RU2593987C2 - Surgical staple cartridges with detachable retaining structures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to surgical instruments, specifically to surgical cutting and stapling elements and, in particular, to staple cartridges for incision and stapling. Surgical staple cartridge comprises a compressible implantable cartridge body made of compressible haemostatic material and holding a plurality of non-moulded staples, and a cartridge holding element. Cartridge holding is connected to compressible cartridge body. Cartridge holding element is configured to be attached to part of terminal clamp of surgical stapling apparatus so that once non-moulded staples in body of cartridge are formed, cartridge body and clamps are removed from terminal clamp without disconnection from it cartridge holding element. End clamp for use with surgical apparatus comprises an elongated chute connected with part of surgical apparatus, and staple cartridge. Cartridge comprises said compressible implanted body and a cartridge holding element attached to longer chute. End clamp additionally comprises support element, which is movably retained relative to chute and has surface to form staples. Support element is configured to move from open position when surface to form staples is spaced from staple cartridge, in closed position, when support element moves in compressing contact with staple cartridge in response to start of motion applied to it surgical apparatus for forming non-moulded staples in cartridge body. In second version of end clamp, attached to surgical apparatus and having thereon a movable locking unit for transmitting among contiguous forces on end clamp comprises elongated chute, support element and locking latch. Elongated chute is connected with part of surgical apparatus for holding with possibility of disconnecting surgical staple cartridge. Support element is retained with respect to elongated chute and moves from open position to closed position relative to elongated chute at application among contiguous forces moving unit. Locking device is retained during operation in an oblong chute and moves away from unlocked position, when staple cartridge is retained in an oblong chute, in locked position, in which staple cartridge is not retained in an oblong chute. Locking device is configured to interact with locking unit to prevent application, at least a certain region from among contiguous forces to support element when locking latch is in locked position.

EFFECT: inventions provide optimum working force to create suture by means of staples and cutting tissue.

19 cl, 243 dwg

Description

BACKGROUND OF THE INVENTION

TECHNICAL AREA

The present invention relates to surgical instruments, and, in various embodiments, to cutting and stapling instruments and cartridges with brackets that have been designed to dissect and stitch tissues.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferable to traditional open surgery devices, as a smaller incision reduces recovery time and complications after surgery. As a result, this has led to significant advances in the creation of endoscopic surgical instruments that are suitable for the precise placement of the distal end clamp in the desired surgical field through the cannula of the trocar. These distal end clamps are able to contact tissues in various ways, which allows them to be used for diagnostic and therapeutic purposes (for example, as a scalpel for endoscopic surgery, a clamp, a scalpel, a stapler, a clip-on applicator, an access device, a drug / gene therapy delivery device ultrasound, radio frequency or laser device, etc.).

In many areas of endoscopic surgery, it is desirable to use end clamps that are only as large as necessary to complete a specific surgical procedure. Smaller end clamps provide better visualization of the surgical field. Smaller end clamps also allow for better access and handling in tight spaces. The developers of these end clamps face many difficulties in trying to develop smaller end clamps. The ability to make small end clamps and, more specifically, small scalpels for endoscopic surgery, which are designed to dissect and stitch tissues, is limited by the amount of force that is usually needed to create a stitch using staples and dissection of the tissue. This force may also vary depending on the thickness and composition of the fabric being treated. For example, more force is usually required to dissect and staple thick tissue. Thus, the magnitude of the force required to dissect and stitch thinner tissues is usually less. Therefore, many existing scalpels for endoscopic surgery typically use strong locking systems with a stop element with a stop element and drive suture devices that are configured to fit within a certain range of tissue thicknesses. However, such devices are often poorly suited for processing thinner fabrics.

Devices with scalpels for endoscopic surgery usually first dissect the tissue, after which they are held together with staples and formed on both sides of the incision. Since such devices are very effective for those manipulations that require dissection and stapling of tissues, they are not suitable for surgeons who have the ability to install clamps without dissecting the tissue. Moreover, since various types of articulated scalpels for endoscopic surgery have been developed to improve surgical access, the components commonly used in such devices may differ significantly from positioning devices, which can create and transmit significant activating and closing forces to the end clamp from the device handle . Thus, these end clamps are often too large to provide effective access in a limited space in the body.

Therefore, there is a need for surgical instruments for cutting and stapling and positioning devices for a removable cartridge with brackets that can solve many of the above problems.

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 accordance with general aspects of at least one kind of invention, a surgical cartridge with brackets is provided that has a compressible cartridge body holding a plurality of unformed brackets. The cartridge holding member is connected to a compressible cartridge housing. The cartridge holding member is configured to be removably attached to the end clamp portion of the surgical stapler so that after the unformed brackets are molded into the cartridge housing, the cartridge housing and brackets are removed from the end clamp without detaching the cartridge holding member.

In accordance with other general aspects of at least one type of invention, an end clamp is provided that is used with a surgical device. In various embodiments, the end clamp comprises an elongated groove that can connect to a portion of the surgical apparatus. The end clip further comprises a cartridge with brackets, various views of which contain a compressible cartridge housing holding a plurality of unformed suture braces. The retaining element of the cartridge is connected to a compressible housing of the cartridge and is detachably attached to an elongated groove. The end clamp further comprises a thrust element that is movably held relative to the elongated groove. The stop element comprises a surface for forming the brackets and is configured to move from the open position when the surface for forming the brackets is at a distance from the cartridge with brackets, to the closed position when the stop element compresses the cartridge with brackets in response to the starting movements attached to it by the surgical device for forming unformed brackets in the cartridge body.

In accordance with other general aspects of at least one type of invention, an end clamp is provided that is attached to a surgical device and comprises a movable locking assembly for transmitting closing forces to the end clamp. In various embodiments, the end clamp comprises an elongated groove that is connected to a portion of the surgical apparatus for holding, with the possibility of detaching the surgical cartridge with brackets. The thrust element is movably held relative to the elongated trough and moves from an open position to a closed position relative to the elongated trough when applying locking forces with a movable locking assembly. During operation, the locking interlock is held in the oblong groove and moves from the unlocked position when the cartridge with brackets is held in the oblong groove to a locked position in which the cartridge with brackets is not held in the oblong groove. The locking locking device is configured to interact with the locking assembly to prevent the application of at least some locking forces to the stop member when the locking locking device is in the locked position.

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.

FIG. 1 is a cross-sectional view of an embodiment of a surgical instrument of the present invention;

FIG. 1A is a perspective view of one embodiment of an implantable cartridge with brackets of the present invention;

FIG. 1B-1E depict end clamp portions in various embodiments of the present invention for fastening and stitching tissues using an implantable cartridge with brackets of an embodiment of the present invention;

FIG. 2 is an exploded perspective view of an embodiment of an end clamp and part of a surgical stapler from an embodiment of the present invention, which is shown in cross section;

FIG. 3 is a side view of a thrust member of an embodiment of the present invention;

FIG. 4 is a cross-sectional view of a part of the handle assembly shown in FIG. one;

FIG. 5 is a partial cross-sectional view of the handle assembly with FIG. 1, made along the cut line 5-5 in FIG. one;

FIG. 6 is a perspective view of a part for transmitting an activating force from an embodiment of the present invention;

FIG. 7 is a partial cross-sectional view of the handle assembly with FIG. 1, made along the cut line 7-7 in FIG. one;

FIG. 8 is a partial cross-sectional view of a portion of the handle assembly with FIG. 7, made along the cut line 8-8 in FIG. 7;

FIG. 9 is a cross-sectional view of an embodiment of a surgical apparatus of the present invention after the end clamp has been connected to and closed in the shaft portion of the surgical apparatus;

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

FIG. 10 is a cross-sectional view of a surgical apparatus of FIG. 9 after the end clamp was closed in the pivotal portion of the surgical apparatus;

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

FIG. 11 is a cross-sectional view of a surgical apparatus of FIG. 9 and 10 after the first starting adapter has been extended to the beginning of the inclined clamping parts of the thrust member;

FIG. 11A is an enlarged view of the end clamp and part of the surgical apparatus of FIG. 11 with a fabric located respectively between the stop element and the cartridge with brackets;

FIG. 12 is a cross-sectional view of a surgical apparatus of FIG. 9-11 after the first trigger adapter has been extended over the inclined clamping portions of the thrust member;

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

FIG. 13 is a cross-sectional view of a surgical apparatus of FIG. 9-12 after the first trigger adapter has been fully extended over the inclined bracket guide to move the brackets inside the implantable bracket cartridge;

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

FIG. 14 is a cross-sectional view of a surgical apparatus of FIG. 9-13 after the first trigger adapter has been fully extended over the inclined bracket guide to move the brackets inside the implantable cartridge with brackets, and after the cutting blade has been positioned longitudinally in the end clip;

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

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

FIG. 16 is a partial cross-sectional view of an embodiment of an end clamp with FIG. 15 in the open position and after joining the embodiment of the surgical apparatus;

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

FIG. 18 is another partial cross-sectional view of an embodiment of an end clamp of FIG. 15-17 in a fully activated position and before the advancement of the distal element for dissecting tissue;

FIG. 19 is another partial cross-sectional view of an embodiment of an end clamp of FIG. 15-18 in the fully activated position and after completion of the promotion of the distal element for dissecting tissue;

FIG. 20 is a partial cross-sectional view of another embodiment of a handle assembly of the present invention;

FIG. 21 is a partial cross-sectional view of a portion of the handle assembly with FIG. 20, made along the cut line 21-21 in FIG. twenty;

FIG. 22 is a partial cross-sectional view of a portion of the handle assembly with FIG. 20, made along the cut line 22-22 in FIG. twenty;

FIG. 23 is a partial cross-sectional view of a portion of the handle assembly with FIG. 20, made along the section line 23-23 in FIG. twenty;

FIG. 24 is a cross-sectional view of part of 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 that is attached to a portion of an embodiment of a surgical apparatus of the present invention with an end clamp that holds an embodiment of a cartridge with surgical brackets of the present invention and the stop member of which is in the open position;

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

FIG. 27 is another partial side cross-sectional view of the end clamp of FIG. 25 and 26, on which the cutting blade begins to extend in the end clamp;

FIG. 28 is another partial side cross-sectional view of the end clamp of FIG. 25-27, on which the cutting blade is partially extended in the end clamp;

FIG. 29 is a partial cross-sectional side view of an embodiment of an end clamp of the present invention that is attached to a portion of an embodiment of a surgical apparatus of the present invention with an end clamp that holds another embodiment of a cartridge with surgical brackets of the present invention and whose stop member is in an open position;

FIG. 30 is another partial cross-sectional side view of the end clamp of FIG. 29, on which the cutting blade is partially extended in the end clamp;

FIG. 31 is a cross-sectional view of another embodiment of a surgical apparatus of the present invention in which the stop member of the end clamp is in the open position;

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

FIG. 33 is a plan view of an end clamp and a portion of an elongated shaft assembly of the surgical apparatus of FIG. 31 with parts thereof, which are shown in cross section drawn along line 33-33 of FIG. 31;

FIG. 34 is a plan view of an end clamp and a portion of an elongated shaft assembly of the surgical apparatus of FIG. 31 with parts thereof, which are shown in cross section;

FIG. 35 is another top view of the end clamp and part of the elongated shaft assembly of the surgical apparatus of FIG. 31, wherein the end clamp is in an articulated position, and where the end clamp is in an open position;

FIG. 36 is another top view of the end clamp of FIG. 35, wherein the end clamp is in a closed or closed position;

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

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

FIG. 39 is another cross-sectional view of a portion of the handle assembly with FIG. 38, made along the cut line 39-39 in FIG. 38;

FIG. 40 is a partial exploded perspective view of the articulation and location of a recess in various embodiments of the present invention;

FIG. 41 is a plan view of an end clip and a portion of an elongated shaft assembly of another embodiment of a surgical apparatus of the present invention in an unjoined position;

FIG. 42 is another top view of the end clamp and part of the elongated shaft assembly of the surgical apparatus of FIG. 41 in the articulated position;

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

FIG. 44 is a partial cross-sectional view of a portion of the articulated shaft assembly of an embodiment of the surgical apparatus of FIG. 43;

FIG. 44A is a cross-sectional view of a portion of a joint shaft assembly of FIG. 44;

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

FIG. 44C is another cross-sectional view of another part of the joint shaft assembly of FIG. 44;

FIG. 44D is another cross-sectional view of another part of the joint shaft assembly of FIG. 44;

FIG. 44E is another cross-sectional view of another part of the joint shaft assembly of FIG. 44;

FIG. 44F is another cross-sectional view of another part of the joint shaft assembly of FIG. 44;

FIG. 45 is a partial cross-sectional view of the joint shaft assembly of FIG. 44, made along the cut line 45-45 in FIG. 44;

FIG. 46 is a partial cross-sectional view of an articulated shaft assembly with FIG. 44, made along the cut line 46-46 in FIG. 44;

FIG. 47 is another cross-sectional view of the surgical apparatus of FIG. 43 with its end clip depicted in a fully articulated position;

FIG. 48 is a cross-sectional view of an end clip of FIG. 47 protective accordion, which extends to the articulation;

FIG. 49 is a cross-sectional view of a handle in an assembly of another embodiment of a surgical apparatus of the present invention;

FIG. 50 is an overall cross-sectional and exploded view of an end clip and a distal end of an elongated shaft assembly with FIG. 49;

FIG. 51 is another cross-sectional view of an end clip and a portion of an elongated shaft assembly of FIG. 50, on which the end clamp is in the open position;

FIG. 52 is another cross-sectional view of an end clamp and a portion of an elongated shaft assembly on which the end clamp is in a closed position;

FIG. 53 is another cross-sectional view of an end clip and a portion of an elongated shaft of FIG. 49-52, wherein the tissue dissection member is in a fully activated position;

FIG. 54 is a perspective view of an end clamp with FIG. 51-53 in the open position;

FIG. 55 is a cross-sectional view of an end clip of FIG. 51-54, performed along the cut line 55-55 in FIG. 51;

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

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

FIG. 58 is a cross-sectional view of a portion of an elongated shaft assembly with FIG. 56 and 57, made along the cut line 58-58 in FIG. 57;

FIG. 59 is an enlarged view of a portion of the handle assembly with FIG. 57;

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

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

FIG. 62 is a cross-sectional view of a portion of a removable gross segment of an elongated shaft of FIG. 61;

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

FIG. 64 is a cross-sectional view of an assembled handle of another embodiment of a surgical apparatus of the present invention;

FIG. 65 is a cross-sectional view of a portion of an elongated shaft assembly with FIG. 63 and 64, made along the cut line 65-65 in FIG. 64;

FIG. 66 is an enlarged view of a portion of the handle assembly with FIG. 64;

FIG. 67 is a cross-sectional view of a portion of a removable gross segment shown in FIG. 63, with tubular connecting parts arranged in a substantially straight line;

FIG. 68 is a cross-sectional view of a portion of a removable gross segment shown in FIG. 63 and 67, with connecting tubular parts essentially spaced along an arc (misaligned);

FIG. 69 is a perspective view of an alternative embodiment of a cartridge with brackets of the present invention installed in an embodiment of a surgical apparatus for cutting and stapling the present invention;

FIG. 70 is a plan view of a surgical cartridge with brackets and an elongated groove of the apparatus shown in FIG. 69;

FIG. 71 is a top view of another embodiment of a surgical cartridge with brackets of the present invention mounted in an oblong groove of an end clamp of an embodiment of the present invention;

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

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

FIG. 74 is another partial perspective view of an embodiment of a set of brackets with FIG. 73, in which the brackets are shown after they have been formed in contact with the thrust element of the surgical apparatus for cutting and stitching;

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

FIG. 76 is a partial perspective view of an alternative embodiment of brackets forming part of another set of brackets of an embodiment of the present invention;

FIG. 77 is a partial perspective view of an alternative embodiment of brackets forming part of another set of brackets of an embodiment of the present invention;

FIG. 78 is a cross-sectional view of end clips of an embodiment of the present invention holding a cartridge with brackets of an embodiment of the present invention;

FIG. 79 is a cross-sectional view of a portion of an oblong groove of the end clamp of FIG. 78 after the part of the body of the implantable cartridge with brackets and brackets was removed from it;

FIG. 80 is a cross-sectional view of end clips of an embodiment of the present invention holding another cartridge with brackets of an embodiment of the present invention;

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

FIG. 82 is another partial cross-sectional view of the surgical stapler of FIG. 81, on which the cartridge with brackets has been removed from the end clamp and the cartridge locking system is in the locked position;

FIG. 83A-83D is a deformation diagram of a surgical brace located inside a deformable cartridge body with brackets in accordance with at least one embodiment;

FIG. 84A is a diagram showing a bracket located in a crease body of a cartridge with brackets;

FIG. 84B is a diagram showing a collapsible cartridge body with brackets of FIG. 84A, which was pressed by a thrust member;

FIG. 84C is a diagram showing a collapsible cartridge body with brackets of FIG. 84A, which was further crushed by a thrust member;

FIG. 84D is a diagram showing a bracket with FIG. 84A in a fully formed configuration and a crease cartridge with brackets from FIG. 84A fully compressed;

FIG. 85 is a diagram depicting a bracket located opposite the bearing surface of the cartridge with brackets, and its possible movements in this gap;

FIG. 86 is a cross-sectional view of a bearing surface of a cartridge with brackets on which there is a groove or slot that has been configured to stabilize the base of the bracket with FIG. 85;

FIG. 87 is a cross-sectional view of a bracket having a cap formed and a slot or recess that has been configured to hold a portion of the cap in accordance with at least one alternative embodiment;

FIG. 88 is a plan view of a bracketed cartridge in accordance with at least one embodiment that includes brackets immersed in a deformable cartridge housing with brackets;

FIG. 89 is a side view of a bracketed cartridge of FIG. 88;

FIG. 90 is a side view of a bracketed cartridge in accordance with at least one embodiment in which there is a protective layer surrounding brackets located inside the deformable cartridge body;

FIG. 91 is a cross-sectional view of a bracketed cartridge of FIG. 90, made along the cut line 91-91 in FIG. 90;

FIG. 92 is a side view of a bracketed cartridge in accordance with at least one embodiment, wherein the brackets at least partially extend beyond the boundaries of the deformable cartridge housing with brackets, and a protective layer surrounds the cartridge housing with brackets;

FIG. 93 is a cross-sectional view of a bracketed cartridge of FIG. 92, performed along the cut line 93-93 in FIG. 92;

FIG. 94 is a partial exploded view of a cartridge with brackets in accordance with at least one embodiment in which the brackets are at least partially located in the deformable body of the cartridge with brackets, with the brackets at least partially located in an empty cavity for the brackets in the body of the cartridge with brackets;

FIG. 95 is a cross-sectional view of a bracketed cartridge of FIG. 94, made along the cut line 95-95 in FIG. 94;

FIG. 96 is a partial exploded view of a bracketed cartridge in accordance with at least one embodiment;

FIG. 97 is an exploded partial view of a cartridge with brackets in accordance with at least one embodiment in which the brackets are at least partially in the deformable body of the cartridge with brackets and are in contact with an alignment substrate that aligns the brackets with respect to each other ;

FIG. 98 is a cross-sectional view of a bracketed cartridge of FIG. 97, made along the cut line 98-98 in FIG. 97;

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

FIG. 100 is a diagram showing an inner layer of FIG. 99 sandwiched between the transfer plate and the carrier plate;

FIG. 101 is a diagram showing brackets inserted in a compressible inner layer with FIG. one hundred;

FIG. 102 is a schematic diagram of a carrier plate of FIG. 100, which has been removed from the inner layer;

FIG. 103 is a nodal assembly diagram consisting of an inner layer of FIG. 99 and parentheses with FIG. 101 inserted into the outer layer;

FIG. 104 is a diagram showing an outer layer of FIG. 103, which has been sealed to form a sealed cartridge with brackets;

FIG. 105 is a cross-sectional view of a sealed cartridge with brackets of FIG. 104;

FIG. 106 is a cross-sectional view of a cartridge with brackets and a groove for a cartridge with brackets in accordance with at least one embodiment;

FIG. 107 is a diagram showing a portion of a cartridge with brackets of FIG. 106 in a deformed state;

FIG. 108 is a side view of an end clamp of a surgical stapler having a stop member that is in the open position and a cartridge with brackets located inside the groove for the cartridge with brackets;

FIG. 109 is a side view of the end clamp of FIG. 108, which shows the stop element in the closed position and the cartridge with brackets sandwiched between the stop element and the groove for the cartridge with brackets;

FIG. 110 is a side view of the end clamp of FIG. 108, which shows a cartridge with brackets from FIG. 108, otherwise located inside the cartridge groove with brackets;

FIG. 111 is a cross-sectional view of an end clamp of a surgical stapler having a compressible cartridge with brackets located inside a groove for the cartridge with brackets, and a fragment of the supporting material attached to the abutment member;

FIG. 112 is a cross-sectional view of an end clip of FIG. 111, in which the thrust element is depicted 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 cartridge that has 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 multi-level stop member and a bracket cartridge that has a multi-level cartridge body;

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

FIG. 117 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that has inclined surfaces for contact with tissue;

FIG. 118 is a cross-sectional view of another alternative embodiment of an end clamp of a surgical stapler that has inclined surfaces for contact with tissues;

FIG. 119 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that has a support insert for supporting a cartridge with brackets;

FIG. 120 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that includes a bracket cartridge consisting of a plurality of compressible layers;

FIG. 121 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that includes a bracket cartridge that has a multi-level compressible cartridge body;

FIG. 122 is a cross-sectional view of another alternative embodiment of an end clamp of a surgical stapler that includes a bracket cartridge that has a multi-level compressible cartridge body;

FIG. 123 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that includes a cartridge with brackets that has curved surfaces for contact with tissues;

FIG. 124 is a cross-sectional view of an alternative embodiment of an end clamp of a surgical stapler that includes a cartridge with brackets that has sloping surfaces for contact with tissues;

FIG. 125 is a cross-sectional view of a compressible brace cartridge containing brackets, and in which at least one medicament is stored;

FIG. 126 is a diagram showing a compressible cartridge with brackets of FIG. 125 after it has been compressed and the brackets inside it have been deformed;

FIG. 127 is a partial cross-sectional view of a bracketed cartridge in accordance with at least one embodiment;

FIG. 128 is a cross-sectional view of a bracketed cartridge of FIG. 127;

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

FIG. 130 is a cross-sectional view of an implantable cartridge with brackets of FIG. 129;

FIG. 131 is a perspective view of an alternative embodiment of a cartridge with brackets containing deformable elements protruding beyond the outer layer of the cartridge with brackets;

FIG. 132 is a perspective view of an alternative embodiment of a cartridge with brackets having an outer layer that is connected to the inner layer of the cartridge with brackets;

FIG. 133 is a cross-sectional view of an alternative embodiment of a bracket cartridge containing a plurality of brackets, a compressible layer, and a compression layer;

FIG. 134 is a perspective view of a compression layer with FIG. 133;

FIG. 135 is a perspective view of a clip that has been separated from the compression layer of FIG. 133, and brackets that have been aligned with the groove in the clip;

FIG. 136 is a perspective view of two connected clips from the compression layer with FIG. 133;

FIG. 137 is a perspective view of a compression support frame of a compression layer with FIG. 133, which was separated from the individual clamps;

FIG. 138 is an exploded perspective view of an alternative embodiment of a compressible cartridge with brackets containing brackets and a system for moving brackets to a stop member;

FIG. 138A is a partial sectional view of an alternative embodiment of a cartridge with brackets from FIG. 138;

FIG. 139 is a partial sectional view of a cartridge with brackets from FIG. 138;

FIG. 140 is a side view of a slide configured to move the cartridge with brackets of FIG. 138 and advancing the brackets to the stop member;

FIG. 141 is a diagram of a drive for brackets that can be lifted to the thrust member using the slide of FIG. 140;

FIG. 142 is an exploded view of a bracketed cartridge in accordance with at least one alternative embodiment in which the brackets are inside the bracket guides;

FIG. 143 is a cross-sectional view of a bracketed cartridge of FIG. 142, which is located inside the groove for the cartridge with brackets;

FIG. 144 is a cross-sectional view of a bracketed cartridge of FIG. 142, which shows how the stop member moves to the closed position and the brackets inside the cartridge with brackets are deformed by the stop member;

FIG. 145 is a cross-sectional view of a bracketed cartridge of FIG. 142, which depicts how the brackets move up to the stop element;

FIG. 146 is a perspective view of an alternative embodiment of a cartridge with brackets in which there are jumpers between the flexible sides of the cartridge with brackets;

FIG. 147 is a perspective view of a slide and an element for dissecting tissue assembly;

FIG. 148 is a diagram of a slide and an element for dissecting tissue assembly with FIG. 147, which is used to raise the brackets from the cartridge with brackets from FIG. 142;

FIG. 149 is a diagram depicting a slide that is configured to grip and raise brackets to a thrust member, and an interlock system configured to selectively limit the movement of the slide distally;

FIG. 150A-150C depict the advancement of a bracket inserted into a bracket cap;

FIG. 151 is a cross-sectional view of a parenthesis cartridge having a support tray or holder;

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

FIG. 153 is a diagram showing a cartridge with brackets of FIG. 152 in the built-in state;

FIG. 154 is a partial cross-sectional view of a compressible cartridge with brackets in accordance with at least one alternative embodiment;

FIG. 155 is a partial sectional view of a cartridge with brackets from FIG. 154;

FIG. 156 is a diagram showing a cartridge with brackets of FIG. 154 in the built-in state;

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

FIG. 158 is a partial sectional view of a deformable cartridge with brackets in accordance with at least one embodiment that includes a plurality of collapsible elements;

FIG. 159 is a perspective view of a collapsible member with FIG. 158 in undeformed state;

FIG. 160 is a perspective view of a collapsible element with FIG. 159 in a deformed state;

FIG. 161A is a partial cross-sectional view of an end clamp of a surgical stapler having jaws, a cartridge groove with brackets that is opposite the jaw, and a cartridge with brackets located in the cartridge groove with brackets, a holding substrate being attached to the branches;

FIG. 161B is a partial cross-sectional view of an end clamp of FIG. 161A, which shows a jaw moved to the cartridge groove with brackets, a cartridge with brackets, compressible by a stop member and a holding substrate, and a bracket that at least partially passes through a fabric located between the holding substrate and the cartridge with brackets;

FIG. 161C is a partial sectional view of the end clamp of FIG. 161A, which depicts a jaw in its final position and a holding substrate adhered to a bracket with FIG. 161B;

FIG. 161D is a partial sectional view of an end clamp of FIG. 161A, which depicts a cartridge jaw and groove with brackets that have been moved away from the implantable cartridge with brackets and a holding substrate;

FIG. 162 is a perspective view of a retaining hole of a retaining substrate in accordance with at least one embodiment that comprises a plurality of retaining elements configured to fix a leg mount therein;

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

FIG. 164 is a perspective view of a holding hole of a holding substrate in accordance with at least one alternative embodiment that includes eight holding elements;

FIG. 165 is a perspective view of a retaining hole of a retaining substrate in accordance with at least one alternative embodiment, which comprises a plurality of retaining elements configured to fix a leg mount therein;

FIG. 166 is a perspective view of a holding hole of a holding substrate in accordance with at least one alternative embodiment that comprises six holding elements;

FIG. 167 is a perspective view of a holding hole of a holding substrate in accordance with at least one alternative embodiment that comprises eight holding elements;

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

FIG. 169 is a perspective view of a holding hole of a holding substrate in accordance with at least one alternative embodiment that comprises a plurality of holes that extend beyond the perimeter of the holding hole;

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

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

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

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

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

FIG. 175 is a plan view of a holding hole of a holding substrate having a holding tab that projects into the holding hole in accordance with at least one alternative embodiment;

FIG. 176 is a plan view of a holding hole of a holding substrate having a holding tab that projects 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 a substrate adhered to the brackets, and a leveling substrate configured to align the brackets;

FIG. 178 is a perspective view of a retaining substrate with FIG. 177;

FIG. 179 is a perspective view of a leveling substrate with FIG. 177;

FIG. 180 is a partial top view of a retaining substrate with FIG. 177, which is coupled with brackets with FIG. 177;

FIG. 181 is a partial bottom view of a retaining substrate with FIG. 177, which is coupled with brackets with FIG. 177;

FIG. 182 is a partial side view of the crosslinking system of FIG. 177;

FIG. 183 is a partial perspective view of a crosslinking system of FIG. 177;

FIG. 184 is a partial cross-sectional view of a retaining substrate of FIG. 177, which is coupled with brackets with FIG. 177;

FIG. 185 is a partial cross-sectional view of the crosslinking system of FIG. 177;

FIG. 186 is a perspective view of a crosslinking system with FIG. 177, which further comprises plugs worn on the legs of the brackets;

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

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

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

FIG. 190 is a side view of an end clip in accordance with at least one embodiment comprising a jaw in an open position holding a substrate, a plurality of plugs located in a jaw, and a cartridge with brackets located in a groove for the cartridge with brackets;

FIG. 191 is a side view of an end clip of FIG. 190 in the closed position;

FIG. 192 is a side view of the end clip of FIG. 190 in the activated position;

FIG. 193 is a side view of a retaining substrate and plugs of FIG. 190 attached to the cartridge with brackets of FIG. 190;

FIG. 194 is a detailed view of the construction of FIG. 193;

FIG. 195 is a side view of the end clamp of FIG. 190, which shows the jaw in the open position with a thin cloth located between the holding substrate and the cartridge with brackets;

FIG. 196 is a side view of the end clamp of FIG. 190 which depicts the branch in the closed position opposite the thin fabric of FIG. 195;

FIG. 197 is a side view of the end clamp of FIG. 190 which depicts the jaw in the activated position to capture fine tissue with FIG. 195 located between the holding substrate and the cartridge with brackets;

FIG. 198 is a side view of a retaining substrate and plugs of FIG. 190 connected to the cartridge with brackets of FIG. 190, with a thin fabric with FIG. 195, which is located between them;

FIG. 199 is a detailed view of the construction of FIG. 198;

FIG. 200 is a cross-sectional view of a plug 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 plugs installed in a material sheet;

FIG. 202 is a perspective view of a branch having a plurality of recesses configured to hold a plurality of plugs therein;

FIG. 203 is a detailed view of a portion of a branch having a sheet covering plugs located in the branch of FIG. 202;

FIG. 204 is a cross-sectional view of a plug located at the end of a bracket leg in accordance with at least one alternative embodiment in which the plug has an inner forming surface;

FIG. 205 is another cross-sectional view of the plug of FIG. 204, which depicts a bracket leg that has been deformed by a forming surface;

FIG. 206 is a plan view of an alternative embodiment of a retaining substrate having a plurality of connected substrate elements;

FIG. 207 is a plan view of an alternative embodiment of a retaining substrate having a plurality of connected substrate elements;

FIG. 208 is a plan view of an alternative embodiment of a retaining substrate having a plurality of connected substrate elements;

FIG. 209 is a plan view of an alternative embodiment of an arrangement of retaining substrates having a plurality of connected substrate elements;

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

FIG. 211 is a partial exploded view of a jaw that has a compressible coated holding substrate;

FIG. 212 is a detailed view of a retaining substrate with FIG. 211;

FIG. 213 is a partial cross-sectional view of a crosslinking system including a compressible coated holding substrate and a plurality of cells in which one or more medicaments are sealed;

FIG. 214 is a diagram depicting the brace legs that puncture the cells of FIG. 213 because they were embedded in a retaining substrate;

FIG. 215 is a partial cross-sectional view of a crosslinking system including a retaining substrate with a compressible layer;

FIG. 216 is a side view of an assembly for mounting a staple cartridge including a holder, a first staple cartridge and a second staple cartridge;

FIG. 217 is a side view of an end clamp of a surgical stapler including a first branch and a second branch, the second branch being shown in an open position;

FIG. 218 is a side view of the end clamp of FIG. 217 depicting the second jaw in the closed position and the assembly for installing the staple cartridge of FIG. 216, which is used to install the first cartridge in the first jaw and the second cartridge in the second jaw;

FIG. 219 is a side view of the charged end clip of FIG. 218 depicting an assembly for installing a cartridge removed from the end clamp, the second jaw again in the open position and the tissue between the first and second jaws;

FIG. 220 is a side view of the charged end clip of FIG. 219 in the activated position;

FIG. 221 is a side view of a first cartridge and a second cartridge in an integrated state;

FIG. 222 is a side view of the end clamp of FIG. 217, which depicts a portion of the first cartridge located in the first clamp in accordance with at least one embodiment;

FIG. 223 is a side view of an alternative embodiment of an assembly for mounting a staple cartridge including a holder, a first staple cartridge and a second staple cartridge;

FIG. 224 is a side view of an assembly for mounting a staple cartridge of FIG. 223, which is used to install the first cartridge in the first jaw and the second cartridge in 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 having a lower jaw and an upper jaw in accordance with at least one embodiment, some parts of the image of a surgical stapler being removed;

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

FIG. 228 is a perspective view of a slide system with a thrust member of the upper jaw of a surgical stapler of FIG. 226, which comprises a first skid stop element and a second skid stop element;

FIG. 229 is an end view of a slide system with a thrust member from FIG. 228;

FIG. 230 is a plan view of a slide system with a thrust member of FIG. 228;

FIG. 231 is a diagram showing a slide system with a thrust member of FIG. 228 in an inactive state;

FIG. 232 is a diagram depicting a first skid stop element of a skid system with a stop element of FIG. 228 in an inactive state and brackets located in the lower jaw in an unexpanded position;

FIG. 233 is a diagram showing brackets located in the lower jaw in an unexpanded position, and a first sled stop member with FIG. 232, which was advanced proximally to deform the legs of the first group of brackets;

FIG. 234 is a diagram showing a first group of brackets with FIG. 233 that were deformed to a fully deformed state;

FIG. 235 is a diagram depicting a second skid stop element of a skid system with a stop element of FIG. 228, which was extended distally to deform the legs of the second group of brackets;

FIG. 236 is a partial perspective view of a thrust member which, in at least one embodiment, has a plurality of molding recesses;

FIG. 237 is a side cross-sectional view of a thrust member with FIG. 236;

FIG. 238 is a diagram depicting a first step in manufacturing molding cavities with FIG. 236;

FIG. 239 is a diagram depicting a second step of manufacturing molding cavities with FIG. 236;

FIG. 240 is a plan view of the location of the molding recess on the thrust member of FIG. 236;

FIG. 241 is a diagram depicting a first step in a manufacturing technology of a thrust member;

FIG. 242 is a diagram depicting a second stage of the manufacturing technology of FIG. 241; and

FIG. 243 is a diagram depicting a third step of the manufacturing technology of FIG. 241.

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

DETAILED DESCRIPTION OF THE INVENTION

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

US Patent Application Ser. No. ____ under the name "Surgical stapler with an adjustable system of molding brackets", the case number in the book of records of the patent attorney END6848USNP / 100533;

US Patent Application Ser. No. ____ under the name “Surgical stapler with interchangeable cartridge configurations with brackets” file number in the patent attorney's record book END6849USNP / 100534;

US Patent Application Ser. No. ____ under the name “Surgical apparatus for cutting and stitching tissue with independent and separate actuation of systems for stitching and dissection of tissue”, case number in the book of records of the patent attorney END6839USNP / 100524;

US Patent Application Ser. No. ____ under the name “Surgical stapler with a compact closure control device”, case number in the book of records of patent attorney END6847USNP / 100532;

US Patent Application Ser. No. ____ under the name “Devices for closing the jaws of surgical instruments”, case number in the book of records of the patent attorney END6736USNP / 100060;

US Patent Application Ser. No. ____ under the name “Surgical Instruments with Remountable Gross Segments”, case number in the book of records of the patent attorney END6734USNP / 100058;

US Patent Application Ser. No. ____, entitled “Surgical cartridges with brackets holding non-linearly arranged brackets, and surgical staplers with similar recesses for molding brackets”, case number in the patent attorney's record book END6735USNP / 100059;

US Patent Application Ser. No. ____ under the name "Implantable staple cartridge having a non-standard arrangement", case number in the book of records of the patent attorney END6840USNP / 100525;

US Patent Application Ser. No. ____ under the name "Implantable staple cartridge containing a support holder", case number in the book of records of the patent attorney END6841USNP / 100526;

US Patent Application Ser. No. ____ under the name "Multilayer Implantable Staple Cartridge", case number in the book of records of the patent attorney END6842USNP / 100527;

US Patent Application Ser. No. ____, entitled “Selectively Oriented Implantable Staple Cartridge”, case number in the Patent Attorney Record Book END6843USNP / 100528;

US Patent Application Ser. No. ____ under the name "Implantable staple cartridge containing biologically absorbable layers", case number in the book of records of patent attorney END6856USNP / 100541;

US Patent Application Ser. No. ____ under the name “Compressible staple cartridge”, case number in the book of records of the patent attorney END6857USNP / 100542;

US Patent Application Ser. No. ____ under the name "Fasteners held by the bearing surface of the staple cartridge", case number in the book of records of the patent attorney END6858USNP / 100543;

US Patent Application Ser. No. ____ under the name “Compressible staple cartridge”, case number in the book of records of the patent attorney END6859USNP / 100544;

US Patent Application Ser. No. ____, entitled “A crosslinking system containing a plurality of connected elements of a retaining substrate”, case number in the book of patent attorney records END6860USNP / 100546;

US Patent Application Ser. No. ____, entitled “A crosslinking system containing a retaining substrate and a leveling substrate”, case number in the patent attorney's record book END6861USNP / 100547;

US Patent Application Ser. No. ____ under the name “Crosslinking system containing a retaining substrate”, case number in the book of records of patent attorney END6862USNP / 100548;

US Patent Application Ser. No. ____ under the name “Stapler for activating the stapling system containing the retaining substrate”, case number in the book of records of the patent attorney END6863USNP / 100549;

US Patent Application Ser. No. ____ under the name “Crosslinking system containing a retaining substrate and coating”, case number in the book of records of patent attorney END6864USNP / 100550; and

US Patent Application Ser. No. ____, entitled “Staple System Containing Multiple Staple Cartridges”, case number in the Patent Attorney Record Book 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 illustrations are non-limiting examples of embodiments, and the scope of various embodiments of the present invention is defined only 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 description of the invention to “various embodiments,” “some embodiments,” “one embodiment”, “embodiment”, and the like. mean that a particular feature, design, or characteristic has been described in accordance with an embodiment or has been included in at least one embodiment. Thus, the presence of the expressions “in various embodiments”, “in some embodiments,” “in one embodiment,” “in an embodiment,” and the like. in the description of the invention does not mean that they all necessarily refer to the same embodiment. Moreover, individual features, designs, or characteristics may be combined in any appropriate manner in one or more embodiments. Thus, individual features, structures, or characteristics that have been depicted or described in accordance with one embodiment, can be fully or partially unlimitedly combined with the features, structures, or characteristics of one or more other embodiments. It is intended that the scope of the present invention covers all modifications and changes.

The terms "proximal" and "distal" in this document are defined with respect to the physician managing the handle of the surgical instrument. The term "proximal" refers to the part lying closer to the doctor, and the term "distal" refers to the part removed from the doctor. It is also proposed for convenience and clarity in relation to the drawings to use in this document such spatial terms as “vertical”, “horizontal”, “up” and “down”. However, the use of surgical instruments involves many orientations and provisions, therefore, these terms are not absolute and (or) do not limit the present invention.

Various exemplary devices and methods are intended for laparoscopic and minimally invasive surgical interventions. However, it will be easy for a person skilled in the art to understand that the various methods and devices described herein can be used in a variety of surgical procedures and applications, which include, for example, their use in open surgical procedures. In accordance with the detailed description of the invention considered, it will be further understood by a person skilled in the art that the various apparatuses described herein can be placed in the body in some way, for example, through a natural opening, through an incision or puncture in tissues, etc. e., and the working parts or parts of the end clamp of the devices can be directly placed in the patient’s body or can be penetrated there using an access device that has a working trough through which the con Eve clip and the elongate shaft of the surgical instrument.

In accordance with the drawings, in which the same numbers indicate the same components in several projections, FIG. 1 depicts a surgical apparatus 10 that may provide in practice some of the unique advantages of the present invention. The surgical stapler 10 is designed to control and / or activate end clamps 12, which are of various types and sizes, and are also attached to this apparatus during operation. For example, in the embodiment shown in FIG. 1 and 2, the end clamp 12 has an oblong groove 14, which forms the lower jaw 13 of the end clamp 12. The oblong groove 14 is configured to hold the “implantable” cartridge with brackets 30, and is also a movable support for the stop element 20, which serves as the upper jaw 15 end clamp 12.

In various embodiments, the elongated groove may be made, for example, of stainless steel 300 & 400, 17-4 & 17-7, titanium, etc., and may consist of side walls 16 that are placed with a gap. The stop element 20 can be made, for example, of grades of stainless steel 300 & 400, 17-4 & 17-7, titanium, etc., and have a bottom surface for forming brackets, which is usually indicated by the number 22 and contains many recesses 23 for molding brackets. See FIG. 1B-1E. In addition, the thrust element 20 has a forked inclined platform assembly 24, which extends proximally beyond its limits. The pin of the thrust member 26 protrudes from each side surface of the inclined platform assembly 24 for connection with a corresponding slot or hole 18 on the side walls 16 of the elongated groove 14 to form its movable or pivot mount.

Different types of implantable cartridges with brackets can be used in various embodiments of surgical devices, which are described in this document. Certain configurations and designs of cartridges with brackets are discussed in detail below. Thus, in the embodiment shown in FIG. 1A and 9-14, an implantable cartridge with brackets 30 is shown. In at least one embodiment, the cartridge with brackets 30 has a housing 31 that consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or a bio-absorbable foam in which a set of undeformed metal brackets 32 is held. In at least some embodiments, to prevent the brackets from acting and activating the hemostatic material during and For positioning purposes, the entire cartridge should be coated or wrapped with a biodegradable film 38, such as a polydioxanone film sold under the PDS® trademark, a polyglyceryl sebacinate (PGS) film, or other biodegradable films formed by PGA (polyglycolic acid sold under the Vicryl trademark), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanate), PGCL (polyglecapron 25 sold under the brand name Monocryl) or a mixture of PGK, PKL, PLA and PDS, which must be impervious to break wa. The cartridge housing 31 with brackets 30 is dimensioned so that it can be movably held inside the elongated groove 14 shown in the figure so that each bracket 32 is aligned with a corresponding recess for forming the brackets 23 on the stop member when the stop member 20 is actuated to contact molding using a cartridge with brackets 30.

During operation, as soon as the end clip 12 was located next to the target fabric, the end clip 12 grabs or clamps the target fabric between the upper surface 36 of the cartridge with brackets 30 and the surface for forming the brackets 22 of the stop member 20. The brackets 32 are formed when the stop member 20 is moved in a direction that is substantially parallel to the elongated groove 14 for moving the surface to form the brackets 22 and, more specifically, the recesses for forming the brackets 23 to form substantially simultaneous contact with the upper surface 36 of the cartridge with brackets 30. Since the stop element 20 continues to move towards the cartridge with brackets 30, the legs 34 of the brackets 32 are in contact with the corresponding recess for forming the brackets 23 of the stop element on the stop element 20, which serves to bend the legs of the bracket 34 to give the brackets 32 V-shaped. Further movement of the thrust member 20 along the elongated groove 14 will further compress and form the brackets 32 until the final desired molding height “FH” is obtained.

The above process of forming brackets is generally depicted 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 an implantable cartridge with brackets 30. FIG. 1C depicts the initial position for clamping the abutment member 20 in which the abutment member 20 has been closed to the target fabric “T” to grip the target fabric “T” between the abutment member 20 and the upper surface 36 of the cartridge with brackets 30. FIG. 1D depicts the initial molding of the brackets in which the thrust member 20 begins to squeeze the cartridge with the brackets 30 so that the legs 34 of the brackets 32 begin to be molded in the recesses to form the brackets 23 of the thrust member 20. FIG. 1E depicts the bracket 32 in its final molded state in the target fabric “T”, where, for clarity, the abutment member 20 has been removed. Immediately after molding and stitching the target tissue “T” with brackets 32, the surgeon must move the stop member 20 to the open position so that the cartridge case 31 and the brackets 32 remain attached to the target tissue when the end clip 12 is removed from the patient. The end clamp 12 simultaneously forms all the brackets if two branches 13, 15 were squeezed together. The materials remaining from the “squeezed” case 31 act as a hemostatic agent (ORC) and reinforcement of the brace seam (films made of PHC, PDS, or any other aforementioned mixtures 38). In addition, since the brackets 32 never leave the cartridge case 31 during molding, the likelihood of under-molding of the brackets 32 is minimized. As used herein, the term “implantable” means that, in addition to the brackets, the material of the cartridge body in which the brackets are held also remains in the patient body and is ultimately absorbed there. Such implantable cartridges with brackets differ from previous cartridge arrangements in which the cartridge remains in the end clip and retracts with it. Such “removable” staple cartridges typically have staple drive units and therefore can be much larger than the end clips of the present invention, which were designed for use with some embodiments of the unique and fundamentally new implantable staple cartridges of the present invention.

In various embodiments, the end clamp 12 is configured to connect to an elongated shaft assembly 40 that protrudes from the handle in the assembly 100. The end clamp 12 (in the closed position) and the elongated shaft assembly 40 may have a similar cross-sectional shape and dimensions so that they can, in working order, pass through the tube of the trocar or the working chute in another form of access apparatus. As used herein, “passing during operation” means that the end clamp and at least a portion of the elongated shaft assembly can be inserted or passed through the opening of the chute or tube, and also controlled in them to complete stitching during surgery . In some closed embodiments, the jaws 13 and 15 of the end clamp 12 can be used with an end clamp that is approximately circular in cross-section and facilitates their passage through the circular duct / hole. However, the end clamps of various embodiments of the present invention, as well as embodiments of an elongated shaft assembly, can presumably have other cross-sectional shapes that may otherwise pass through access channels and openings that are non-circular in cross-sectional shape. Thus, the total cross-sectional dimension of the closed end clamp is related to the size of the channel or hole through which it must pass. Thus, for example, one end clamp can be called an end clamp with a diameter of "5 mm", which means that during operation it can pass through an opening whose diameter is at least about 5 mm.

In various embodiments of the present invention, the elongated shaft assembly 40 may have an outer diameter that substantially coincides with the outer diameter of the end clamp 12 in the closed position. For example, an end clamp with a diameter of 5 mm can be connected to an elongated shaft assembly 40, which has a cross-sectional diameter of 5 mm. However, based on this detailed description of the invention, it will become apparent that various embodiments of the present invention can be effectively used with end clamps of various sizes. For example, an end clamp with a diameter of 10 mm can be attached to an elongated shaft assembly, which has a cross-sectional diameter of 5 mm. Conversely, in devices in which the access hole or channel has a diameter of 10 mm or more, the elongated shaft assembly 40 may have a cross-sectional diameter of 10 mm (or more), but it can also be used to actuate an end clamp with diameters 5 mm or 10 mm. Accordingly, the outer shaft 40 may have an outer diameter matching or different from the outer diameter of the closed end clamp 12 attached thereto.

As shown, the elongated shaft assembly 40 protrudes distally from the handle assembly 100, forming a substantially straight line that forms the longitudinal axis A-A. In various embodiments, the elongated shaft assembly 40 in length may, for example, be about 229-406 mm (9-16 inches). However, the elongated shaft assembly 40 may have a different length, in other embodiments it may be articulated, or in other cases configured to facilitate the articulation of the end clamp 12 relative to other parts of the shaft or handle assembly, which is further discussed in detail. below. In various embodiments, the elongated shaft in the assembly 40 includes a shaft 50 that protrudes from the handle in the assembly 100 toward the end clamp 12. The proximal end of the elongated groove 14 of the end clamp 12 has paired holding trunnions 17 that protrude from it and have a size that allows them to mate with the corresponding holes or sockets 52 located on the distal end of the shaft 50 to provide a movable articulation of the end clamp 12 with the elongated shaft assembly 40. The shaft 50 may be Otovlen, for example, from alloys of aluminum 6061 or 7075, stainless steel, titanium, etc.

In various embodiments, the handle in the assembly 100 has a pistol-type housing that can be made of two or more parts for assembly. For example, in accordance with the image, the handle in the assembly 100 has a right ferrule member 102 and a left ferrule element 104 (FIGS. 5, 7 and 8), which were injection molded or otherwise made of a polymer or plastic material, and were designed to connect together. Such ferrules 102 and 104 may be connected to each other using latch parts, pins or indentations, molded into them under pressure or otherwise formed, and / or using glue, screws, etc. The rod 50 has a proximal end 54, which has a flange 56 formed therein. The flange 56 is designed so that it can rotate inside a groove 106 formed by articulated ribs 108 that protrude inside each of the elements of the cage 102, 104. This arrangement facilitates attachment the rod 50 to the handle in the assembly 100, during which the rod 50 rotates relative to the handle in the assembly 100 around the longitudinal axis AA through 360 °.

As can be seen further in FIG. 1 and 4, the rod 50 is inserted and held in a holding sleeve 60, which is rotatably attached to the handle in the assembly 100. The holding sleeve 60 has a proximal flange 62 and a distal flange 64, which form a groove for rotation 65, which is configured to rotate the front handle parts 101 in assembly 100 between these flanges. This arrangement allows the retaining sleeve 60 to rotate along the longitudinal axis AA relative to the handle in the assembly 100. The shaft 50 is fixedly bolted to the holding sleeve 60 by a protruding pin 66. In addition, a rotary sleeve 70 is attached to the holding sleeve 60. In one embodiment, for example, the rotary clutch 70 has a recessed portion of the mounting flange 72, which is of such a size that allows it to connect to a part of the holding sleeve 60. In various embodiments, the implementation of the rotary clutch 70 The article is made, for example, of glass-filled or carbon-filled nylon, polycarbonate, Ultem®, etc., and is also attached to the holding sleeve 60 with a protruding pin 66. In addition, an inwardly protruding holding flange is formed on the part of the mounting flange 72. 74, and it is configured to connect to a radial groove 68, which is formed in the holding sleeve 60. Thus, the surgeon can rotate the shaft 50 (and the end clip 12 attached thereto) along the longitudinal axis AA by 360 ° while gripping the rotary sleeve 70 and its pov Rothe relative to the handle assembly 100.

In various embodiments, the thrust member 20 is held open by the spring of the thrust member 21 or other biasing device shown in FIG. 1, 9A, 10A and 11A. The stop element 20 is selectively movable when moving from an open position to various closed, pinched or starting positions using a cutting-stitching system, usually denoted by 109. The cutting-stapling system 109 includes a “starting unit” 110, which in various embodiments comprises a hollow tubular starting guide 110. The hollow tubular starting guide 110 makes axial movement along the shaft 50, thereby forming the outer part of the elongated shaft assembly 40. The tubular starting guide 110 may be made of polymer or other suitable material and have a proximal end 112, which is attached to the trigger clip 114 of the cutting-crosslinking system 109. See FIG. 4. In various embodiments, for example, a trigger clip 114 may be formed at the proximal end 112 of the tubular trigger guide 110. In addition, other fasteners may be used.

As can be seen in FIG. 1 and 4, the trigger clip 114 can be rotatably held in a holding collar 120, which is configured to axially move inside the handle in the assembly 100. In various embodiments, the holding collar 120 has paired ribs 122 that extend laterally and have a size that allows them slide in grooves for ridges 103 and 105, which are formed in the right and left elements of the cage 102, 104, respectively. See FIG. 7. Thus, the holding sleeve 120 can axially move inside the handle housing 100, at the same time as the trigger clamp 114 and the tubular trigger guide 110 rotate relative to each other and further along the longitudinal axis A-A. As seen in FIG. 4, a longitudinal slot 111 in the tubular trigger guide 110 allows the protruding pin 66 to move along the rod 50, which facilitates the axial movement of the tubular trigger guide 110 along the rod 50.

The cutting-crosslinking system 109 further comprises a trigger device 130, which serves to control the axial movement of the tubular trigger guide 110 along the shaft 50. See FIG. 1. Such an axial movement in the distal direction of the tubular trigger rail 110 for trigger interaction with the thrust member 20 is referred to herein as a “trigger motion”. As seen in FIG. 1, the trigger device 130 is movably or pivotally connected to the handle in the assembly 100 using a pivot pin 132. A torsion spring 135 is used to bias the trigger device 130 relative to a portion of the pistol grip 107 of the handle assembly 100 to an inactive “open” or trigger position. As seen in FIG. 1 and 4, the trigger device 130 has an upper portion 134 that is movably connected to the (pinned) trigger hinges 136, which are movably connected to the (pinned) holding sleeve 120. Thus, the movement of the trigger device 130 from its initial position (FIGS. 1 and 9 ) to the end position located next to the part of the pistol grip 107 of the handle in the assembly 100 (FIG. 14), actuates the trigger clamp 114 and the tubular trigger guide 110 in the distal direction "DD". The movement of the trigger device 130 from the part of the pistol grip 107 of the handle in the assembly 100 (with the torsion spring 135 displaced) will cause the trigger clip 114 and the tubular trigger guide 110 to move in the proximal direction “PD” along the shaft 50.

Various embodiments of the present invention can be used with implantable cartridges with brackets of various sizes and configurations. For example, the surgical apparatus 10 used with the first trigger adapter 140 can be used with an end clamp 12 with a diameter of 5 mm and a length of about 20 mm (or another length) that holds the implantable cartridge with brackets 30. This size of the end clamp can especially well suited, for example, to perform a relatively thin incision and vascular interventions. However, as will be discussed in more detail below, the surgical device 10 can also be used, for example, with end clamps and cartridges with brackets of other sizes when replacing the first trigger adapter 140 with the second trigger adapter 150. In other embodiments, the elongated shaft the assembly 40 is configured so that it only connects to the end clamp of one size. In such embodiments, for example, pressure surfaces 146 or 158 (typically located on trigger transitions 140, 150, respectively) may be entirely formed at the distal end of the tubular trigger rail 110, depending on the particular size of the end clamp 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 expand to the open distal end 116 of the tubular trigger rail 110. The first retaining plug 144 is formed on the first spring portion 142 and is sized to fit into the holding hole 117 located on the distal end portion of the tubular launch guide 110. See FIG. 1 and 2. Thus, to disconnect the first trigger adapter 140 from the tubular trigger rail 110, the user simply needs to remove the retaining plug 144 from the holding hole 117 and disconnect the first trigger adapter 140 from the tubular trigger rail 110. As can also be seen in FIG. 2, the first trigger adapter 140 has an internal pressure surface 146 that is configured to interface with a forked ramp assembly 24 of the stop member 20.

In various embodiments, the forked ramp assembly 24 of the thrust member 20 has paired teeth 45 that are separated from each other by a groove for a blade (not shown). Each tooth 45 has a proximal surface 27 that is substantially parallel to the bottom surface of the elongated groove 14 when the stop member 20 is in the closed position. Then, the proximal surface 27 is moved to the inclined clamping portion 28, which is located distally relative to the proximal surface 27. See FIG. 3. The inclined clamping portion 28 is oriented at a clamping angle “A” relative to the proximal surface 27. In various embodiments, for example, the clamping angle “A” can be approximately 15 to 30 degrees. As will be discussed in more detail below, when the first pressing surface 146 of the first starting adapter 140 contacts the inclined clamping part 28, the stop member 20 will be moved to the elongated groove 14 and, more specifically, to the cartridge inside it with brackets 30. Since the first starting adapter the device 140 will then be moved distally, the first pressing surface 146 is in contact with the inclined guide for the brackets 29 on each tooth 45 of the stop element 20 for its further movement into the cartridge with brackets 3 0 to form brackets 32 therein. As also shown in FIG. 3, the inclined guide for the brackets 29 is located at the molding angle “B” relative to the inclined clamping part 27. In various embodiments, for example, the molding angle “B” can be approximately 5 to 20 degrees. The inclined platform assembly 24 of the stop element 20 may further have such an inclined bottom surface 25 (located, for example, at an angle “C”, which is approximately 5 to 40 degrees) such that when the stop element 20 is in the open position, the inclined bottom surface 25 allows you to rotate the thrust element 20 to 15˚ of the opening threshold (angle "β" in FIG. 11A).

One way of moving the docking of the end clamp 12 to the rod 50 will now be explained. The joining process begins by inserting the retaining trunnions 17 on the elongated groove 14 into the trunnion sockets 52 on the rod 50. After that, the surgeon moves the trigger device 130 to the pistol grip 107 of the housing assembly 100 for distal movement of the tubular starting guide 110 and the first starting adapter 140 over the proximal end portion 47 of the elongated groove 14 for holding the pins 17 in the respective slots 52. See FIG. 10 and 10A. Such positions of the first trigger adapter 140 above the pins 17 are referred to herein as a “connected position”. In various embodiments of the present invention, there may also be an end clamp lock mechanism assembly 160 for locking the trigger 130 in a position that holds the end clamp 12 after attaching to the rod 50.

More specifically and in accordance with FIG. 5, 7 and 8, one embodiment of the end clamp locking mechanism assembly 160 includes a holding pin 162 that is movably held in the upper portion 134 of the trigger 130. The spring-loaded holding pin 162 is biased to the left clip member 104 by the holding spring 166. When the trigger 130 is in a fixed (starting) position, the holding pin 162 is displaced to be connected end-to-end with the stopper of the initial position 163, which protrudes inside the left element of the cage 104. See FIG. 7 and 8. As discussed above, the tubular trigger guide 110 must first be moved distally to the connected position, in which the first trigger adapter 140 holds the retaining pins 17 of the end clamp 12 in the pin sockets 52 of the rod 50. The surgeon moves the distal trigger adapter 140 to the connected position, pulling the trigger 130 from its initial position to the pistol grip 107. When the trigger 130 was initially actuated, the holding pin 162 slides for connection eniya abutting with the stopper 163 to the initial position until the tubular launcher rail 110 will move first trigger adapter 140 to the connected position, wherein the retaining pin 162 is displaced in the locking recess 164 formed in the left yoke member 104. See. FIG. 8. In various embodiments, when the holding pin 162 enters the locking recess 164, the pin 162 can either produce an audible “click” or other sound, or generate tactile signals for the surgeon that the end clip 12 has been “locked” on the shaft 50 In addition, the surgeon cannot accidentally actuate the trigger device 130 to start forming the brackets 32 in the end clamp 12 without purposefully displacing the holding pin 162 from the locking recess 164. Similarly, if the surgeon releases the trigger device 130 when it is in the connected position, it is held in this position by a retaining pin 162 for preventing the return of trigger 130 to its original position and, consequently, disconnecting the clamping end 12 of the rod 50.

In various embodiments, the release button of the trigger device 167 is installed inside the left member of the handle clip 104 in the assembly 100 so that the surgeon deliberately releases the holding pin 162, which is used to trigger the trigger 130 later or return to its original position . See FIG. 5, 7 and 8. The release button of the starter 167 is movably mounted inside the locking recess 164 and is shifted to the inactive position by the spring (FIG. 8). When pressed, the release button of the trigger 167 contacts the holding pin 162 and moves it from the locking recess 163 to further activate the trigger 130.

As described previously, the surgical device 10 can be used as a gripping device for surgical interventions and tissue movement. Further movement of the trigger device 130 to the pistol grip part 107 after the trigger device 130 has been unlocked (by pressing the release button of the trigger device 167) may cause the trigger adapter 140 to approach the inclined clamping portion 28 of the stop member 20. When the portion of the pressure surface 146 is first the trigger adapter will hit the inclined clamping part 28, the stop element will move to the cartridge with brackets 30 in the elongated groove 14. Thus, the surgeon can control the movement of pore element 20 to the cartridge with brackets 30 or from it to capture and release the clamped tissue without forming brackets.

Various embodiments of the present invention may further include a lock button for the cutting-stapling system 137, which is pivotally connected to the handle in the assembly 100. See FIG. 1 and 4. In one form, the lock button of the cutting-stitching system 137 has a stopper 138 formed at the distal end and is oriented to engage with the trigger clip 114 when the trigger button of the trigger device is in the first locked position. As seen in FIG. 1 and 4, the locking spring 139 serves to shift the lock button of the cutting-stitching system 137 to the first locked position (FIGS. 11 and 12). As will be further explained in more detail below, the stopper 138 serves to hold the trigger clip 114 at a point where the position of the trigger clip 114 on the shaft 50 corresponds to the point at which the pressure surface 146 of the first trigger adapter 140 begins to advance the distally inclined clip portion 28 on the stop element 20. It should be borne in mind that when the first starting adapter 140 performs axial movement of the inclined clamping part 28, the stop element 20 will move so that the part is surface ti for forming staples 22 will be substantially parallel to the upper surface 36 of the staple cartridge 30.

After connecting the end clamp 12 to the rod 50, the process of forming the brackets begins first when the lock button of the cutting-stitching system 137 is pressed for the first time to further distally advance the start clamp 114 along the rod 50 and, ultimately, to press the stop element 20 against the cartridge with brackets 30. See FIG. 13. After pressing the lock button of the cutting-stapling system 137, the surgeon continues to actuate the trigger device 130 with the pistol grip 107, thereby advancing the pressure surface 146 of the first bracket clip 140 to the corresponding inclined bracket guide 29 to move the stop member 20 into the forming contact with the brackets 32 in the cartridge with the brackets 30. The lock button of the cutting-stapling system 137 prevents accidentally forming the brackets 32 before the surgeon is ready to start this process. In this embodiment, the surgeon may press the lock button of the cutting-stapling system 137 before the trigger device 130 can be further actuated to start the brace molding process.

If desired, the surgical device 10 can be used exclusively as a device for stitching tissue. However, various embodiments of the present invention may also include a tissue dissection system, which is usually denoted by 170. In at least one aspect, the tissue dissection system 170 includes a tissue dissection member 172 that can selectively move from an inactive position near the proximal end of the end clamp 12 (FIGS. 1 and 9-13) to the activated position (FIG. 14) using a trigger for extending the scalpel 200. The tissue dissection element 172 is movably held in the rod 50, and also attached or protrudes from the cutting shaft 180. The element for dissecting the fabric 172 can be made, for example, of stainless steel 420 or 440 with a hardness of more than 38HRC (on the Rockwell C-scale) and have a cutting edge for dissection tissue 176, which was formed at the distal end 174, and can also be configured to slide in the slot 31 in the abutment member 20 and in the central slot 33 of the cartridge with brackets 30 for dissecting the tissue that was caught in the end clip 12. See FIG. 14A. As seen in FIG. 4, the cutting shaft 180 protrudes from the rod 50 and has a proximal end portion 182. The proximal end portion 182, with the possibility of transmitting a driving force, interacts with the scalpel drive 190, which is connected to the trigger for extending the scalpel 200 during operation. In various embodiments, the trigger to extend the scalpel 200 is attached to the pivot pin 132 so that it can be rotated or otherwise actuated without actuating the trigger device 130. In various embodiments, the first gear of the scalpel 192 is also attached to the pivot pin 132 so that actuation of the trigger for extending the scalpel 200 also rotates the first gear of the scalpel 192. A return spring 202 is attached between the first gear of the scalpel 192 and the handle body 100 to bias the trigger to extend the scalpel 200 to its original, or inactive, position. See FIG. 1 and 4.

Returning to FIG. 5 and 6, various embodiments of the drive of the scalpel 190 also include a second gear of the scalpel 194, which is pivotally supported on the second spindle of the gear 193 and engaged with the first gear of the scalpel 192. The second gear of the scalpel 194 is meshed with the third gear the scalpel 196, which is held on the third gear spindle 195. On the third gear spindle 195, the fourth gear gear of the scalpel 198 is also held. Fourth gear giving the scalpel 198 is adapted to engage with the possibility of transmitting drive force with a system of teeth or gear rings with internal gearing 184 at the proximal end of the cutting shaft 180. Thus, this arrangement allows the fourth gear transmission of the scalpel 198 to perform axial movement of the cutting shaft 180 in the distal direction DD "or in the proximal direction" PD ", at the same time as the rotation of the cutting shaft 180 about the longitudinal axis AA relative to the fourth gear of the scalpel 198. Naturally, the surgeon can axially move the cutting shaft 180 and, ultimately, the tissue dissection element 172 distally while moving the trigger to extend the scalpel 200 to the pistol grip 107 of the handle in assembly 100.

Various embodiments of the present invention further include a scalpel 210 locking system that prevents the tissue cutting member 72 from being pulled out if the trigger 130 has not been moved to the fully activated position (FIGS. 13 and 14). This feature prevents the activation of the scalpel extension system 170 until the brackets are first released or molded into tissue. As seen in FIG. 1, various embodiments of a scalpel blocking system 210 include a scalpel blocking plate 211 that is rotatably held in a portion of the pistol grip 107 of the handle assembly 100. The scalpel blocking plate 211 has an activating end 212 that is adapted to engage the trigger 130 when the trigger device 130 is in a fully activated position. In addition, the scalpel blocking plate 211 has a holding hook 214 at the other end that is adapted to engage the locking rod 216 on the first gear of the scalpel 192. The scalpel 218 retaining spring is used to slide the scalpel blocking plate 211 into a “locked” position in which the holding the hook 214 is held in engagement with the locking rod 216, thereby preventing the trigger from actuating to extend the scalpel 200 until the trigger 130 is in Using the fully activated position. See FIG. 9.

Various control methods will now be explained for at least one embodiment of the surgical apparatus of the present invention in accordance with FIG. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A. As can be understood in accordance with FIG. 1, 9 and 9A, when the scalpel shaft 172 is in the depicted start or inactive position, the cutting edge for dissecting tissue 176 is located proximal to the distal end of the first trigger adapter 140 so that the sharp cutting edge for dissecting tissue 176 is not facing to the user. In alternative embodiments in which the elongated shaft assembly is made to be used with one type or size of end clamp (for example, which do not use trigger adapters 140, 150), the cutting edge 176 of the scalpel shaft 172 should be proximal to the distal end of the tubular a trigger guide to prevent the user from exposing the cutting edge for fabric 176 in these embodiments.

FIG. 9 and 9A depict end clamp 12 after it has been attached to rod 50 by inserting the retaining pins 17 of end clamp 12 into journal sockets 52 on rod 50. As shown in FIG. 9, the starting device 130 is in an inactive or starting position, and the end clamp 12 is not yet locked in the rod 50 by the first starting adapter 140. “P ₀ ” indicates the distance that the starting device 130 can travel before the first the adapter 140 extends to the inclined clamping portion 28 of the abutment member 20. The trigger for extending the scalpel 200 is also in an inactive locked position.

FIG. 10 and 10A depict the position of the trigger device 130 after it has been extended to a position in which the end clip 12 is locked in the shaft 50 by the first trigger adapter 40. This position is referred to herein as a “connected” position. In the connected position, when the holding pin 162 enters the locking recess 164 (FIG. 8), sound and tactile signals are given to the surgeon that the end clip 12 has been “locked” on the shaft 50. The trigger 130 cannot be further actuated until until the surgeon purposefully presses the release button of the trigger 167 (FIGS. 5, 7 and 8) to bias the holding pin 62 from the locking recess 164. The distance by which the distal end 141 of the first trigger adapter moves oystva 140, denoted as the distance «l» (FIG. 10A), and the corresponding distance that rod 50 is moved by the trigger clip 114 is called «l '» distance. FIG. 11 and 11A depict the position of the trigger device 130 after the trigger button (not shown) was pressed and the surgeon activated the trigger device 130 to move the first trigger adapter 140 to the beginning of the inclined clamping parts 28 of the stop member 20. According to these drawings, the spring the stop element 21 biases the stop element 20 to the open position. The movement of the distal end of the first trigger adapter 140 is designated as a distance “l ₁ ”, and the corresponding distance by which the trigger clip 114 moves along the rod 50 is indicated as a distance “l ' ₁ ”. FIG. 12 and 12A depict the position of the first trigger adapter 140 after it moves to the beginning of the inclined guide for the brackets 29 of the stop member 20. This position indicates the maximum number of clamps that can be attached before starting to form the brackets. This position is referred to in this document as the “maximum grip position”. As seen in FIG. 12, the trigger clip 114 is in contact with the stopper 138 on the trigger button of the trigger device 137, and therefore cannot be further distally moved until the trigger button of the trigger device 137 is pressed. As seen in FIG. 12A, the surface for forming the brackets 22 of the abutment member 20 is substantially parallel to the upper surface 31 of the cartridge with the brackets 30. The distance between the part for forming the brackets 22 of the abutment member 20 and the upper holding surface of the elongated groove 14 is denoted “C _max ”. In various embodiments, C _max may be, for example, from about 2.15 to 3.65 mm (0.085 to 0.144 inches) for cartridges with brackets 30 with body parts 31 that have a substantially equivalent thickness. In at least one embodiment, for example, the thickness of the cartridge may be approximately 0.25-0.76 mm (approximately 0.01-0.03 inches) larger than the size of the bracket. The total distance that the first starter adapter 140 moves from the starting position to the maximum grip position is denoted as “l ₂ ”, and the corresponding distance that the starter clip 114 moves along the rod 50 is denoted as “l ' ₂ ”. FIG. 13 and 13A depict the position of the trigger clamp 114 in the fully activated position in which the brackets 32 have been fully molded into the cartridge with the brackets 30. In this position, the distance between the part for forming the brackets 22 of the stop member 20 and the upper holding surface of the elongated groove 14 is indicated as “C _min . " In various embodiments, the implementation of "C _min " can be, for example, from about 0.38 mm to 0.76 mm (from about 0.015 to 0.030 inches) for cartridges with brackets that hold brackets, the length of the legs of which in unformed form is approximately from 1.90 mm to 3.40 mm (approximately 0.075 to 0.134 inches) (UF distance in FIG. 1A), and the height of which, when fully formed, is, for example, approximately 0.63 mm to 1.01 mm (approximately 0.025 to 0.04 inches), and includes the “FF” distance in FIG. 1D. The total distance that the first starter adapter 140 moves from the starting position to the maximum activation position is denoted by “l ₃ ”, and the corresponding distance by which the starter clip 114 moves along the rod 50 is denoted as “l ' ₃ ”. As can also be seen in FIG. 13, the trigger 130 in the fully activated position is in contact with the activating end 212 of the lock plate of the scalpel 211 to release the holding hook 214 from engagement with the locking rod 216 on the first gear gear of the scalpel 192.

Dissection, especially vascular dissection, may be one of the most stressful stages of any surgical procedure. In the field of laparoscopic surgery, this stage is even more stressful, because if something goes wrong, then all the intervention will need to be transferred almost immediately to open surgery mode to prevent catastrophic situations. Thus, it is desirable to use a surgical stapler, which can further dissect the tissue after the brackets have been expanded. Various embodiments of the present invention meet these requirements.

After the brackets have been “activated” (molded) in the target tissue, the surgeon can press the release button of the trigger device 167 to return the trigger device 130 to its original position by displacing the torsion spring 135, which moves the stop element 20 to the open position using the spring 21. In the open position, the surgeon can remove the end clamp 12 without removing the implantable cartridge with brackets 30 and brackets 32 located therein. In embodiments in which the end clamp passes through channel, working chute, etc., the surgeon returns the stop element 20 to the closed position by activating the trigger device 130 to ensure the extraction of the end clamp 12 through the channel or working chute. However, if the surgeon wishes to dissect the target tissue after the stitching is done, he will activate the trigger for extending the scalpel 200 in the manner described above to move the scalpel 72 through the target tissue to the end of the end clamp, as shown in FIG. 14, 14A. FIG. 14 shows the displacement of the trigger for extending the scalpel 200 in various embodiments for different lengths of end clamps / cartridges with brackets in which the scalpel 72 is extended to the fully activated position using end clamp 12. After that, the surgeon can release the trigger for extending the scalpel 200 in order for the return spring 202 to transmit an activating force to return the scalpel shaft 72 to its initial (inactive) position (FIG. 13, 13A). Once the scalpel rod 72 has returned to its original position, the surgeon can open the jaws of the end clamp 13, 15 to release the implantable cartridge 30 into the patient’s body and then remove the end clamp 12 from it. Thus, these surgical devices of the present invention facilitate the use of small implantable cartridges with brackets that can be passed through relatively small working troughs and channels, thereby giving the surgeon the opportunity to create a staple stitch without dissecting the tissue or, if desired Also cut the fabric after the creation of the bracket joint.

As indicated above, the surgical device 10 can be used with other end clamps that support different sizes of cartridges with brackets that contain different sizes and numbers of brackets. FIG. 15-19 depict the use of an end clip 12 ′ that during operation holds a cartridge with brackets 30 ′ containing brackets 32 ′ that are larger than the brackets 32 of the cartridge with brackets 30. For example, the brackets 32 in the cartridge with brackets 30 may have a size of about 2.03 to 2.15 mm (approximately 0.080-0.085 inches), while the brackets 32 'in the cartridge with the brackets 30' may have a size of about 1.90 mm (approximately 0.075 inches). In various embodiments, the cartridge with brackets 30 'is longer than the cartridge with brackets 30. For example, the cartridge with brackets 30 may be about 20 mm (approximately 0.78 in) long; while the cartridge with brackets 30 'may have a length of about 40 mm (approximately 1.57 inches). FIG. 15 is an exploded view of an end clip 12 ′, a second trigger adapter 150, and a distal end 55 of the rod 50. As seen in FIG. 15, the elongated groove 14 'has paired side walls 16' that are positioned with a gap and have a slot or hole 18 'that is sized to fit the corresponding pin of the thrust member 26'. The abutment member 20 'and the elongated groove 14' may together form an end clamp 12 ', the total diameter of which should allow the end clamp 12' to pass through an opening whose diameter is at least about 5.0 mm (approximately 0.20 inches) . The stop element 20 'also has a part for forming the brackets 22', in which there are many formed recesses for forming the brackets, and a forked inclined platform assembly 24 ', which protrudes proximally from it. The proximal end 15 'of the elongated groove 14' has a pair of retaining trunnions 17 'that protrude from it and are of such a size that allows them to enter the corresponding jacks for trunnions 52, which are provided on the rod 50.

As seen in FIG. 15, the second trigger adapter 150 has a substantially hollow portion of the housing 151 and a proximal cuff portion 152 that has an inwardly protruding retaining protrusion 154. A slot 156 is located between the casing portion 151 and the proximal cuff portion 152 to ensure that the cuff portion 152 is biased relative to a portion of the housing 151 to facilitate insertion of the holding protrusion 154 into the holding hole 117 of the tubular trigger rail 110. To disconnect the second trigger adapter 150 from the tubular trigger 110 guide the surgeon presses the proximal portion of the sleeve 152 to extract the retaining protrusion 154 from the retaining apertures 117, allowing the trigger to pull the second adapter 150 to distally guide tube 110 starter.

In various embodiments, the abutment member 20 'has a forked inclined pad assembly 24' that comprises paired teeth 45 ', each of which has a proximal surface 27' that moves to an inclined clamp portion 28 'that is distal to the proximal surface 27 '. See FIG. 15. The inclined clamping portion 28 ′ is oriented at an angle “A” relative to the proximal surface 27 ′. In various embodiments, for example, the angle "A '" may be from about 50 to 30 degrees. As will be discussed in more detail below, when the second pressing surface 158 of the second starting adapter 150 is in contact with the inclined clamping parts 28 ', the stop element 20' will move to the elongated groove 14 'and, more specifically, to the cartridge inside it with brackets 30'. See FIG. 17. Since the second starting adapter 150 is further distally moved, the second pressing surface 158 is in contact with the inclined guides for the brackets 29 'on the teeth of the stop element 45 to further move the stop element 20' to the cartridge with brackets 30 'to form brackets 32' therein. See FIG. 18. The inclined guide for the brackets 29 'is oriented at an angle "B" "relative to the inclined clamping part 27'. In various embodiments, for example, the angle "B '" may be from about 5 to 20 degrees. A spring (not shown) may be located between the inclined platform assembly 24 'and the bottom of the elongated groove 14' to move the thrust member 20 'to the open position.

FIG. 16 shows the position of the second trigger adapter 150 after the surgeon moves the second trigger adapter 150 distally to the beginning of the inclined clamping parts 28 ′. The control of the second starter adapter 150 is controlled by the starter 130 using the method described above for the first starter adapter 140. FIG. 17 depicts the position of the second trigger adapter 150 in a fully closed position. FIG. 18 depicts the position of the second trigger adapter 150 in a fully activated state in which the brackets 32 'of the cartridge with brackets 30' were molded with a clamped fabric (not shown).

As indicated above, the implantable cartridge with brackets 30 'is longer than the implantable cartridge with brackets 30. Thus, as shown in FIG. 15, the end clamp 12 ′ also includes a distal element for dissecting tissue 124, which is movably held in the elongated groove 14 ′. The distal tissue dissection member 124 has an edge for dissecting the tissue 125 and a proximal portion 126 that is configured for attachment using the scalpel 72. Thus, if the surgeon wishes to dissect the tissue after applying the staple suture, he activates the trigger 200 in the manner described above for driving the scalpel shaft 172 in the distal direction for contact with the distal tissue dissection member 124 to drive the distal member for dissecting the tissue 124 in the tissue, as obrazheno in FIG. 19. The distal tissue dissection member 124 may have at least one holding portion that is adapted to slide in a slot of a corresponding shape (not shown) in the elongated groove 14 ′. This arrangement allows the end clamp 12 'to remain in the open position after molding brackets and dissection of the fabric. The distal tissue dissection member 124 remains in the abutment member 20 ′ and is removed along with the end clamp 12 ′ when it is removed from the patient’s body.

Thus, various embodiments of the surgical apparatus 10 have separate mechanisms for stitching and dissection, so that the surgeon can stitch the tissue without dissecting it. Various embodiments of the stapler of the present invention can be successfully used with end clamps of various sizes, which are adapted for suturing using different sizes and the number of brackets. The surgical device can be supplied in the form of a kit, which includes the device 10, the first trigger adapter 140 and the second trigger adapter 150, which allow the use of the device with different sizes of implantable cartridges with brackets.

In various unique and fundamentally new embodiments of the present invention, a compressible cartridge with brackets is used that holds the brackets substantially stationary to make contact with the stop member and the stop member. Unlike previous surgical stapler arrangements that used the drive suture units, in various embodiments of the present invention, the brackets are not actuated by the stop member. In various embodiments of the present invention, the thrust member is driven by unshaped brackets. The degree of formation of the brackets achieved depends on how far the stop element has been advanced towards the brackets. This arrangement allows the surgeon to adjust the amount of molding or activating pressure that is applied to the brackets, and thereby change the final height of the molded brackets.

In various embodiments, the amount of activating movement that must be made to move the thrust element depends on the degree of actuation of the starting device. For example, if the surgeon wants to receive only partially formed brackets, then the trigger device is also only partially pressed against the pistol grip 107. To obtain more formed brackets, the surgeon simply presses the trigger device further, which leads to the further activation of the stop element for contact with the brackets. As used herein, the term “contact molding” means that the surface for forming the brackets or the recess for forming the brackets is in contact with the ends of the legs of the brackets, and in the molding position, the forming or folding of the legs of these brackets begins. The degree to which the brace is molded indicates how much the brace legs were bent and, ultimately, the height of the brace formed, as indicated above. Therefore, it will be further understood by a person skilled in the art that since the stop member 20 moves substantially parallel to the cartridge with brackets, as well as the forces applied thereto to effect an activating movement, the brackets are molded substantially simultaneously and have substantially the same height after molding.

FIG. 20-23 depict an alternative surgical apparatus 10 in which the bracket height indicator assembly 220 is used. In various embodiments, the bracket height indicator assembly 220 includes an indicator shaft 222 that is attached to an upper portion 134 of a trigger device 130 for rotating them simultaneously . Since the trigger 130 is rotated toward a portion of the pistol grip 107 of the handle assembly 100 to bring the stop member 20 to the cartridge with brackets 30 in the manner described above, the indicator rod 222 is visible through the window 223 in the left clip member 104. In this embodiment, the bracket height indicator assembly 220 also comprises a series of stoppers 24, 26, 28, which are formed in the left member of the cage 104 and correspond to three degrees of molding brackets. In particular, when the trigger 130 is initially actuated, the retaining pin 162 will slide to fit right against the stopper of the initial position 163 until the tubular trigger guide 110 extends the trigger adapter 140 or 150 to the lock position described above, in wherein the holding pin 162 is biased into the locking recess 164 formed in the left clip member 104. When the surgeon wants to begin closing the jaws 13, 35 of the end clamp 12, the release button of the trigger 167 dol to be pressed to further actuate the trigger 130. While being pressed, the trigger of the trigger 167 contacts the holding pin 162 and pushes it out of the locking recess 163 to activate the trigger 130. As described above, the surgeon can then use the lower and the upper branches 13, 15, respectively, of the end clamp 12 for gripping and performing surgical intervention in the tissue. If the surgeon wants to start the process of forming the brackets, the release button of the trigger 167 should be pressed to allow the trigger clip 114 to extend distally if the surgeon continues to push the trigger 130.

Further advancement of the trigger device 130 drives the stop member 20 for contact forming the brackets 32 in the cartridge with the brackets 30. If the trigger device 130 is held further, the flat end 165 of the holding pin 162 will slide off the initial stopper 163 and come into contact with the first stopper 224, which corresponds to the first stage of molding the brackets, which is indicated by the symbol of the first height of the brackets 230 on the left element of the holder 104. See FIG. 20. As shown, the first height symbol of the bracket 230 is an image of a bracket that has just begun to form. Other symbols / signs may be used to indicate this stage of brace formation. When the holding pin 162 engages with the first stopper 224, the surgeon may hear an audible click. The engagement of the holding pin 162 with the first stopper 224 may also provide some feedback to the surgeon through the trigger 130. In addition, the rod of the height indicator bracket 222 can be seen through the viewing window 223, which is located near the symbol of the first height of the bracket 230. If the surgeon wants to continue forming the brackets 32 in the cartridge with brackets, the holding pin 162 disengages from the first stopper 224 by pressing the release button 240, which is located in the left element of the clip 104. In various embodiments, For example, in the left element of the clip 104, the release button 240 may be integral with the hinge part 242, which is part of the left element of the clip 104. This arrangement allows the release button 240 to come close to the end 165 of the holding pin 162 to engage it with any from the first, second and third stops 224, 226, 228. After disengaging the holding pin 162 from the first stop 224, the trigger 130 must be pushed further until the holding pin 162 engages with the stopper of the second stage of forming the brackets 226. This position of the starting device 130 leads to further advancement of the stop element 20 for contact molding of the brackets 32 in the cartridge with the brackets 30. The holding pin 162 is latched again with the stopper of the second stage of forming the brackets 226, which provides a sound and tactile feedback from the surgeon that the starting device 130 is in the position of the second stage of molding brackets. In this position, the rod of the bracket height indicator 222 can be seen through the viewing window 223 and located near the symbol of the second bracket height 232. If the surgeon wants to continue forming brackets 32 in the cartridge with brackets 30, the holding pin 162 disengages from the second stopper 226 by pressing the shutter button 240. After that, the starter should be pressed until the holding pin 162 engages with the stopper of the third molding step of the bracket 228, which corresponds to the last molding step of the bracket. The holding pin 162 is latched again with a stopper of the third molding stage of the bracket 228, which provides audible and tactile feedback to the surgeon that the trigger 130 is in position of the third molding stage of the bracket. In this position, the bracket of the height indicator of the bracket 222 can be seen through the viewing window 223 and be near the symbol of the height of the bracket 234. After reaching the desired degree of molding of the bracket, the surgeon can move the retaining pin 162 out of engagement with the third stopper of the height of the bracket 228 to return the trigger 130 to its original position. position. Or, if desired, the surgeon can begin the process of dissecting the tissue as described above before returning the trigger device 130 to its original position.

FIG. 24 depicts an alternative embodiment of an indicator of the height of the bracket assembly, usually denoted by the number 220 ', which does not include a sequence of stoppers that correspond to the various stages of forming the bracket. However, this embodiment includes a bracket for the height indicator bracket 222 and the viewing window 223. Thus, the surgeon can control the degree of molding of the brackets by observing the position of the bracket for the height indicator bracket 222 through the viewing window 223. This embodiment may include the symbols of the bracket height indicators described above. 230, 232, 234. In addition, this embodiment may also include an unshaped bracket symbol 229 that corresponds to a starting position in which the brackets 32 have not yet begun to be molded. I am using the thrust member 20. Otherwise, this embodiment is controlled in the same manner as described above.

FIG. 25 and 26 depict an alternative end clamp 12 ”that is similar to the end clamp 12 ′ described above with the exception of the following differences that have been configured to accommodate the cutting blade 172 ′. The cutting blade 172 'is connected to or protrudes from the cutting shaft 180, but otherwise its control is as described above for the cutting blade 172. However, in this embodiment, the cutting blade 172' is long enough to move along the entire length of the end clamp 12 ″, and therefore, the distal tissue dissection member is not used with a 12 ”end clamp.” An upper transverse member 173 'and a lower transverse member 175' are formed in the cutting blade 172 '. The upper transverse element 173 'is oriented for sliding movement in the corresponding elongated groove 250 in the abutment element 20 ", and the lower transverse element 175' is oriented for movement in the elongated groove 252 in the elongated groove 14" of the end clamp 12 ". The releasing groove (not shown) also provides support for the abutment member 20 ″ in such a way that when moving the cutting blade 172 ′ to the end position using the thin end clamp 12 ″, the upper transverse member 173 ’slides into the corresponding groove to move the abutment member 20 ″ in the open position to separate stitched and dissected tissue. The abutment member 20 ″ may otherwise be identical to the abutment member 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 displaced to the fully open position (FIG. 25) by means of a spring or other opening device (not shown). The stop element 20 ”is moved between the open and fully closed position during axial movement of the starting transition device 150, which is carried out as described above. As soon as the trigger adapter 150 has been extended to the fully closed position (FIG. 26), the surgeon can extend the cutting blade 172 ”distally as described above. If the surgeon wants to use the end clamp as a grip for surgical intervention in the tissue, then the trigger adapter should be moved proximally to ensure that the stop member 20 "is withdrawn from the oblong groove 14", as indicated in FIG. 27 dashed lines. In this embodiment, as the cutting blade 172 ″ moves, the distally upper transverse member 173 ′ and the lower transverse member 175 ′ bring the stop member 20 ”and the elongated groove 14” towards each other to achieve the desired brace formation, while the cutting blade 172 ”extends distally through the 12 ”end clamp. See FIG. 28. Thus, in this embodiment, the molding of the brackets occurs simultaneously with the dissection of the fabric, although the brackets themselves can be molded after the cutting blade 172 ”will reciprocate outward.

FIG. 29 and 30 depict the use of a 12 ”end clamp that has a 20” stop element made, for example, of stainless steel, titanium, PGA (polyglycolic acid) or other absorbable and somewhat flexible plastics. These figures also depict the use of a retaining substrate 6250 and a leveling substrate 6206, which are discussed in detail above. As seen in FIG. 29, the stop member 20 ”bends the brackets into a fully formed position, while the cutting blade 172” through it makes reciprocating movements outward.

In many areas of surgery, it is desirable or useful to use a surgical apparatus for cutting and stapling with an end clamp that can rotate relative to the elongated shaft assembly. The ability to access hard-to-reach areas primarily with articulated devices, however, is often limited by the size and design of the nodes used in the joints of the end clamp. FIG. 31-40 depict another surgical apparatus of an embodiment of the present invention in which the end clamp can be rotated relative to an elongated shaft and a relatively compact rotation control device in the handle assembly is used.

The surgical apparatus 310 of this embodiment is substantially similar to the various embodiments of the surgical apparatus 10 that have been described above, except that this embodiment uses an articulated shaft assembly 312 to facilitate the selective positioning of the end clamp 12 relative to the elongated longitudinal axis A-A. Although the surgical apparatus 310 will be described herein in connection with the end clamp 12 described above, those skilled in the art will understand that the surgical apparatus 310 can also be used with the second trigger adapter 150 to actuate the end clamp 12 ′ or other devices end clamp. As seen in FIG. 31 and 32, the articulated shaft assembly 312 includes a distal portion of the articulated shaft assembly 314, which is pivotally connected to the proximal part of the articulated shaft assembly 316, which during operation is connected to the handle assembly 100. In various embodiments, for example, the distal part the hinge shaft Assembly 314 includes a distal shaft 320, which contains a pair of sockets for pins 322 to accommodate pins 17. See FIG. 32. The distal shaft 320 has a proximal end 324 that includes a hinge base 326, from which a hinge pin 328 protrudes.

As seen in FIG. 32, the proximal portion of the articulated shaft assembly 316 includes a proximal rod link 330 to which the proximal articulated base and scalpel guide 332 are attached. The scalpel guide 332 can, for example, be welded or attached to the proximal rod link 330 with glue or other fasteners. A hinge hole 334 is formed in the proximal hinge base of the guide of the scalpel 332 for rotationally connecting with the pivot pin 328 to rotate the distal pin link 320 relative to the proximal pin link 330 about the first axis of rotation FA-FA, which is essentially perpendicular to the longitudinal axis A-A. The surgical device 310 further includes a distal segment of the tubular launch guide 370, which is rotatably connected to the paired connecting parts of the tubular launch guide 380, 382 for rotation around the second axis SA-SA. The distal segment of the tubular launch guide 370 has a holding hole 372 for holding the holding plug 144 of the first trigger adapter 140 therein. The paired connecting portions of the tubular trigger guide 380, 382 are pivotally connected to the proximal tubular trigger guide 390 for rotation about the third axis of rotation TA-TA. See FIG. 32.

In various embodiments, the proximal tubular guide 390 is attached to a rotary sleeve 400, which is rotatably attached to a handle in the assembly 100. See FIG. 31, 38, and 39. The swivel sleeve 400 may be injection molded from a plastic or plastic material and include a collar portion of the flange 402 and a flange portion 404 that is spaced apart from the collar portion 402. The front portion 101 of the handle assembly 100 is located between the collar portion 402 and a flange portion 404 to allow rotation of the rotary clutch 400 relative to the handle in the assembly 100 about the longitudinal axis AA. In other embodiments, the rotary sleeve 400 may be made of other suitable materials. In the depicted embodiment, each of the proximal tubular launch guide 390 and the proximal rod link 330 are fixedly attached to the rotary sleeve 400. As can be seen in FIG. 38 and 39, the proximal rod assembly 330 and the proximal tubular launch guide 390 are pinned to the rotary sleeve 400 using a pin 406. Thus, the surgeon can rotate the end clip 12 relative to the handle body 100 360 ° around the longitudinal axis A-A by turning the rotary sleeve 400.

In accordance with FIG. 37, 38 and 40, in various embodiments, the end clamp 12 can be selectively articulated along the longitudinal axis AA using paired articulating assemblies 420, 430 that are attached to the distal hinge base 326, and the hinge 440, which is rotatably held in the recess 408 of the swivel sleeve 400. In various embodiments, the coupling assemblies 420, 430 may include, for example, cables that are made of cable bundle, nitinol, titanium, and the like. The first, or right, joint assembly 420 has a distal end 422 in which a tip 424 is formed having a size that allows it to be pressed into the second mounting hole for cable 327, which is formed in the distal hinge base 326. Similarly, the second or left the articulating assembly 430 has a distal end 432 in which a tip 434 is formed having a size that allows it to be pressed into a second mounting hole for cable 329, which is formed in the distal hinge base 326. See FIG. 37. Thus, the end clamp 12 can be rotated to the right around the first axis of the FA-FA (FIGS. 35 and 36) by tensioning the first or right joint assembly 420, and the end clamp 12 can be rotated to the left around the first axis of the FA-FA by tensioning the second or left joint assembly 430. In various embodiments, the right joint assembly 420 may slide into the right cable groove 336 formed in the proximal shaft link 330, and the left joint assembly 430 may slide into the left cable groove 338 at the proximal core link 3 thirty.

Returning to FIG. 38-40, the first joint assembly 420 has a proximal end 426 having a locking ball 428 that is held therein by compression or other means, and is also adapted to be held in the first holding groove 442 in the articulation 440 that is rotatably held inside the recess 401 in the rotary sleeve 400. Similarly, the second articulating assembly 430 has a proximal end 436 having a locking ball 438 that is held therein by compression or other means, and is also intended to be held in the second rod ivayuschem slot 444 in the articulation 440. As more particularly seen in FIG. 40, the articulated joint 440 further comprises an actuator groove 446, which facilitates the unhindered entry of the proximal segment of the tubular launch guide 390 into it. As shown in FIG. 38, the actuator groove 446 can be sharpened away from the wide bore portions 448, 450 towards the channel 452 of the center of articulation 440, which provides a sliding movement of the proximal segment of the tubular launch guide 390. As discussed in more detail below, articulation 440 is pivotally or articulated in the recess 401 and selectively moves from the neutral position (shown in FIG. 38 in solid lines) to the first or second position of the articulated controller (shown in FIG. 38 in dashed lines ) The articulation 440 also axially moves within the recess 401.

As shown in FIG. 40, the surgical device 310 may include a locking device, usually denoted by the number 453, to block the articulation 440 in one of the neutral, first or second positions of the articulated controller. In various embodiments, the locking device 453 comprises a series of locking locking segments 454 that are located on the articulation 440 and are adapted to connect with locking ribs 410 that are formed in recesses 408 formed in the collar portion 402 that is oriented inwardly to the area of the socket 401 of the rotary sleeve 400 The actuator channel 412 protrudes from the collar portion 402 and is in line with the actuator groove 446 in the articulation 440 for passing the proxy through it the imal segment of the tubular launch guide 390. As can be seen in FIG. 38 and 39, the actuating bell spring 456 is pivotally coupled to a holding sleeve for the spring 414, which is part of the rotary clutch 400, to bias the articulated joint 440 proximally so that the locking stops 454 engage in retaining engagement with the locking ribs 410 of the collar portion 402.

To facilitate articulated movements in the articulation 440, a pair of articulated arms 458, 460 located in diametrically opposite directions protrude laterally from the articulation 440. In various embodiments, the articulated joint 440 may be made, for example, of unfilled, glass filled, carbon filled, mineral filled polycarbonate, nylon, Ultem®, and the like, and may contain locking stops 454 that were obtained by machining or injection molding . Articulated arms 458, 460 may be attached to articulated joint 440 by means of press fit, welding, or the like. Such a locking device allows the articulated joint 440 to be locked in any of the neutral, first or second positions of the articulated controller. Once the surgeon has moved the articulated joint 440 to achieve the desired articulated position of the end clamp, the surgeon must release the articulated joint 440 to ensure that the actuating bell spring 456 of the articulated joint 440 is displaced proximally so that the locking stops 454 engage in retaining engagement with the locking parts 40 4 In various embodiments, the actuator bell 456 may be sized to allow articulation neniyu 440 rebound into the neutral position, if the articulated end clamp was firmly pulled back through the trocar or similar opening. Moreover, the use of articulated handles 458, 460 allows you to "adjust" the degree of articulation in accordance with a specific type of surgical intervention.

As seen in FIG. 38, the first, or right, articulated arm 458 protrudes from the right groove 416 in the rotary sleeve 400, and the second, or left, articulated arm 460 protrudes from the left groove 418 in the rotary sleeve 400. To surgeon the end clamp 12 relative to the longitudinal axis AA, the surgeon first performs axial movement of the right and left hinge arms 458, 460 in the distal direction "DD" to disconnect the locking stops 454 from the locking ribs 410 in the collar portion 402 of the rotary coupling 400. After that, the surgeon must rotate the articulation 440 by m turning the articulated arms 458, 460 in the desired direction to transmit articulated movements to the articulating units 420, 430. For example, the end clamp 12 can be rotated to the right by turning the right articulated arm 458 in the proximal direction "PD" and the left articulated arm 460 in the distal direction “DD” for transmitting the pulling motion (articulated movement) to the right articulating assembly 420 and pushing motion to the left articulating assembly 430. Similarly, the end clamp 12 can be turned to the left by turning the left the articulated arm 460 in the proximal direction “PD” and the right articulated arm 458 in the distal direction “DD” for transmitting the pulling movement (articulated movement) to the left articulating unit 430 and pushing motion to the right articulating unit 420. Different ranges of movements of the right and left articulated arms 458, 460 are shown as dashed lines in FIG. 38. Thus, the end clamp 12 can be optimally positioned in various inclined positions, for example, when tilted clockwise or counterclockwise without the need for rotation or other movement of the elongated shaft assembly 40. FIG. 35 depicts an angle α, which in various embodiments is from 0 ° to 45 °.

Various embodiments of the surgical apparatus 310 include a scalpel shaft 472, which is movably held in a hollow proximal shaft link 330 and a retaining groove for the scalpel 333, which tapers from a narrow proximal portion 335 to a wide distal portion 337 to allow bending of the scalpel shaft 472 around it to accommodate rotation end clamp 12 around the longitudinal axis AA. See FIG. 37. In various embodiments, the scalpel 472 can be made, for example, of grade 300 or 400 stainless steel and have a cutting edge for cutting tissue 476 that is formed at its distal end. As can be seen further in FIG. 37, the scalpel shaft 472 slides through the groove of the scalpel 473 into the distal hinge base 326. The proximal end 478 of the scalpel shaft 472 is attached to the cutting shaft 480, which protrudes from the proximal shaft link 330, for engagement with the possibility of transmitting drive force with the trigger drive 190 as described above . See FIG. 31. The retaining pin 406 protrudes into an elongated groove 392 (FIG. 38) in the proximal segment of the tubular launch guide 390 through the hole 339 in the proximal pin link 330 (FIG. 39) and into an elongated groove 482 in the cutting shaft 480 to provide axial movement of the proximal segment a tubular trigger guide 390 and a cutting shaft 480 relative to the proximal rod link 330 and the handle assembly 100. Thus, the surgeon can selectively control tissue dissection using the scalpel shaft 472 by controlling the trigger stroystvom for extension scalpel 200 in the manner described above.

Various articulated devices are described in US Patent Application Ser. No. 12/775809 (file number in the book of patent attorney END6755USNP) entitled “Laparoscopic devices with lockable end clamps” by Frederick E. Shelton IV, filed May 7, 2010, and in US Patent Application Ser. No. 12/775699 (file number in the book of patent attorney records END6756USNP) entitled “Bendable barrel for positioning the handle” by Frederick E. Shelton IV et al, filed May 7, 2010, the disclosure of which has been incorporated herein by reference throughout their fullness. FIG. 41 and 42 depict an alternative articulated shaft assembly 490 that is substantially identical to the articulated shaft assembly 340 and is controlled in substantially the same way except for the intermediate segment of the tubular launch guide 492, which replaces the connecting portion of the tubular launch guide 380 used in the articulated shaft in collection 340. As can be seen in FIG. 41 and 42, the intermediate segment of the tubular launch guide 492 protrudes from the distal segment of the tubular launch guide 370 to the proximal segment of the tubular launch guide 390. In various embodiments, the intermediate segment of the tubular launch guide 492 may be made of nylon, Isoplast® or other flexible plastic. In various embodiments, the intermediate segment of the tubular starting guide 492 has two longitudinal protruding compressive rod parts 494, of which there are a plurality of rib segments 496 arranged with a gap, which are separated from each other by gaps 498 and form a substantially hollow tubular segment through which during operation other components of the shaft assembly and the scalpel shaft may pass. The rod portions 494 are configured to transmit compressive movements from the proximal segment of the tubular trigger guide 390 to the distal segment of the tubular trigger guide 370, which are large enough to bring the thrust member 20 to a fully activated position, while the end clamp 12 selectively rotates relative to the longitudinal axis AA. The intermediate segment of the tubular launch guide 492 has a distal end portion 491 that is attached to the distal segment of the tubular launch guide using, for example, pins, grooves, snap-fit devices, and the like, while the proximal part 493 is attached to the proximal segment tubular launch guide 390 using the same or similar means. In this embodiment, the end clamp 12 can be optimally positioned in various inclined positions, for example, when tilted clockwise or counterclockwise without the need for rotation or other movement of the elongated shaft assembly 490. FIG. 42 depicts an angle α, which in various embodiments is from 0 ° to 45 °.

FIG. 43-47 depict another surgical apparatus in accordance with an embodiment of the present invention. The surgical apparatus 510 of this embodiment is substantially similar to the above-described embodiment of the surgical apparatus 310 with the exception of various differences discussed below. Although the surgical apparatus 510 will be described herein in connection with the end clamp 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 other end devices clamping. Various embodiments of the surgical apparatus 510 comprise an articulated shaft assembly 512 to facilitate the selective positioning of the end clamp 12 relative to the longitudinal axis A-A. As seen in FIG. 43 and 44, the articulated shaft assembly 512 comprises a distal shaft 520 having paired sockets for trunnions 522, in which the trunnions 17 are placed. The distal shaft 520 has a proximal end 521 that is articulated with the distal end 531 of the proximal rod 530. In particular, the proximal end 521 of the distal rod 520 has a pair of teeth 523 located with a gap on the distal rod to hold the hinge pin 524, which protrudes from the distal end 531 of the proximal rod 530 to indicate the hinge B AA-AA, which is substantially perpendicular to the longitudinal axis AA. See FIG. 46.

In various embodiments of the present invention, the end clamp 12 can pivotally move in a variety of different directions around the longitudinal axis A-A. For example, the angle α 'in FIG. 47 may vary from 180 ° to 90 °. The end clamp 12 is on average articulated with at least one articulating assembly 550, which is connected to the hinge 540. The hinge 540 is pivotally connected to the distal end 521 of the distal rod 520 using the distal pin 542. See FIG. 43. The articulated link 540 is pivotally connected to the distal end 552 of the cutting shaft 550 with a pin of the cutting shaft 554, as shown in FIG. 46. As can be seen in FIG. 43, the articulating assembly 550 projects from the articulated shaft assembly 512 and has a proximal end 556 that projects into a rotary clutch 560 that is rotatably coupled to a handle assembly 100. The proximal end 556 of the articulating assembly 550 is connected to a rotation control unit or button 558 which is slidably coupled to a rotary clutch 560 for axial movement relative to it. Thus, the axial sliding of the actuator button 558 in the distal direction "DD" will lead to the rotation of the end clamp 12 around the longitudinal axis A-A in the manner shown in FIG. 47. To return the end clamp to its initial non-articulated position, in which the end clamp is mounted coaxially with the longitudinal axis A-A, the surgeon simply moves the actuator 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 fixedly connected to the holding sleeve 570, which is rotatably attached to the handle assembly 100. See FIG. 43 and 47. The holding sleeve 570 has a proximal flange 572 and a distal flange 574 that form a rotational groove 575 that is configured to rotate the handle front 101 in assembly 100 between these flanges. This arrangement allows the holding sleeve 570 to rotate around the longitudinal axis AA relative to the handle assembly 100. The proximal shaft link 530 is fixedly pinned or otherwise attached (welded, glued, etc.) to the holding sleeve 570 so that the rotation of the rotary sleeve 560 around the longitudinal axis AA causes the end clamp 12 to rotate about the longitudinal axis AA. It should be understood that such an arrangement can facilitate the rotation of the end clamp 12 360 ° around the longitudinal axis A-A.

This embodiment also includes a distal segment of the tubular starting guide 580, which is connected to the first trigger adapter 140 and axially moves along the distal rod link 520. In particular, the retaining plug 144 on the first trigger adapter 140 is inserted into the holding hole 581 in the distal segment tubular launch guide 580 as described above. The distal segment of the tubular trigger guide 580 is driven by at least one trigger assembly attached thereto. In a preferred embodiment, the distal segment of the tubular trigger guide 580 is driven by a pair of trigger rings 582, 584 attached thereto. The trigger rings 582, 584 are attached to a ring holder 585 connected to the proximal segment of the tubular trigger guide 590 that is attached to the trigger clip 114 as described above. The protective tube 592 is also articulated with the proximal rod link 530 and connected to the rotary sleeve 560 for rotation therein. The proximal tubular trigger guide 590 and the ring holder 585 can axially move relative to the protective tube 592. The trigger rings 582, 584 slide into the side ring grooves 526 in the distal shaft 520, as shown in FIG. 44C. In various embodiments, each of the starter rings 582, 584 comprises a flexible assembly made, for example, of stainless steel, and is capable of advancing the distal segment of the tubular starter guide 580 to actuate the stop member 20 in the manner described above to form the brackets 32 in an implantable cartridge with brackets 30. The actuation of the starter cables 582, 584 is accompanied by the advancement of the starter device 130 as described above. Returning the trigger device 130 to its initial position causes the trigger cables 582, 584 to be tensioned and the stop element 20 to move to the open position or position in which the spring (not shown) biases the stop element 20 to the open position by the first trigger adapter 140.

Surgical apparatus 510 may further comprise a scalpel 534 that is movably held in a retaining groove for the scalpel 528 in the distal shaft link 520. See FIG. 44B. In various embodiments, the scalpel 534 can be made, for example, of grade 300 or 400 stainless steel and the like, and have a cutting edge for dissecting tissue 535 that is formed at its distal end. The scalpel shaft 534 is attached to the ring of the scalpel 536, which can be made of stainless steel 300 or 400 grades. The scalpel tape may, for example, consist of stainless steel tape with a thickness of 0.18 to 0.30 mm (0.007 to 0.012 inches), the material of which is harder than the cutting shaft. The scalpel cable 536 protrudes from the distal shaft link 520 and the proximal shaft link 530 and is attached to the cutting shaft 480, which engages with the possibility of transmitting drive force with the trigger actuator 190 as described above. Thus, the surgeon can selectively control tissue dissection using the cutting blade 534 by controlling the trigger for extending the scalpel 200 in the manner described above. In various embodiments, the assembly can also be used with a protective accordion 594 to prevent articulation from being contaminated with dirt, cloth, decay products, and the like. See FIG. 48.

FIG. 49-53 depict another surgical apparatus in accordance with an embodiment of the present invention. The surgical apparatus 610 of this embodiment is substantially similar to the above-described embodiment of the surgical apparatus 10 with the exception of the differences explained below. The surgical device 610 is configured to actuate the end clamp 612, which contains two movable branches 613, 615. In various embodiments, the end clamp 612 is connected to an elongated shaft assembly 655 that protrudes from the handle assembly 100. See FIG. 49. The elongated shaft assembly 655 comprises an elongated shaft assembly 658 and an elongated closure tube assembly 680 that axially moves along the shaft assembly 658 in the proximal and distal directions. As shown, the elongated shaft assembly 655 protrudes distally from the handle assembly 100 as a generally straight line relative to the longitudinal axis A-A. In various embodiments, the elongated shaft assembly 655 may be approximately 228.8 mm to 406.4 mm (approximately 9 to 16 inches) in length. However, the elongated shaft assembly 655 may have a different length.

Returning to FIG. 50 and 51, in various embodiments, the lower jaw 613 of the end clamp 612 contains an elongated groove 614, and the upper jaw 615 contains a thrust element 620. The elongated groove 614 contains paired side walls 616 that are spaced and end in the form of a protruding closing end or nozzles 618. The elongated groove 614 can be made, for example, of stainless steel grades 17-4 or 400, and have a size that during operation allows you to hold in it a cartridge with brackets 630 or another type of cartridge with bkami. The stop element 620 can be made of stainless steel grades 416, 17-4, 17-7, etc. In at least one embodiment, for example, the end clamp 612 (in the closed position) and the elongated shaft assembly 655 have a maximum outer diameter that allows the device during operation to pass through an opening having a diameter of at least about 8 -12 mm (approximately 0.31-0.47 inches). However, end clamp 612 and oblong shaft assembly 655 may have other diameters and shapes. The end clamp 612 further comprises a distal rod 660, which is adapted to be detachably connected to the distal end of the proximal rod 670, as will be further explained below.

The stop element 620 comprises a part for forming the brackets 622, in which a plurality of recesses for forming the brackets are formed. In addition, the abutment element 620 has a bifurcated closing portion 624, which contains at least one and, more preferably, a pair of protruding downward closing heads 625. As can be seen in FIG. 50-53, in at least one embodiment, the closing heads 625 and the corresponding closing ends or heads 618 of the elongated groove 614 are pivotally pinned to the rod cams 663 of the bifurcated distal end 662 of the distal rod link 660 (FIG. 55) of the rod assembly 658 when using the pivot pin 626 so that when viewed from the side, the closing heads 625 and the closing heads 618 form a movable scissor-like locking structure, usually denoted by the number 628. In other embodiments, the thrust member 620 can be movably connected to an elongated groove 614.

Various embodiments of end clamp 612 also include an axially movable scalpel assembly 640 that includes a scalpel panel 642 that contains a pair of gap-mounted scalpels 644 that protrude distally from it and are configured to axially slide between the rod fists 663 of the distal shaft link 660. See FIG. 55. The tissue dissection member 646 is attached or, alternatively, formed at the distal ends of the scalpel rods 644. In various embodiments, the scalpel rods 644 and the tissue dissection member 646 may be made, for example, of 300 or 400 stainless steel. A cutting edge for dissecting tissue 648 is formed at the distal end of the element for dissecting tissue 646. The lower portion 649 of the element for dissecting tissue 646 is configured to engage with the slide to move the brackets 650, which are movably held in the elongated shaft 614. The slide to move the brackets 650 can be held in a groove or slot devices (not shown) in an elongated groove 614 to facilitate axial movement of the slide to move the brackets 650 from the initial position (FIG. 50-52) to the final position (FIG. 53) elongated the groove 614. The slides for moving the brackets 650 have an injection surface or surfaces 652 that are oriented for engaging with the possibility of transferring the driving force to the brackets 632 in the cartridge with brackets 630 and moving the brackets 632 up to the part for forming the brackets 622 of the stop element 620, while while the tissue cutting member 646 extends distally through the end clip 612.

Furthermore, in various embodiments, the distal shaft threaded sleeve 668 is pivotally connected to the proximal end 664 of the distal shaft link 660 to rotate relative to the longitudinal axis A-A. The distal threaded threaded sleeve coupling 668 has paired trunnions 669 that protrude inward and are sized to fit into the corresponding trunnion grooves 674 at the distal end 672 of the proximal rod link 670, which protrudes from the handle assembly 100 to allow rotation of the distal rod link 660 relative to the proximal pivotal link 670. As can be seen in FIG. 49, the proximal shaft link 670 is pinned to the pivot sleeve 70 (using pin 66), which is mounted to rotate on the handle in assembly 100 in the manner described above to facilitate 360 ° rotation of end clamp 612 about longitudinal axis A-A.

As also seen in FIG. 49, a flange 676 is formed at the proximal end 671 of the proximal rod 670. The flange 676 is configured to rotate within a groove 106 formed by articulated ribs 108 that protrude inside each of the ferrule members 102, 104. This arrangement facilitates attachment of the proximal rod 670 to the handle assembly 100, during which the proximal shaft 670 rotates relative to the handle assembly 100 around the longitudinal axis AA by 360 °. The proximal segment of the closure tube 682 may be made of polymer or other suitable material and have a proximal end 683 that is attached to the trigger clip 114, designed and movably mounted in the handle in the assembly 100 in accordance with various methods described above. In various embodiments, for example, trigger clip 114 may be formed at the proximal end 683 of the proximal segment of the closure tube 682. In addition, other fasteners may be used. As described above, the trigger clip 114 may be rotatably held in the holding collar 120, which is configured to axially move within the handle assembly 100. As shown in FIG. 49, a longitudinal groove 681 located in the proximal segment of the closure tube 682 provides contact of the protruding pin 66 with the proximal rod link 670, while facilitating the axial movement of the proximal segment of the closure tube 682 along the distal rod link 670.

As seen in FIG. 49, the trigger device 130 has an upper portion 134 that is pivotally connected (pinned) to the trigger hinges 636, 638, which are movably connected (pinned) to the holding collar 120. Thus, the movement of the trigger device 130 to the pistol grip part 107 of the handle assembly 100 will cause the trigger clip 114 and the proximal segment of the closure tube 682 to move in the proximal direction “PD” (shown by dashed lines in FIG. 49). The movement of the clamp and the trigger device 130 from the part of the pistol grip 107 of the handle assembly 100 will cause the trigger clamp 114 and the tubular trigger guide 110 to move in the proximal direction “DD” along the proximal shaft 670.

As seen in FIG. 50-53, the proximal segment of the closure tube 682 has a distal end 684 that is configured to connect to the proximal end 692 of the distal segment of the closure tube 690. In the depicted embodiment, the distal segment of the closure tube 690 is configured to threaded to the distal end 684 of the proximal segment of the closure tube 682 The distal end 694 of the distal segment of the closure tube 690 has a cone-shaped actuator member 696 that is configured to interact with a scissor a snapping structure 628 so that when the distal segment of the closure tube 690 is in the position shown in FIG. 51, the spring or springs of the end clamp 617 are located between the oblong groove 614 and the stop member 620 to bias the stop member 620 to the open position shown in this figure. Thus, when the distal segment of the closure tube 690 is extended in the proximal direction “PD”, the cone-shaped drive member 696 contacts the scissor-like closure structure 628 to rotate the clamps 613 (oblong groove 614) and 615 (stop member 620) to each other. See FIG. 52 and 53.

The surgical device 610 may further comprise a scalpel extension system 639, which includes a cutting shaft 700 that projects from the proximal shaft link 670 and has a proximal end portion 702 that interacts with the possibility of transmitting drive force to the trigger actuator 190, which is attached to the trigger actuator during operation a device for extending the scalpel 200 as described above. Thus, the surgeon can extend the cutting shaft 700 distally by moving the trigger to extend the scalpel 200 as described above. As seen in FIG. 52 and 53, the cutting shaft 700 has a bifurcated distal end 704, which comprises an upper link of the cutting shaft 706 and a lower link of the cutting shaft 708, which are configured to adhere to the scalpel panel 642. As seen in FIG. 51-54, the upper link of the cutting shaft 706 is configured to slide in the upper groove 773 of the threaded rod coupling 668, and the lower link of the cutting shaft 708 is configured to slide in the lower groove of the rod 775 of the threaded rod coupling 668.

To use the surgical device 610, an end clamp 612 is attached to the distal end 672 of the proximal shaft link 670 by inserting the trunnions 669 of the threaded rod coupling 668 into the corresponding socket trunnions 674 in the proximal shaft link 670. See FIG. 50. Thereafter, the surgeon or clinician can rotate the end clamp 612 relative to the elongated shaft assembly 655 to screw the distal segment of the closure tube 690 onto the proximal segment of the closure tube 682 to form the closure tube assembly 680. The end clamp 612 may include a cartridge with brackets 630, or the clinician may at the same time or later install the cartridge with brackets into the elongated groove 614. As soon as the end clamp 612 was attached to the oblong shaft in assembly 655 of the surgical device 610, the surgeon should women to insert the end clamp 612 and the elongated shaft assembly 655 through the channel for access to the patient’s body (for example, either through a trocar or endoscope, etc., or through an incision in case of open surgery) to capture the target tissue using the jaws of the end clamp 613 , 615. As in the embodiments described above, the jaws 613, 615 close when the trigger 130 moves relative to the pistol grip 107 of the grip assembly 100. Once the target tissue has been sandwiched between the jaws of the end clamp 613, 615, the surgeon can “activate” or to form brackets 632 in the target fabric by pressure of the abutment element 620 on the cartridge with brackets 630 as described above. If the intervention does not require dissection of the target tissue, then the surgeon can release the trigger device 130, which will allow the stop element 620 to move to the open position (under the action of the spring 617) and thereby disconnect the implantable cartridge with brackets 630 from the end clamp 612. Then, the surgeon can re-close jaws of the end clamp 613, 615 to allow extraction of the end clamp 612 through the access channel or work chute. However, if the surgeon wishes to dissect the target tissue between the staples 632, he must activate the scalpel assembly 640 by controlling the trigger to extend the scalpel 200 as described above to move the tissue dissection element 648 distally through the target tissue. During distal movement of the tissue dissection member 648 in the end clamp 612, it contacts the slide to move the brackets 650, which serve to further move the brackets 632 into forming contact with the surface to form the brackets 622 of the thrust element for further molding the brackets 632. See FIG. 53. After that, the surgeon can open the end clamp 612 to release the dissected / stapled target tissue in which the implantable cartridge with brackets 630 is located.

Thus, the unique and fundamentally new arrangement of the closure tube, at which the jaws of the end clamp are closed by moving the closure tube distally, allows the use of smaller locking structures while maintaining the ability to exert great forces for closure, which are necessary for forming the brackets. In addition, this embodiment of the present invention, due to its flexibility, allows the surgeon to sew tissue without dissection, if the intervention does not require tissue dissection.

FIG. 56-60 depict an alternative embodiment of a surgical apparatus 810 that is substantially identical to the surgical apparatus 610 described above with the exception of the differences discussed below. The surgical device 810, for example, comprises a flexible rod assembly 820 that has a proximal end with a flange 822 that is rotatably held in a groove 106 formed by articulated ribs 108 that protrude inside each element of the clip 102, 104 formed in the handle assembly 100. See FIG. 57 and 58. This arrangement facilitates the rotatable movement of the flexible rod assembly 820 relative to the handle assembly 100. In various embodiments, the flexible rod assembly 820 may be made of, for example, nylon, acrylonitrile butadiene styrene (ABS plastic), polycarbonate, liquid crystal polymer, stainless steel, titanium, etc., and can be configured for use with end clamp 612 of the kind described above.

Surgical apparatus 810 further comprises an elongated shaft assembly, typically denoted by the number 830. In various embodiments, for example, an elongated shaft assembly 830 comprises a retriggable shaft segment 840 and a proximal shaft segment 844. As seen in FIG. 56, for example, the re-adjustable shaft segment 840 may have a distal support ring 842 that is fixedly attached to a portion of the flexible rod assembly 820 using, for example, glue, welding, fasteners, etc. The redeployable shaft segment 840 selectively re-aligns between a linear configuration in which all parts of the redeployable shaft segment 840 are substantially aligned with each other (for example, they form a substantially straight hollow tubular structure) and configurations in which at least one part is misaligned or not parallel to other parts of the redeployable segment 840. In the embodiment depicted in FIG. 56, for example, the re-adjustable shaft segment 840 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS plastic), polycarbonate, etc., and have many ribs 846 that facilitate the re-adjustment of segment 840 from parallel or coaxial orientation to non-linear or misaligned orientation (e.g., loop, bent, etc.) and maintaining this orientation before the user changes the shaft segment 840 manually or using other surgical devices such as grippers and the like. Thus, the re-adjustable shaft segment 840 is a “passive articulation”, which means that this device is not intended for articulated movements made to actively control the rotation of segment 840.

In various embodiments, the proximal shaft segment 844 is connected to the re-adjustable shaft segment 840 by, for example, interlocking parts or pins, and is used to facilitate rotatably attachment of the re-shiftable shaft segment 840 to the handle assembly 100. At least , in one embodiment, for example, the proximal shaft segment 844 is connected to a holding sleeve 60, which is rotatably attached to the handle in the assembly 100 as described above. See FIG. 57 and 59.

In addition, in various embodiments, the closure tube segment 832 is movably mounted on a portion of the flexible rod assembly 820 for selective movement therethrough. See FIG. 56 and 60. As can be seen in FIG. 60, in at least one embodiment, the closure tube segment 832 and the rod assembly 820 are formed with opposite flange portions 833, 821, respectively, so that the closure tube segment 832 is protected from slipping off the rod assembly 820 when it is movable installed on it. In various embodiments, the flexible locking assembly 848 comprises or is associated with a portion of the trigger clamp 114. See FIG. 57 and 59. The flexible locking assembly 848 can be made, for example, of stainless steel, etc., and have a distal end portion 849 that projects from an elongated groove 834 in the rod assembly 820 for connection to a segment of the closure tube 832. Such the arrangement facilitates the movement of the segment of the closure tube 832 in the distal direction "DD" and the proximal direction "PD" along the rod assembly 820 when actuating the starting device 130 as described above.

As seen in FIG. 56, surgical device 810 may be used with end clamp 612, which has been described in detail above. In particular, the end clamp 612 may be movably connected to the flexible rod assembly 820 by inserting the trunnions 669 of the threaded rod coupling 668 into the corresponding grooves for the trunnions 825 at the distal end 825 of the rod assembly 820. See FIG. 60. The distal end 835 of the segment of the closure tube 832 is configured to screw with the proximal end 692 of the distal segment of the closure tube 690 as described above.

In at least one embodiment, the surgical apparatus 810 further comprises a scalpel extension system 639, which comprises a cutting shaft 700 that projects from the shaft assembly 820 and has a proximal end portion 702 that interacts with the ability to transmit drive force to the trigger actuator 190 which, during operation, is attached to the trigger for extending the scalpel 200 in the manner described above. Thus, the surgeon can extend the cutting shaft 700 distally by moving the trigger to extend the scalpel 200 as described above. The cutting shaft 700 has a bifurcated distal end 704, which comprises an upper link of the cutting shaft 706 and a lower link of the cutting shaft 708, which are configured to engage with the scalpel panel 642 of the end clamp 612. See FIG. 60.

To use the surgical device 810, an end clamp 612 is attached to the distal end 823 of the rod assembly 820 by inserting the trunnions 669 of the threaded threaded sleeve 668 into the corresponding receptacle slots 825. Thereafter, the surgeon or clinician can rotate the end clamp 612 to screw the distal segment of the closure tube 690 onto segment of the closing tube 832. The end clamp 612 may comprise a cartridge with brackets 630, or the clinician may at the same time or later install the cartridge with brackets into the elongated groove 614. As soon as the end howl clamp 612 was attached to an elongated closure tube assembly 830 of surgical device 810, the surgeon must adjust the retractable shaft segment 840 so that portions of the oblong shaft assembly are coaxial for insertion through an opening or working chute into the patient’s body (e.g., or through trocar or endoscope, etc., or through an incision in case of open surgery). After that, the surgeon can readjust the re-adjustable shaft segment 840 so that its parts are not aligned with each other to orient the attached end clamp 612, which is in the desired position relative to the target tissue. As in the embodiments described above, the jaws 613, 615 are closed when the trigger 130 is moved relative to the pistol grip 107 of the grip assembly 100. Once the target tissue has been sandwiched between the jaws of the end clamp 613, 615, the surgeon can “activate” or form brackets 632 in the target tissue by pressure of the abutment element 620 on the cartridge with brackets 630 as described above. If the intervention does not require dissection of the target tissue, then the surgeon can release the trigger device 130, which will allow the stop element 620 to move to the open position (under the action of the spring 617) and thereby disconnect the implantable cartridge with brackets 630 from the end clamp 612. Then, the surgeon can re-close jaws of the end clamp 613, 615 for retooling the re-adaptable shaft segment 840 to ensure the extraction of the end clamp 612 through the access channel or work chute. However, if the surgeon wishes to dissect the target tissue between the staples 632, he must activate the scalpel assembly 640 by controlling the trigger to extend the scalpel 200 as described above to move the tissue dissection element 648 distally through the target tissue. When distally moving the tissue dissection member 648 in the end clamp 612, it contacts the slide to move the brackets 650, which serve to further move the brackets 632 into forming contact with the surface to form the brackets 622 of the abutment element to further form the brackets 632. After that, the surgeon can open end clip 612 to release the dissected / stapled target tissue in which the implantable cartridge with brackets 630 is located.

FIG. 61 and 62 depict another embodiment of a surgical device 810 'that is substantially identical to the above-described embodiment of a surgical device 810 with the exception of a re-adjustable shaft segment 850, which comprises a portion of an elongated shaft assembly 830' that is connected to the handle assembly during operation for controlling end clamp 612. In various embodiments, the re-adaptable shaft segment 850 comprises a plurality of mating tubular connecting portions 852. Each connecting the tubular portion 852 may be made, for example, of nylon, acrylonitrile butadiene styrene (ABS plastic), polycarbonate with or without glass or carbon filler, etc., and have a tubular portion of the housing 854. A sphere-like shape may be formed in the tubular portion of the housing 854. or a spherical connecting part 856, which contains a channel for the rod 858. In addition, the tubular channel for the rod 858 protrudes into the hollow recess 860 formed in the tubular part of the housing 854, which is of such a size that allows it to be movably mounted live the spherical connecting part 856 of the adjacent connecting tubular part 852. The spherical connecting parts 856 are sized relative to the recesses 860, which allows the spherical connecting part 856 to be fixed in them and held in the desired configuration, in which the shaft segment essentially forms a straight line relative to the configurations, which shaft 850 may be curved (FIG. 62) or a loop-shaped configuration (FIG. 61).

Since the spherical connecting portions 856 and the recesses 860 can be sized to each other to create a small friction force that can hold the segment 850 in the desired position until 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 subsequent detachment or fixed locking of the connecting tubular parts 852 together in the desired configuration. As can be seen in these Figures, the locking devices 862 comprise at least one and, more preferably, a plurality of flexible locking latches or assemblies 864 formed around the perimeter of the connecting tubular portion 852 near one end of 853 thereof. In a preferred embodiment, four locking latches are used 864. Other embodiments may include 1, 2, 3, or more than four interlock latches 864. Each tubular connecting portion 852 further comprises an interlock 866 that corresponds to is associated with each locking latch 864 adjacent to the other end 865 of the connecting portion 852. Each locking assembly 866 includes a socket for the latch 868 configured to hold subsequently removably a portion of the corresponding locking latch 864 formed in the adjacent tubular connecting portion 852.

To use the surgical apparatus 810 ', an end clamp 612 is attached to the distal end 823 of the shaft assembly 820 in the manner described above. The distal segment of the closure tube 690 of the end clamp 612 is screwed onto the segment of the closure tube 832. Once the end clamp 612 has been attached to the elongated closure tube assembly 830 of the surgical device 810 ', the surgeon must adjust the retractable shaft segment 850 so that parts of the elongated shaft assembly were coaxial for insertion through an opening or a working trough into the patient’s body (for example, either through a trocar or endoscope, 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 connecting parts 852 of the removable shaft segment 850 to give them the desired orientation, and then click on the corresponding locking latches 864 on each connecting part 852, which are located in the corresponding slots for latches 868 for fixing the connecting parts 852 in the desired orientation. See FIG. 62. As in the embodiments described above, the jaws 613, 615 are closed when the trigger 130 is moved relative to the pistol grip 107 of the grip assembly 100. Once the target tissue has been sandwiched between the jaws of the end clamp 613, 615, the surgeon can “activate” or shape brackets 632 in the target fabric by pressure of the abutment element 620 on the cartridge with brackets 630 as described above. If the intervention does not require dissection of the target tissue, then the surgeon can release the trigger device 130, which will allow the stop element 620 to move to the open position (under the action of the spring 617) and thereby disconnect the implantable cartridge with brackets 630 from the end clamp 612. Then the surgeon can re-close jaws of the end clamp 613, 615 and use the gripping tool 869 to remove the locking latches 864 from the corresponding latches for the latches 868 to ensure that the connecting parts 852 will be located In a way that allows you to remove the device through the channel for access or work trough. However, if the surgeon wishes to dissect the target tissue between the staples 632, he must activate the scalpel assembly 640 by controlling the trigger to extend the scalpel 200 as described above to move the tissue dissection element 648 distally through the target tissue. When distally moving the tissue dissection member 648 in the end clamp 612, it contacts the slide to move the brackets 650, which serve to further move the brackets 632 into forming contact with the surface to form the brackets 622 of the abutment element to further form the brackets 632. After that, the surgeon can open end clamp 612 to release the dissected / stapled target tissue in which the implantable cartridge with brackets is located.

FIG. 63-68 depict another embodiment of a surgical apparatus 810 ″ that is substantially identical to the above-described embodiments of a surgical apparatus 810, 810 ′ with the exception of the repositionable shaft segment 870 and the associated oblong shaft locking system 882 assembly. In various embodiments, the re-adaptable shaft segment 870 comprises a plurality of mating tubular connecting portions 872 and is connected to a proximal shaft segment 871 that is connected to a holding sleeve 60 rotatably held in the handle assembly 100 in accordance with the details described above. Each connecting tubular portion 872 may be made, for example, of nylon, acrylonitrile butadiene styrene (ABS plastic), polycarbonate, etc., and have a tubular portion of the housing 874. See FIG. 67. A spherical or spherical connecting portion 876 may be formed in the tubular portion of the housing 874, which includes a channel for the rod 878. In addition, the tubular channel for the rod 878 protrudes into a hollow recess 880 formed in the tubular portion of the housing 854, which has such a size, which allows it to moveably hold the spherical connecting part 876 of the adjacent connecting tubular part 872. The spherical connecting parts 876 have a size relative to the recesses 880, which allows the spherical connection itelnoy portion 876 fixed therein and held in a desired configuration in which the gross readjusted segment 870 substantially forms a straight line (FIG. 67) relative to configurations in which the shaft 870 can be in a curved (FIG. 68) or a loop configuration.

Since, in accordance with at least one embodiment, the spherical connecting parts 876 and the recesses 880 can be sized in accordance with each other to create a small friction force that can hold the connecting tubular parts 872 of the removable shaft segment 870 in the desired position until no external force will be applied to it, in the embodiment depicted in FIG. 63-68, a locking system 862 is used to securely hold or fixedly fix the tubular connecting parts 872 together in the desired configuration. As seen in FIG. 67 and 68, the locking devices 882 comprise at least one and, more preferably, two selectively expanding locking inflatable chambers 884 that protrude from the tubular connecting parts 872 in diametrically opposite directions. In various embodiments, blocking inflatable chambers 884 may be made, for example, of nylon film, etc., and may be adapted to hold gas or liquid under pressure from a gas or liquid source under pressure 886. In the embodiment shown in FIG. . 64, the gas or liquid pressure source 886 comprises a liquid-jet pump 888, which is adapted to supply pressurized air to the blocking inflatable chambers 884. In particular, in at least one embodiment, the liquid-liquid pump 888 comprises a cylinder 889 in which there is a piston 890. The piston 890 has a sealing ring or other seal 891 around the perimeter and is attached to the threaded handle of the pump 892, which is connected by thread to the part of the handle assembly 100. Thus, by screwing the handle of the pump 892 onto the ru the seat assembly 100, the air in the cylinder 890 is pumped by the pump through the supply pipe 893, which leaves the cylinder 890, into the manifold assembly 894, which is located on the rod assembly 820. The air pressure in the blocking inflatable chambers 884 can be reduced by twisting the handle of the pump 894 in the opposite direction.

As seen in FIG. 65, the collector assembly 894 comprises an annular collector region 895, which is sealed on each side with a sealing ring or other seals 896. The annular collector region 895 communicates with a pneumatic line 897 that originates from the proximal shaft segment 871 and is connected for supply with blocking inflatable chambers 884. This arrangement allows the supply of pressurized air to the blocking inflatable chambers 884, thereby facilitating the movement with the possibility of rotation of the rod assembly 820 around the longitudinal axis AA about in relation to the handle assembly 100. As used herein, the term "gas or liquid under pressure" may mean, for example, air, saline, or, more preferably, glycerin. In alternative embodiments, the tubular assemblies may be filled with very low hardness rubber or elastomer. When pressure is applied to the rubber material, it begins to deform the void filler and fix the shaft in the same manner as the gas or liquid in the embodiment of the present invention.

To use the surgical apparatus 810 ″, an end clamp 612 is attached to the distal end 823 of the shaft assembly 820 ′ in the manner described above. The distal segment of the closure tube 690 of the end clamp 612 is screwed onto the segment of the closure tube 832. Once the end clamp 612 has been attached to the oblong shaft assembly 830 ″ of the surgical device 810 ′, the surgeon must adjust the tunable shaft segment 870 so that parts of the oblong shaft assembly were coaxial for insertion through an opening or a working trough into the patient’s body (for example, either through a trocar or endoscope, 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 connecting parts 872 of the removable shaft segment 870 to give them the desired orientation. Once the retractable shaft segment 870 is oriented in the desired direction, the surgeon can screw the handle of the pump 892 onto the body of the handle 100 to increase the pressure in the blocking inflatable chambers 884 to fix the movable connecting parts 872 in the position shown in FIG. 68. As in the embodiments described above, the jaws 613, 615 are closed when the trigger device 130 is moved relative to the pistol grip 107 of the handle assembly 100. Once the target tissue has been sandwiched between the jaws of the end clamp 613, 615, the surgeon can “activate” or shape brackets 632 in the target fabric by pressure of the abutment element 620 on the cartridge with brackets 630 as described above. If the intervention does not require dissection of the target tissue, then the surgeon can release the trigger device 130, which will allow the stop element 620 to move to the open position (under the action of the spring 617) and thereby disconnect the implantable cartridge with brackets 630 from the end clamp 612. Then the surgeon can re-close jaws of the end clamp 613, 615 and reduce the pressure in the blocking inflatable chambers 884 by twisting the handle of the pump 892 in the opposite direction. The gripping tool can be used to control the movable connecting parts 872 to give them a substantially coaxial position (FIG. 67) or other orientation necessary to allow the device to be removed from the patient’s body. However, if the surgeon wishes to dissect the target tissue between the staples 632, he must activate the scalpel assembly 640 by controlling the trigger to extend the scalpel 200 as described above to move the tissue dissection element 648 distally through the target tissue. When distally moving the tissue dissection member 648 in the end clamp 612, it contacts the slide to move the brackets 650, which serve to further move the brackets 632 into forming contact with the surface to form the brackets 622 of the abutment element to further form the brackets 632. After that, the surgeon can open end clamp 612 to release the dissected / stapled target tissue in which the implantable cartridge with brackets is located.

The various embodiments that have been described herein and comprise a retractable shaft segment have a huge advantage over traditional articulated surgical hardware devices that utilize lockable articulations. Such surgical devices are usually limited to 1 or 2 degrees of freedom when placing the end clamp in the incision area. Various embodiments of the present invention provide a wider range of possible positions of the end clamp and, due to its flexibility, allows the surgeon to use the device through a single laparoscopic access.

Unique and fundamentally new features of various surgical cartridges with brackets and surgical devices of the present invention allow the use of brackets, one or more sets of which are located in these cartridges linearly or nonlinearly. Many of these sets of brackets can be located on each side of the elongated groove, which is located in the center of the cartridge with brackets to hold the element for cutting tissue for cutting tissue. In one embodiment, for example, the brackets can be arranged in a single line, which can be essentially parallel to the brackets in the adjacent set (s) of brackets, but at the same time be at a distance from them. In other embodiments, one or more sets of brackets may be substantially non-linear. Thus, the base of at least one bracket from a set of brackets may protrude along an axis that is substantially perpendicular to the bases of other brackets in the same set of brackets. For example, as will be discussed in detail below, in alternative embodiments, the sets of brackets on each side of the elongated groove may have a zigzag shape. This non-linear arrangement of the brackets can be achieved due to the fact that the brackets do not move up to the stop element. Instead of these embodiments, the thrust member can contact form the ends of the fixed brackets. Such a non-linear arrangement of the brackets can provide better results for stitching the fabric than the various linear arrangements of the brackets that used the previous versions of the cartridges with brackets, in which the brackets actually move upward for contact molding using a stop element.

FIG. 69 depicts the use of an embodiment of a surgical cartridge with brackets 900 in an embodiment of the end clamp 612 ′ of the present invention. The end clamp 612 'can be used with the surgical device 610 in various ways, which have been described above. The end clamp 612 'may be identical to the end clamp 612 described above, except for the differences described below. As seen in FIG. 69 and 70, an embodiment of a surgical cartridge with brackets 900 comprises a cartridge case 902 that includes a centrally elongated groove 904 extending through the proximal end 903 into an area adjacent to the distal end 605. The elongated groove 904 is configured to provide axial movement of the scalpel 646 of the surgical apparatus 610 during an operation with dissection of tissue as described above. In at least one embodiment, the cartridge housing with brackets 902 comprises a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or a bio-absorbable foam made, for example, from PGA (polyglycolic acid sold under Vicryl brand name), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanate), PGCL (polyglecaprone 25 sold under the Monocryl brand), or a mixture of PGK, PCL, PLA and PDS in which 920 kits are to be held 930 undeformed Koboko. However, the cartridge case 902 may be made of other materials that serve to hold the unformed brackets 922 in the desired position so that they can be compressed in contact with the stop element 910. As in the various embodiments described above, the cartridge brackets 900 is implantable and therefore remains attached to the stitched fabric after completion of the stitching procedure. In at least some embodiments, in order to prevent exposure of the brackets 922 and activation of hemostatic material during insertion and positioning processes, the entire cartridge 900 may be coated or wrapped with a biodegradable film 906, such as the polydioxanone film sold under the brand name PDS® , polyglyceryl sebacinate (PGS) film or other biodegradable films formed by PGA (polyglycolic acid sold under the trademark Vicryl), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanate), PGCL (polyglexapron 25 sold under the brand name Monocryl) or a mixture of PGC, PCL, PLA and PDS, which must be impervious to rupture. The cartridge body 902 of the cartridge with brackets 900 is sized to be movably held in the elongated groove 614 of the end clamp 612 '.

In the embodiment depicted in FIG. 69, 73 and 74, a surgical cartridge with brackets 900 during operation holds the first set 920 of brackets 922 on one side wall 907 of the elongated groove 904 and the second set 930 of brackets 922 on the other side wall 909 of the elongated groove 904. In various embodiments, the brackets 922 may be made, for example, of a metal material such as titanium, titanium alloys (for example, 6AI-4V titanium, 3al-2.5V titanium), stainless steel, etc., and have a bracket base 924 and two vertical protruding from it bracket legs 926. On each bracket leg 926 a puncture end 928 is formed. In the first set 920 of brackets 922, the base of the bracket 924 of at least one bracket 922 overlaps the base of another bracket 922. In a preferred embodiment, the base of the bracket 924 of each bracket 922 overlaps the base 924 of two adjacent brackets 922 except the base 924 of the last bracket 922 at each end of the first set of brackets 920. See FIG. 73. Thus, the first set of brackets 920 has a substantially non-linear shape. More specifically, when viewed from above, the first set of brackets 920 is essentially zigzag.

As seen in FIG. 72, the stop member 90 has two successive longitudinal recesses for forming the brackets 912, each of which has a substantially zigzag shape that corresponds to the first set 920 of brackets 922 so that when the stop member 910 is molded into the brackets 922, their legs 926 are formed in accordance with FIG. 74. Thus, the distal leg of one bracket divides one recess with the proximal leg of the next bracket in the longitudinal direction. This arrangement allows for a denser arrangement of the recesses, even if the brackets will interact with each other (for example, stack on top of each other). In the previous embodiment, the location of the recess for the brackets, in General, the metal thickness / gap between one set of recesses and the next set ranged from 0.13 to 0.38 mm (0.005 to 0.015 inches). However, in this embodiment of the present invention, the size of the gaps for grazing / overlapping is from 0 to 0.51 mm (0 to 0.02 inches) (essentially -0.51 mm (-0.020 inches)), since, for example, one the bracket is in contact with the next bracket. This arrangement allows you to place 15-30% more brackets in the same place. Moreover, when brackets are coupled, the need for many side rows of brackets disappears. In previous embodiments, three rows were usually used on each side along the cut line of the fabric to prevent the appearance of an uncoated area from which blood could flow. When using sets of linked brackets, there is less chance of missing sections from which blood can flow. Another important advantage is provided by the various arrangements of the interlocked brackets of the present invention, which are necessary to improve the “tensile strength”, which refers to the amount of force that must be applied to break the open set of brackets.

Another arrangement of the brackets for forming brackets of the present invention may include a common groove for forming brackets. As used herein, the term “general recess for forming brackets” means that all brackets from the same set of brackets that are opposite the stop element of the previous construction, in which a separate molding recess was intended to form each leg of each bracket, can be molded in one forming recess.

FIG. 75 depicts another embodiment of the bracket 922 ′ in which the base 924 ′ has a curved portion 928 that facilitates a tight overlap of the bases 924 ′. As indicated above, the cartridge with brackets 900 contains a second set 930 of brackets 922 that are held on the second side wall 909 of the elongated groove 904. The second set 930 of brackets 922 is essentially identical to the first set 920 of brackets 922. Thus, the stop element 910 contains a second common recess for molding brackets 912, which corresponds to a second set of brackets 930 during contact molding. However, in alternative embodiments, the second set of brackets 930 922 may differ from the first set 920 of brackets in shape, and possibly in the number of brackets.

FIG. 71 shows a surgical cartridge with brackets 900 ', which is substantially identical to the cartridge with brackets 900 described above except that brace sets 922' 922 'are held therein. For example, in this embodiment, brackets 922 are positioned relative to set 920' each other so that the main axis SS of at least one base of the bracket 924 is essentially perpendicular to the main axis SS of the base of the bracket 924 of at least one other adjacent bracket 922. Such a predetermined arrangement of brackets when viewed from above has essentially a zigzag appearance. In the embodiment depicted in FIG. 76, the respective bases 924 of the brackets 922 may further comprise an assembly for holding the base 927, which has been pressed under pressure in accordance with this drawing. In various embodiments, the base holding assembly 927 may be made, for example, of non-absorbable plastic, such as PEEK polyester-ether-ketone, or absorbable plastic, such as, for example, polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA” (polylactic acid), polydioxanone “PDS”, PCL (polycaprolactone), PHA (polyhydroxyalkanate), PGCL (polyglecaprone 25 sold under the brand name Monocryl) or various mixtures of PGS, PDS, PGA and PCL. The nodes for holding the base 927 facilitate the adhesion of the brackets to each other without overlapping. Thus, this arrangement allows molding brackets in the form of “B” or in the form of an inverted “W” without overlapping the legs of the brackets with each other. However, the caps are knotted together to hold the base in such a way that they act as brackets that overlap each other. This arrangement allows you to combine the recesses so that for each leg there are two separate trajectories.

In the embodiment depicted in FIG. 77, a bracket set 920 ″ is used in which the legs 926 of adjacent brackets 922 are joined together by a connecting part 929 that has been injection molded or otherwise attached. Each connecting part 929 can be made, for example, of a PEEK polyester-ether-ketone or an absorbable plastic, such as, for example, polyglycolic acid “PGA”, polylactic acid “PLA” or “PLLA” (polylactic acid), polydioxanone “ PDS ”, PCL (polycaprolactone), PHA (polyhydroxyalkanate), PGCL (polyglecaprone 25 sold under the brand name Monocryl) or various mixtures of PGS, PDS, PLA, PGC and PCL. Such a set of brackets 920 ″ when viewed from above has a substantially zigzag appearance. Since various embodiments of surgical cartridges with brackets 900, 900 'have been explained with their use with end clamps 612' and surgical stapler 610, it should be understood that cartridges with brackets 900, 900 'can be effectively used with various other end clamps and surgical devices that were described above in this document, with the corresponding locations of the recesses for molding brackets that are on the thrust elements of these devices to achieve the degree of formation of the brackets during the movement of the thrust element during contact molding of the brackets.

FIG. 78 and 79 depict an embodiment of another surgical cartridge with brackets 940 that is held in an elongated groove 14 of the surgical apparatus 10 of the present invention. In at least one embodiment, the surgical cartridge with brackets 940 comprises a cartridge case 942 that comprises a centrally elongated groove 944 that protrudes at least partially from this body. The elongated groove 944 is configured to provide axial movement of the scalpel body of the surgical apparatus 10 during tissue dissection operations as described above. In various embodiments, the cartridge housing 942 consists of a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (“ORC”) or bio-absorbable foam of the types described above or below, in which sets 946, 948, 950, 952 of undeformed metal are held brackets 922. In at least some embodiments, in order to prevent exposure to the brackets 922 and activation of hemostatic material during insertion and positioning processes, the entire cartridge 940 may be coated t or wrapped in a biodegradable 954 film such as a polydioxanone film sold under the PDS® trademark, polyglyceryl sebacinate (PGS) film or other biodegradable films formed by PGA (polyglycolic acid sold under the Vicryl trademark), PCL (polycaprolactone, PL) or PLLA (polylactic acid), PHA (polyhydroxyalkanate), PGCL (polyglexapron 25 sold under the brand name Monocryl) or a mixture of PGC, PCL, PLA and PDS, which must be impervious to rupture.

In the embodiment depicted in FIG. 78, the cartridge 940 further comprises a cartridge holding assembly 960 that is connected to the cartridge case 942. In various embodiments, the cartridge holding assembly 960 may be made of such rigid material as, for example, titanium, stainless steel, aluminum, any alloy of the previous materials, etc., and can be partially integrated into the housing of the cartridge 942. In various embodiments, the cartridge holding assembly 960 can be held in place, for example by film 954. In other embodiments, in which x limited use of a binder is desirable; cyanoacrylate can sporadically be used to “glue” the two components together. In other embodiments, the cartridge housing 942 may be heated and “welded” or “welded” to the cartridge holding assembly 960. In various embodiments, the cartridge holding assembly 960 forms at least a portion of the lower surface of the cartridge housing 942 for elongation the chute 14. In a preferred embodiment, the cartridge holding assembly 960 has one or more latch members 962 that protrudes therefrom for connection with the possibility of subsequently releasing the cartridge holding assembly 960 with elongated groove 14. For connection with the possibility of subsequent detachment of the node to hold the cartridge 960 with the elongated groove 14, other types of latch parts / fasteners may be used.

In various embodiments, the cartridge retainer assembly 960 comprises a series of support ribs 964, 966, 968, 970, 972, 974, 976 that are formed to provide some lateral support for the bases 924 of the brackets 922 in the brace sets 946, 948, 950, 952, as shown in FIG. 78. Thus, in at least some embodiments, the support ribs are substantially the same in length with the sets of brackets. FIG. 80 depicts an alternative embodiment of a cartridge with brackets 940 ', which is essentially identical to the cartridge 940 except for the attachment of the vertical ridge portions 978, 979, 980, 981, 982, 983 that protrude from the supporting ribs 964, 966, 968, 970, 972, 976, respectively, to provide additional lateral support for the brackets 922. In various embodiments, the ridge portions may be integrally formed with an assembly for holding the cartridge 960 and have a height that is approximately ½ or less of the height of the cartridge. Thus, in a preferred embodiment, for example, any standing parts that hold the foam cannot protrude above the maximum height of the foam in a compressed state. Thus, for example, if the cartridge is designed in such a way that when activated it compresses to 1/3 of its original height, the ridges will be about 66% of the height in an uncompressed state, and the entire depth will be up to 10% of the height in an uncompressed state.

As soon as the brackets 922 are formed in contact with the stop element 20 in the manner described above, during operation, the stop element 20 will be opened and the end clip 12 will be removed from the stitched fabrics. Since the end clamp 12 is removed from the stitched fabrics, the cartridge body 942 remains attached to the stitched fabric and then is separated from the cartridge holding assembly 960, which remains connected to the elongated groove 14. In various embodiments, the cartridge holding assembly 960 has a color that differs as from the color of the material that makes up the cartridge case 942, and from the color of the elongated trough 14. Such a device is an easily recognizable signal for the surgeon that at the moment there is no car in the end clamp ridge with brackets. Thus, the surgeon cannot accidentally try to re-insert / use the end clamp without first installing a new cartridge with brackets in it. To do this, the surgeon simply detaches the latch parts of the cartridge holding assembly 960 from the elongated groove 14 to use the cartridge holding assembly 960 with the newly inserted cartridge with brackets 940. Although the cartridge with brackets 940, 940 'has been described in connection with the surgical device 10, it should be understood that these cartridges can be effectively used with many other embodiments of the surgical apparatus that have been described herein, without departing from the essence and scope of the present invention.

FIG. 81 and 82 depict the use of an embodiment of a surgical apparatus 10 with an end clamp 990 that is substantially identical to the end clamp 12 described above except for the locking interlock 991 that is movably connected or otherwise held in the elongated groove 14. In various embodiments, the closing interlock 991 includes a locking link 992, which has a distal end 993 and a proximal end 994. The locking link 992 is pivotally connected to an elongated a chute by means of a pivoting element or trunnion 995. A leaf spring 996 or other biasing member is attached to the distal end portion to bias the locking link 992 into the activated, or locked, position in which the proximal end portion 994 engages with the distal end 141 of the first launching sleeve 141 for preventing distal displacement of the first launch cuff 140 to the “activated” position. However, after installing the cartridge with brackets 30 in the elongated groove 14, the cartridge with brackets 30 causes the blocking link 992 to move to an inactive or unlocked position so that the trigger collar 140 can be moved distally beyond the blocking link 992 to complete the activation process of the brackets . See FIG. 81.

In the locked position, the trigger cuff 140 cannot be moved distally to complete the activation process. In addition, the trigger device 130 cannot be moved to a fully activated position, in which the scalpel blocking plate 210 is moved to the unlocked position, thereby allowing the surgeon to extend the scalpel shaft 172. Thus, in the absence of a cartridge in the end clip 990, the closing blocking device 991 is in a locked position, which ultimately prevents the extension of the scalpel shaft 172. In this regard, the surgeon is not able to extend the scalpel shaft 172 to dissect the tissue and if there is no cartridge 30 in the end clip 990. It should be understood that the closure locking device 991 described above can be effectively integrated into the many embodiments of surgical devices that have been described herein without departing from the spirit and scope of the present invention.

In various embodiments, the implementation of the cartridge with brackets may include a cartridge body and a lot of brackets that are stored inside this cartridge case. During operation, the cartridge with brackets can be inserted into the surgical field and placed on the operated side of the tissue. In addition, the thrust element for forming brackets can be located on the opposite side of the fabric. In various embodiments, the thrust member can be held by the first jaw, and the cartridge with brackets can be held by the second jaw, while the first jaw and / or second jaw can be moved toward each other. As soon as the cartridge with brackets and the stop element are placed on the fabric, the brackets can be removed from the cartridge case with brackets so that the brackets can pierce the fabric and come closer to the stop element to form the brackets. After unfolding the brackets from the cartridge case with brackets, it can then be removed from the surgical field. In various embodiments described herein, a cartridge with brackets or at least a portion of the cartridge with brackets may be implanted together with brackets. In at least one such embodiment, which is described in more detail below, the cartridge with brackets may comprise a cartridge body that can be compressed, squeezed, and / or deformed by the stop member when the stop member moves from the open position to the closed position. When compressing, squeezing and / or deforming the cartridge case, the brackets that are located inside the cartridge case can be deformed by the stop element. Otherwise, the jaw holding the cartridge with brackets can be moved to the thrust element, which is in the closed position. Alternatively, in various embodiments, the brackets may be deformed while they are at least partially located inside the cartridge body. In some embodiments, the brackets may not be removed from the cartridge housing until, in some embodiments, the brackets are removed from the cartridge with brackets along with part of the cartridge housing.

Returning to FIG. 83A-83D, a compressible cartridge with brackets, such as a cartridge with brackets 1000, for example, may comprise a compressible implantable cartridge case 1010 and, in addition, a plurality of brackets 1020 located in the compressible cartridge case 1010, although in FIG. 83A-83D, only one bracket 1020 is shown. FIG. 83A depicts a cartridge with brackets 1000 held by a unit for holding a cartridge with brackets, or a groove for a cartridge with brackets, 1030, in which the cartridge with brackets 1000 is shown in an uncompressed state. In this uncompressed state, the abutment element 1040 may or may not come in contact with the fabric T. During operation, the abutment element 1040 can be moved from the open position to contact the fabric T, as shown in FIG. 83B, and the location of the fabric T opposite the cartridge body 1010. Even if the abutment member 1040 can position the fabric T against the surface for contacting the cartridge body fabric 1019 with brackets 1010, referring to FIG. 83B, it can be seen that the cartridge housing with brackets 1010 may be subjected to weak (if any) compressive force or pressure, while the brackets 1020 may remain in an unformed or inactive state. As shown in FIG. 83A and 83B, the cartridge housing with brackets 1010 may comprise one or more layers, and the legs of the brackets 1021 of the brackets 1020 may extend vertically through these layers. In various embodiments, the cartridge case 1010 may comprise a first layer 1011, a second layer 1012, and a third layer 1013, the second layer 1012 being located between the first layer 1011 and the third layer 1013 and the fourth layer 1014, the third layer 1013 being between a second layer 1012 and a fourth layer 1014. In at least one embodiment, the bases 1022 of the brackets 1020 can be located in the cavities 1015 in the fourth layer 1014, and the legs of the brackets 1021 can vertically extend from the bases 1022 and pass, for example, through the fourth layer 1014 , t ety layer 1013 and second layer 1012. In various embodiments, each deformable leg 1021 may comprise end, such as a pointed end 1023 which, for example, may be disposed in the second layer 1012, e.g., when the staple cartridge 1000 is in an uncompressed position. In at least one such embodiment, the ends 1023 may not protrude and / or penetrate the first layer 1011, while in at least one embodiment, the ends 1023 may not protrude through the surface for contacting the fabric 1019 to as long as the cartridge with brackets 1000 is in an uncompressed state. In some other embodiments, the sharp ends 1023 may be located in the third layer 1013 and / or any other layer when the cartridge with brackets is in an uncompressed state. In various alternative embodiments, the implementation of the cartridge housing with brackets may contain any suitable number of layers, for example, at least four layers or not more than four layers.

In various embodiments, which are described in more detail below, the first layer 1011 may consist of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGC), and the second layer 1012 may consist of bio-absorbable foam material and / or compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC). In various embodiments, one or more of the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 can hold the brackets 1020 in the body of the cartridge with brackets 1010 and, in addition, hold the brackets 1020 in a certain position to each other. In various embodiments, the third layer 1013 may consist of supporting material, sufficiently incompressible material, or inelastic material that can be configured to hold the legs 1021 of the brackets 1020 in a specific position 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 mobility of the brackets 1020, even if the second layer 1012 and the fourth layer 1014 will consist of compressible foam or elastic material. In some embodiments, the ends of the brackets 1023 of the legs of the brackets 1021 can be at least partially located 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 legs of the brackets 1021 in the set position. In at least one embodiment, the first layer 1011 and the third layer 1013 may consist of a biologically absorbable plastic sheet, such as, for example, polyglycolic acid (PGA), which is sold under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL) sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PHC, PLA, PDS, PHA, PGCL and / or PCL, for example, second layer 1012 and the fourth layer 1014 may consist of at least one hemostatic one material or substance.

Although the first layer 1011 can be compressible, the second layer 1012 can be substantially more compressible than the first layer 1011. For example, the second layer 1012 can be almost two times more compressible, almost three times more compressible, almost four times more compressible , almost five times more compressible, and / or almost ten times more compressible than, for example, the first layer 1011. In other words, when the force is applied, the second layer 1012 can be compressed almost two times, almost three times, almost three times four times, almost five times and / or almost ten times better than the first with loy 1011. In some embodiments, the second layer 1012 can be from about three times more compressible to about ten times more compressible than, for example, the third layer 1011. In at least one embodiment, the second layer 1012 can contain many air cavities moreover, the number and / or size of air cavities in the second layer 1012 can be controlled to provide the desired compressibility of the second layer 1012. Similarly to the above, although the third layer 1013 can be compressible, the fourth layer 1014 can be substantially more compressed washable than the third layer 1013. For example, the fourth layer 1014 can be almost two times more compressible, almost three times more compressible, almost four times more compressible, almost five times more compressible, and / or almost ten times more compressible than, for example, the third layer 1013. In other words, when the force is applied, the fourth layer 1012 can compress almost twice, almost three times, almost four times, almost five times and / or almost ten times better, than the third layer 1013. In some embodiments, the fourth layer 1014 may be from about two times more compressible to about ten times more compressible than, for example, the third layer 1013. In at least one embodiment, the fourth layer 1014 may contain many air cavities, and the number and / or size of the air cavities in the fourth layer 1014 may be monitored to provide the desired compressibility of the fourth layer 1014. Under various conditions, the compressibility of the cartridge body or the layer of the cartridge body can be expressed by the compression ratio, i.e. the distance that the layer compresses when a certain force is applied. For example, a layer having a high compression ratio will compress over a greater distance when a predetermined force is applied to it compared to a layer that has a lower compression ratio. As said, 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 than the third layer 1013. In various embodiments, the second layer 1012 and the fourth layer 1014 can consist of the same material and have the same compression ratio. In various embodiments, the second layer 1012 and the fourth layer 1014 may consist of materials with different degrees of compression. Similarly, the first layer 1011 and the third layer 1013 may consist of the same material and have the same compression ratio. In some embodiments, the first layer 1011 and the third layer 1013 may consist of materials with various compression ratios.

While the stop member 1040 is moved to the closed position, the stop member 1040 may come into contact with the fabric T to exert a compressive force on the fabric T and the cartridge with brackets 1000, as shown in FIG. 83C. Under such conditions, the abutment element 1040 can extend the upper surface, or the fabric contact surface, 1019 of the cartridge case 1010 down to the cartridge holding assembly 1030. In various embodiments, the cartridge holding assembly 1030 may comprise a supporting surface of the cartridge 1031, which can be configured for holding the cartridge with brackets 1000 so that the cartridge with brackets 1000 is compressed between the bearing surface of the cartridge 1031 and the surface for contact with the fabric 1041 of the stop element 1040. Sun by applying pressure with the stop element 1040, the cartridge case 1010 can be compressed and the stop element 1040 can come into contact with the brackets 1020. More specifically, in various embodiments, the compression of the cartridge case 1010 and the downward movement of the surface to come in contact with the fabric 1019 can result in that the ends 1023 of the legs of the brackets 1021 can pierce the first layer 1011 of the cartridge case 1010, pierce the fabric T and enter the molding recesses 1042 of the stop element 1040. Since the cartridge case 1010 is then compressed by the stop element 1040, the ends 1023 can they can come into contact with the walls corresponding to the molding recesses 1042, as a result of which the legs 1021 can be deformed or bent from the inside, for example, as shown in FIG. 83C. After deformation of the legs of the brackets 1021, also shown in FIG. 83C, the bases 1022 of the brackets 1020 may be contacted or supported by the cartridge holding assembly with brackets 1030. In various embodiments, as described in more detail below, the cartridge holding assembly with brackets 1030 may comprise a plurality of supporting parts, such as rotational grooves, grooves to hold the brackets or slots 1032, which, for example, can be configured to hold the brackets 1020 or at least the bases 1022 of the brackets 1020 after the brackets 1020 have been deformed. As also shown in FIG. 83C, cavities 1015 in the fourth layer 1014 may be compressed by applying compressive force to the cartridge body with brackets 1010. In addition to the cavities 1015, one or more air cavities, such as cavity 1016, which, for example, it may or may not contain a portion of the bracket located in the body of the cartridge, as well as compressing the housing of the cartridge 1010. In various embodiments, the cavities 1015 and / or the air cavities 1016 can be configured to compress in this way then the walls forming the cavity and / or the walls deflecting downward, which are in contact with the bearing surface of the cartridge 1031 and / or are in contact with the layer of the housing of the cartridge 1010, are located under the cavities and / or air cavities.

When comparing FIG. 83B and FIG. 83C, it will be appreciated that the second layer 1012 and the fourth layer 1014 are substantially compressed by applying a compressive force by the abutment member 1040. It can also be noted that the first layer 1011 and the third layer 1013 have also been compressed. When the stop element 1040 is moved to the closed position, the stop element 1040 can continue to further compress the cartridge body 1010 by extending the contact surface of the fabric 1019 down to the cartridge holding assembly 1030. Since the cartridge case 1010 is further compressed, the stop element 1040 may deform the brackets 1020 to give him fully formed view depicted in FIG. 83D. Returning to FIG. 83D, the legs 1021 of each bracket 1020 can be deformed when moving down to the base 1022 of each bracket 1020 to grip a piece of fabric T, a first layer 1011, a second layer 1012, a third layer 1013 and a fourth layer 1014 between the deformable legs 1021 and the base 1022. When comparing FIG. 83C and FIG. 83D, it will be appreciated that the second layer 1012 and the fourth layer 1014 were substantially further compressed by applying a compressive force using the abutment member 1040. When comparing FIG. 83C and 83D, it can also be noted that the first layer 1011 and the third layer 1013 were also further compressed. After the brackets 1020 have been completely or at least partially formed, the abutment element 1040 can be pulled away from the fabric T, after which the cartridge holding unit with brackets 1030 can be removed and / or disconnected from the cartridge with brackets 1000. How depicted in FIG. 83D, as a result of the above, the housing of the cartridge 1010 can be implanted together with brackets 1020. Under various circumstances, the implantable housing of the cartridge 1010 can hold the fabric along with the staple seam. Under various circumstances, a hemostatic substance and / or other suitable drug that is contained in the implantable body of cartridge 1010 may act on the tissue for some time. The hemostatic agent mentioned above can reduce bleeding from stitched and / or dissected tissue, while a binder or tissue adhesive can provide tissue strength for some time. The implantable cartridge case 1010 may consist of materials such as ORC (oxidized regenerated cellulose), a protein matrix, polyglycolic acid (PGA) sold under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglecaprone 25 (PGCL) sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PGC, PLA, PDS, PHA, PGCL and / or PCL. In some circumstances, the cartridge case 1010 may contain an antibiotic and / or antimicrobial material, such as, for example, colloidal silver and / or triclosan, which can reduce the likelihood of infection of the surgical field.

In various embodiments, the implementation of the layers of the housing of the cartridge 1010 can be connected to each other. In at least one embodiment, the second layer 1012 can be glued to the first layer 1011, the third layer 1013 can be glued to the second layer 1012, and the fourth layer 1014 can be glued to the third layer 1013 using at least one an adhesive, such as, for example, fibrin and / or protein hydrogel. In some embodiments, although not shown, the layers of the cartridge body 1010 may be connected to each other using mechanical coupling devices. In at least one such embodiment, the first layer 1011 and the second layer 1012 may comprise suitable connecting devices, such as, for example, protrusions and grooves of a gear connection and / or dovetail connection. Similarly, the second layer 1012 and the third layer 1013 may contain the respective connecting devices, while the third layer 1013 and the fourth layer 1014 may contain the corresponding connecting devices. In some embodiments, although not shown, the cartridge with brackets 1000 may comprise one or more rivets, which, for example, may extend through one or more layers of the cartridge body 1010. In at least one embodiment, each rivet may comprise a first end, or a head, located near the first layer 1011, and a second head, located near the fourth layer 1014, which can either be connected or formed at the second end of the rivet. In at least one embodiment, due to the compressive properties of the cartridge case 1010, rivets can compress the cartridge case 1010 in such a way that the rivet heads can, for example, be immersed relative to the surface to come in contact with fabric 1019 and / or bottom surface 1018 cartridge housing 1010. In at least one embodiment, the rivet may be comprised of biologically absorbable materials, such as polyglycolic acid (PGA), sold under the trade name Vicryl, according to lactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL), sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PGA, PLA, PDS, PHA, PGCL and / or PKL. In some embodiments, the implementation of the layers of the housing of the cartridge 1010 may not be connected to each other in any way other than using the brackets 1020 contained therein. In at least one such embodiment, friction coupling between the legs of the brackets 1021 of the cartridge housing 1010, for example, can hold the layers of the cartridge case 1010 together, and immediately after the brackets are formed, the layers can be gripped by the brackets 1020. In some embodiments, at least a portion of the legs of the brackets 1021 may comprise a rough surface or a lumpy coating that can increase the frictional force between the brackets 1020 and the cartridge case 1010.

As described above, the surgical device may comprise a first jaw containing an assembly for holding the cartridge with brackets 1030, and a second jaw containing the stop member 1040. In various embodiments, which are described in more detail below, the cartridge with brackets 1000 may comprise one or more a holding device that can be configured to engage the assembly for holding the cartridge with brackets 1030 to provide retention with the possibility of subsequent detachment of the cartridge with brackets 1000 using the assembly to hold the cartridge with brackets 1030. In some embodiments, the cartridge with brackets 1000 may be glued to the assembly for holding the cartridge with brackets 1030 using at least one adhesive, such as, for example, fibrin or protein hydrogel. When operating in at least one environment, in particular under laparoscopic and / or endoscopic surgery, the second jaw can be moved to the closed position relative to the first jaw, for example, so that the first and second jaws can be inserted through the trocar into the operating room field. In at least one such embodiment, the trocar may comprise an opening or cannula with a diameter of about 5 mm through which the first and second branches can be inserted. In some embodiments, the second jaw can be moved to a partially closed position that is intermediate between the open position and the closed position, which allows the first and second jaws to be inserted through the trocar without deforming the brackets 1020 contained in the cartridge body with brackets 1010. At least one such embodiment, the thrust member 1040 may not apply compressive force to the cartridge housing with brackets 1010 when the second jaw is in an intermediate partially closed position, while As in some embodiments, the thrust member 1040 may compress the cartridge body with brackets 1010 when the second jaw is in an intermediate partially closed position. Even if the stop element 1040 can compress the cartridge case with brackets 1010 when it is in such an intermediate position, the stop element 1040 will not significantly compress the cartridge case with brackets 1010, because the stop element 1040 contacts the brackets 1020 and / or so that the brackets 1020 are deformed by the stop element 1040. As soon as the first and second branches are inserted through the trocar into the surgical field, the second branch can be opened again, and the stop element 1040 and the cartridge with brackets 1000 can be placed relative to the target Kani manner described above.

In various embodiments, referring to FIG. 84A-84D, the end clamp of the surgical stapler may include an implantable cartridge with brackets 1100 that is located between the stop element 1140 and the cartridge holding assembly with brackets 1130. Similar to the above, the stop element 1140 may comprise a tissue contact surface 1141, the cartridge with the brackets 1100 may comprise a surface for contacting the fabric 1119, and the cartridge holding assembly with brackets 1130 may comprise a bearing surface 1131 that may be configured to hold the cartridge IJ with brackets 1100. Returning to FIG. 84A, the abutment member 1140 can be used to position the fabric T against the surface for contacting the cartridge fabric 1119 with the brackets 1100 without deforming the cartridge with the brackets 1100, and when the abutment element 1140 is in this position, the contact surface with the fabric 1141 can be spaced apart 1101a from the bearing surface of the cartridge with brackets 1131, and the surface for contact with the fabric 1119 may be located 1102a from the bearing surface of the cartridge with brackets 1131. After that, the stop element 1140 placed to the node for holding the cartridge with brackets 1130 and, in accordance with FIG. 84B, the abutment member 1140 biases the upper surface, or tissue contact surface 1119 of the cartridge with brackets 1100 down, and compresses the first layer 1111 and the second layer 1112 of the cartridge body 1110. After compression of the layers 1111 and 1112, in accordance with FIG. 84B, the second layer 1112 can also be compressed, and the legs 1121 of the brackets 1120 can pierce the first layer 1111 and enter tissue T. In at least one such embodiment, the brackets 1120 can be at least partially located inside the cavities for brackets, or air cavities, 1115 in the second layer 1112, and when the second layer 1112 is compressed, the cavities for the brackets 1115 can also be compressed, which ultimately allows the second layer 1112 to be compressed around the brackets 1120. In various embodiments, the second layer 1112 may contain cover parts 1116 that may protrude above the cavities for the brackets 1115 and surround, or at least partially surround, the cavities for the brackets 1115. FIG. 84B depicts cover portions 1116 that have been pressed downward into the cavity for brackets 1115. In some embodiments, the second layer 1112 may comprise one or more weakened portions that may facilitate compression of the second layer 1112. In various embodiments, such weakened portions may comprise, for example , scuff marks, perforations, and / or thin transverse notches that may facilitate controlled compression of the cartridge body 1110. In at least one embodiment, the first layer 1111 may comprise squeeze one or more weakened parts, which can facilitate the passage of the legs of the brackets 1121 through the first layer 1111. In various embodiments, the implementation of such weakened parts may contain, for example, marks of scoring, perforations and / or thin transverse notches that can be located on one axis or at least partially on the same axis as the legs of the brackets 1121.

When the abutment element 1140 is in a partially closed, or inactive, position, in accordance with FIG. 84A, the abutment member 1140 may be at a distance 1101a from the bearing surface of the cartridge with brackets 1131 such that a gap is formed between them. This gap can be filled with a cartridge with brackets 1100 having the height of the cartridge with brackets 1102a and fabric T. Since the abutment element 1140 moves downward to compress the cartridge with brackets 1100, in accordance with FIG. 84B, the distance between the surface for contacting the fabric 1141 and the bearing surface of the cartridge 1131 may be determined by a distance 1101b, which is less than the distance 1101a. Under various conditions, the gap between the surface for contact with the fabric 1141 of the abutment element 1140 and the bearing surface of the cartridge 1131 is determined by the distance 1101b, which may exceed the original height of the undeformed cartridge with brackets 1102a. Since the abutment element 1140 is located near the bearing surface of the cartridge 1131, then, in accordance with FIG. 84C, the second layer 1112 may continue to contract, and the distance between the legs of the brackets 1121 and the forming recesses 1142 may decrease. Similarly, the distance between the contact surface of the fabric 1141 and the bearing surface of the cartridge 1131 may decrease by a distance 1101c, which in various embodiments may be greater, equal to, or less than the original height of the undeformed cartridge with brackets 1102a. Returning to FIG. 84D, the abutment member 1140 may be moved to the resulting, or activated, position in which the brackets 1120 are fully formed or at least formed to obtain the desired height. In this position, the contact surface with the fabric 1141 of the abutment member 1140 may be at a distance 1101d from the bearing surface of the cartridge 1131, while the distance 1101d may be less than the original height of the undeformed cartridge with brackets 1102a. As also shown in FIG. 84D, the cavities for the brackets 1115 can be fully or at least partially compressed, and the brackets 1120 can be completely or at least partially surrounded by a compressed second layer 1112. Under various circumstances, the abutment element 1140 can then be removed from the cartridge with brackets 1100. As soon as the stop element 1140 has been disconnected from the cartridge with brackets 1100, the housing of the cartridge 1110 can be at least partially re-enlarged in different sections, for example, in the sections between adjacent brackets 1120. B, by less m Here, in one embodiment, the cartridge housing 1110 may not regain its shape due to elasticity. In various embodiments, the molded brackets 1120 and, in addition, the cartridge body 1110, which is located between adjacent brackets 1120, can exert pressure or compressive forces on tissue T, which can provide various beneficial therapeutic effects.

As mentioned above with reference to the embodiment depicted in FIG. 84A, each bracket 1120 may comprise protruding legs of the bracket 1121. Although the brackets 1120 are shown as brackets with two legs 1121, various brackets may be used that may have one bracket leg or, in other cases, more than two bracket legs, for example three brace legs or four brace legs. As depicted in FIG. 84A, each leg of the bracket 1121 can be immersed in the second layer 1112 of the cartridge body 1110 so that the brackets 1120 are fixed in the second layer 1112. In various embodiments, the brackets 1120 can be inserted into the cavity for the brackets 1115 in the body of the cartridge 1110 so that the ends 1123 of the legs of the brackets 1121 enter the cavities 1115 in front of the bases 1122. After the ends 1123 have been inserted into the cavities 1115, in various embodiments, the ends 1123 can be pressed into the cover parts 1116 and crash into the second layer 1112. In various embodiments osuschest The brackets 1120 can be immersed to a substantial depth in the second layer 1112 so that the brackets 1120 do not move or at least essentially do not move relative to the second layer 1112. In some embodiments, the brackets 1120 can be immersed to a significant depth in the second layer 1112 such that the bases 1122 cannot be placed or immersed in the cavities for the brackets 1115. In other various embodiments, the bases 1122 may not be placed or immersed in the second layer 1112. In some embodiments, the implementation eniya, in accordance with FIG. 84A, the bases 1122 may protrude from the lower surface 1118 of the cartridge body 1110. In some embodiments, the bases 1122 may rest or lie directly opposite the bearing surface of the cartridge 1130. In various embodiments, supporting parts may protrude and / or form supporting parts, in which, in at least one such embodiment, the bases 1122 of the brackets 1120 can be located inside and thereby be held in one or more, for example, supporting present the recess rotatably recess or slot 1132 in the node for retaining the staple cartridge 1130, as described in more detail below.

In addition to the above, returning to FIG. 85, the bases 1122 of the brackets 1120 may be located directly opposite the bearing surface of the cartridge 1131 of the cartridge holding assembly 1131. In various embodiments, including embodiments in which the bases of the brackets 1122 have rounded or curved lower surfaces 1124, for example, the bases of the brackets 1122 may move or slide along the bearing surface of the cartridge with brackets 1131. Such sliding can occur if the stop element 1140 is pressed against the ends 1123 of the legs of the brackets 1121 during the process ormovaniya brackets. In some embodiments, implementation, as described above and in accordance with FIG. 86, the cartridge holding assembly with brackets 1130 may comprise one or more retaining grooves 1132, which may be configured to eliminate or at least reduce the relative mobility between the bases of the brackets 1122 and the bearing surface of the cartridge with brackets 1131. At least , in one such embodiment, the surface of each retaining groove 1132 may be indicated by a contour that matches or at least substantially matches the contour of the bottom surface of the bracket therein. For example, the lower surface 1124 of the base 1122 shown in FIG. 86 has a circular or at least substantially circular shape, and the surface of the retaining groove 1132 may also have a circular or substantially circular shape. In at least one such embodiment, the surface of the groove 1132 may be limited by a radius of curvature that is greater than or equal to the radius of curvature that defines the lower surface 1124. Although the grooves 1132 can be used to prevent or reduce the relative sliding movement that occurs between the brackets 1120 and by the cartridge holding unit with brackets 1130, the grooves 1132 can also be configured to prevent or reduce the relative rotational movement that occurs between the brackets 1120 and the unit for holding the cartridge with brackets 1130. More specifically, in at least one embodiment, the grooves 1132 can be configured to closely contact the bases 1122 to prevent or reduce the rotation of the brackets 1120 around the axes 1129, for example, so that the brackets 1120 do not rotated or twisted during deformation.

In various embodiments, in addition to the foregoing, each bracket 1120 may be formed from a round or substantially round wire. In some embodiments, the legs and base of each bracket may be formed of a wire that has a non-circular cross section, such as, for example, a rectangular cross section. In at least one such embodiment, the cartridge holding assembly with brackets 1130 comprises corresponding non-circular grooves, such as, for example, rectangular grooves that are configured to connect to the bases of such brackets. In various embodiments, returning to FIG. 87, each bracket 1120 may include a cap, such as, for example, a cap 1125 that has been injection molded on the base 1122, with each cap 1125 being located in a retaining groove in the cartridge holding unit with brackets 1130. At least , in one embodiment, each cap 1125 may have a square and / or rectangular cross section, which, for example, can be configured to hold in square and / or rectangular grooves 1134, for example, in a node for holding the cartridge with brackets 1130. In various In embodiments, the caps 1125 may consist of a biologically absorbable plastic, such as polyglycolic acid (PGA) sold under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL) ) sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PGC, PLA, PDS, PHA, PGCL and / or PCL, and can be formed around the bases 1122 of the brackets 1120, for example, using an injection molding process. Various caps and methods for forming various caps are described in US Patent Application Ser. No. 11/541123 entitled "SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME", filed September 29, 2006, which is hereby incorporated by reference in its entirety. Returning to FIG. 87, the grooves 1134 may further comprise guiding parts, or inclined surfaces, 1135, which can be configured to facilitate insertion of the caps 1125 into the grooves 1134. In various embodiments, the base and / or caps of the brackets 1120 can be located in the grooves 1134 when the cartridge has the brackets 1100 is connected to the cartridge holding assembly with brackets 1130. In some embodiments, the caps 1125 of the brackets 1120 may be aligned with grooves 1134 when the cartridge with brackets 1100 is connected to the cartridge holding assembly with brackets 1130. In at least one such embodiment, the caps 1125 may not fit into the grooves 1134 until the compressive force exerted on the legs of the brackets 1121, the bases and / or caps of the brackets 1120, push them down into these grooves 1134.

In various embodiments, returning to FIG. 88 and 89, a cartridge with brackets 1200, for example, may comprise a compressible implantable cartridge case 1210 that has an outer layer 1211 and an inner layer 1212. Similarly to the above, the cartridge with brackets 1200 may comprise a plurality of brackets 1220 located in the body of the cartridge 1210. In various In embodiments, each bracket 1220 may comprise a base 1222 and one or more protruding legs of the bracket 1221. In at least one such embodiment, the legs of the bracket 1221 can be inserted into the inner layer 1212 and immersed in to a depth at which the base 1222 of brackets 1220, e.g., borders and / or are nearest to the bottom surface 1218 of the inner layer 1212. In the embodiment depicted in FIG. 88 and 89, the inner layer 1212 does not contain cavities for the brackets configured to immerse part of the brackets 1220 therein, while in other embodiments, the inner layer 1212 may contain such cavities for the brackets. In various embodiments, in addition to the foregoing, the inner layer 1212 may consist of a compressible material, such as, for example, biologically absorbable foam and / or oxidized regenerated cellulose (“ORC”), which can compress the cartridge housing 1210 when attached to it compressive load. In various embodiments, the inner layer 1212 may consist of a lyophilized foam containing, for example, polylactic acid (PLA) and / or polyglycolic acid (PGA). ORCs may be commercially available under the trade name Surgicel and include loose woven fabric (like a surgical sponge), a loose fabric (like a cotton swab) and / or foam. In at least one embodiment, the inner layer 1212 may consist of a material containing or coated with drugs such as, for example, lyophilized thrombin and / or fibrin, which can be activated, for example, in the presence of water or body fluids in the patient's body. In at least one such embodiment, lyophilized thrombin and / or fibrin can be retained, for example, in a matrix of Vikril (PGA). In some circumstances, however, activated drugs may be activated accidentally when a cartridge with brackets 1200, for example, is inserted into the surgical field in the patient’s body. In various embodiments, returning to FIG. 88 and 89, the outer layer 1211 may consist of a waterproof or at least substantially waterproof material, so that the liquids do not contact or at least substantially do not contact the inner layer 1212 until the cartridge case 1210 will be compressed, and the legs of the brackets will not pierce the outer layer 1211, and / or the outer layer 1211 will not be dissected in any way. In various embodiments, the outer layer 1211 may consist of a support material and / or plastic material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGC). In some embodiments, the outer layer 1211 may comprise a winding that surrounds the inner layer 1212 and the brackets 1220. More specifically, in at least one embodiment, the brackets 1220 can be inserted and then immersed in the inner layer 1212, and the outer layer 1211 can be wound around a nodal assembly consisting of an inner layer 1212 and brackets 1220.

In various embodiments, returning to FIG. 90 and 91, a cartridge with brackets, such as a cartridge with brackets 1300, for example, may comprise a compressible implantable cartridge case 1310 that has an outer layer 1311 and an inner layer 1312. Similarly to the above, the cartridge with brackets 1300 may further comprise brackets 1320 located in the body of the cartridge 1310, while each bracket 1320 may contain a base 1322 and one or more protruding legs of the bracket 1321. Like a cartridge with brackets 1200, the bases 1322 of the brackets 1320 can protrude below the bottom surface 1318 of the inner 1312, and the outer layer 1311 can surround the bases 1322. In at least one such embodiment, the outer layer 1311 can be substantially so flexible that it covers each base of the bracket 1322 so that the outer layer 1311 matches the outline of the bases 1322 In at least one alternative embodiment, returning to FIG. 89, the outer layer 1211 can be substantially so rigid that it protrudes around the bases 1222 without matching each base 222. In any case, in various embodiments, the outer layer 1311 can be located between the bases 1322 of the brackets 1320 and, for example, the bearing surfaces of the cartridge with brackets 1031 or 1131 that hold the cartridge with brackets 1300. In at least one such embodiment, the outer layer 1311 may be located between the bases 1322 and retaining grooves, such as, for example, grooves 1032 or 1132, azovannye airfoil in the staple cartridge. In at least one such embodiment, in addition to the foregoing, the outer layer 1311 may be configured to limit the mobility of the bases 1322 and / or increase the coefficient of friction between the bases 1322 and the bearing surface of the cartridge with brackets and / or retaining grooves to reduce them relative mobility relative to each other. In various alternative embodiments, returning to FIG. 92 and 93, the outer layer of the cartridge with brackets, such as, for example, the cartridge with brackets 1400, may not completely surround the brackets located therein. In at least one such embodiment, the outer layer 1411 of the compressible implantable cartridge case 1410 may be connected to the inner layer 1412 before the legs of the brackets 1421 of the brackets 1420 are inserted into the cartridge case 1410. As a result of the above, the base 1422 of the brackets 1420 may protrude from the outer layer, 1411 and, in at least one such embodiment, the bases 1422 can be located, for example, directly in the retaining grooves 1032 or 1132 of the bearing surfaces of the cartridge with brackets 1031 or 1131. In various embodiments, the brackets 1421 feet may dissect the outer layer 1411 when they are inserted. In various circumstances, the holes created by the legs of the brackets 1421 can closely surround the legs of the brackets 1421 so that a very small, if any, amount of liquid can seep between the legs of the brackets 1421, and the outer layer 1411 reduces the likelihood or prevents premature activation or leakage of the drug, contained in the body of the cartridge with brackets 1410, from the cartridge body 1410.

As discussed above, returning to FIG. 88 and 89, the legs 1221 of the brackets 1220 may be integrated into the cartridge housing 1210, and the bases 1222 of the brackets 1220 may protrude outward from the lower surface 1218 of the inner layer 1212. In various embodiments, in addition to the above, the inner layer 1212 may not contain a cavity for brackets that are configured to hold brackets 1220. In other various embodiments, returning to FIG. 94 and 95, the cartridge with brackets 1500, for example, may include a compressible implantable cartridge case 1510 containing cavities for brackets 1515 that can be configured to hold at least part of the brackets 1520. In at least one such embodiment the upper part of the legs of the brackets 1521 of the brackets 1520 can be embedded in the inner layer 1512, while the lower part of the legs of the brackets 1521 and their bases 1522 can be located in the cavity for the brackets 1515. In some embodiments, the implementation of the base 1522 may be entirely in brackets for brackets 1515, while in some embodiments, the base 1522 may at least partially protrude below the bottom surface 1518 of the inner layer 1512. Similarly, the outer layer 1511 can surround the inner layer 1512 with brackets 1520 located therein. some other embodiments, returning to FIG. 96, the cartridge with brackets 1600 may include brackets 1620 located in the cavity for brackets 1615 in the compressible implantable body of the cartridge 1610, while at least part of the brackets 1620 is not surrounded by the outer layer 1611. In at least one such In an embodiment, each bracket 1620 may comprise legs of brackets 1621 that are at least partially embedded in the inner layer 1612, and furthermore, a base 1622 that protrudes outward from the outer layer 1611.

In various embodiments, returning to FIG. 97 and 98, a cartridge with brackets, such as, for example, a cartridge with brackets 1700, may comprise a compressible implantable cartridge case 1710 and a plurality of brackets 1720 that are at least partially located in the cartridge case 1710. The cartridge case 1710 may include an outer layer 1711, the inner layer 1712, and, in addition, the alignment substrate 1740, which can be configured to align and / or hold the brackets 1720 in a certain position in the body of the cartridge 1710. In at least one embodiment, the inner layer 1712 may contain squeeze the recess 1741, which can be configured to hold the alignment substrate 1740. In various embodiments, the implementation of the alignment substrate 1140 can be pressed into the recess 1741 and / or other suitable way is fixed in the inner layer 1712, for example, using at least one adhesive agents such as fibrin and / or protein hydrogel. In at least one embodiment, the recess 1741 may be configured such that the lower surface 1742 of the alignment substrate 1740 is aligned or at least substantially coaxial with the lower surface 1718 of the inner layer 1712. In some embodiments, the lower surface 1742 of the alignment substrate may be deepened and / or protrude relative to the bottom surface 1718 of the second layer 1712. In various embodiments, each bracket 1720 may include a base 1722 and one or more legs 1721 protruding and the base 1722, and at least a portion of the legs of the brackets 1721 may protrude through the leveling substrate 1740. The leveling substrate 1740 may further comprise, for example, a plurality of protruding holes and / or grooves that can be configured to hold the legs of the brackets 1721. B, by in at least one such embodiment, each hole may be configured to tightly hold the leg of the bracket 1721 to provide a small, if any, relative mobility of the leg of the bracket 1721 relative to the side walls ok holes. In some embodiments, the openings of the alignment substrate may not completely extend beyond the alignment substrate 1740, and for the legs of the brackets 1721 to pass through the alignment substrate 1740, dissection of this substrate may be required.

In various embodiments, the alignment substrate 1740 may consist of a molded plastic body, which in at least one embodiment may be more rigid or less compressible than the inner layer 1712 and / or the outer layer 1711. In at least one In such an embodiment, the leveling substrate 1740 may consist of a plastic material and / or any other suitable material, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In some embodiments, the implementation of the alignment substrate 1740 may be connected to the inner layer 1712 before the legs of the brackets 1721 will be inserted through the alignment substrate 1740 and embedded in the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment substrate 1740 may contain, for example, one or more rotatable groove, groove or slot that can be configured to at least partially support the bases 1722 of the brackets 1720. Similarly to the above, the outer layer 1711 can then t be located around a nodal assembly comprising an outer layer 1712, a leveling substrate 1740 and brackets 1720. Alternatively, an outer layer 1711 can be placed around a nodal assembly containing an inner layer 1712 and a leveling substrate 1740, whereby the brackets 1720 can then be inserted through the outer a layer 1711, a leveling substrate 1740 and an inner layer 1712. In any case, due to the above-described inner layer 1712, a leveling substrate 1740 and / or an outer layer 1711 can be configured to hold the brackets 1720 in a specific position until and / or after they are deformed stop member in the manner described above. In at least one such embodiment, the alignment substrate 1740 can serve to hold the brackets 1720 in place before the cartridge with brackets 1700 is implanted in the patient, and, in addition, it strengthens the tissue around the bracket seam after implantation of the cartridge with brackets 1700. In at least one embodiment, the brackets 1720 can be fixed to the leveling substrate 1740 without immersion, for example, in the inner layer 1712 and / or the outer layer 1711.

In various embodiments, returning to FIG. 99-105, a cartridge with brackets, such as a cartridge with brackets 1800, for example, can be included in the assembly 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 into the outer layer 1811. Referring mainly to FIG. 99, the compressible inner layer 1812 is shown with a plurality of parenthesis cavities 1815 disposed therein, although other embodiments are provided in which the inner layer 1812 does not include parenthesis cavities, as described above. Returning to FIG. 100, a compressible inner layer 1812 may be located between the transfer plate 1850 and the carrier plate 1860, and is compressed between their compression surfaces 1852 and 1862, respectively. As depicted in FIG. 100, the upper and lower surfaces of the inner layer 1812 can be pressed against each other, and in response to this, the inner layer 1812 can protrude outward in the lateral directions. In some embodiments, the inner layer 1812 may be compressed to a height that is approximately one third of the original height, for example, and may have a height or thickness, such as from about 1.52 mm (0.06 inches) to about 2.03 mm (0.08 inches) in a compressed state. As also shown in FIG. 100, the transfer plate 1850 may further comprise a plurality of brackets, such as, for example, brackets 1820 located in a plurality of holes for the brackets 1853. In addition, the transfer plate 1850 may further comprise a plurality of guides 1851, which may be configured to extend the brackets 1820 upward from holes for brackets 1853. Returning to FIG. 101, the guides 1851 can be used to extend the legs of the brackets 1821 of the brackets 1820 in depth and through a compressible inner layer 1812. In various embodiments, the guides 1851 can be configured so that their upper surfaces are flush or at least almost flush with the compressive surface 1852 of the transfer plate 1850, when the brackets 1820 are fully deployed in the holes for the brackets 1853 of the transfer plate 1850. In some embodiments, also shown in FIG. 101, the carrier plate 1860 may comprise a plurality of retaining holes 1861 that can be configured to hold the legs of the brackets 1821 or at least the ends of the legs of the brackets 1821 after they have been moved through the inner layer 1812. The holding holes 1861 and the like can be necessary in embodiments in which the inner layer 1812 is compressed to a height that is less than the height of the brackets 1820, and thus, when the brackets 1820 are completely removed from the holes for the brackets 1853, the legs of the brackets 1821 may protrude from the top overhnosti compressible inner layer 1812. In certain other embodiments, the inner layer 1812 may be compressed to a height which is greater than the height of the brackets 1820, and as a consequence, the need for retaining holes 1861 in the carrier plate 1860 is absent.

After the introduction of the brackets 1820 into the inner layer 1812, in accordance with FIG. 102, the carrier plate 1860 may be removed from the transfer plate 1850 to reduce pressure on the inner layer 1812. In some circumstances, the inner layer 1812 may resiliently restore its shape to its original or at least almost original height in an uncompressed state. Since the inner layer 1812 can restore its shape, the height of the inner layer 1812 can increase so that it exceeds the height of the brackets 1820, and therefore the legs of the brackets 1821 of the brackets 1820 will no longer protrude from the upper surface of the inner layer 1812. In various circumstances, the holding holes 1861 may be configured to hold the legs of the brackets 1821 in a certain position, at least until the carrier plate 1860 is essentially retracted so that the legs 1821 will no longer have I'm holding holes 1861. In these circumstances, the holding holes 1861 can be used to maintain the relative alignment of staples 1820 in the inner layer 1812 in view of its ability to recover form. In various circumstances, the inner layer 1812 and the brackets 1820 located therein may comprise a nodal assembly 1801, which, in accordance with FIG. 103 may be inserted, for example, into the outer layer 1811. In at least one such embodiment, the outer layer 1811 may comprise a cavity 1802 that is configured to hold the assembly 1801 therein. In various circumstances, an instrument such as, for example , pincers 1855, can be used to tension the outer layer 1811 to the nodal assembly 1801. After the nodal assembly 1801 has been substantially located in the outer layer 1811, in accordance with FIG. 104, the outer layer 1811 may be sealed. In various embodiments, the outer layer 1811 may be sealed by applying heat energy to a portion thereof. More specifically, in at least one embodiment, the outer layer 1811 may consist of a plastic material, wherein the open end of the outer layer 1811 may be fused using one or more heating elements, or iron, 1856 to adhere and / or seal the perimeter the open end of the outer layer 1811. In at least one such embodiment, returning to FIG. 105, the excess portion 1857 of the outer layer 1811 can be removed, and then the cartridge with brackets 1800 can be used in the manner described here.

As described above, the cartridge with brackets may be located and / or fixed in the connecting part of the cartridge with brackets. In various embodiments, returning to FIG. 106 and 107, the connecting portion of the cartridge with brackets may include a groove for the cartridge with brackets, such as, for example, a groove for the cartridge with brackets 1930, which may be configured to hold at least a portion of the cartridge with brackets, such as, for example cartridge with brackets 1900. In at least one embodiment, the groove for the cartridge with brackets 1930 may include a lower bearing surface 1931, a first side bearing wall 1940 and a second side bearing wall 1941. During operation, the cartridge with brackets 1900 may can be located in the cartridge groove with brackets 1930 so that the cartridge with brackets 1900 is located opposite and / or near the lower bearing surface 1931 and between the first side bearing wall 1940 and the second side bearing wall 1941. In some embodiments, the first side bearing wall 1940 and the second side bearing wall 1941 may limit the lateral gap between them. In at least one such embodiment, the cartridge with brackets 1900 may have a lateral width 1903 that is the same and / or wider than the side gap defined by the bearing walls 1940 and 1941 so that the compressible implantable housing of the cartridge cartridge 1910 with brackets 1900 is held tightly between the walls 1940 and 1941. In some other embodiments, the lateral width 1903 of the cartridge with brackets 1900 may be less than the gap defined by the first and second side load-bearing walls 1940 and 1941. In various embodiments, at least a portion of the walls 1940 and 1941 and the lower bearing surface 1931 may be limited by a stamped metal trough, while in at least one embodiment, at least a portion of the side bearing wall 1940 and / or the side bearing wall 1941 may consist of a flexible material, such as, for example, an elastomeric material. Returning mainly to FIG. 106, the first side wall 1940 and the second side wall 1941 of the cartridge groove with brackets 1930 may consist of a rigid portion 1933 protruding upward from a lower bearing surface 1931, and a flexible portion 1934 protruding upwardly from the rigid portions 1933.

In various embodiments, in addition to the foregoing, the cartridge body 1910 of the cartridge with brackets 1900 may consist of one or more compressible layers, such as, for example, the first layer 1911 and the second layer 1912. When the cartridge body 1910 is compressed by the lower bearing surface 1931 by thrust element as described above, the side parts of the housing of the cartridge 1910 may protrude laterally. In embodiments in which the cartridge with brackets 1930 contains rigid side walls, lateral expansion of the cartridge body 1910 may be prevented or at least limited by rigid side walls, whereby significant internal pressure or internal stress may develop in the body of the cartridge 1910. In embodiments in which at least a portion of the cartridge with brackets 1930 includes flexible side walls, the flexible side walls can be adapted to deform laterally and allow lateral expansion of the side portions of the cartridge housing 1910, thereby reducing internal pressure or stress generated in the body of the cartridge 1910. In embodiments where the cartridge chute does not contain lateral side walls or contains lateral side walls that are relatively shorter than the cartridge with brackets, side portions of the cartridge with brackets may laterally or at least substantially indefinitely. In any case, returning to FIG. 107, the cartridge groove with brackets 2030 may comprise lateral side walls 2040 and 2041, which may be entirely composed of a flexible material, such as, for example, an elastomeric material. The cartridge groove with brackets 2030 may further comprise lateral grooves 2033 protruding along the sides of the lower bearing surface 2031 of the cartridge groove with brackets 2030, which can be configured to hold and fix at least part of the lateral side walls 2040 and 2041. In some embodiments, the lateral side walls 2040 and 2041 can be fixed in the grooves 2033 by means of a latch and / or press fit, while in at least some embodiments, the lateral e side walls 2040 and 2041 can be fixed in the grooves 2033 using one or more adhesive substances. In at least one embodiment, the side walls 2040 and 2041 may be detached during use from the lower bearing surface 2031. In any case, the compressible implantable cartridge case 2010 may separate and / or detach from the lateral side walls 2040 and 2041 when the case cartridge 2010 is implanted with brackets 2020.

In various embodiments, returning to FIG. 108, the surgical device may include a shaft 2150 and an end clip protruding from the distal end of the shaft 2150. Similar to the foregoing, the end clip may include a cartridge groove with brackets 2130, a stop member 2140 moving between the open position and the closed position, and the cartridge with brackets 2100 located between the groove for the cartridge with brackets 2130 and the stop element 2140. Also similar to the above, the cartridge with brackets 2100 may include a compressible implantable housing of the cartridge 2110 and a plurality of brackets 2120, positioned married to the cartridge housing 2110. In various embodiments, the cartridge chute with brackets 2130 may include, firstly, a lower bearing surface 2131, opposite which is a cartridge with brackets 2100, secondly, a distal end 2135, and thirdly proximal end 2136. In at least one embodiment, as shown in FIG. 108, the bracket cartridge 2100 may comprise a first end 2105, which may be located at the distal end 2135 of the cartridge groove 2130, and a second end 2106, which may be located at the proximal end 2136 of the cartridge groove 2130. In various embodiments the implementation of the distal end 2135 of the groove for the cartridge with brackets 2130 may contain at least one distal device for holding, such as, for example, a supporting wall 2137, and, similarly, the proximal end 2136 may contain, at least one proximal retention device, such as, for example, a support wall 2138. In at least one such embodiment, the distal support wall 2137 and the proximal support wall 2138 may limit a gap that may be the same or less in length than the cartridge with brackets 2100 so that the cartridge with brackets 2100 can be held tightly in the groove for the cartridge with brackets 2130 when a cartridge with brackets 2100 is inserted into it.

In various embodiments, returning to FIG. 88 and 89, a cartridge with brackets, such as, for example, a cartridge with brackets 1200, may comprise a flat or at least substantially flat surface for contact with tissue 1219. In at least one such embodiment, the cartridge housing has the brackets 210 of the cartridge with brackets 1200 may include a first end 1205, which can be determined using the first height or thickness, 1207 and a second end 1206, which can be determined using the second height, or thickness, 1208, and the first height 1207 can be equal to or at least e, is substantially equal to the second height 1208. In some embodiments, the cartridge housing 1210 may have a constant or at least substantially constant height, or thickness, between the first end 1205 and the second end 1206. In at least one such an embodiment, the contact surface with the fabric 1219 may be parallel or at least substantially parallel to the lower surface 1218 of the cartridge housing 1210. In various embodiments, returning again to FIG. 108, the first end 2105 of the cartridge housing 2110 of the cartridge with brackets 2100 can be determined using a first height 2107 that is different from the second height 2108 of the second end 2106. In the illustrated embodiment, the first height 2107 is greater than the second height 2108, although the second height 2108 may be larger first height 2107 in alternative embodiments. In various embodiments, the height of the cartridge housing 2110 may linearly and / or geometrically decrease between the first end 2105 and the second end 2106. In at least one such embodiment, the contact surface with tissue 2119 that is between the first end 2105 and the second end 2106 may be oriented along their defined angle. In at least one such embodiment, the contact surface with the tissue 2119 may be parallel to the bottom surface 2118 of the cartridge housing 2110 and / or parallel to the bearing surface 2131 of the cartridge groove with brackets 2130.

In various embodiments, returning again to FIG. 108 and 109, the abutment member 2140 may comprise a contact surface with a fabric 2141, which may be parallel or at least substantially parallel to the carrier surface 2131 of the cartridge chute 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 can be configured to exert more pressure on the first end 2105 of the cartridge with brackets 2100 than on the second end 2106, due to the greater height of the first end 2105 and the shorter length of the second end 2106. In some circumstances, including circumstances in which tissue T placed between surfaces for contacting tissue 2119 and 2141 has a constant or at least substantially constant thickness, the pressure created in tissue T and cartridge 2100 can t be greater near the distal end of the terminal connector, than near the proximal end of the terminal connectors. More specifically, when the fabric T between the abutment member 2140 and the cartridge with brackets 2100 has a substantially constant thickness, the tissue T located between the distal end 2145 of the abutment element 2140 and the first end 2105 of the cartridge with brackets 2100 can be compressed more strongly than the fabric T, located between the proximal end 2146 of the abutment element 2140 and the second end 2106 of the cartridge with brackets 2100. In various embodiments, a pressure gradient in the tissue T can be created between the proximal end and the distal end of the end clip. More specifically, in at least one embodiment, when the tissue T between the abutment member 2140 and the cartridge with brackets 2100 has a substantially constant thickness and the height of the cartridge with brackets 2100 decreases linearly from the distal end to the proximal end of the end clamp, the pressure at tissue T may 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 tissue T between the abutment member 2140 and the cartridge with brackets 2100 has a substantially constant thickness, and the height of the cartridge with brackets 2100 decreases exponentially from the distal end to the proximal end of the end clamp, tissue pressure T may decrease exponentially from the distal end of the end clamp to the proximal end of the end clamp.

In various embodiments, returning again to FIG. 108, the fabric T located between the cartridge with brackets 2100 and the abutment element 2140 may not have a constant thickness throughout. In at least one such circumstance, the tissue T located between the proximal end 2146 of the stop member 2140 and the second end 2106 of the cartridge with brackets 2100 may be thicker than the tissue T located between the distal end 2145 of the stop member 2140 and the first end 2105 of the cartridge with brackets 2100. In some circumstances, as a result, the thicker tissue T should mostly be located above the shorter proximal end 2106 of the cartridge with brackets 2100, and the thinner tissue T should mostly be located above the higher m distal end 2105. During operation, the starting sleeve 2152 of the shaft 2150 can be extended distally along the shaft shaft 2151 so that the starting sleeve 2152 engages with the cylindrical part 2143 of the stop element 2140 and rotates the stop element 2140 toward the cartridge with brackets 2100, as shown in FIG. 109. As soon as the stop member 2140 is rotated to the fully closed position, the tissue T can be squeezed between the surfaces to contact the tissue 2119 and 2141, and even if the height of the cartridge with brackets 2100 is constant between the proximal and distal ends of the end clamp, pressure or the compressive force applied to the tissue T may be constant or at least substantially constant throughout. More specifically, a thinner fabric T may be associated with a higher height of the cartridge with brackets 2100, and a thicker fabric T may be associated with a lower height of the cartridge with brackets 2100, the total or total height of the fabric T and the cartridge with brackets 2100 may 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 cumulative height by means of the abutment member 2140 may be constant or at least substantially constant throughout.

In various embodiments, returning again to FIG. 108 and 109, the cartridge with brackets 2100 may have an asymmetric configuration. In at least one such embodiment, for example, the height of the cartridge with brackets 2100 at its first end 2105 may be greater than the height of the cartridge with brackets 2100 at its second end 2106. In some embodiments, the cartridge with brackets 2100 and / or the cartridge groove with brackets 2130 may include one or more alignment and / or holding devices that can be configured to ensure that the cartridge brackets 2100 can only be located in the cartridge groove with brackets 2130 in one direction for example, in the direction in which the first end 2105 is located at the distal end 2135 of the cartridge groove with brackets 2130, and the second end 2106 is located at the proximal end 2136. In various alternative embodiments, the cartridge with brackets 2100 and / or the cartridge groove with the brackets 2130 may comprise one or more alignment and / or holding devices that can be configured to ensure that the cartridge with brackets 2100 can be located in the cartridge groove with brackets 2130 in more than one direction. Returning to FIG. 110, for example, the cartridge with brackets 2100 can be located in the groove for the cartridge with brackets 2130 so that the first end 2105 of the cartridge with brackets 2100 is located at the proximal end 2136 of the cartridge groove with brackets 2130, and the second end 2106 is located at the distal end 2135 As a result of this, in various embodiments, the implementation of the part with a lower height of the cartridge with brackets 2100 can be located in close proximity to the distal supporting wall 2137, and the part with a higher height of the cartridge with brackets 2100 can be located in close proximity to the proximal support wall 2138. In at least one such embodiment, the cartridge with brackets 2100 may be appropriately positioned to apply constant or at least substantially constant pressure when clamped to tissue T, thicker part of which is located at the distal end of the end clamp, and a thinner part is located at the proximal end of the end clamp. In various embodiments, the cartridge with brackets 2100, for example, can be selectively oriented in the groove for the cartridge with brackets 2130. In at least one such embodiment, devices for aligning and / or holding the cartridge with brackets 2100 can be symmetrical, and the surgeon can selectively orient the cartridge with brackets 2100 in the groove for the cartridge with brackets 2130, for example, in the directions shown in FIG. 108 and FIG. 110.

In addition to the above, the implantable cartridge housing 2110 may have a longitudinal axis 2109 which, when the cartridge with brackets 2100 is located in the groove for the cartridge with brackets 2130, can extend between the proximal and distal ends of the end clamp. In various embodiments, the thickness of the cartridge housing 2110 may generally decrease and / or increase generally 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 the contact surface with the fabric 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 cartridge housing 2110 may increase and decrease in length l is the longitudinal axis 2109. In at least one such embodiment, the thickness of the cartridge housing 2110 may comprise one or more parts whose thickness is increasing and one or more parts whose thickness is decreasing. In various embodiments, the implementation of the cartridge with brackets 2100 may contain many brackets 2120, which are located inside it. In operation, 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 bracket can be measured, for example, from the bottom of the base of the bracket to the top, or the end, of the longest leg of the bracket.

In various embodiments, the brackets in the bracket cartridge may have different brace heights. In at least one such embodiment, the cartridge with brackets may comprise a first group of brackets having a first bracket height that is located in the first part of the compressible cartridge body and a second group of brackets having a second bracket height that is located in the second part of the compressible cartridge cartridge. In at least one such embodiment, the first bracket height may be higher than the second bracket height, and the first bracket group may be located at the first end 2105 of the cartridge with brackets 2100, while the second bracket group may be located in the second end 2106. Otherwise, the first group of higher brackets may be located at the second end 2106 of the cartridge with brackets 2100, while the second group of shorter brackets may be located at the first end of 2105. In some embodiments, implementation may use vatsya many groups of brackets, each of which has a different height brackets. In at least one such embodiment, a third group of brackets that has an intermediate bracket height may be located in the body of the cartridge 2110 between the first group of brackets and the second group of brackets. In various embodiments, each bracket in a row of brackets in a bracket cartridge may have a different bracket height. In at least one embodiment, the highest bracket in the row of brackets may be located near the first end of the row of brackets, and the shortest bracket may be located at the opposite end of the row of brackets. In at least one such embodiment, the brackets located between the highest bracket and the shortest bracket can be arranged so that the heights of the brackets, for example, decrease from the highest bracket to the shortest bracket.

In various embodiments, returning again to FIG. 111, the end clamp of the surgical stapler may include a stop member 2240, a cartridge groove with brackets 2230, and a cartridge with brackets 2200 held by a cartridge groove with brackets 2230. The cartridge with brackets 2200 may include a compressible implantable cartridge case 2210 and a plurality of brackets such as, for example, brackets 2220a and brackets 2220b. In various embodiments, the cartridge groove with brackets 2230 may comprise a bearing surface of the cartridge 2231 and a plurality of retaining grooves for brackets indicated therein, such as, for example, retaining grooves 2232a and 2232b. In at least one such embodiment, the cartridge with brackets 2200 may comprise two outer rows of brackets 2220a and two inner rows of brackets 2220b, the retaining grooves 2232a may be configured to hold the brackets 2220a, and the retaining grooves 2232b may be configured to hold the brackets 2220b. Returning to FIG. 111 and 112, the stop element 2240 may comprise a plurality of recesses for forming the brackets 2242, which can be configured to hold and deform the brackets 2220a and 2220b when the stop element 2240 moves to the cartridge with brackets 2200. In at least one such embodiment the lower surfaces of the retaining grooves 2232a can be removed a first distance 2201a from the upper surfaces of the recesses for forming the brackets 2242, while the lower surfaces of the retaining grooves 2232b can be removed a second distance 2201b from the upper surfaces of the depressions for forming the brackets 2242. In at least one such embodiment, the retaining grooves 2232b are located closer to the abutment element 2240 due to the convex step in the bearing surface 2231 in which they are formed. Due to 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 different heights after molding. In various circumstances, brackets deformed to different heights after molding may exert different pressures or forces when clamped onto fabric T during stitching. In addition to the above, the brackets may initially have different heights in the unformed state. In at least one such embodiment, returning again to FIG. 111, the outer brackets 2220a may have an initial height in the unformed state that is greater than the original height in the unformed state of the inner brackets 2220b. As shown in FIG. 111 and 112, the inner brackets 2220b, which have a lower height in the unformed state than the outer brackets 2220a, can also have a lower height in the molded state than the outer brackets 2220b. In various alternative embodiments, the inner brackets 2220b may have a greater height in the unformed state than the outer brackets 2220a, even if they have a lower height in the deformed state than the outer brackets 2220a.

In various embodiments, in addition to the foregoing, the abutment member 2240 may be moved to the closed position, as shown in FIG. 112, for compressing the cartridge housing 2210 and deforming the brackets 2220a and 2220b. In some embodiments, a surgical stapler comprising an end clip depicted in FIG. 111 and 112, for example, may further comprise a tissue dissection element, which may be configured to dissect tissue T located between the abutment element 2240 and the cartridge with brackets 2200. In at least one such embodiment, the abutment element 2240, a groove for a cartridge with brackets 2230 and / or a cartridge with brackets 2200 may limit a groove configured to hold a sliding element for cutting tissue. More specifically, the thrust member 2240 may comprise a groove portion 2249, the cartridge groove with brackets 2230 may comprise a groove portion 2239, and the cartridge with brackets 2200 may comprise a groove portion 2203 that must be mounted coaxially or at least substantially aligned to each other when the thrust member 2240 is in a closed or at least substantially closed position. In various embodiments, the tissue dissection member can be moved from the proximal end of the end clamp to the distal end of the end clamp after the abutment member 2240 can be closed and the brackets 2220a, 2220b are deformed. In at least one embodiment, the tissue dissection member can be moved independently of the deformation of the brackets. In some embodiments, the implementation of the element for cutting tissue can be extended simultaneously with the deformation of the brackets. In any case, in at least one embodiment, the tissue dissection member may be configured to dissect tissue along a line between the inner rows of brackets 2220b.

In various embodiments, as shown in FIG. 112, the inner brackets 2220b after molding may have a lower height than the outer brackets 2220a, and the inner brackets 2220b may exert more pressure or force on the fabric near the cut line created by the tissue dissection member. In at least one such embodiment, the greater pressure or clamping force created by the inner brackets 2220b may provide various therapeutic benefits, such as the reduction of bleeding from dissected tissue T, while the lower clamping pressure created by the outer brackets 2220a, can provide flexibility to stitched fabric. In various embodiments, returning again to FIG. 111 and 112, the stop member 2240 may further comprise at least one piece of support material, such as, for example, an attached support material 2260. In at least one such embodiment, the legs of the brackets 2220a, 2220b may be configured to cut supporting material 2260 and / or passing through holes in the supporting material 2260 when the cartridge with brackets 2200 is compressed by the stop element 2240 and then comes into contact with the recesses to form the brackets 2242 in the stop element 2240. After deformation of the legs of the brackets 2220a, 2220b, these legs can again come into contact and / or dissect the support material 2260. In various embodiments, the support material 2260 can improve hemostasis and / or provide tissue strength after suturing.

In various embodiments, returning again to FIG. 111 and 112, the lower surface of the cartridge housing 2210 may comprise a stepped contour that matches or at least substantially matches the stepped contour of the bearing surface of the cartridge 2231. In some embodiments, the lower surface of the cartridge housing 2210 may be deformed to match or at least essentially matching the contour of the bearing surface of the cartridge 2231. In various embodiments, returning to FIG. 113, an end clip similar to the end clip shown in FIG. 111, for example, may comprise a cartridge with brackets 2300 located therein. A cartridge with brackets 2300 may include a compressible implantable housing 2310 comprising an inner layer 2312 and an outer layer 2311, wherein, in addition to the foregoing, in at least one embodiment the outer layer 2311 may consist of a waterproof material. In various embodiments, the outer layer 2311 may protrude around the brackets 2220a, 2220b and extend between the brackets 2220a, 2220b and the holding grooves 2232a, 2232b, respectively. In various embodiments, returning to FIG. 114, an end clip similar to the end clip shown in FIG. 111, for example, may comprise a cartridge with brackets 2400 located therein. Like a cartridge with brackets 2300, the compressible implantable housing of the cartridge 2410 of the brackets 2400 may include an inner layer 2412 and an outer layer 2411; however, in at least one embodiment, the cartridge housing 2410 may not contain a groove for the tissue dissection member. In at least one such embodiment, a tissue dissection element may be necessary to dissect the inner layer 2412 and / or the outer layer 2411, for example, as it extends through a cartridge with brackets.

In various embodiments, returning to FIG. 115, the end clamp of the surgical stapler may include a stop member 2540, a cartridge groove with brackets 2530 and a cartridge with brackets 2500 located in the groove for the cartridge with brackets 2530. Similar to the above, the cartridge with brackets 2500 may include a compressible implantable cartridge case 2510, the outer row of brackets 2220a and the inner row of brackets 2220b. The cartridge groove with brackets 2530 may comprise a flat or at least substantially flat bearing surface of the cartridge 2531 and the retaining grooves for brackets 2532 indicated therein. The stop element 2540 may comprise a stepped surface 2541 and a plurality of recesses indicated therein for forming brackets, such as, for example, recesses for molding 2542a and 2542b. Similarly to the above, the molding recesses 2542a and the retaining grooves 2532 can limit the distance between them, which is greater than the distance between the molding recesses 2452b and the retaining grooves 2532. In various embodiments, the stop member 2540 may further comprise a piece of support material 2560 attached to the stepped surface 2541 of the abutment member 2540. In at least one embodiment, the supporting material 2560 may correspond to, or at least substantially with tvetstvovat stepped surface 2541. In various embodiments, the supporting material 2560 can be releasably attached to surface 2541, e.g., by means of at least one bonding agent, such as, e.g., fibrin and / or protein hydrogel. In some embodiments, the cartridge housing 2510 may also have a stepped profile that in at least one embodiment is parallel or at least substantially parallel to the stepped surface 2541 of the stop member 2540. More specifically, in at least one In an embodiment, the stop member 2540 may comprise steps 2548 protruding toward the cartridge with brackets 2500, while steps 2548 may have steps that are equal to or at least substantially equal to the steps to 2508 protruding from the cartridge housing 2510. In at least one such embodiment, as a result of the above, the magnitude of the portion of the compressible cartridge housing 2510 that may be gripped by the first brackets 2220a may differ from the portion of the compressible cartridge housing 2510, which, for example, may be captured by second brackets 2220b.

In some embodiments, returning to FIG. 116, the end clip may include a stop member 2640, a cartridge groove with brackets 2530, and a cartridge with brackets 2600 located between them. The cartridge with brackets 2600 may include a compressible implantable cartridge case 2610 comprising an inner layer 2612, an outer layer 2611, and a plurality thereof brackets, such as, for example, brackets 2220a and 2200b. In various embodiments, the thrust member 2640 may comprise a plurality of recesses for forming the brackets 2642 on the surface 2641, and the cartridge groove with brackets 2530 may comprise a plurality of grooves for forming the brackets 2532 indicated on the bearing surface 2531. As shown in FIG. 116, the surface of the thrust member 2641 may be parallel or at least substantially parallel to the bearing surface of the cartridge 2531, with each molding recess 2642 being equally spaced or at least substantially equal to the distance from the opposite and corresponding retaining groove 2532. In various embodiments, the implementation of the cartridge with brackets 2600 may contain brackets having the same or at least substantially the same initial height of the bracket in an unformed state, and, in addition, identical or at least substantially the same height of the bracket in the molded state. In some other embodiments, the outer rows of brackets may comprise brackets 2220a, and the inner rows of brackets may comprise brackets 2220b, wherein, as discussed above, the brackets 2220a and 2220b have different brace heights in an unformed state. When the stop member 2640 moves toward the cartridge with the brackets 2600 in the closed position, the brackets 2220a and 2220b can be molded so that they have the same or at least substantially the same height of the bracket in the molded state. In at least one such embodiment, as a result of the foregoing, the formed outer brackets 2220a and inner brackets 2220b can capture the same or at least substantially the same amount of compressible implantable cartridge case 2610; however, the outer brackets 2220a have a larger brace height in the unformed state than the inner brackets 2220b, and yet can have the same brace height in the molded state, and greater grip pressure can be created, for example, by the outer brackets 2220a compared to the inner brackets 2220a brackets 2220b.

In various embodiments, returning to FIG. 117, the end clamp of the surgical stapler may include a stop member 2740, a cartridge groove with brackets 2530, and a cartridge with brackets 2700 located in the cartridge groove with brackets 2530. Similar to the above, the cartridge with brackets 2700 may include a compressible implantable cartridge case 2710, comprising an inner layer 2712, an outer layer 2711 and a plurality of brackets disposed therein, such as, for example, brackets 2220a and 2220b. In at least one embodiment, the thickness of the cartridge housing 2710 may vary across its entire width. In at least one such embodiment, the cartridge housing 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 thickest portion of the cartridge housing 2710 may be located in the central portion 2708, while the thinnest portion of the cartridge housing 2710 may be located in the side portions 2709. In at least one such embodiment, the thickness of the cartridge housing 2710 may be foam decreases between the central portion 2708 and the side portions 2709. In some embodiments, the thickness of the cartridge housing 2710 may decrease linearly and / or geometrically between the central portion 2708 and the side portions 2709. In at least one such embodiment, the contact surface with the fabric 2719 of the cartridge housing 2710 may contain two inclined, or angled, surfaces that are chamfered downward from the central part 2708 to the side parts 2709. In various embodiments, The stop element 2740 may comprise two inclined, or angled, surfaces that are parallel or at least substantially parallel to the inclined surfaces for contacting the fabric 2719. In at least one such embodiment, the stop element 2740 may further contain at least one fragment of the supporting material 2760, which is 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 cartridge with brackets 2700 may contain higher brackets 2220a, and the outer rows of brackets may contain shorter brackets 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or near the thickest central part 2708, while the brackets 2220b may be located inside and / or near the side parts 2709. B, at least , in one such embodiment, as a result of the above, the higher brackets 2220a can capture more material from the implantable housing of the cartridge 2710 than the shorter brackets 2220b. Such circumstances can lead to the fact that the brackets 2220a apply more pressure during capture to the tissue T than the brackets 2220b. In some embodiments, even if the higher brackets 2220a can capture more cartridge body material 2710 than the shorter brackets 2220b, the higher brackets 2220a may have a higher height after molding than the shorter brackets 2220b due to the recesses for molding brackets 2742a and 2742b are located on an inclined plane. Such considerations can be used to achieve the desired gripping pressure in the fabric held by the brackets 2220a and 2220b, whereby the gripping pressure of the brackets 2220a can be greater than, less than, or equal to the gripping pressure that, for example, is applied to the fabric by the brackets 2220b. In various alternative embodiments, the end clamp shown in FIG. 117, shorter brackets 2220b may be located inside and / or near the thickest central part 2708 of the cartridge case 2710, while higher brackets 2220a may be located inside and / or near the thinner side parts 2709. Moreover, although the cartridge with brackets 2700 is shown containing the inner and outer rows of brackets, the cartridge with brackets 2700 can contain additional rows of brackets so that, for example, rows of brackets are located between the inner and outer rows of brackets. In at least one such embodiment, the intermediate rows of brackets may include brackets having an intermediate height in the unformed state compared to the height in the unformed state of the brackets 2220a and 2220b, and, for example, a height in the formed state that is intermediate in comparison with molded height brackets 2220a and 2220b.

In various embodiments, returning to FIG. 118, the end clamp of the surgical stapler may include a stop member 2840, a cartridge groove with brackets 2530 and a cartridge brackets 2800 located in the cartridge groove with brackets 2530. Similar to the above, the cartridge with brackets 2800 may include a compressible implantable cartridge case 2810, comprising an inner layer 2812, an outer layer 2811 and a plurality of brackets disposed therein, such as, for example, brackets 2220a and 2220b. In at least one embodiment, the thickness of the cartridge housing 2810 may vary across its entire width. In at least one such embodiment, the cartridge housing 2810 may include a central portion 2808 and side portions 2809, the central portion 2808 may be thinner than the thickness of the side portions 2809. In various embodiments, the thinnest portion of the cartridge housing 2810 may be located in the central part 2808, while the thickest part of the cartridge body 2810 may be located in the side parts 2809. In at least one such embodiment, the thickness of the cartridge body 2810 may be increase between the central part 2808 and the side parts 2809. In some embodiments, the thickness of the cartridge housing 2710 may increase linearly and / or geometrically between the central part 2808 and the side parts 2809. In at least one such embodiment, the contact surface with the fabric 2819 of the cartridge housing 2810 may contain two inclined, or angled, surfaces that are beveled upward from the central part 2808 to the side parts 2809. In various embodiments, the thrust element 2840 may comprise two inclined, or angled, surfaces that are parallel or at least substantially parallel to the inclined surfaces for contacting the fabric 2819. In at least one such embodiment, the thrust element 2840 may further contain at least one fragment of the supporting material 2860, which is attached to the inclined surfaces of the thrust element 2840. In various embodiments, in addition to the above, the outer rows of brackets to the staple cartridge 2800 can contain higher brackets 2220a, and inner rows of staples may contain shorter braces 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or near the thickest side portions 2809, while the brackets 2220b may be located inside and / or near the central part 2808. B, at least , in one such embodiment, as a result of the above, the higher brackets 2220a can capture more material from the implantable housing of the cartridge 2810 than the shorter brackets 2220b.

As described above in connection with the embodiment of FIG. 111, for example, the cartridge groove with brackets 2230 may include a stepped bearing surface 2231, which can be configured to hold the brackets 2220a and 2220b at different heights relative to the stop element 2240. In various embodiments, the cartridge groove with brackets 2230 may consist of metal, and steps on the bearing surface 2231 may be formed in the bearing surface 2231, for example, during sharpening. In various embodiments, returning to FIG. 119, the end clamp of the surgical stapler may include a cartridge groove with brackets 2930 in which the holding insert 2935 is located. More specifically, in at least one such embodiment, the cartridge groove with brackets 2930 can be formed so that it has a flat or at least substantially flat bearing surface 2931, which, for example, can be configured to hold an insert 2935 having a stepped surface for holding the brackets 2220a and 2220b of the cartridge with brackets 2200 and different heights. In at least one such embodiment, insert 2935 may comprise a flat or at least substantially flat bottom surface that may be located opposite the bearing surface 2931. Insert 2935 may further comprise retaining grooves, rotational or slotting grooves 2932a and 2932b, which can be configured to hold the brackets 2220a and 2220b, respectively, at different heights. Similarly to the above, the insert 2935 may contain a groove of the scalpel 2939, which can be configured to allow passage through it of an element for dissecting tissue. In various embodiments, the cartridge groove with brackets 2930 may consist of the same material or a different material than the holding tab 2935. In at least one embodiment, the cartridge groove with brackets 2930 and the holding tab 2935 may consist, for example, of metal while in other embodiments, the cartridge groove with brackets 2930 may consist, for example, of metal, and the holding tab 2935 may consist, for example, of plastic. In various embodiments, the holding tab 2935 may be attached and / or welded to the cartridge groove with brackets 2930. In some embodiments, the holding tab 2935 may be secured by a latch and / or press fit in the cartridge groove with brackets 2930. B, by in at least one embodiment, the holding tab 2935 may be secured in the cartridge groove with brackets 2930 using adhesive.

In various embodiments, returning to FIG. 120, the end clamp of the surgical stapler may comprise a stop member 3040, a cartridge groove with brackets 3030, and a compressible implantable cartridge case with brackets 3000 located in the cartridge groove with brackets 3030. Similarly to the above, the stop member 3040 may comprise a plurality of molding recesses brackets 3042 and a groove of the scalpel 3049, which can be configured to hold a sliding element for tissue dissection. Also similar to the foregoing, the cartridge groove with brackets 3030 may comprise a plurality of grooves for holding the brackets 3032 and a groove of the scalpel 3049, which can also be configured to hold the sliding element for cutting tissue. In various embodiments, the cartridge with brackets 3000 may comprise a first layer 3011, a second layer 3012, and a plurality of brackets located therein, such as, for example, brackets 3020a and 3020b. In at least one embodiment, the brackets 3020a may have a height of the bracket in the unformed state that is greater than the height of the bracket in the unformed state of the brackets 3020b. In various embodiments, the first layer 3011 may consist of a first compressible material, and the second layer 3012 may consist of a second compressible material. In some embodiments, the first compressible material has a greater compression ratio than the second compressible material, although in some other embodiments, the first compressible material may have a lower compression ratio than the second compressible material. In at least one embodiment, the first compressible material may consist of an elastic material that has a first coefficient of elasticity, and the second compressible material may consist of an elastic material that has a second coefficient of elasticity that is different from the first coefficient of elasticity. In various embodiments, the first compressible material may have a greater 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, the first stiffness being different from the second stiffness. In various embodiments, the first compressible layer may have greater rigidity than the rigidity of the second compressible layer. In some other embodiments, the first compressible layer may have less rigidity than the rigidity of the second compressible layer.

In various embodiments, returning again to FIG. 120, the second layer 3012 of the cartridge with brackets 3000 may have a constant or at least substantially constant thickness over its entire width. In at least one embodiment, the first layer 3011 may have a thickness that varies across its entire width. In at least one such embodiment, the first layer 3011 may consist of one or more steps 3008, which may increase the thickness of the cartridge housing 3010 in some parts of the cartridge housing 3010, such as, for example, a central portion. Returning again to FIG. 120, shorter brackets 3020b may be positioned or aligned with steps 3008, for example, of the thicker portion of the cartridge case 3010, and higher brackets 3020a may be positioned or aligned with respect to thinner parts of the cartridge case 3010. In various embodiments, due to the presence of thicker and thinner parts of the cartridge case 3010, the stiffness of the cartridge case 3010 may be greater along the inner rows of brackets 3020b than 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 connectors that can hold layers 3011 and 3012. together. In some embodiments, the first layer 3011 may consist of a first laminate, and the second layer 3012 may consist of a second laminate, wherein the first laminate may be adhered to the second laminate using one or more leyaschego substances. In various embodiments, the implementation of the cartridge with brackets 3000 may contain a groove of the scalpel 3003, which can be configured to hold with the possibility of sliding element for cutting tissue.

In various embodiments, returning to FIG. 121, the cartridge with brackets 3100 may include a compressible implantable cartridge case 3110 containing one layer of compressible material and, in addition, a plurality of brackets located therein, such as, for example, brackets 3020b. In at least one embodiment, the thickness of the cartridge housing 3110 may vary across its entire width. In at least one such embodiment, the cartridge housing 3110 may include steps 3108 protruding along its side portions. In various embodiments, returning to FIG. 122, the cartridge with brackets 3200 may include a compressible implantable cartridge housing 3210 containing one layer of compressible material and, in addition, a plurality of brackets located therein, such as, for example, brackets 3020b. In at least one embodiment, the thickness of the cartridge housing 3210 may vary across its entire width. In at least one such embodiment, the cartridge housing 3210 may include steps 3208 protruding along its central portion. In various embodiments, returning to FIG. 123, the cartridge with brackets 3300 may include a compressible implantable cartridge case 3310, in which, similar to the cases described above, the thickness of the cartridge case 3310 can vary across its entire width. In at least one embodiment, the thickness of the cartridge case 3310 may increase exponentially between the side portions and the central part of the cartridge case 3310. In at least one such embodiment, the thickness of the cartridge case 3310 may increase in a vertical section in the form of an arc or curve, and also contain arched or curved surfaces for contact with the fabric 3319. In some embodiments, the thickness of the cartridge body 3310 and the surface contour for contact with the TC New York 3319 can be defined by a single radius or curvature, or otherwise, for example, several curves or radii. In various embodiments, returning to FIG. 124, the cartridge with brackets 3400 may comprise a compressible implantable cartridge case 3410, wherein the thickness of the cartridge case 3410 may increase linearly or at least substantially linearly between the side portions and the central portion of the cartridge case 3410.

In various embodiments, returning to FIG. 125, the cartridge with brackets 3500 may comprise a compressible implantable cartridge case 3510 and a plurality of brackets 3520 located therein. The implantable cartridge case 3510 may include a first inner layer 3512, a second inner layer 3513 and an outer layer 3511. In at least one embodiment the first inner layer 3512 may have a first thickness, and the second inner layer 3513 may have a second thickness, the second inner layer 3513 may be thicker than the first inner layer 3512. In at least one alternative embodiment, The first inner layer 3512 may be thicker than the second inner layer 3513. In another alternative embodiment, the first inner layer 3512 may have the same or at least substantially the same thickness as the second inner layer 3513. In some embodiments, each bracket 3520 may comprise a base 3522 and one or more deformable legs 3521 that protrudes from the base 3522. In various embodiments, each leg 3521 may include an end 3523 that is immersed in the first inner layer 3511, and in addition, each base 3522 of the brackets 3520 may be immersed in a second inner layer 3512. In at least one embodiment, the first inner layer 3512 and / or the second inner layer 3513 may contain at least one drug and, in various embodiments, the outer layer 3511 can seal and fix the first inner layer 3512 and the second inner layer 3513 so that the medicine does not flow out of the cartridge body with brackets 3510 until the outer layer 3511 is dissected by brackets 3520 . Bole specifically, in addition to the foregoing, the abutment member may be pushed downward against a fabric opposite the surface for contacting the cartridge fabric 3519 with brackets 3500, so that the cartridge body 3510 is compressed and the surface 3519 moves downward and at least partially under the ends of the brackets 3523 so that the ends 3523 tear or pierce the outer layer 3511. After tearing the outer layer 3511 using the legs of the brackets 3521, at least one medicine M can leak out of the cartridge case 3510 around the legs of the brackets 3521. Different Under circumstances, additional compression of the cartridge case 3510 may squeeze an additional amount of medicament M from the cartridge case 3510, as shown in FIG. 126.

In various embodiments, returning again to FIG. 125, the outer layer 3511 may comprise a waterproof or at least substantially waterproof winding that is configured to, firstly, prevent premature release of the drug from the cartridge with brackets 3500, and secondly, to prevent premature entry, for example, fluid from the surgical field into the cartridge with brackets 3500. In some embodiments, the first inner layer 3512 may comprise a first drug that is stored or absorbed in this layer and a second inner layer 35 13 may contain a second drug that is stored or absorbed in this layer, the second drug may be different from the first drug. In at least one embodiment, the initial compression of the cartridge case 3510, which causes the outer layer 3511 to rupture, can mostly release the first drug from the first inner layer 3512, and the subsequent compression of the cartridge case 3510 can mostly release the second drug from the second inner layer 3513. In such embodiments, however, portions of the first drug and the second drug can be released simultaneously, although most of the drugs that are released initially may be per th medicine, and most of the drugs that are released later, there may be a second drug. In some embodiments, in addition to the foregoing, the first inner layer 3512 may consist of more compressible material than the second inner layer 3513 so that the initial compressive forces or pressure, which may be less than subsequent compressive forces or pressure, can cause greater initial bending in the first inner layer 3512 than in the second inner layer 3513. This larger initial bending in the first inner layer 3512 may cause the release of most of the first drug from the first inside the backing layer 3512 than the second drug from the second inner layer 3513. In at least one embodiment, the first inner layer 3512 may be more porous and / or more flexible than the second inner layer 3513. In at least one such In an embodiment, the first inner layer 3512 may comprise a plurality of pores, or air cavities, 3508, and the second inner layer 3513 may comprise a plurality of pores, or air cavities, 3509, wherein in various embodiments, the pores 3508 may be configured to store first of the drug in the first inner layer 3512, and the pores 3509 can be configured to store the second drug in the second inner layer 3513. In some embodiments, the size and density of the pores 3508 in the first inner layer 3512 and pores 3509 in the second inner layer 3513 can be selected for providing the desired result described herein.

In various embodiments, returning again to FIG. 125 and 126, the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513 may consist of biologically absorbable material. In at least one embodiment, the first inner layer 3512 may be composed of a first biologically absorbable material, the second inner layer 3513 may be comprised of a second biologically absorbable material, and the outer layer 3511 may be comprised of a third biologically absorbable material, the first biologically absorbable material , the second biologically absorbable material and / or the third biologically absorbable material may consist of various materials. In some embodiments, the first biologically absorbable material can be biologically absorbed at a first speed, the second biologically absorbable material can be biologically absorbed at a second speed, and the third biologically absorbable material can be biologically absorbed at a third speed, with the first speed, second speed and third speed being different. In at least one such embodiment, when the material is biologically absorbed at a certain rate, that rate can be defined as the amount of mass of material that is absorbed by the patient’s body per unit time. As you know, the bodies of different patients can absorb different materials at different speeds, and therefore these speeds can be expressed as average speeds to calculate this probability. In any case, a higher velocity may be a velocity at which a greater mass is absorbed per unit time than at a lower velocity. In various embodiments, returning again to FIG. 125 and 126, the first inner layer 3512 and / or the second inner layer 3513 may consist of a material that is biologically absorbed faster than the material that the outer layer 3511 consists of. In at least one such embodiment, the first inner layer 3512 and / or the second inner layer 3513 may consist of a biologically absorbable foam, tissue sealing material and / or hemostatic material, such as, for example, oxidized regenerated cellulose (ORC), and the outer layer 3511 may consist of a support a material and / or plastic material such as polyglycolic acid (PGA) sold under the Vicryl trademark, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL) sold under the Monocryl trademark , polycaprolactone (PCL) and / or a mixture of PGC, PLA, PDS, PHA, PGCL and / or PCL. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can immediately have a therapeutic effect on the tissue and can, for example, reduce bleeding, while the outer layer 3514 can provide long-term structural support and is also biologically absorbed at a lower rate .

Due to the slower biological absorption rate of the outer layer 3511, in addition to the above, the outer layer 3511 can support or structurally strengthen the tissue along the stitch line while it heals. In some embodiments, one of the first inner layer 3512 and the second inner layer 3513 may consist of a material that is biologically absorbed faster than the other, so that in at least one embodiment, one of the layers can provide an initial release of the treatment substance and another layer may provide an extended release of the same therapeutic substance and / or another therapeutic substance. In at least one such embodiment, the rate at which a treatment substance can be released from layer 3512, 3513 can be represented by the biological absorption function of the substrate in which the drug is absorbed or dispersed. For example, in at least one embodiment, the substrate containing the first inner layer 3512 can be biologically absorbed faster than the substrate containing the second inner layer 3513, and, as a result, the drug can be released from the first inner layer 512 faster than for example, from a second inner layer 3513. In various embodiments, as described herein, one or more layer 3511, 3512, and 3513 of the cartridge body 3510 may be glued to another using at least one adhesive Twa, such as, e.g., fibrin and / or protein hydrogel. In some embodiments, the adhesive may be water soluble and applied so that the joints between the layers allow immediately and / or after some time to implant the cartridge with brackets 3500. In at least one such embodiment, the adhesive can be biologically absorbed faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

In various embodiments, returning to FIG. 127 and 128, a bracket cartridge, such as, for example, a bracket cartridge 3600, may include a cartridge case 3610 comprising a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a detachable compressible layer 3613 attached to the second layer 3612. In at least one such embodiment, the first layer 3611 may consist of a compressible foam material, the second layer 3612 may consist of a laminate adhered to the first layer 3611 using one or more adhesives, and the third layer 3613 may comprise It is a compressible foam material adhered removably to the second layer 3612 using, for example, one or more adhesive. In various embodiments, the implementation of the cartridge with brackets 3600 may additionally contain many brackets, such as, for example, brackets 3620 located in the body of the cartridge 3610. In at least one such embodiment, each bracket 3620 may contain a base 3622 located in the third layer 3613, and one or more deformable legs 3621, which, for example, protrudes upward from the base 3622 through the second layer 3612 to the first layer 3611. During operation, in addition to the above, the upper surface 3619 of the cartridge housing with brackets and 3610 may be pushed down by the abutment member until the legs of the bracket 3621 pass through the upper surface 3619 and the target fabric until it contacts the abutment element. After a significant deformation of the legs of the brackets 3621, the stop element can be removed from the cartridge with brackets 3600 so that its compressible layers can at least partially restore their shape. In various circumstances, the insertion of brackets into the tissue can lead to bleeding from this tissue. In at least one embodiment, the third layer 3613 may consist of an absorbent material, such as, for example, a protein hydrogel that can absorb blood from stitched tissue. In addition to or instead of the above, the third layer 3613 may consist of a hemostatic material and / or tissue sealant, such as, for example, lyophilized thrombin and / or fibrin, which can 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, wherein the third layer 3613 may consist of biologically absorbable material and / or biologically non-absorbable material. In any case, in various embodiments, the third layer 3613 may be detached from the second layer 3612 after implantation of the cartridge with brackets 3610. In embodiments where the third layer 3613 contains implantable material, the surgeon may choose whether to detach the third layer 3613 from the housing of the cartridge 3610. In at least one embodiment, the third layer 3613 may be configured to detach completely from the second layer 3612.

In various embodiments, the first layer 3611 may consist of a first foam material, and the third layer 3613 may consist of a second foam material, which may be different from the first foam material. In at least one embodiment, the first foam material may have a first density, and the second foam material may have a second density, the first density being different from the second. In at least one such embodiment, the second density may be higher than the first density, and, as a consequence, the third layer 3613 may be less compressible or have a lower compression ratio than the first layer 3611. In at least one alternative embodiment the first density may be higher than the second density, and, as a consequence, the first layer 3611 may be less compressible or have a lower compression ratio than the third layer 3613. In various embodiments, returning to FIG. 129 and 130, a cartridge with brackets 3700, similar to a cartridge with brackets 3600, may comprise a cartridge body 3710 comprising a first compressible foam layer 3711, a second layer 3712 attached to the first layer 3711, and a detachable compressible foam third layer 3713 that is affixed detachment to the second layer 3712. In at least one such embodiment, the third layer 3713 may comprise a plurality of slots for holding the brackets, or recesses 3709, each of which may be configured to hold at least a portion of the bracket 3620, t such as, for example, the base of the bracket 3622. In some embodiments, the brackets 3620 can be configured to slide in the slots to hold the brackets 3709 or, in other words, the third layer 3713 can be configured to slide relative to the brackets 3620 when the cartridge with brackets 3700 is located, for example, opposite the target fabric and is compressed by the stop element. In at least one embodiment, the retaining grooves 3709 may be configured so that a gap is formed between the brackets 3620 and the side walls of the retaining grooves 3709. In at least one such embodiment, as a consequence 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 grooves for holding the brackets 3709 near the second layer 3712 may be covered by part of the third layer 3713, and as a result, a smaller part of the third layer 3713 may be gripped by brackets 3620 when they are deformed. In any case, the third layer 3713 may contain, for example, one or more perforations and / or scuff marks 3708, which can be configured to detach the third layer 3713 from the second layer 3712 in the form of two or more fragments, as shown in FIG. 129. In FIG. 129 depicts one of the fragments of the third layer 3713, which was removed using the tool 3755. In various embodiments, the perforations 3708 can be aligned along a line located between the first row of brackets and the second row of brackets.

In various embodiments, returning again to FIG. 129 and 130, the bases 3622 of the brackets 3620 may be located in the retaining grooves 3709, and in at least one embodiment, the side walls of the retaining grooves 3709 may be configured to contact or hold with the possibility of subsequent removal of the legs of the brackets 3621 in a certain position. In some embodiments that have not been shown, the third layer 3713 may include an oblong groove surrounding all the brackets in the set of brackets. In at least one such embodiment, the cartridge with brackets containing four rows of brackets, for example, may contain an oblong groove mounted on the same axis with each row of brackets in the bottom layer of the cartridge with brackets. In addition to the above, at least a portion of the cartridge with brackets 3600 and / or a cartridge with brackets 3700 can be implanted in the patient’s body, and at least a portion of the cartridge with brackets can be removed from the patient’s body. In at least one embodiment, returning again to FIG. 129 and 130, the first layer 3711 and the second layer 3712 can be gripped by brackets 3620 and implanted with brackets 3620, the third layer 3713 optionally being removed or disconnected from the cartridge with brackets 3700. In various circumstances, removing a portion of the implanted cartridge with brackets can reduce the amount of material , which should be reabsorbed in the patient’s body, which can provide various therapeutic benefits. If a part of the cartridge with brackets was disconnected or removed, for example, using a laparoscopic instrument 3755, the detached part of the cartridge with brackets 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 cartridge housing may contain more than one layer that can be removed. For example, the cartridge housing 3710 may contain four layers, of which the third layer 3713 of the cartridge housing 3710 may consist of hemostatic material, and the fourth layer may be a support layer. In at least one such embodiment, the surgeon may remove the support layer and then decide whether, for example, the hemostatic layer needs to be removed.

In various embodiments, returning again to FIG. 131, a bracket cartridge, such as a bracket cartridge 3800, for example, may comprise a cartridge case 3810 comprising an outer layer 3811 and an inner layer 3812. The inner layer 3812 may consist of a compressible foam material, and the outer layer 3811 may at least partially wrap around the inner layer 3812. In at least one embodiment, the outer layer 3811 may comprise a first portion 3811a configured to be located on the first side of the inner layer 3812, and a second portion 3811b configured to position on the second side of the inner layer 3812, the first part 3811a and the second part 3811b can be connected using a flexible hinge, such as, for example, hinge 3809. In at least one such embodiment, at least one adhesive, such as, for example, fibrin and / or 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 on them. In various embodiments, the outer layer 3811 may contain one or more protruding fasteners al In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3821 protruding from one side of the outer layer 3811 that may be immersed in a compressible inner layer 3812. In at least one such embodiment, the legs 3821 may not protrude from the second side of the inner layer 3812, while in at least one alternative embodiment, the legs 3821 may at least partially protrude from the inner layer 3812. When the compressible housing of the cartridge 3810 is compressed t, during use, the legs 3821 may be configured to pierce 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 comprise holes, such as, for example, holes 3808 that can be configured to retaining the legs of the brackets 3821. In some embodiments, at least portions of the cartridge with brackets 3800 may include a scalpel groove 3803 that is configured to hold a slice element for dissection I'm fabric. In at least one such embodiment, the groove of the scalpel 3803 may not completely extend through the entire thickness of the cartridge case 3810, and as a result, the tissue dissection element may cut through the cartridge case 3810 when moving relative to it.

In various embodiments, returning to FIG. 132, the cartridge with brackets 3900 may comprise, like the cartridge with brackets 3800, a cartridge case 3910 comprising an inner layer 3812 and an outer layer 3811, the outer layer 3811 may comprise a first portion 3811a located near the first side of the inner layer 3812 and a second portion 3811b located near the second side of the inner layer 3812. In at least one embodiment, similarly to the above, the outer layer 3811 may include one or more protruding fasteners. In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3921 protruding from one side of the outer layer 3811 that may be immersed in a compressible inner layer 3812. In some embodiments, each deformable leg 3921 may comprise at least one protruding hook, or beard, 3923, which can be configured to mesh with the second part 3811b of the outer layer 3811, and, as a result, hold the outer layer 3811 near the inner layer 3812. B, at least In at least one such embodiment, the barbs 3923 may protrude from the second side of the inner layer 3812 and pass through the holes 3808 in the second portion 3811b of the outer layer 3811 so that the barbs 3923 can engage with the outer surface of the outer layer 3811 and fix the outer layer 3811 to the inner layer 3812. To assemble the cartridge with brackets 3900, the inner layer 3812 can be at least partially compressed to ensure that the barbs protrude from it and pass through holes 3808. In at least one such embodiment, ticipate staple cartridge 3900 may be at least partially pre-compressed, for example, during its introduction into the staple cartridge. In some embodiments, in addition to the above, at least a portion of the legs 3921 may be immersed in the first portion 3811a of the outer layer 3811, while in at least one embodiment, the outer layer 3811 may consist of plastic material such as, for example, dioxanone (PDS) and / or polyglycolic acid (PGA), and the plastic material can be applied by injection molding around at least part of the legs 3921.

In various embodiments, returning to FIG. 133-137, a cartridge with brackets, such as, for example, a cartridge with brackets 4000, may include a cartridge case 4010 containing a compressible first layer 4011, a second layer 4012 and, in addition, a plurality of brackets 4020 located in the cartridge case 4010. In some embodiments, returning to FIG. 135, each bracket 4020 may include a base 4022 and at least one deformable leg 4023 that protrudes from the base 4022. In at least one embodiment, returning to FIG. 133, the cartridge with brackets 4000 may be located between the cartridge groove with brackets 4030 and the end clamp member 4040 of the surgical stapler, in which the second layer 4012 of the cartridge case 4010 and / or the base 4022 of the brackets 4020 can be opposite the cartridge groove with brackets 4030 In various embodiments, returning to FIG. 134, the second layer 4012 may comprise a compression layer with clips 4060 that are interconnected by a compression support frame 4061. In at least one such embodiment, the clips 4060 and compression support frame 4061 may consist of a molded plastic material, such as for example polyglycolic acid (PGA). Each clip 4060 may include one or more holes or grooves 4062, which can be configured to hold the protruding legs of the brackets 4021, as shown in FIG. 135 and 136. Each clip 4060 may further comprise a retaining groove 4063, which may be configured to hold the base 4022 of the bracket 4020. In various embodiments, returning again to FIG. 134, the clips 4060 and / or the compression support frame 4061 may comprise a plurality of scuff marks, perforations, and the like, which can be configured to detach the clips 4060 from the compression support frame 4061 in a selected area. Similarly, returning to FIG. 136, one or more pressers 4060 may be connected to another along a line that contains, for example, perforations and / or scuff marks 4064. During operation, the compressible foam layer 4011 may be located opposite the target fabric T, and the cartridge body 4010 may be compressed by the stop element 4040 so that the stop element 4040 can deform the brackets 4020. After the brackets 4020 are deformed, the legs of the brackets 4021 of each deformed bracket 4020 can grab the fabric T, part of the first layer 4011 and the clip 4060. When the cartridge groove with brackets 4030 is removed from the implanted staple cartridge 4060, then, for example, compression base plate 4061 may be disconnected from the clamps 4060, and / or clamps 4060 may be disconnected from each other. In some circumstances, the clips 4060 may be disconnected from the chassis 4061 and / or each other when the brackets 4020 are deformed using the stop member 4040 in the manner described above.

In the various embodiments described herein, the brackets of the cartridge with brackets can be fully molded by the stop element when the stop element is moved to the closed position. In other various embodiments, returning to FIG. 138-141, the brackets of the cartridge with brackets, such as, for example, the cartridge with brackets 4100, can be deformed by the stop element when the stop element is moved to the closed position, and in addition, a guide bracket system that moves the brackets to the closed stop element . The cartridge with brackets 4100 may comprise a compressible housing of the cartridge 4110, which may comprise, for example, foam material and a plurality of brackets 4120 that are at least partially located in the compressible housing of the cartridge 4110. In various embodiments, the guide bracket system may include a guide holder 4160 , a plurality of guide brackets 4162 that are located in the guide holder 4160, and a cartridge tray with brackets 4180, which can be configured to hold the guides 4162 in the guide holder there are 4160 of them. In at least one such embodiment, the guide brackets 4162 can be located in one or more groove 4163 in the guide holder 4160, and the side walls of the groove 4163 can participate in the direction of the guide brackets 4162 up towards the stop element. In various embodiments, the brackets 4120 can be held in the grooves 4163 by means of the guide brackets 4162, wherein in at least one embodiment, the brackets 4120 can be completely located in the grooves 4163 when the brackets 4120 and the guide brackets 4162 are in their inactive position. In some other embodiments, at least a portion of the brackets 4120 may protrude upwardly through the open ends 4161 of the grooves 4163 when the brackets 4120 and the guide brackets 4162 are in their inactive position. In at least one such embodiment, referring mainly to FIG. 139, the bases of the brackets 4120 may be located in the rail holder 4160, and the ends of the brackets 4120 may be immersed in the compressible housing of the cartridge 4110. In some embodiments, approximately one third of the height of the brackets 4120 may be in the holder of the rails 4160, and approximately two third of the height of the brackets 4120 may reside in the body of cartridge 4110. In at least one embodiment, returning to FIG. 138A, the cartridge with brackets 4100 may further comprise a waterproof winding or membrane 4111 that surrounds, for example, the cartridge case 4110 and the rail holder 4160.

During operation, the cartridge with brackets 4100 can be located, for example, in the groove for the cartridge with brackets, and the stop element can be moved to the cartridge with brackets 4100 in the closed position. In various embodiments, the thrust member may touch and compress the compressible housing of the cartridge 4110 when the thrust member is moved to the closed position. In some embodiments, the thrust member may not come in contact with the brackets 4120 when the thrust member is in the closed position. In some other embodiments, the implementation of the stop element may be in contact with the legs of the brackets 4120 and at least partially deform the brackets 4120 when the stop element is in the closed position. Alternatively, the cartridge with brackets 4100 may further comprise one or more slides 4170 that can be extended longitudinally into the cartridge with brackets 4100 so that the slide 4170 can sequentially engage the guide brackets 4162 and move the guide brackets 4162 and the brackets 4120 to the stop element. In various embodiments, the slide 4170 may slide between the cartridge tray with brackets 4180 and the guide brackets 4162. In embodiments in which closing the stop element starts the molding process of the brackets 4120, the upward movement of the brackets 4120 towards the stop element may complete the molding and deformation of the brackets 4120 to fully formed state, or at least to the desired height. In embodiments in which closing the stop member does not deform the brackets 4120, upward movement of the brackets 4120 towards the stop member can start and complete the molding and deformation process of the brackets 4120 to a fully formed state or at least to a desired height. In various embodiments, the slide 4170 can be extended from the proximal end of the cartridge with brackets 4100 to the distal end of the cartridge with brackets 4100 so that the brackets 4120 located at the proximal end of the cartridge with brackets 4100 are fully formed before the brackets 4120 are fully formed located at the distal end of the cartridge with brackets 4100. In at least one embodiment, returning to FIG. 140, each slide 4170 may comprise at least one angled or inclined surface 4711, which may be configured to slide under the guide brackets 4162 and raise the guide brackets 4162, as shown in FIG. 141.

In various embodiments, in addition to the foregoing, the brackets 4120 can be molded to grab at least a portion of the fabric T and at least a portion of the compressible body of the cartridge cartridge 4110 with the brackets 4100. After forming the brackets 4120, the abutment member and trough for the cartridge with brackets 4130 of the surgical stapler can be removed from the implantable cartridge with brackets 4100. In various circumstances, the pallet of the cartridge 4180 can be fixedly engaged with the groove for the cartridge with brackets 4130, moreover, as a result , The cartridge tray 4180 may begin to be detached from the compressible body of the cartridge 4110 when the cartridge gutter with brackets 4130 begins to move away from the housing of the implantable cartridge 4110. In various embodiments, again returning to FIG. 138, the cartridge tray 4180 may comprise opposing side walls 4181 between which the cartridge body 4110 is movably located. In at least one such embodiment, the compressible cartridge body 4110 may be compressed between the side walls 4181 so that the cartridge body 4110 during of use can be movably held between them and movably disconnected from the pallet of the cartridge 4180 if the pallet of the cartridge 4180 begins to move. In at least one such embodiment, the rail holder 4160 can be connected to the cartridge tray 4180 so that the rail holder 4160, the guides 4162 and / or the slide 4170 can remain in the cartridge tray 4180 when the cartridge tray 4180 is removed from the surgical field . In some other embodiments, the guides 4162 may be removed from the guide holder 4160 and remain in the operative field. In at least one such embodiment, the guides 4162 may consist of a biologically absorbable material, such as, for example, polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglecaprone 25 (PGCL) sold under the brand name Monocryl, polycaprolactone (PCL) and / or a mixture of PGC, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the guides 4162 can be attached to the brackets 4120 so that the guides 4162 actuate the brackets 4120. In at least one such embodiment, each guide 4162 may include a slot configured to hold the bases of the brackets 4120, for example , in at least one embodiment, the slots can be configured to hold the bases of the brackets by means of a press fit and / or latch.

In some embodiments, in addition to the foregoing, the rail holder 4160 and / or the slide 4170 can be removed from the tray of the cartridge 4180. In at least one such embodiment, the rail 4170 can slide between the cartridge tray 4180 and the rail holder 4160 such so that when sliding the slide 4170 to move the guide brackets 4162 and the brackets 4120 upward, the slide 4170 can also move the rail holder 4160 upward regardless of the tray of the cartridge 4180. In at least one such embodiment In an embodiment, the guide holder 4160 and / or the slide 4170 may consist of a biologically absorbable material, such as, for example, polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA) ), polyglecaprone 25 (PGCL) sold under the brand name Monocryl, polycaprolactone (PCL) and / or a mixture of PGC, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the slide 4170 may be completely formed and / or attached to a drive rod or tissue cutting member that advances the slide 4170 through the cartridge with brackets 4100. In some embodiments, the slide 4170 may not be removed from the pallet of the cartridge 4180 and remain in surgical stapler, while in other embodiments, in which the slide 4170 is not attached to the drive rod, the slide 4170 may remain in the surgical field. In any case, in addition to the foregoing, the compressibility of the cartridge body 4110 may allow the use of thicker cartridge bodies in the end clamp of the surgical stapler, since the cartridge body 4110 may contract or contract when the stop member of the stapler is closed. In some embodiments, due to the fact that the brackets were at least partially deformed during the closure of the stop element, higher brackets, such as brackets with a bracket height of, for example, about 4.57 mm (0.18 inch), can be used. while the brackets with a bracket height of about 0.12 inches can be located in the compressible layer 4110, and the compressible layer 4110 can have a height in the uncompressed state, for example, about 3.56 mm (0.14 inch).

In various embodiments, returning to FIG. 142-145, a cartridge with brackets, such as, for example, a cartridge with brackets 4200, may comprise a compressible cartridge housing 4210, a plurality of brackets 4220 located therein and a plurality of flexible lateral retaining elements 4234. In various embodiments, returning to FIG. 143, a cartridge with brackets 4200 may be located between the stop element 4240 and the cartridge groove with brackets 4230, in at least one embodiment, the lateral retaining elements 4234 can be attached to the cartridge groove with brackets 4230. When the stop element 4240 moved down to compress the housing of the cartridge 4210 and at least partially deforms the brackets 4220, as shown in FIG. 144, the side portions of the cartridge housing 4210 may laterally protrude and push the lateral retaining elements 4234 out. In at least one such embodiment, the lateral retaining elements 4234 may be attached to the cartridge housing 4210, and when the cartridge housing 4210 protrudes laterally in the manner described above, the lateral retaining elements 4234 may be detached from the cartridge housing 4210, as shown in FIG. 144. In at least one embodiment, the lateral retaining elements 4234 may be adhered to the housing of the cartridge 4210 using, for example, at least one adhesive, such as fibrin and / or protein hydrogel. Similar to the above, the closure of the stop member 4240 can only partially deform the brackets 4220, while the molding of the brackets 4220 can be completed by moving one or more slides 4270 through the cartridge with brackets 4200, as shown in FIG. 145. In various embodiments, returning to FIG. 147 and 148, the slide 4270 can be moved from the proximal end of the cartridge with brackets 4200 to the distal end of the cartridge with brackets 4200 using a tissue dissection element 4280. In at least one such embodiment, the tissue dissection element 4280 may comprise a tissue dissection element , go to the scalpel, 4283, which can advance through tissue T and / or the compressible housing of the cartridge 4210. In some embodiments, the tissue dissection element 4280 may comprise eccentric nodes 4282 that can move inward Use the outer surfaces of the jaws 4230 and 4240 to move or hold the jaws in a specific position. In various embodiments, as a consequence of the foregoing, the brackets 4220 may take their final shape during molding simultaneously or at least substantially simultaneously with the dissection of the fabric T. In at least one such embodiment, the rails 4270 may be located distally relative to the scalpel 4283 so that the tissue T only dissects when the treated part of the tissue has, for example, been completely stitched.

In various embodiments, returning again to FIG. 147 and 148, the slide 4270 may comprise separate sliding units that are telescoped together by the tissue cutting member 4280. In at least one such embodiment, the slide 4270 may be in the cartridge with brackets 4200, and the tissue cutting member 4280 may be pushed into the cartridge with brackets 4200 using the trigger rod 4281 so that the tissue dissection element 4280 engages with the slide 4270 and extends the slide 4270 distally. In some embodiments, the slide 4270 may be coupled to each other. Alternatively, each slide 4270 may comprise an angular surface, or a curved surface, 4271 which can be configured to coaxially lift the brackets 4220 in a series of brackets. In some embodiments, the implementation of the angular surface 4271 may be integral with the element for cutting tissue 4280. In at least one embodiment, again returning to FIG. 147 and 148, each bracket 4200 may include a base, at least one deformable element that projects from the base, and a cap 4229, injection molded over / or located around at least a portion of the base and / or deformable elements of the bracket 4200 In various embodiments, such caps 4229 may be configured to be driven by, for example, a slide 4270. More specifically, in at least one such embodiment, caps 4229 of brackets 4220 may be configured in such a manner The fact is that the angular surfaces 4271 of the slide 4270 can slide under the caps 4229 or directly come into contact with these caps in the absence of a guide bracket between them. In such embodiments, each cap 4229 may comprise at least one joining angular or inclined surface that can be engaged with the angled surface 4271 of the slide 4270 such that the combining corner surfaces can move the brackets 4220 upward when the slide 4270 slides under the brackets 4220.

In various embodiments, returning to FIG. 146, a cartridge with brackets, such as, for example, a cartridge with brackets 4300, may comprise a compressible housing 4310 and a plurality of brackets 4320 located in the compressible housing 4310. Similarly to the above, the cartridge with brackets 4300 may comprise flexible lateral supports 4334, which may be attached to the cartridge groove with brackets and / or glued to the compressible housing 4310. In addition to the above, the flexible lateral supports 4334 can be connected to each other using one or more compressed elements, or a connecting link, 4335, cat Other can be configured to hold the lateral supports 4334 together. During operation, the connecting links 4335 may be configured to prevent or at least deter the premature detachment of the lateral supports 4334 from the cartridge body 4310. In some embodiments, the connecting links 4335 may be configured to hold the lateral supports 4334 together after compression of the cartridge with brackets 4300 persistent element. In such embodiments, lateral supports 4334 may prevent lateral protrusion, or deformation, of the side portions of the cartridge case 4310. In some embodiments, a tissue dissection member, such as, for example, a tissue dissection member 4280, may be configured to dissect connecting links 4335 throughout the time for distally moving the tissue dissection member 4280 in the cartridge case 4310. In at least one such embodiment, the tissue dissection member 4280 may be configured To extend one or more slides, such as, for example, the slide 4270, distally to form the brackets 4320 opposite the stop element. The slide 4270 can guide the cutting edge 4283 in such a way that the tissue dissection element 4280 does not cut the connecting link 4335 until the brackets 4320 near the connecting link 4335 are completely molded or at least molded to the desired height. In various circumstances, coordinated operation of the connecting links 4335 and lateral supports 4334 can prevent or at least reduce lateral movement of the compressible cartridge body 4310 and at the same time prevent or at least reduce lateral movement of the brackets 4320 located in the cartridge case 4310 In such circumstances, the connecting links 4335 can hold the brackets 4320 in this position until they are deformed, after which the connecting links 4335 can be dissected to release waiting for the lateral parts of the cartridge case 4310. As mentioned above, the lateral supports 4334 can be connected to the cartridge groove with brackets and, as a result, can be removed from the surgical field with the cartridge groove with brackets after implanting the cartridge with brackets 4300. In some embodiments, lateral supports 4334 may consist of implantable material and therefore may remain in the surgical field. In at least one embodiment, the connecting links 4335 may be located between the cartridge housing 4310 and the tissue T, and after disconnecting the connecting links 4335 from the lateral supports 4334, the connecting links 4335 can be implanted into the patient’s body. In at least one such embodiment, the connecting links 4335 may consist of a compressible material, and, in some embodiments, the connecting links 4335 may consist of the same material as, for example, lateral supports 4334. In various embodiments, the connecting units 4335 and / or lateral supports 4334 may consist of a flexible, biologically absorbable material, such as, for example, polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioc anon (PDS), poligidroksialkanat (PHA), poliglekapron 25 (PGCL), sold under the trade name Monocryl, polycaprolactone (PCL) and / or a mixture of PGA, PLA, PDS, PHA, PGCL and / or PCL. In various embodiments, the connecting link may comprise a sheet of material connecting to the lateral supports 4334. In some embodiments, the cartridge with brackets may include connecting links passing through the upper surface of the housing of the cartridge 4310, and, in addition, connecting links passing around the lower surface of the housing cartridge 4310.

In various embodiments, returning again to FIG. 149, the bracket cartridge may include brackets, such as, for example, brackets 4420, which may include a wire portion inserted in the cap portion. In at least one embodiment, the wire portion may consist of a metal such as, for example, titanium and / or stainless steel and / or plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGC) . In at least one embodiment, the cap portion may consist of a metal such as, for example, titanium and / or stainless steel and / or plastic, such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA) . In some embodiments, the wire portion of each bracket 4420 may comprise a base 4422 and deformable legs 4421 protruding from the base 4422, the cap portion of each bracket 4420 may comprise a cap 4429 that may be configured to hold at least a portion of the base 4422 To assemble parts of each bracket 4420, returning to FIG. 150A-150C, the legs 4421 of the wire part can be inserted into the hole 4426 in the cap 4429, and the hole 4426 can be configured to guide the legs 4421 into the cavity of the base 4427. The wire part can then be inserted into the cap 4429 so that the legs 4421 cover the cavity of the base 4427 and the base 4422 of the wire portion enters the cavity of the base 4427. In at least one such embodiment, the cavity of the base 4427 can be configured so that the wire portion rotates in the cap 4429 when the base 4422 enters the base of the cavity 4427 so that the bracket legs 4421 are directed upwards, or at least substantially upwards. In various embodiments, returning again to FIG. 149, cap 4429 may include outlet openings 4425, which may be configured to hold the legs of brackets 4421.

In various embodiments, in addition to the foregoing, the surgical stapler may include a slide 4470 configured to intersect the cartridge with brackets 4400 and the groove for the cartridge with brackets 4430 and move the brackets 4420 contained in the cartridge body 4410 to the abutment member. In various circumstances, the slide 4470 may move from the proximal end of the cartridge groove with brackets 4430 to the distal end of the cartridge groove with brackets 4430 for implanting the cartridge body 4410 and brackets 4420. In some circumstances, the slide 4470 may be removed or returned to the proximal groove for the 4430 cartridge , and another cartridge with brackets 4400 can be inserted into the cartridge groove with brackets 4430. As soon as a new cartridge with brackets 4400 is located in the groove for the cartridge 4430, the rails 4470 can again in move distally. In various embodiments, the surgical stapler may include one or more interlocks that can prevent the slide 4470 from re-extending distally without a new cartridge with brackets 4400 located in the groove for the cartridge 4430. In at least one such embodiment, returning again to FIG. 149, the cartridge groove with brackets 4430 may include a locking shoulder 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 configured to fit back against the shoulder 4439 if the slide 4470 were not partially raised above the shoulder 4439 with, for example, a lifting device 4428 located between the most proximal brackets 4420 in the cartridge with brackets 4400. In other words, in the absence of of the most proximal brackets 4420 in the new cartridge with brackets 4400 the rails 4470 cannot be extended. Thus, when the expended cartridge with brackets 4400 is in the groove for the cartridge 4430 or in the groove for the cartridge 4430 there is no cartridge with brackets 4400, the rails 4470 cannot be extended in the gutter for the 4430 cartridge.

In addition to the above, returning to FIG. 151, a cartridge with brackets, such as, for example, a cartridge with brackets 4500, may be located in the groove for the cartridge with brackets 4530 and comprise a compressible cartridge case 4510, a plurality of brackets 4520 located in the cartridge case 4510, and a cartridge tray or holder, 4580. In various embodiments, the compressible cartridge housing 4510 may comprise an outer layer 4511 and an inner layer 4512, wherein in at least one embodiment, the outer layer 4511 can hermetically cover the inner layer 4512. In at least one such var Ante the implementation of the outer layer 4511 may be between the inner layer 4512 and the tray of the cartridge 4580. In some other embodiments, the implementation of 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 pallet cartridges 4580 may jointly surround or at least substantially surround the inner layer 4512. In various embodiments, in addition to the foregoing, the brackets 4520 can be held by the pallet of the cartridge 4580, while the pallet to the cartridge 4580 may include one or more brackets to hold the brackets, configured to hold the brackets 4520. In some embodiments, the cartridge tray 4580 may be attached to the cartridge body 4510, and in at least one such embodiment, the cartridge body 4510 may be compressed from the sides between the opposite walls of the cartridge pallet 4580. In various embodiments, the side walls of the cartridge pallet 4580 can hold the cartridge body 4510 from the sides, and in at least one such embodiment In addition, the cartridge tray 4580 may comprise one or more walls, or a rib 4582 protruding upward from the bottom surface 4583 into the cartridge housing 4510. In at least one such embodiment, the cartridge housing 4510 may comprise one or more grooves, or troughs, which may be configured to hold and / or connect to walls 4582. In various embodiments, walls 4582 may partially or almost completely protrude through cartridge body 4510. In at least one such embodiment, walls 4582 may extend cator longitudinally through the staple cartridge 4500 between the first row of staples 4520 and a second row of staples 4520.

In various embodiments, the implementation of the cartridge housing 4510 and / or the pallet of the cartridge 4580 may contain common holding devices that provide a snap connection between the pallet of the cartridge 4580 and the housing of the cartridge 4510. In some other embodiments, the implementation of the cartridge with brackets 4500 may be located in the groove for the cartridge 4530 such that the cartridge tray 4580 is opposite and / or attached to the groove for the cartridge 4530. In at least one embodiment, the cartridge tray 4580 may be attached with the possibility of detachment to the groove for the cartridge 4530 so that after compressing the cartridge with brackets 4500 by the stop element 4540 and deforming the brackets 4520, the pallet of the cartridge 4580 can be disconnected from the groove for the cartridge 4530 and implanted with the cartridge body 4510. In at least one in such an embodiment, the cartridge tray 4580 may consist of a biologically absorbable material, such as, for example, polyglycolic acid (PGA) sold under the trademark Vicryl, polylactic acid (PLA or PLLA), polydioxano n (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL) sold under the brand name Monocryl, polycaprolactone (PCL) and / or a mixture of PGK, PLA, PDS, PHA, PGCL and / or PCL. In some embodiments, the surgical stapler may further comprise a trigger and / or a guide that can slide between the cartridge groove with brackets 4530 and the lower guide surface on the cartridge tray 4580, which can be configured to lift or remove the cartridge tray 4580 from the groove for cartridge 4530. In some embodiments, the housing of the cartridge 4510 may be detachably attached to the pallet of the cartridge 4580 so that after compression I of the cartridge with brackets 4500 by the stop member 4540 and deforming the brackets 4520, the cartridge body 45810 can be detached from the cartridge tray 4580. In at least one such embodiment, the cartridge tray 4580 can remain fixedly connected to the cartridge groove 4530 so that the cartridge tray 4580 is removed from the surgical field along with the groove for cartridge 4530. In some embodiments, the surgical stapler may further comprise a trigger and / or a guide that may between the pallet of the cartridge with brackets 4530 and the lower guide surface on the cartridge case 4580, which can be configured to lift or remove the cartridge case 4580 from the pallet of the cartridge 4580. In at least one such embodiment, the cartridge with brackets 4500 may further comprise guides brackets located between the cartridge tray 4580 and brackets 4520 so that when the trigger is sliding in the distal direction, the brackets and brackets 4520 can move upward porn element to the thrust element. In at least one such embodiment, the guide brackets may be at least partially immersed in a compressible cartridge housing 4510.

In various embodiments, the implementation of, similar to the above, the cartridge with brackets 4500 may include a locking system that can be configured to prevent or at least limit the distal movement of the element for cutting tissue, if an inactive cartridge with brackets 4500 is not located in the groove for cartridge with brackets 4530. In some embodiments, the pallet of the cartridge with brackets 4580 may include a surface that raises the element for cutting tissue up and, for example, above the locking surface in the cartridge groove with brackets 4530. If the cartridge with brackets 4500 containing the tray of the cartridge 4580 is not in the groove for the cartridge 4530, the tissue dissection element cannot be extended. In at least one embodiment, the most proximal brackets and / or other suitable brackets in the cartridge with brackets 4500 may contain a bearing surface that essentially raises the tissue dissection member above the blocking surface. In addition to or instead of the above, the various parts of the cartridge with brackets 4500 may consist of materials of different colors. In such circumstances, the surgeon can visually determine when an inactive and / or activated cartridge with brackets is present in the groove for the cartridge with brackets 4530. In at least one embodiment, the outer layer 4511 of the cartridge housing 4510 may have a first color, the tray of the cartridge 4580 may have a second color, and the cartridge groove with brackets 4530 may have a third color. If the surgeon sees the first color, the surgeon can find out that in the groove for the cartridge with brackets 4530 there is an inactive cartridge 4500; If the surgeon sees the second color, the surgeon can find out that the activated cartridge 4500 is located in the groove for the cartridge with brackets 4530, and the remaining tray of the cartridge 4580 must be removed; and if the surgeon sees the third color, the surgeon can find out that a part of the cartridge with brackets 4500 remains in the groove for the cartridge with brackets 4530.

In various embodiments, returning to FIG. 152, a cartridge with brackets, such as, for example, a cartridge with brackets 4600, may comprise a compressible implantable cartridge case 4610 and a plurality of brackets 4620 located therein. The cartridge case 4610 may include an outer layer 4611 and an inner layer 4612. In some embodiments, the inner layer 4612 may comprise a plurality of recesses, such as, for example, recesses or cavities, 4615, which may facilitate compression of the cartridge body 4610. In at least one such embodiment, the inner layer 4612 may comprise a grooved Whether mesh grid system that is configured to resist a compressive force or pressure so long as the compressive force or pressure will not exceed a certain threshold. When the threshold value is not exceeded, the inner layer 4612 can be deformed at a linear or at least substantially linear velocity with respect to the applied compressive force or pressure. After exceeding the threshold value by the compressive force or pressure, the inner layer 4612 may suddenly succumb to form a large bend and contract, or bend, due to the compressive load. In various embodiments, the lattice system of the inner layer 4612 may consist of a plurality of sublayers 4612a that can be joined together. In at least one embodiment, each sublayer 4612a may comprise a plurality of intermittent grooves and protrusions, or undulations, which may be aligned with the alternating grooves and protrusions of the adjacent sublayer 4612a. In at least one such embodiment, the grooves of the first sublayer 4612a can be located near the protrusions of the second sublayer 4612a, and, similarly, the protrusions of the first sublayer 4612a can be located near the grooves of the second sublayer 4612a. In various embodiments, the adjacent sublayers 4612a can be bonded to each other and / or the outer layer 4611 using at least one adhesive, such as, for example, fibrin and / or protein hydrogel. FIG. 153 shows a cartridge with brackets 4600 after compressing the cartridge body 4610 and deforming the brackets 4620 to grasp and hold tissue T opposite the cartridge case 4610.

In various embodiments, returning to FIG. 154-156, a cartridge with brackets, such as, for example, a cartridge with brackets 4700, may comprise a compressible implantable cartridge case 4710 and a plurality of brackets 4720 located in the cartridge case 4710. Similarly to the above, the cartridge case 4710 may include an outer layer 4711 and an inner a layer 4712, wherein the inner layer 4712 may comprise a plurality of sublayers 4712a. Also similar to the above, each sublayer 4712a may contain intermittent grooves 4717 and protrusions 4718, which can be aligned relative to each other to form between them recesses, or cavities, 4715. In at least one such embodiment, the grooves 4717 and / or protrusions 4718 may extend along axes that are parallel to each other and / or parallel to the longitudinal axis 4709. In various embodiments, brackets 4720 may be arranged to form a plurality of rows of brackets that may extend along axes, which matured parallel to each other and / or parallel to the longitudinal axis 4709. In various alternative embodiments, again returning to FIG. 152 and 153, the brackets 4620 contained in the cartridge case 4600 may extend along axes that extend transversely, or perpendicularly, to the axes defined by the grooves and protrusions of the sublayers 4612a. Returning again to FIG. 154-156, the brackets 4720 can pass through the grooves 4717 and the protrusions 4718, and the frictional force between the brackets 4720 and the sublayers 4712a can hold the brackets 4720 in the housing of the cartridge 4710. In some embodiments, the plurality of sublayers 4712a may consist of supporting material and / or plastic material such as, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), which can be configured to hold the brackets 4720, for example, in an upright position, and / or to hold the brackets 4720 in a certain order relative to each other as shown in FIG. 154 and 155. FIG. 156 shows a cartridge with brackets 4700 for compressing the body of the cartridge 4710 and deforming the brackets 4720 to grasp and hold tissue T opposite the body of the cartridge 4710.

In various embodiments, returning again to FIG. 154-156, the cartridge housing 4710 in a compressed state can elastically or elastically compress. In at least one such embodiment, the undulation formed on each sublayer 4712a by grooves 4717 and protrusions 4718 can be flattened or at least substantially flattened when the cartridge housing 4710 is compressed, and the cavities 4715 located therein can be compressed or at least substantially compressed. In various embodiments, the implementation of the cartridge housing 4710 or at least parts of the housing of the cartridge 4710 can resiliently or elastically recover from the compression force or pressure that has been applied to the housing of the cartridge 4710. In at least one such embodiment, the connection between the grooves 4717 and the protrusions 4718 of the adjacent sub-layers 4712a may remain intact or at least substantially intact when the cartridge housing 4710 is compressed in such a way that, after eliminating the compressive force the cartridge housing 4710, the sub-layers 4712a can offset each other, resulting in at least partial restoration of the shape of the cartridge housing 4710. In some embodiments, the housing of the cartridge 4710 may be plastically deformed or squeezed under compression, whereby the cartridge housing 4710 may do not regain shape after eliminating the force or pressure that compresses the housing of the cartridge 4710. In some embodiments, returning to FIG. 157, a cartridge with brackets, such as, for example, a cartridge with brackets 4800, may comprise a compressible cartridge housing 4810 comprising an outer layer 4811 and an inner layer 4812, the inner layer 4812 may comprise a corrugated or mesh grid system having a plurality of recesses or cavities , 4815. In various embodiments, the walls defining the lattice system of the inner layer 4812 may comprise one or more weakened, or thinned, cross-sections 4819, which may be configured to provide p zryva walls bounding grid system compressive cartridge body 4810. In such circumstances, the cartridge housing 4810 may be compressed after implantation of the staple cartridge 4800.

In various embodiments, returning to FIG. 158-160, a cartridge with brackets, such as, for example, a cartridge with brackets 4900, may include a cartridge case 4910 comprising an outer layer 4911 and a plurality of collapsible elements 4912 located, for example, between the upper and lower parts of the outer layer 4911. Basically returning to FIG. 158 and 159, the cartridge with brackets 4900 may further comprise a plurality of brackets 4920, each bracket 4920 may be located in a collapsible element 4912. More specifically, each collapsible element 4912 may comprise a first part 4912a, a second part 4012b and a third part 4012c, which may together limit the cavity 4915 configured to hold the bracket 4920. During operation, in addition to the above, the cartridge with brackets 4900 can be located in the groove for the cartridge with brackets, and to compress the body of the cartridge 4910 to the surface for In contact with fabric 4919, compressive force may be applied. When moving down surfaces to come in contact with fabric 4919, collapsible elements may be compressed 4912. In such circumstances, the second part 4912b of each collapsible member 4912 may be compressed in the corresponding first part 4912a, and similarly, the third part 4912c of each collapsible member 4912 may be compressed in the corresponding second part 4912b. After compression of the cartridge housing 4910 and the collapsible members 4912, the brackets 4920 located inside the collapsible members 4912 may be deformed, as shown in FIG. 160. In various embodiments, the second part 4912b of each collapsible member 4912 can be coupled by friction and / or riveted to the corresponding first part 4912a so that if the compressive force applied to the collapsible member 4912 exceeds the holding force that holds 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 compressible member 4912 can be coupled by friction and / or riveted to the corresponding second part 4912b so that if the compressive force applied to the collapsible member 4912 exceeds the holding force that holds 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 embodiments described herein, a cartridge with brackets may include multiple brackets. In various embodiments, the implementation of such brackets may consist of a metal wire deformed to obtain essentially U-shaped configuration, which has two legs of the bracket. Other embodiments are provided wherein the brackets may have various configurations containing two or more wires, which may be interconnected and have three or more legs of brackets. In various embodiments, the wire or wires used to form the brackets may have a circular or at least substantially circular cross section. In at least one embodiment, the wire for the brackets may have any other cross section, such as, for example, square and / or rectangular cross sections. In some embodiments, the brackets may consist of plastic wire. In at least one embodiment, the implementation may consist of plastic coated metal wire. In various embodiments, the cartridge may comprise any suitable type of mount in addition to or in place of the brackets. In at least one such embodiment, such a fastener may comprise pivoting links that can be folded upon engagement with the thrust member. In some embodiments, two-part fasteners may be used. In at least one such embodiment, the cartridge with brackets may comprise a plurality of first fastening parts, and the thrust element may comprise a plurality of second fastening parts that are connected to the first fastening parts when the thrust element is compressed against the cartridge body with brackets. In some embodiments, implementation, as described above, the slide or guide may be extended into the cartridge with brackets to complete the brace forming process. In some embodiments, the slide or rail may be pushed against the abutment element to move one or more forming element down to engage the opposed cartridge with brackets and brackets or fixtures located therein.

In various embodiments, the implementation of the cartridge with brackets may contain four rows of brackets stored in it. In at least one embodiment, four rows of brackets can be ordered to form two inner rows of brackets and two outer rows of brackets. In at least one such embodiment, the inner rows of brackets and the outer rows of brackets may be located on the first side of the groove of the tissue or scalpel element, and, similarly, the inner row of brackets and the outer row of brackets may be located on the second side of the groove of the element for dissecting tissue, or a scalpel. In some embodiments, the implementation of the cartridge with brackets may not contain a groove element for dissecting tissue; however, such a cartridge with brackets may comprise a designated part configured to be cut by the tissue cutting element, instead of the groove of the cartridge with brackets. In various embodiments, the inner row of brackets may be located in the cartridge with brackets so that it is equidistant or at least substantially equidistant from the groove of the tissue dissection element. Similarly, the outer row of brackets can be arranged in a cartridge with brackets so that it is equidistant or at least substantially equidistant from the groove of the tissue dissection element. In various embodiments, the implementation of the cartridge with brackets may contain more or less than four rows of brackets in the cartridge with brackets. In at least one embodiment, the cartridge with brackets may comprise six rows of brackets. In at least one such embodiment, the bracket cartridge may comprise three rows of brackets on the first side of the groove of the tissue dissection element and three rows of brackets on the second side of the groove of the tissue dissection element. In some embodiments, the implementation of the cartridge with brackets may contain an odd number of rows of brackets. For example, a cartridge with brackets may contain two rows of brackets on the first side of the groove of the tissue dissection element and three rows of brackets on the second side of the groove of the tissue dissection element. In various embodiments, the rows of brackets may comprise brackets having the same or at least substantially the same height of the brackets in an unformed state. In some other embodiments, one or more rows of brackets may include brackets that have a different bracket height in an unformed state than other brackets. In at least one such embodiment, the brackets on the first side of the groove of the tissue cutting element may have a first height in the unformed state, and the brackets on the second side of the groove of the tissue cutting element may have a second height in the unformed state, which, for example, differs from the first height.

In various embodiments, returning to FIG. 161A-161D, the end clamp of the surgical stapler may include a bracket for connecting the cartridge with brackets, such as, for example, a cartridge groove with brackets 5030, a cartridge mount that can be detached in a cartridge groove with brackets 5030, such as, for example, a cartridge with brackets 5000, and branches 5040 located opposite the cartridge with brackets 5000 and the groove for the cartridge with brackets 5030. The cartridge with brackets 5000 may include a compressible housing 5010 and a plurality of brackets 5020 and / or any other suitable fixtures, which are at least partially located in a compressible housing 5010. In at least one such embodiment, each bracket 5020 may comprise a base 5022 and, in addition, legs 5021 protruding upward from their base 5022, at least a portion of the legs 5021 may be immersed in the cartridge housing 5010. In various embodiments, the compressible housing 5010 may comprise an upper or fabric contacting surface 5019 and a lower surface 5018, the lower surface 5018 being opposite and holding be supported by the carrier surface 5031 of the cartridge groove with brackets 5030. Similarly to the foregoing, the carrier surface 5031 may comprise, for example, a plurality of retaining grooves 5032 (FIG. 161D), which can be configured to accommodate and hold the bases 5022 of the brackets 5020. In various embodiments, the end clamp of the surgical stapler may further comprise a holding substrate, such as, for example, a holding substrate 5050 that can be configured to adhere to the brackets 5020 and holding fabric in between. In at least one such embodiment, the retaining substrate 5050 may be detachably mounted to the jaw 5040. During operation, as soon as the cartridge with brackets 5000 was located in the cartridge groove with brackets 5030, the jaw 5040 with a holding bracket attached thereto the substrate 5050 can be moved to the cartridge with brackets 5000 and the cartridge groove with brackets 5030. In at least one embodiment, the jaw 5040 can be moved down along the axis 5099 so that the jaws 5040 and the cartridge groove with brackets 5030 are parallel or at least substantially parallel to each other when the jaws 5040 are closed. More specifically, in at least one such embodiment, the jaws 5040 can be closed so that the contact surface with the tissue 5051 of the holding substrate 5050 is parallel or at least substantially parallel to the contact surface with the tissue 5019 of the cartridge with brackets 5000 when the jaws 5040 are moved to the cartridge with brackets 5000.

In various embodiments, returning to FIG. 161A, the holding substrate 5050 can be detachably fixed to the jaw 5040 so that it is possible to slightly, if any, move the holding substrate 5050 relative to the jaw 5040 when the holding substrate 5050 is attached to the jaw 5040. In at least one embodiment the jaw 5040 may include one or more holding devices that can be configured to hold the holding substrate 5050 in a specific position. In at least one such embodiment, the holding substrate 5050 may be secured by a latch and / or press fit on the jaw 5040. In some embodiments, the holding substrate 5050 may be glued to the jaw 5040 using at least one adhesive . In any case, the jaw 5040 can be moved to a position where the holding substrate 5050 is in contact with the fabric T and the fabric T is located opposite the surface for contacting the fabric 5019 of the cartridge with brackets 5000. When the fabric T is located opposite the cartridge with brackets 5000 using the jaw 5040 , the compressible cartridge case 5010 with brackets 5000 may or may not be compressed by the jaw 5040. In other circumstances, in various embodiments, the legs 5021 of the brackets 5200 may not protrude from the surface to come into contact with the cartridge fabric 5019 with brackets 5000, as shown in FIG. 161A. Moreover, as also shown in FIG. 161A, the jaw 5040 can hold fabric T opposite the compressible body 5010 without adhering the holding substrate 5050 to the brackets 5020. Such embodiments allow the surgeon to open and close the jaws 5040 many times to achieve the desired position of the end clamp in the surgical field, for example, without damaging the tissue T. However, other embodiments are provided in which the ends of the brackets 5023 may protrude from the surface for contact with the fabric 5019 before the cartridge body 5010 is compressed by the stop member 5040. How only the end clamp will be properly positioned, returning to FIG. 161B, the jaw 5040 can be moved downward to the cartridge groove with brackets 5030 so that the compressible body 5010 is compressed by the stop member 5040 and the contact surface of the fabric 5019 extends downward relative to the brackets 5020. When the contact surface of the fabric 5019 is pulled down, the ends 5023 of the legs of the brackets 5021 can pierce the contact surface with the fabric 5019 and pierce at least a portion of the fabric T. In such circumstances, the holding substrate 5050 can be located above the brackets 5020 so that holding guides holding hole 5052 of the substrate 5050 are coaxial or at least substantially coaxial with the ends of the legs 5023 of brackets 5021.

When the holding substrate 5050 is pulled down along the axis 5099, returning to FIG. 161C, the legs of the brackets 5021 of the brackets 5020 may fit into the holding holes 5052. In various embodiments, the legs of the brackets 5021 can engage with the side walls of the holding holes 5052. In some embodiments, which are described in more detail below, the holding substrate 5050 may contain one or more holding an element protruding inwardly and / or around the holding holes 5052, which can be caught by the legs of the brackets 5021. In another case, the legs of the brackets 5021 can be held in the holding holes 5052. In different In circumstances, the ends 5023 of the legs of the brackets 5021 can enter the holding holes 5052 and can be coupled by friction to the holding elements and / or the side walls of the holes 5052. When the holding substrate 5050 is extended to the bases 5022 of the brackets 5020, the legs of the brackets 5021 can slide relative to the side walls and / or holding elements. As a result of the above described, sliding friction forces can be generated between the legs of the brackets 5021 and the holding substrate 5050, and such sliding friction forces can prevent the introduction of the brackets 5020 into the holding substrate 5050. In various embodiments, the sliding friction forces between the holding substrate 5050 and the brackets 5020 can be constant or at least substantially constant when the holding substrate 5050 slides down along the legs of the brackets 5021 of the brackets 5020. In some embodiments, the friction forces When sliding, they can increase and / or decrease if the holding substrate 5050 slides down along the legs of the brackets 5021 due to changes in the geometric shape of the legs of the brackets 5021, the holding holes 5052 and / or the holding elements protruding, for example, inward and / or around the holding holes 5052 In various embodiments, the introduction of the brackets 5020 into the retaining substrate 5050 will also be prevented by the compressible cartridge body 5010 with the brackets 5000. More specifically, the compressible housing 5010 may consist of an elastic material that The other, for example, can transmit a drag force to the holding substrate 5050, which increases with increasing distance by which the cartridge body 5010 has been compressed. In at least one such embodiment, the increase in drag force generated by the cartridge body 5010 may be linearly proportional or at least substantially linearly proportional to the distance over which the cartridge housing 5010 is compressed. In some embodiments, an increase in the drag force generated by the cartridge housing 50 10 may be geometrically proportional to the distance over which the cartridge 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 retaining substrate 5050 to overcome the drag and friction forces described above. During operation, the holding substrate 5050 can be immersed to any suitable depth relative to the brackets 5020. In at least one embodiment, the holding substrate 5050 can be immersed to a depth relative to the bases 5022 of the brackets 5020, which allows two or more layers of fabric to be fixed together. and at the same time create compressive force or pressure in the tissue. In various circumstances, a system comprising a retaining substrate 5050 and brackets 5020 may allow the surgeon to select the amount of compressive forces, or pressures that are applied to the tissue, by selecting the depth at which the retaining substrate 5050 is immersed. For example, the retaining substrate 5050 can be moved down to the bases of the brackets 5022 of the brackets 5020 until the retaining substrate 5050 sinks to a certain depth 5011 from the bottom of the retaining grooves 5032, and a smaller depth 5011 can lead to the emergence of large compressive forces, whether the pressures that are applied to the fabric T are greater than the depth 5011, which can lead to lower compressive forces, or the pressures that are applied to the fabric T. In various embodiments, the compressive forces or pressures that are applied to the fabric T can be linear are proportional or at least substantially linearly proportional to the depth 5011 on which the holding substrate 5050 is immersed. In various circumstances, the compressive forces or pressure applied to the fabric T may depend on the thickness of the fabric T, p memory location 5050 between the holding substrate and the staple cartridge 5020. More specifically, at a predetermined distance 5011 Choose thicker tissue T can lead to high compressive forces or pressure than in the presence of a thin tissue T.

In various circumstances, in addition to the above, the surgeon can adjust the depth at which the retaining substrate 5050 is immersed, taking into account the larger and / or smaller thickness of the tissue located in the end clamp, to apply some or a predetermined pressure to the tissue T, regardless the thickness of the fabric. For example, the surgeon can immerse the retaining substrate 5050 to a shallower depth 5011 when a thinner fabric T is stitched, or to a greater depth 5011 when a thicker fabric T is stitched 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 can selectively determine the amount of pressure applied to the tissue T, which is located between the retaining substrate 5050 and the cartridge with brackets 5010. In various circumstances, the surgeon may adhere the retaining substrate 5050 to the brackets 5020 and position the retaining the substrate 5050 at a first distance from the bases 5022 of the brackets 5020 for applying a first compression pressure to the fabric. Alternatively, the surgeon may position the retaining substrate 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 that exceeds the first compression pressure. Alternatively, the surgeon may position the retaining substrate 5050 at a third distance from the bases 5022, which is shorter than the second distance, to apply third compression pressure to the tissue that exceeds the second compression pressure. In various embodiments, a crosslinking system comprising a retaining substrate 5050 and brackets 5020 can be configured to allow a surgeon to apply a wide range of compression pressures to the target tissue.

In various embodiments, returning to FIG. 161D, the legs of the brackets 5021 can be inserted into the holding substrate 5050 so that the ends of the legs of the brackets 5023 protrude above the upper surface of the holding substrate 5050. In at least one embodiment, returning again to FIG. 161C, the jaw 5040 may further comprise intermediate holes 5042 that can be configured to hold the ends of the legs of the brackets 5023 as they pass through the holding holes 5052 in the holding substrate 5050. In at least one such embodiment, the intermediate holes 5042 can be aligned with retaining holes 5052 such that the legs 5021 do not touch the jaw 5040. In various embodiments, the intermediate holes 5042 may have a substantial depth that allows the legs to 5021 by side not in contact with the jaws 5040, regardless of how far the holding substrate was immersed 5050. After coupling holding substrates 5050 with brackets 5020 and its immersion to the desired depth, returning to FIG. 161D, the cartridge groove with brackets 5030 and the jaw 5040 can be removed from fabric T. More specifically, the cartridge groove with brackets 5030 can be detached from the implantable cartridge with brackets 5000, and the abutment member 5040 can be detached from the implantable holding substrate 5050. When the jaw 5040 is removed from the holding substrate 5050 and the holding grooves for the brackets 5032 are removed from the lower parts of the brackets 5022, the distance 5011 between the holding substrate 5050 and the bottom of the bases 5022 can be maintained even though the jaw 5040 and the cartridge groove with about brackets 5030 no longer support it. In various embodiments, the static frictional force between the legs of the brackets 5021 and the holding substrate 5050 may be sufficient to hold the holding substrate 5050 in a certain position despite the biasing force that is applied to the holding substrate 5050 by the compressed cartridge body 5010 and / or the compressed fabric T. B, in at least one such embodiment, the cartridge housing 5010 may consist of an elastic material that, when compressed, can exert an elastic biasing force on the holding substrate 5050 and the brackets 5020, otorrhea tends to push individually retaining brackets substrate 5050 and 5020, as a motion counteracts the adhesion forces of friction between the legs of brackets 5021 and 5050 holding the substrate.

In the various embodiments described above, the holding substrate may comprise a plurality of holding holes, while the holding holes may be configured to hold the fastening legs. In at least one embodiment, returning to FIG. 162, a portion of a holding substrate 5150 is shown, which may include a holding hole 5152 having a perimeter 5156. In various embodiments, the perimeter 5156 of the hole 5152 may have a round or at least substantially circular shape and / or any other suitable shape. In some embodiments, the holding substrate 5150 may comprise one or more holding elements, such as, for example, the holding element 5153, which may protrude into the hole 5152 and may be configured to engage with the fastening leg when the fastening leg is inserted therein. In at least one such embodiment, each locking element 5153 may comprise a cross member that projects inward to the central axis 5159, i.e. to the center of the hole 5152. In various embodiments, each cross member may include a first end that is attached to the housing of the holding substrate 5158, and a second end that forms the 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 a width and a fastening leg can be defined by a second diameter or a width, the second diameter being larger than the first diameter. In at least one such embodiment, the fastening leg may be configured to touch and deflect one or more of the holding member 5153 to increase the diameter of the holding hole 5152 when the fastening leg is inserted into it. In some embodiments, in addition to the foregoing, the bonding leg may be defined by a perimeter that is larger than the perimeter 5156 of the holding hole 5152, whereby, when inserted, the bonding leg can extend the perimeter 5156.

In various embodiments, returning again to FIG. 162, the opening 5152 may be limited by deformable elements 5153, each deformable element 5153 may be configured to deviate relatively or independently from other deformable elements 5153. In at least one such embodiment, adjacent deformable elements 5153 may be separated by grooves 5154, which can be configured to allow bending of each deformable member 5153 relative to others. In some embodiments, each groove 5154 may comprise a first end 5155 in the housing of the holding substrate 5158, a second end opening into the holding hole 5152, and a constant or at least substantially constant width extending from the first end 5155 to 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 the first and second ends of the groove. 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 deformation return to the bases of deformable elements 5153 attached to the housing of the holding substrate 5158, and, secondly, serves to increase the flexibility of the deformable elements 5153. In various embodiments, the geometric shape of the deformable elements 5153 and / or grooves 5154 can be selected so as to provide the desired flexibility of the deformable elements 5 153. In some embodiments, for example, grooves 5154 can be extended to create longer deformable elements 5153, which can be more flexible than deformable elements 5153, which are shorter. In at least one embodiment, the width of each deformable member 5153 can be selected so as to provide the desired flexibility. More specifically, deformable elements that have a smaller width may be more flexible than deformable elements with a larger width. In some embodiments, implementation, again returning to FIG. 162, the first ends of the cross members of deformable elements 5153 attached to the housing of the holding substrate 5158 may be wider than the second ends of the cross members. In at least one such embodiment, the cross members may linearly or at least substantially linearly cone between their first and second ends.

In various embodiments, returning again to FIG. 162, the housing of the holding substrate 5158 may consist of a flat or at least substantially flat sheet of material having a contact surface with fabric 5151 and an upper surface 5157. In at least one such embodiment, the contact surface with fabric 5151 and the upper surface 5157 may be parallel or at least substantially parallel to each other. In various embodiments, each deformable member 5153 may comprise a first part 5153a and a second part 5153b, with the first part 5153a protruding in the first direction and the second part 5153b protruding in the other or second direction. In at least one such embodiment, the housing of the holding substrate 5158 can be determined using a plane, and the first parts 5153a of the deformable elements 5153 can lie in this plane. In various embodiments, the second parts 5153b of the deformable members 5153 may project at an angle with respect to the first parts 5153a. In at least one such embodiment, the second parts 5153b may protrude in directions that may diverge from the upper surface 5157 of the housing of the holding substrate 5158, and, in some embodiments, the second parts 5153b may converge to 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 the fastening leg passes through them. In embodiments where the leg of the bracket 5021 of the bracket 5020 is inserted into the holding hole 5152, the deformable elements 5153 can be deformed in a direction that normally deviates from the bases 5122 of the brackets 5120. In some embodiments, as a result, the deformable elements 5153 can usually deviate in the direction which coincides or at least substantially coincides with the direction in which the legs of the brackets 5021 are inserted.

In various embodiments, each second part 5153b of the deformable elements 5153 may have a sharp end, which, for example, can be configured to slide relative to the bracket foot 5021 when the bracket foot 5021 is inserted. The sharp ends of the second parts 5153b can also be configured to bite the foot brackets 5021 in the case where the bracket leg 5021 should extend in the opposite direction, i.e. in the direction in which the leg of the bracket 5021 can be removed from the holding hole 5052. In some circumstances, the second parts 5153b may be tilted to the side of the legs of the bracket 5021 at an angle exceeding 90 degrees, as a result of which the second parts 5153b may cut into or sink into the side the legs of the bracket 5021, when the leg of the bracket 5021 is subjected to a force that helps to remove the legs of the bracket 5021 from the retaining hole 5052. In some embodiments, the legs of the bracket 5021 may include depressions on their surfaces and / and and recesses, such as, for example, micropressures, which can be configured, for example, to hold the ends of the deformable elements 5053. In at least one such embodiment, the ends of the deformable elements 5053 can be caught and immersed in the depressions in the legs of the brackets 5021 when force is applied to the legs of the brackets 5021 to remove them. In various embodiments, by immersing the second parts 5153b into the legs of the brackets 5021, the forces involved in removing the legs of the brackets 5021 from the retaining holes 5022 can only insert the second parts 5153b deeper into the legs of the brackets 5021 and increase the force required to remove the legs of the brackets 5021. Moreover, due to the tilt of the second parts 5153b upward in at least one embodiment, the second parts 5153b can more strongly contribute to the introduction of the legs of the bracket 5021 in the holding hole 5152 and provide greater resistance to removal the foot of the bracket 5021. As a consequence, in at least one embodiment, the force required to insert the bracket foot 5021 into the holding hole 5022 may be less than the force required to remove the bracket foot 5021 from the holding hole 5022. In various embodiments the force required to remove the leg of the bracket 5021 from the holding hole 5022 may be approximately 50 percent greater than, for example, the force required to insert the leg of the bracket 5021 into the holding hole 5022. In various other embodiments, The force required to remove the leg of the bracket 5021 can be approximately 10% -100% greater than, for example, the force required to insert the leg of the bracket 5021. In some embodiments, the force required to remove the leg of the bracket 5021 can be approximately 100 percent, about 150 percent, about 200 percent and / or more than about 200 percent more than, for example, the force required to insert the legs of the bracket 5021.

In some embodiments, implementation, again returning to FIG. 162, the second parts 5153b may be located around the hole 5152 and thus limit the recess. More specifically, the second parts 5153b may define a recess 5160 that can be configured to hold the end of the fastening leg when it is inserted into the holding hole 5152. In various embodiments, the second parts 5153b of the deformable elements 5153 may have an annular or at least substantially an annular contour that can jointly form, for example, an annular or at least substantially annular cross-section of a recess 1560. In at least one such embodiment, the second portions 5153b may define a recess that is in the shape of a cone or a truncated cone. In various embodiments, the recess may be limited by a suitable number of deformable elements, such as, for example, four deformable elements 5153 (FIG. 162), six deformable elements 5153 (FIG. 163), or eight deformable elements 5153 (FIG. 164). In some embodiments, returning to FIG. 165, deformable elements of a retaining substrate, such as, for example, a retaining substrate 5250, may have, for example, a pyramidal shape or at least a substantially pyramidal shape. In various embodiments, the holding substrate 5250 may comprise a plurality of holding holes, such as, for example, a holding hole 5252, which may be limited by the perimeter 5256. In various embodiments, the perimeter 5256 may have a polygonal or at least substantially polygonal shape, and / or any other suitable form. In some embodiments, the holding substrate 5250 may comprise one or more holding elements, such as, for example, the holding element 5253, which may protrude into the hole 5252 and may be configured to engage with the fastening leg when the fastening leg is inserted into it. In at least one such embodiment, each locking element 5253 may comprise a cross member that projects inwardly towards the central axis 5259, i.e. to the center of the hole 5252. In various embodiments, each cross member may include a first end that is attached to the housing of the holding substrate 5258, and a second end that forms the perimeter 5256 of the holding hole 5252. In some embodiments, the perimeter 5256 of the holding hole 5252 may be defined by a first diameter or a width and a fastening leg can be defined by a second diameter or a width, the second diameter being larger than the first diameter. In at least one such embodiment, the fastening leg may be configured to touch and deflect one or more of the holding member 5253 to increase the diameter of the holding hole 5252 when the fastening leg is inserted into it. In some embodiments, in addition to the foregoing, the bonding leg can be defined by a perimeter that is larger than the perimeter 5256 of the holding hole 5252, whereby when inserted, the bonding leg can increase the perimeter 5256.

In various embodiments, returning again to FIG. 165, hole 5252 may be delimited by deformable members 5253, each deformable member 5253 may be configured to deviate relatively or independently from other deformable members 5253. In at least one such embodiment, adjacent deformable members 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 implementation of the housing of the retaining substrate 5258 may consist of a flat or at least essentially flat sheet of material having a surface for contact with fabric 5251 and an upper surface 5257. In at least one such embodiment, the surface for contact with fabric 5251 and the upper surface 5257 may be parallel or at least substantially parallel to each other. In various embodiments, each deformable member 5253 may comprise a first part 5253a and a second part 5253b, with the first part 5253a protruding in the first direction and the second part 5253b protruding in a different or second direction. In at least one such embodiment, the housing of the holding substrate 5258 can be determined using a plane, and the first parts 5253a of the deformable elements 5253 can lie in this plane. In various embodiments, the second parts 5253b of the deformable members 5253 may project 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 may diverge from the upper surface 5257 of the housing of the holding substrate 5258, and, in some embodiments, the second parts 5253b may converge to 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 as the fastening leg passes through them. In some embodiments, implementation, again returning to FIG. 165, the second portions 5253b may be located around the hole 5252, while limiting the recess. More specifically, the second parts 5253b may limit the recess that can be configured to hold the end of the fastening leg when it is inserted into the holding hole 5252. In various embodiments, the second parts 5253b of the deformable elements 5253 are limited, for example, polygonal or at least essentially a polygonal recess. In various embodiments, the recess may be limited by a suitable number of deformable elements, such as, for example, four deformable elements 5253 (FIG. 165) that define a square, six deformable elements 5253 (FIG. 166) that may define a hexagon, or eight deformable elements 5253 (FIG. 167), which may limit, for example, an octagon.

In various embodiments, returning to FIG. 168, the holding substrate 5350, for example, may consist of 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 in the housing 5358 of the holding substrate 5350 may be formed during one or more stamping processes. The sheet of material can be located in the stamping die, when activated, some parts of the material can be knocked out to form, for example, grooves 5354, holes 5355 of grooves 5354 and / or perimeter 5356 of the holding hole 5352. The stamping stamp can also be configured to bend deformable elements 5353 in the required configuration. In at least one such embodiment, the embossing stamp may deform the second parts 5353b with respect to the first parts 5353a upward along the bend 5353c. In various embodiments, returning to FIG. 169, a holding substrate, such as, for example, a holding substrate 5450, may comprise a plurality of holding holes 5452. Similarly to the above, the perimeter 5456 of each holding opening 5452 may be limited to a plurality of deformable elements 5453 separated by grooves or cuts, 5454. B, at least in at least one such embodiment, each deformable element 5453 can be completely bent upward, the free ends of the cross members of the deformable elements 5453 may define a perimeter 5456. In various embodiments, the axis The holding substrate 5450 may include holes 5455 that surround or at least substantially surround the holding hole 5452. In at least one such embodiment, the holes 5455 can be arranged in the form of an annular antenna array surrounding or surrounding the perimeter, bounded by the fixed ends of the cross members of the deformable elements 5453. In some embodiments, each hole 5455 may have a circular or at least substantially circular perimeter, and / or any other approach dyaschy perimeter. During use, holes 5455 can provide, firstly, deformation return to the bases of deformable elements 5453 attached to the housing of the holding substrate 5458, and secondly, to increase the flexibility of deformable elements 5453. In various embodiments, large holes 5455 can provide large the flexibility of the deformable elements 5453 in comparison with the smaller holes 5455. Moreover, the holes 5455, which are closer to the deformable elements 5453, can provide greater flexibility compared to versts 5455, which are located further.

In various embodiments, returning to FIG. 170, the holding substrate 5550, for example, may comprise a plurality of holding holes 5552. Each holding hole 5552 may include an elongated groove 5554 having widened round or at least substantially circular ends 5555. In at least one such embodiment the ends 5555 may be determined by a diameter that is wider than the groove 5554. In some embodiments, the oblong groove 5554 and the ends 5555 may be located along and / or in the center of the longitudinal axis 5559. In various embodiments, the groove 5554 and seedlings 5555 may be limited by two opposing legs 5553 which can be configured to engage with the fastening foot and its rejection when fastening leg is inserted between them. In at least one embodiment, ends 5555 having a larger perimeter or diameter may limit longer supports 5553, which may be more flexible than supports 5553 bounded by ends 5555, which have a smaller perimeter or diameter. In various embodiments, the ends 5555 may have the same perimeter and diameter, and in at least one embodiment, each support 5553 may be symmetrical about an axis that is perpendicular or at least substantially perpendicular to the longitudinal axis 5559. B in another case, the ends 5555 may have different perimeters and / or diameters, and in at least one embodiment, each support 5553 may not be symmetrical about this axis. In at least one alternative embodiment, the supports 5553 can rotate around their axes when the fastening leg is inserted into the holding hole 5552. In various embodiments, returning to FIG. 171, the holding substrate 5650, for example, may comprise a plurality of holding holes 5652. Each holding hole 5652 may comprise an elongated groove 5654 having widened round or at least substantially circular ends 5655. In at least one such embodiment the elongated groove 5654 and the ends 5655 may be located along and / or located in the center of the longitudinal axis 5659. In various embodiments, each end 5655 may be determined by a diameter that matches or at least substantially matches with a groove width of 5654.

In various embodiments, returning to FIG. 172, a holding substrate, such as a holding substrate 5750, for example, may comprise a plurality of holding holes 5752. Each holding hole 5752 may comprise a plurality of grooves, such as, for example, grooves 5754 that have widened ends 5755. In at least one In such an embodiment, the grooves 5754 and the ends 5755 may be located along and / or located in the center of the longitudinal axes 5759. In various embodiments, the axes 5759 may extend in directions that are perpendicular or transverse to each other. ha. In some embodiments, the grooves 5754 and the ends 5755 may limit, for example, four supports 5753, which can be configured to engage and deflect the fastener leg when the fastener leg is inserted into the holding hole 5752. In at least one embodiment, each the support 5753 may have a triangular or at least substantially triangular shape, forming, for example, an equilateral triangle. In other various embodiments, returning to FIG. 173, a holding substrate, such as, for example, a holding substrate 5850, may comprise a plurality of holding holes 5852. Each holding hole 5852 may comprise a plurality of grooves, such as, for example, grooves 5854 that have widened ends 5855, grooves 5854 and ends 5855 may be located along and / or in the center of the longitudinal axes 5859. In various embodiments, the axles 5859 may extend in directions that are perpendicular or transverse to each other. In some embodiments, grooves 5854 and ends 5855 may limit supports 5853, which can be configured to engage and deflect the fastener leg when the fastener leg is inserted into the holding hole 5852. In at least one embodiment, each leg 5853 may have curved cross section. More specifically, each support 5853 may include a curved end opposite the pointed end shown in FIG. 170, which can be configured to come into contact with the fastening leg.

In various embodiments, returning to FIG. 174, a holding substrate, such as a holding substrate 5950, for example, may contain many holding holes 5952. Each holding hole 5952 may contain many grooves, such as, for example, grooves 5954, and each groove 5954 may be located along and / or in the center longitudinal axis 5959. In various embodiments, axles 5959 can intersect each other and, in at least one such embodiment, axes 5959 can be ordered so that all axes 5959 pass through the center of the holding hole I 5952 and equidistant or at least substantially equidistant from each other. In at least one embodiment, each groove 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 groove 5954. Similarly, the grooves 5954 and the ends 5955 may limit, for example, three supports 5953 that can be configured to engage and deflect the fastener leg when the fastener leg is inserted into the holding hole 5952. In various embodiments, each support 5953 may have a curved shape and be between the adjacent ends of 5955 grooves 5954. In various embodiments, returning to FIG. 175, a holding substrate, such as a holding substrate 6050, for example, may comprise a plurality of holding holes 6052. Each holding hole 6052 may include a support 6053 that can be configured to engage and deflect the fixing leg when the fixing leg is inserted into the holding hole 6052 In at least one such embodiment, the support 6053 may include a base attached to the housing of the holding substrate 6058, and a free end having an arcuate or curved transversely section 6056 which can be configured to be in contact with the fastening foot. In some embodiments, the fastening foot may be a brace foot consisting of a round wire, wherein the curved cross section 6056 can be configured to match, or at least substantially match, the curved outer surface of the round wire.

In various embodiments, returning to FIG. 175, the housing of the holding substrate 6058 may comprise a plurality of grooves 6065 and holes 6055, which may be configured to limit the support 6053 and various parts of the holding hole 6052. In at least one embodiment, the support 6053 may have a rectangular shape having parallel or, at least substantially parallel sides. In some embodiments, returning to FIG. 176, a holding substrate, such as, for example, a holding substrate 6150, may comprise a plurality of holding holes 6152. Each holding hole 6152 may include a support 6153 that can be configured to engage with the fastening leg and deflect it when the fastening leg is inserted into the holding hole 6152. In at least one such embodiment, the support 6153 may include a base attached to the housing of the holding substrate 6158 and a free end having an arcuate or curved transversely Section 6156, which can be configured to come into contact with the fastening foot. In various embodiments, the implementation of the housing of the holding substrate 6158 may contain many grooves 6165 and holes 6155, which can be configured to limit the support 6153 and various parts of the holding hole 6152. In at least one embodiment, the support 6153 may have the shape of a cone having an arcuate shape surface. In at least one such embodiment, the support 6153 may taper off exponentially, the base, for example, being wider than the free end.

In various embodiments, as described above, the crosslinking system may comprise a plurality of brackets containing brace legs that are inserted into the holding substrate through the plurality of holding holes. In some embodiments, which are described in more detail below, the brackets can be held in the first jaw, and the holding substrate can be held in the second jaw, wherein at least one of the first jaw and the second jaw can be moved toward the other. In various circumstances, the brackets located in the first jaw can be fixed in it so that the legs of the brackets are aligned with the retaining holes when the retaining substrate is adhered to the legs of the brackets. In some embodiments, returning to FIG. 177 and 178, the stapling system may comprise, for example, a cartridge with brackets 6200 located in the first branch of the surgical stapler and a holding substrate 6250, for example, located in the second branch of the surgical stapler. Returning to FIG. 184 and 185, in addition to the above, the holding substrate 6250 may comprise a plurality of holding holes 6252, each holding hole 6252 may have a perimeter 6256 defined by one or more deflectable members 6253. In at least one such embodiment, in addition to the above, the deflectable elements 6253 defining each hole 6252 may limit the recess 6201. In various embodiments, each recess 6201 may comprise, for example, a curved and / or concave surface, otorrhea may be configured to guide the legs of a bracket end into the hole 6252 in the event that leg braces shifted relative to the retaining holes 6252 and first came into contact, for example, the biasing member 6253 and / or a surface for contact with the tissue 6251.

In various embodiments, in addition to the foregoing, the crosslinking system may further comprise a plurality of brackets 6220 containing legs of brackets 6221 that are inserted into the holding substrate 6250 through the plurality of holding holes 6252. In at least one embodiment, each bracket 6220 may for example, have a substantially U-shape and comprise a base 6222, from which the legs of the bracket 6221 extend upward. In various embodiments, returning to FIG. 180 and 181, the holding holes 6252 in the holding substrate 6250 can be arranged, for example, in the form of two parallel or at least substantially parallel longitudinal rows that can extend along, or parallel to, the longitudinal axis of the holding substrate. In some embodiments, the holding holes 6252 in the first row may be offset or steps relative to the holding holes 6252 in the second row. In at least one such embodiment, each bracket 6220 may comprise a first bracket leg 6221 located in the holding hole 6252 in the first row and a second bracket leg 6221 located in the holding hole 6252 in the second row, whereby the bases 6222 may protrude in a direction that is perpendicular to the longitudinal axis of the holding substrate 6250. In at least one such embodiment, the brackets 6220 may be parallel or at least substantially parallel to each other. More specifically, the base 6222a of the bracket 6220a is parallel or at least substantially parallel to the base 6222b of the bracket 6220b, which may be parallel or at least substantially parallel, for example, to the base 6222c of the bracket 6220c. In at least one embodiment, the legs of the bracket 6221a of the bracket 6220a may be in a plane that is parallel or at least substantially parallel to the plane formed by the legs of the bracket 6221b of bracket 6220b, which may be, for example, parallel or at least substantially parallel to the plane formed by the legs of the bracket 6221 of the bracket 6220c.

In various embodiments, returning to FIG. 177 and 179, the cartridge with brackets 6200 may comprise a plurality of brackets 6220 and, in addition, a leveling substrate 6260 comprising a plurality of alignment guides, such as, for example, grooves, rotatable grooves and / or holes that can be configured to align the brackets 6220. In various circumstances, the alignment substrate 6260 may be configured so that the legs of the brackets 6221 of the brackets 6220 are aligned with the holding holes 6252 in the holding substrate 6250 before the holding substrate 625 0 interlocks with the legs of the brackets 6221. In various embodiments, returning to FIG. 182 and 183, the alignment substrate 6260 may comprise a plurality of alignment holes 6262 that can be configured to tightly hold the legs of the brackets 6221 of the brackets 6220. In at least one such embodiment, each bracket 6220 may comprise a base 6222 and two legs of the bracket 6221, protruding from the base 6222, and the base 6222 of the brackets 6220 may be around the bottom surface 6264 of the holding substrate 6260, and the legs of the brackets 6221 may protrude upward through the alignment holes 6262. In some embodiments, each the alignment hole 6262 may have a round or at least substantially circular shape and also be determined by a diameter that may be equal to or slightly larger than the diameter of the bracket leg 6221 extending therein. In various embodiments, the alignment substrate 6260 may further comprise a plurality of protruding elements 6263 that can protrude upward from the upper surface 6261 of the alignment substrate 6260 and surround or at least substantially partially surround the alignment holes 6262. In some embodiments In the implementation, the protruding elements 6263 may be intended for elongated alignment holes 6262, and, in various circumstances, the presence of elongated holes 6262 can provide better control of the alignment of the legs of the brackets 6221 than the presence of shorter holes 6262.

During operation, in various embodiments, the first jaw holding the cartridge with brackets 6200 may be located on the side of the fabric to be sewn, and the second jaw holding the holding substrate 6250 may be located on the other side of the fabric. Once the jaws have been properly positioned relative to the fabric, in some embodiments, the second jaw and the holding substrate 6250 can be moved to the cartridge with brackets 6200. After inserting the legs of the brackets 6221 into the holding holes 6252 of the holding substrate 6250, in various embodiments, the surface for contact with the fabric, or the lower surface 6251 of the holding substrate 6250 may come into contact with the fabric and press it to the surface for contact with the fabric, or the upper surface, 6261 alignment the substrate 6260. In various other embodiments, as described in more detail below, the cartridge with brackets 6200 may further comprise a compressible cartridge housing located, for example, above the upper surface 6261 of the alignment substrate 6260, which may come in contact with the fabric. In some embodiments, implementation, again returning to FIG. 179 and 183, the alignment substrate 6260 may further comprise one or more holes 6203, which may be configured to hold a portion of the fabric when the alignment substrate 6260 is opposite the fabric. In embodiments in which the compressible cartridge housing is located above and / or opposite the alignment substrate 6260, a portion of the compressible cartridge housing may enter holes 6203 when the cartridge housing is in a compressed state. Similarly, the holding substrate 6250 may comprise a plurality of holes 6202 that can be configured to hold at least a portion of the fabric when the holding substrate 6250 is located opposite the fabric.

After inserting the legs of the brackets 6221 of the brackets 6220 into the holding holes 6252 of the holding substrate 6250, in addition to the above, the ends of the legs of the brackets 6221 may protrude upward through the upper surface 6257 of the holding substrate 6250. In various circumstances, as described above, the ends of the legs of the brackets 6221 may remain straightened after they have been inserted into the holding holes 6252. In some embodiments, returning to FIG. 186-189, a crosslinking system comprising a cartridge with brackets 6200 and a holding substrate 6250 may further comprise a plurality of protective caps or caps, such as, for example, caps 6270 that can be attached to the legs of the brackets 6221 that protrude above the holding substrate 6250. In various embodiments, each end cap 6270 may completely or at least partially cover the sharp end of the leg of the bracket 6221 so that the sharp end cannot come in contact with the fabric adjacent to it. In at least one embodiment, returning to FIG. 189, each plug 6270 may include an opening 6271 that can be configured to hold the end of the leg of the bracket 6221 tightly. In various embodiments, the plugs 6270 may consist of an elastomeric material, such as, for example, silicone, polyisoprene, santoprene and / or natural rubber. In at least one embodiment, the opening 6271 may have a perimeter or diameter that may be smaller than the perimeter or diameter of the bracket leg 6221 inserted into it. In at least one such embodiment, the hole 6271 in the protective plug 6270 may expand to accommodate the legs of the brackets 6221. In various alternative embodiments, the plugs 6270 may not have holes, and the ends of the legs of the brackets 6221 may be configured to pierce the plugs 6270 when inserting the legs 6221 into them. In any case e, in various embodiments, each plug 6270 can be put on the leg of the bracket 6221 until the base 6272 of the plug 6270 is in contact or near the upper surface 6257 of the holding substrate 6250. In various circumstances, the plugs 6270 can be configured so that they can fit so tightly over the ends of the legs of the brackets 6221 that they cannot be easily removed from them. In some embodiments, each plug 6270 may have, for example, a conical or at least substantially conical outer surface. In various embodiments, plugs 6270 may have any suitable outer surface shape, such as, for example, a parabolic or at least substantially parabolic outer surface.

In various embodiments, the cross-linking system described above, for example, can be deployed using the surgical cross-linking apparatus shown, for example, in FIG. 190-192. In various embodiments, the end clip may comprise a first jaw, or a cartridge chute with brackets, 6230 that can be configured to hold the cartridge with brackets 6200, and a second jaw 6240, which can be configured to hold the holding substrate 6250 and a plurality of security plugs 6270. Returning mainly to FIG. 190, which shows the first 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 between the holding substrate 6250 and the cartridge with brackets 6200. In various embodiments, as discussed above, the cartridge with brackets 6200 may further comprise a compressible cartridge housing, such as, for example, cartridge housing 6210, in which brackets 6220 and alignment matrix 6260 are located. In at least one such embodiment, fabric T may be disposed a top of the cartridge housing 6210. In some embodiments, the second jaw 6240 may comprise a plurality of recesses, or holes, 6245 that are configured to hold a plurality of security plugs 6270 and, furthermore, one or more restraining devices, or a holder that can be configured for holding the holding substrate 6250 over the plugs 6270. In at least one such embodiment, the holding substrate 6250 may be configured to hold the plugs 6270 in the hole Rep 6245. In various embodiments, returning to FIG. 202, each hole 6245 may be configured to hold part or all of the plug 6270 in itself. In some embodiments, the holes 6245 may be substantially sized and configured to allow the plugs 6270 to be secured in them with, for example, a latch and / or devices for press fit. In some embodiments, at least one adhesive may be used to secure plugs 6270 in openings 6245. In at least one such embodiment, such an adhesive may be selected so that the plugs 6270 can be detached from the second jaw 6240 after the plugs 6270 are engaged with the legs of the brackets 6221 and the second jaw 6240 is moved from the implantable stapler assembled. In some embodiments, returning to FIG. 203, the second jaw 6240 may further comprise at least one cladding sheet 6246, which may be attached to the second jaw 6240, and also cover and hold the plugs 6270 in the openings 6245. In at least one such embodiment, at least at least a portion of the sheathing sheet 6246 may be attached to the jaw 6240, for example, using at least one adhesive. During operation in at least one embodiment, the sheathing sheet 6246 may be at least partially detached from the jaw 6240 before the end clamp is inserted into the operative field. In some embodiments, the sheathing sheet 6246 may consist of an implantable material, such as, for example, PDS and / or PGC, which can be dissected by the legs of the brackets 6221 when the legs of the brackets 6221 come out of the retaining substrate 6250. In at least one such In an embodiment, the sheathing sheet 6246 may be fixed in the crosslinking system between the plugs 6270 and the holding substrate 6250.

In addition to the above, returning to FIG. 191, the jaw 6240 can move from the open to the closed position, in which the tissue T is located opposite the holding substrate 6250 and the cartridge body 6210. In this position, the holding substrate 6250 may not yet engage with the brackets 6220. In various embodiments, the jaw 6240 can move between the open and closed by means of a drive 6235. In at least one such embodiment, the jaw 6240 may include a distal pin 6243 and a proximal pin 6244, and the distal pin 6243 can slide vertically but or at least substantially vertically in the distal groove 6233 located in the groove for the cartridge 6230, while the proximal pin 6244 can slide vertically or at least substantially vertically in the proximal groove 6234, which is also located in a cartridge chute with brackets 6230. During operation, the drive 6235 can be pulled out proximally to move the pins 6243 and 6244 to the upper ends of the corresponding slots 6233 and 6234, as shown in FIG. 191. In at least one such embodiment, the actuator 6235 may comprise a distal groove of the actuator chain 6236 and a proximal groove of the actuator chain 6237, wherein the side walls of the grooves of the actuator chain 6236 and 6237 can be configured to engage with a distal pin 6243 and a proximal pin 6244 respectively, and moving the pins 6243 and 6244 upward when moving the actuator 6235 in the proximal direction. More specifically, when moving the actuator 6235, the proximal distal pin 6243 can slide along the inclined first portion 6236a of the distal groove of the drive chain 6236 to the intermediate or second part 6236b, and similarly, the proximal pin 6244 can slide along the inclined first portion 6237a of the distal groove of the chain drive 6237 to the intermediate, or second, part 6237b. After moving both pins 6243 and 6244 up, the jaw 6240 can be turned down to the tissue T in the closed position.

In addition to the above, returning to FIG. 192, the actuator 6235 can be further extended proximally to push the second jaw 6240 down toward the first jaw 6230, compress the cartridge housing 6210 and engage with the holding substrate 6250 and a plurality of protection plugs 6270 with legs of brackets 6220. In at least one such embodiment the implementation of additional proximal movement of the actuator 6235 may lead to contact of the side walls of the grooves of the drive chain 6236 and 6237 with the pins 6243 and 6244, respectively, and the movement of the pins 6243 and 6244 down to the lower ends of the grooves 6233 and 6234, respectively Twain. In such circumstances, the actuator 6235 can be extended proximally so that, firstly, the distal pin 6243 exits the second part 6236b of the groove of the drive chain 6236 and enters the inclined third part 6236c, and, similarly, the proximal pin 6244 exits the second part 6237b the groove of the drive chain 6237 and is included in the inclined third part 6237c. After moving both pins 6243 and 6244 down, the second jaw 6240 can be moved down to the first jaw 6230 to the activated position. In at least one such embodiment, the second jaw 6240 can be moved down so that the retaining substrate 6250 remains parallel or at least substantially parallel to the upper surface of the cartridge housing 6210 and / or parallel or at least essentially parallel to the leveling substrate 6260. In any case, after the engagement of the holding substrate 6250 and the protective caps 6270 with the legs of the brackets 6221 of the brackets 6220, as shown in FIG. 194, the second jaw 6240 may be returned to the open or at least substantially open position. In at least one such embodiment, the actuator 6235 can be extended distally to move the pins 6243 and 6244 to the upper ends of the grooves 6233 and 6234, respectively, after which the pins move down to the lower ends of the grooves 6233 and 6234 to pass through the intermediate parts 6236b and 6237b of the corresponding grooves of the drive chain 6236 and 6237. After opening the second jaw 6240, the first jaw 6230 can be disconnected from the implantable cartridge with brackets 6200, and the first and second jaws 6230, 6240 can be removed from the implantable stapler in failure e, as shown in FIG. 193.

Returning again to FIG. 192, the reader will notice that it was not shown how the pins 6243 and 6244 were installed in the lowermost parts of the corresponding slots 6233 and 6234, even if the holding substrate 6250 and the plugs 6270 were engaged with the legs of the brackets 6221. Such circumstances may occur if when a thick fabric T is located between the holding substrate 6250 and the cartridge case 6210. In circumstances where a thinner fabric T is located between the holding substrate 6250 and the cartridge case 6210, returning to FIG. 195, the pins 6243 and 6244 can be further extended downward in respective grooves 6233 and 6234, as shown in FIG. 197. In general, in at least one such embodiment, the actuator 6235 can be extended proximally to move the pins 6243 and 6244 up and down in the sequence described above, which is shown in FIG. 195-197, and, due to the smaller thickness of the fabric T, the holding substrate 6250 and the protective caps 6270 can be further moved to the legs of the brackets 6221 of the brackets 6220, as shown in FIG. 198 and 199. In various embodiments, due to the adjustability provided for the retaining substrate 6250, the same or at least substantially the same pressure can be obtained in the stitched fabric regardless of the thickness of the fabric that has been gripped by the end clip. In some embodiments, the adjustability provided for the retaining substrate 6250 may allow the surgeon to determine whether a greater compressive force or less compressive force is applied to the tissue by selecting the immersion depth of the retaining substrate 6250. In at least one such embodiment, the immersion range of the brace legs 6221 in the holding matrix 6250 may be determined, for example, by the length, or range, of the slots 6233 and 6234.

In various embodiments, as described above, the protective plugs 6270 may consist of soft or flexible material, which, for example, may be configured to grip the ends of the legs of the brackets 6221. In some embodiments, the protective plugs 6270 may consist, for example, of a biologically absorbable plastic, polyglycolic acid (PGA), which is sold under the trade name Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL), sold under the trade name Niemi Monocryl, polycaprolactone (PCL) and / or different mixtures of PGA, PLA, PDS, PHA, PGCL and / or EPM and / or biocompatible metal, such as, for example, titanium and / or stainless steel. As shown in FIG. 189, in at least one embodiment, each plug 6270 may not communicate with other plugs 6270. In some other embodiments, one or more plug 6270 may be installed in a holding substrate 6250. In at least one such embodiment the plugs 6270 can be connected to the holding substrate 6250, for example, using at least one adhesive, and the holes 6271 in the plugs 6270 can be coaxial or at least essentially coaxial with the holding holes 6 252 in a holding substrate 6270. In various embodiments, returning to FIG. 200, a protective plug, such as, for example, plug 6370, may comprise an internal cavity, or arch, 6374, which may be configured to hold, for example, the end of the leg of bracket 6221. In at least one such embodiment, the plug 6370 may comprise a base 6372 and an opening 6371 located at the base 6372. in various embodiments, the opening 6371 may be delimited by one or more deflectable member 6373, which may be configured to deflect when a bracket leg 6221 is inserted into the plug. in some embodiments, for example, two or more plugs 6370 may be connected together to form a chain of plugs 6370. In at least one such embodiment, returning to FIG. 201, a plurality of plugs 6370 can be connected to each other using sheet material 6375. In some embodiments, sheet 6375 can be substantially rigid to maintain the desired location and / or alignment of plugs 6370. In at least one such embodiment, plugs 6370 may consist of a biocompatible metal, such as, for example, titanium and / or stainless steel, and sheet 6375 may consist, for example, of biologically absorbable plastic, polyglycolic acid (PGA), which is sold under the trade on Vicryl, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglecaprone 25 (PGCL) sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PGA, PLA, PDS, PHA, PGCL and / or PKL. In various embodiments, sheet 6375 may consist of a biologically absorbable material containing an antimicrobial agent stored or dispersed therein, such as, for example, colloidal silver and / or triclosan, which can be released, for example, through biological absorption of sheet 6375.

In various embodiments, in addition to the foregoing, sheet 6375 can be injection molded around plugs 6370 using, for example, an injection molding process such that plugs 6370 are immersed in sheet 6375. In some other embodiments, sheet 6375 may be cast, for example, by an injection molding process, wherein holes 6376 can be formed on sheet 6375 during the injection molding process and / or after the injection molding process, for example, during the stamping process. Alternatively, plugs 6370 may be inserted and secured in holes 6376 by pressing and / or snap-fit connections and / or at least one adhesive. In some embodiments, each plug 6370 may include an annular groove surrounding or at least substantially surrounding the perimeter of the plug 6370, which may be configured to hold the perimeter of the hole 6376. In some embodiments, sheet 6375 may consist of a flexible and / or plastic material, which can provide relative movement between plugs 6370. In at least one such embodiment, flexible sheet 6375 may consist, for example, of rubber, plastic and / or silicone material, and plugs 6370 may consist of a rigid material, such as, for example, metal. In at least one such embodiment, similarly to the above, the flexible material may be injection molded around the plugs 6370. In some embodiments, the plugs 6370 may be pressed into, for example, a pre-cast sheet 6375. In various embodiments, the hardness of the flexible material can be selected to provide the desired rigidity of the sheet 6375. In some embodiments, the implementation of the sheet 6375 can be configured so that it contains flexible stripes. In any case, the sheet 6375 can facilitate the installation of the plugs 6370 in the end clip when a plurality of plugs 6370 are placed and / or arranged in the end clip at the same time. Moreover, the sheet 6375 in contact with the plugs 6370 can, for example, strengthen or support the tissue along the line of the stitch seam. In addition to, or instead of, the sheet in contact with the plugs 6370, the plugs 6370 may be connected together by a plurality of links. In at least one such embodiment, such links may be flexible while still providing relative mobility between the plugs 6370.

In various embodiments, returning to FIG. 204 and 205, a protective plug, such as, for example, plug 6470, may comprise a forming surface that can be configured to deform the end of the bracket leg. In at least one such embodiment, the plug 6470 may comprise a base 6472 that includes a hole 6471. In various embodiments, the hole 6471 may be configured to tightly hold a bracket leg, such as, for example, a bracket leg 6221. B, in at least one embodiment, the aperture 6471 may be defined by a diameter or perimeter, which may be equal to or greater than the diameter or perimeter of the legs of the bracket 6221. In various embodiments, the plug 6470 may further neigh cavity, or arch, 6474 which can be configured to hold the end of the legs of the bracket 6221 after it is inserted into the plug 6470. Returning mainly to FIG. 205, the plug 6470 may further comprise a thrust plate or molding surface 6473, which may be configured to bend or deform the legs of the bracket 6221. In various circumstances, the forming surface 6473 may be, for example, curved and / or concave, and configured to twist the legs brackets 6221 after inserting it into plug 6470. In some embodiments, the bracket leg 6221 can be substantially deformed so that it cannot be removed through hole 6471, and as a result, the lug 6470 can be fixed to the leg of the bracket 6221. In at least one such embodiment, the base 6472 of the plug 6470 can form a protrusion around the hole 6471, which can prevent the deformed leg of the bracket 6221 from being removed from the cavity 6474. In various circumstances, as a consequence of the above , one or more plug 6470 can prevent or reduce reverse movement or detachment of the retaining substrate, such as, for example, the retaining substrate 6250, from the brackets 6220. In various embodiments, phenomena, although they have not been shown, the plug 6470 may be formed symmetrical or at least substantially symmetrical, and the hole 6471 may be located along a central axis 6479 passing through the plug 6470. In various alternative embodiments, returning again to FIG. 204, the hole 6471 may be offset relative to the central axis 6479. In at least one such embodiment, the offset hole 6471 may allow the bracket leg 6221 to touch the side of the forming surface 6473 and to twist around the other side of the forming surface 6473 instead of touching the center of the forming surface 6473, which may occur in embodiments comprising the aforementioned center hole 6471.

In various embodiments, as discussed above, a holding substrate, such as, for example, a holding substrate 6250, may consist of a sheet of material and a plurality of holding holes 6252 therein. In at least some embodiments, a sheet of material comprising a retaining substrate 6250 may be rigid or substantially inflexible. In some other embodiments, the implementation of the holding substrate may contain a chain of holding elements of the substrate and many flexible connectors, or links connecting the holding elements of the substrate. In various embodiments, returning to FIG. 206, the holding substrate or part of the holding substrate 6550 may comprise a plurality of working parts of elements 6505, which can be joined together by one or more connecting members 6507. In at least one embodiment, each working part of the element 6505 may contain many deformable elements 6553, which define a holding hole 6552. In some embodiments, the working parts of the elements 6505 and the connecting links 6507 of the holding substrate 6550 may be integral and consist of bottom piece of material. In various embodiments, the holding substrate 6550 may be stamped or cast, for example, from a metal material, such as, for example, titanium and / or stainless steel. In at least one embodiment, the retaining substrate 6550 may consist of plastic, such as, for example, polyetheretherketone (PEEK), polypropylene sold under the trade name Prolen, polyester, polyethylene terephthalate sold under the trade names Ethibond and Mersilene, polyvinylidene fluoride, polyvinylidene fluoride -hexafluoropropylene, polyhexafluoropropylene-vinylidene fluoride sold under the trade name Pronova, and / or long chain aliphatic polymers Nylon 6 and Nylon 6,6, which are sold under the trade names Eth ilon & Nurolon, and can be molded, for example, during injection molding. In some embodiments, the working parts of the elements 6505 may not be integral with the connecting links 6507. In various embodiments, a plurality of individual working parts of the elements 6505 can be manufactured that are connected in series with each other and embedded in a holding substrate. In at least one such embodiment, the working parts of the elements 6505 can be stamped from a metal material, such as, for example, titanium and / or stainless steel, and placed in a mold for injection, and the plastic material can be introduced into the mold for molding, for molding, firstly, the edges 6506 of the material that surrounds or at least partially surrounds the working parts of the elements 6505, and, secondly, the connecting links 6507 protruding from the edges 6506. In some other embodiments, the implementation could a connecting lattice system is formed comprising openings bounded by a plurality of edges 6506, each such opening being configured to hold the working portion of element 6505 in itself. In at least one embodiment, each working portion of element 6505 may have a round or, according to at least a substantially circular perimeter, and, in a similar manner, each edge 6506 may define a circular or at least substantially circular opening, the diameter of the opening being equal to or smaller, we have the diameter of the working part of the element 6505. In at least one such embodiment, the working parts of the elements 6505 can be pressed in or embedded in the holes in the edges 6505. In some embodiments, the working parts of the elements 6505 can be fixed in the holes with at least , one adhesive.

In various embodiments, in addition to the foregoing, the holding substrate may comprise a plurality of working parts of elements 6505 and a plurality of connecting links 6507 that can connect the working parts of elements 6505 in any suitable chain, for example, as shown in FIG. 207-210. Regardless of the chain layout, in various embodiments, the connecting links 6507 can provide mobility of the working parts of the elements 6505 and the holding holes 6552 relative to each other. In at least one such embodiment, the lattice system of the working parts of the elements 6505 and the connecting links 6507 contained in the holding substrate 6550 may be configured to stretch, twist, compress and / or otherwise bend when in contact with the fabric to provide at least at least some mobility in the tissue and, at the same time, to prevent greater mobility in it. In various embodiments, each link 6507 may include a flexible member configured to stretch, twist, and / or compress to bend the holding substrate 6550, for example, between the holding elements of the substrate 6505. Returning again to FIG. 206, each link 6507 protruding from the edge 6506 may be denoted by a width that is narrower than the width of the working part of the element 6505 and / or the edge 6506. In some embodiments, returning to FIG. 207-210, one or more link 6507 may comprise straight parts that extend along a line running, for example, between adjacent working parts of elements 6506. In at least one such embodiment, each link 6507 may comprise a first end attached to a first edge 6506, and a second end attached to a second edge 6506. In some embodiments, returning 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, for example, using an intermediate hinge 6509. In various embodiments, the hinge 6509 may have a reduced thickness of the cross section in one or more directions compared to the thickness of the cross section of the links 6507, which can provide, for example, the mobility of the connecting links 6507 to each other. In some embodiments, the holding substrate 6550 may further comprise hinges 6508 that can connect the links 6507 to the edges 6506 and provide mobility between the links 6507 and the edges 6506. Similar to the hinges 6509, the hinges 6508 can have a reduced cross-sectional thickness in one or more directions compared to thickness, for example, of a cross section of links 6507.

In various embodiments, in addition to the foregoing, the connecting links 6507 may protrude in various directions. In at least one such embodiment, the first link 6507 may protrude in the first direction, and the second link 6507 may protrude in the second direction, the first direction may be different from the second direction. In some embodiments, the first link 6507 can protrude along the first line, and the second link 6507 can protrude along the second line, the first line can intersect the second line at an angle of, for example, approximately 30 degrees, approximately 45 degrees, approximately 60 degrees, and / or approximately 90 degrees. In various embodiments, hinges 6508 and / or hinges 6509 may include flexible hinges that can provide a number of movements of links 6507 relative to each other without breaking. In some embodiments, hinges 6508 and / or hinges 6509 may contain brittle or easily tearing portions that can tear when bent too much and / or too many bends. In at least one such embodiment, such fragile parts may tear one or more parts of the holding substrate 6550 from another part of the holding substrate 6550. In various embodiments, hinges 6508 and / or hinges 6509, for example, may form zones of the holding substrate 6550 which are easier to dissect than other parts of the holding substrate 6550. More specifically, the implantable holding substrate and the fabric stitched with the implantable holding substrate can often be dissected by the cross-section of the fabric for various reasons, and to facilitate such a cross-section, the hinges 6508 and / or hinges 6509 may provide access or have a thin section through which, for example, a tissue-cutting element may pass easier to pass through the holding substrate 6550. In various embodiments , in addition to the above, the connecting links 6507 may contain, for example, one or more stamped parts or weakened material, which can facilitate the bending, tearing and / or dissection of the connecting enev 6507.

In various embodiments, the holding substrate may comprise a plurality of holding substrate elements, such as, for example, the working parts of the substrate elements 6505, which can be embedded in a flexible sheet, or ring, of material. In at least one embodiment, the flexible sheet of material may be formed from a biologically absorbable elastomeric material, such as, for example, silicone, and the flexible sheet may be made with many holes formed therein. In at least one such embodiment, a dense flexible sheet can be obtained by injection molding, and many holes can be knocked out in this flexible sheet. In various alternative embodiments, a flexible sheet can be obtained by injection molding, and holes therein can also be formed during the injection process. Otherwise, the holding elements of the substrate 6505, for example, can be inserted and held in a flexible sheet. In some other embodiments, as described above, a flexible sheet may be formed around the substrate elements 6505. In at least one embodiment, the flexible sheet may consist, for example, of a woven mesh and / or any other suitable material. Such a woven mesh, in addition to the above, can be easily dissected in the transverse direction.

In various embodiments, returning to FIG. 211 and 212, a crosslinking system comprising a retaining substrate, such as, for example, a retaining substrate 6250, may further comprise a coating, such as, for example, a coating 6670 that can cover the ends of the legs of the brackets 6221 when they protrude above the upper surface 6257 of the holding substrate 6250. In various embodiments, coating 6670 may be attached to a holding substrate 6250. In some embodiments, coating 6670 and / or holding substrate 6250 may include holding devices that may The pads are configured to hold the coating 6670 on the holding substrate 6250. In at least one embodiment, at least one adhesive may be used to adhere the coating 6670 to the holding substrate 6250. In at least one embodiment, the coating 6670 may consist of one layer, although the coating 6670 is depicted as consisting of two layers, which is described in more detail below. In various embodiments, mainly returning to FIG. 212, the ends of the legs of the brackets 6221 may protrude through the lower surface 6673 of the coating 6670; however, the cover 6670 may be of sufficient thickness so that the ends of the brackets do not protrude through the upper surface 6675 of the cover 6670. As a result, in at least one such embodiment, the ends of the legs of the brackets 6221 may not protrude from the cover 6670. In various embodiments, the coating 6670 may contain multiple layers. In at least one such embodiment, the coating 6670 may comprise a first layer 6671 and a second layer 6672. In at least one embodiment, the first layer 6671 and the second layer 6672 may be attached to each other, in at least in one embodiment, the second layer 6672 may have 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 the same new thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 may have substantially the same width and / or length. In alternative embodiments, layers 6671 and 6672 may have different widths and / or lengths.

In various embodiments, in addition to the foregoing, the first layer 6671 may consist, for example, of compressible foam, mesh material and / or hydrogel, which can be dissected by the legs of brackets 6211. In at least one embodiment, the second layer 6672 may consist of a rigid material, or shell, such as, for example, PGC and / or PDS, and / or any suitable support material. In at least one such embodiment, the legs of the brackets 6221 may be configured to pierce the first layer 6671; although in various embodiments, the legs of the brackets 6221 are incapable of piercing the second layer 6672. In some embodiments, the second layer 6672 may consist of a material having sufficient elasticity and / or strength, which, when in contact with the leg of the bracket 6221, biases the second layer 6672 without cutting it or only with edge dissection by the end of the bracket 6221. Although not shown, the coating may contain more than two layers, and one or more layers may be resistant to dissection. During operation, in at least one such embodiment, the holding substrate 6250 can be positioned opposite the stitched fabric and pushed down so that the legs of the brackets 6221 of the brackets 6220 pass through the fabric T, the holding holes 6252 in the holding substrate 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 not enter or at least substantially not enter the second layer 6272 of the cover 6270. After the retaining substrate 6250 has been properly positioned m, the Branche 6240 can be opened and the cover 6670 and the holding substrate 6250 can detach from the jaws 6240, as shown in FIG. 211. As shown in FIG. 211, the jaw 6640 may be configured to grip more than one holding substrate 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 hold the 6670 cover, and a holding substrate 6250, which is positioned thereon so that the contact surface with tissue 6251 of each holding substrate 6250 extends downward from the bottom surface of the jaw 6240. In at least one such embodiment, the holding base The brackets 6250 and coating 6270 can be placed in a jaw 6640 on each side of the groove of the scalpel 6678. During operation, the holding substrates 6250 and coatings 6670 can be installed simultaneously and / or at the same depth relative to the cartridges with brackets located on the opposite side, such as, for example, cartridges 6200. After this, in various embodiments, the stitched tissue can be dissected along the cut line using a tissue dissection element that moves along the groove of the scalpel 6678, and then the jaw 6640 can be reopened. In some embodiments, the coatings 6670 may not be attached to the retaining substrate 6250. In at least one such embodiment, the coatings 6670 may be located in the grooves 6679 and held in the grooves 6679 using the holding substrates 6250 that are fixed to the jaw 6640. In various in embodiments, each holding substrate 6250 may be wider and / or longer than the corresponding coating 6670 such that the holding substrates 6250 can entirely hold the coatings 6670 in a certain position. In some embodiments, implementation, each holding substrate 6250 may have, for example, the same width and / or length as the corresponding groove 6670.

In various embodiments, as described above, the crosslinking system may comprise a layer of material that can be attached to a holding substrate, such as, for example, a holding substrate 6250. In at least one embodiment, returning to FIG. 215, a layer of material 6870 can be attached to the bottom surface 6251 of the holding substrate 6250. In some embodiments, the layer 6870 and / or the holding substrate 6250 may include holding devices that can be configured to hold the layer 6870 on the holding substrate 6250. B, at least in at least one embodiment, at least one adhesive may be used to adhere the layer 6870 to the retaining substrate 6250. In any case, layer 6870 may comprise a bottom surface or a fabric contact surface 6873 that can be configured to contact fabric T when the holding substrate 6250 is moved downward to the brackets 6220 to adhere the legs of the brackets 6221 to the holding holes 6252. B in at least one such embodiment, the layer 6870 may consist of a compressible material, such as, for example, biologically absorbable foam, which can be compressed between the bottom surface 6251 of the holding substrate 6250 and the fabric new T. In various embodiments, the implementation of the layer 6870 may additionally contain at least one stored or absorbed drug that can be released from the layer 6870 when it is compressed. In at least one embodiment, the drug may include at least one tissue sealing material, a hemostatic substance and / or antimicrobial material, such as, for example, ionized silver and / or triclosan. In various embodiments, the compression of layer 6870 may cause the drug to extrude from layer 6870 so that all or at least part of the surface of tissue T is coated with the drug. Moreover, by compressing layer 6870, as well as piercing tissue T and layer 6870 with legs of brackets 6221, the medicine can drain down the legs of brackets 6221 and have a therapeutic effect on tissue that has, for example, been dissected by legs of brackets 6221. In various embodiments, the body the retaining substrate 6250 may comprise a first layer, which is composed of a biocompatible material, such as, for example, titanium and / or stainless steel, and a lower layer 6870 may comprise a second layer, consisting of a biologically absorbable material, such as oxide regenerated cellulose (ORC), biologically active substances, such as fibrin and / or thrombin (which are in a liquid or lyophilized state), glycerin, sprayed or foamed pork gelatin, and / or antimicrobial substances, such as, for example, ionized silver and / or triclosan. Additional biologically absorbable materials may include, for example, Surgicel Nu-Knit, Surgicel Fibrillar, collagen ORC, which was combined with an integrated collagen matrix and sold under the trade name Promogran, polyglycolic acid (PGC), sold under the trade name Vicryl, polylactic acid ( PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanate (PHA), polyglexaprone 25 (PGCL) sold under the trade name Monocryl, polycaprolactone (PCL) and / or various mixtures of PGC, PLA, PDS, PHA, PGCL and / or PCL. Although in FIG. 215 shows only one layer 6870, any suitable number of layers may be used. In at least one embodiment, the first layer containing the first drug may be attached to the holding substrate 6250, and the second layer containing the second or other drug may be attached to the first layer. In at least one such embodiment, multiple layers may be used, each layer may contain a different drug and / or a different combination of the drugs contained therein.

In various embodiments, returning to FIG. 213, the crosslinking system may comprise a layer of material 6770 that is attached to the bottom surface 6251 of the holding substrate 6250. In some embodiments, the layer 6770 and / or the holding substrate 6250 may include holding devices that can be configured to hold the layer 6770 on the holding substrate 6250. In at least one embodiment, at least one adhesive may be used to adhere layer 6770 to retaining substrate 6250. In any case, the layer 6770 may comprise a bottom surface or a fabric contact surface, 6773, which can be configured to contact the fabric T when the holding substrate 6250 is moved downward to the brackets 6220 to adhere the legs of the brackets 6221 to the holding holes 6252. B in at least one such embodiment, the layer 6770 may consist of a compressible material, such as, for example, biologically absorbable foam, which can be compressed between the bottom surface 6251 of the holding substrate 6250 and the fabric new T. In various embodiments, layer 6770 may further comprise at least one or more capsules, or cells, 6774, which may be configured to store one or more drugs. In some embodiments, returning to FIG. 214, the capsules 6774 can be mounted coaxially or at least substantially coaxially with the retaining holes 6252 such that when the legs of the brackets 6221 pass through the fabric T and the layer 6770, the legs of the brackets 6221 can pierce and / or otherwise tear the capsules 6774. After rupture of capsules 6774, at least one drug M stored in capsules 6774 may spill onto tissue T. In at least one such embodiment, drug M may be a liquid that can lubricate or drain the legs of brackets 6221 to provide therapeutic effect on tissue T, which was dissected by the legs of the brackets. As a result of the above, the drug stored in capsules 6774 may have a local therapeutic effect on the tissue. In some embodiments, capsule 6774 in sheet 6770 may contain various medications. For example, the first group of capsules 6774 may contain one medicine or one combination of drugs, and the second group of capsules may contain another medicine or another combination of drugs. In various embodiments, the implementation of the layer 6770 may consist of a flexible sheet of silicone, and capsules 6774 may correspond to the cavities in the sheet of silicone. In at least one such embodiment, the silicone sheet may comprise two layers that can be attached to each other, wherein capsules 6774 may be formed between the two layers. In various embodiments, layer 6770 may comprise one or more thin walls or weakened portions formed, for example, by partial perforations that can facilitate dissection of layer 6770 and rupture of capsules 6774 by legs 6221. In some embodiments, at least a portion of capsules 6774 can be located under the arches 6777, and the arches 6777 can protrude upward above the sheet 6770. In at least one such embodiment, the arches 6777 and / or at least part of the capsules 6774 can be located in the recess Barrier-6201 formed in the holding substrate 6250. In some embodiments, the capsule 6774 may form the individual cells that are not associated with each other. In some other embodiments, one or more capsules 6774 may form a fluidic bond with other capsules via, for example, one or more connecting ducts, tubes, and / or grooves that extend into layer 6770. Disclosure of US Pat. No. 7,780,685, entitled " ADHESIVE AND MECHANICAL FASTENER ", which was published on August 24, 2010, is incorporated herein by reference in its entirety.

In various embodiments, in addition to the foregoing, a bracketed cartridge comprising a cartridge body, brackets, and / or an alignment substrate may be placed in the first end clamp jaw, while the holding substrate and / or one of the coatings may be placed in the second end clamp jaw. In some embodiments, returning to FIG. 216, a tool such as a cartridge input device 6990 may be used to similarly insert two or more cartridges of the stapler into the end clip. In at least one embodiment, the cartridge input device 6990 may include a handle 6991 and a cartridge holder 6992, the cartridge holder 6992 may include a first holding portion configured to hold the cartridge housing 6210 of the cartridge with brackets 6200, and, in addition, a second holding portion configured to hold the cartridge housing Ms. 6980, which, for example, holds in itself, firstly, a plurality of protective caps 6270, and, secondly, a retaining substrate 6250, which is located along its lower surface. In various embodiments, the first and second holding parts may comprise one or more holding elements configured to engage detachably with cartridge housings 6210 and 6980. During operation, returning to FIG. 217 and 218, the end clip may comprise a first or lower jaw 6230 and a second or upper jaw 6200, the cartridge with brackets 6200 can be placed in the first jaw 6230 and the cartridge body 6980 can be placed in the second jaw 6940. B in various circumstances, the upper jaw 6940 can be rotated from the open position (FIG. 217) to the closed position (FIG. 218) using the actuator 6235, the operation of the actuator 6235 described above and not repeated here for brevity. After moving the upper jaw 6940 to the closed position, returning to FIG. 218, the distal end 6993 of the cartridge holder 6992 can be inserted into the end clip so that the cartridge with brackets 6200 slides along the distal end 6938 of the first branch 6930 into the first connecting part, or the chute 6939 of the first branch 6230. Similarly, the distal end 6993 of the holder cartridge 6992 can be inserted into the end clamp so that the body of the cartridge 6980 slides along the distal end 6948 of the second jaw 6940 into the second connecting part, or chute, 6949 of the second jaw 6940. The surgeon or other clinician using the handle 69 The 91 cartridge input devices 6990 can advance the cartridge with brackets 6200 and the cartridge body 6980 through the grooves 6939 and 6949, respectively, until the cartridge with brackets 6200 and the cartridge body 6980 are completely installed in them.

After installing the cartridge with brackets 6200 and the cartridge body 6980, the cartridge with brackets 6200 and the cartridge body 6980 can be engaged with one or more retaining parts in the respective grooves 6230 and 6940, as described in more detail below. In any case, after installing the cartridge with brackets 6200 and cartridge body 6980, returning to FIG. 219, the input device of the cartridge 6990 can be disconnected from the cartridge with brackets 6200 and the cartridge body 6980, and also removed from the end clip. In at least one such embodiment, the holding force that holds the cartridge with brackets 6200 in the first jaw 6230 may be greater than the holding force that holds the cartridge with brackets 6200 in the input device of the cartridge 6992, so that when the device is distally moved The cartridge with brackets 6200 may remain in the first jaw 6230 to insert the cartridge 6992 from the end clamp. Likewise, the holding force that holds the cartridge body 6980 in the second jaw 6940 may be greater than the holding s a, which holds the cartridge case 6940 in the cartridge input device 6992, so that when the cartridge input device 6992 is distally moved from the end clip, the cartridge body 6940 can remain in the first jaw 6940. After removing the cartridge input device 6990 from the end clip, the first jaw 6230 is filled and filled the second jaw 6940 may be located near the fabric T, which must be sewn. Returning to FIG. 220, the second jaw 6940 can be moved from the open position (FIG. 219) to the activated position (FIG. 220) for engaging with a holding substrate 6250 and a plurality of protective plugs 6270 that are held in the cartridge case 6980 with brackets 6220 located in the cartridge with brackets 6200.

Returning to FIG. 221 and 222, the second jaw 6940 can be re-opened, and the plurality of security plugs 6270 and the holding substrate 6250 can be detached from the cartridge body 6980 so that the plugs 6270 and the holding substrate 6250 can mesh with the T fabric and the cartridge with brackets 6200. In at least one embodiment, the cartridge housing 6980 may comprise a plurality of recesses in which a plurality of plugs 6270 may be detachably held, and one or more retaining grooves are configured to hold in place zmozhnostyu detachably holding the substrate 6250. In various embodiments, retention elements 6940 of second jaws adhered to the cartridge body 6980, the cartridge 6980 may hold the second housing jaws 6940 after the second Branche 6940 was opened. In some embodiments, the implementation of the cartridge housing 6980 may be configured to tear, since the second jaw 6940 is opened so that part of the housing of the cartridge 6980 is implanted with plugs 6270, and the retaining substrate 6250 and part of the housing of the cartridge 6980 remain in the second jaw 6940. Similarly, again returning to FIG. 221 and 222, the retaining elements of the first jaw 6230 coupled to the cartridge case 6210 can hold the cartridge case 6210 in the first jaw 6230 after the second jaw 6940 has been opened. In some embodiments, the cartridge housing 6210 may be configured to tear, since the first jaw 6230 is diverted from the implantable cartridge 6200 so that a portion of the cartridge housing 6210 is implanted with brackets 6220, and the alignment substrate 6260 and part of the cartridge housing 6210 remain in the first jaw 6230. In various embodiments, returning to FIG. 223-225, a cartridge with brackets, such as, for example, a cartridge with brackets 6900, may comprise one or more longitudinal retaining grooves 6913 located along the length of the cartridge body 6910, which, for example, after inserting the cartridge with brackets 6900 into jaw 6930 may be configured to hold one or more longitudinal retaining rails 6916 that protrudes from jaw 6930. During operation, in at least one embodiment, the ends of the retaining grooves 6913 can be aligned with the distal ends of the retaining guides 6916 before the staple cartridge 6900, for example, begins to slide on the distal end 6938 of the holding trough 6939.

In various embodiments, returning again to FIG. 225, jaw 6940 may include two retaining grooves 6949, each holding groove 6949 may be configured to hold the cartridge body 6980, comprising a plurality of plugs 6270 and a holding substrate 6250. In some embodiments, each cartridge housing 6980 may contain one or more holding a shoulder 6917 that can be configured to slide along one or more of the longitudinal retaining rails 6918 of the second jaw 6940 when the cartridge housings 6980 are inserted into the respective holding the holding grooves 6949 in the jaw 6940. In various embodiments, the holding guides 6918 and the holding shoulders 6917 can hold the cartridge case 6980 in the second jaw 6940 together when the caps 6270 and the holding substrate 6250 contained therein are disconnected. In various embodiments returning to FIG. 224, the second jaw 6940 may further comprise one or more distal contact posts, or a retaining member, 6915, which may be configured to detachably engage the cartridge housings 6980 in respective retaining grooves. In at least one such embodiment, the second jaw 6940 may comprise a distal contact column 6915 configured and disposed relative to each holding trough 6949 so that each cartridge case 6980 can bend around the contact columns 6915 when the cartridge cases 6980 are inserted into the troughs 6949, and after full installation of the cartridge cases 6915 in the grooves 6949, the distal ends of the cartridge housings 6980 can open and snap over the contact posts 6915. To remove the cost of the cartridge cartridge housings 6980, the cartridge housings 6980 can be pulled back over the contact posts 6915 and removed from the retaining grooves 6949. Similarly to the foregoing, the first branch 6930 may include one or more distal contact posts 6914, which may be configured to fit in one or more holding grooves with the possibility of rotation, or groove, 6912 (FIG. 223) in the housing of the cartridge 6910, when the cartridge with brackets 6900 was fully installed.

In various embodiments, in addition to the foregoing, a first staple cartridge containing a plurality of first fasteners may be located in a first jaw of a surgical stapler, and a second staple cartridge containing a plurality of second fasteners can be located in a second jaw surgical stapler. During operation, the first jaw and / or second jaw can be moved to each other to engage the first fasteners with the second fasteners and fix the fabric between them. In some embodiments, the first staple cartridge and the second staple cartridge may be engaged with each other when the first fasteners are engaged with the second fasteners. In at least one embodiment, the body of the first staple cartridge may consist of a first compressible material, and the body of the second staple cartridge may consist of a second compressible material, the first body and / or second body can be compressed against the fabric to be sewn. After stitching the tissue, the first jaw can be retracted from the first implanted staple cartridge, and the second jaw can be retracted from the second implanted staple cartridge. After that, the first jaw can re-grab another first staple cartridge and the like, and the second jaw can re-grab another second staple cartridge and the like, after which the surgical stapler can be reused. Although brackets can be used in some embodiments, other types of fasteners can be used in other provided embodiments, such as two-part fasteners, which, for example, are fixed to each other when engaged. In at least one such embodiment, the first staple cartridge may comprise a first storage part in which the first parts of the fasteners are stored, and the second staple cartridge may contain a second storage part in which the second parts of the fasteners are stored. In various embodiments, fasteners that are composed of any suitable material and / or have any suitable shape may be used in the crosslinking systems described herein. In some embodiments, the fasteners may include dissection elements. Such dissection elements may consist, for example, of a polymer, a mixture and / or a multilayer substrate. Examples of a multilayer substrate are a wire or sheet substrate with an elastomeric or polymer coating. A thin sheet may be used, formed so that the cutting elements are perpendicular or at least substantially perpendicular to the connecting element. Dissecting elements can have a rectangular cross section, a semicircular cross section and / or any beam profile. In various embodiments, the fasteners described herein can be fabricated using any suitable process, such as, for example, extrusion molding. It is also possible to use microprocessing to create hollow dissecting elements. These dissecting elements can be made in a process that is different from the extrusion process of a wire, and combinations of materials can be used in it.

As described above, the ends of the legs of the brackets that protrude from the retaining substrate may be coated with one or more plugs and / or coatings. In some embodiments, the ends of the legs of the brackets may be deformed after they have been inserted into the holding substrate. In at least one embodiment, the jaw holding the holding substrate may further comprise recesses of the abutment element located above and / or mounted coaxially to the holding holes, which can be configured to deform the legs of the brackets if they protrude above the holding substrate. In various embodiments, the legs of the brackets of each bracket can be twisted inward, for example, to another bracket and / or to the center of the bracket. In some other embodiments, one or more legs of the bracket can be twisted outward relative to other brackets and / or from the center of the bracket. In various embodiments, regardless of the direction in which the brace legs are twisted, the ends of the brace legs can come into contact with the housing of the retaining substrate and cannot reenter the fabric that was sewn with brackets. In at least one embodiment, deformation of the legs of the brackets after they have passed through the retaining substrate can fix the retaining substrate in a certain position.

In various embodiments, returning to FIG. 226 and 227, a surgical stapler, such as, for example, a surgical stapler 7000, may include a first jaw 7030 and a second jaw 7040, the second jaw 7040 can be moved and removed from the first jaw 7030 due to movement of the drive 6235. The operation of the drive 6235 is described above and is not reproduced here for brevity. In various embodiments, the first jaw 7030 may have a distal end 7031 and a proximal end 7032, the first jaw 7030 may form a groove located between the distal end 7031 and the proximal end 7032, which is configured to hold the bracket cartridge. For clarity, the cartridge case of such a cartridge with brackets is not shown in FIG. 226, although such a cartridge with brackets may include a cartridge body, brackets 6220 located in the cartridge body, and guide brackets 7012 located under the brackets 6220. In some embodiments, which were not shown for brevity in FIG. 226, the second jaw 7040 may be configured to hold the holding substrate, such as, for example, the holding substrate 6250 over the brackets 6220 and / or to move the holding substrate to adhere to the legs of the brackets 6220 in the manner described above. In at least one embodiment, the surgical stapler 7000 may further comprise a slide 7010 located in the first jaw 7030, which can slide from the distal end 7031 of the first jaw 7030, for example, to the proximal end 7032, and raise the guide brackets 7012 and held on them brackets 6220 to the holding substrate and the second jaw 7040. In various other embodiments, the slide 7010 can be moved from the proximal end 7032 to the distal end 7031, for example, to install the brackets 6020. B, at least In at least one embodiment, the slide 7010 may comprise one or more tilted contact posts, or a protrusion 7011, which may be configured to slide under the guide brackets 7012 and lift the guide brackets 7012 up. In various embodiments, the surgical stapler 7000 may further comprise a tension or push rod, which during operation can be attached to the slide 7010, which can be moved proximally and / or distally using a drive located, for example, in the handle and / or shaft surgical stapler 7000.

In various embodiments, returning 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 further comprise a guide system that includes one or more guides, such as for example, guides 7045 and 7046 that extend along the longitudinal axis of the chassis 7041, which, as described in more detail below, can be configured to guide one or more thrust members, or protrusions that can engage and deform the legs of the brackets 6220 after the legs of the brackets 6221 of the brackets 6220 have passed through the retaining substrate. In at least one such embodiment, the rails 7045 and 7046 may comprise a conductor or cable that extends, for example, along the top or surface of the chassis 7041 around the distal post 7047 and returns along the top or surface of the chassis 7041 In various embodiments, implementation, as mentioned above and mainly in accordance with FIG. 228 and 230, the second jaw 7040 may further comprise one or more thrust plates or protrusions, such as, for example, the first thrust element 7050 and the second thrust element 7060, which can be moved longitudinally along the second jaw 7040 to deform the legs of the brackets 6220 after how they got through the retaining substrate. In at least one embodiment, the surgical stapler 7000 may further comprise a drive of a first stop member, or a drive, 7051 that connects and / or attaches during operation to a first stop member 7050, which can be configured to retract the first stop member 7050 in the proximal direction and / or extension of the first thrust member 7050 in the distal direction. Similarly, in at least one embodiment, the surgical stapler 7000 may further comprise a drive of a second stop member, or a drive that connects and / or attaches during operation to a second stop member 7060, which can be configured to extend the second stop element 7060 in the distal direction and / or pulling the second thrust element 7060 in the proximal direction. In various embodiments, the first abutment member 7050 may include guide grooves 7052, and the second abutment member 7060 may comprise guide grooves 7062, each of which may be configured to hold the guide 7045 or the guide 7046 in a sliding manner. B, at least in one such embodiment, the rails 7045 and 7046 can be held tightly in the rails 7052 and 7062 to prevent or at least limit the relative lateral mobility between them, or movement from side to side.

In some embodiments, in addition to the foregoing, the first abutment member 7050 can be pulled proximally and the second abutment member 7060 can be extended distally. In at least one embodiment, returning to FIG. 226, guides 7045 and 7046, and a distal post 7047 may comprise a block system configured to distally extend a second abutment member 7060 and / or proximally attract a second abutment member 7060. In at least one such embodiment, the guide 7045 and the guide 7046 may comprise a continuous wire or cable that runs around the distal post 7047, wherein a portion of the continuous wire can be stretched to wind the wire around the distal post 7047. In various embodiments, the wasp For example, the guide 7046 can be mounted on the second stop element 7060 so that when winding a continuous cable in the first direction, the second stop element 7060 can extend distally to the distal end 7048 of the jaw 7040, and when winding a continuous cable in the second, or vice versa, in a first direction, the second abutment member 7060 can extend proximal to the proximal end 7049. In at least one embodiment, returning to FIG. 228, the guide 7046 can be fixed in the guide groove 7062 so that a pulling force can occur between them. In at least one such embodiment, the guide 7045 can be configured to slide in another guide groove 7062. In various embodiments, the first stop element 7050 can be controlled independently of the second stop element 7060, and the block system and guide grooves 7052 formed by the stop the element in the first stop element 7050, can be configured to hold slideways 7045 and 7046 so that they can be relatively movable with each other. In various embodiments, the continuous cable comprising the rails 7045 and 7046 may be substantially flexible to withstand the opening and closing of the upper jaw 7040. The continuous cable may also be substantially flexible to withstand the vertical movement of the second stop member 7060 as it approaches and moves away from lower jaw 7030, which is described in more detail below.

In various embodiments, returning again to FIG. 228 and 230, the first stop member 7050 may include tracking members 7055, which may be configured to move in one or more beveled grooves, or a guide groove, such as, for example, beveled groove 7070 (FIG. 231), which is formed in the chassis 7041 second jaw 7040. More specifically, in at least one embodiment, the chassis 7041 may include a first beveled groove 7070 extending longitudinally along the first side of the chassis 7041, and a second beveled groove 7070 extending longitudinally along the second or opposite side of the chassis 7 041, the servo elements 7055 protruding from the first side of the first stop element 7050, can move in the first beveled groove 7070, and the servo elements 7055 protruding from the second side of the first stop element 7050, can move in the second beveled groove 7070. B, at least in at least one such embodiment, the contours of each beveled groove 7070 may be the same or at least substantially the same and may be mounted coaxially or at least substantially coaxially to each other. Similarly, in various embodiments, the second stop member 7060 may include followers 7065 that can be configured to move in the beveled grooves 7070 (FIG. 231) formed in the chassis 7041 of the second jaw 7040. More specifically, in at least in one embodiment, the tracking elements 7065 protruding from the first side of the second stop element 7060 can move in the first beveled groove 7070, and the tracking elements 7065 protruding from the second side of the second stop element 7060 can move I am in the second beveled groove 7070. During operation, the follower elements 7055 of the first stop element 7050 and the followers 7065 of the second stop element 7060 can slide in the beveled grooves 7070 so that the first stop element 7050 and the second stop element 7060 move along the contours of the beveled grooves 7070 whereby the first abutment element 7050 and the second abutment element 7060 are attracted proximally and / or extend distally. In various embodiments, each beveled groove 7070 may comprise a plurality of cylindrical or upper parts 7071 and a plurality of guides or lower parts 7072 that may be configured to move the stop elements 7050 and 7060 vertically, i.e. towards the lower jaw 7030 and away from it, while the thrust elements 7050 and 7060 move longitudinally, 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 in an inactive position, returning to FIG. 231, a first abutment member 7050 may be located at the distal end 7048 of the chassis 7041, and a second abutment member 7060 may be located at the proximal end 7049 of the chassis 7041; moreover, returning to FIG. 232, the brackets 6220 located in the first jaw 7030 may not yet be in the tissue T and / or the support substrate located above it when the stapler 7000 is in the inactive position. During operation, returning to FIG. 233, the brackets 6220 can be moved upward in the cavity for the brackets 7033 of the cartridge with brackets using the guiding brackets 7012, and in addition, the first stop member 7050 can be moved proximally from the distal end 7048 of the chassis 7041 to the distal end 7049 to engage with the legs of the brackets 6221 brackets 6220. In at least one embodiment, the brackets 6220 can be moved upward before the first stop member 7050 engages with the legs of the brackets 6221. In various embodiments, all brackets 6220 can be moved upward using a slide to 7010 before the first stop member 7050 extends to touch the legs of the brackets 6221, or, otherwise, the slide 7010 can move proximally at the same time as the first stop member 7050 moves proximally, although the slide 7010 can be significantly ahead of the first stop an element 7050 for mounting brackets 6220 in front of the first stop element 7050. In various embodiments, as shown in FIG. 233, the chamfered grooves 7070 can be configured and aligned so that forming surfaces, such as forming, or cam, surfaces 7053 and 7054, for example, the first protrusion 7050 can come into contact with at least some of the legs of the brackets 6221, when the first cam 7050 goes through the upper position, or the stop position. In various circumstances, each servo element 7055 of the first stop element 7050 may be located in the cylindrical part 7071 of the beveled grooves 7070 so that the forming surfaces 7053 and 7054 are in the raised position and the legs of the brackets 6221 only partially deform when the stop element 7050 passes through the stop position . When the first cam 7050 moved further along the beveled grooves 7070, as shown in FIG. 234, the tracking elements 7055 of the first stop element 7050 can be moved to the reduced or lower position 7072 in the beveled grooves 7070 so that the forming surfaces 7053 and 7054 move vertically down to the legs of the brackets 6021 to move the legs of the brackets 6021 to their final position in molded condition. After that, when the stop element 7050 moves further along the beveled grooves 7070, the first stop element 7050 can be moved vertically to another set of cylindrical parts 7071 of the beveled grooves 7070. As shown in FIG. 233 and 234, the reader may notice that the first thrust member 7050 can only engage with some legs of the brackets, and does not engage with others. In at least one such embodiment, the first stop member 7050 can only be configured to deform a group of staple legs that includes, for example, the distal legs of the staples 6221 of the staples 6220. In at least one such embodiment, the first stop member 7050 can be configured to deform the distal legs of the brackets 6221 to the center of the brackets 6220. In various embodiments, each proximal leg of the bracket 6221 can be in contact twice with the first stop member 7050, for example by a first forming surface 7053 and a second forming surface 7054 mounted coaxially with the first forming surface 7053. In at least one such embodiment, the first forming surfaces 7053 can deform the distal legs of the brackets 6221 to a partially deformed state when the first stop member 7050 is in the upper the stop position and the second forming surface 7054 can deform the distal legs of the brackets 6221 to a completely deformed state when the first stop member 7050 is over eschena in reduced, or lower, position. In various embodiments, returning to FIG. 228 and 229, the first abutment member 7050 may comprise a plurality of first molding surfaces 7053 and a plurality of second molding surfaces 7054 for deforming the distal legs of the brackets 6221 of the brackets 6220 when the legs of the brackets 6221 are mounted coaxially in the form of more than one row or set. In various embodiments, as described in more detail below, the proximal legs of the brackets 6221 of the brackets 6020 may be deformed, for example, by a second stop member 7060.

In various embodiments, in addition to the above, the first stop member 7050 can be moved from the distal end 7048 of the chassis 7041 to the proximal end 7049 to deform all the distal legs of the brackets 6221 of the brackets 6220. The reader may notice that the first stop member 7050 can move up and down relative to the undeformed proximal legs of the brackets 6221, and, in order to maintain such relative mobility, in various embodiments, the first abutment element 7050 may comprise one or more intermediate ny groove 7057 (FIG. 230), which can be configured to hold the proximal legs straightened staples 6221, when the first stop element 7050 flexes the distal legs of brackets 6221. Similarly, again returning to FIG. 228, the second stop member 7060 may include an intermediate groove 7067 that can be configured to withstand the vertical movement of the drive of the first cam 7051, which moves up and down when the first stop member 7050 moves between the stop position and the above position as described above. After bending all the distal legs of the brackets 6221 in at least one embodiment, the second abutment element 7060 can be moved from the proximal end 7049 of the chassis 7041 to the distal end 7048 using the actuator of the abutment element 7061. Similarly to the above, returning to FIG. 235, the tracking elements 7065 of the second abutment element 7060 can slide in the beveled grooves 7070 so that the second abutment element 7060 moves between the upper position or the stop position and the lower or reduced position for deformation of the proximal legs of the brackets 6221, for example, inwardly toward the centers of the brackets 6220. Similarly to the above, the second stop element 7060 may comprise a plurality of first forming, or cam, surfaces 7063, and a plurality of second forming, or cam, surfaces 7064, each of which it may be configured for at least partial deformation and / or complete deformation of one or more brackets proximal legs 6021. Again returning to FIG. 229, the second abutment member 7060 may comprise a plurality of first molding surfaces 7063 and a plurality of second molding surfaces 7064, which may be configured to deform the proximal legs of the brackets 6221 of the brackets 6220, which are mounted coaxially, for example, in a plurality of rows or sets. As also shown in FIG. 229, the first forming surfaces 7063 and the second forming surfaces 7064 of the second abutment member 7060 may not be aligned with the first forming surfaces 7053 and the second molding surfaces 7054 of the first abutment element 7050, and as a result, the proximal legs 6221 of the brackets 6220 may be arranged in other rows , or sets than the distal legs 6221 of the brackets 6220. The reader may also notice that the second stop element 7060 can extend the first stop element 7050 when the second stop element 7060 is distally moved. In at least one such embodiment, the second abutment member 7060 can slide the first abutment member 7050 back into the distal end 7048 of the chassis 7041 so that the first abutment member 7050 can return to its original, or inactive, position. After deformation of all the proximal legs of the brackets 6221 of the brackets 6220, the second abutment element 7060 can be retracted proximal and returned to its original, or inactive, position. Thus, the surgical stapler 7000 can be reinstalled so that a new cartridge with brackets can be placed in the first jaw 7030, and a new retaining substrate can be installed in the second jaw 7040 for reuse of the surgical stapler 7000.

In various embodiments, implementation, as described above, the surgical stapler may contain two or more abutment elements that can be moved longitudinally to engage the legs of multiple brackets in the transverse direction. In some embodiments, the surgical stapler may include a stop member that moves, for example, proximal to deform the first group of brace legs and, for example, distally to deform the second group of brace legs. In at least one such embodiment, such a stop member may comprise, for example, forming surfaces that are proximal facing and forming surfaces that are distally facing.

In various embodiments, returning to FIG. 236, a stop element, such as, for example, a stop element 7140, may comprise a bottom surface or a contact surface with a fabric, 7141, and a plurality of forming recesses formed therein 7142. In at least one embodiment, the stop element 7140 may contain more than one plate, such as, for example, a plate with recesses 7143, which can be welded to the frame 7144. In at least one such embodiment, each plate with recesses 7143 can be located in the groove for plates 7145 in the frame 714 4 and welded to the frame 7144 through a welding groove 7146 located in the frame 7144 to form a longitudinal weld 7147. In various circumstances, the longitudinal weld 7147 may be, for example, a continuous weld running along the entire length of the welding groove 7146, or adjacent to the distance from each other of the weld points along the entire length of the welding groove. In various embodiments, each recessed plate 7143 may comprise two or more parts of the plate that are welded to each other. In at least one such embodiment, each recessed plate 7143 may include a first part of the plate 7143a and a second part of the plate 7143b, which can be welded to each other along the seam line 7148. In various embodiments, the first part of the plate 7143a and the second part the plates 7143b of each plate 7143 can be welded to each other before the plates 7143 are welded to the grooves for the plates 7145 in the frame 7144. In at least one embodiment, the first part of the plate 7143a and the second part of the plate 7143b m can have common cross sections, such as, for example, toothed cross sections shown in FIG. 236, which can be installed together to form a tight seam 7148. In at least one embodiment, each plate 7143 may have a height, for example, of about 0.51 mm (0.02 inches) that exceeds the depth of the grooves for plates 7145 such such that the contact surfaces with the fabric 7141 may protrude from the frame 7044 of the abutment member 7040. In some embodiments, returning to FIG. 237, the plates 7143 can be connected to each other, for example, using at least one weld 7149 at the distal ends of the plates 7143.

As shown in FIG. 236 and 237, each plate with recesses 7143 may comprise a plurality of forming recesses 7142. In various embodiments, forming recesses 7142 may be formed in the plates 7143 by any suitable manufacturing process, such as, for example, sharpening and / or burning by electrodes. In at least one such embodiment, returning to FIG. 238 and 239, each forming recess 7142 can be made, for example, by forming a deep hole 7150 followed by the formation of an arcuate or curved surface 7151 surrounding the deep hole 7150, after which a guide groove for the leg of the bracket 7152 is formed in the curved surface 7151. embodiments, these steps may be performed in any suitable order. In various embodiments, returning to FIG. 240, the depressions for forming the brackets 7142 can be formed in such a way that the inner edges 7153 of the molding depressions are separated from each other by a constant or at least substantially constant gap 7154. In at least one such embodiment, the gap 7154 may be for example, about 20 mm (0.008 in). Moreover, in at least one such embodiment, the forming recesses 7142 can be arranged along two or more rows, or sets, the axial lines of which can be separated from each other using constant or at least essentially constant gaps 7155 In at least one such embodiment, the gap 7155 between the center lines may be approximately 0.89 mm (0.035 in), for example. In various embodiments, returning again to FIG. 240, each forming recess 7142 may taper between the narrow portion 7156 and the wide portion 7157. In at least one such embodiment, for example, the width of the narrow portion 7156 may be about 1.14 mm (0.045 inches) and the width the wide portion 7157 may be about 1.91 mm (0.075 inches). In various embodiments, the plates 7143 may consist of the same material as the frame 7144. In at least one such embodiment, the plates 7143 and the frame 7144 may consist, for example, of stainless steel, such as, for example, stainless steel 300 or 400 grades, and / or titanium. In various other embodiments, implementation of the plate 7143 and the frame 7144 may consist of different materials. In at least one such embodiment, the plates 7143 may consist, for example, of a ceramic material, and the frame 7144 may consist, for example, of stainless steel and / or titanium. In various circumstances, depending on the material used, for fixing the plates 7143 to the frame 7144, in addition to or instead of the above-described welding process, for example, at least one brazing process can be used.

In various embodiments, returning to FIG. 241-243, the stop member 7240 may comprise a frame 7244 and a plurality of plates with recesses 7243 that can be inserted into the frame 7244. Similarly to the above, each plate with recesses 7243 may include a plurality of forming recesses 7242. B, at least in one embodiment, the frame of the stop member 7244 may include retaining grooves 7246, each of which may be configured to hold a retaining guide 7247 protruding from the plate with recesses 7243. To connect the plates with recesses 7243 with the frame of the stop member 7244, the side walls 7245 of the frame of the stop member 7244 can be bent or stretched outward, as shown in FIG. 242, to expand the holding grooves 7246 so that each holding groove 7246 can accommodate the holding plate guide 7247 with recesses 7243. After placing the holding guides 7247 in the holding grooves 7246, the side walls 7245 can be detached, as shown in FIG. 243, thereby allowing the frame 7244 to resiliently come into contact with them and / or return to an undeformed state. In such circumstances, the retaining grooves 7246 may touch and thereby grasp the retaining guides 7247. In some embodiments, the holding guides 7247 and / or the retaining grooves 7246 may comprise one or more common conical surfaces which, after releasing the curved retaining grooves 7246, may form a joint in the form clamping cone, which can hold the holding guides 7247 in the holding grooves 7246. Similarly to the above, the plates with recesses 7243 can consist of the same or different material than the frame 7244. In at least one such embodiment, the plate 7243 may be composed for example of ceramic material, and the frame 7244 may contain, for example, stainless steel and / or titanium. In various circumstances, depending on the material used, for fixing the plates 7243 to the frame 7244, for example, at least one soldering or welding process can be used.

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 use. Recovery may include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts, followed by assembly. 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 later use either in the restoration workshop 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 rebuild the device. The use of such techniques and the resulting reconditioned device are included in the scope of this application.

Preferably, the subject matter described herein will undergo treatment prior to surgery. First, a new or used tool must be obtained and cleaned if necessary. Then the instrument can be sterilized. In one sterilization method, the instrument 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 instrument thus sterilized can then be stored in its sterile container. A 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 (19)

1. A surgical cartridge with brackets containing:
a compressible implantable cartridge housing made of a compressible hemostatic material and holding a plurality of unformed brackets; and
a cartridge holding member connected to said compressible cartridge body, said cartridge holding member being configured to be detachably attached to the end clamp portion of the surgical stapler so that after said unformed brackets in said cartridge body are formed, said cartridge body and the brackets are removed from the end clamp without detaching the cartridge holding member from it. 2. The surgical cartridge with brackets according to claim 1, in which at least a portion of said retaining element of the cartridge is implanted in said cartridge body. 3. The surgical cartridge with brackets according to claim 1, wherein said unformed brackets in said cartridge body are arranged in at least one oblong set of brackets inside the cartridge case, said cartridge holding element comprising at least one retaining rib , which is essentially the same in extent with said at least one elongated set of brackets. 4. The surgical cartridge with brackets according to claim 3, wherein said unformed brackets in said cartridge case are arranged in the form of at least two elongate sets inside the bracket cartridge case, said at least one retaining rib extending between said at least two oblong sets of brackets. 5. The surgical cartridge with brackets according to claim 1, which further comprises an elongated groove passing through a portion of said cartridge body. 6. The surgical cartridge with brackets according to claim 5, in which the unformed brackets are arranged in the form of two pairs of sets of brackets on each side of said elongated groove and in which said holding element of the cartridge contains a holding rib that corresponds to each said pair of sets of brackets and extends between them. 7. The surgical cartridge with brackets according to claim 1, wherein said cartridge holding element has a color that is different from the color of said cartridge body with brackets and from the color of said portion of the end clip to which it is attached. 8. The surgical cartridge with brackets according to claim 4, in which at least one of said retaining rib comprises a protruding vertical ridge. 9. The surgical cartridge with brackets according to claim 8, in which the cartridge body has a case thickness and wherein said cartridge retaining element, said retaining rib, and a corresponding vertical ridge protruding from said retaining rib, have a total height that is less than said total thickness of said cartridge cases. 10. An end clamp for use with a surgical apparatus, said end clamp comprising:
an oblong groove connected to a part of the surgical apparatus;
cartridge with brackets containing:
a compressible implantable cartridge housing made of a compressible hemostatic material and holding a plurality of unformed brackets; and
a cartridge holding member connected to said compressible cartridge body and detachably attached to said elongated groove, and wherein said end clamp further comprises a stop member that is movably held relative to said oblong groove and has a surface for forming brackets, said stop member being configured to moving from the open position when the surface for forming the brackets is at a distance from the cartridge kami, in the closed position, when the thrust element is moved into compressive contact with the cartridge with brackets in response to the starting movements attached to it by the surgical apparatus for forming said unformed brackets in said cartridge body. 11. The end clip of claim 10, wherein said elongated groove has a first color, the cartridge body has a second color, and the cartridge holding member has a third color that is different from the first and second colors. 12. The end clamp of claim 10, wherein the surgical device comprises a locking assembly that performs axial movement and is configured to apply said starting movements to said stop element, and said end clamp further comprises a locking locking assembly configured to prevent said axial movement of the locking node in a fully activated position relative to the said stop element, when in the said elongated groove cartridge with brackets. 13. The end clamp of claim 10, wherein said cartridge holding member is implantably detachable into said cartridge housing. 14. The end clamp according to claim 10, wherein said unformed brackets in the cartridge body are arranged in the form of at least one elongated set of suture brackets inside the cartridge body, said cartridge retaining element having at least one retaining rib, which essentially the same extent with said at least one oblong set of brackets. 15. The end clamp according to claim 14, wherein said unformed brackets in the cartridge housing are arranged in at least two elongated brace sets inside the cartridge housing, said at least one retaining rib extending between said at least , two oblong sets of brackets. 16. The end clamp of claim 10, wherein said cartridge retaining member has a pair of protruding vertical retaining ridges corresponding to each side surface of the cartridge housing. 17. An end clamp attached to the surgical device and containing a movable locking assembly thereon for transmitting closing forces to the end clamp, said end clamp comprising:
an elongated groove connected to a portion of said surgical apparatus for holding with the possibility of detaching the surgical cartridge with brackets;
a stop element that can be detachably held relative to said elongated trough and moved from an open position to a closed position relative to said elongated trough when applying locking forces with a movable locking assembly; and
a locking locking device that is held during operation in said elongated groove and is moved from the unlocked position when the cartridge with brackets is held in said longitudinal groove to a locked position in which the cartridge with brackets is not held in the longitudinal groove, said locking locking device being configured for interaction with the said locking node to prevent the application of at least a certain area of these see repentieth force to said abutment member when said locking antitheft device is in said locked position. 18. The end clamp of claim 17, wherein said locking locking device comprises a biasing member for biasing said locking locking device to said locked position when said cartridge with brackets has been removed from said elongated groove. 19. The end clamp of claim 17, wherein the surgical apparatus comprises a tissue dissection member configured to axially move along the cartridge with brackets in said elongated groove, said locking locking device preventing axial movement of the tissue dissection member in said oblong groove when said locking locking device is in said locked position.

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