In addition to or in place of the foregoing, various parts of the brackets block 4500 may be made of materials of different colors. In such embodiments, the surgeon is able to visually determine when the brace block in the inoperative and / or operational state is in the groove 4530 for the brace block. In at least one such embodiment, the outer layer 4511 of the bracket block body 4510 may be painted in a first color, the bracket block tray 4580 may be painted in a second color, and the bracket block groove 4530 may be painted in a third color. If the surgeon sees the first color, the surgeon can understand that there is a bracket block 4500 in the inoperative position in the groove 4530 of the bracket block; if the surgeon sees the second color, the surgeon can understand that in the gutter 4530 for the bracket block there is a bracket block 4500 in the working position, and that it is necessary to remove the tray 4580 of the bracket block; and if the surgeon sees the third color, the surgeon can understand that part of the bracket block 4500 remains in the groove 4530 for the bracket block.

In various embodiments, referring again to FIG. 152, a bracket block, such as a bracket block 4600, for example, may include a crushable, implantable bracket block body 4610 and a plurality of brackets 4620 located therein. The bracket block body 4610 may include an outer layer 4611 and an inner layer 4612. In some embodiments, the inner layer 4612 may include a plurality of cavities, such as, for example, cavities or voids 4615 formed therein, which can facilitate faster compression of the housing 4610 block brackets. In at least one such embodiment, the inner layer 4612 may include a corrugated or honeycomb lattice structure that can be configured to withstand compression force or pressure until the compression force or pressure exceeds a certain threshold value. As long as the threshold value is not exceeded, the inner layer 4612 can be deformed linearly, or at least substantially linearly, with respect to the applied compression force or pressure. After the compression force or pressure exceeds a threshold value, the inner layer 4612 may suddenly succumb to large deviations and collapse, or collapse, as a result of the compression load. In various embodiments, the lattice structure of the inner layer 4612 may include a plurality of sub-layers 4612a that can be connected to each other. In at least one embodiment, each sub-layer 4612a may include a plurality of alternating grooves and ridges, or teeth, which may align with the alternating grooves and ridges, or teeth of an adjacent sub-layer 4612a. In at least one such embodiment, the grooves of the first sublayer 4612a may be adjacent to the ridges of the second sublayer 4612a, and, likewise, the ridges of the first sublayer 4612a may be located adjacent to the furrows of the second sublayer 4612a. In various embodiments, adjacent sublayers 4612a may adhere to each other and / or to the outer layer 4611 using at least one adhesive, such as fibrin and / or protein hydrogel, for example. In FIG. 153, a bracket block 4600 is shown after compressing the bracket block body 4610 and deforming the brackets 4620 to grip and hold the fabric T relative to the bracket block body 4610.

In various embodiments, referring again to FIG. 154 to 156, a bracket block, such as a bracket block 4700, for example, may include a crushable, implantable bracket block body 4710 and a plurality of brackets 4720 located in the bracket block body 4710. Similar to the foregoing, the bracket block body 4710 may include an outer layer 4711 and an inner layer 4712, while the inner layer 4712 may include a plurality of sub-layers 4712a. Also similar to the above, each sub-layer 4712a may include intermittent grooves 4717 and ridges 4718, which can be aligned with each other to form cavities, or voids, 4715 between them. In at least one such embodiment, the furrows 4717 and / or ridges 4718 may extend along axes parallel to each other and / or parallel to the longitudinal axis 4709. In various embodiments, brackets 4720 may be oriented to a plurality of rows of brackets that extend along the axes, parallel to each other and / or parallel to the longitudinal axis 4709. In various alternative embodiments, referring again to FIG. 152 and 153, the brackets 4620 contained in the bracket block body 4600 may extend along axes intersecting or perpendicular to the axes defined by grooves and ridges of sub-layers 4612a. Turning again to FIG. 154-156, the brackets 4720 can pass through the furrows 4717 and ridges 4718, while the frictional forces between the brackets 4720 and the sub-layers 4712a can hold the brackets 4720 in the body 4710 of the bracket block. In some embodiments, the plurality of sub-layers 4712a may be made of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), which can be used to hold the brackets 4720 in a vertical orientation, for example , and / or holding the brackets 4720 aligned with each other, as shown in FIG. 154 and 155. In FIG. 156, a brace block 4700 is shown after breaking the brace block body 4710 and deforming the brackets 4720 to grip and hold the fabric T relative to the brace block body 4710.

In various embodiments, referring again to FIG. 154-156, the bracket block body 4710 may elastically or elastically flatten when compressed. In at least one such embodiment, the wave-like structures formed in each sublayer 4712a by grooves 4717 and ridges 4718 can be brought to a flat state, or at least substantially flat state, when the bracket block body 4710 contracts when flattening, or at least substantially flattening, of the cavities 4715 marked between them. Under various circumstances, the bracket unit housing 4710, or at least a portion of the bracket unit housing 4710, can elastically or elastically expand again after the compression force or pressure is removed from the bracket unit housing 4710. In at least one such embodiment, the joints between the furrows 4717 and ridges 4718 of adjacent sub-layers 4712a may remain intact or at least substantially intact when the bracket block body 4710 is compressed so that after releasing the compression force from the block body 4710 of the brackets, the sub-layers 4712a could be displaced relative to each other, and, as a result, the bracket block body 4710 could at least partially straighten out again. In some embodiments, the bracket block body 4710 may undergo plastic deformation or fracture during compression, and as a result, the bracket block body 4710 may not expand again after the compression force or pressure is removed from the bracket block body 4710. In some embodiments, referring now to FIG. 7, a bracket block, such as a bracket block 4800, for example, may comprise a destructible bracket bracket body 4810 including an outer layer 4811 and an inner layer 4812, wherein the inner layer 4812 may have a corrugated, honeycomb lattice structure having a plurality of cavities or voids 4815 designated in it. In various embodiments, the walls indicating the lattice structure of the inner layer 4812 may include one or more softened, or thin, transverse cuts 4819, which can be performed in order to ensure the destruction of the walls forming the lattice structure, while compressing the body 4810 bracket block. In such circumstances, the bracket block housing 4810 may flatten when the bracket bracket 4800 is implanted.

In various embodiments, referring to FIG. 158-160, a bracket block, such as a bracket block 4900, for example, may include a bracket block housing 4910, an outer layer 4911, and a plurality of crease elements 4912 located between the upper and lower portions of the outer layer 4911, for example. Turning primarily to FIG. 158 and 159, the bracket block 4900 may also include a plurality of brackets 4920, wherein each suture bracket 4920 may be located in 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 can interact to define a cavity 4915 in it for inserting a suture bracket 4920. When used, in addition to the foregoing, the block of brackets 4900 can be placed in the groove for the block of brackets, and the compressive force can be applied to the contact with Anya surface 4919 in order to compress the housing unit 4910 staples. As the surface 4919 in contact with the fabric moves down, the crease elements 4912 may collapse. Under such circumstances, the second part 4912b of each destructible element 4912 may fall into the corresponding first part 4912a, and, likewise, the third part 4912c of each destructible element 4912 may fall into the corresponding second part 4912b. As the casing 4910 of the block of brackets compresses and the crease elements 4912 fall off, the brackets 4920 located in the crease elements 4912 may become deformed, as shown in FIG. 160. In various embodiments, the second part 4912a of each crease member 4912 can mesh by friction and / or be pressed into the corresponding first part 4912a so that as soon as the compressive force exerted on the crease member 4912 exceeds the holding force, holding the first part 4912a and the second part 4912b in the extended position (FIG. 159), the first part 4912a and the second part 4912b can begin to slide relative to each other. Similarly, the third part 4912c of each crease member 4912 may mesh due to friction and / or be pressed into the corresponding second part 4912b so that as soon as the compressive force exerted on the crease member 4912 exceeds the holding force holding the second part 4912b and the third part 4912c in the extended position (FIG. 159), the second part 4912b and the third part 4912c may begin to slide relative to each other.

In many of the embodiments described herein, a block of brackets may include a plurality of brackets in it. In various embodiments, the implementation of such brackets can be made of metal wire, substantially bent into a U-shape with two legs. Other embodiments are contemplated in which the brackets may have a different shape, such as made of two or more wires connected together with three or more legs of the bracket. In various embodiments, the wire or wire used to make the brackets may have a circular, or at least substantially circular, cross-section. In at least one embodiment, the wire from which the bracket is made may have any other suitable cross section, such as a square and / or rectangular cross section, for example. In some embodiments, the brackets may be made of plastic wire. In at least one embodiment, the brackets may be made of metal wire in a plastic sheath. In various embodiments, the block of brackets may include staples of any suitable type in addition to or in place of the brackets. In at least one such embodiment, such a stapling element may include pivoting arms that can be bent when it engages with the abutment element. In some embodiments, two-component crosslinking elements may be used. In at least one such embodiment, the block of brackets may include a plurality of first parts of the stapling elements, and the stop element may include a set of second parts of the stapling elements that connect to the first parts of the stapling elements when the stop element is pressed into the block of brackets. In some embodiments, implementation, as described above, the slide or the pusher can be extended in the block of brackets to complete the process of forming the brackets. In some embodiments, the slide or pusher may extend outward within the thrust member to move one or more forming members downward to engage with the opposite block of brackets and brackets, or with stapling members placed therein.

In various embodiments described herein, a bracket block may include four rows of brackets contained therein. In at least one embodiment, four rows of brackets may be distributed 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 slot for the cutting element, or scalpel, in the block of brackets and, similarly, the inner row of brackets and the outer row of brackets can be located on the second side of the slot for a cutting element, or a scalpel. In some embodiments, a slot for a cutting element may not be included in the bracket block; however, such a block of brackets may contain a special part configured to be cut by the cutting element instead of the slot of the block of brackets. In various embodiments, the implementation of the inner rows of brackets can be placed inside the block of brackets so as to be located at the same, or at least substantially the same distance from the slot for the cutting element. Similarly, the outer rows of brackets can be placed inside the block of brackets so as to be located at the same, or at least substantially the same distance from the slot for the cutting element. In various embodiments, a block of brackets may include more or less than four rows of brackets within the block of brackets. In at least one embodiment, a block of brackets may include six rows of brackets. In at least one such embodiment, the bracket block may include three rows of brackets on the first side of the slot for the cutting element and three rows of brackets on the second side of the slot for the cutting element. In some embodiments, a block of brackets may include an odd number of rows of brackets. For example, the bracket block may include two rows of brackets on the first side of the slot for the cutting element and three rows of brackets on the second side of the slot for the cutting element. In various embodiments, the rows of brackets may include brackets having the same, or at least substantially the same, height in an unformed form. In some other embodiments, one or more rows of brackets may include brackets at different brace heights in unformed form compared to other brackets. In at least one such embodiment, the brackets on the first side of the slot for the cutting element may have a first height in an unformed form, and the brackets on the second side of the slot for a cutting element may have a second height in an unformed form that differs from the first height, for example .

In various embodiments, referring now to FIG. 161A-161D, the end clamp of the surgical stapler may include a mounting portion of a bracket block, such as, for example, a groove 5030 for a bracket block, a bracket block disposed removably from a groove 5030 for a bracket block, such as a bracket block 5000 and a branch 5040 located opposite the bracket block 5000 and the groove 5030 for the bracket block. The brace unit 5000 may include a crease body 5010 and a plurality of brackets 5020 and / or other suitable stapling elements at least partially located in the crease case 5010. In at least one such embodiment, each suture bracket 5020 may include a base 5022 and, in addition, legs 5021 extending upward from the base 5022, wherein at least a portion of the legs 5021 may be enclosed in a bracket block body 5010. In various embodiments, the collapsible body 5010 may include an upper or fabric contacting surface 5019 and a lower surface 5018, wherein the lower surface 5018 can be opposed and supported by a supporting surface 5031 of the bracket block groove 5030. Similarly to the above, the supporting surface 5031 may include a set of supporting grooves 5032 (FIG. 161D), for example, indicated on it, which can be used to insert and support the bases 5022 of the brackets 5020. In various embodiments, the end clamp of the surgical stapler may also include a holding matrix, such as a holding matrix 5050, for example, which can be performed to come into contact with the brackets 5020 and capture tissue between them. At least in one such embodiment, the holding matrix 5050 can be movably mounted to the jaw 5040. When used, as soon as the bracket block 5000 is placed in the gutter 5030 for the bracket block, the jaw 5040 and the holding matrix 5050 attached to it can move in the direction to the bracket block 5000 and the chute 5030 for the bracket block. In at least one embodiment, the jaw 5040 can move down along the axis 5099 so that the jaw 5040 and the chute 5030 for the bracket block remain parallel, or substantially parallel, to each other when closing the jaw 5040. More specifically, at least in one such embodiment, the jaw 5040 may be closed so that the tissue-contacting surface 5051 of the holding matrix 5050 is parallel, or at least substantially parallel, the tissue-contacting surface 5019 of the block to 5000 as the jaw 5040 moves in the direction of the bracket block 5000.

In various embodiments, referring now to FIG. 161A, the holding matrix 5050 can be detachably attached to the jaw 5040 so that there is little, if any, relative movement between the holding matrix 5050 and the jaw 5040 when the holding matrix 5050 is attached to the jaw 5040. At least in one embodiment, the jaw 5040 may include one or more holding devices that are configured to hold the holding matrix 5050 in place. In at least one such embodiment, the holding matrix 5050 may snap and / or be pressed into the jaw 5040. In some embodiments, the holding matrix 5050 can be glued to the jaw 5040 using at least one adhesive. In any case, the jaw 5040 can move to a position where the holding matrix 5050 comes in contact with the fabric T and the fabric T is located opposite the fabric contacting surface 5019 of the bracket block 5000. When the tissue T is opposite the bracket block 5000 using the jaw 5040, the crumpled case 5010 of the bracket block 5000 may be compressed by the jaw 5040 or may not be compressed by the latter. In any case, in various embodiments, the legs 5021 of the brackets 5200 cannot protrude through the tissue-contacting surface 5019 of the bracket block 5000, as shown in FIG. 161A. Moreover, as also shown in FIG. 161A, the jaw 5040 can hold the tissue T in front of the wrinkled case 5010 without the holding matrix 5050 coming into contact with the brackets 5020. Such embodiments allow the surgeon to open and close the jaw 5040 several times to achieve the desired location of the end clamp in the surgical field, for example, without damage fabric T. Other embodiments are contemplated, however, in which the ends of the brackets 5023 may protrude through the surface 5019 in contact with the fabric before the bracket unit body 5010 is compressed by the stop member ohm 5040. Once the end clamp is suitably referring to FIG. 161B, the jaw 5040 can be moved down in the direction of the bracket block groove 5030 so that the collapsible body 5010 is compressed by the stop member 5040, and so that the fabric contacting surface 5019 is pushed downward relative to the brackets 5020. As the fabric contacting surface 5019 pushed down, the ends 5023 of the legs 5021 of the brackets can pierce the tissue contacting surface 5019 and pierce at least a portion of the fabric T. Under such circumstances, the holding matrix 5050 can be positioned above the brackets 5020 so that it strikes ivayuschie retaining holes 5052 of matrix 5050 are aligned, or at least substantially aligned, with the tips of the legs 5023 5021 parentheses.

As the holding matrix 5050 is pushed down along the axis 5099, referring again to FIG. 161C, the legs 5021 of the brackets 5020 may enter the holding holes 5052. In various embodiments, the legs 5021 of the brackets may come into contact with the walls of the holding holes 5052. In some embodiments, as described in more detail below, the holding matrix 5050 may include one or more retaining elements protruding in and / or around the retaining holes 5052, which may come into contact with the legs 5021 of the bracket. In any case, the brace legs 5021 can be held in the holding holes 5052. In various circumstances, the ends of the brace legs 5023 5023 can fit into the holding holes 5052 and can be engaged due to friction with the holding elements and / or side walls of the holes 5052. As as the holding matrix 5050 is pushed towards the bases 5022 of the brackets 5020, the legs 5021 of the bracket can slide relative to the side walls and / or the holding elements. As a result of the foregoing, sliding friction forces can be generated between the bracket legs 5021 and the holding matrix 5050, and such sliding friction forces can resist insertion of the holding matrix 5050 onto the brackets 5020. In various embodiments, the sliding friction forces between the holding matrix 5050 and the brackets 5020 may be constant, or at least substantially constant, as the holding matrix 5050 slides down along the legs 5021 of the brackets 5020. In some embodiments, the friction forces the slides may increase and / or decrease as the holding matrix 5050 slides down along the bracket legs 5021, due to changes in the geometry of the bracket legs 5021, the holding holes 5052 and / or the retaining elements protruding in and / or around the holding holes 5052, to for example. In various embodiments, the insert of the holding matrix 5050 onto the brackets 5020 may also be resisted by the crease body 5010 of the bracket unit 5000. More specifically, the crease body 5010 can be made of an elastic material, for example, which can exert a reaction force to the retention matrix 5050, which increases in as the distance increases over which the crease body 5010 is compressed. In at least one such embodiment, the counteracting force occurring in the bracket block body 5010 may increase in arithmetic progression, or at least essentially in arithmetic progression, relative to the distance at which the bracket block body 5010 is compressed. In some embodiments, the counter force that occurs in the bracket block body 5010 can grow exponentially with respect to the distance that the bracket block body 5010 is compressed.

In various embodiments, in addition to the foregoing, a substantial starting force can be applied to the jaw 5040 and the holding matrix 5050 to overcome the reaction and friction forces described above. In use, the holding matrix 5050 can be placed at any suitable depth relative to the brackets 5020. In at least one embodiment, the holding matrix 5050 can be placed at a depth relative to the bases 5022 of the brackets 5020 to hold one or more layers of fabric together and generate compression force or pressure in the fabric. Under various circumstances, a system including a holding matrix 5050 and brackets 5020 allows the surgeon to select the level of compression force or pressure applied to the tissue by selecting the depth at which the holding matrix 5050 is placed. For example, the holding matrix 5050 can be pushed towards the bases 5022 brackets 5020, until the retaining matrix 5050 is placed at a certain depth 5011 from the bottom of the support grooves 5032, while a smaller depth 5011 can cause more force or compression pressure applied to the fabric T, the greater I have a depth of 5011, which can cause less compression force or pressure applied to the fabric T. In various embodiments, the compression force or pressure applied to the fabric T can be linearly proportional, or at least substantially linearly proportional, to the depth 5011 on which the holding matrix 5050 is placed. Under various circumstances, the compressive force or pressure applied to the fabric T may depend on the thickness of the fabric T located between the holding matrix 5050 and the bracket unit 5020. More specifically, for Given a distance of 5011, the presence of tissue T of greater thickness can cause greater force or compression pressure than the presence of tissue T of smaller thickness.

Under various circumstances, in addition to the foregoing, the surgeon may adjust the depth at which the retaining matrix 5050 is placed in order to match tissue of greater and / or lesser thickness and apply a predetermined or predetermined pressure to tissue T, irrespective of tissue thickness. For example, the surgeon may place the retaining matrix 5050 at a shallower depth 5011 when stitching tissue T of smaller thickness and at a greater depth 5011 when stitching tissue T of greater thickness to achieve the same, or at least substantially the same compression pressure in the tissue. In some embodiments, in addition to the foregoing, the surgeon may selectively determine the level of compression pressure applied to the tissue T located between the retaining matrix 5050 and the bracket block 5010. Under various circumstances, the surgeon may engage the retaining matrix 5050 with brackets 5020 and place a holding matrix 5050 at a first distance from the bases 5022 of the brackets 5020 for applying a first compression pressure to the fabric. The surgeon may alternatively place the holding matrix 5050 at a second distance from the bases 5022, which is shorter than the first distance to apply a second compression pressure to the tissue in excess of the first pressure. The surgeon may alternatively place the holding matrix 5050 at a third distance from the bases 5022, which is shorter than the second distance to apply a third compression pressure to the tissue in excess of the second pressure. In various embodiments, the stapling system including the retaining matrix 5050 of the bracket 5020 may be configured so that the surgeon is able to apply a wide range of compression pressure to the target tissue.

In various embodiments, referring now to FIG. 161D, the bracket legs 5021 can be inserted through the holding matrix 5050 so that the ends 5023 of the bracket legs extend above the upper surface of the holding matrix 5050. In at least one embodiment, referring again to FIG. 161, the jaw 5040 may also include dimensional holes 5042, designated therein, for inserting the ends of the bracket legs 5023 as they pass through the holding holes 5052 in the holding matrix 5050. In at least one such embodiment, the dimensional holes 5042 can be aligned with the holding holes 5052 so that the legs 5021 do not come into contact with the jaw 5040. In various embodiments, the overall holes 5042 can have a substantial depth so that the legs 5021 of the brackets do not enter in contact with the jaw 5040, regardless of the distance at which the holding matrix 5050 is located. After the holding matrix 5050 is engaged with the brackets 5020 and placed in the desired position, referring now to FIG. 161D, the gutter 5030 for the brace block and jaw 5040 can move away from the tissue T. More specifically, the gutter 5030 for the brace block can be separated from the implanted brace block 5000, and the stop member 5040 can be separated from the implanted holding matrix 5050. As the jaw 5040 is moved away from the holding matrix 5050, brace supports 5032 are moved away from the base 5022 of the brackets, a distance 5011 between the holding matrix 5050 and the bottom of the bases 5022 may be maintained, although the branch 5040 and the groove for the bracket block 5030 no longer support them. In various embodiments, the level of static friction between the legs 5021 of the bracket and the holding matrix 5050 may be sufficient to hold the holding matrix 5050 in place, despite the bias applied to the holding matrix 5050 by the compressed housing 5010 of the bracket unit and / or the compressed fabric T. in at least one such embodiment, the bracket block body 5010 may be made of an elastic material that, when compressed, may apply elastic force to the holding matrix 5050 and the brackets 502 so that holding The fifth matrix 5050 and the brackets 5020 tend to diverge in different directions, although this movement is opposite to the friction between the legs 5021 of the brackets and the holding matrix 5050.

In various embodiments, as described above, the retaining matrix may include a plurality of retaining holes, with each retaining hole being configured to insert legs of the stapling element therein. In at least one embodiment, referring now to FIG. 162, a portion of the holding matrix 5150 is shown, which may include a holding hole 5152 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 other suitable profile. In some embodiments, the holding matrix 5150 may include one or more holding elements, such as holding elements 5153, for example, which protrude into the hole 5152 and can be configured to engage the leg of the stapling element when the leg of the stapling element is inserted into it . In at least one such embodiment, each holding member 5153 may include a cantilever that extends inward toward the central axis 5159, i.e. toward the center of the hole 5152. In various embodiments, each console may include a first end attached to the retaining matrix housing 5158 and a second end defining a perimeter 5156 of the holding hole 5152. In some embodiments, the perimeter 5156 of the holding hole 5152 may be defined by a first diameter, or width, and the leg of the crosslinking element may be outlined by a second diameter, or width, while the second diameter may exceed the first diameter. In at least one such embodiment, the crosslinker foot may be configured to contact and deflect one or more of the holding elements 5153 to increase the diameter of the holding hole 5152 as the crosslinker foot is inserted into it. In some embodiments, in addition to the foregoing, the leg of the stapling element may indicate a perimeter greater than the perimeter 5156 of the holding hole 5152 so that the leg of the stapling element can expand the perimeter 5156 when the leg of the stapling element is inserted into it.

In various embodiments, referring again to FIG. 162, the opening 5152 can be delineated by deformable elements 5153, wherein each deformable element 5153 can be configured to deflect relative to, or independently of, the other deformable elements 5153. In at least one such embodiment, adjacent deformable elements 5153 can be separated by grooves 5154, which can be designed to ensure the bending of each deformable element 5153 relative to others. In some embodiments, each groove 5154 may include a first end 5155 in the holding matrix housing 5158 and a second end opening into the holding hole 5152 and have a constant, or at least substantially constant, width between the first end 5155 and the second end. In various other embodiments, the width of each groove 5154 may not be constant, and the width of each groove 5154 may increase and / or decrease between its first and second ends. In some embodiments, the first ends 5155 of the grooves 5154 may include an enlarged part, such as a circular part, which can, firstly, provide tension compensation to the bases of deformable elements 5153 attached to the housing 5158 of the holding matrix 5158 and, secondly, means to increase the flexibility of the deformable elements 5153. In various embodiments, the geometry of the deformable elements 5153, and / or grooves 5154, can be selected so as to provide the desired level of flexibility of the deformable elements 515 3. In some embodiments, for example, grooves 5154 can be extended to form longer deformable elements 5153, which may be more flexible than smaller deformable elements 5153. In at least one embodiment, the width of each deformable member 5153 may be selected so as to provide it with a desired level of flexibility. More specifically, deformable elements with a smaller width may have a higher level of flexibility than deformable elements with a larger width. In some embodiments, referring again to FIG. 162, the width of the first ends of the consoles of deformable elements 5153 attached to the housing 5158 of the holding matrix may exceed the width of the second ends of the consoles. In at least one such embodiment, the consoles may taper linearly, or at least substantially linearly, between their first and second ends.

In various embodiments, referring again to FIG. 162, the holding matrix housing 5158 may include a flat, or at least substantially flat, sheet of material with 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, with respect to each other. In various embodiments, each deformable member 5153 may include a first portion 5153a and a second portion 5153b, wherein the first portion 5153a may protrude in a first direction and the second portion 5153b may protrude in a different or second direction. In at least one such embodiment, the holding matrix housing 5158 may outline a plane, and the first parts 5153a of deformable elements 5153 may lie within such a plane. In various embodiments, the second parts 5153b of the deformable members 5153 may extend at an angle relative to the first parts 5153a. In at least one such embodiment, the second parts 5153b may protrude in directions that extend from the upper surface 5157 of the holding matrix housing 5158, and, in some embodiments, the second parts 5153b may converge on the central axis 5159 of the holding hole 5152. In any case, in various embodiments, the second parts 5153b may be configured to deviate from the central axis 5159 when a stapling leg is inserted therein. In embodiments, when the leg 5021 of the bracket 5020 is inserted into the holding hole 5152, the deformable element 5153 may deform in a direction that generally extends from the bases 5122 of the brackets 5120. In some embodiments, as a result, the deformable elements 5153 may deviate in general a direction that matches, or at least substantially matches, the direction in which the brackets legs 5021 are inserted.

In various embodiments, referring again to FIG. BD, each of the second parts 5153b of the deformable elements 5153 may include a sharp tip, for example, which can be slid against the bracket leg 5021 as the bracket leg 5021 enters it. The sharp tips of the second parts 5153b can also be configured to engage in the bracket leg 5021 if the bracket leg 5021 extends in the opposite direction, i.e. in the direction of removal of the bracket leg 5021 from the retaining hole 5052. In some circumstances, the second parts 5153b may tilt at an angle relative to the side of the bracket leg 5021 greater than 90 degrees, and as a result, the second parts 5153b may extend or penetrate toward the leg 5021 brackets, when a force is exerted on the bracket leg 5021 to extract the bracket leg 5021 from the retaining hole 5052. In some embodiments, the bracket legs 5021 may include hollows and / or holes, such as, for example, a microdent others in surfaces that can be made to insert the tips of deformable elements 5053 into them, for example. In at least one such embodiment, the ends of the deformable members 5053 may fall and stick into the depressions in the bracket leg 5021 when a release force is applied to the bracket legs 5021. In various embodiments, by inserting the second parts 5153b into the bracket legs 5021, the forces directed to removing the bracket legs 5021 from the holding holes 5022 can only further penetrate the second parts 5153b into the bracket legs 5021 and increase the force required to remove the legs 5021 brackets. Moreover, due to the upward inclination of the second parts 5153b, in at least one embodiment, the second parts 5153b may be more susceptible to inserting the bracket leg 5021 into the holding hole 5152 and, to a greater extent, resist removing the bracket leg 5021. In at least one embodiment, as a result, the force required to insert the bracket leg 5021 into the holding hole 5022 may be less than the force required to remove the bracket leg 5021 from the holding hole 5022. In various embodiments, the force required to remove the bracket leg 5021 from the retaining hole 5022, for example, may exceed, for example, about 50 percent the force required to insert the bracket leg 5021 into the retaining hole 5022. In various other embodiments, the force required imaya to retrieve legs brackets 5021 may, for example, exceed an amount of from about 10 percent to about 100 percent of the force needed to insert the brackets 5021 feet. In some embodiments, the force required to remove the bracket leg 5021 may be greater than about 100 percent, about 150 percent, and / or more than about 200 percent greater than the force required to insert the bracket leg 5021.

In some embodiments, referring again to FIG. 162, the second portions 5153b may be circumferentially arranged around the opening 5152 and may define a recess between them. More specifically, the second parts 5153b can define a recess that 5160 can be made to insert the tip of the bracket leg when it is inserted into the holding hole 5152. In various embodiments, the second parts 5153b of the deformable elements 5153 may include, for example, a circular, or at least a substantially circular contour that can jointly outline a circular, or at least substantially circular, profile of a recess 1560. In at least one such embodiment, the second portions 5153b may be outlined s recess-shaped cone or a truncated cone shape. In various embodiments, the recess may be defined by a suitable number of deformable elements, such as four deformable elements 5153 (FIG. 162), six deformable elements 5153 (FIG. 163), or eight deformable elements 5153 (FIG. 164), for example. In some embodiments, referring now to FIG. 165, deformable elements of a holding matrix, such as a holding matrix 5250, for example, may form a pyramidal shape, or at least a substantially pyramidal shape. In various embodiments, the holding matrix 5250 may include a plurality of holding holes, such as a holding hole 5252, for example, which may be limited to the perimeter 5256. In various embodiments, the perimeter of the hole 5256 may have a polygonal, or at least substantially polygonal, profile, and / or other suitable profile. In some embodiments, the holding matrix 5250 may include one or more holding elements, such as holding elements 5253, for example, which protrude into the hole 5252 and can be configured to engage the leg of the stapling element when the leg of the stapling element is inserted into it. In at least one such embodiment, each holding member 5253 may include a console that extends inward toward the central axis 5259, i.e. toward the center of the hole 5252. In various embodiments, each console may include a first end attached to the retaining matrix body 5258 and a second end forming the perimeter of the retaining hole 5256 5252. In some embodiments, the perimeter of the retaining hole 5256 may be defined by a first diameter, or width, and the leg of the crosslinking element may be outlined by a second diameter, or width, while the second diameter may exceed the first diameter. In at least one such embodiment, the leg of the stapling element may be configured to contact and deflect one or more of the holding elements 5253 to increase the diameter of the holding hole 5252 as the leg of the stapling element is inserted into it. In some embodiments, in addition to the foregoing, the leg of the stapling element may indicate a perimeter greater than the perimeter 5256 of the holding hole 5252 so that the leg of the stapling element can expand the perimeter 5256 when the leg of the stapling element is inserted into it.

In various embodiments, referring again to FIG. 165, the hole 5252 may be defined by deformable elements 5253, with each deformable element 5253 being configured to deflect relative to, or independently from, the other deformable elements 5253. In at least one such embodiment, adjacent deformable elements 5253 may be separated by grooves 5254, which can be configured to allow bending of each deformable member 5253 relative to others. In various embodiments, the holding matrix housing 5258 may include 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 fabric contacting surface 5251 and the upper surface 5257 may be parallel, or at least substantially parallel, with respect to each other. In various embodiments, each deformable member 5253 may include a first portion 5253a and a second portion 5253b, with the first portion 5253a extending in the first direction and the second portion 5253b extending in a different or second direction. In at least one such embodiment, the retaining matrix housing 5258 may outline a plane, and the first portions 5253a of deformable elements 5253 may lie within such a plane. In various embodiments, the second parts 5253b of the deformable elements 5253 may extend at an angle with respect to the first parts 5253a in at least one such embodiment, the second parts 5253b may protrude in directions that extend from the upper surface 5257 of the holding die body 5258, and, in in some embodiments, the second parts may converge 5253b toward the central axis 5259 of the holding hole 5252. In any case, in various embodiments, the second parts 5253b may be configured to deviate from the central axis 5259 when a leg of the stapling element is inserted into them. In some embodiments, referring again to FIG. 165, the second parts 5253b may be circumferentially around the hole 5252 and may define a recess between them. More specifically, the second parts 5253b can define a recess that can be made to insert the tip of the bracket leg when it is inserted into the holding hole 5252. In various embodiments, the second parts 5253b of the deformable elements 5253 can outline, for example, polygonal or at least essentially a polygonal recess. In various embodiments, the recess may be defined by a suitable number of deformable elements, for example, four deformable elements 5253 (FIG. 165) that can form a square, six deformable elements 5253 (FIG. 166) that can form a hexagon, or eight deformable elements 5253 (FIG. . 167), which can form an octagon, for example.

In various embodiments, referring now to FIG. 168, a holding matrix, such as a holding matrix 5350, for example, 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 an embossing stamp, which, when actuated, can extrude some parts of the material to form slots 5354, holes 5355 of slots 5354 and / or perimeter 5356 of the holding hole 5352. The stamp for embossing can be made to bend the deformable element 5353 in a suitable configuration. In at least one such embodiment, the embossing stamp may deform the second parts 5353b upward relative to the first parts 5353a along the fold 5353c. In various embodiments, referring now to FIG. 169, a holding matrix, such as a holding matrix 5450, for example, may include a set of holding holes 5452. Similar to the above, the perimeter 5456 of each holding hole 5452 can be outlined by a set of deformable elements 5453 separated by slots or slots 5454. In at least one In this embodiment, each deformable element 5453 can be completely bent upward, while the free ends of the consoles including the deformable elements 5453 can define the perimeter 5456. In p In various embodiments, the holding matrix 5450 may include a plurality of holes 5455 surrounding, or at least substantially surrounding, the holding hole 5452. In at least one such embodiment, the holes 5455 can be arranged in a circle surrounding or enclosing the perimeter, defined by the fixed ends of the brackets of the deformable elements 5453. In some embodiments, the perimeter of each hole 5455 may have a round, or at least substantially round, shape and / or buoy another suitable form. During operation, the holes 5455 can provide, firstly, compensation for the tension of the bases of the deformable elements 5453 attached to the housing 5458 of the holding matrix, and secondly, means for increasing the flexibility of the deformable elements 5453. In various embodiments, the implementation of the larger holes 5455 can provide higher flexibility of deformable elements 5453 compared to smaller holes 5455. Moreover, holes 5455 located closer to deformable elements 5453 can provide a greater degree of flexibility compared to holes 5455 located further.

In various embodiments, referring now to FIG. 170, a holding matrix, such as a holding matrix 5550, for example, may include a plurality of holding holes 5552. Each holding hole 5552 may include an elongated slot 5554 with enlarged ends 5555 of a round, or at least substantially circular shape. In at least one such embodiment, the ends 5555 may be outlined with a diameter larger than the slot 5554. In some embodiments, the elongated slot 5554 and the ends 5555 may be aligned along and / or centered along the longitudinal axis 5559. In various embodiments, the slots 5554 and the ends 5555 can outline two opposite holders 5553, which can be made to engage with the leg of the stapling element and reject the leg of the stapling element inserted into it. In at least one embodiment, ends 5555 having a perimeter, or a larger diameter, can define longer holders 5553, which may have greater flexibility than holders 5553, defined ends 5555 having a perimeter, or a smaller diameter. In various embodiments, the ends 5555 may have the same perimeter and diameter, and in at least one such embodiment, each holder 5553 may be symmetrical along an axis that is perpendicular, or at least substantially perpendicular, to the longitudinal axis 5559. In accordance with another embodiment, the ends 5555 may have different perimeters and / or diameters, with at least one embodiment, each holder may be located asymmetrically about its axis. At least one such alternative embodiment, the holders 5553 can rotate about its axis as the leg of the stapling element is inserted into the holding hole 5552. In various embodiments, referring now to FIG. 171, a holding matrix, such as a holding matrix 5650, for example, may include a plurality of holding holes 5652. Each holding hole 5652 may include an elongated slot 5654 with round or at least substantially circular ends 5655. In at least one such embodiment, the elongated slot 5654 and the ends 5655 may be aligned lengthwise and / or centered along the longitudinal axis 5659. In various embodiments, each end 5655 may be outlined with a diameter of the same size, or at least essentially coincides with a slot width of 5654.

In various embodiments, referring now to FIG. 172, a holding matrix, such as a holding matrix 5750, for example, may include a plurality of holding holes 5752. Each holding hole 5752 may include a plurality of slots, such as slots 5754, for example with enlarged ends 5755. In at least one such In an embodiment, the slots 5754 and the ends 5755 may be located along and / or aligned centrally along the longitudinal axis 5759. In various embodiments, the axes 5759 may extend in directions perpendicular or transverse to each other at. In some embodiments, slots 5754 and ends 5755 can contour four holders 5753, for example, which can be made to engage the leg of the stapling element and deflect when the leg of the stapling element is inserted into the holding hole 5752. In at least one embodiment, each holder 5753 may have a triangular, or at least substantially triangular, configuration, such as, for example, an equilateral triangle. In various other embodiments, referring now to FIG. 173, a holding matrix, such as a holding matrix 5850, for example, may include a plurality of holding holes 5852. Each holding hole 5852 may include a plurality of slots 5854, for example, ends 5855, while slots 5854 and ends 5855 may be located along and / or centered along the longitudinal axis 5859. In various embodiments, the axles 5859 may extend in directions perpendicular or transverse to each other. In some embodiments, slots 5854 and ends 5855 can outline holders 5853 that can be made to engage the leg of the stapling element and deflect when the leg of the stapling element is inserted into the holding hole 5852. In at least one embodiment, each holder 5853 can have arcuate profile. More specifically, each holder 5853 may include a curved end, as opposed to the pointed end shown in FIG. 170, which may be made to come into contact with the leg of the stapling element.

In various embodiments, referring now to FIG. 174, a holding matrix, such as a holding matrix 5950, for example, may include a plurality of holding holes 5952. Each holding hole 5952 may include a plurality of slots, such as slots 5954, for example, each slot 5954 may extend along and / or , aligned centrally along axis 5959. In various embodiments, axles 5959 can be spaced transversely to each other and in at least one such embodiment, axes 5959 can be spaced so that all axes 5959 pass through the center while holding and its holes 5952 are arranged at the same distance from each other, or at least substantially equidistant from each other. In at least one embodiment, each slot 5954 may include an open end facing the center of the retaining hole 5952, and a second, or closed, end 5955 at the opposite end of the slot 5954. Like the above, the slots 5954 and the ends 5955 may outline, for example , three holders 5953 that can be made to engage with the leg of the stapling element and deflect when the leg of the stapling element is inserted into the holding hole 5952. In various embodiments, each holder 5953 can include chat arcuate configuration extending between adjacent ends 5955 of the slots 5954. In various embodiments, referring now to FIG. 175, a holding matrix, such as a holding matrix 6050, for example, may include a plurality of holding holes 6052. Each holding hole 6052 may include a holder 6053, which may be designed to engage the leg of the stapling element and tilted when the leg of the stapling element is inserted into a holding hole 6052. In at least one such embodiment, the holder 6053 may include a base attached to the holding matrix body 6058 and a free end having an arcuate or and ognuty profile 6056 which is configured to come into contact with the stalk of cross-linking element. In some embodiments, the leg of the stapling element may be a brace leg made of round wire, wherein the curved profile 6056 can be made to match, or at least substantially match, the curved outer surface of the round wire.

In various embodiments, referring again to FIG. 175, the holding matrix housing 6058 may include a plurality of slots 6054 and holes 6055 that may be provided to outline the holder 6053 and various parts of the holding holes 6052. In at least one embodiment, the holder 6053 may have a rectangular configuration that includes parallel, or at least substantially parallel sides. In some embodiments, referring now to FIG. 176, a holding matrix, such as a holding matrix 6150, for example, may include a plurality of holding holes 6152. Each holding hole 6152 may include a holder 6153 that can be engaged to engage the leg of the stapling element and deflect when the leg of the stapling element is inserted into a holding hole 6152. In at least one such embodiment, the holder 6153 may include a base attached to the holding matrix body 6158 and a free end having an arcuate or from curved profile 6156, which is made to come into contact with the leg of the stapling element. In various embodiments, the holding matrix housing 6158 may include a plurality of slots 6154 and holes 6155 that may be provided to define the holder 6153 and various parts of the holding holes 6152. In at least one embodiment, the holder 6153 may include a tapering configuration including arcuate sides . In at least one such embodiment, the holder 6153 may taper exponentially with a wider base than the free end, for example.

In various embodiments, as described above, the crosslinking system may include a plurality of brackets containing brace legs inserted through a plurality of holding holes in the holding matrix. In some embodiments, implementation, as described in more detail below, the brackets may be contained in the first jaw, and the holding matrix may be contained in the second jaw, with at least one of the two, the first jaw or the second jaw, can move towards the other. Under various circumstances, the brackets placed in the first jaw can be fixed in it so that the legs of the brackets align with the retaining holes when the retaining matrix is engaged with the legs of the brackets. In some embodiments, referring to FIG. 177 and 178, the stapling system may include a block of brackets 6200, for example, located in the first jaw of the surgical stapler, and a holding matrix 6250, for example, located in the second jaw of the surgical stapler. Turning now to FIG. 184 and 185, in addition to the foregoing, the holding matrix 6250 may include a plurality of holding holes 6252, wherein each holding hole 6252 may have a perimeter 6256 defined by one or more deflectable elements 6253. In at least one such embodiment, in addition to the foregoing, deflectable members 6253 defining each hole 6252 may define a recess 6201. In various embodiments, each recess 6201 may include a rounded and / or concave surface, n Examples which may be performed to guide the tip of the brace legs into the hole 6252 if the brackets are not aligned with the leg of the retaining holes 6252 and initially engages the deflectable elements 6253 and / or the tissue contacting surface 6251, for example.

In various embodiments, in addition to the foregoing, the crosslinking system may also include a plurality of brackets 6220 having brace legs 6221 that can be inserted through the holding holes 6252 in the holding matrix 6250. In at least one such embodiment, each suture bracket 6220 may have a substantially U-shaped configuration, for example, comprising a base 622 from which legs 6221 can extend upward. In various embodiments, referring now to FIG. 180 and 181, the holding holes 6252 in the holding matrix 6250 may be arranged in two parallel, or at least substantially parallel, longitudinal rows, for example, which extend along, or parallel to, the longitudinal axis of the holding matrix. In some embodiments, the holding holes 6252 in the first row may be offset, or staggered, relative to the holding holes 6252 in the second row. In at least one such embodiment, each suture brace 6220 may include a first brace leg 6221 located in the holding hole 6252 in the first row and a second brace leg 6221 located in the holding hole 6252 in the second row, thereby the bases 6222 may be located in a direction transverse to the longitudinal axis of the holding matrix 6250. In at least one of such embodiments, the brackets 6220 may be parallel, or substantially parallel, to each other. More specifically, the base 6222a of the suture bracket 6220a 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 suture 6220c, for example. In at least one embodiment, the legs 6221a of the suture bracket 6220a may define a plane that is parallel, or at least substantially parallel, to a plane defined by the legs 6221b of the suture bracket 6220b, which may be parallel, or at least substantially parallel to the plane outlined by the legs 6221 of the bracket 6220c, for example.

In various embodiments, referring now to FIG. 177 and 179, the bracket block 6200 may include a plurality of brackets 6220 and, in addition, a alignment matrix 6260 including a plurality of alignment guides, such as grooves, cutouts and / or holes, for example, made to align the brackets 6220. Under various circumstances, the alignment bracket the matrix 6260 may be configured so that the legs 6221 of the brackets 6220 align with the holding holes 6252 in the holding matrix 6250 before the holding matrix 6250 is engaged with the legs 6221 of the brackets. In various embodiments, referring now to FIG. 182 and 183, the alignment matrix 6260 may include a plurality of alignment holes 6262 designed to fit the legs 6221 of the brackets 6220 tightly. In at least one such embodiment, each bracket 6220 may include a base 6222 and two bracket legs 6221 extending from the base 6222, however, the bases 6222 of the brackets 6220 may extend along the bottom surface 6264 of the holding matrix 6260, the legs of the brackets 6221 may extend upward through the alignment holes 6262. In some embodiments, each alignment hole 6262 may have a round, or at least essentially round, shape and can be delineated with a diameter equal to or slightly greater than the diameter of the legs 6221 brackets passing through it. In various embodiments, the alignment matrix 6260 may also include a plurality of raised elements 6263 that extend upward from the upper surface 6261 of the alignment matrix 6260 and surround, or at least partially surround, the alignment holes 6262. In some embodiments, the raised elements 6263 may provide alignment holes 6262 longer, while under various circumstances, holes 6262 longer can provide greater control of the alignment of the legs 6221 brackets compared with 6262 holes of shorter length.

In use, in various embodiments, the first jaw supporting the brace block 6200 may be located on one side of the fabric to be stapled, and the second jaw supporting the holding matrix 6250 may be located on the other side of the fabric. Once the jaws are positioned in a suitable position relative to the fabric, in some embodiments, the second jaw and the holding matrix 6250 can move toward the bracket block 6200. As soon as the legs 6221 of the bracket are inserted into the holding holes 6252 of the holding matrix 6250, in various embodiments, the contacting with the fabric, or the lower surface 6251 of the holding matrix 6250 may come into contact with the fabric and press the fabric against the fabric in contact with the fabric, or the upper surface 6261 of the alignment matrix 6260. B azlichnyh other embodiments, as described in more detail below, brackets block 6200 may also comprise a housing block crushes brackets located above the upper surface of the alignment matrix 6261 6260, for example, which may come into contact with the cloth. In some embodiments, referring again to FIG. 179 and 183, the alignment matrix 6260 may also include one or more holes 6203, indicated herein, which, when the alignment matrix 6260 is located at the fabric level, can be used to insert tissue into them. In embodiments in which the crease block body of the brackets is located above and / or at the level of the alignment matrix 6260, a portion of the crease block body of the brackets may enter holes 6203 when the bracket block body is compressed. Similarly, the retention matrix 6250 may include a plurality of holes 6202 that can be provided to insert at least a portion of the tissue into them when the retention matrix 6250 is located at the tissue level.

As the legs 6221 of the brackets 6220 pass through the holding holes 6252 of the holding matrix 6250, in addition to the foregoing, the ends of the legs of the brackets 6221 may extend upward from the upper surface 6257 of the holding matrix 6250. Under various circumstances, as described above, the ends of the legs of the brackets 6221 may remain unbent after being inserted through the retaining holes 6252. In some embodiments, referring now to FIG. 186-189, a crosslinking system including a bracket block 6200 and a retaining matrix 6250 may also include a plurality of protective caps or covers, such as caps 6270, for example, which can be mounted on the legs 6221 of the brackets protruding above the holding matrix 6250. In various embodiments of implementation, each cap 6270 can completely, or at least partially, cover the sharp ends of the brace legs 6221 so that the sharp ends do not come in contact with the tissue adjacent to them. In at least one embodiment, referring now to FIG. 189, each cap 6270 may include an opening 6271 defined by it, which can be made to fit the tip of the bracket leg 6221 tightly into it. In various embodiments, caps 6270 may be made of an elastomeric material, such as, for example, silicone, polyisoprene, sanoprene, and / or natural rubber. In at least one embodiment, the hole 6271 may have a perimeter or diameter smaller than the perimeter or diameter of the bracket leg 6221 embedded therein. In at least one such embodiment, the opening 6271 in the protective cap 6270 may expand to fit brace legs 6221. In various alternative embodiments, the caps 6270 may not have holes, and the ends of the bracket legs 6221 may be pierced by the caps 6270 as the legs 6221 are inserted into them. In any case, in various embodiments, each cap 6270 may be worn on the bracket leg 6221, until the base 6272 of the cap 6270 adjoins or is adjacent to the upper surface 6257 of the holding matrix 6250. Under various circumstances, the caps 6270 can be made to fit snugly onto the ends of the legs 6221 of the brackets so that It was not easy to remove them from the tips. In some embodiments, implementation, 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 shape, such as a parabolic, or at least substantially parabolic shape of the outer surface.

In various embodiments, the cross-linking system described above, for example, can be activated using the surgical cross-linking tool described in FIG. 190-192. In various embodiments, the end clamp may include a first jaw or brace block chute 6230 that can be made to support the brace block 6200, while a second jaw 6240 can be made to support the holding matrix 6250 and the plurality of protective caps 6270. Turning primarily to FIG. 190, showing the second jaw 6240 in the open position, 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 block of brackets 6200. In various embodiments, as previously disclosed, the block of brackets 6200 may also include a collapsible bracket block body, such as a bracket block housing 6210, for example, in which the brackets 6220 and the alignment matrix 6260 can be accommodated. In at least one such embodiment, the fabric T may be at the same level with the upper surface of the housing unit 6210 staples. In some embodiments, the second jaw 6240 may include a plurality of recesses or holes 6245 made to insert a plurality of protective caps 6270 and, in addition, one or more holding devices or clips made to hold the holding matrix 6250 in place above the caps 6270. At least in at least one such embodiment, a holding matrix 6250 may be configured to hold the caps 6270 in the holes 6245. In various embodiments, referring now to FIG. 202, each orifice 6245 may be configured to insert portions of cap 6270 or the entire cap into it. In some embodiments, the openings 6245 can substantially be sized and configured to secure caps 6270 on them using at least one device for, for example, pressing and / or snapping. In some embodiments, at least one adhesive may be used to secure caps 6270 in openings 6245. In at least one such embodiment, such adhesive may be selected so that caps 6270 can be detached from second jaw 6240 after caps 6270 engage with the legs of 6221 brackets, and the second jaw 6240 is retracted from the implanted block of brackets. In some embodiments, referring now to FIG. 203, the second jaw 6240 may also include at least one cover sheet 6246 that can be mounted to the second jaw 6240 and can cover the caps 6270 and hold them in the holes 6245. In at least one such embodiment, at least a portion of the cover sheet 6246 may be attached to jaw 6240 with a single adhesive, for example. When used in at least one embodiment, the cover sheet 6246 may at least partially detach from jaw 6240 before inserting the end clamp into the surgical field. In some embodiments, the cover sheet 6246 may be made of an implantable material, such as PDS and / or PGC, for example, which may be dissected by the brace legs 6221 as the brace legs 6221 exit the holding matrix 6250. In at least one In such an embodiment, the cover sheet 6246 may be attached to the bracket system between the caps 6270 by the holding matrix 6250.

In addition to the foregoing, referring again to FIG. 191, the jaw 6240 can be moved from an open position to a closed position in which the tissue T is flush with the holding matrix 6250 and the bracket block body 6210. In this position, the holding matrix 6250 may not yet engage with the brackets 6220. In various embodiments, the jaw 6240 may be moved between the open position and the closed position by the actuator 6235. In at least one such embodiment, the jaw 6240 may include a distal pin 6243 and the proximal pin 6244 emerging from it, while the distal pin 6243 can slide vertically, or at least substantially vertically, along the distal groove 6233 formed in the groove 6230 of the bracket block, and, when volume, the proximal pin 6244 can slide vertically, or at least substantially vertically, along the proximal groove 6234 formed in the groove 6230 of the bracket block. In use, the actuator 6235 can be retracted proximally to advance the pins 6243 and 6244 to the upper ends of the corresponding grooves 6233 and 6234, as shown in FIG. 191. In at least one such embodiment, the actuator 6235 may include a distal actuator groove 6236 and a proximal actuator groove 6237, wherein the side walls of the actuator grooves 6236 and 6237 may be configured to engage the distal pin 6243 and the proximal pin 6244, respectively, and push pins 6243 and 6244 up as the actuator 6235 moves proximally. More specifically, as the actuator 6235 moves proximally, the distal pin 6243 can slide along the first inclined portion 6236a of the distal drive groove 6236 into the intermediate, or the second, portion 6236b and, similarly, the proximal pin 6244 can slide along the inclined first distal portion 6237a the groove 6237 drive in the intermediate, or second, part 6237b. As both pins 6243 and 6244 move up, the jaw 6240 can rotate in the closed position down towards tissue T.

In addition to the foregoing, referring now to FIG. 192, the actuator 6235 can be pushed further proximally to move the second jaw 6240 down in the direction of the first jaw 6230, compress the bracket block body 6210, and hold the retaining matrix 6250 and the combination of protective caps 6270 into engagement with the legs of the brackets 6220. In at least one such embodiment implementation, as a result of additional proximal movement of the actuator 6235, the side walls of the grooves 6236 and 6237 of the actuator come into contact with the pins 6243 and 6244, respectively, and move the pins 6243 and 6244 down in the direction of the lower ends of the grooves 6233 and 6234, respectively etstvenno. Under such circumstances, the actuator 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 third inclined part 6236c and, similarly, the proximal pin 6244 exits the second part 6237b of the actuator groove 6237b and entered the inclined third part 6237c. As the pins 6243 and 6244 both move down, the second jaw 6240 can move down in the direction of the first jaw 6230 in the operating position. In at least one such embodiment, the second jaw 6240 can move downward so that the retaining matrix 6250 can remain in a parallel, or at least substantially parallel, position relative to the upper surface of the bracket block body 6210 and / or in parallel, or at least essentially parallel, position relative to the alignment matrix 6260. In any case, as soon as the holding matrix 6250 and the protective caps 6270 engage with the legs 6221 of the brackets 6220, as shown in FIG. 194, the second jaw 6240 may return 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 to the upper ends of the grooves 6233 and 6234, respectively, and then move down towards the lower ends of the grooves 6233 and 6234 as soon as the pins pass through the intermediate parts 6236b and 6237b of the respective grooves 6236 and 6237 of the drive. As soon as the second jaw 6240 opens, the first jaw 6230 can be detached from the implanted bracket block 6200, and the first and second jaws 6230, 6240 can be moved away from the implanted bracket block, as shown in FIG. 193.

Turning to FIG. 192 again, it will be understood by the reader that the pins 6243 and 6244 are not shown to be placed at the very bottom of the corresponding slots 6233 and 6234, despite the fact that the holding matrix 6250 and the caps 6270 are engaged with the legs 6221 of the bracket. This may occur when a thick fabric T is located between the holding matrix 6250 and the bracket block body 6210. Under conditions where the tissue T of smaller thickness is located between the holding matrix 6250 and the body 6210 of the bracket block, referring now to FIG. 195, pins 6243 and 6244 can move further down 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 extend the pins 6243 and 6244 up and down through a series of motions described above and shown in FIG. 195-197, and, due to the smaller thickness of the fabric T, the holding matrix 6250 and the protective caps 6270 can move further along the legs 6221 of the brackets 6220, as shown in FIG. 198 and 199. In various embodiments, as a result of the ability of the holding matrix 6250 to regulate, the same, or at least substantially the same, compression pressure can be created in the stitched fabric, regardless of the thickness, large or small, of the fabric gripped by the end clamp . In some embodiments, the adjustment ability of the holding matrix 6250 allows the surgeon to choose whether to apply greater compression pressure or lower compression pressure to the tissue by choosing at what depth to hold the holding matrix 6250. In at least one such embodiment, the range of placement of the holding matrix matrix 6250 on the legs 6221 brackets can be determined by the length, or range, of the grooves 6233 and 6234, for example.

In various embodiments, implementation, as described above, the protective caps 6270 may be made of soft or flexible material, for example, which may be suitable for crimping the ends of the legs 6221 brackets. In some embodiments, the protective caps 6270 may be made from bioabsorbable plastic, such as polyglycolic acid (PGA), which is sold under the trade name Vicryl, Polylactic Acid (PMA), Polydioxanone (PDS), Polyhydroxyalkanate (PHA), Polyglexaprone 25 (PHCL) which is sold under the trade name monocryl, polycaprolactone (PCL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL, for example, and / or from a biocompatible material, such as titanium and / or stainless steel, to for example. As shown in FIG. 189, in at least one embodiment, each cap 6270 may not be disconnected from the other caps 6270. In some other embodiments, one or more caps 6270 may be mounted to the holding matrix 6250. In at least one such embodiment, the caps 6270 can be attached to the holding matrix 6250 using at least one adhesive, for example, while the holes 6271 in the caps 6270 can be aligned, or at least substantially aligned, with respect to the retention openings 6252 in a holding matrix 6270. In various embodiments, referring now to FIG. 200, a protective cap, such as cap 6370, for example, may define an internal cavity, or dome, 6374, which may be performed, for example, to insert the tip of the bracket leg 6221 into it. In at least one such embodiment, cap 6370 may include a bottom 6372 and an opening 6371 extending through the bottom 6372. In various embodiments, the opening 6371 may be defined by one or more deflectable members 6373 that are designed to deflect when legs 6221 are inserted through it. parentheses. In some embodiments, two or more caps 6370, for example, can be joined together to form an array of caps 6370. In at least one such embodiment, referring now to FIG. 201, several caps 6370 can be joined together using a sheet of material 6375. In some embodiments, sheet 6375 can be substantially rigid to maintain the desired location and / or alignment of caps 6370. In at least one embodiment, caps 6370 can be made of a biocompatible material, such as titanium and / or stainless steel, for example, and the sheet can be made of bioabsorbable plastic, such as polyglycolic acid (PGC), which is sold under called Vicryl, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglecaprone 25 (PHCL), which is sold under the trade name monocryl, polycaprolactone (PCL) and / or composite material PGC, PMC, PDS, PHA, PHCL and / or PKL, for example. In various embodiments, the sheet 6375 may be made from a bioabsorbable material including an antimicrobial preparation, such as colloidal silver and / or triclosan, for example, contained in the accumulated form and / or dispersible therein, with the possibility of release after the bioabsorbable sheet 6375, for example.

In various embodiments, in addition to the foregoing, sheet 6375 may be injection molded around caps 6370 during the injection molding process, for example, so that caps 6370 are pressed into sheet 6375. In some other embodiments, sheet 6375 may be molded under pressure, for example, while holes 6376 may form on sheet 6375 during the injection molding process and / or after the completion of the injection molding process with approx neniem stamping process, for example. In any case, the caps 6370 can be inserted and fixed in the holes 6376 by means of a connection by pressing and / or snapping and / or at least one adhesive. In some embodiments, implementation, each cap 6370 may include an annular groove surrounding, or at least partially surrounding, the perimeter of the cap 6370, which can be made to fit the perimeter of the hole 6376. In some embodiments, the sheet 6375 may be made of flexible and / or a bendable material providing relative movement between the caps 6370. In at least one such embodiment, the flexible sheet 6375 may be made of rubber, plastic and / or silicone about the material, for example, and the caps 6370 can be made of rigid material, such as metal. In at least one such embodiment, similar to the foregoing, flexible material may be formed around the caps 6370. In some embodiments, the caps 6370 may be pressed into a preformed sheet 6375, for example. In various embodiments, the hardness of the flexible material can be selected to provide the desired stiffness of the sheet 6375. In some embodiments, sheet 6375 may be configured to include a flexible tape. In any case, the sheet 6375 can facilitate the installation of the caps 6370 in the end clamp, since the set of brackets 6370 can simultaneously be located and / or aligned in the end clamp. Moreover, the sheet 6375 connecting the caps 6370, after implantation, can reinforce or strengthen the tissue along the seam line, for example. In addition to or in lieu of the sheet connecting the caps 6370, the caps 6370 may be joined together by a plurality of links. In at least one such embodiment, such links may be flexible and may provide relative movement between caps 6370.

In various embodiments, referring now to FIG. 204 and 205, a protective cap, such as cap 6470, for example, may include a forming surface that can be made to deform the ends of the legs of the bracket. In at least one such embodiment, cap 6470 may have a base 6472, which may include an opening 6471 passing through it. In various embodiments, an opening 6471 may be provided for firmly inserting a bracket leg, such as, for example, leg 6221. In at least one embodiment, the hole 6471 may be defined by a diameter or perimeter that may be equal to or greater than the diameter or perimeter of the leg 6221 brackets. In various embodiments, cap 6470 may also include a cavity, or dome, 6474, which may be configured to insert the tip of bracket foot 6221 as it is inserted into cap 6470. Referring first to FIG. 205, cap 6470 may also include a stop member or forming surface, 6473, designed to bias and deform the brace legs 6221. Under various circumstances, the forming surface 6473 may have a rounded and / or concave shape, for example, and may be performed to bend the bracket leg 6221 as it is inserted into the cap 6470. In some embodiments, the bracket leg 6221 can be substantially deformed so that it became impossible to remove from the hole 647, and, as a result, the cap 6470 may be blocked on the leg 6221 block brackets. In at least one such embodiment, the base 6472 of the cap 6470 may contour an edge extending around the opening 6471, which may prevent the deformed bracket leg 6221 from being removed from the cavity 6474. Under various circumstances, as a result of the foregoing, one or more caps 6470 may prevent or inhibit the movement in the opposite direction or the detachment from the brackets 6220 of the holding matrix, such as, for example, the holding matrix 6250. In various embodiments, although not shown, lpachok 6470 may be formed symmetrically, or at least substantially symmetrical and the opening 6471 can be located along the central axis 6479 through the cap 6470. In various alternative embodiments, referring again to FIG. 204, the hole 6471 can be offset relative to the central axis 6479. In at least one such embodiment, the offset hole 6471 can make the bracket leg 6221 contact the side of the forming surface 6473 and bend to the other side of the forming surface 6473 instead of making contact with the center of the forming surfaces 6473, as may be the case in embodiments comprising a centered hole 6471 mentioned above.

In various embodiments, as disclosed above, a holding matrix, such as a holding matrix 6250, for example, may include a sheet of material and a plurality of holding holes 6252 passing through it. In at least some embodiments, a sheet of material including a holding matrix 6250 may be rigid or substantially inflexible. In some other embodiments, the holding matrix may include an array of sections of the holding matrix and a plurality of flexible connectors, or links connecting sections of the holding matrix. In various embodiments, referring now to FIG. 206, the holding matrix, or part of the holding matrix, 6550 may include a plurality of section bodies 6505 that can be connected to each other using one or more connecting links 6507. In at least one embodiment, each section body 6505 may include a plurality of deformable elements 6553 which define a holding hole 6552 in it. In some embodiments, implementation, the body section 6505 and the connecting links 6507 of the holding matrix 6550 can form an integral part of it and can be performed as a separate piece of material. In various embodiments, the holding matrix 6550 may be manufactured by stamping or casting, for example, from a metal material, such as, for example, titanium and / or stainless steel. In at least one embodiment, the retention matrix 6550 may be made of plastic, such as polyetheretherketone (PEEK), polypropylene, which is sold under the trade name Prolene, polyester, polyethylene terephthalate, which is sold under the trade name Etibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride / copolymer hexafluoropropylene, a mixture of PVI polymers and a poly (fluorovinylidene / hexafluoropropylene) copolymer sold under the trade name Pronova, and / or long chain aliphatic Limeron 6 and Nylon 6.6, which are sold under the trade names Ethilon and Nurolon, and can be formed, for example, by injection molding. In some embodiments, the body 6505 sections may not be integral with the connecting links 6507. In various embodiments, a plurality of individual body 6505 sections may be formed, which are subsequently connected together and attached to the holding matrix. In at least one such embodiment, the bodies of 6505 sections can be stamped from a metal material such as titanium and / or stainless steel, for example, and placed in a mold for plastic products, with the plastic material being introduced into the mold for forming, first, a rim 6506 of material surrounding or at least partially surrounding a body of sections 6505, and, second, connecting links 6507 extending from the rims 6506. In some other embodiments, about a bottom or several connecting lattice structures, including openings outlined by a set of rims 6506, each such opening can be made for inserting section bodies 6505 into it. In at least one embodiment, each sectional body 6505 may include a round, or at least substantially circular, outer perimeter, and, likewise, each rim 6506 may define a circular, or at least substantially circular, opening in it, in this case, the diameter of the hole may be equal to or less than the diameter of the body 6505 section. In at least one such embodiment, sectional bodies 6505 can be pressed into or attached to holes in rims 6505. In some embodiments, sectional bodies 6505 can be fixed in openings with at least one adhesive.

In various embodiments, in addition to the foregoing, the retaining matrix may include a plurality of bodies 6505 sections and a plurality of connectors 6507, which can connect the bodies 6505 sections in any suitable array, such as the array shown in FIG. 207-210, for example. Regardless of the layout of the array, in various embodiments, the connecting links 6507 may be configured to provide movement of the section bodies 6505 and the holding holes 6552 relative to each other. In at least one such embodiment, the lattice structure of the section bodies 6505 and the connecting links 6507 forming the retaining matrix 6550, upon entering into engagement with the fabric, can stretch, twist, compress and / or bend in another way to provide at least at least some movement in the tissue, at the same time, for resistance to movement in it of a larger amplitude. In various embodiments, each link 6507 may include a flexible member designed to stretch, twist, and / or contract to allow folding of the holding matrix 6550 between the matrix holding sections 6505, for example. Turning again to FIG. 206, each link 6507 exiting the rim 6506 may be outlined with a width that is narrower than the width of the section body 6505 and / or rim 6506. In some embodiments, referring to FIG. 207-210, one or more links 6507 may include straight parts running along a line between adjacent section bodies 6506, for example. In at least one such embodiment, each link 6507 may include a first end attached to the first rim 6506 and a second end attached to the second rim 6506. In some embodiments, referring again to FIG. 206, two or more links 6507 may be interconnected. In at least one such embodiment, two or more links 6507 may be connected by an intermediate swivel 6509, for example. In various embodiments, the hinges 6509 may have a decrease in the thickness of the cross section in one or more directions compared to the thickness of the cross section of the links 6507, which allows the connecting links 6507 to move relative to each other, for example. In some embodiments, the holding matrix 6550 may also include hinges 6508, which can attach the links 6507 to the rims 6506 and provide relative movement between the links 6507 and the rims 6506. Similar to the hinges 6509, the hinges 6508 may have a decrease in thickness in the cross section of one or more directions than the thickness in the cross section of links 6507, for example.

In various embodiments, in addition to the foregoing, the connected links 6507 can go 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 some 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 with each other at an angle, such as approximately 30 degrees, approximately 45 degrees , approximately 60 degrees and / or approximately 90 degrees, for example. In various embodiments, hinges 6508 and / or hinges 6509 may include flexible hinges that allow links 6507 to move relative to each other a number of times without breaking. In some embodiments, the hinges 6508 and / or the hinges 6509 may include brittle or easily tearing portions that can tear when overly bent and / or too often bent. In at least one such embodiment, such brittle parts may tear one or more parts of the holding matrix 6550 from another part of the holding matrix 6550. In various embodiments, hinges 6508 and / or hinges 6509, for example, may include portions of the holding matrix 6550, which are easier to dissect than other parts of the holding matrix 6550. More specifically, the implanted holding matrix and fabric stitched with the implanted holding matrix can often be dissected by the cutting element for various reasons, and to facilitate this dissection, hinges 6508 and / or hinges 6509 may provide passages or narrow cuts through which the cutting element can more easily pass through the holding die 6550, for example. In various embodiments, in addition to the foregoing, the connecting links 6507 may include one or more extruded sections or gaps in the integrity of the material, for example, outlined in them, which can facilitate bending, tearing and / or dissection of the connecting links 6507.

In various embodiments, the holding matrix may include a plurality of sections of the holding matrix, such as bodies of 6505 sections of the matrix, for example, which can be embedded in a flexible sheet or tape of material. In at least one embodiment, the flexible sheet of material can be made of a bioabsorbable elastomeric material, such as silicone, for example, while the flexible sheet can be made with a plurality of holes indicated therein. In at least one such embodiment, a continuous flexible sheet may be cast, and a plurality of holes may be extruded into the flexible sheet. In various alternative embodiments, the flexible sheet may be molded, and the holes indicated therein may be formed during the molding process. In any case, sections 6505 of the holding matrix 6505, for example, can be nested and remain in the flexible sheet. In some other embodiments, implementation, similar to the above, a flexible sheet can be formed in sections 6505 of the matrix. In at least one embodiment, the flexible sheet may be made of a woven mesh, for example, and / or other suitable material. Such a woven mesh, in addition to the foregoing, can be easily dissected.

In various embodiments, referring now to FIG. 211 and 212, a crosslinking system including a holding matrix, such as a holding matrix 6250, for example, may also include a coating, such as, for example, a coating 6670, which covers the ends of the legs 6221 brackets, when they go over the upper 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 holding matrix 6250 may include holding devices that may be provided to hold coating 6670 on the holding matrix 6250. In at least one embodiment, it is possible to use at least one adhesive to adhere the coating 6670 to the holding matrix 6250. In at least one embodiment, the coating 6670 may include one layer, although coating 6670 is shown as containing two layers, as described in more detail below. In various embodiments, referring first to FIG. 212, the ends of the legs 6221 brackets can pass through the lower surface 6673 of the coating 6670; However, the cover 6670 may have a substantial thickness so that the ends of the brackets do not protrude through the upper surface 6675 of the cover 6670. In at least one such embodiment, as a result, the ends of the legs 6221 of the brackets may not protrude from the cover 6670. In various embodiments, the coating 6670 may include a plurality of layers. In at least one such embodiment, the coating 6670 may include 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 attached to each other in at least one embodiment , the second layer 6672 may include a lower surface 6676 that is adhered to the first layer 6671. In various embodiments, the first layer 6671 and the second layer 6672 may have different thicknesses, while in some embodiments, they may have one nakova thick. In at least one embodiment, the first layer 6671 and the second layer 6672 can have substantially the same width and / or length. In alternative embodiments, layers 6671 and 6672 may have equal width and / or length.

In various embodiments, in addition to the foregoing, the first layer 6671 may be made of compressible foamed, mesh material and / or hydrogel, for example, which can be dissected by the legs 6211 brackets. In at least one embodiment, the second layer 6672 may be made of a denser material or film, such as PGC and / or PDS, for example, and / or any suitable reinforced material. In at least one such embodiment, the legs of the brackets 6221 may be configured to penetrate the first layer 6671; however, in various embodiments, the bracket legs 6221 may not be able to penetrate the second layer 6672. In some embodiments, the second layer 6672 may be made of material with a significant degree of elastic deformation and / or stiffness, due to which the bracket leg 6221 can fit contact and displace the second layer 6672, but do not dissect it or only slightly insect it with the tip of the bracket leg 6221. Although not shown, the coating may include more than two layers, however, one or more layers may be resistant to penetration. When used in at least one such embodiment, the holding matrix 6250 can be flush with the fabric to be stapled and pushed down so that the legs 6221 of the brackets 6220 are pushed through the fabric T and the holding holes 6252 in the holding matrix 6250 and enter into the first layer 6271 of the cover 6270. In various embodiments, the ends of the legs of the brackets 6221 may enter, or at least substantially enter, the second layer 6272 of the cover 6270. After a suitable arrangement of the holding ma Ritsa 6250 may open the jaws 6240 and the cover 6670 and the holding matrix 6250 can detach from the jaws 6240, as shown in FIG. 211. As shown in FIG. 211, a jaw 6640 may be configured to hold more than one retaining matrix 6250 and a cover 6670. In at least one such embodiment, the jaw 6640 may include two grooves 6679, each of which may be configured to insert a 6670 cover, and a holding matrix 6250 located above so that the tissue-contacting surface 6251 of each holding matrix 6250 extends downward from the bottom of the jaw 6240. In at least one such embodiment, the holding matrix 6250 and coating 6270 may accommodate located in the jaw 6640 on each side of the knife slot 6678. In use, both the holding matrices 6250 and the cover 6670 can be activated simultaneously and / or at the same depth relative to the opposite brace blocks, such as, for example, the brace blocks 6200 located on the other side. Thereafter, in various embodiments, the stitched fabric can be dissected along the cut line using a cutting element that extends through the knife slot 6678, while the jaw 6640 can then be re-opened. 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 using holding matrices 6250 that may be attached to the jaw 6640. B in various embodiments, each holding matrix 6250 may be wider and / or longer than the corresponding coating 6670, so that the holding matrices 6250 can hold their coatings 6670 in place in integrity. In some embodiments, each holding matrix 6250 may have the same width and / or length as the corresponding coating 6670, for example.

In various embodiments, as described above, the crosslinking system may include a layer of material that can be attached to a retaining matrix, such as, for example, a holding matrix 6250. In at least one embodiment, referring now to FIG. 215, a layer of material 6870 may be attached to the bottom surface 6251 of the holding matrix 6250. In some embodiments, the layer 6870 and / or the holding matrix 6250 may include holding devices that may be provided to hold the layer 6870 on the holding matrix 6250. In at least one In the embodiment, it is possible to use at least one adhesive to adhere the layer 6870 to the holding matrix 6250. In any case, the layer 6870 may include a lower, or tissue-contacting surface 6873, which is Jet performed to enter into contact with the cloth T, when the retaining matrix 6250 is moved downward in the direction of brackets 6220 to enter the retaining holes 6252 into engagement with the legs 6221 of brackets. In at least one such embodiment, layer 6870 may be made of a compressible material, such as bioabsorbable foam, for example, which may be compressed between the bottom surface 6251 of the holding matrix 6250 and fabric T. In various embodiments, the layer 6870 may also comprise at least at least one drug, accumulated and / or absorbed therein, which can be released from layer 6870 as the layer 6870 is compressed. In at least one embodiment, the drug can include at least one tissue sealant, hemostatic agent and / or antimicrobial material, such as, for example, ionized silver and / or triclosan. In various embodiments, the compression of layer 6870 may squeeze the drug from layer 6870 so that the drug covers T tissue completely or at least a significant portion thereof. Moreover, as the layer 6870 contracts and the brackets 6221 penetrate into the T fabric and layer 6870, the drug can drain down the brace legs 6221 and have a therapeutic effect on the tissue that has just been cut by the brace legs 6221, for example. In various embodiments, the holding matrix housing 6250 may include a first layer made of a biocompatible material, such as titanium and / or stainless steel, for example, and the bottom layer 6870 may include a second layer made of a bioabsorbable material, such as oxidized regenerated cellulose (ORC), biologically active substances, such as fibrin and / or thrombin (in liquid or sublimated form), glycerin, easily absorbable pork gelatin in sprayed or foam form, and / or antimicrobial agents such as ionized silver and / or triclosan, for example. Additional bioabsorbable materials may include Surgicel Nu-Knit, Surgicel Fibrillar, collagen / ORC, which is a hybrid with an integrated collagen matrix and marketed under the trade name Promogan, polyglycolic acid (PGC) sold on the market under the trade name Vicryl, polylactic acid ( PMK), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglecapron 25 (PGKL), which is marketed under the trade name monocryl, polycaprolactone (PCL) and / or composite material PGK, PMK, PDS, PHA, PGKL and / or PKL to approx pv. Although in FIG. 215 shows only one layer 6870, any number of layers may be used. In at least one embodiment, the first layer containing the first drug can be attached to the retention matrix 6250, and the second layer containing the second or other drug can be attached to the first layer. In at least one such embodiment, multiple layers may be used, wherein each layer may comprise a drug and / or a combination of drugs that is different from the other layer.

In various embodiments, referring now to FIG. 213, the crosslinking system may include 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 devices that can be made to hold the layer 6770 on the holding matrix 6250. At least in at least one embodiment, it is possible to use at least one adhesive to adhere the layer 6770 to the holding matrix 6250. In any case, the layer 6770 may include a lower fabric contact a surface 6773 that can be made to contact tissue T when the holding matrix 6250 moves downward in the direction of the brackets 6220 to engage the holding holes 6252 into engagement with the legs 6221 of the brackets. In at least one such embodiment, layer 6774 may be made of a compressible material, such as bioabsorbable foam, for example, which may be compressed between the bottom surface 6251 of the holding matrix 6250 and fabric T. In various embodiments, layer 6770 may also comprise at least one or more capsules or cells 6774, which are made to store at least one drug in them. In some embodiments, referring to FIG. 214, the capsules 6774 can be aligned or at least substantially aligned with the holding holes 6252 so that when the brace legs 6221 are pushed through the fabric T and layer 6770, the brace legs 6221 can pierce and / or tear the capsules 6774 in any other way . After capsule 6774 ruptures, at least one drug M contained in capsule 6774 can leak onto tissue T. In at least one such embodiment, drug M can be a liquid that can drain or soak down the legs of 6221 brackets and exert a therapeutic effect on T tissue, which can be incised with brace legs. As a result of the above, the drug contained in capsule 6774 may have a local therapeutic effect on the tissue. In some embodiments, capsules 6774 in sheet 6770 may contain various medications. For example, the first group of capsules 6774 may contain the first drug or the first combination of drugs, the second group of capsules may contain another drug or other combination of drugs. In various embodiments, layer 6770 may be made of a flexible silicone sheet, and capsules 6774 may be voids in the silicone sheet. In at least one such embodiment, the silicone sheet may include two layers that can be attached to each other, with capsules 6774 may be between the two layers. In various embodiments, layer 6770 may include one or more lesser thickness components or parts with weakened strength, partial perforations, for example, which may facilitate dissection of layer 6770 and rupture of capsules 6774 by legs 6221. In some embodiments, at least a portion of capsules 6774 may be located in domes 6777, while domes 6777 may rise above sheet 6770. In at least one such embodiment, domes 6777 and / or at least portions of capsules 6774 may be located in cavities 6201, about azovannyh in retaining matrix 6250. In some embodiments, the capsule 6774 may be individual cells, are not connected with each other. In some other embodiments, implementation, one or more capsules 6774 can be connected to each other with the possibility of transferring fluid using one or more ducts, tubes and / or tubules, for example, passing through layer 6770. Disclosure of US patent No. 7,780,685 under the title " ADHESIVE OR MECHANICAL SEWING ELEMENT ", released on August 24, 2010, is hereby incorporated by reference in its entirety.

In various embodiments, in addition to the foregoing, a bracket block including a bracket bracket body, brackets and / or alignment matrix may be loaded into the first end clamp jaw and, likewise, a holding matrix and / or one or more coatings may be loaded into the second end clamp jaw. In some embodiments, referring now to FIG. 216, a tool, such as a tool for loading a bracket block 6990, can be used to insert two or more bracket blocks into an end clip at one time. In at least one embodiment, the tool for loading the bracket block 6990 may include a handle 6991, a bracket block holder 6992, wherein the bracket block holder 6992 may include a first holding portion designed to hold the bracket block body 6210 in it, and, in addition, a second holding part made to hold the bracket block body 6980, which supports, the first, a plurality of protective caps 6270, and the second holding matrix 6250 along its lower surface, for example. In various embodiments, the first and second retaining parts may include one or more retaining elements configured to engage releasably with the brackets block bodies 6210 and 6980. In use, referring now to FIG. 217 and 218, the end clamp may include a first or lower jaw 6230 and a second or upper jaw 6940, while the bracket block 6200 can be loaded into the first jaw 6230, and the bracket block body 6980 can be loaded into the second jaw 6940. When 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 here for brevity. As soon as the upper jaw 6940 comes into the closed position, now referring to FIG. 218, the distal end 6993 of the bracket block holder 6992 can be inserted into the end clamp so as to allow the bracket block 6200 to slide through the distal end 6938 of the first branch 6930 into the first mounting part, or channel 6939 in the first branch 6230. Similarly, the distal end 6993 of the holder 6992 brace blocks can be inserted into the end clamp so that the bracket block body 6980 slides through the distal end 6948 of the second jaw 6940 and into the second mounting part, trough 6949 in the second jaw 6940. A surgeon or other clinician holding the handle of a 6991 instrument coagulant unit 6990 for loading the brackets, the brackets can push block 6200 and a housing 6980 for block brackets channels 6939 and 6949, respectively, until the staples 6200 and the block body 6980 is not completely block brackets to accommodate them.

As the brackets block 6200 and the brackets block body 6980 are placed, the brackets block 6200 and the brackets block body 6980 may mesh with one or more holding parts of the respective branches 6230 and 6940, as described in more detail below. In any case, as soon as the bracket block 6200 and the housing 6980 bracket block are placed in place, referring now to FIG. 219, a tool 6990 for loading a bracket block can be separated from the bracket block 6200 and the bracket block body 6980 and removed from the end clip. In at least one such embodiment, the holding force holding the bracket block 6200 in the first jaw 6230 may exceed the holding force holding the bracket block 6200 in the bracket block holder 6992 so that when the bracket block holder 6992 extends distally from the end clamp, the block the brackets 6200 could remain in the first jaw 6230. Similarly, the holding force holding the bracket block body 6940 in the second jaw 6940 may exceed the holding force holding the bracket block body 6940 in the bracket block holder 6992 so that to where the bracket block holder 6992 was pulled distally from the end clamp, the bracket block 6980 could remain in the second jaw 6940. After removing the tool for loading the 6990 bracket block from the end clamp, the loaded first jaw 6230 and the loaded second jaw 6940 may occupy a position relative to the fabric T, which is necessary sew. Turning now to FIG. 220, the second jaw 6940 can be moved from the open position (FIG. 219) to the working position (FIG. 220) for the entry of the holding matrix 6250 and the combination of protective caps 6270 located in the housing 6980 of the bracket block into engagement with the brackets 6220 located in the block brackets 6200.

Turning now to FIG. 221 and 222, the second jaw 6940 can be reopened, and the combination of the protective caps 6270 and the holding matrix 6250 can be separated from the body 6980 of the bracket block so that the caps 6270 and the holding matrix 6250 can mesh with the T fabric and the bracket block 6200. in at least one embodiment, the bracket block body 6980 may include a plurality of cavities in which it is possible to place, with the possibility of removal, a plurality of caps 6270, and one or more retaining grooves configured to hold therein, the removal of the holding matrix 6250. In various embodiments, the retaining elements of the second jaw 6940 engaged with the bracket block body 6980 may hold the bracket block body 6980 in the second jaw 6940 after opening the second jaw 6940. In some embodiments, the housing 6980 the brace block can be designed to break as the second jaw 6940 opens so that a portion of the brace block body 6980 is implanted with caps 6270 and a holding matrix 6250 and the brace block body part 6980 remains second jaws 6940. Similarly, referring again to FIG. 221 and 222, the retaining elements in the first jaw 6230 engage with the bracket block body 6210 and hold the brace block housing 6210 in the first jaw 6230 after opening the second jaw 6940. In some embodiments, the bracket block housing 6210 may break open as after the first branch 6230 is diverted from the implanted bracket block 6200 so that a portion of the bracket block body 6210 is implanted with brackets 6220 and alignment matrix 6260, and the portion of the bracket block body 6210 remains in the first branch 6230. In different cases Ianthe embodiment, referring now to FIG. 223-225, a block of brackets, such as a block of brackets 6900, for example, may include one or more longitudinal retaining grooves 6913 extending along the length of the body 6910 of the block of brackets, which, when inserting the block of brackets 6900 in the jaw 6930, for example, be intended to insert into them one or more longitudinal retaining runners 6916 exiting the jaw 6930. When using at least one embodiment, the end of the retaining grooves 6913 may align with the distal ends of the holding runners 6916 before ak brackets block 6900 slides through the distal end 6938 of the retaining channel 6939, for example.

In various embodiments, referring again to FIG. 225, jaw 6940 may include two holding channels 6949, wherein each holding channel 6949 may be configured to insert a bracket block body 6980 into it, including a plurality of caps 6270 and a holding matrix 6250. In some embodiments, each bracket block body 6980 may include one or more longitudinal holding arms 6917, which are designed to slide along one or more longitudinal holding runners 6918 of the second jaw 6940 as the bracket block body 6980 is inserted into the corresponding holding the holding channels 6949 in the jaw 6940. In various embodiments, the holding slides 6918 and the holding arms 6917 can interact to hold the bracket block body 6980 in the second jaw 6940 as the bracket block body 6980 is separated from the caps 6270 and the holding matrix 6250, contained in it. In various embodiments, referring now to FIG. 224, the second jaw 6940 may also include one or more distal columns or retaining elements 6915 coming out of it, which can be performed to fix, with the possibility of removal, the case 6980 block brackets in the respective holding channels. In at least one such embodiment, the second jaw 6940 may include a distal column 6915 configured and positioned relative to each retaining groove 6949 so that each bracket block body 6980 can bend around columns 6915 as the bracket block body 6980 is inserted into the groove 6949, however, as soon as the body 6915 of the bracket unit is completely located in the trough 6949, the distal ends of the bodies 6980 of the bracket unit can be released and fixed on the posts 6915. In order to remove the housing 6980 of the bracket unit after its use As described above, the bracket block body 6980 can be pulled back above the columns 6915 and removed from the retaining groove 6949. As described above, the first jaw 6930 may include one or more retaining columns 6914 emerging from it, which may be inserted into one or more retaining grooves or slots 6912 (FIG. 223) in the bracket block body 6910 when the bracket block 6900 is completely in place.

In various embodiments, in addition to the foregoing, a first block of brackets including a plurality of first stapling elements placed therein may be located in a first branch of a surgical stapling device, and a second block of brackets including a plurality of second stapling elements placed therein may located 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 stapling elements with the second stapling elements and fixing the fabric between them. In some embodiments, the first block of brackets and the second block of brackets may mesh with each other as the crosslinking elements mesh with the second crosslinking elements. In at least one embodiment, the casing of the first block of suture staples may include a first compressible material, and the casing of the second block of suture staples may include a second compressible material, wherein the first casing and / or second casing can be compressed relative to the stitched fabric. After stitching the tissue, the first jaw can be moved away from the first implanted block of brackets, the second jaw can be moved away from the second implanted block of brackets. After that, another first block of brackets, or the like, can be placed in the first jaw, another second block of brackets, or the like, can be placed in the second jaw, and the surgical stapler can be reused. Although brackets are used in some embodiments, other embodiments provide for the inclusion of other types of cross-linking elements, such as two-part cross-linking elements that join together when they mesh with each other, for example. In at least one such embodiment, the first block of brackets may include a first storage part for storing the first parts of the stapling elements, and the second block of brackets can include a second storage part for storing the second parts of the stapling elements. In various embodiments, in the crosslinking systems described herein, it is possible to use crosslinking elements made of a material of any suitable type and / or having any suitable shape. In some embodiments, crosslinking elements may include inwardly penetrating elements. Such inwardly penetrating elements can be made, for example, from polymer, composite and / or multilayer substrates. As an example of a multilayer substrate, a substrate of wire or sheet with an elastomeric or polymer coating can be considered. This can be a thin sheet, formed so that the penetrating elements have a perpendicular, or at least essentially perpendicular, orientation with respect to the connecting element. Penetrating elements may have a rectangular profile, a semicircular profile and / or any beam profile. In various embodiments, the crosslinking elements described herein can also be manufactured using a suitable manufacturing process, such as a wire forming process, for example. Another possibility is the use of microprocessing technologies to create elements that penetrate holes. These inwardly penetrating elements may be manufactured during a manufacturing process other than the wire forming process, and a combination of materials may be used in them.

As described above, the ends of the legs of the brackets penetrating through the retaining matrix can be closed with one or more caps and / or caps. In some embodiments, the ends of the legs of the brackets may be deformed after they penetrate the holding matrix. In at least one embodiment, the jaw holding the holding matrix may also include recesses of the abutment element located above and / or aligned with the holding holes, which are designed to deform the legs of the brackets as they protrude above the holding matrix. In various embodiments, the legs of each suture can be folded inward toward each other and / or toward the center of the suture, for example. In some other embodiments, one or more legs of the suture brace can be folded outward from other legs of the staples and / or from the center of the suture staple. In various embodiments, regardless of the direction in which the legs of the brackets are bent, the ends of the legs of the brackets can come into contact with the holding matrix and cannot re-enter the fabric already stitched with brackets. In at least one embodiment, deformation of the legs of the brackets after they have passed through the holding matrix can lock the holding matrix in place.

In various embodiments, referring now to FIG. 226 and 227, a surgical stapler, such as a surgical stapler 7000, for example, may include a first jaw 7030 and a second jaw 7040, while the second jaw 7040 can move toward and from the first jaw 7030 due to movement of the drive 6235. The operation of the 6235 drive is described above and is not repeated here for brevity. In various embodiments, the first jaw 7030 may include a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 may define a channel extending between the distal end 7031 and the proximal end 7032, which is designed to insert a bracket block. For purposes of illustration, the case of the bracket block of such a bracket block is not shown in FIG. 226, although such a block of brackets may include a bracket block body, brackets 6220 located in the bracket block body, and bracket pushers 7012 located under the brackets 6220. In some embodiments, although not shown in FIG. 226 for purposes of clarity, the second jaw 7040 may be configured to hold the holding matrix, such as the holding matrix 6250, for example, over the brackets 6220 and / or moving the holding matrix into engagement with the legs of the brackets 6220, as described above. In at least one embodiment, the surgical stapler 7000 may also include a slide 7010 located in the first jaw 7030, which can slide from the distal end 7031 of the first jaw 7030 to the proximal end 7032, for example, and raise the pushers 7012 brackets, and brackets 6220 based on them, in the direction of the holding matrix of the second jaw 7040. In various other embodiments, the slide 7010 can move from the proximal end 7032 to the distal end 7031 to bring the brackets 6020 to the working position, for example measures. In at least one embodiment, the slide 7010 may include one or more beveled slats or cams, 7011, which are designed to slide under the bracket pushers 7012 and raise the bracket pushers 7012 up. In various embodiments, the surgical stapler 7000 may also include a pulling or pushing rod connected in position to the slide 7010, which can be moved proximally and / or distally using a drive located on the handle and / or trunk of the surgical stapler 7000, for example .

In various embodiments, referring again to FIG. 226, the second jaw 7040 of the surgical stapler 7000 may include 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 also include a guide system including one or more guides, such as as guides 7045 and 7046, for example, extending along the longitudinal axis of the frame 7041, which, as described in more detail below, can be made to guide one or more thrust plates, or cams, which enter t mesh and deform the legs of the brackets 6220 after the legs 6221 of the brackets 6220 pass through the holding matrix. In at least one such embodiment, the guides 7045 and 7046 may include a guide wire or cable that runs along the top or surface of the frame 7041, around the distal pin 7047, and back along the top or surface of the frame 7041, for example. In various embodiments, as mentioned above and as shown primarily in FIG. 228 and 230, the second jaw 7040 may also include one or more thrust plates or cams, such as a first thrust element 7050 and a second thrust element 7060, for example, which can be moved longitudinally along the second jaw 7040 in order to deform the legs brackets 6220 after they pass through the holding matrix. In at least one embodiment, the surgical stapler 7000 may also include a pusher or drive of the first abutment member 7051 connected and / or connected in operative position to the first abutment member 7050, which may be designed to extend the first abutment member 7050 proximally and / or pushing the first thrust member 7050 distally. Similarly, in at least one embodiment, the surgical stapler 7000 may also include a second pusher or actuator coupled and / or connected in operative position to a second abutment member 7060, which may be designed to extend the second abutment member 7060 proximally and / or eject the second thrust member 7060 distally. In various embodiments, the first abutment member 7050 may include guide grooves 7052, and the second abutment member 7060 may include guide grooves 7062, each of which may be slidably inserted into it, guide 7045 or guide 7046. At least in one such embodiment, the rails 7045 and 7046 can fit snugly into the rails 7052 and 7062 so that relative lateral or lateral movement between them can be prevented, or at least limited .

In some embodiments, in addition to the foregoing, the first abutment member 7050 may extend proximally and the second abutment member 7060 may be distally extruded. In at least one embodiment, referring to FIG. 226, guides 7045 and 7046, and a distal pin 7047 may constitute a pulley system configured to extend the second stop element 7060 distally and / or to extend the second stop element 7060 proximally. In at least one such embodiment, the guide 7045 and the guide 7046 may include a continuous wire or cable extending from the distal pin 7047, while a portion of the continuous wire may be pulled to wrap the wire around the distal pin 7047. In various embodiments, the guide 7046, for example, can be mounted to the second stop element 7060 so that when the continuous cable rotates in the first direction, the second stop element 7060 can be pulled distally in the direction of the distal the end 7048 of the jaw 7040, and when the continuous cable rotates in the second or opposite direction, the second stop member 7060 can extend proximally towards the proximal end 7049. In at least one embodiment, referring again to FIG. 228, the guide 7046 can be fixed in the guide groove 7062 so that a pulling force can be transmitted between them. In at least one such embodiment, the guide 7045 can be slid in other guide grooves 7062. In various embodiments, the first stop element 7050 can operate separately from the second stop element 7060 and the pulley system, and the guide grooves 7052 defined in the first stop element 7050, can be designed for insertion, with the possibility of sliding, guides 7045 and 7046 so that between them provided relative movement. And in various embodiments, the continuous cable, including guides 7045 and 7046, may have significant flexibility to allow opening and closing of the upper jaw 7040. The continuous cable may also have significant flexibility to allow vertical movement of the second thrust member 7060 toward and away from the lower jaw 7030, which is described in more detail below.

In various embodiments, referring again to FIG. 228 and 230, the first stop member 7050 may include cam followers 7055 exiting from it, which may be configured to move along one or more shaped grooves, or guide grooves, such as a shaped groove 7070 (FIG. 231), for example, contoured in the frame 7041 of the second jaw 7040. More specifically, in at least one embodiment, the frame 7041 may include a first shaped groove 7070 extending longitudinally along the first side of the frame 7041 and a second shaped groove 7070 extending longitudinally along the second or opposite side of the frame 7041, at et ohm, cam followers 7055 extending from the first side of the first stop element 7050 may extend in the first curly groove 7070, and cam followers 7055 extending from the second side of the first retaining element 7050 may extend in the second curly groove 7070. At least in one such embodiment, the contours of each curly groove 7070 may be identical or at least substantially identical, and may be aligned, or at least substantially aligned, with respect to each other . Similarly, in various embodiments, the second stop member 7060 may include cam followers 7065 exiting from it, which may be configured to advance along the figured grooves 7070 (FIG. 231), for example, outlined in the frame 7041 of the second jaw 7040. More specifically, in at least one embodiment, cam followers 7065 exiting the first part of the second stop member 7060 may extend in the first curly groove 707, and cam followers 7065 exiting the second part of the second pack element 7060, I can extend in the second curly groove 7070. When used, cam followers 7055 of the first stop element 7050 and cam followers 7065 of the second stop element 7060 can slide along the curly grooves 7070 so that the first stop element 7050 and the second stop element 7060 followed the contours of the figured grooves 7070 as the first abutment element 7050 and the second abutment element 7060 extend proximally and / or distally. In various embodiments, each shaped groove 7070 may include a plurality of retarding or upper parts 7071 and a plurality of moving or lower parts 7072 that may be configured to move the stop elements 7050 and 7060 vertically, i.e. towards and away from the upper jaw 7030, at the same time as the thrust members 7050 and 7060 move in the longitudinal direction, i.e. between the distal end 7048 and the proximal end 7049 of the frame 7041, as described in more detail below.

When the surgical stapler 7000 is inoperative, referring to FIG. 231, the first stop member 7050 may be located at the distal end 7048 of the frame 7041, and the second stop member 7060 may be located at the proximal end 7049 of the frame 7041. Moreover, referring now to FIG. 232, the brackets 6220 located in the first jaw 7030 may not be inserted into the tissue T and / or the retaining matrix located above when the surgical stapler 7000 is in the idle position. In use, referring now to FIG. 233, the brackets 6220 can advance upward in the brace cavities 7033 of the brace block under the action of the brace pushers 7012, and further, the first stop member 7050 can move proximally from the distal end 7048 of the frame 7041 towards the distal end 7049 to engage the brace legs 6221 6220. In at least one embodiment, the brackets 6220 may move upward before the first stop member 7050 engages with the corresponding bracket legs 6221. In various embodiments, all brackets 6220 can be pushed upward by the slide 7010 before the first stop element 7050 is pushed into contact with the legs 6221 of the brackets, or, in another way, the slide 7010 can move proximally at the same time as the movement of the first stop element 7050 proximally, although the slide 7010 can substantially move the first stop element 7050 to push the brackets 6220 in front of the first stop element 7050. In various embodiments, as shown in FIG. 233, the shaped grooves 7070 can be made and arranged so that forming surfaces, such as forming, or cam, surfaces 7053 and 7054, for example, of the first cam 7050, can come into contact with at least some bracket legs 6221 when the first cam 7050 passes through a restraining or upper position. Under various circumstances, each of the cam followers 7055 of the first stop member 7050 can be positioned in the retaining portion 7071 of the figured grooves 7070 so that the forming surfaces 7053 and 7054 are in a raised position and so that the legs 6221 of the brackets only partially bend when the stop member 7050 passes in a holding position. As the first cam 7050 moves forward along the figured grooves 7070, as shown in FIG. 234, the cam followers 7055 of the first stop member 7050 can move to the advance or lower position 7072 of the figured grooves 7070 so that the forming surfaces 7053 and 7054 move vertically towards the bracket legs 6021 to advance the bracket legs 6021 to their finally bent shape. Thereafter, as the first stop element 7050 moves further along the figured grooves 7070, the first stop element 7050 can extend vertically into another set of retaining parts 7071 of the figured grooves 7070. As shown in FIG. 233 and 234, it will be clear to the reader that the first thrust member 7050 can engage only with some legs of the brackets, but not others. In at least one embodiment, the first abutment member 7050 may be configured to bend only a group of brace legs, including distal legs 6221 of brackets 6220, for example. In at least one such embodiment, the first abutment element 7050 may be configured to bend the distal staple legs 6221 of the bracket to the center of the staples 6220. In various embodiments, each proximal staple 6221 of the staple may come into contact twice with the first stub element 7050, i.e. . with a first forming surface 7053 and a second forming surface 7054 aligned with the first forming surface 7053. In at least one such embodiment, the first forming surfaces 7053 can bend the distal legs 6221 of the bracket into a partially deformed shape when the first stop member 7050 is restraining, or upper position, and the second forming surfaces 7054 can bend the distal legs 6221 brackets in a fully bent shape when the first stop element 7050 moves in advance lower or lower position. In various embodiments, referring now to FIG. 228 and 229, the first abutment member 7050 may include a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 for bending the distal legs 6221 of the brackets 6220 when the legs 6221 of the bracket are placed in more than one row or line. In various embodiments, as described in more detail below, the proximal legs 6221 of the brackets 6020 may be bent by a second abutment member 7060, for example.

In various embodiments, in addition to the foregoing, the first stop member 7050 can move from the distal end 7048 of the frame 7041 to the proximal end 7049 to bend all the distal legs 6221 of the brackets 6220. As the reader will understand, the first stop member 7050 can move up and down relative to the undeformed proximal legs of the bracket, and to provide such relative movement, in various embodiments, the first abutment element 7050 may include one or more clearance grooves 7057 (FIG. 230) which may be intended for inserting the non-bent proximal legs of the brackets 6221 when the first stop member 7050 bends the distal legs 6221 of the brackets. Similarly, referring again to FIG. 228, the second stop member 7060 may include a clearance groove 7067 that is designed to vertically move the first cam actuator 7051, which moves up and down as the first stop member 7050 moves between the hold and advance positions, as described above. After all the distal legs 6221 of the brackets have been folded in at least one embodiment, the second abutment element 7060 can be moved from the proximal end 7049 of the frame 7041 to the distal end 7048 using the actuator 7061 of the abutment element. Similar to the above, now referring to FIG. 235, cam followers 7065 of the second abutment element 7060 can slide along the figured grooves 7070 so that the second abutment element 7060 moves between the retention or upper positions and the advance or lower positions for folding the proximal legs 6221 of the bracket inward towards the centers of the brackets 6220 , eg. Similarly to the above, the second abutment element 7060 may include a combination of the first forming, or curved, surfaces 7063 and a combination of second forming, or curved, surfaces 7064, each of which can be performed in order to at least partially bend and / or completely bend one or several proximal legs 6021 brackets. Turning again to FIG. 229, the second abutment member 7060 may include a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064 that can be formed to bend the proximal legs 6221 of the brackets 6220 arranged in several rows or lines, for example. As also shown in FIG. 229, the first forming surfaces 7063 and the second forming surfaces 7064 of the second abutment element 7060 may not align with the first forming surfaces 7053 and the second forming surfaces 7054 of the first abutment element 7050, with the result that the proximal legs 6221 of the brackets 6220 may be arranged in other rows, or lines than the distal legs 6221 of the brackets 6220. As the reader will understand, the second stop element 7060 can push the first stop element 7050 as the second stop element 7060 moves distally. In at least one such embodiment, the second abutment member 7060 may push the first abutment member 7050 back toward the distal end 7048 of the frame 7041 so that the first abutment member 7050 can return to its original or inactive position. After bending all the proximal legs 6221 of the brackets 6220, the second abutment element 7060 can move back proximal and return to its original, or inoperative, position. At this point, the surgical stapler 7000 can be recharged so that a new block of brackets can be placed in the first jaw 7030, a new retention matrix can be placed in the second jaw 7040 to reuse the 7000 surgical stapler.

In various embodiments, as described above, the surgical stapler may comprise two or more abutment elements that can move in the longitudinal direction in order to engage the legs of the plurality of brackets in the transverse direction. In some embodiments, the surgical stapler may include a stop member that moves proximally, for example, to bend the first group of brace legs and distally, for example, to bend the second group of brace legs. In at least one such embodiment, such a thrust member may include forming surfaces facing proximal and forming surfaces facing distally, for example.

In various embodiments, referring now to FIG. 236, a stop member, such as a stop member 7140, for example, may include a lower or tissue contacting surface 7141 and a plurality of forming recesses 7142 formed therein. In at least one embodiment, the abutment member 7140 may include more than one plate, such as a recess plate 7143, for example, which can be welded to a frame 7144. In at least one such embodiment, each recess plate 7143 can be positioned in the channel 7145 of the plate in the frame 7144 and be welded to the frame 7144 through a welding groove 7146 extending through the frame 7144 to form a longitudinal weld 7147. Under various circumstances, the longitudinal weld 7147 may be a weld, a passage indeed created along the entire length of the welding groove or 7146 spaced spot welding seams extending along its length, for example. In various embodiments, each recessed plate 7143 may consist of two or more parts of the plate welded together. In at least one such embodiment, each recessed plate 7143 may include a first plate part 7143a and a second plate part 7143b welded together along the seam 7148. In various embodiments, the first plate part 7143a and the second plate part 7143b of each plate 7143 can be welded together before the plates 7143 are welded into the channels 7145 of the plates in the frame 7144. In at least one such embodiment, the first plate part 7143a and the second plate part 7143b may include interacting profiles, such as a tooth atye profiles shown in FIG. 236, for example, which can fit together to form a tight seam 7148. In at least one embodiment, the height of each plate 7143 may be approximately 0.051 cm (0.02 ”), for example, which may exceed the depth of the channels 7145 for plates so that the corresponding tissue-contacting surfaces 7141 protrude from the frame 7044 of the abutment member 7040. In some embodiments, referring again to FIG. 237, plates 7143 can be joined together by at least one weld 7149 at the distal ends of plates 7143, for example.

As shown in FIG. 236 and 237, each recessed plate 7143 may include a plurality of forming recesses 7142 formed therein. In various embodiments, forming recesses 7142 can be formed in the plates 7143 during any suitable manufacturing process, such as, for example, grinding and / or electric discharge burning. In at least one such embodiment, referring again to FIG. 238 and 239, each forming recess 7142 can be made by first forming a deep hole 7150 and then forming an arched or curved surface 7151 around a deep hole 7150, and then forming a guide groove 7152 of the bracket foot in a curved surface 7151, for example. In various other embodiments, implementation, these stages can be performed in any suitable order. In various embodiments, referring now to FIG. 240, the forming brackets of the recess 7142 can be formed so that the inner edges 7153 of the forming recesses are separated by uniform, or at least substantially uniform, gaps 7154. In at least one embodiment, the gap 7154 can be, for example, about 0.020 cm (0.008 ”). Moreover, in at least one such embodiment, the forming recesses 7142 may be arranged along two or more rows, or lines, the centerlines of which may be divided, by a uniform or at least substantially uniform gap 7155. In at least one such In an embodiment, the gap 7155 between the center lines may be, for example, approximately 0.089 cm (0.035 ”). In various embodiments, referring again to FIG. 240, each forming recess 7142 may taper between a narrow width section 7156 and a wide width section 7157. In at least one such embodiment, the width of the narrower portion 7156 may be approximately 0.11 cm (0.045 ”), and the width of the wider portion 7157 may be approximately 0.19 cm (0.075”), for example. In various embodiments, plates 7143 can be made of the same material as frame 7144. In at least one such embodiment, plates 7143 and frame 7144 can both be made of stainless steel, such as 300 series or 400 series stainless steel. for example, and / or 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 of, for example, ceramic material, and frame 7144 may be made of stainless steel and / or titanium, for example. In various circumstances, depending on the materials used, a soldering process can be applied at least once to secure the plates 7143 in the frame 7144, for example, in addition to or in place of the welding processes described above.

In various embodiments, referring now to FIG. 241-243, the stop member 7240 may include a frame 7244 and a plurality of recessed plates 7243 that can be inserted into a frame 7244. Similar to the above, each recessed plate 7243 may include a plurality of forming recesses 7242 formed therein. In at least one embodiment, the stop member frame 7244 may include retaining grooves 7246 designated therein, each of which may be configured to insert retaining runners 7247 exiting the recessed plate 7243. For mounting plates 7243 with recesses to the frame 7244 thrust element, the side walls 7245 of the frame 7244 thrust element can bend or expand outward, as shown in FIG. 242, to expand the retaining grooves 7246 so that the retaining runner 7247 of the plate 7243 with recesses is inserted into each retaining groove 7246. After the retaining runners 7247 are placed in the retaining grooves 7246, the side walls 7245 can return to their original state, as shown in FIG. 243, thereby allowing the frame 7244 to elastically contract and / or return to a flattened state. Under such circumstances, the retaining grooves 7246 can be compressed and thereby grasp the retaining skids 7247. In some embodiments, the holding grooves 7247 and / or the retaining grooves 7246 may have one or more interacting tapering surfaces that, after releasing the curved holding grooves 7246, can form a clamping cone grip holding the holding skids 7247 in the holding grooves 7246. Similar to the above, the plates 7243 with recesses can be made of th same material as the frame 7244 or other material. In at least one such embodiment, plates 7243 can be made of ceramic material, for example, and frame 7244 can be made of stainless steel and / or titanium, for example. In various circumstances, depending on the materials used, a soldering process and / or a welding process can be used at least once, for example, for fixing plates 7243 in a frame 7244.

The devices disclosed herein may be designed to be disposed of after a single use, or their design may be reusable. In any case, however, the device can be prepared for reuse after at least one application. Preparation for reuse may include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts that are accompanied by assembly of the apparatus. In particular, the device can be disassembled, and any number of specific elements or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the device can be reassembled for subsequent use either in a training workshop for reuse or by the surgical team immediately before the surgical procedure. It will be apparent to those skilled in the art that a variety of disassembly, cleaning / replacing, and reassembly techniques can be used to prepare the device for reuse. The use of such techniques and the resulting reconditioned device are included in the scope of this application.

Preferably, the subject matter described herein is processed prior to surgery. First, you need to get a new or already used device and, if necessary, clean it. Then the device can be sterilized. According to one sterilization method, the apparatus is placed in a closed and sealed container, such as a plastic bag or Tyvek bag (TYVEK). Said tool container is then placed in the field of radiation capable of penetrating into the container, such as gamma radiation, x-rays or a beam of fast electrons. Radiation kills bacteria on the surface of the device and in the container. The apparatus thus sterilized can then be stored in this sterile container. A hermetically sealed container keeps the instrument sterile 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 they do not contradict the definitions, provisions and other information presented in this document. In this regard, the description presented in this document, to the extent necessary, prevails over any information that contradicts 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 in this document is included in this document to the extent that there is no conflict between the material incorporated by reference and this document .

Since examples of embodiments are provided in the description of the present invention, the present invention may be modified within the spirit and scope of the description. This application covers all possible variations, methods of application or modification of the invention, consistent with its basic principles. In addition, this application covers such deviations from the present description that fall under the well-known or generally accepted practice in the field of technology to which the present invention belongs.

Claims (17)

1. A block of brackets, including:
crumpled block housing brackets containing:
top;
bottom opposite the said top;
a first side extending between said top and said bottom; and
the second side extending between the aforementioned top and said bottom, wherein said bracket unit further includes a flexible support, wherein said crumpled housing of the bracket assembly is able to separate from said flexible support, said flexible support comprising:
a lower supporting side extending around said bottom of said wrinkled case of the bracket unit;
a first supporting side extending around said first side of said crumpled casing of the bracket block;
a second supporting side extending around said second side of said crumpled casing of the bracket block; and
an upper surface extending between said first abutment side and said second abutment side, wherein said upper surface may be configured to separate from said first abutment side and a second abutment side; and
a set of brackets embedded in said crushable casing of the block of brackets, and
said flexible support includes holding devices designed to hold said lower supporting side, said first supporting side and said second supporting side in a groove of the staple unit brackets after separating said crumpled bracket unit body from said flexible support. 2. Block brackets, including:
crumpled block housing brackets containing:
top;
bottom opposite the said top;
a first side extending between said top and said bottom; and
the second side extending between the aforementioned top and said bottom, wherein said bracket unit further includes a flexible support, wherein said crumpled housing of the bracket assembly is able to separate from said flexible support, said flexible support comprising:
a lower supporting side extending around said bottom of said wrinkled case of the bracket unit;
a first supporting side extending around said first side of said crumpled casing of the bracket block;
a second supporting side extending around said second side of said crumpled casing of the bracket block; and
an upper surface extending between said first abutment side and said second abutment side, wherein said upper surface may be configured to separate from said first abutment side and a second abutment side; and
a set of brackets embedded in said crushable casing of the block of brackets, and
the bracket unit further includes an adhesive adhering at least one of said first supporting side, said second supporting side and said lower supporting side to said crumpled casing of the bracket unit. 3. The block of brackets according to claim 1 or 2, in which said crumpled casing of the block of brackets is wrapped in a layer made of a waterproof material. 4. The block of brackets according to claim 3, wherein said layer is made of bioabsorbable material, and said crumpled casing of the block of brackets is made of hemostatic material. 5. The block of brackets according to claim 3, in which said crumpled casing of the block of brackets is made of oxidized regenerated cellulose, and said layer is made of PDS film. 6. The block of brackets according to claim 3, wherein said layer includes a surface in contact with the fabric and a supporting surface, said said supporting surface being made to engage with the groove of the bracket block of the stapler. 7. The bracket unit according to claim 1 or 2, in which each said surgical bracket includes a base, a first bracket leg extending from said base, and a second bracket leg extending from said base, wherein said crumpled housing of the bracket block includes a plurality cavities for brackets, wherein said set of brackets is located in said set of cavities for brackets, wherein each cavity for brackets includes a cover and an empty space, while said bracket legs are placed in said ies coatings, and said base braces are placed in said empty spaces. 8. The bracket unit according to claim 2, wherein said flexible support includes holding devices made to hold said lower supporting side, said first supporting side and said second supporting side in the groove of the staple unit brackets after separating said wrinkled body of the bracket unit from said flexible support. 9. The bracket block according to claim 1, further comprising an adhesive adhering at least one of said first supporting side, said second supporting side and said lower supporting side to said crumpled casing of the bracket unit. 10. The bracket block according to claim 1 or 2, wherein said upper surface includes a plurality of struts extending between said first support side and said second support side. 11. The block of brackets according to claim 1 or 2, in which said first supporting side and said second supporting side are made of elastomeric material. 12. The block of brackets according to claim 1 or 2, also including an alignment matrix connecting the above brackets to each other. 13. The block of brackets according to claim 12, wherein said alignment matrix is molded around said bases of said brackets. 14. The bracket block according to claim 12, wherein said alignment matrix includes a plurality of holes for the bracket legs, and said bracket legs are inserted and pass through said bracket leg holes. 15. The brackets block according to claim 12, wherein said crumpled brackets block body includes a first side and a second side, wherein said brackets are located in said crumpled brackets block body so that said bracket legs point to said first side and said bracket bases were adjacent to said second side, wherein said block of brackets also includes a support layer extending along said first side, and wherein said alignment matrix extends along said second side. 16. The block of brackets according to claim 1 or 2, in which said crumpled casing of the block of brackets includes a lower surface, and wherein said bases of said brackets are aligned with said lower surface. 17. The bracket block according to claim 1 or 2, also including a plurality of bracket pushers nested in said crushable bracket block body, wherein each bracket bracket pusher is designed to push said bracket through said crushable bracket bracket housing.

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